Faculty of Health and Medicine

School of Health Sciences

PHTY3100
COURSE MANUAL
SEMESTER 2 2023

Critical Thinking in
Musculoskeletal
Physiotherapy

CONTACTS

Dr Wei-Ju Chang – Course Coordinator

T: (02) 4921 5110
[email protected]
 PHTY3100 – Critical Thinking in
Musculoskeletal Physiotherapy
Course Outline

OVERVIEW
Course Description Higher level analytical and clinical reasoning skills in the
assessment and management of musculoskeletal disorders. This
course emphasises the critical thinking process in examination,
problem analysis and treatment prescription extensively using a
case-based approach.

Requisites This course is only available to students enrolled in the Bachelor of

Physiotherapy (Honours) program [12337]. Students must have
successfully completed PHTY2020, HUBS2505, HUBS2503.

Assumed Knowledge All year 1 and 2 Courses in the B PHTY (Hons)

Contact Hours Callaghan

Lecture
Face to Face on Campus
12 hour(s)
Lectures will occur in weeks 1 to 5, 8, 10 and 11
Practical
Face to Face on Campus
2 hour(s) per Week for 6 Weeks
Practical to occur in weeks 2 to 5, 8 and 10
Tutorial
Face to Face on Campus
2 hour(s) per Week for 6 Weeks
Tutorial to occur in weeks 2 to 5, 8 and 10

Unit Weighting 10

Workload Students are required to spend on average 120-140 hours of effort

(contact and non-contact) including assessments per 10-unit
course.
CONTACTS
Course Coordinator Callaghan
Dr Wei-Ju Chang
[email protected]
(02) 4921 5110

Teaching Staff Other teaching staff will be advised on the course Canvas
site.

School Office School of Health Sciences

Room 302, ICT Building
Callaghan
[email protected]
+61 2 4921 7053

SYLLABUS
Course Content 1. Clinical reasoning skills needed for planning and
interpreting the clinical examination of more complex
musculoskeletal disorders, in addition to planning and
implementing an individual rehabilitation program
2. Multidisciplinary approach to the management of
selected complex musculoskeletal disorders
3. Exercise prescription: advanced procedures/preventive
applications, indications/contraindications, adaptation
and progression, including, strengthening, conditioning,
periodisation
4. Biopsychosocial models for the management of
persistent pain
5. Psychosocial considerations in managing patients with
selected complex musculoskeletal disorders, including
chronic pain and psychosocial risk factors (flags)
6. Sophisticated outcome measures, including the
reliability, validity and responsiveness of functional
measures
7. Modify and progress advanced musculoskeletal
physiotherapy interventions in response to changes in
outcome measures
8. The use of statistical processes such as clinical prediction
rules and diagnostic statistics and their role within a
clinical reasoning context

Course Learning On successful completion of this course, students will

Outcomes be able to:
1. Apply biomedical and behavioural scientific knowledge
to the evaluation and management of complex
musculoskeletal disorders

2. Demonstrate a well-developed clinical reasoning and

evidence-based approach to decision-making in
musculoskeletal physiotherapy clinical practice
 3. Understand the role of diagnostic statistics in evaluation
of musculoskeletal disorders

4. Adapt the clinical examination for more complex

disorders of the musculoskeletal system, integrating
advanced physical examination procedures

5. Appropriately select, modify as necessary, and correctly

demonstrate advanced active and passive treatment
procedures commonly used in the management of
musculoskeletal dysfunction

6. Apply sophisticated treatment evaluation and

intervention outcome processes appropriate for
musculoskeletal physiotherapy practice

Course Materials Textbooks:

Brody, L. T., & Hall, C. M. (2018). Therapeutic Exercise: Moving
Toward Function, 4th ed.
Philadelphia: Lippincott Williams and Wilkins.
Brukner, P., & Khan, K. (2017). Clinical Sports Medicine, 5th
ed. Sydney: McGraw-Hill.

Recommended texts:
Hengeveld, E., & Banks, K. (2014). Maitland’s Peripheral
Manipulation, 5th ed. Edinburgh:
Churchill-Livingstone.
Hengeveld, E., & Banks, K. (2013). Maitland's Vertebral
Manipulation, 8th ed. Edinburgh: Churchill-Livingstone.
Jones, M. A., & Rivett, D. A. (2019). Clinical Reasoning in
Musculoskeletal Practice (2nd edn.). Edinburgh: Elsevier.

