Session Descriptions

Pre-Conference Sessions

Integrated Manual Therapy and Exercise for the Cervicothoracic spine and Shoulder: A Regional Interdependence Approach
This session is for Physical therapists interested in current best evidence for manual physical therapy techniques and exercise for patients with upper quarter impairments. It will discuss patients with spine and upper quarter impairments, which make up a sizable percentage of the case load in an outpatient physical therapy practice. With current best evidence pointing towards a multimodal management strategy including manual physical therapy and exercise, this course will provide the busy physical therapy clinician with the essential hands on tools to effectively treat this large patient population. The presenters of this course are leading researchers and authors of evidence supporting manual physical therapy and exercise in patients with cervicothoracic and upper quarter impairments. They will present the most recent best evidence for this patient population. Additionally, the presenters will also demonstrate and teach the manual techniques that were used in the studies which support the best evidence.
Presenters: Robert Boyles, Joshua Cleland and Paul Mintken

The Three Pillars of the Mulligan Concept — Why: Clinical Research — When: Clinical Reasoning — How: Clinical Skill
This will be a one-day program offering a balanced mixture of didactic lectures discussing the clinical reasoning foundation of the Mulligan concept, along with a skill-acquisition laboratory session with references and discussion of supporting evidence for each technique demonstrated.
Presenters: Jack Miller and Jim Millard

The Transition from Acute to Chronic Musculoskeletal Pain: Assessments and Principles for Management
Traumatic joint injury is a common occurrence in the young and elderly population and can lead to post-traumatic osteoarthritis (OA) and chronic pain. Over time, patients may experience increased tissue tenderness and expansion of symptoms, a sequellae of a sensitized nervous system. The specific drivers of these neurophysiological changes are largely unknown. Central sensitization, evidenced by laboratory measures of central nociceptive excitability, has been demonstrated in patient populations of knee OA and following acute ligament injury, and surprisingly, was not found to be dependent on the presence of resting pain. Thus, a greater emphasis on clinical measures that may help the stage the disease of chronic pain is warranted. Ideal management of chronic pain involves early detection. This course will discuss clinical tools for identifying characteristic features of chronic musculoskeletal pain. Clinical assessment of pain patterns, clinical outcome tools and quantitative sensory testing (QST) will be discussed and participants will have the opportunity to practice with these tools. Strategies for management including exercise prescription and manual therapy will be presented. Techniques of manual therapy for the purpose of pain relief will be presented and attendees will apply these techniques and appreciate the principles underlying these treatment methods.
Presenters: Carol A. Courtney and Michael O'Hearn

Pelvic Girdle Pain, a New Approach to Low Back Pain
An estimated 76% of women experience low back and posterior pelvic girdle pain and accounts for the majority of sick leave among pregnant women. Often, these symptoms go untreated due to patient or practitioner beliefs that pregnancy is the cause of pain and symptoms will resolve postpartum. Low back or posterior pelvic girdle pain during pregnancy is the biggest predictor for pain post partum and recurrence or worsening of symptoms in subsequent pregnancy. Research also shows that women who experience low back or posterior pelvic girdle pain are 3 times as likely to suffer from post partum depression. Pregnancy causes significant biomechanical changes within a woman's body, which can result in faulty movement patterns, pain, and dysfunction. This course aims to educate attendees regarding tests and measures for the differential diagnosis of low back versus pelvic girdle pain and manual interventions to treat pelvic girdle pain. The session will also cover appropriate questioning during history taking to allow clinicians to hone in on patient values and preferences to improve clinical outcomes.
Presenter: Stephanie Fournier

Common Clinical Findings with Uncommon Links
The Orthopaedic Manual Therapist is uniquely qualified to act as a primary screener and interventionist for a majority of non - traumatic upper extremity impairments. This will be an interactive course focusing on the manual therapists' assessment and treatment of the upper extremity from the cervico-thoracic-rib region through the upper limb. Participants will implement clinical decision making skills based on evidence in order to link kinetic chain relationships to tissue specific impairments. Interventions will include manual therapy techniques as well as supportive neuromuscular treatments. This session will detail clinically relevant relationships for diverse patient populations, including athletes, based on an organized examination and decision making process.
Presenters: Catherine Patla, Amanda Grant, Libby Bergman and Erin Conrad

