8 Differential Diagnosis and Management of the Hip and Knee. 14 Physical Therapy Management of Patients with Ankle and Foot Disorders

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1 Orthopedic Physical Therapy Residency Program and Continuing Education Course Descriptions PAGE COURSE 2 Clinical Application of Pain Sciences 3 Clinical Reasoning for Physical Therapists 4 Diagnostic Imaging 7 Differential Diagnosis 8 Differential Diagnosis and Management of the Hip and Knee 11 HVLA Thrust Manipulation of the Spine & Extremities 14 Physical Therapy Management of Patients with Ankle and Foot Disorders 17 Physical Therapy Management of the Elbow, Wrist, and Hand 19 Physical Therapy Management of the Head, Neck, and Upper Thoracic Region 22 Management of Lumbo-Pelvic Conditions 24 The Management of Shoulder Girdle Conditions; A Case-Based Exploration 27 Strength and Conditioning 1

2 Orthopedic Physical Therapy Residency Program and Continuing Education Course Descriptions Clinical Application of Pain Sciences Course Description This course examines the neurobiology of pain and its management. A continuum of normal/physiologic pain to abnormal/pathologic pain will be presented including peripheral and central mechanisms. Treatment approaches based on pathophysiologic mechanisms will be discussed. Incorporating this information into the clinical decision making process for conditions such as chronic low back pain, osteoarthritis, whiplash associated disorder, fibromyalgia and myofascial pain syndromes, and neurogenic pain will be explored through lecture and case study format. Course Instructor Michael Costello PT, DSc, OCS, MTC Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives Explain the continuum of pain neurobiology from physiological to pathological responses. Identify the mechanisms that dominate a patient s pain condition. Incorporate pain neurobiology concepts into clinical decision making regarding Examination Procedures Manual Therapy Exercise Patient Education Modalities Safely and effectively examine and evaluate physical impairments of neurodynamics. Safely and effectively provide interventions to address physical impairments of neurodynamics. Recognize and address psychosocial factors that impact the management of individuals with pain. Compare and contrast management of peripherally mediated versus centrally mediated pain conditions. Stimulate a re-appraisal of Physical Therapy Practice. 2

3 Course Outline DAY 1: Friday: 8:00 a.m.-5:00 p.m. 8:00 a.m.-9:45 a.m. Introduction to Neurodynamics: Anatomy, Physiology, Pathophysiology MORNING BREAK 10:00 a.m.-noon Clinical Reasoning: Classification by Pain Mechanisms Neural Mechanical Sensitivity: Peripheral Mechanisms LUNCH BREAK 1:00 p.m.-3:00 p.m. Neurodynamic Testing AFTERNOON BREAK 3:15 p.m.-5:00 p.m. Management of Peripheral Neuropathic Pain DAY 2: Saturday: 8:00 a.m.-5:00 p.m. 8:00 a.m.-9:45 a.m. Review Central Sensitization MORNING BREAK 10:00 a.m.-noon Psychosocial Factors and Pain Management of Central Mechanisms LUNCH BREAK 1:00 p.m.-3:00 p.m. Explain Pain to your Patient AFTERNOON BREAK 3:15 p.m.-5:00 p.m. Graded Motor Imagery CBT Approach, Graded Exposure Clinical Reasoning for Physical Therapists Course Description This course addresses concepts integral to clinical decision making in the Physical Therapy Practice to develop expert practitioners. This course will present principles of a biospychosocial clinical reasoning approach for physical therapy. Concepts regarding tissue healing, pain neurobiology, and their implications for rehabilitation will be discussed. The effect of various physical therapy interventions such as manual therapy techniques, therapeutic exercise, and modalities will be discussed, with a focus on tendinopathy and cartilage degeneration. Instruction will include lecture and case presentations.

4 Course Instructor Michael Costello PT, DSc, OCS, MTC Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives Compare different models of clinical reasoning in physical therapy Describe the effects of physical stress on neuromusculoskeletal tissue Describe the effects of various physical therapy modalities on tissue healing. Summarize factors that may adversely influence the healing process of neuromusculoskeletal tissue Organize a treatment plan based on the phases of tissue healing Justify treatment choices based on tissue healing principles for a given patient scenario Recognize the value of metacognition in clinical reasoning Course Outline Clinical Reasoning Models Physical Stress Theory Introduction of Pain Neurobiology in Clinical Reasoning EdUReP: Tendinopathy Management as a Reasoning model Applied Reasoning in the Management of Osteoarthritis Case Examples: Pitfalls and Solutions Diagnostic Imaging Course Description This course covers the history of diagnostic imaging beginning with Wilhem Rontgen s discovery of X-rays to the most recent advances in 3D computer technology. Basic radiographic densities, views, and structural analysis will be taught using digital imaging. Students will become competent in understanding radiologic interpretations of X-rays, Fluroscopy, Computed Tomography, Magnetic Resonance Imaging (MRI), Nuclear, and ultrasound imaging. Patient cases will be used to compare pathostructural diagnosis with actual symptoms and clinical presentation.

