Cervical Traction for Neck Pain (Raney 2008) Ottawa C-spine rules for radiographs (Stiell 2001)

1. Pt reported peripheralization with lower -To be used with individuals with neck pain who’ve had trauma
cervical spine (C4-C7) mobility testing 1. Any high risk factor = IF YES RADIOGRAPH
2. Positive shoulder abduction sign - Age ≥ 65 y/o
3. Age ≥ 55 y/o - Paresthesias in the extremities
4. Positive ULTTA - Dangerous MOI
5. Relief of sx with manual distraction - Fall from 3 feet / 5 stairs
3 of 5 present + LR 4.81 - Axial load to the head
4 of 5 present + LR 11.7 - High speed MVA or roll over crash/bike crash
2. Any low risk factor that allows safe assessment of ROM = NO RADIOGRAPH
Diagnosis of Cervical Radiculopathy (Wainner 2003) - Simple rear-end MVA
1. Positive Spurling’s - Sitting position in ER
2. Decreased sx with distraction - Ambulating at any time since trauma
3. Positive ULTTA - Delayed ( not immediate) onset of pain
4. C-spine rotation < 60° to involved side - Absence of midline cervical spine tenderness
3 of 4 present + LR 6.1 3. AROM neck rotation < 45 degrees bilaterally – RADIOGRAPH
All 4 present + LR 30.3
3/4 94% specificity; 4/4 99% specificity Predicting success in individuals with cervical radiculopathy: CPR (Cleland 2007)
Most common in 4th/5th decades 1. Age < 54 y/o
Most common C6-7 2. Dominant arm not affected
Neck pain w/without UE pain in conjunction with 3. Looking down doesn’t aggravate sx’s
-Diminished DTRs 4. Multi-focal rx for ≥ 50% of visits (OMPT, c/s traction, deep neck flexor strengthening)
-Diminished sensation -3 variables present: + LR 5.2
-Motor weakness -4 variables present: + LR 8.3
Ruling out: - ULTT A = sensitivity .97
Ruling in: where are you symptoms? Neck/scapula = specificity .84 Thoracic Outlet Syndrome
Hx: 1. Pt may present eith C8-T1 or ulnar nerve distribution of symptoms as a result of
Thoracic Spine Manipulation for Neck Pain (Cleland 2007) the position of the 1st rib relative to the inferior aspect of the brachial plexus.
1. Sx duration < 30 days 2. Paresthesias, pain, weakness worse with postures that stress the NV bundle.
2. No sx distal to the shoulder Physical Exam: 1. Limited CT junction and 1st rib mobility (inferior); +CRLF Test
3. Pt reports looking up does not aggravate sx 2. + ULTT – ulnar bias. 3. Most cases are neurogenic. 4. Mms imbalances: short or
4. FABQ PA < 12 hypertonic scalenes; weak scapular depressors. 5. Abnormal breathing ratio
5. Diminished upper thoracic spine kyphosis (normal 2:1 ratio diaphragm excursion); TOS patients may initiate with chest.
6. Cervical extension < 30° Treatment: 1. Mobilize tight/hypertonic structures, CT junction, 1st rib; 2. Lengthen
-4 of 6 present + LR 12.0 shortened mms (scalenes, pec minor). 3. Normalize breathing pattern – diaphragmatic
-3 of 6 present + LR 5.5 breathing. 4. Neural gliding techniques.
Cervical Myelopathy CPR Diagnostic Cluster for Cervicogenic Headaches
Stocking/glove sensory changes feet/hands 1. Decreased AROM cervical extension
Intrinsic mms wasting 2. Palpable/painful OA – C3/4 joint dysfunctions
Hyper reflexia (3+) 3. Deep cervical flexor strength impairments with cranio-cervical flexion test (CCFT)
Weakness below level of compression - These conditions are not present in migraine or tension headaches.
Bowel/bladder changes
Unsteady gait
Positive pathological reflexes (clonus, Babinski, Hoffmans’s)
1. Gait deviations
2. Hoffman’s reflex
3. Inverted supinator sign
4. Babinski
5. Age > 45 y/o
≥ 3 out of 5 + LR 30.9