Functional Manual Therapy Approach to Foot and Ankle Dysfunction
Research has revealed that manual therapy can enhance foot and ankle function and address painful conditions. Hundreds of physical therapists, trained in Functional Manual Therapy™ (FMT) through the Institute of Physical Art, utilize the systematic Functional Mobilization (FM) approach to the foot and ankle as an aspect of their treatments. After many years of clinical experience, the Functional Manual Therapy approach has developed a philosophical construct related to foot and ankle analysis and function. The approach offers an organized systematic strategy for the management of mechanical, neuromuscular, and motor control dysfunctions of the lower limb. FMT offers the patient a conceptual framework for producing efficient function. The speaker will share the clinical reasoning behind certain observations and pre-tests which can guide the clinician in determining if a patient will likely benefit from treatment of the foot and ankle. While the speaker will present published research which supports foot and ankle mobilization, this presentation focuses on the clinician experience and patient preference, utilizing research to support clinical reasoning based on interregional dependency.
Presenters: Gregory Johnson, Dean Hazama and Ryan Johnson

Ohio Physical Therapy Association Legislative Session — The Role of the PT in the New Healthcare Arena
Health care is in a dynamic stage of transformation with the implementation of the Affordable Care Act and reforms on how care is delivered and paid. These pressure points offer physical therapy a unique opportunity to show the profession as a solution to a health care system that is too costly, limited in access, and disparate in quality. APTA is collaborating on initiatives, programs and resources designed to take advantage of these pressure points and show the value of physical therapy to payers and the public. This session will focus on key policy, practice and payment trends in the Washington DC and statehouses across the country, including threats and opportunities for physical therapists. Advancing payment reforms, efforts to measure and standardize practice, and the increasing need to show value, accountability, and innovation offer the profession the opportunity to transform its role in our health care delivery system. Physical therapy will change through the implementation of health care reform by state and region and now is the time to redefine our value, our role, and our potential as essential health care providers.
Presenters: Justin Moore and Sharon Dunn

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Keynote Presentations

The Value of a Focused Subjective Examination
Keynote Presenter: Ali Rushton
Ali Rushton will discuss the importance of performing a focused Subjective Examination when managing patients. A well performed Subjective Examination is the key to understanding the nature of the patient's complaints and how they relate to their functional capabilities. The Subjective Examination is far more than just a passive history taking, it is an active investigation of the conditions and how they respond to different movements, postures and challenges, throughout the entire day. The focused Subjective Exam allows a clinician to establish clinical hypotheses to be tested in the Physical Exam and subsequent treatment.

The Role of the Physical Examination
Keynote Presenter: Duncan Reid Duncan Reid will discuss the role and the importance of the Physical Exam. The Physical Exam is one of the keys to determining what potential treatments may be valuable to manage a patient's conditions. It offers an opportunity to establish the patient's response to different movements and further the clinician's information regarding the conditions involved. The Physical Examination allows the clinician to revisit the clinical hypotheses established in the Subjective Exam. Thus the Physical exam allows the clinician to confirm/modify/reject existing hypotheses and develop new hypotheses as needed.

Special Tests
Keynote Presenter: Jim Meadows
Jim Meadows will discuss the relative value of Special Tests commonly used in clinical practice. In recent years, numerous tests have become well established due to their Sensitivity, Specificity, and Likelihood Ratios. The role of certain tests will be discussed within the framework of their clinical utility.

Management of Thoracic, Lumbar and Pelvic Conditions: Case Based Discussion Demonstration
Presenters: Duncan Reid, Tim Flynn and Joseph Farrell
Drs. Reid, Flynn and Farrell will present clinical case scenarios of various patients with Thoracic, Pelvic and Lumbar conditions. The patient's signs and symptoms, and movement disorders will be presented to the audience followed by demonstrations by each of the presenters showing different options for manual therapy management on a patient model including a discussion of the underlying clinical reasoning for each approach.

Panel Discussion: The Value of Philosophical Frameworks
Panel: Ali Rushton, Duncan Reid, Tim Flynn, Stanley Paris, Joe Farrell, Jim Meadows, Gail Deyle
Moderator: Elaine Lonnemann
Historically, the Academy was originally formed by a number of leading clinicians interested in sharing their viewpoints and promoting the value of Orthopedic Manual Physical Therapy. While the Founding Fellows of the Academy came from different philosophical backgrounds they shared the same common goal of promoting and furthering the study of OMT. The distinguished panel of presenters will continue that tradition and discuss the relative value of clinicians using different philosophical frameworks to evaluate and manage a variety of patients with manual therapy interventions.

