Clinical Reasoning in Musculoskeletal Practice

Front Cover
Clinical Reasoning in Musculoskeletal Practice
Copyright Page
Table Of Contents
Foreword
Preface
	References
Contributors
Introduction
	References
1 Key Theory Informing Clinical Reasoning in Musculoskeletal Practice
	1 Clinical Reasoning
		Introduction
		The Scope of Clinical Reasoning
		Clinical Reasoning in a Biopsychosocial Framework
		Focus of Our Clinical Reasoning: Clinical Reasoning Strategies
		Categories of Clinical Decisions Required: Hypothesis Categories
			Activity and Participation Capability and Restriction
			Patient Perspectives on Their Experiences and Social Influences (Psychosocial Status)
			Pain Type
			Source of Symptoms
			Pathology
			Impairments in Body Function or Structure
			Contributing Factors
			Precautions and Contraindications to Physical Examination and Treatment
				General Health Screening
			Management and Treatment
			Prognosis
			How to Use the Hypothesis Categories Framework
			Inferences Within the Different Hypothesis Categories: Deduction, Induction/Pattern Recognition and Inference to the Best Explanation (Abduction)
			Thinking on Your Feet: Interpreting Information Across Different Hypothesis Categories
		Factors Influencing Clinical Reasoning
			Critical Thinking
			Metacognition
			Knowledge Organization
			Data-Collection and Procedural Skills
			Patient–Clinician Therapeutic Alliance
			Rapport
			Emotions
			Perception and Empathy
			Patient–Clinician Collaboration
			Ethical Reasoning
		Skilled Clinical Reasoning Contributes to Clinicians’ Learning
			Creative, Lateral Thinking
		Summary
		References
	2 Understanding Pain in Order to Treat Patients in Pain
		Understanding Pain
		The Biology of Pain – A Brief Primer
			Pain Is a Feeling
			Neurotags
			Danger Detection Is Important
			Peripheral Sensitization, Primary Allodynia and Hyperalgesia
			Spinal Sensitization, Secondary Allodynia and Hyperalgesia
			Descending Modulation of Nociception
			Central Sensitization – Tertiary Allodynia and Hyperalgesia
		Classifying Pain
			Nociceptive Pain
			Neuropathic Pain
			Mixed Pain
			Nociplastic Pain
		Implications of Pain Type Categorization
		Conclusions
		References
	3 Influence of Stress, Coping and Social Factors on Pain and Disability in Musculoskeletal Practice
		Theoretical Framework
		Behavioural Factors in Musculoskeletal Disorders
			Stress and Coping Model
				Cognitive Appraisal
				Personal and Situational Factors
				Different Appraisals
				Coping
		Managing Stressors: Coping With the Stressor of Pain
			Biopsychosocial Models of Pain
			Stress-Diathesis Model of Pain
		Managing Stressors: Coping With the Stressor of Disability
			Disability and Functioning
			ICF Framework
			Functioning
			Contextual Factors
				Application of Functioning and Disability in LBP
			Resource Theories of Stress and Coping
		Self-Rated Health as a Psychosocial Construct
			Appraisal of Health
			Application of Self-Rated Health
		Social Cognitive Theory and the Psychosocial Construct of Self-Efficacy
			Self-Efficacy
			Application of Self-Efficacy
			Application of Self-Efficacy During Treatment
		Social Relationships and Health
			Social Support
			Application of Social Support in Treatment
		Conclusion
		References
	4 Assessment, Reasoning and Management of Psychological Factors in Musculoskeletal Practice
		Musculoskeletal Clinicians’ Lack of Knowledge and Ability to Assess and Manage Psychological Factors
		The ‘Flag’ System of Screening for Psychosocial-Related Risk Factors
			Psychosocial ‘Yellow Flag’ Screening and Assessment Process
		Psychological Factor Screening by Questionnaire
			Examples of Multidimensional Measures
				STarT Back Screening Tool (SBT)
				Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ)
			Examples of Unidimensional Measures
				Fear Avoidance Beliefs Questionnaire (FABQ)
				Pain Catastrophizing Scale (PCS)
				Tampa Scale of Kinesiophobia (TSK-11)
				Pain Anxiety Symptoms Scale (PASS-20)
				Patient Health Questionnaire (PHQ-9)
				Pain Self-Efficacy Questionnaire (PSEQ)
				Chronic Pain Acceptance Questionnaire (CPAQ)
				Brief Illness Perception Questionnaire (Brief IPQ)
		Psychological Factor Screening by Patient Interview
		Three Avenues for Psychological Factor Screening and Monitoring
		Psychological Factor Management
		Summary
		References
	5 Clinical Prediction Rules
		An Overview of Statistics in Healthcare Clinical Reasoning
		Clinical Prediction Rules
			Diagnostic Clinical Prediction Rules
			Prognostic Clinical Prediction Rules
			Prescriptive Clinical Prediction Rules
		Development of Clinical Prediction Rules
			Derivation
			Validation
			Impact Analysis
		Methodological Considerations
		Readiness for Application in Clinical Practice
		Clinical Application of CPRs in Musculoskeletal Practice
		Future Directions
		References
2 Clinical Reasoning in Action: Case Studies From Expert Musculoskeletal Practitioners
	6 A Multifaceted Presentation of Knee Pain in a 40-Year-Old Woman
		Subjective History
			Past History of Complaint
			Present History of Complaint
		Physical Examination
		Treatment 1
		Treatment 2 (1 Week Later)
		Treatment 3 (4 Weeks Later)
		Treatment 4 (1 Month Later)
		Treatment 5 (2 Months Later)
		Treatment 6 (2 Months Later)
		Treatment 7 (2 Weeks Later)
		Treatment 8 (3 Months Later)
		Review Note (6 Months Later)
		References
	7 Lateral Elbow Pain With Cervical and Nerve-Related Components
		Initial Examination
			Patient Profile and Reported Symptoms
			Behaviour of Symptoms
			History
		Physical Examination
			Response After Physical Examination
		Treatment (Appointment 1, Day 1)
		Appointment 2, Day 4 (3 Days Later)
		Appointment 3, Day 8 (4 Days Later)
		Appointment 4, Day 11 (3 Days Later)
		Appointment 5, Day 15 (4 Days Later)
		Appointment 6, Day 22 (1 Week Later)
		Appointment 7, Day 35 (2 Weeks Later)
		Follow-Up (1 Month Later)
		References
	8 Nonspecific Low Back Pain
		Patient History
		Physical Examination
			Observations and Functional Examination
			Standing Lumbar Active Range of Motion
			Sitting
			Supine
			Prone
		Prognosis and Goals
		Treatment 1 (Day 1)
		Treatment 2 (3 Days Later)
		Treatment 3 (5 Days Later)
		Treatment 4 (5 Days Later)
		References
	9 Chronic Facial Pain in a 24-Year-Old University Student
		Interview
		Current Symptoms
		History
			Previous Assessments
			Previous Treatments
			Impact of Pain on Her Life
			General Health
		Examination
		Further Assessments
			Questionnaires
			Other Tests
		Treatment (Sessions 1 and 2)
		Session 3 (1 Week Later)
		Sessions 4–8 (Held on Consecutive Days)
		Sessions 9–13 (Held Once Per Week)
		Sessions 14–16 (Held Once Every 2 Weeks)
		Sessions 17 and 18 (Held Over Consecutive Months)
		Session 19 (7 Months After Initial Presentation)
		References
	10 Targeting Treatment Distally at the Foot for Bilateral Persistent Patellofemoral Pain in a 23-Year-Old
		Patient Interview
			Symptom Behaviour
			Self-Report Forms
		Physical Examination
			Observation
			Functional Tests
			Knee Tests
			Foot Tests
			Treatment Direction Test (TDT)
			Ankle Range of Motion
			Hip Muscle Strength Tests
		Treatment
		Appointment 2 (3 Days After Initial Appointment)
		Appointment 3 (11 Days After Initial Appointment)
		Appointment 4 (27 Days After Initial Appointment)
		Appointment 5 (48 Days After Initial Appointment)
		Appointment 6 (16 Weeks After Initial Appointment)
		Appointment 7 (32 Weeks After Initial Appointment)