Further specific references will be indicated during the course

by the relevant lecturer.
ASSESSMENTS
This course has 3 assessments. Each assessment is described in more detail in the sections below.

Assessment Name Due Date Involvement Weighting Learning

Outcomes
1 Formal Exam Examination period Individual 50% 1, 3, 6
2 Clinical Reasoning Friday of Weeks 6, 7, 9, 11 Individual 20% (4x5% each) 1, 2, 3, 4, 5, 6
Case Exercises x 4
3 Clinical Reasoning Friday of Week 12 Individual 30% 1, 2, 3, 4, 5, 6
Case Examination

Late Submissions The mark for an assessment item submitted after the
designated time on the due date, without an approved
extension of time, will be reduced by 10% of the possible
maximum mark for that assessment item for each day or part
day that the assessment item is late. Note: this applies equally
to week and weekend days.

Assessment 1 - Formal
Exam
Assessment Type Formal Examination
Description Written exam (2 hours)
Weighting 50%
Due Date
Submission Method
Assessment Criteria
Return Method Nil
Feedback Provided Nil

Assessment 2 - Clinical Reasoning Case Exercises x 4

Assessment Type Case Study / Problem Based Learning
Description Four (4) short clinical reasoning exercises (15 minutes each)
Weighting Each exercise worth 5% each. Total 20%
Due Date Friday of Weeks 6, 7, 9, 11
Submission Method Online
Assessment Criteria Response to targeted questions
Return Method Nil
Feedback Provided Online

Assessment 3 - Clinical Reasoning Case Examination

Assessment Type Case Study / Problem Based Learning
Description Complete patient case examination (1 hour)
Weighting 30%
Due Date Friday of Week 12
Submission Method Online
Assessment Criteria Response to targeted questions
Return Method Nil
Feedback Provided Online

ADDITIONAL INFORMATION
Grading Scheme This course is graded as follows:
Range of Grade Description
Marks
85-100 High Outstanding standard indicating comprehensive
Distinction knowledge and understanding of the relevant
(HD) materials; demonstration of an outstanding level
of academic achievement; mastery of skills*; and
achievement of all assessment objectives.
75-84 Distinction Excellent standard indicating a very high level of
(D) knowledge and understanding of the relevant
materials; demonstration of a very high level of
academic ability; sound development of skills*;
and achievement of all assessment objectives.
65-74 Credit Good standard indicating a high level of
(C) knowledge and understanding of the relevant
materials; demonstration of a high level of
academic achievement; reasonable development
of skills*; and achievement of all learning
outcomes.
50-64 Pass Satisfactory standard indicating an adequate
(P) knowledge and understanding of the relevant
materials; demonstration of an adequate level of
academic achievement; satisfactory
development of skills*; and achievement of all
learning outcomes.
0-49 Fail Failure to satisfactorily achieve learning
(FF) outcomes. If all compulsory course components
are not completed the mark will be zero. A fail
grade may also be awarded following disciplinary
action.

*Skills are those identified for the purposes of assessment task(s).

Communication Communication methods used in this course include:

Methods

Course Evaluation Each year feedback is sought from students and other
stakeholders about the courses offered in the University for the
purposes of identifying areas of excellence and potential
improvement.

Oral Interviews As part of the evaluation process of any assessment item in this
(Vivas) course an oral examination (viva) may be conducted. The
purpose of the oral examination is to verify the authorship of the
material submitted in response to the assessment task. The oral
examination will be conducted in accordance with the principles
set out in the Oral Examination (viva) Procedure. In cases where
the oral examination reveals the assessment item may not be the
student's own work the case will be dealt with under the Student
Conduct Rule.

Academic All students are required to meet the academic integrity standards
Misconduct of the University. These standards reinforce the importance of
integrity and honesty in an academic environment. Academic
Integrity policies apply to all students of the University in all modes
of study and in all locations. For the Student Academic Integrity
Policy, refer to https://policies.newcastle.edu.au/document/view-
current.php?id=35.
Adverse The University acknowledges the right of students to seek
Circumstances consideration for the impact of allowable adverse circumstances
that may affect their performance in assessment item(s).
Applications for special consideration due to adverse
circumstances will be made using the online Adverse
Circumstances system where:
1. the assessment item is a major assessment item; or
2. the assessment item is a minor assessment item and the
Course Co-ordinator has specified in the Course Outline that
students may apply the online Adverse Circumstances system;
3. you are requesting a change of placement; or
4. the course has a compulsory attendance requirement.