Recognizing 200 Years of International OMT Practice
The key focus of this presentation is to explore the early history of PT education and practice in Europe and international extensions of this. To lay a foundation from which we can start to understand how PT came before competing manipulative professions, and how it was that the PT profession in the USA started as a hands on manually direct approach but morphed into a modality and exercises dominated approach, only to be re-aligned by international influences from the 19060's forward to our current blended OMPT approach.
Presenter: Cameron MacDonald

IFOMPT International Framework for Cervical Screening
Presenter: Ali Rushton
Keynote Speaker Ali Rushton is the Chair of the IFOMPT Standard Committee and Lead Author on the recently released International Framework for Cervical Screening Document. Ali will present the background of the document and its value to clinicians. Ali will present the outline of the document and discuss how clinicians should incorporate the document into their clinical practice.

Balanced Orthopaedic Physical Therapy Practice in an Unbalanced EBP World
Evidence based practice (EBP) is the integration of 1) best research evidence with 2) clinical expertise, and 3) patient values and circumstances. Physical therapists adhering to EBP principles have a seemingly easy decision when best research evidence strongly supports the use of a particular intervention approach for a specific patient. The clinical decision making process becomes more difficult when research evidence is lacking in support of a specific intervention for a specific patient or when that patient does not respond optimally to interventions supported by research evidence. Patient specific factors such as preference, expectation, and psychological factors have potential to guide treatment when research evidence is lacking. Furthermore, patient specific factors can enhance or diminish treatment responses when they support or oppose best research evidence respectively. The purpose of this case-based breakout session is to review patient specific factors likely to influence clinical outcomes in patients treated for musculoskeletal pain. Specifically, we will focus on psychological factors indicative of poor prognosis, patient expectation, and patient preference for treatment. Case examples will demonstrate how the pillars of EBP may uniquely and jointly influence patient outcomes and how the integration of each pillar during clinical decision making may be unbalanced based on individual patient scenarios.
Presenter: Jason Beneciuk, Joel Bialosky and Nata Salvatori

Integrating Patient Preference and Clinical Expertise into the EBP Triad: The Skill of Interaction
Joseph Farrell and Matt Lee will present examples of case studies to demonstrate the integration of the three pillars of EBP through power point presentation and videotape of the authors and colleagues interviewing, examining and treating various patients. Particular attention will be directed at the communication skills required of an advanced clinician to collect relevant interview data, which in turn drives the clinical reasoning behind the physical examination and treatment.

This interactive session will provide numerous clinical examples to demonstrate the importance of patient preference and clinical expertise when the clinical research evidence does not fit the patient's presentation.
Presenter: Joseph Farrell and Matt Lee

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Breakout Sessions

Clinical Application of Evidence in the Multi-System Approach to the Evaluation and Treatment of Whiplash Associated Disorder
This presentation will be an interactive lecture. Seventy five percent will be lecture and 25% demonstration and lab. Lecture will cover key components of evaluation techniques as well as treatment that are all based on the most recent research in the area of focus. Lecture will include video and graphics demonstrating techniques to support the didactic. This is a multi-system approach to evaluation and treatment of cervical trauma including cervical-ocular dyskinesia, vestibular, proprioception, trigeminal involvement, and visual disturbance using neurophysiological, biomechanical, and biomedical models. Treatment will include a variety of options for the participant to consider.
Presenter: Richard Kring

Update on Thrust Manipulation in First Professional Physical Therapy Programs in the US and around the World
This session will be an opportunity for participants to review the current methods in which thrust manipulation is taught in entry level physical therapy programs in the United States & worldwide. The current beliefs and practices of clinical instructors and students will be reviewed as an update from previous surveys. The current evidence related to recommendations for the use of thrust manipulation in clinical practice will be reviewed as. Methods of instruction will be discussed and presented to enhance performance of instruction of techniques with emphasis on safety, effectiveness, and ease of learning.
Presenters: Elaine Lonnemann, Kenneth Olson and William Bissonault

Conservative Management of Scoliosis using 3D Curve Specific Exercise
This will be a presentation of the current literature and an explanation of the process of progression of scoliosis. Discussion will be held on assessment and treatment of scoliosis using self corrective curve specific exercise.
Presenter: Amy Sbihli

Integrating Patient Preference and Clinical Expertise into the EBP Triad: The Skill of the Interaction
Joseph Farrell and Matt Lee will present examples of case studies to demonstrate the integration of the three pillars of EBP through power point presentation and videotape of the authors and colleagues interviewing, examining and treating various patients. Particular attention will be directed at the communication skills required of an advanced clinician to collect relevant interview data, which in turn drives the clinical reasoning behind the physical examination and treatment.