5 Course Instructor John Winslow, PT, DPT, OCS, MTC, ATC, CSCS Assistant Professor, Department of Physical Therapy, Ithaca College Instructor, Orthopedic Physical Therapy Residency Program, Cayuga Medical Center Course Objectives Understand what the different diagnostic imaging modalities are and how they work Learn what regions of the body and/or diagnosis are best imaged with each diagnostic imaging modality State the benefits, limitations and safety considerations of each diagnostic imaging modality Select appropriate radiological views that provide the most pertinent information Describe normal radiographic anatomy and be able to differentiate from pathological radiographic anatomy Discuss the benefits of each diagnostic modality compared to the others Interpret radiologic reports and be able to discuss patient cases with radiologists Provide sound reasoning for recommending that a patient have a diagnostic test Compare radiological findings with actual patient symptoms and clinical presentation Determine how the diagnostic imaging results impact the physical therapy plan of care Instruction Methods Lecture instruction Digital imaging Independent reading Course Outline 8:00 a.m.-9:45 a.m. What is an X-ray 5 basic radiographic densities Why is it important to have different views on X-ray When should imaging studies be considered Analysis of structure on an X-ray ABC s Normal radiographic anatomy What are X-rays used to identify Identifying fractures, growth plate injuries, dislocations, arthritis, bone density, infection, and tumors on an X-ray Benefits and limitations of X-rays What are the risks involved with X-rays

6 Elements of radiation safety What is Fluoroscopy Radiological diagnostic and therapeutic procedures that utilize Fluoroscopy MORNING BREAK 10:00 a.m.-noon What is a CT and how does it work Common CT attenuation values What parts of the body are best studied with CT Benefits and limitations of CT What is a contrast CT What are 3D CT and sagittal and coronal reconstructions What is a CT Myelogram What is a CT Arthrogram What are the benefits of CT compared to X-rays What are the benefits of CT compared to MRI What is nuclear medicine imaging What is the difference between a SPECT and PET scan When is nuclear imaging indicated LUNCH BREAK 1:00 p.m.-3:00 p.m. How does an MRI work What is relaxation What are T1 and T2 weighted images What views can be obtained with MRI What is meant by MRI signal What s the difference between open and closed MRI What is a surface coil What are the regions of the body and/or diagnosis best imaged with MRI What are the safety considerations for MRI What is an MRI Arthrogram What is an MRI Myelogram What are the benefits of MRI compared to X-rays and CT scans AFTERNOON BREAK 3:15 p.m.-5:00 p.m. What is diagnostic ultrasound What MSK structures can be imaged with diagnostic ultrasound How is diagnostic ultrasound used in physical therapy Diagnostic ultrasound lab

7 Differential Diagnosis Course Description This course is intended to help prepare the orthopedic physical therapist to function as a direct access provider capable of accurately screening for medical diagnoses. Concepts related to specificity, sensitivity, likelihood ratios and predictive values will be discussed. Pathology of the major body systems/regions will be covered with an emphasis on conditions that mimic neuromusculoskeletal conditions. Lecture, lab and case presentation format will be used. Course Instructor Karl W. Bergmann, PT, ScD, OCS, COMT, CSCS Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives Identify patients who may present with serious pathology or require referral to another practitioner Describe visceral local and referred pain Perform abdominal palpation to screen the organs Summarize specificity, sensitivity, likelihood ratios and predictive values Utilize information from the history and self-report measures to accurately screen for medical diagnosis Analyze lab values and correlate with medical diagnosis Synthesize information gathered from the subjective and physical examination to diagnose/ classify the patient and determine prognosis. Judge the usefulness of a test in clinical decision making based on specificity, sensitivity, likelihood ratios, and/or predictive values Evaluate subjective and objective data to effectively screen for systemic disease. Accept responsibility to screen out systemic disease Exhibit skills and knowledge necessary to provide direct access care Patient questionnaire and subjective examination Visceral local and referred pain: Pelvic organs, Retroperitoneal organs, Digestive organs, Cardiopulmonary organs Screening for red flags in the diagnosis and management of musculoskeletal spine pain Screening for serious pathology: Neoplasms, Infection, Bone Disorders Lab values Utilization of sensitivity, specificity, likelihood ratios, predictive values in clinical decision making