Before applying you must refer to the Adverse Circumstance

Affecting Assessment Items Procedure available at:
https://policies.newcastle.edu.au/document/view-
current.php?id=236

Important Policy The 'HELP for Students' tab in UoNline contains important
Information information that all students should be familiar with, including
various systems, policies and procedures.
 PHTY3100 2023 TIMETABLE
Week Lecture 1 Lecture 2 Tutorial Practical

Thursday 9-10 AM Thursday 10-11 AM Friday 9-11 AM (ICT328), Friday 9-11 AM, 11 AM-1
11AM-1 PM (EA102), 1-3 PM PM, 1-3 PM, 3-5 PM (ICT337)
(ICT338)
1 CLINICAL REASONING
Wei-Ju Chang (GP201)
2 DIFFERENTIAL DIAGNOSIS CLINICAL REASONING Session 1 DIFFERENTIAL DIAGNOSIS
Peter Osmotherly (GP201)
3 COMBINED MOVEMENTS ARTHROKINEMATICS OF CLINICAL REASONING Session 2 COMBINED MOVEMENTS
Peter Osmotherly (GP201) MANUAL THERAPY (Pre-recorded LUMBAR SPINE
video)
4 EXERCISE PRESCRIPTION I EXERCISE PRESCRIPTION II CLINICAL REASONING Session 3 COMBINED MOVEMENTS
Lucia Chambers (GP201) Lucia Chambers (MS202) CERVICAL SPINE
5 DIAGNOSTIC STATISTICS CLINICAL REASONING Session 4 EXERCISE PRESCRIPTION
Peter Osmotherly (GP201)
6 CLINICAL PREDICTION RULES
(Pre-recorded video)
7
8 COMPLEX SPORTS INJURIES BIOMECHANICS IN RUNNING CLINICAL REASONING Session 5 BIOMECHANICS IN RUNNING
Lucia Chambers (GP201) Lucia Chambers
*11 am - 12 pm (MS202)
9
10 REHABILITATION OF THE ON-FIELD MANAGEMENT OF CLINICAL REASONING Session 6 ON-FIELD MANAGEMENT OF
ATHLETE SPORTS INJURIES SPORTS INJURIES
Lucia Chambers (GP201) Lucia Chambers
*11 am - 12 pm (MS202)
11
12
*Any changes to the schedule will be announced on Canvas
 PHTY3100 Lecture Series Schedule
Week 1

Clinical reasoning in manual therapy

Aim: To provide an overview of clinical reasoning theories and processes as they apply
to musculoskeletal examination.

Leaning objectives: At the end of this lecture, students will be able to:
1. Describe the relationship of evidence based practice within a clinical reasoning
framework.
2. Understand the main models, processes and strategies proposed for clinical
reasoning.
3. Comprehend the collaborative role of clinical reasoning practiced within a patient
centred paradigm.
4. Understand common errors occurring during a clinical reasoning process.
5. Understand available strategies to develop and improve clinical reasoning skills.

Essential reading:
Jones, M. A., & Rivett, D. A. (2004). Clinical Reasoning for Manual Therapists.
Edinburgh: Butterworth-Heinemann. Chapter 1.

Week 2

Differential diagnosis

Aim: To develop an understanding of the principles of differential diagnosis and the

associated physical examination skills.

Learning Objectives: At the end of this lecture, students will be able to:
1. Discuss the principles of differential diagnosis for musculoskeletal pain.
2. Demonstrate an understanding of the types of differentiation
▪ Contractile vs. non-contractile
▪ Spinal vs. peripheral
▪ Joint vs. joint (adjacent)
▪ Intra- vs. extra-articular

Essential Reading:
Maitland, G. D., Hengeveld, E., Banks, K., & English, K. (2005). Maitland's Vertebral
Manipulation (7th ed.). Edinburgh: Butterworth-Heinemann, pp 162-169.

Petty, N. J. (2006). Neuromusculoskeletal Examination and Assessment: A Handbook

for Therapists (3rd ed.). Edinburgh: Churchill Livingstone., pp 53.

Recommended Reading:
Grieve, G. P. (1991). Mobilisation of the Spine: A Primary Handbook of Clinical Method
(5th ed.). Edinburgh: Churchill Livingstone, pp 130-133.
 Week 3

Combined movements of the spine

Aim: To familiarise the student with the concepts of assessment and treatment of
spinal disorders using an approach emphasising combined and coupled movements.