This interactive session will provide numerous clinical examples to demonstrate the importance of patient preference and clinical expertise when the clinical research evidence does not fit the patient's presentation.
Presenters: Joseph Farrell and Matt Lee

Spinal Pain in the Elderly: Results of Two Multi-Centered Observational Studies and the Implications on the Management of Low Back Treatment in the Elderly
Christopher Chase will utilize PowerPoint presentation to review literature about centralization and directional preference. A recently published study (Oliver and May, 2010) will be reviewed as well as unpublished data from a follow up study that is being prepared for submission to publication will be shared that demonstrates even thought the elderly do not centralize as frequently as younger back patients, they still demonstrate directional preference. Secondarily the need for x-ray, MRI and other diagnostic imaging is often unnecessary and does not add much to your clinical decision making process. A video demonstration of a patient from the study may be included that demonstrates pre and post mechanical baselines and treatment intervention as well as frequently utilized manual therapy and repeated movement interventions.
Presenter: Christopher Chase

Knowledge Translation and Manual Therapy: Improving the Interaction of Clinicians and Researchers
The history of knowledge translation will be discussed. The application of knowledge translation to health care and physical therapy will be presented and specific recommendations will be made to allow attendees to use this knowledge to more critically read the literature, design education courses and in-services, and improve patient care. Researchers and educators will benefit from this information to more effectively have their results utilized. Clinicians will benefit from this information by gaining an understanding of how they can improve outcomes and satisfaction of their patients through utilization of clinical research.
Presenter: Steve Karas

The transition from Acute to Chronic Musculoskeletal Pain: Assessments and Principles for Management
This is a shortened, lecture version, of the Pre-Conference Session offered.

Traumatic joint injury is a common occurrence in the young and elderly population and can lead to post-traumatic osteoarthritis (OA) and chronic pain. Over time, patients may experience increased tissue tenderness and expansion of symptoms, a sequellae of a sensitized nervous system. The specific drivers of these neurophysiological changes are largely unknown. Central sensitization, evidenced by laboratory measures of central nociceptive excitability, has been demonstrated in patient populations of knee OA and following acute ligament injury, and surprisingly, was not found to be dependent on the presence of resting pain. Thus, a greater emphasis on clinical measures that may help the stage the disease of chronic pain is warranted. Ideal management of chronic pain involves early detection. This course will discuss clinical tools for identifying characteristic features of chronic musculoskeletal pain. Clinical assessment of pain patterns, clinical outcome tools and quantitative sensory testing (QST) will be discussed. Strategies for management including exercise prescription and manual therapy and techniques of manual therapy for the purpose of pain relief will be presented.
Presenters: Carol A. Courtney and Michael O'Hearn

Putting Psychosomatic and Psychosocial Theories of Chronic Neck Pain into Context with Biological Factors: Where Does Manual Therapy Fit?
Patients with cervical spine pain and dysfunction frequently present with a myriad of physical and psychological complaints that recent literature published in high impact journals has reduced to a purely psychosocial phenomena. Despite this prevailing opinion, our aim with this presentation is to provide compelling evidence to the contrary. Our work and that of others is helping to contextualize the condition into distinct biological and psychosocial factors. The literature suggests these symptoms are associated with a number of measurable impairments in cervical sensorimotor functioning. Furthermore, emerging evidence suggests that traumatic onset neck pain poses different challenges from non-traumatic neck pain. Finally, recent literature suggests that manual therapy plays a significant role in the management of patients with these complaints.

This session will emphasize information that is impactful and potentially disruptive to conventional wisdom. We link recent data on the pathophysiological mechanisms underlying these impairments to the clinical presentation so that the clinician can develop an evidence-based examination and management plan. Current best evidence and clinical experience suggests a combination of manual therapy techniques, vestibular rehabilitation, balance retraining, and specific sensorimotor exercise prescription may be effective in treating these patients. The purpose of this session is to 1) explore potential pathophysiological mechanisms underlying these signs and symptoms, 2) present common sensorimotor deficits found primarily in patients with traumatic neck injury and pain, 3) present the emerging evidence supporting a rational examination for identifying and objectifying sensorimotor impairments and the underlying mechanisms, and 4) offer management approaches for these patients that includes manual therapy as a key component.
Presenter: Rob Landel and James Elliot