		References
	11 Post-Partum Thoracolumbar Pain With Associated Diastasis Rectus Abdominis
		Tara’s Story
			Tara’s Current Complaints
			Tara’s Personal Profile (Social History)
			Tara’s Perspectives on Her Problem
		Physical Examination
			Standing Posture – Relevant Positional Findings of the Trunk
			Supine Curl-Up Task
			Seated Trunk Rotation With and Without Resistance
			8th Thoracic Ring Assessment
		Treatment – First Session
		Follow-up – 1 Month Later
			Subjective Report
		Physical Examination
			Standing Posture
			Supine Curl-Up Task
		Seven Months Later
		References
	12 A Construction Project Manager With Insidious Onset of Lateral Hip Pain
		Subjective Examination
			History of Current Complaint
			Past Medical History
			Self-Report Questionnaires
			Pain Behaviour
		Physical Examination
			General Morphology
			Posture and Function
			Specific Tests of Gluteal Function
		Treatment
			Load Management
			Exercise Therapy
				Isometric Exercise
				Functional Strengthening
				Targeted Abductor Loading
		Treatment 2 (1 Week Later)
			Functional Strengthening Progressions
		Treatments 3–14 (Weeks 3–8)
			Outcomes After 4 Weeks of Intervention
			Functional Strengthening Progressions
			Targeted Abductor-Loading Progressions
			General Activity
		Outcomes After 8 Weeks
		References
	13 A Pain Science Approach to Postoperative Lumbar Surgery Rehabilitation
		Subjective Examination
			History
			Personal Circumstances
			Area and Behaviour of Symptoms
			General Health, Medication and Oswestry Disability Index Score
		Physical Examination
			Observation
			Active Movement Tests (Resting Symptoms as per Fig. 13.1 – Constant Leg and Low Back Pain)
			Neurological Examination (Butler, 2000)
			Straight Leg Raise (SLR) (Butler, 2000)
		Postoperative Physical Therapy Appointment 1 (5 Weeks Post-op)
			Subjective Examination
		Physical Examination
			Observation
			Active Movement Tests (Resting Pain 3/10)
			Neurological Examination
			SLR (Butler, 2000)
			Hip Joint Passive Range-of-Movement Screening
			Tinnell Test of the Tibial Nerve (Walsh and Hall, 2009a)
			Motor Control (Richardson et al., 2004, Puentedura et al., 2009)
		Management
			Phase 1: Pain Control
			Phase 2: Motor Control and Function
		Treatment
		Appointment 2 (4 Days Later)
			Re-assessment
		Appointment 3 (4 Days Later)
			Re-assessment and Treatment
		Appointment 4 (1 Week Later)
			Re-assessment
			Treatment
		Appointment 5 (1 Week Later)
			Re-assessment
			Treatment
		Appointments 6, 7 and 8 (Over the following 2 Weeks)
		Appointments 9, 10, 11 and 12 (Over the Following 4 Weeks)
		References
	14 A Lawyer With Whiplash
		Patient Interview
		Physical Examination
			Posture
			Active Movements
			Sensorimotor Function
				Balance
				Joint Position Sense
				Cervical Movement Sense
				Eye Movement Control
			Sensory Testing
				Sensitivity to Pressure
				Sensitivity to Cold
			Neurological Examination
			Examination of Nerve Tissue Movement
			Manual Examination
				Passive Physiological Intervertebral Movements (PPIVMs) in Supported Supine Lying
				Passive Accessory Movement Examination
			Tests of Neuromuscular Control
				Craniocervical Flexion Test
				Neck Extensor Muscle Testing
				Scapular Muscle Testing
		Treatment 1
			Education and Assurance
			Multimodal Management
				Movement and Muscle Facilitation
				Balance
				Posture
				Home and Work Program and Advice
		Treatment 2 (4 Days Later)
			Re-assessment
			Physical Examination
			Treatment
		Treatment 3 (4 Days Later)
			Re-assessment
			Physical Examination
			Treatment
		Treatment 4 (1 Week Later)
			Re-assessment
			Physical Examination
				Joint Position Sense
				Cervical Movement Sense
				Eye Movement Control
			Treatment