8 Differential Diagnosis and Management of the Hip and Knee Course Description This course covers the clinical anatomy, biomechanics, pathology, examination, diagnosis, prognosis and management of conditions of the hip and knee. It will focus on integrating basic sciences and current best evidence into the clinical decision-making process. A variety of intervention strategies including manual therapy, therapeutic exercise, patient education, functional training, taping/bracing and orthotics will be presented. Surgical procedures and their impact on management will be discussed. Instruction will include lectures, lab time, and independent reading. Course Instructor Karl Bergmann PT, ScD, OCS, COMT, CSCS Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives Identify patients who may present with serious pathology or require referral to another practitioner Describe anatomic, physiologic, and biomechanical principles as they relate to a case description Utilize information from the history and self-report measures to select appropriate physical examination procedures Demonstrate clinical examination procedures for body region Synthesize information gathered from the subjective and physical examination to diagnose/ classify the patient and determine prognosis Select interventions based on the diagnosis/classification incorporating current best evidence Demonstrate the application of interventions including: - Advanced Therapeutic Exercise Techniques - Manual Therapy Techniques - Patient Education - Functional Training - Therapeutic Modalities - Other (orthotics, taping, biofeedback, etc) - Evaluate the efficacy of the treatment plan - Discuss post-operative rehabilitation principles and how they impact the clinical decision making process - Incorporate diagnostic imaging in the clinical decision making process

9 Course Outline DAY 1: The Hip: 8:00 a.m.-5:00 p.m. 8:00 a.m.-8:15 p.m. Welcome and Introductions 8:15 a.m.-9:45 a.m. Review clinically relevant anatomy Review normal biomechanics (osteokinematics, arthrokinematics, muscle balance) and pathomechanics (i.e. hip weakness in females w/ knee pain) Surface Anatomy Differential Diagnosis MORNING BREAK 10:00-Noon Examination and Evaluation of findings Common hip disorders LUNCH BREAK 1:00 p.m.-2:45 p.m. Extra-articular hip disorders - Diagnosis specific examination findings - Diagnostic imaging - Prognosis - Manual therapy interventions - Therapeutic exercise interventions - Other interventions (i.e. ergonomics, orthotics/ taping/bracing, modalities, education, biofeedback, etc.) AFTERNOON BREAK 3:00 p.m.-5:00 p.m. Intra-articular hip disorders - Diagnosis specific examination findings - Diagnostic imaging - Prognosis - Manual therapy interventions - Therapeutic exercise interventions - Other interventions (i.e. ergonomics, orthotics/ taping/bracing, modalities, education, biofeedback, etc.) Outcome measures related to region (PSFS, HOOS/KOOS, LEFS, etc.) Post-operative rehab considerations

10 DAY 2: The Knee: 8:00 a.m.-5:00 p.m. 8:00 a.m.-8:15 a.m. Review of Day 1 8:15 a.m.-9:45 a.m. Review clinically relevant anatomy Review normal biomechanics (osteokinematics, arthrokinematics, muscle balance) and pathomechanics (i.e. hip weakness in females w/ knee pain) Surface Anatomy Differential Diagnosis Regional Interdependence MORNING BREAK 10:00-Noon Examination and Evaluation of findings Common knee disorders LUNCH 1:00 p.m.-2:00 p.m. Patellofemoral Pain Syndrome - Diagnosis specific examination findings - Diagnostic imaging - Prognosis - Manual therapy interventions - Therapeutic exercise interventions - Other interventions (i.e. ergonomics, orthotics/taping/bracing, modalities, education, biofeedback, etc.) 2:00 p.m.-2:45 p.m. Ligamentous Injuries - Diagnosis specific examination findings - Diagnostic imaging - Prognosis - Manual therapy interventions - Therapeutic exercise interventions - Other interventions (i.e. ergonomics, orthotics/taping/ bracing, modalities, education, biofeedback, etc.) AFTERNOON BREAK 3:00 p.m.-5:00 p.m. Meniscus Injuries and Osteoarthritis - Diagnosis specific examination findings - Diagnostic imaging - Prognosis - Manual therapy interventions 10

11 - Therapeutic exercise interventions - Other interventions (i.e. ergonomics, orthotics/taping/ bracing, modalities, education, biofeedback, etc.) Outcome measures related to region (PSFS, HOOS/KOOS, LEFS, etc.) Post-operative rehab considerations HVLA Thrust Manipulation of the Spine & Extremities Course Description This course covers the history of manipulation, evidence for manipulative therapy, clinical reasoning and treatment models, safety of manipulation, patient rights and informed consent, state practice acts and APTA guidelines, joint anatomy and arthrokinematics, motion palpation, HVLA thrust manipulation techniques, and a review of case reports. Instruction will include lectures, lab time, and independent reading. Course Instructor John Winslow, PT, DPT, OCS, MTC, ATC, CSCS Assistant Professor, Department of Physical Therapy, Ithaca College Instructor, Orthopedic Physical Therapy Residency Program, Cayuga Medical Center Course Objectives Understand the history of manipulation Evaluate the scientific evidence for manipulation Review clinical reasoning and treatment models for manipulation Identify safety issues related to manipulation Discuss patient s rights and informed consent Research state practice acts for a physical therapist to perform manipulation Review anatomy and arthrokinematics of the spine and extremity joints Demonstrate motion palpation techniques and be able to determine if a joint is hypomobile Select appropriate HVLA thrust techniques based on the physical examination Demonstrate HVLA thrust techniques in a safe and effective manner 11

