Can PT's do grade 5 mob's? (Full Version)

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hobby31 -> Can PT's do grade 5 mob's? (September 20, 2006 4:41:00 AM)

I am a PTA in Florida. In school I received the "crash course" in joint mobs. I remember being told that grade 5 mobs were chriropractor only or something. I've worked with a few PT's and no one seems to really know. Can anyone answer this question, thanks.



jlharris -> Re: Can PT's do grade 5 mob's? (September 20, 2006 10:31:00 AM)

It depends on your state practice act. Here in Nebraska where I practice, Grade V is ok. In Washington, where a friend of mine practices, they are forbiden too (battle won by the chiropractors).

Contact your state health and human services for a copy of your state practice act, or contact your state APTA org. with your question. They should be able to easily help you.

Oh, for the record, in no way are or should grade V be "chiropractor only".



hobby31 -> Re: Can PT's do grade 5 mob's? (September 20, 2006 12:33:00 PM)

Thanks Jason



ragempt -> Re: Can PT's do grade 5 mob's? (September 26, 2006 5:34:00 AM)

My question is how often are you using a grade 5 mobs? I find its not needed very often. Some scholars say less then 15% of the time. I never use that grade but im not a scholar. just a small town PT



jlharris -> Re: Can PT's do grade 5 mob's? (September 26, 2006 11:39:00 AM)

Good question. I've only used it for LBP pt's that fit into the LB manipulation CPR. How many is that? In my case, out of say 50 LBP pt's, I've manipulated 5. So, that's 10% I guess. However, 4/5 walked in the next treatment without pain, and the 5th with in a week had no pain.

So, you say to yourself...why take the time to manipulate those 5? Because research shows that not only will those 5 have dramatic pain resolution, but may have poorer outcomes if you DO NOT manipulate them.

BTW, back pain is back pain regardless of the size of your town.



proud -> Re: Can PT's do grade 5 mob's? (September 26, 2006 1:36:00 PM)

Nice response Jason. The manip is a valuable tool for a sub group of patients. We should all have the skill to perform manipulation when appropriate.

I try to locate the exact segement and the exact type of motion problem( is it the left side that is hypomobile or is it the right side moving too much? hmmmm). Then I will deterermine the nature of the decreased joint play( is it capsular, myofascial, or fixated). Or if it is increased joint play I will want to determine the segemental stability of the segement by doing shear test and rotation stability testing...

I am joking of course...This is actually taught on some courses I have been on...

In any case the non specific manip is valuable( all manips are non specific regardless of what some will claim).



PHSPT -> Re: Can PT's do grade 5 mob's? (September 27, 2006 5:27:00 AM)

I didnt hear anyone mention, Thoracic manipulations. I perform these quite regularly in my practice, particularly w Cx radic, ala clelands study Dec 05 JOSPT. A clnical prediction rule for Tx manips to treat Cx pain has been established, although not validated yet. Cleland 2006 Spine "Thoracic manipulation for neck pain".
Thoracic manips Gde V work very well also for flexion, extension restrictions, as well as Cervicogenic HA's.
In fact a new study is coming out, regarding Tx manipulation in the decrease of Sx's for Shld pathology e.g Impingement.



proud -> Re: Can PT's do grade 5 mob's? (September 27, 2006 2:52:00 PM)

PHSPT,

Regarding shoulder impingement, what type of thoracic manip is discussed in those articles? I am assuming to promote extension? Afterall thoracic extension is a part of shoulder elevation so if it is lacking, it may lead to impingement. Do you know the type of thoracic manip?



PHSPT -> Re: Can PT's do grade 5 mob's? (September 28, 2006 4:53:00 AM)

Proud,
I agree w your assumption, unfortunately the study im referring to has not been submitted yet, but i did come across an abstract that also promoted Tx manips for subacromial impingement, from the AAOMT 2006 abstracts.
The manip in question is pnt supine, w hand (collapsible) under thoracic SP applying AP force. The cleland study shows some nice photos and descriptions.

AAOMPT abstracts:
[URL=http://jmmtonline.com/documents/v14n3/AAOMPTConf2006Abstracts.pdf#search=%22The%20Immediate%20Effects%20of%20Thoracic%20Manipulation%20in%20Patients%20with%20Shoulder%20Impingement%22]http://jmmtonline.com/documents/v14n3/AAOMPTConf2006Abstracts.pdf#search=%22The%20Immediate%20Effects%20of%20Thoracic%20Manipulation%20in%20Patients%20with%20Shoulder%20Impingement %22[/URL]



PHSPT -> Re: Can PT's do grade 5 mob's? (September 28, 2006 5:09:00 AM)

The abstract unfortunately is only a case report, but it is shedding some light in this arena. "Treatment of subacromial impingement syndrome with manual physical therapy and exercise directed to the upper quarter: case report"



steve -> Re: Can PT's do grade 5 mob's? (September 28, 2006 7:58:00 AM)

Proud,

Check out this month's ODR for more on Cleland and the shoulder, including manual therapy to the upper t-spine.

Steve



proud -> Re: Can PT's do grade 5 mob's? (September 28, 2006 1:53:00 PM)

Steve,

Just got the ODR...man that is ironic. Thanks.



nick jaylor -> Re: Can PT's do grade 5 mob's? (February 17, 2007 1:18:00 AM)

---------------------------------------
"I am a PTA in Florida. In school I received the "crash course" in joint mobs"
----------------------------------------
Good luck with your experiment. Just make sure sure you tell the patient that before you pop him around.

Nick



Andrew M. Ball PT PhD -> Re: Can PT's do grade 5 mob's? (February 18, 2007 11:26:00 AM)

Here in North Carolina, PT's are permitted to do grade 5 spinal mobilizations under authorization of an MD or DO (e.g. signing off on plan of care). PTA's, however, are prohibited from spinal mobilizations of any kind. One of the PTA's I work with used to work in FLA. I seem to remember her saying that PTA's could not do spinal mobs in that state either . . . I'll double check on Monday.



yarringtonpt -> Re: Can PT's do grade 5 mob's? (February 19, 2007 12:29:00 PM)

What is the ODR?



jma -> Re: Can PT's do grade 5 mob's? (February 19, 2007 3:48:00 PM)

I believe it stands for, "Orthopaedic Division Review".I think it is a publication from Canada.



USAPT -> Re: Can PT's do grade 5 mob's? (February 20, 2007 2:45:00 AM)

Mitch, here is the FL practice Act for defining PT/PTA..

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0486/SEC021.HTM&Title=->2006->Ch0486->Section%20021#0486.021


FL Act for DCs..

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0460/SEC403.HTM&Title=->2006->Ch0460->Section%20403#0460.403

So, if that isn't vague for you...don't call them manipulations; however, if you only received a 'crash' course and you were my PTA, I would not be comfortable with you performing mobs/manips on my pts unless you can adequately discuss the anatomy, arthrokinematics, and justification of why you're doing it.

I'm not saying you can't, that is just my position with any PTA, student, or fellow PT who I know not to be trained in joint manipulations....just looking out for my pts and my license:)



bhenchodh -> Re: Can PT's do grade 5 mob's? (March 11, 2007 8:27:00 PM)

Crash course?! Some continuing ed would not be a bad idea.



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