The Guide to Physical Therapy School

So peeps, I’m going on vacation this week.

So instead of a debrief, I present to you the first legit episode of the Zac Cupples show.

I’ll be putting these bad boys out occasionally when I have a topic that I feel would be better to riff on as opposed to discussing in a debrief or writing about.

Here’s an outline of the topics I discussed

  • Reasons to go into physical therapy
  • What to look for in a PT school
  • The goals of physical therapy school
  • What you should take away from school
  • What classes I recommend a student to take

Enjoy!

                

Here were the links I mentioned tonight

All Gain, No Pain

South College Physical Therapy Program

Bill Hartman

Continuing Education: The Complete Guide to Mastery

Explain Pain Course Notes

Therapeutic Neuroscience Education Course Notes

Lorimer Moseley Explain Pain Course Notes

Kettlebell Mashup

FMS Level 2

Ultimate MMA Conditioning

Dermoneuromodulation Course Notes

ART

Dry Needling Course Notes

Spinal Manipulation Institute

A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain

Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

Also, check out the mentoring, movement, and training services I offer:

Mentoring, Movement, and Training

The Sensitive Nervous System Chapter XII: Upper Limb Neurodynamic Tests

This is a summary of Chapter XII of “The Sensitive Nervous System” by David Butler.

Intro

Today we will take a look at assessing upper limb neurodynamic tests (ULNT). These assessments used to be called tension tests, but that terminology is now a defunct mechanical description. We now describe these as neurodynamic tests to better appreciate the neurophysiologic aspects of mechanosensitivity and upper limb homunculi stability.

Neural tension is so passé
Neural tension is so passé

These tests are numbered based on the movement sensitizer, which are as follows:

1 – Shoulder abduction.

2 – Shoulder depression.

3 – Elbow flexion.

ULNT1: Median Nerve

Here is the quick test first.

Here is how to do the manual test.

A quick heads up regarding head motions.

  • Sidebending away increases symptoms in 90% of people.
  • Sidebending toward decreases symptoms in 70% of people.

ULNT2: Median Nerve

Here is the manual test

ULNT2: Radial Nerve

Here is the active test.

And the manual test.

ULNT3: Ulnar Nerve

Here is the active test

And the manual test.

Musculocutaneous Nerve

Here is the active test

And the passive test.

Axillary Nerve

Here is the passive test.

Suprascapular Nerve

Here is the test.

Final Words

Have some fun with these tests, and be mindful that you are not too aggressive.

Thanks to Scott and Sarah for your videotaping help. You guys rock.

 

The Sensitive Nervous System Chapter X: Neurodynamic Tests in the Clinic

 This is a summary of Chapter X of “The Sensitive Nervous System” by David Butler.

The Tests

When assessing neurodynamics, there is a general system that is used including the following tests:

  • Passive neck flexion (PNF).
  • Straight leg raise (SLR).
  • Prone knee bend (PKB).
  • Slump.
  • 4 different upper limb neurodynamic tests (ULNT).

I will demonstrate these tests for you in later chapters.

Many clinicians when discussing the lower extremity-biased tests deem that maybe only one or two of the tests need to be performed, however this assertion is erroneous. Slump, SLR, and PNF all need to be tested as a cluster. The reason being is that the clinical responses may often differ.

This difference is especially noticeable when comparing the SLR and the slump. These two are not equal tests for the following reasons:

  • Components are performed in a different order.
  • Spine position is different.
  • Patients may be more familiar with the SLR, therefore give more familiar responses.
  • The patient is in control during the slump, not in the SLR.
  • The slump is more provocative.
Slump ≠ SLR, and SLR ≠ Slump. New product name?
Slump ≠ SLR, and SLR ≠ Slump. New product name?

Rules of Thumb

When testing neurodynamics, here are the following guidelines:

1)      Active before passive.

2)      Differentiate structures – add/subtract other movements to see if symptoms can change.

3)      Document the test order.

Positive Test

The positive testing here is a little dated based on what Butler’s group and the research says as of right now. Based on what I have learned from Adriaan Louw, having any of the following is what constitutes a positive test.

  • Symptom reproduction.
  • Gross range of motion asymmetry between sides.
  • Gross sensitivity asymmetry between sides.

Source Identification

There are several pieces to look at when determining potential sources of neural findings.

  • Area: Cutaneous zones generally nerve trunk; dermatome generally nerve root.
  • Motor loss: Reflex loss is usually the nerve root; specific motor loss can be the root or trunk.
  • Patient history.
  • Palpation: Generally how to find AIGS.
  • The movement exam: Good at showing neural container dysfunction.

Unexpected Responses

There are several unexpected responses that often have very rational explanations.

  • Release worsens, addition is better: Likely a neural container problem.
  • Ulnar symptoms with ULNT1 (a median nerve test): Tests are crude, and could have an anatomical variance.
  • Bizzare pain responses.
  • Multiple positive tests: Generally treat the least sensitive.