Learning Objectives: At the end of this lecture, students will be able to:
1. Be reacquainted with the anatomy and functional biomechanics of movement
of the lumbar and lower cervical spine.
2. Understand the concepts of regularity and irregularity of movement patterns
in the examination of spinal disorders.
3. Comprehend and create a “Box Diagram”.
4. Understand how the relationship between pain and resistance can alter in
different treatment positions.
5. Describe the rationale behind selecting an initial treatment for a presenting
spinal disorder using Combined Movements.

Essential Reading:
Edwards, B.C. (1994). Combined movements in the lumbar spine; their use in
examination and treatment. In Boyling, J.D. and Palastanga, N. (eds), Grieves
Modern Manual Therapy of the Vertebral Column. (2nd ed.) Edinburgh. Churchill
Livingstone. Pp 745-752.

Further Reading:
Barrett, C.J., Singer, K.P., Day, R. (1999). Assessment of combined movements of
the lumbar spine in asymptomatic and low back pain subjects using a three-dimensional
electromagnetic tracking system. Manual Therapy, 4(2), 94-99.

Edwards, B.C. (1999). Manual of Combined Movements (2nd ed). Edinburgh. Churchill
Livingstone.

Arthrokinematics in manual therapy

Aim: To provide an understanding of the arthrokinematics associated with manual

therapy techniques.

Learning Objectives: At the end of this lecture, students will be able to:
1. Describe the kinematics and kinetics of passive joint mobilisation.
2. List the components of manual therapy that contribute to the treatment
dose.
3. Understand patient responses to mobilisation forces.
4. Demonstrate an awareness of the evidence for proposed biological
mechanisms for the effects of manual therapy.
5. Discuss the factors associated with an alteration in mobilisation stiffness.
6. Discuss the factors that affect a therapist’s perception of patient stiffness.

Essential Reading:
Snodgrass SJ, Rivett DA, Robertson VJ (2006). Manual forces applied during
posterior to anterior spinal mobilization: A review of the evidence. Journal of
Manipulative and Physiological Therapeutics, 29 (4), 316-329.
Shirley, D. (2004). Manual therapy and tissue stiffness. In Boyling, J. D., Jull, G. A.
(eds.). Grieve’s Modern Manual Therapy: The Vertebral Column (3rd ed.). Edinburgh:
Churchhill Livingstone.

Further Reading:
Lee, M., Gal, J., & Herzog, W. (2000). Biomechanics of manual therapy. In Clinical
Biomechanics (Z. Dvir, ed.). New York: Churchill Livingstone, pp. 209-238.

Threlkeld, A. J. (1992) The effects of manual therapy on connective tissue. Physical

Therapy 72(12): 893-902.

Week 4

Exercise prescription – upper limb

Aim: To provide an overview of specific strengthening, stretching, and

proprioception exercise techniques for treating musculoskeletal disorders of the
upper limb.

Learning Objectives: At the end of this lecture, students will be able to:
1. Design an exercise program for the upper limb that achieves a specific
rehabilitation goal related to an upper limb musculoskeletal disorder.
2. Understand the clinical reasoning underpinning the prescription of specific
exercises for the upper limb.
3. Discuss the indications for strengthening, stretching, proprioceptive and
functional exercises for the upper limb.
4. Understand the potential risks of performing certain exercises or movements
in the presence of musculoskeletal injury in the upper limb.
5. Prescribe an exercise to improve a component of functional movement in the
upper limb.
6. Discuss the evidence for exercise in the treatment of musculoskeletal
disorders of the upper limb.

Essential Reading:
Hall, C. M. & Brody, L. T. (2005). Therapeutic exercise: moving toward function (2nd
ed.). Philadelphia: Lippincott Williams and Wilkins, pp 653-685, 715-736.

Brukner, P. & Khan, K. (2007). Clinical Sports Medicine (3rd ed.). Sydney: McGraw-
Hill, pp 276-286

Recommended Reading:
Kibler, W. B., McMullen, J. (2001) Shoulder rehabilitation strategies, guidelines, and
practice. Orthopedic Clinics of North America, 32(3), 527-38.

DePalma, M. J., Johnson, E. W. (2003) Detecting and treating shoulder impingement

syndrome: The role of scapulothoracic dyskinesis. The Physician and Sportsmedicine,
31(7), 25-32.