		Treatment 5 (1 Week Later)
			Re-assessment
			Treatment
		Treatment 6 (1 Week Later)
			Re-assessment
			Physical Examination
			Treatment
		Treatment 7 (2 Weeks Later)
			Re-assessment
			Treatment
		Treatment 8 (2 Weeks Later)
			Re-assessment
			Treatment
		Treatment 9 (4 Weeks Later)
			Re-assessment
			Treatment
		References
	15 Management of Profound Pain and Functional Deficits From Achilles Insertional Tendinopathy
		Subjective Assessment
			Demographics and Social History
			Pain Presentation
			Onset of Pain
			Behaviour of Symptoms
			Patient Perspectives: Expectations/Goals/Understanding of the Problem
			General Health
			Previous Interventions
		Physical Assessment
			Observation
			Gait
			Knee-to-Wall Lunge
			Functional Assessment
			Imaging
			VISA-A Questionnaire
		Treatment
			Education
				Debunking the Myths and Reducing Fear Around Language
				Understanding the Importance of Load
				Teaching Her When and How to ‘Listen’ to Her Tendon
			Instruction in Home Exercise
			Between Treatments
		Second Appointment (2 Months After Initial Assessment)
			Subjective Assessment
				Goals
			Physical Assessment
				Imaging
				VISA-A
			Treatment
				Education
			Exercise
		Third Appointment (7 Months Later; 9 Months After Initial Assessment)
			Subjective Assessment
			Physical Assessment
			Imaging
			Goals and Expectations
			Treatment
		References
	16 Cervicogenic Headache
		Subjective Examination
			History
			Physical Examination
			Active and Combined Cervical Movements
				Upper Cervical Spine Retraction and Protraction
				Cervical Spine Flexion and Extension
				Cervical Spine Rotation and Lateral Flexion
				Cervical Spine Combined Movement
			Segmental Mobility and Pain Provocation Tests
				Segmental Movement Tests
				Segmental Pain Provocation Tests
			Muscle Function
				Cranio-cervical Flexion Test
			Neurodynamic Tests
			Temporomandibular Joint
			Special Tests
		Appointment 1
		Appointment 2 (1 Week Later)
		Appointment 3 (1 Week Later)
		Appointment 4 (1 Week Later)
		Appointments 5–8 (Weekly Intervals)
		Further Management
		References
	17 Shoulder Pain
		Appointment 1
			Subjective Examination
				Social History
			Area and Behaviour of Symptoms
			History
			Physical Characteristics and Medical History
			Patient Perspectives
			Questionnaires
		Physical Examination
			Posture
		Treatment
		Appointment 2 (1 Week Later)
		Assessment 3 (1 Week Later)
		Appointment 4 (3 Weeks Later)
		Appointment 5 (3 Weeks Later)
		Weeks 8–14
		Appointment 6 (Week 14)
		Appointment 7 (34 Weeks After the Start of Treatment)
		References
	18 Post-Traumatic Neck Pain, Headache and Knee Pain Following a Cycling Accident
		First Appointment Subjective Assessment – Part 1
		First Appointment Subjective Assessment – Part 2
			Current Symptoms
			Map of Symptoms
			Frequency of Symptoms
			Symptom Characteristics, Pain Descriptors and Pain Behavior
				Neck Pain and Headache
				Knee Pain
			Imaging Tests
			Mood, Family History, Sleep Quality
			Current Pharmacological Treatment
		Objective Assessment
			Active Movement of the Cervical Spine
			Cervical Spine Manual Assessment
			Right Knee Assessment
			Treatment 1
			Treatment 2
				Re-assessment of Patient Pain Cognitions
			Treatment 3
				Fear-Avoidance Behaviors
				Posturography
			Treatment 4
				Re-assessing Fear-Avoidance Behaviors
				Assessing Neck Mobility
				TMJ Assessment
				Sensorimotor Control Assessment
			Treatment 5
				Increasing Desensitization With Active Exercises
			Treatment 6
				Joint Passive Mobility Assessment Is Performed
			Treatment 7
			Treatment 8
				Reassuring the Patient and Improving Sensorimotor Deficits
				Improving Sensorimotor Deficits
				Desensitizing the ‘Bad Knee’
			Treatment 9