Thrust Joint Manipulation Skills Development for the Cervical Spine
This break out session will be primarily devoted to developing and improving the psychomotor skills necessary to perform safe and effective thrust manipulations to the cervical spine. It will briefly discuss the basic ground rules for performing thrust manipulations using component techniques as well as the indications and evidence supporting manipulation. The lab session will be devoted to honing your skills with a short series of drills to help develop speed, stance, positioning, and proper use of core stabilizers of the therapist's spine during manipulation. Finally, some problem solving for accomplishing effective cervical manipulation for different clinician and patient body sizes and conditions will be demonstrated.
Presenters: William O'Grady and Louie Puentedura

A Function Based Postural Classification System: Measurable Outcomes for Determining Efficient Posture
Current research documents the relationship between postural alignment and motor control. However, existing classification systems are based on an analysis of typical human postures, not on functional outcomes. The Function Based Postural Classification System (FBPCS) classifies patients based on the necessary corrections needed to enhance the patient's motor control, strength, and postural stability. The FBPCS immediately directs the clinician, through observation, to the postural dysfunctions which can impair the patient's strength, stability, or motor control and directs the clinician's training which promotes a patient's optimum motor control, strength, and stability. This session will present clinical and controlled studies to support the following hypothesis: A clinician can predict a patient's postural efficiency and objectively determine the patient's most efficient posture if motor control, strength, and stability are the measurable outcomes. Two of the primary functional tests utilized to verify the classification system are the Vertical Compression Test (VCT) and the Elbow Flexion Test (EFT) (Saliba and Johnson, 1984). Data collected in the lab and clinic will demonstrate both the validity and reliability of these two functional tests to confirm the patient's most "efficient" standing posture. The two Functional Tests presented provide the clinician direct objective feedback on each patient's strength, stability, and motor control which can be used to confirm the presence or absence of an efficient posture. This proprioceptive feedback guides the clinician and serves as a proprioceptive training enhancement tool for the patient, providing both the clinician and the patient immediate feedback related to the functionality of the patient's posture. The "efficient" standing posture, as defined by the FBPCS, is applicable to all patients, both orthopedic and neurological, and is applicable to alignment for all ADL.

This session will provide an opportunity for the participants to practice their observation skills, the two Functional Tests, and correlate their findings.
Presenter: Vicky Saliba Johnson

Balanced Orthopaedic Physical Therapy Practice in an Unbalanced EBP World
Evidence based practice (EBP) is the integration of 1) best research evidence with 2) clinical expertise, and 3) patient values and circumstances. Physical therapists adhering to EBP principles have a seemingly easy decision when best research evidence strongly supports the use of a particular intervention approach for a specific patient. The clinical decision making process becomes more difficult when research evidence is lacking in support of a specific intervention for a specific patient or when that patient does not respond optimally to interventions supported by research evidence. Patient specific factors such as preference, expectation, and psychological factors have potential to guide treatment when research evidence is lacking. Furthermore, patient specific factors can enhance or diminish treatment responses when they support or oppose best research evidence respectively. The purpose of this case-based breakout session is to review patient specific factors likely to influence clinical outcomes in patients treated for musculoskeletal pain. Specifically, we will focus on psychological factors indicative of poor prognosis, patient expectation, and patient preference for treatment. Case examples will demonstrate how the pillars of EBP may uniquely and jointly influence patient outcomes and how the integration of each pillar during clinical decision making may be unbalanced based on individual patient scenarios.
Presenters: Jason Beneciuk, Joel Bialosky and Nata Salvatori

Pelvic Girdle Pain, a New Approach to Low Back Pain
This is a shortened, lecture version, of the Pre-Conference Session offered.

An estimated 76% of women experience low back and posterior pelvic girdle pain and accounts for the majority of sick leave among pregnant women. Often, these symptoms go untreated due to patient or practitioner beliefs that pregnancy is the cause of pain and symptoms will resolve postpartum. Low back or posterior pelvic girdle pain during pregnancy is the biggest predictor for pain post partum and recurrence or worsening of symptoms in subsequent pregnancy. Research also shows that women who experience low back or posterior pelvic girdle pain are 3 times as likely to suffer from post partum depression. Pregnancy causes significant biomechanical changes within a woman's body, which can result in faulty movement patterns, pain, and dysfunction. This course aims to educate attendees regarding tests and measures for the differential diagnosis of low back versus pelvic girdle pain and manual interventions to treat pelvic girdle pain. The session will also cover appropriate questioning during history taking to allow clinicians to hone in on patient values and preferences to improve clinical outcomes.
Presenters: Stephanie Fournier

