“Chess is one of the few arts where composition takes place simultaneously with performance.” - Garry Kasparov

There has been a resurgence in interest in Chess of late, specifically because of the highly acclaimed Netflix miniseries The Queen’s Gambit. This has led me to thinking about chess, physical therapy and advancing excellence in the clinic during the current healthcare environment.

Since PT school we have all been taught to be wary of serious pathology masquerading as musculoskeletal pain. We learn about the red flag, the 5 Ds, and the 3 Ns, etc. In fact, research has presented 163 possible signs and symptoms which can be reported as red flags for spinal pathology alone! There are some who disregard the screening for serious pathology as an unnecessary impediment to proving the intervention they prefer. Also, in their opinion, these signs and symptoms are so rare, they should not be a major concern for your average therapist. I would like to stress that even though these conditions are atypical for most patients, for those who have the pathology, the diagnosis is “devastating and life changing.” I call these patients the one-percenters, because although serious pathology is rare, they deserve appropriate screening.

Screening of the cervical spine for safety prior to performing techniques should be routine for most manual physical therapists. Over my practice in the past 23 years, I have learned many ways to screen structures, particularly the vertebral artery. It has been well established that the vertebral artery is at most risk during the performance of manual therapy to the cervical spine. It is also established that the risk is relatively low measured at 0.75-2.9 incidents per 100,000 people.

To ensure safety, the International Federation of Orthopeadic Manual Therapists (IFOMPT) published a “Framework” for assessing the cervical spine prior to treatment. IFOMPT has recently released its 2020 update entitled, “International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy (OMT) Intervention”. 

Some of the highlights of the article are the following:

In this video NAIOMT teaching faculty Terry Pratt outlines and demonstrates weight bearing strategies he uses in the clinic for lumbar stabilization.

One of the concerns we have as clinicians—one that patients also have—is a serious diagnosis when they present with an MSK issue. The Society for Vascular Surgery published guidelines in January of 2018 for care of patients with AAA (3). The chances of encountering AAA are pretty slim, so I consider this one of the one-percenters. The majority of lumbar pain does not have a serious origin, but on average 1% do, and AAA is a life threatening diagnosis, which results in death of 9,000 individuals a year in the USA (2).  Here are some basic facts about AAA:

In the manual therapy video below, NAIOMT faculty instructor Terry Pratt demonstrates four ways to asses shoulder abduction and outlines the clinical reasoning associated with each way.

When it comes to patients experiencing neck pain and pressure, it's valuable to have an array of tools we can choose from and employ on a case-by-case basis. In the manual therapy video below, NAIOMT faculty member, Terry Pratt, MS, PT, COMT, FAAOMPT demonstrates HA taping that can help relieve tension.

Patient experiencing pain when turning head to the right? In the manual therapy video below, Terry Pratt discusses and demonstrates trigeminal signs and symptoms.

Have a patient presenting with TMJ pain? In the manual therapy video below, I demonstrate some efficient ways to screen the TMJ.

In the manual therapy video below, NAIOMT Faculty Member Terry Pratt, MS, PT, COMT, FAAOMPT discusses some common clamshell exercise errors and how to help your patient adjust them.