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KEY POINTS

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KEY POINTS

  1. Physical therapy can be of help for patients who require specialized support in reengaging in physical activity by providing biomechanically informed modified movement strategies for return to functional tasks, developing a therapeutic exercise program targeted to improve the individuals’ movement impairments, and helping to reduce pain-related fear and/or avoidance of movement through education, motivational enhancement, and graded activity or exposure.

  2. Identifying the presence or absence of sinister beliefs about their pain is critical in the early stages of care, as this helps to identify the appropriate treatment approach.

  3. The primary purpose of the physical examination is to identify impairments in body functions and structures (ie, mobility, motor function-control, muscle performance, sensory processing) in order to inform treatment decisions and prognostic decisions and determine a physiotherapy diagnosis.

  4. Certain clinical tests hold high sensitivity and a low likelihood ratio, and are therefore appropriate only to rule out a diagnosis. Other tests have high specificity and a high likelihood ratio, and are appropriate to rule in a diagnosis.

  5. For certain diagnoses, one or two carefully selected tests can be sufficient to rule out a diagnosis, but for many diagnoses, three or more tests are required to accurately rule in the suspected diagnosis.

  6. For people presenting with signs and symptoms consistent with peripheral neuropathic pain, spinal neurodynamics can be assessed through passive/active neck flexion, slump sitting, or a bilateral straight leg raise test; sciatic, femoral, and saphenous neurodynamics can be assessed with lower limb movement variations; and median, radial, ulnar, and axillary neurodynamics can be assessed with upper limb movement variations.

  7. In regard to understanding neural mechanics, there are three key points to consider: (1) the magnitude of nerve excursion is greatest closest to the moving joint; (2) nerves converge toward the joint motion that increases tension; and (3) while nerves are very responsive tissues capable of sustaining many mechanical forces during movement, if the level of physical stress is either too low (ie, when immobilized) or too high (ie, when compressed), the ability of the nerve to tolerate subsequent stress becomes altered and compromised.

  8. In addition to central or top-down changes in the brain, there are also peripheral or bottom-up changes in the body occurring simultaneously, such as osseoligamentous insufficiency, impaired proprioception (availability, utility, interpretation), muscle atrophy, and fatty infiltration. Both of these top-down and bottom-up changes can lead to either augmented or compromised muscle activity as a response to protect the perceived injury and/or painful body region(s).

  9. There are many different types of exercises, each with their own targets and expected outcomes. For example, while certain exercises are focused on developing general aerobic fitness, strength, endurance, or flexibility, other exercises are focused on improving motor control and coordination to specific regions of the body. Other movement or body-based exercises are focused on improving cognitive and/or sympathetic regulation. While other exercises are focused on reducing pain-related fear of movement or enhancing self-efficacy and pain-acceptance.

  10. Before recommendations are made for a particular form ...

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