Lumbopelvic Manipulation for LBP (Flynn 2001, Childs 2004) Dx of SI Origin of Pain CPR (Laslett 2003)
1. Duration <16 days -Pre conditions: no pain above L5, no peripheralization w/repeated LB flexion,
2. No sx distal to the knee no centralization with repeated LB extension.
3. FABQW <19 1. + SI Distraction test
4. At least 1 hypomobile segment in L-spine 2. + SI Compression test
5. At least one hip >35° IR 3. + Gaenslen’s test R
4 of 5 present + LR 24.4 4. + Gaenslen’s test L
First 2 items present + LR 12.6 5. + Sacral thrust
6. + Thigh thrust (POSH test)
Lumbar Stabilization Training: Success (Hicks 2005) ≥ 3 variables present: + LR = 4.29
1. + Prone Instability Test
2. + Aberrant motions Lumbopelvic Manipulation for PFPS
3. Average SLR >91° 1. Side to side difference in hip IR >14°
4. Age <40 y/o 2. No reported stiffness sitting > 20 min
3 or more present + LR 4.0 3. Squatting most painful activity
4. Navicular Drop > 3mm
Lumbar Stabilization Training: Failure (Hicks 2005) 5. Ankle Dorsiflexion > 16°
1. – Prone Instability Test Hip IR diff > 14° and any 3 0f 4 predictors: LR 10.0
2. No aberrant movement with LB flexion
3. FABQ physical activity >9
4. No hypermobility with spring testing
≥ 3 variables present: + LR 18.8 (for predicting failure)
Hip Mobilization for Knee OA CPR for Hip OA (Sutlive in review)
1. Ipsilateral anterior thigh pain 1. Self-reported squatting as aggravating factor
2. Ipsilateral pain or paresthesia in hip/groin 2. Passive IR of involved side ≤ 25°
3. Ipsilateral knee flex <122° 3. Active hip flexion causing lateral hip pain
4. Ipsilateral hip IR <17° 4. Active hip extension causing hip pain
5. Pain with ipsilateral hip distraction 5. Scour test w/adduction causing lateral hip/groin pain
1 variable present: LR 5.1 3 of 5 present: LR 5.2
2 variables present: LR 12.0 4 of 5 present: LR 24.3

Criteria for Hip OA (Altman 1991) Criteria for Knee OA (Altman 1991)
Variables, Set #1 Variables, Set #1
1. Hip Pain 1. Knee pain
2. Hip IR ROM < 15° 2. Age ≤ 38
3. Hip flexion ROM < 115° 3. Bony enlargement
Variables, Set #2 Variables, Set #2
1. Age > 50 1. Knee pain
2. Hip pain with IR ROM 2. Age ≥ 39
3. AM stiffness ≤ 60 min 3. AM stiffness > 30 min
Meets criteria if: pt has all 3 variables for either 4. Bony enlargement
variable set. + LR 3.44 Variables, Set #3
1. Knee pain
Ottawa Knee Rules (Stiel 1997) 2. Crepitus on active motion
Rule out fx with acute knee injury 3. AM Stiffness > 30 min
Variables: 4. Age ≥ 38
1. Age ≥ 55 Meets criteria if: pt has all variables in at least one of the above sets. + LR 7.4
2. Bony Tenderness at fibular head
3. Isolated tenderness at the patella Ottawa Ankle Rules (Stiel 1997) Ruling our fx with acute ankle injury
4. Inability to flex knee to 90° 1. Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus
5. Inability to bear weight after injury and for four steps 2. Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lat malleolus
during initial evaluation. 3. Bony tenderness at the base of the 5th metatarsal
Interpretation: Radiographs are only required for individuals 4. Boney tenderness at the navicular
+ for one or more of the above variables. 5. Inability to bear wt both immediately after injury and for 4 steps during initial eval
Interpretation: Radiographs are only required for individuals + for one or more of the
Above variables. Sn = 98%, -LR = 0.10
Shoulder Pain Outcome Predictors (Kunpers 2006) Factors for short term outcomes in individuals with
Factors related to poor 6-mo outcomes in individuals shoulder pain receiving cervical manipulation
suffering from shoulder pain. 1. Symptoms < 90 days
Variables: 2. No medications for shoulder pain
1. Duration of symptoms > 3 months 3. (-) Neer’s Test
2. Gradual onset of pain 4. Pain free flexion < 127°
3. High pain level at baseline 5. IR < 53°, glenohumeral 90° abduction
No known +/- LR or Sn/Sp 3/5 factors, 89% post-test probability

Diagnostic cluster for secondary shoulder impingement Cluster of tests for shoulder impingement
1. + Hawkins Kennedy 1. Hawkins Kennedy
2. + Painful arc 2. Neer’s
3. + Infraspinatus test 3. Painful arc
2/3 – 90% post-test probability; 3/3 – 95% post-test probability 4. Empty can (Jobe)
5. External rotation resistance
3/5 positive tests best predictive value
Diagnostic clusters for Rotator cuff tear
1. Drop arm sign
2. Painful arc
3. Infraspinatus muscle test
2/3 variables: 69% CPR for treatment of Lateral Epicondyalgia with MWM
3/3 variables: 91% 3 predictors of success with MWM
1. Age < 49
Carpal Tunnel Syndrome CPR (Wainner 2005) 2. Affected UE pain free grip > 25lbs
1. Shaking of hand for symptom relief 3. Unaffected UE pain free grip > 75.5 lbs
2. Wrist-ratio index > .67 (AP/ML) 3/3: 100% success
3. Sx-severity scale score >1.9 2/3: 93% success
4. Reduced median sensory field 1st digit 1/3: 87% success
5. Age > 45 years
All 5 variables present: LR 18.3, 90% Sp
≥ 4 variables present: LR 4.6, 70% Sp