The Evolution of Expertise as an Evidence-Informed Practitioner
Just as the hands of a manual therapist gain skill and prowess over time, so too do the skills of the evidence-informed practitioner gain efficiency and depth as one moves forward on the path of the master clinician. This evolution does not occur as an automated process, but rather through thoughtful curating of method and technique. This presentation will review the traditional process of evidence-based practice and the evolution of new models of clinical science and learning that evolve, as the practitioner evolves and increases their expertise. Underpinning this evolution is the expert practitioner's role in advocacy and working to magnify the message of manual therapy. Modern learning theories, knowledge brokers, the role of technology in evidence-based practice, developing persistent questions and combining different forms of professional learning and development will be discussed as part of this presentation. It's time to take evidence-based practice to the next level.
Presenters: Eric Robertson, Timothy Noteboom and Britt Smith

The Three Pillars of the Mulligan Concept — Why: Clinical Research — When: Clinical Reasoning — How: Clinical Skill
This is a shortened, lecture version, of the Pre-Conference Session offered.

This session will offer didactic lectures discussing the clinical reasoning foundation of the Mulligan concept, along with references and discussion of supporting evidence for each technique.
Presenters: Jack Miller and Jim Millard

Expert Language in Manual Therapy — Maximizing Outcomes — Student Only Session
The science and application of Manual Therapy is now a significant component of orthopaedic physical therapist curricula. However, often student interns report that patient communication surrounding manual and other interventions can be very challenging. It has been reported that the amount of time with a therapist, positive patient expectations, and therapist-patient trust are associated with improved patient satisfaction and outcomes. Ultimately, patient communication (verbal and non-verbal) is a key skill that must be mastered to achieve clinical excellence. In this student-only interactive session, students will be exposed to practical and efficient ways to use language as an advantage to maximize manual therapy interventions and patient satisfaction in order to have expert outcomes.
Presenters: Timothy W Flynn, PT, PhD, FAAOMPT

Manual Therapy for the Cervical Spine in the Pediatric Population: What Do We Need to Know?
This session will focus on three components of patient management to treat cervical spine pain in the pediatric population. First, relevant research related to the physiology and anatomical development of the pediatric spine, along with diagnostic features, will be discussed to support the examination process. Second, practice guidelines utilizing cervical spine clearance protocols to assist diagnosis of cervical spine pain in the pediatric population will be proposed. Third, topics to consider when determining the appropriateness of manual therapy intervention to the pediatric cervical spine will be presented.
Presenter: Paul Jurica and Brenda Boucher

When One-Size Fits All Doesn't Work: Engineering Customized Manipulations for Complex and Difficult Patients
While most of our patients are fairly straightforward when it comes to delivering a manipulation or even mobilization some provide issues that require thought and a different technique to the one or two that we customarily use. Locking through painful segments, segments that simply will not lock and positioning the target segment in position that does not cause painful "twitching" are all problems that we face from time.

This session will look at the principles and practices of varying patient and therapist positions, locking techniques and thrust directions to overcome these difficulties.
Presenter: Jim Meadows

Lumbar-Hip Connection, Treating the Kinetic Chain with Applied Functional Science and EBP
This session will present concepts and ideas of Applied Functional Science (AFS) within a framework of Evidence Based Practice and the 3 Pillars of EBP. It will explain how to utilize the AFS approach to treat the lumbar spine-hip complex region. The core thought process of AFS is Principlesà Strategies à Techniques (PST). This correlates well with the EBP 3 Pillars: Patient Values, Relevant Research, and Clinical Experience. This session will explain the correlation between PST, and EBP 3 Pillars, and how to apply these concepts directly into patient care techniques that are effective, and practical to use immediately.
Presenter: Steve Politis

Defining Value in Physical Therapy — The Case for Early Physical Therapist Intervention: Matching the Evidence with Practice Integrity and Patient Expectations
Several international guidelines consider acute low back pain to be a self-limiting condition and consider medical management and advice to be an appropriate intervention during the acute phase of the disorder. However, the prognosis for acute low back pain may not always be favorable. Furthermore, the vast majority of evidence related to physical therapy intervention suggests that the greatest efficacy occurs when manual therapy and targeted therapeutic exercise interventions are prescribed during more acute pain episodes. Research has shown that the timing (i.e., early intervention) of physical therapist intervention can bring value to a patient care episode by improving outcomes, reducing downstream medical costs, and reducing fear- avoidance behaviors. . This presentation will discuss the implementation and value of physical therapy when provided in settings focused on early intervention (i.e., roving/ "on-call" physical therapy and primary care settings). The incorporation of these early intervention programs (in both referral and direct access settings) have assisted physical therapists in enhancing collaboration with referral sources, provided a forum for appropriately trained physical therapists to showcase their skills in manual therapy and differential diagnosis, and positioned physical therapists as a front line providers in the provision of the right care at the right time. We will also discuss the evidence from these early intervention programs and their impact on increasing physical therapy market share, the triage and early recognition of patients at high risk for chronicity, and the role of physical therapists in matching the most efficacious, ethical care with a patient's values and expectations.
Presenters: Michael Ross, Ryan Elliot and Jeremy Jackson