				Functional Exercises
			Treatment 10
				Developing Active Coping Strategies
		References
	19 Orofacial, Nasal Respiratory and Lower-Quarter Symptoms in a Complex Presentation With Dental Malocclusion and Facial Scoliosis
		Subjective Examination
			Personal Profile
			Orofacial and Head-Region Symptoms
			Spine, Hip and Knee-Area Symptoms
			Patient Perspectives
			General Health Screening
			History
			Past History
		Physical Examination
			Clinical Observation
				Face
				Intraoral (Assessed in Supine Lying, Floor’s Relaxed Habitual Occlusion Position)
			Nasal Respiration
			Spine
			Centre of Gravity
			TMJ Assessment
				TMJ Active Movement Assessment (Performed with the Mandible Passively Corrected to the UPPM)
				TMJ Passive Physiological Movement Assessment
				TMJ Accessory Movement Assessment
				Masticatory Muscles Assessment
			Cervical Spine Assessment
				Active Physiological Movements Assessment
				Flexion/Rotation Test
				Passive Physiological Intervertebral Movement Assessment (PPIVM)
				Passive Accessory Movement Assessment (PAM)
			Craniofacial Region
				Neurocranium
				Viscerocranium
					Neurodynamics of the Cranial Nervous System.
					Lateralization and Emotion Recognition Assessment.
					Questionnaires.
		First Appointment Treatment (Day 1)
		Second Appointment (8 Days Later)
			Physical Re-assessment
			Additional Screening of the Thoracic and Lumbar Spines, Hips and Knees
			Treatment
		Third Appointment (2 Weeks Later, Day 21)
			Physical Re-assessment
			Treatment
				Re-assessment
		Fourth Appointment (2 Weeks Later, Day 34)
			Subjective Re-assessment
			Physical Re-assessment
				Home Exercises
				Nasal Respiration
				Neurocranium
				Upper Cervical Spine
				Occlusal Kinaesthetic Sensitizing Test
			Treatment
			Physical Re-assessment
				Nasal Respiration
				TMJ
				Neurocranium
		Fifth Appointment (2 Weeks Later, Day 47)
			Subjective re-assessment
			Physical Re-assessment
				TMJ and Upper Cervical Spine
				Craniofacial Region
				Spine and Posture
				Lateralization and Emotion Recognition Assessment
			Treatment
		Sixth Appointment (4 Weeks Later, Day 72)
			Subjective Re-assessment
			Visit to the Psychologist
			Visit to the Maxillofacial Surgeon
			Physical Re-assessment
				Lateralization Test
			Treatment
				Lateralization and Emotion Recognition Training
		Seventh (2 Months Later, Day 91) and Eighth (3 Months Later, Day 108) Appointments
		References
	20 Cervical Radiculopathy With Neurological Deficit
		History
			Aggravating and Easing Activities and Postures
			General Health and Medical Management
		Physical Examination
			Posture
			Neurological Examination
			Neurodynamics
			Movement Testing
				Cervical Spine
				Right Shoulder
			Repeated Movement Testing
		Management Day 1
			Educational Element
			Exercise Element
			Guidelines for Daily Living
		Second Appointment (24 Hours Later)
			Subjective Re-assessment
			Physical Re-assessment
			Treatment
		Third Appointment (2 Days After the Second Appointment)
			Subjective Re-assessment
			Physical Re-assessment
			Treatment
		Fourth Appointment (6 Days After the Third Appointment)
			Subjective Re-assessment
			Physical Re-assessment
			Treatment
		References
	21 Incontinence in an International Hockey Player
		Subjective Assessment
			Personal Profile and Main Problem
			History of Incontinence and Medical Details
				Medications
			Obstetric History
			Previous Management
			Urinalysis and Post-Void Residual Tests
			Bladder Diary
			Patient-Reported Outcome Assessment
			Patient’s Perspectives
		Education
		Physical Assessment
			Observation
			Lumbar-Pelvic Deep Muscle Activation
			Pelvic Floor Muscle Assessment
		Discussion of Findings and Management
