International Framework for Examination of the Cervical Region
A variety of manual assessment and intervention techniques are being used in the assessment and management of the cervical spine. The reports of patient harm from OMT in the cervical region have typically been in the practice of cervical manipulation. The teaching of OMT for the cervical region requires instructors to have a thorough understanding and proficiency in:
- assessment for pathology that is outside the usual physical therapist’s scope of practice
- understanding of the implications of findings from musculoskeletal diagnostic imaging
- the use of tools to determine baseline status, treatment outcomes, and prognostic indicators
- neuromusculoskeletal examination procedures including sensory-motor function, vascular status and ligamentous integrity
- palpatory skills of the cervical region
- differential diagnosis and clinical reasoning
Practical skills teaching and examination of competency are necessary components of manipulation instruction at all levels of physical therapy education programmes. Based on the available literature, instruction should particularly emphasise the continuum of the amplitude, velocity, patient comfort, and sensitivity and specificity of handling during manipulation tutoring[1][2]. This continuum reflects the excellence in manual skills to enable physical therapists to perform manipulation efficiently and effectively.
Practical skills teaching and examination of competency involves students practising cervical techniques on their peers. Instruction should therefore include a process of evaluation of peers to act as models for OMT technique practice.
Educational qualifications for first professional (entry-level) and post-professional training instructors vary across the world. However, recommended attributes of instructors responsible for teaching the cognitive and psychomotor skills used in cervical manipulation are described below (these are provided to guide educational programmes when planning instructor development processes and resources). Importantly, instructors should:
- Be actively engaged in clinical practice within the area of their expertise and instruction, and have an appropriate amount of relevant clinical experience.
- Possess teaching experience that preferably includes mentoring or formal training in adult educational processes and methods.
- Apply evidence-based concepts within both their clinical practice and teaching.
- Have been trained and examined in didactic and psychomotor aspects of manual therapy, including manipulation, or the equivalent.
- Have completed a formally accredited (by an IFOMPT recognised national body) post-professional programme in manual therapy.
- Regularly undertake ongoing professional education and training relevant to cervical manipulation.
The instructor should be appropriately qualified to ensure that the student can:
- Demonstrate competency in both performing and interpreting examination procedures appropriate for physical therapy management and prevention of musculoskeletal disorders of the cervical spine.
- Demonstrate competency in both the technical application and interpretation of response to manipulative interventions utilised in the management of musculoskeletal disorders of the cervical spine.
Furthermore, specific safety precautions associated with manipulation in general, and particularly manipulation in the cervical spine are a necessary component of instruction. Students should be competent in making decisions regarding when to utilise manipulation, and when to refer to a physician or other practitioner based on safety or other medical concerns.
When teaching manipulation techniques in the cervical region it is essential to present techniques which are easy to understand and implement in the clinical setting. There is a vast array of physical therapy and medical resources that describe the management of cervical spine disorders, including those related to manual and manipulative therapy. Physical therapists should be well versed in current best evidence for managing cervical disorders. This document does not endorse any specific philosophy or approach to manipulation, however the physical therapist is responsible for choice, application, and monitoring of responses to manipulative techniques following the principles outlined in this document.
- ↑ Flynn TW, Wainner RS, Fritz JM (2006). Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice. J Orthop Sports Phys Ther 36(8):577-587.
- ↑ Mintken PE, DeRosa C, Little T, et al (2008b). AAOMPT clinical guidelines: A model for standardizing manipulation terminology in physical therapy practice. J Orthop Sports Phys Ther 38(3):A1-A6.