12 Instruction Methods Lecture instruction Lab instruction and practice Independent reading Lab Requirements Appropriate lab clothing males (shorts), females (shorts & bathing suit top or halter) Complete cervical spine questionnaire Informed consent all those who have pre-existing conditions, are not in good health, or are pregnant should be cautious about participating in the lab. Please be responsible for yourself. You do not have to do anything asked of you by the instructor or other students. If you have a pre-existing spine or extremity problem it could become aggravated by the activities of the class unless you exclude yourself from such activities. Course Outline: DAY 1: 8:00 a.m.-5:00 p.m. 8:00 a.m.-9:45 a.m. History of Manipulation Clinical Reasoning and Treatment Models Patient Rights and Informed Consent Safety of Manipulation State Practice Acts and APTA Guidelines Manipulation Curricula in PT Professional Degree Programs Evidence for Manipulative Therapy MORNING BREAK 10:00 a.m.-noon Lumbar Spine Anatomy and Arthrokinematics Motion Palpation of the Lumbar Spine HVLA Thrust techniques for the Lumbar Spine SIJ and Pelvis Anatomy and Arthrokinematics Motion Palpation of the SIJ and Pelvis HVLA Thrust techniques for the SIJ and Pelvis LUNCH BREAK 1:00 p.m.-3:00 p.m Hip Anatomy and Arthrokinematics Motion Palpation of the Hip HVLA Thrust Techniques for the Hip 12

13 Knee Anatomy and Arthrokinematics Motion Palpation of the Knee HVLA Thrust Techniques for the Knee Ankle Anatomy and Arthrokinematics Motion Palpation of the Ankle HVLA Thrust Techniques for the Ankle Foot Anatomy and Arthrokinematics Motion Palpation of the Foot HVLA Thrust Techniques for the Foot AFTERNOON BREAK 3:15 p.m.-5:00 p.m. Thoracic Spine Anatomy and Arthrokinematics Motion Palpation of the Thoracic Spine HVLA Thrust Techniques for the Thoracic Spine Rib Cage Anatomy and Arthrokinematics Motion Palpation of the Rib Cage HVLA Thrust Techniques for the Rib Cage DAY 2: 8:00 a.m.-5:00 p.m. 8:00 a.m.-9:45 a.m. Cervicothoracic Junction Anatomy and Arthrokinematics Motion Palpation of the Cervicothoracic Junction HVLA Thrust Techniques for the Cervicothoracic Junction Mid Cervical Spine Anatomy and Arthrokinematics Motion Palpation of the Mid Cervical Spine HVLA Thrust Techniques for the Mid Cervical Spine MORNING BREAK 10:00 a.m.-noon Upper Cervical Spine Anatomy and Arthrokinematics Motion Palpation of the Upper Cervical Spine HVLA Thrust Techniques for the Upper Cervical Spine LUNCH BREAK 1:00 p.m. -3:00 p.m. Shoulder Anatomy and Arthrokinematics Motion Palpation of the Shoulder HVLA Thrust Techniques for the Shoulder Elbow Anatomy and Arthrokinematics Motion Palpation of the Elbow HVLA Thrust Techniques for the Elbow Wrist Anatomy and Arthrokinematics 13

14 Motion Palpation of the Wrist HVLA Thrust Techniques for the Wrist Hand Anatomy and Arthrokinematics Motion Palpation of the Hand HVLA Thrust Techniques for the hand AFTERNOON BREAK 3:15 p.m.-5:00 p.m. Review, practice, case reports Physical Therapy Management of Patients with Ankle and Foot Disorders Course Description This course covers the clinical anatomy, biomechanics, pathology, examination, diagnosis, prognosis and management of conditions of the ankle and foot. It will focus on integrating basic sciences and current best evidence into the clinical decision-making process. A variety of intervention strategies including manual therapy, therapeutic exercise, patient education, functional training, taping/bracing and orthotics will be presented. Surgical procedures and their impact on management will be discussed. Instruction will include lectures, lab time, clinical mentoring, independent reading, and clinical rounds. Residents will present a case describing the clinical decision-making process, treatment and outcomes. Course Instructors Brian T. Lee, PT, OCS, CSCS Cayuga Medical Center Orthopedic Physical Therapy Residency Program Jackie Barbano, PT, DPT, OCS Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives Identify patients who may present with serious pathology or require referral to another practitioner. Describe anatomic, physiologic, and biomechanical principles as they relate to a case description. Utilize information from the history and self-report measures to select appropriate physical examination procedures. Demonstrate clinical examination procedures for ankle and foot. Synthesize information gathered from the subjective and physical examinationto diagnose/classify the patient and determine prognosis. 14