		Second Consultation (2 Weeks Later)
		Third Consultation (2 Weeks Later)
		Fourth Consultation (2 Weeks Later)
		Abdominal Muscle Training
		Outcomes
		Ongoing Management
		References
	22 Neck and Upper Extremity Pain in a Female Office Assistant
		History
		Physical Examination
			Observation
			Cervical Range of Motion
			Shoulder/Elbow Range of Motion
			Joint Mobility
			Strength Assessment
			Neurological Assessment
			Other Tests
			Appointment 1
			Appointment 2 (2 Days Later)
			Appointment 3 (1 Week Later)
			Appointment 4 (2 Days Later)
			Appointment 5 (1 Week Later)
			Appointment 6 (2 Weeks Later)
		Outcome
		References
	23 Managing a Chronic Whiplash Problem When the Patient Lives 900 Kilometres Away
		First Appointment
			Current Complaints and Their History
			Behaviour of Current Symptoms
			General Health
			Patient Perspectives
			Physical Examination
			Muscle Testing
			First Trial Treatment
		Second Appointment (Next Day)
			Re-Assessment
			Second Trial Treatment
			Third Trial Treatment
		Third Appointment (Next Day)
			Result of the Third Trial Treatment
			Fourth Trial Treatment
		Fourth Appointment (1 Week Later)
			Re-Assessment
			Treatment – Prolonged Home Exercise Program
			First Email Contact: 8 Days Later
			Second Email Contact: 2 Weeks Later
			Third Email Contact: 3 Weeks Later
			Fourth Email Contact: 4 Weeks Later
			Fifth Email Contact: 6 Weeks Later
		Fourth Appointment (1 Week Later) (Because Sabrina Was Back for 4 Days Attending a Professional Development Course, We Agreed to Have at Least Three Appointments in This Time)
		Appointments 5 and 6 (Next Day)
		Appointment 7 (2 Days Later)
			Sixth Email Contact (6 Weeks Later)
			Seventh Email Contact (2 Months Later)
			Eighth Email Contact (10 Months After First Appointment)
			Epilog
		References
	24 A Professional Football Career Lost
		Subjective Examination
			Pain Characteristics
			Primary Aggravating Factors
			Easing Factors
			Sleep
			Activity Levels
			Beliefs
			Levels of Distress
			Coping Strategies
			Protective Behaviours
			Social Factors
			General Health and Comorbidities
			Medication
			MRI Scans
			Goals
			Örebro Screening Questionnaire
		Physical Examination
		Cognitive Functional Therapy (CFT) Intervention
			Making Sense of His Pain
			Exposure With Pain Control
			Lifestyle Aspects
		Session 2 (1 Day Later)
		CFT Intervention
			Making Sense of Pain
			Exposure With Control
			Lifestyle
		1-Year Follow-up
		References
	25 Applying Contemporary Pain Neuroscience for a Patient With Maladaptive Central Sensitization Pain
		A Brief Background of Pain Neuroscience
		History
		Questionnaires
		Clinical Examination
		Treatment
			Pain Neuroscience Education
			How We Provided Pain Neuroscience Education to Anna
			Stress Management
			Graded Activity and Exercise Therapy
		Outcome and Conclusions
		Acknowledgments
		References
	26 Thoracic Spine Pain in a Soccer Player
		History of Present Complaint
			Behaviour of Symptoms
			Previous Management
			General Health
		Planning the Physical Examination
		Physical Examination
			Observation
			Active Movements
			Palpation and Passive Movement Testing
			Positional Asymmetry
		Home Programme and Take-Home Message
		Second Session (1 Week Later)
			Physical Re-Examination
		Outcome
		Acknowledgments From Christopher McCarthy
		References
	27 Incorporating Biomechanical Data in the Analysis of a University Student With Shoulder Pain and Scapula Dyskinesis
		Subjective Examination
		Physical Examination
			Posture and Alignment (No Symptoms at Rest)
			Active Shoulder Movement Testing
			Impingement Tests
			Shoulder Passive-Movement Testing
			Shoulder Palpation
			Awareness and Dissociation of Thoracic Segmental Movement