McMullen, J., Uhl, T. L. (2000) A kinetic chain approach for shoulder rehabilitation.
Journal of Athletic Training, 35(3), 329-337.
 Exercise prescription – lower limb

Aim: To provide an overview of specific strengthening, stretching, and

proprioception exercise techniques for musculoskeletal disorders of the lower limb.

Learning Objectives: At the end of this lecture, students will be able to:
1. Design an exercise program for the lower limb that achieves a specific
rehabilitation goal related to a lower limb musculoskeletal disorder.
2. Understand the clinical reasoning underpinning the prescription of specific
exercises for the lower limb.
3. Discuss the indications for strengthening, stretching, proprioceptive and
functional exercises for the lower limb.
4. Understand the potential risks of performing certain exercises or movements
in the presence of musculoskeletal injury in the lower limb.
5. Prescribe an exercise to improve a component of functional movement in the
lower limb.
7. Discuss the evidence for exercise in the treatment of musculoskeletal
disorders of the lower limb.

Essential Reading:
Hall, C. M. & Brody, L. T. (2005). Therapeutic Exercise: Moving Toward Function (2nd
ed.). Philadelphia: Lippincott Williams and Wilkins, pp 450-482, 494-520, 535-549.

Brukner, P. & Khan, K. (2007). Clinical Sports Medicine (3rd ed.). Sydney: McGraw-
Hill, pp 414-416, 450-453, 475-488, 519-522, 600-602, 618-622.

Recommended viewing:
Brukner, P. & Khan, K. (2007). Clinical Sports Medicine (3rd ed.) DVD. Sydney:
McGraw-Hill. View Rehabilitation of Acute knee, Patellofemoral, and Patellar tendon.

Further Reading:
Escamilla, R., Fleisig, G., Zheng, N., Barrentine, S., Wilk, K. E., Andrews, J. (1998)
Biomechanics of the knee during closed kinetic chain and open kinetic chain
exercises. Medicine and Science in Sports and Exercise, 30(4), 556-569.

MacAuley, D., Best, T. (2002) Evidence-based Sports Medicine. London: BMJ Books,
pp181-195.

Huang, M., Lin, Y., Yang, R., Lee, C. (2003) A comparison of various therapeutic
exercises on the functional status of patients with knee osteoarthritis. Seminars in
Arthritis and Rheumatism, 32(6), 398-406.

Week 5

Diagnostic statistics

Aim: To develop an understanding of the use and meaning of commonly diagnostic

statistics.
Learning Objectives: At the end of this lecture, students will be able to:
 1. Describe the extent to which test results can influence diagnostic hypotheses.
2. Understand the role of diagnostic statistics within an evidence based practice and a
clinical reasoning context.
3. Define and understand the terms sensitivity, specificity, predictive value, likelihood
ratio, pre and post-test probability.
4. Apply likelihood ratios using a nomogram to calculate the change in post-test
probability of a given test result.

Essential reading:
Davidson M. (2002). The interpretation of diagnostic tests: A primer for physiotherapists.
Australian Journal of Physiotherapy. 48:227-233.

Week 6

Clinical prediction rules

Aim: To introduce the student to the concept of clinical prediction rules and the concept of
probabilistic reasoning.
Learning Objectives: At the end of this lecture, students will be able to:
1. Understand what meant by the term probabilistic reasoning.
2. Be able to define a clinical prediction rule (CPR), including the various types of CPR
proposed.
3. Understand the positions for and against the use of statistical prediction models in
clinical care.
4. Discuss the role of CPR’s in a broader clinical reasoning context.

Recommended Reading:
Haskins R, Rivett DA, Osmotherly PG. (2012). Clinical prediction rules in the
physiotherapy management of low back pain. A systematic review. Manual Therapy, 17:9-
21
Nee RJ, Coppieters MW. (2011). Interpreting research on clinical prediction rules for
physiotherapy treatments. Manual Therapy, 16:105-108.

Week 8
Biomechanics in running

Aim: To provide an overview of the analysis of running gait, and discuss

biomechanical abnormalities associated with musculoskeletal symptoms in the
running athlete.

Learning Objectives: At the end of this lecture, students will be able to:
1. Describe the ground reaction forces that occur at the foot during running.
2. Describe specific joint kinematics during the running gait cycle.
3. Describe the function of muscle groups during the running gait cycle.
4. Discuss the effect of training schedule on running injuries, and describe a
return-to-running program following injury.
5. Discuss common injuries in running athletes and relate them to running
biomechanics.
6. Discuss selected biomechanical issues related to other sporting activities
 including the overhead throw and the free-style swimming stroke.