15 Select interventions based on the diagnosis/classification incorporating current best evidence. Demonstrate the application of interventions including: - Therapeutic Exercise - Manual Therapy - Patient Education - Functional Training - Therapeutic Modalities - Other (orthotics, taping, biofeedback, etc.) Evaluate the efficacy of the treatment plan Discuss post-operative rehabilitation principles and how they impact the clinical decision making process. Incorporate diagnostic imaging in the clinical decision making process. Course Outline Review clinically relevant anatomy Review normal biomechanics (osteokinematics, arthrokinematics, muscle balance) and pathomechanics (i.e. ankle/foot pain in patients with weak core musculature) Subjective examination Physical examination Common disorders (plantar fasciitis, ankle sprains, posterior tibialis and peroneal tendonosis, etc.) Manual therapy interventions Exercise interventions Other interventions (i.e. ergonomics, orthotics/taping/bracing, modalities, education, biofeedback, etc.) Outcome measures related to region (FADI, FADI Sport, FAFSM, FFI, etc.) Differential diagnosis: red flags and yellow flags Post-operative rehab considerations Instructional Methods Lecture instruction Lab instruction and practice Independent reading Clinical Mentoring Course Outline 15

16 DAY 1: Friday: 8:00 a.m.-4:30 p.m. Time Topic Details 9:00 a.m.-9:15 a.m. Welcome Schedule, objectives, etc. 9:15 a.m.-10:00 a.m. Anatomy Lab Surface identification 10:00 a.m.-11:00 a.m. Kinematics Assess mobility at TC, ST, midfoot, hallux 11:00 a.m.-11:15 a.m. MORNING BREAK Drink, stretch (GS, quad, HS, hip flexors) 1:15 a.m.-noon Functional Movement Screen, corrective ex s Screen Noon-1:00 p.m. Taping intervention, Dance-specific part I 1:00 p.m.-2:00 p.m. LUNCH BREAK 2:00 p.m.-3:00 p.m. Gait evaluation I Video of walking gait of participants 3:00 p.m.-3:30 p.m. Taping intervention, For other injuries or part II populations 3:00 p.m.-4:30 p.m. Gait evaluation II Video of running gait of participants DAY 2: Saturday: 8:00 a.m.-noon 8:00 a.m.-9:00 a.m. Running Mechanics Efficient running 9:00 a.m.-10:00 a.m. Treatment strategies I Mobilization, modalities review 10:00 a.m.-11:00 a.m. Treatment strategies II Orthotics: modify insoles, semi-rigid,evaluation for custom orthotic (cast) 11:00 a.m.-noon Case Studies and Review Q&A Lab Requirements Appropriate lab clothing males (shorts), females (shorts & bathing suit top or halter) Informed consent all those who have pre-existing conditions, are not in good health, or are pregnant should be cautious about participating in the lab. Please be responsible for yourself. You do not have to do anything asked of you by the instructor or other students. If you have a pre-existing foot or ankle problem it could become aggravated by the activities of the class unless you exclude yourself from such activities. 16

17 Physical Therapy Management of the Elbow, Wrist, and Hand Course Description This course covers the clinical anatomy, biomechanics, pathology, examination, diagnosis, prognosis and management of conditions of the elbow, wrist, and hand. It will focus on integrating basic sciences and current best evidence into the clinical decision-making process with an emphasis on treatment by classification. A variety of intervention strategies focusing on manual therapy, therapeutic exercise, splinting, and patient education will be presented. Surgical procedures and their impact on management will be discussed. Instruction will include lectures, lab time, and independent reading. Course Instructors Jeff Humphrey, PT, CHT, CEAS Cayuga Medical Center Orthopedic Physical Therapy Residency Program Mark Malys, PT, CHT Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives Identify patients who may present with serious pathology or require referral to another practitioner. Describe anatomic, physiologic, and biomechanical principles as they relate to a case description. Utilize information from the history and self-report measures to select appropriate physical examination procedures. Demonstrate clinical examination procedures for body region. Synthesize information gathered from the subjective and physical examination to diagnose/ classify the patient and determine prognosis. Select interventions based on the diagnosis/classification incorporating current best evidence. Demonstrate the application of interventions including: - Therapeutic Exercise - Manual Therapy - Patient Education - Functional Training - Therapeutic Modalities - Other (splinting, taping, biofeedback, etc) 17

18 Evaluate the efficacy of the treatment plan Discuss post-operative rehabilitation principles and how they impact the clinical decision making process. Incorporate diagnostic imaging in the clinical decision making process. Course Outline Each day is scheduled 8:00 a.m.-5:00 p.m. with a morning, lunch (Noon-1:00 p.m.), and an afternoon break. The following will be covered for each in the elbow, wrist, and hand sections: Review clinically relevant anatomy Review normal biomechanics (osteokinematics, arthrokinamatics, muscle balance) and pathomechanics Subjective examination Physical examination Common disorders Manual therapy interventions Exercise interventions Other interventions (i.e. ergonomics, splinting/taping/bracing, modalities, education, biofeedback, etc.) Differential diagnosis: red flags and yellow flags Post-operative rehab considerations DAY 1: 8:00 a.m.-5:00 p.m. Physical therapy management of the elbow - Case study - Lab work Physical therapy management of the wrist - Case study - Lab work Physical therapy management of elbow and wrist nerve entrapments - Case study - Lab work DAY 2: 8:00 a.m.-5:00 p.m. Physical therapy management of thumb injuries and finger fractures - Case study - Lab work 18