Clinical Practice Guidelines: A Facilitator, Not a Stopper, for Clinical Decision Making
Clinical practice guidelines have an increasing role in healthcare delivery. Multiple professional organizations including IFOMPT (International Federation of Orthopaedic Manual Physical Therapists) and APTA (American Physical Therapy Association) are actively developing guidelines. Guideline authors synthesize evidence and make practice recommendations which may lead to standardized care. Appropriate translation of well-developed guidelines into clinical practice necessitates clinicians know 1) how to find guidelines in databases, 2) understand strengths and weaknesses of how the guidelines are developed, and 3) appraise guidelines.

Retrieval of guidelines will focus on key features of three freely available databases: PubMed/MEDLINE, PEDro (Physiotherapy Evidence Database), and guideline.gov. Although guidelines are developed using multiple processes, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) process will be illustrated. GRADE has been endorsed by various organizations including WHO (World Health Organization), The Cochrane Collaboration, and the AHRQ (Agency for Healthcare Research and Quality). The AGREE II instrument (Appraisal of Guidelines for Research and Evaluation) will be used to illustrate key considerations when appraising clinical guidelines. Using published evidence, participants will be guided in a discussion of strategies for translating guidelines into clinical practice.
Presenters: Randy Richter, Tricia Austin and Chris Sebelski

Moving Artificial Pillars: Manual Therapy after Total Joint Arthroplasty
We know that manual therapy and exercise is effective for patients with osteoarthritis of the hip and knee, and can delay the need for total joint arthroplasty. One pillar of evidence-based practice is simply the evidence. This talk will review the evidence related to treating patients after total joint arthroplasty and integrate this with known evidence supporting regional manual therapy and exercise for patients with osteoarthritis. This is an underrepresented topic in the body of literature when considered in light of how many patients are seen in physical therapy clinic following arthroplasty.
Presenters: Eric Robertson, Michael Bade and Christian Little

Common Clinical Findings with Uncommon Links
This is a shortened, lecture version, of the Pre-Conference Session offered.

The Orthopaedic Manual Therapist is uniquely qualified to act as a primary screener and interventionist for a majority of non - traumatic upper extremity impairments. This course will focus on the manual therapists' assessment and treatment of the upper extremity from the cervico-thoracic-rib region through the upper limb. This session will detail clinically relevant relationships for diverse patient populations, including athletes, based on an organized examination and decision making process.
Presenters: Catherine Patla, Amanda Grant, Libby Bergman and Erin Conrad

Functional Manual Therapy Approach to Foot and Ankle Dysfunction
Presenters: Gregory Johnson and Ryan Johnson

Integrated Manual Therapy and Exercise for the Cervical Spine and Shoulder: A Regional Interdependence Approach
Course Audience: Physical therapists interested in current best evidence for manual physical therapy techniques and exercise for patients with upper quarter impairments.

Relevance to Physical Therapy: Patients with spine and upper quarter impairments make up a sizable percentage of the case load in an outpatient physical therapy practice. With current best evidence pointing towards a multimodal management strategy including manual physical therapy and exercise, this course will provide the busy physical therapy clinician with the essential hands on tools to effectively treat this large patient population.

Evidence based nature and references: The presenters of this course are leading researchers and authors of evidence supporting manual physical therapy and exercise in patients with cervicothoracic and upper quarter impairments. They will present the most recent best evidence for this patient population. Additionally, the presenters will also demonstrate and teach the manual techniques that were used in the studies which support the best evidence.
Presenters: Robert Boyles, Joshua Cleland and Paul Mintken