Essential Reading:
Brukner, P. & Khan, K. (2012). Clinical Sports Medicine (4th ed.). Sydney: McGraw-
Hill, pp 61-107.

Novacheck, T.F. (1998). Running injuries: A biomechanical approach. Journal of

Bone and Joint Surgery (American), 80(8), 1220-1233.

Further Reading:
Schache, A. G., Blanch, P., Rath, D., Wrigley, T. and Bennell, K. (2003) Differences
between the sexes in the three-dimensional angular rotations of the lumbo-pelvic-hip
complex during treadmill running. Journal of Sport Sciences, 21,105-118.

van Mechelen, W. (1992) Running injuries: A review of the epidemiological

literature. Sports Medicine, 14(5), 320-335.

Hoke, B. R. (2001). Running. In Sports Injury: Prevention and Rehabilitation,

Shamus, E. and Shamus, J., eds. New York: McGraw-Hill, pp 241-266.

Complex sports injuries and their management

Aim: To review key components of the assessment and treatment of complex

sports-related injuries that are seen frequently in the clinical setting, including ACL
tears, patellofemoral pain, shoulder instability, recurrent ankle sprains, and chronic
muscle strains.

Learning Objectives: At the end of this lecture, students will be able to:
1. Discuss the assessment and management of complex sports-related injuries
that can be resistant to physiotherapy treatment.
2. Describe the process of physiotherapy management, including principles of
treatment and management of training and playing time for specific complex
sports-related injuries.
3. Discuss the clinical reasoning behind interventions to control patellofemoral
pain, and list the sports commonly linked with PFP.
4. Discuss rehabilitation issues and functional restoration following ACL repair.
5. Describe rehabilitation methods to improve stability in the shoulder of an
overhead athlete and discuss guidelines for activity.
6. Describe strategies for facilitating advanced proprioception skills in the athlete
with recurrent ankle sprains.
7. Discuss key issues in the rehabilitation of chronic muscle strains.

Essential Reading:
Brukner, P. & Khan, K. (2007). Clinical Sports Medicine (3rd ed.). Sydney: McGraw-
Hill, pp 472-494 (ACL), 506-537 (anterior knee pain), 243-288 (shoulder), 405-426
(chronic groin pain), 590-645 (achilles and ankle).

Further Reading:
Prentice, W. (2003), Arnheim’s Principles of Athletic Training: A Compentency-based
Approach (11th ed.). Boston, McGraw-Hill, pp. 630-635.
Wilk, K. E., Meister, K., Andrews, J. R. (2002) Current concepts in the rehabilitation
of the overhead throwing athlete. The American Journal of Sports Medicine, 30(1),
136-151.

Crossley, K., Bennell, K., Green, S., Cowan, S., McConnell, J. (2002) Physical therapy
for patellofemoral pain: A randomized double-blinded, placebo-controlled trial. The
American Journal of Sports Medicine, 30(6), 857-865.

Crossley, K., Bennell, K., Green, S., and McConnell, J. (2001) A systematic review of
physical interventions for patellofemoral pain syndrome. Clinical Journal of Sports
Medicine, 11(2),103-110.

Lynch, S.A., Renstrom, P. A. F. H. (1999) Groin injuries in sport: Treatment

strategies. Sports Medicine, 28(2), 137-144.

Week 10

Rehabilitation of the athlete

Aim: To review key criteria for return to competition after injury and rehabilitation
and assessment strategies that will ensure the athlete has achieved full function.

Learning Objectives: At the end of this lecture, students will be able to:
1. List key criteria for return to full activity in terms of athletic performance and
reducing risk of re-injury.
2. Discuss rehabilitation strategies used in the later stages of recovery from
injury, including strategies to improve strength, endurance, proprioception,
cardiorespiratory fitness, and sport-specific functional demands.
3. Discuss methods of assessment that can be used to determine if the athlete is
ready to return to full activity.
4. Discuss the physiotherapist’s role in monitoring psychological factors and
educating the athlete about their responsibility to monitor pain signals and
recognise potential re-injury situations.
5. Discuss the roles of members of the athlete’s support system, including team
physician, coach, sports trainer, family and others, and how the
physiotherapist can best function within this team framework.