19 Physical therapy management of tendon injuries - Case study - Lab work Splinting - Fabricate splints Physical Therapy Management of the Head, Neck, and Upper Thoracic Region Course Description This course covers the clinical anatomy, biomechanics, pathology, examination, diagnosis, prognosis and management of conditions of the cervico-thoracic region, as well as cervicogenic headache and temporomandibular joint disorders. It will focus on integrating basic sciences and current best evidence into the clinical decision-making process with an emphasis on treatment by classification. A variety of intervention strategies focusing on manual therapy, therapeutic exercise, and patient education will be presented. Surgical procedures and their impact on management will be discussed. Instruction will include lectures, lab time, and independent reading. Course Instructors Michael Costello PT, DSc, OCS, MTC Cayuga Medical Center Orthopedic Physical Therapy Residency Program Colleen Masterson PT, DPT, OCS Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives Identify patients who may present with serious pathology or require referral to another practitioner. Describe anatomic, physiologic, and biomechanical principles as they relate to clinical decision making for a given case description. Utilize information from the history and self-report measures to select appropriate physical examination procedures. Demonstrate clinical examination procedures for the cervical and upper thoracic regions and Temporomandibular Joint Syndrome (TMJ). Synthesize information gathered from the subjective and physical examinationto diagnose/ classify the patient and determine prognosis. 19

20 Select interventions based on the diagnosis/classification incorporating current best evidence. Demonstrate the application of interventions including: - Therapeutic Exercise - Manual Therapy - Patient Education - Functional Training - Education Evaluate the efficacy of the treatment plan Discuss post-operative rehabilitation principles and how they impact the clinical decision making process. Incorporate diagnostic imaging in the clinical decision making process. Course Outline DAY 1: 8:00 a.m.-5:00 p.m. 8:00 a.m.-9:45 a.m. Epidemiology of neck pain. (Review of pre-recorded presentation) Anatomy and Biomechanics (Review of pre-recorded presentation) Classification Systems for Cervical Spine Disorders (Review of pre-recorded presentation) Subjective Examination Hypothesis Generation Outcome measures related to region (PSFS, NDI, NPRS, FABQ) Red and Yellow Flags MORNING BREAK 10:00 a.m.-noon Physical Examination (General Cervico-Thoracic region) Hypothesis Testing (Lab) Diagnostic imaging for the region Prognosis LUNCH BREAK 1:00 p.m.-3:00 p.m. Mobilization Classification Evidence to Support Manual Therapy Interventions Pre-manipulative Screening Manual Therapy and Mobility Exercise Interventions (Lab) Thoracic Mobilization/Manipulation Cervical Mobilization/Manipulation AFTERNOON BREAK 20

21 3:15 p.m.-5:00 p.m. Increase Exercise Tolerance Classification Common Neuromuscular Impairments in Cervical Disorders Evidence for Exercise Interventions Strengthening/Endurance/Coordination Exercise Prescription (Lab) DAY 2: 8:00 a.m.-5:00 p.m. 8:00 a.m.-9:45 a.m. Centralization Classification and Cervical Radiculopathy Evidence to Support use of Traction, Repeated Movements, and Neuromobilization Traction, Repeated Movements, Neuromobilization (Lab) Post-Op Rehabilitation Considerations MORNING BREAK 10:00 a.m.-noon Reduce Headache Classification Upper Cervical Biomechanics Upper Cervical Examination (Lab) Evidence for Physical Therapy interventions for Headaches Manual therapy and Exercise Interventions (Lab) Upper Cervical Mobilization/Manipulation Soft Tissue Mobilization LUNCH BREAK 1:00 p.m.-3:00 p.m. Pain Control Classification and related interventions Whiplash Associated Disorder (WAD) Evidence for Physical Therapy interventions for WAD Proprioception training, Occulomotor, Education, self treatment (Lab) Biopsychosocial considerations and related interventions. AFTERNOON BREAK 3:15 p.m.-5:00 p.m. Epidemiology, anatomy and Biomechanics of TMJ disorders TMJ Examination (Lab) Evidence for Physical Therapy interventions for TMJ Disorders TMJ Interventions (Lab) Lab Requirements Appropriate lab clothing males (shorts), females (shorts & bathing suit top or halter) Informed consent all those who have pre-existing conditions, are not in good health, or are pregnant should be cautious about participating in the lab. Please be responsible for yourself. 21