			Active Cervical and Thoracic Movement Testing
			Dynamic Rotary Stability Test (Magarey and Jones, 2003; Magarey and Jones, 2003a)
			Muscle Activation Pattern (Assessed With Surface Electromyography [EMG])
			Manual Muscle Testing (Kendall et al., 1993)
		Questionnaire Assessment of Disability
		Management
		First-Appointment Treatment
		Appointment 2 (1 Week Later)
			Re-Assessment
		Appointment 3 (1 Week Later)
			Re-Assessment
		Appointment 4 (1 Week Later)
			Re-Assessment
		Appointment 5 (3 Months Later)
		References
	28 Acute Exacerbation of Chronic Low Back Pain With Right-Leg Numbness in a Crop Farmer
		Subjective Examination
			Area, Nature and Type of Pain
			Pain Behavior and Irritability
		Aggravating and Easing Factors
		Past and Present History
		Medication and Special Questions
		Imaging
		Self-Report Questionnaires
		Physical Examination
			Observation
			Neurological Examination
		Active Physiological Movements
			Step Test
		Passive Physiological Movements
		Palpation and Passive Accessory Intervertebral Movements (PAIVMs)
		Neurodynamic Testing
		Functional Instability Testing
		Management
			Treatment 1 (Day 1)
			Treatment 2 (Day 2)
			Treatment 3 (Day 4)
		Clearing or ‘Ruling Out’ Adjacent Areas
			Treatment 4 (Day 6)
			Treatment 5 (Day 14)
			Treatment 6 (Day 30)
			Treatment 7 (Day 70)
		References
	29 Physical Therapy Chosen Over Lumbar Microdiscectomy
		Subjective Examination
		Physical Examination
			Posture
			Neurological Examination
			Selective Functional Movement Assessment (SFMA)
		Treatment (First Appointment)
		Appointment 2 (1 Week Later)
		Appointment 3 (1 Week Later)
			Treatment
		Fourth Appointment (1 Week Later)
		Acknowledgements
		References
	30 A 30-Year History of Left-Sided ‘Chronic Sciatica’
		Subjective Examination
			History of Present Complaint
			Symptom Pattern
		Physical Examination
			Vascular Examination
				Observation, Palpation and Resting Blood Pressure
				Exercise Test
		Management
		Outcome
		References
3 Learning and Facilitating Clinical Reasoning
	31 Strategies to Facilitate Clinical Reasoning Development
		Introduction
		Describing Clinical Reasoning
		Clinical Reasoning and Transformative Learning
			Capability as a Learning Outcome
		Clinical Reasoning Capability
			Reflective Thinking
			Critical Thinking
			Complexity Thinking
			Dialectical Thinking
		Making Learning More Likely
			Making Visible the Invisible: Use of Common Definitions, Language and Models
			Using Clinical Reasoning as a Curricular Framework
			Facilitating Reflection on Hypothetico-Deductive Reasoning and Authentic Pattern Development
			Facilitating Critical Self-Reflection Through Focused Questioning
			Facilitating the Questioning of Assumptions
			Facilitating Lateral and Creative Thinking
			Using Knowledge of Clinical Reasoning Errors to Facilitate Self-Reflection
		The Role of Skilled Clinical Mentoring in the Facilitation of Clinical Reasoning
		Using Technology to Enhance Opportunities for Clinical Reasoning Development
		Specific Strategies for Independent Self-Directed Learning
		Conclusion
		References
Appendix 1 Clinical Reasoning Reflection Form
	Perceptions/Analysis
		On Completion of the Subjective Examination (S/E)
	Perceptions/Analysis
		On Completion of the Physical Examination (P/E)
	Perceptions/Analysis
		On Completion of the Day 1 Treatment
Appendix 2 Clinical Reasoning Reflection Worksheet
	Clinical Reasoning Based on the Subjective Examination
	Perceptions, Interpretations and Implications
		Following the Physical Examination and First Treatment
	Implications of Perceptions and Interpretations for Ongoing Management
	After Third Visit
	After Sixth Visit
	After Discharge
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Y