21.1, Cervical and Thoracic Pain: Evidence for Effectiveness of Physical Therapy

Comprehensive coverage of the cervical and thoracic spine with regard to anatomy, biomechanics, evaluation, and treatment. Emphasis throughout the series is on evidence-based decision making leading to appropriate utilization of thrust and nonthrust manual interventions. Differential diagnosis that develops the reader’s skills in distinguishing between musculoskeletal and nonmusculoskeletal origins of pain is a unique aspect of the series.

 

1. Describe the clinical anatomy and biomechanics of the cervical and thoracic spine and rib cage.
2. Identify the innervation pain patterns of anatomical structures within the cervical and thoracic spine.
3. Identify the characteristic “red flag” signs of nonmusculoskeletal spine pain using Goodman’s five-step screening process.
4. Discuss the clinical presentation, diagnostic criteria, and concept of convergence as the proposed mechanism for referred pain and cervicogenic headaches. 
5. Discuss the clinical presentations associated with traumatic cervical pain, including whiplash-associated disorders, cervical instabilities, and cervical fractures.
6. Be familiar with the current evidence that supports the need for subgrouping patients with neck pain and assigning them to specific treatments from which they are most likely to respond.
7. Understand the current evidence regarding subgrouping patients with cervical and thoracic pain and the advantage of developing a treatment-based classification and intervention program. 
8. Utilize appropriate self-report questionnaires and outcome measures as part of the examination and re-examination process.
9. Use best practice methodologies in selecting and performing procedural interventions, including thrust and nonthrust techniques in addition to therapeutic exercise.
10. Become familiar with an essential skill set of effective nonthrust mobilizations and thrust cervical spine manipulation techniques that can be immediately incorporated into clinical practice.
11. Analyze criteria utilized to determine which patients may be candidates for cervical and thoracic spine surgery.
12. Synthesize the examination findings in determining appropriate physical therapy interventions, including but not limited to neuromobilization, soft tissue mobilization, and mobility and/ or stability exercises for postoperative patients.

• Origins of Cervical Pain
  Michael J. Walker, PT, DSc, OCS, CSCS, FAAOMPT; Norman W. Ayotte, PT, DSc, OCS, Cert MDT, FAAOMPT; and Duneley A. Rochino, PT, DSc, OCS, FAAOMPT
• Origins of Thoracic Pain
  Catherine C. Goodman, PT, MBA, CBP
• Best Evidence for Examination and Treatment of the Cervical Spine
  Michael Leal, PT, DPT, MPT, OCS, and Bryan Dennison, PT, DPT, MPT, OCS, CSCS, FAAOMPT 
• Best Evidence for Examination and Treatment of the Thoracic Spine
  Gary P. Austin, PT, PhD, OCS, FAAOMPT
• Clinical Decision Making in the Application of Cervical Spine Manipulation
  Christopher H. Wise, PT, DPT, OCS, FAAOMPT, MTC, ATC, and Ronald J. Schenk, PT, PhD, OCS, FAAOMPT, Cert MDT
• Cervical and Thoracic Spine: Postoperative Management
  Ronald J. Schenk, PT, PhD, OCS, FAAOMPT, Cert MDT, and Christopher H. Wise, PT, DPT, OCS, FAAOMPT, MTC, ATC

 

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