22 You do not have to do anything asked of you by the instructor or other students. If you have a pre-existing spinal problem it could become aggravated by the activities of the class unless you exclude yourself from such activities. Management of Lumbo-Pelvic Conditions Course Description This course covers the clinical anatomy, biomechanics, pathology, examination, diagnosis, prognosis and management of conditions of the lumbo-pelvic region. It will focus on integrating basic sciences and current best evidence into the clinical decision-making process with an emphasis on treatment by classification. A variety of intervention strategies including manual therapy, therapeutic exercise, patient education, and ergonomics will be presented. Surgical procedures and their impact on management will be discussed. Instruction will include lectures, lab time, and independent reading. Residents will present a case describing the clinical decision-making process, treatment and outcomes. Instructor Michael Costello PT, DSc, OCS, MTC Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives Learn basic lumbar anatomy and arthrokinematics as they relate to pain and function Understand classification systems for the management of individuals with low back pain Demonstrate clinical examination procedures for the lumbar spine and pelvis Review diagnostic imaging and incorporate in the clinical decision making process Identify patients with serious pathology who require medical referral Classify patients with low back pain into treatment subgroups Select treatment interventions based on the diagnosis/classification incorporating current best evidence Demonstrate the application of interventions including: therapeutic exercise, manual therapy, posture education, body-mechanics training, and modalities Discuss post-operative rehabilitation principles and how they impact the clinical decision making process Determine appropriate guidelines for return to activity, work, and leisure 22

23 Course Outline DAY 1: 8:00 a.m.-5:00 p.m. 8:00 a.m.-9:45 a.m. Epidemiology of low back pain Classification systems & clinical prediction rules for treating low back pain Lumbar spine anatomy & arthrokinematics Classification System and Clinical Practice Guidelines for the management of LBP MORNING BREAK 10:00 a.m.-noon History taking Screening/outcome tools Red flags for non musculoskeletal low back pain Magnified illness behavior Posture assessment Lumbar ROM measurement Surface and motion palpation Special tests Diagnostic imaging LUNCH BREAK 1:00 p.m. 3:00 p.m. Lumbar Mobility Impairments Spinal Mobilization/Manipulation AFTERNOON BREAK 3:15 p.m.-5:00 p.m. Pelvis and Sacrum Impairments Mobilization/Manipulation of the Pelvis and Sacrum DAY 2: 8:00 a.m.-5:00 p.m. 8:00 a.m.-10:00 a.m. Movement Coordination, Strength and Endurance Impairments Core strengthening Disc dysfunctions McKenzie Method directional preference Traction MORNING BREAK 10:15 a.m.- 12:15 p.m. Vertebral Dysfunction - Spondylolysis and spondylolisthesis - Stenosis 23

24 Muscle Dysfunctions Posture Education Strain-Counterstrain LUNCH 1:15 p.m.-3:15 p.m. Soft Tissue Mobilization Flexibility Exercises Neural Dynamics Neural Mobilization AFTERNOON BREAK 3:30 p.m.-5:00 p.m. Case reports Lab Requirements Appropriate lab clothing males (shorts), females (shorts & bathing suit top or halter) Informed consent all those who have pre-existing conditions, are not in good health, or are pregnant should be cautious about participating in the lab. Please be responsible for yourself. You do not have to do anything asked of you by the instructor or other students. If you have a pre-existing spinal problem it could become aggravated by the activities of the class unless you exclude yourself from such activities. The Management of Shoulder Girdle Conditions; A Case-Based Exploration Course description The shoulder is the certainly one of the most amazing joint complexes in the body. Its structure allows for more degrees of freedom than any other joint, while also being able to withstand high angular velocities and enormous compressive/distractive forces. The rich variety of pathologies around the shoulder complex can often present a diagnostic and treatment challenge. For this course we will use case-examples to allow for detailed exploration of the evaluation and treatment of individuals in all of their diversity - and begin the process of developing the pattern recognition skills employed by experienced clinicians. The course will be structured around the 4 gross patterns of shoulder dysfunction (the stiff shoulder, the loose or unstable shoulder, the painful shoulder without marked global stiffness or instability, and 24

25 the arthritic shoulder) and sports specific patterns of dysfunction. General principles that inform the evaluation/treatment cycle (knowledge of anatomy and pathoanatomy, the physical stress theory, principles of tissue healing, regional interdependence, motor learning and dynamic systems theory) will be included in case presentations. The goal of this exploration will be to develop a systematic approach to evaluation of the painful shoulder that leads to diagnostic labels that effectively guide treatment. Lab time will be incorporated into each case and will include practice with examination techniques, manual treatment techniques, and specific exercise instruction. Course Instructors Andrew M. Jordan, PT, DPT, OCS Cayuga Medical Center Orthopedic Physical Therapy Residency Program Mark Jackson, PT, DPT, OCS Cayuga Medical Center Orthopedic Physical Therapy Residency Program Course Objectives At the conclusion of this course, the participant will: Demonstrate a solid understanding of the anatomy and biomechanics of the upper quarter as they relate to specific impairments of the shoulder by being able to explain the results of the evaluation process to patients/clients. Demonstrate an understanding of the difference between a pathoanatomic diagnosis and a physical therapy diagnosis of shoulder dysfunction by effectively communicating the PT diagnosis to referral sources. Be able to effectively identify humeral and scapular positional and movement pattern faults, and be able to evaluate the relevance of these findings to patient complaints and dysfunction. Demonstrate appropriate selection and correct performance of special tests Demonstrate appropriate selection and performance of manual treatment techniques for the shoulder, cervical spine and thoracic spine where appropriate for treatment of shoulder disorders Understand how to progress post-operative patients based on knowledge of surgical procedures and techniques, time frame of healing, and patient progression to predetermined goals. Explain the etiology of a variety of sports specific injuries and be able to present the best evidence for prevention strategies. 25

