1st Edition

Physical Therapy Management of Patients with Spinal Pain An Evidence-Based Approach

By Deborah Stetts, Gray Carpenter Copyright 2013

    In this rapidly changing health care environment, a challenge today’s physical therapist faces is finding, evaluating, and implementing current best evidence into practicce, an integral part of health care professional educational programs. With that goal in mind, Physical Therapy Management of Patients With Spinal Pain: An Evidence-Based Approach provides a comprehensive research-based overview of the examination and physical therapy interventions of the spine.

    Inside Physical Therapy Management of Patients With Spinal Pain, Drs. Deborah M. Stetts and J. Gray Carpenter evaluate the current evidence related to spinal pain and present it in a format that allows for an easy transition to the clinical environment. By providing effective clinical interventions, rather than relying on habits or tradition, patients benefit from an increased likelihood of improved quality of life with the least potential of personal and financial risk.

    Some features include:
    • Over 650 photographs, images, and tables
    • Access to a supplemental video Website with new book purchase
    • Best practice for evaluating and treating the lumbar spine, thoracic spine, and cervical spine
    • Comprehensive coverage of the clinical presentation of spine-related pathologies from evaluation to treatment

    Each chapter outlines the history, physical examination, physical therapy diagnosis, evidence-based management guidelines, and case studies for each topic. Case studies will challenge the reader’s clinical reasoning skills with the use of current best evidence throughout the initial examination and subsequent treatment sessions.

    Also included with Physical Therapy Management of Patients With Spinal Pain is access to a supplemental Website containing more than 375 video demonstrations corresponding to the tests and measures, examination, evaluation, and intervention procedures covered within the text.

    Physical Therapy Management of Patients With Spinal Pain: An Evidence-Based Approach is the go-to reference text and accompanying Web site for the physical therapy students, or clinicians who are reaching for best practice through providing the highest level of evidence-informed care in the evaluation and management of patients with spinal pain.



    About the Authors


    Foreword by Mary C. (Mary Kay) Hannah, PT, DPT

    Chapter 1Evidence-Based Practice in Physical Therapy

    The Practice of Evidence-Based Physical Therapy

    Critical Appraisal of Literature Related to Diagnostic Tests

    A Case Study in Diagnosis Using the Critical Appraisal Criteria

    Critical Appraisal of Literature Related to Intervention or Prevention

    Effect Size and Confidence Intervals

    A Case Study in Intervention Using the Critical Appraisal Criteria

    Critical Appraisal of Literature Related to Outcomes and Prognosis

    Chapter 2Subjective Examination: A Patient’s History

    Communication During the Patient Interview

    Goals of the Subjective Examination

    Content Areas of the Patient History

    Pre-Examination Questionnaires

    Patient Demographic Profile

    Chief Complaint (In Your Own Words, Please Tell Me What Your Main Problem Is)

    Completing the Body Chart or Symptom Diagram

    Description and Assessment of Pain and Other Symptoms

    History (Present or Current Episode)

    History (Previous Episode[s] of Similar Problem)

    Symptom Behavior

    Review of Medical Screening Questionnaire

    Patient Expectations and Goals

    Interview Summary

    Planning the Physical Examination

    Chapter 3Components of the Basic Neuromusculoskeletal Examination: Tests and Measures

    Goals of the Physical Examination

    Conducting the Physical Examination



    Gait Screen

    Balance Screen

    Movement Testing

    Neurological Examination

    Muscle Length Tests

    Muscle Performance

    Special Tests

    Neurodynamic Tests

    Screening Tests for Regions Above and Below the Area of Symptoms


    Additional Studies




    Chapter 4Evidence-Based Physical Therapy Practice for Low Back Pain



    Components of the Patient’s History (Subjective Examination)

    Physical Examination of the Lumbopelvic Region (Includes Lower Thoracic Spine)

    Diagnostic Classification and Matched Intervention

    Chronic Low Back Pain Classification

    Classification and Management of Chronic Low Back Pain

    Interventional Therapies, Interdisciplinary Rehabilitation, Pharmacology, and Surgery

    Patient Expectations and Patient Satisfaction

    Pelvic Girdle Pain

    Components of the Subjective Examination for Persons With Pelvic Girdle Pain

    Components of the Physical Examination for Persons With Pelvic Girdle Pain

    Evidence of Conservative Management of Pelvic Girdle Pain

    Chapter 5Evidence-Based Physical Therapy Practice for Thoracic Spinal Pain

    Prevalence, Incidence, and Risk Factors

    Classification of Thoracic Spinal Pain

    History and Diagnostic Triage

    Components of the History (Subjective Examination)