Functional Manual Therapy and the Case for the Interregional Significance of Coccyx Mobilization
This is a shortened, lecture version, of the Pre-Conference Session offered.
This session will provide a review of the anatomy of the coccyx and surrounding structures. Emphasis will be placed on neural tissues, dural tissues, pelvic floor musculature, and surrounding bony structures. Current evidence will be reviewed which addresses the effects of coccygeal mobilization. Functional Mobilization™ for the coccyx will be described. Pictures and/or videos will be used to demonstrate objective changes before and after coccygeal mobilization. Depicted changes may include range of motion of the cervical spine, shoulder abduction, trunk flexion, lumbar spine quadrants, passive trunk rotation, slump sitting neural tension test. A Plausible rationale will be suggested for anatomical and physiological theories behind observed changes in function and clinical reasoning pearls will be shared to assist the therapists in determining who will most likely benefit from coccygeal mobilization. Suggestions will be discussed for assessment of patient preference to determine if the intervention is appropriate.
Presenters: Gregory Johnson and Ryan Johnson

The Pelvic Floor: The Missing Link between Lumbar Instabilities and Lower Quarter Symptoms for the Orthopedic Manual Therapist
This break out session will focus on how lumbar instabilities and subsequent pelvic floor inhibition/facilitation can cause lower quadrant pain/dysfunction. The session will begin with an explanation of the biomechanics of a lumbar instability which leads to muscle inhibition/facilitation in the pelvic floor. We will then discuss how inhibition/facilitation of the proximal core muscles can cause pain/dysfunction throughout the entire lower quadrant chain. We will instruct the orthopedic manual therapist in the use of non-invasive assessment and treatment techniques for the pelvic floor to supply the missing linkbetween the lumbar spine/pelvic floor and lower quadrant dysfunction. We will also show how the use of surface EMG can be useful to help isolate muscle contractions to the targeted muscles in the pelvic floor. Throughout the session, case studies will be used to highlight how central dysfunction leads to peripheral symptoms and until the pelvic floor was addressed, the patient was unable to return to pain free functioning.
Presenters: Stacy Soappman, Patti Green and Kathy Berglund

Centralization: Well Known, but often Misunderstood and Under-Appreciated
Centralization is a phenomenon first discovered by Robin McKenzie in the 1950's and first published in his text The Lumbar Spine: Mechanical Diagnosis & Therapy (1981). Since that time an extensive amount of literature studying this phenomenon has been published. Over the years many definitions and varying interpretations have been proposed. Centralization has also found its way into varying treatment classification systems. This course will discuss the varying definitions, the importance of coming to a common definition, the literature to date supporting the phenomenon, the implication that this literature has upon the many classification systems using it, the role of centralization in prognosis, and the optimal strategy to elicit this important response. Case studies will be used to demonstrate testing and utilization of the phenomenon.

We hope that this session will serve to further discussion amongst AAOMPT membership to agree upon a common definition of centralization.
Presenter: Brian McClenahan and Bob Robinson

Balanced Orthopaedic Physical Therapy Practice in an Unbalanced EBP World
Evidence based practice (EBP) is the integration of 1) best research evidence with 2) clinical expertise, and 3) patient values and circumstances. Physical therapists adhering to EBP principles have a seemingly easy decision when best research evidence strongly supports the use of a particular intervention approach for a specific patient. The clinical decision making process becomes more difficult when research evidence is lacking in support of a specific intervention for a specific patient or when that patient does not respond optimally to interventions supported by research evidence. Patient specific factors such as preference, expectation, and psychological factors have potential to guide treatment when research evidence is lacking. Furthermore, patient specific factors can enhance or diminish treatment responses when they support or oppose best research evidence respectively. The purpose of this case-based breakout session is to review patient specific factors likely to influence clinical outcomes in patients treated for musculoskeletal pain. Specifically, we will focus on psychological factors indicative of poor prognosis, patient expectation, and patient preference for treatment. Case examples will demonstrate how the pillars of EBP may uniquely and jointly influence patient outcomes and how the integration of each pillar during clinical decision making may be unbalanced based on individual patient scenarios.
Presenters: Jason Beneciuk, Joel Bialosky, and Nata Salvatori

Be a Contestant on the "Know Pain or No Gain" Game Show
Come join the speaker for an energetic reverse Q&A mock game show (and educational session) on pain management and the research behind how physical therapists should treat patients in pain. Virtual contestants will complete across 3 rounds of action packed play to see who will be champion. Those interested in playing along should review the following categories before attending the show: Peripheral and Central Sensitization; Acute vs. Chronic Pain: Top 10 Painful Conditions; Pain Mechanisms; IASP Taxonomy and Curricular Requirements; Pain Assessment Tools; Key Research Related to Pain; PT Interventions for Pain Management, Documentation Strategies and much more! Dont miss out on this opportunity to compete against your friends.
Presenter: Mary Beth Geiser

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