26 Understand the unique stresses place on the shoulder girdle by participation in overhead sports, and be able to screen participants for susceptibility to injury Be able to implement effective treatment programs include manual therapies, motor learning strategies, and functional (sports specific) training for a variety of patients with complaints of shoulder pain and dysfunction Course Outline DAY 1: 8:00 p.m.-5:00 p.m. (This is a rough schedule and may be subject to change.) 8:00 a.m.-8:30 a.m. Introduction and Overview 8:30 a.m.-12:30 p.m. The Unstable Shoulder - First Time Dislocation: - Atraumatic - Traumatic - Recurrent Dislocations Post-Op Capsulolabral Repair: Rehabilitation Guidelines, Contrasting Two Patients SLAP Surgery: Two Different Surgical Procedures, Two Different Rehab Plans Capsular Shifts LUNCH BREAK 1:30 p.m.-2:30 p.m. The Stiff Shoulder - Idiopathic - Post-traumatic - Post-surgical 2:30 p.m.-5:00 p.m. The Painful Shoulder - Impingment Syndromes - Subacromial - Post-op Subacromial Debridement and Biceps Tenodesis - Post-op Rotator Cuff Rehabilitation: Using Evidence to Guide Patient-Specific Progressions DAY 2 8:00 a.m.-10:00 a.m. Sports Specific Cases - The Overhead and Throwing Athlete - Biomechanics 26

27 - GIRD - SICK Scapula - Internal Impingement The Swimmers Shoulder Shoulder Pain in a Rower 10:00 a.m.-noon Regional Interdependence: An Introduction to Concepts and a Few Cases LUNCH BREAK 1:00 p.m.-2:30 p.m. Resident Cases 2: 30 p.m.-4:15 p.m. The Arthritic Shoulder - AC Joint OA - GH jt arthritis - Post op TSA and Reverse TSA - Post Humeral Fracture 4:15 p.m. Wrap-up Discussion Note: Please wear lab clothes for all sessions. Strength and Conditioning Course Description This course covers skeletal muscle physiology and the adaptations that occur following goal specific conditioning. This course will focus on understanding the energy systems utilized during physical activity, creating goal/sport orienting programs, the principals of periodization, and application of these principals to an outpatient setting. Students will also learn how to perform, instruct, and modify basic Olympic lifts, plyometric movements, and commonly employed exercise techniques. There will be a focus on scaling exercises to meet the needs of injured and low functioning individuals up to high level athletes. This course will be instructed through online lectures, live lectures, discussions, and lab. Course Instructor Dan Agnese PT, DPT, CSCS Cayuga Medical Center Orthopedic Physical Therapy Residency Program 27

28 Course Objectives At the conclusion of this course, the participant will: Understand the muscle cell physiology and energy pathways as they relate to physical exercise. Describe adaptations that occur at the cellular, tissue, and systemic levels following specific training protocols. Differentiate training techniques to apply to specific goals. Create a strength and conditioning program designed to reach specific anaerobic and aerobic goals. Demonstrate correct exercise technique for commonly employed lifts. Understand proper goal setting as it relates to sports/positions. Apply the concept of periodization to new and existing training routines. Scale exercises to meet the needs of a given individual. Course Schedule and Outline Noon-6:00 p.m. NOON-12:30 p.m. Intro/pre-recorded Lecture Q and A 12:30 p.m.-1:00 p.m. Lecture - Program design resistance, needs analysis and FMS 1:00 p.m.-1:30 p.m. Lab - FMS 1:30 p.m.-2:00 p.m. Lecture - Program design plyometric, speed, and agility 2:00 p.m.-2:30 p.m. Lab - Plyometrics: tuck jump assessment, plyo routine AFTERNOON BREAK 2:30 p.m.-3:00 p.m. Lecture - Program design endurance, periodization, scaling 3:00 p.m.-4:00 p.m. Lab - Lab scaling, senarios 4:00 p.m.-4:30 p.m. Lab - Jump/hop testing: ACL and ankle 4:30 p.m.-5:30 p.m. Lab - Olympic lifting 5:30 p.m.-6:00 p.m. Wrap up, Q and A 28