    Components of the Physical Examination

    Physical Examination of the Thoracic Region

    Diagnostic Classification and Impairment-Based Management

    Neurodynamics and the Thoracic Spine

    Miscellaneous Disorders of the Thorax

    Interventional Radiology and Surgical Management of Thoracic Disorders

    Chapter 6Evidence-Based Physical Therapy Practice for Neck Pain


    Classification Systems

    General Overview of the Clinical Manifestations of Neck Pain


    Components of the Patient’s History

    Components of the Physical Examination

    Considerations for Ligamentous Stability and Vertebral Artery Testing

    Physical Examination of the Cervical Spine (Includes Upper Thoracic Spine)

    Diagnostic Classification and Matched Intervention

    Neck Pain With Headache Classification

    Whiplash-Associated Disorders Classification

    Surgical Management of Cervical Radiculopathy and Myelopathy

    Postsurgical Rehabilitation

    Appendix ACase Study for Limited Examination

    Appendix BCase Study for Full Examination

    Appendix CCase Study for Low Back Pain

    Appendix DCase Study for Low Back Pain

    Appendix ECase Study for Pelvic Girdle Pain

    Appendix FCase Study for Thoracic Spinal Pain

    Appendix GCase Study for Thoracic Spinal Pain

    Appendix HCase Study for Cervical Pain

    Appendix ICase Study for Cervical Pain



    Deborah M. Stetts, PT, DPT is an associate professor in the Department of Physical Therapy at Elon University, NC, where she teaches professional students in the area of musculoskeletal management. Current research interests involve the use of real-time ultrasound imaging to examine abdominal muscle performance in select patient populations. Dr. Stetts is board certified in orthopedic physical therapy and a Fellow of the American Academy of Orthopedic and Manual Physical Therapists. She has over 23 years of service as a physical therapist in the United States Army working in a variety of clinical, academic, and administrative positions. Dr. Stetts completed her DPT from Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, in 2003; a master of physical therapy from the U.S. Army–Baylor University Graduate Program in Waco, TX in 1981; and a bachelor of science in health and physical education from Pennsylvania State University, State College, PA in 1976. She completed a residency in advanced orthopedic manual therapy at the Kaiser Physical Therapy Program, Hayward, CA, in 1990. Her professional experience and training have been primarily in orthopedic and manual physical therapy.

    J. Gray Carpenter, PT, DPT, COMT graduated with a bachelor’s degree in physical therapy from East Carolina University, Greenville, NC in 1992 and completed his doctor of physical therapy from the University of North Carolina at Chapel Hill in 2006. Dr. Carpenter also completed the Certificate in Orthopedic Manual Therapy from Manual Concepts, Curtin University, Perth, Western Australia, in 2002. He became a board-certified specialist in orthopedics through the American Physical Therapy Association in 2008 and became a Fellow of the American Academy of Orthopedic and Manual Physical Therapists in 2009. During his career, Dr. Carpenter has primarily worked in outpatient orthopedic settings but has experience in several settings such as acute care, home health, inpatient rehab, and wound care. He currently works as a staff physical therapist at Alamance Regional Medical Center in Burlington, NC as well as serving as associate faculty at Elon University in the musculoskeletal module. Dr. Carpenter has been very active in the North Carolina Physical Therapy Association (NCPTA) and has held several positions with the NCPTA.

    “The book systematically and eclectically approaches the evaluation and management of spinal pain using a clinical reasoning framework that allows for continual integration of emerging evidence and bio-psychosocial concepts based on patient response, current best practice, and a clinician’s knowledge.  The goal is to reach an informed decision that balances the best available evidence with what is safe and, most important, for the patient to reach an optimal outcome.”


    “The authors have written a book with an accompanying video supplement that is the perfect combination of clinical practice and evidence-based practice.  The format makes it easy to use the book as a quick reference in the clinical setting.”

    -  Jeff Yaver, PT, Kaiser Permanente, Doody’s Review Service

    “The book is comprehensive within the scope of orthopaedic practice.  It is also well organized and well written, making it an excellent entry-level text, with adequate information for new graduates to enjoy the book well into their careers.  The case studies demonstrate the application of the chapters, giving the reader a sense of how a simple versus complex patient might be approached.  The video clips are neatly filmed and straightforward.  This is an excellent text to have on hand in a clinic or department…This is an excellent text that takes evidence-based practice and sculpts it into a clinical reality.  The price is reasonable, making it an easy addition to a personal library.”

    - Anne H. Campbell, PT, OCS, FAAOMPT, Access Rehab Clinics and Fitness Centers, Journal of Orthopaedic & Sports Physical Therapy