Essential Reading:
Brukner, P. & Khan, K. (2007). Clinical Sports Medicine (3rd ed.). Sydney: McGraw-
Hill, pp 174-196, 716-723, 954-967, 1006-1012.

Jones, M. A. & Rivett, D. A. (2004). Clinical Reasoning for Manual Therapists.

Edinburgh: Butterworth-Heinemann, 194-205.

Further Reading:
Davies, G. J., Wilk, K., Ellenbecker, T. S. (1997) Assessment of strength. In Malone,
T., McPoil, T, & Nitz, A. Orthorpedic and Sports Physical Therapy (3rd ed.). St. Louis:
Mosby-Yearbook, Inc., pp 225-246.

Reinhold, M.M., and Wilk, K.E. (2003). Elbow. In Kolt, G.S., & Snyder-Mackler, L.
(Eds.) Physical Therapies in Sport and Exercise. Edinburgh: Churchill Livingstone,
pp306-310.

Saxon, L., Finch, C., and Bass, S. (1999) Sports participation, sports injuries and
osteoarthritis. Sports Medicine, 28(2), 123-135.

On-field management of sports injuries

Aim: To provide an overview of common acute injuries encountered in the sports

arena, and the immediate onsite management of such injuries.

Learning Objectives: At the end of this lecture, students will be able to:
1. Demonstrate an understanding of the importance of establishing a plan for
handling emergency situations.
2. Discuss the components of the primary and secondary survey in relation to
the assessment of on-field injuries.
3. Describe the types of haemorrhage and their management.
4. Recognise signs and symptoms of shock and explain the management of
different types of shock.
5. Demonstrate an understanding of the various grading systems for severity of
concussion, and describe the process of sideline and follow-up management
of concussions.
6. Describe techniques for moving and transporting the injured athlete,
particularly the components of transferring the athlete with a suspected spinal
injury.
7. Discuss various musculoskeletal assessment techniques used on-field to
assess the severity of injury.

Essential Reading:
Brukner, P. & Khan, K. (2007). Clinical Sports Medicine (3rd ed.). Sydney: McGraw-
Hill, pp 3-7, 201-206, 789-802.

Starkey, R., Ryan, J., (2002) Evaluation of Orthopedic and Athletic Injuries (2nd ed.).
Philadelphia: F. A. Davis Company, pp19-22, 25, 180-184, 239-241, 298-301, 420-
423, 484-488, 516-517, 564-565, 606-608, 637-650, 664-666, 678.

Further Reading:
Prentice, W. (2003), Arnheim’s Principles of Athletic Training: A Compentency-based
approach (11th ed.). Boston, McGraw-Hill, pp. 301-339, 885-896
 PHTY3100 Practical Schedule

Week 2

Title: Differential diagnosis

Aims: To develop physical examination skills that utilise the principles of differential
diagnosis.

Learning Objectives: By the end of this lab session, the student should be able to:
1. Perform appropriate differential diagnostic procedures in the physical
examination of the spine and the periphery.

Class Activities:
1. Introduction and discussion of lab objectives.
2. Discussion of principles of differential diagnosis for musculoskeletal pain led
by educator (contractile v. non-contractile tissues, intra-articular v. extra-articular
structures, adjacent joints etc).
3. Demonstration by educator of specific physical skills used in the spine and
periphery to facilitate differential diagnosis of structures.
4. Student practice of differential diagnostic examination procedures.

Essential Reading:
Christensen, N., Jones, M., Edwards, I. (2004). Clinical reasoning in the diagnosis
and management of spinal pain. In Boyling, J. D. & Jull, G. A. Grieve’s Modern
Manual Therapy: The Vertebral Column (3rd ed.). pp. 391-403. Edinburgh: Churchill
Livingstone.

Week 3

Title: Combined movements – Lumbar spine

Aims: To develop skills in undertaking the clinical examination and treatment of a

patient using a combined movements approach.

Learning Objectives: By the end of this lab session, the student should be able to:
1. Describe the structure of a physical examination of both the lumbar and
mid/lower cervical regions incorporating a combined movements examination
to highlight aspects of examination findings of the standard examination.
2. Interpret information gained from a combined movements examination and
describe the pattern of presentation.
3. Appreciate the differences in passive movement of both accessory and
physiological examination procedures for the lumbar and mid/lower cervical
regions when performed away from the neutral position.
4. Select and perform an initial treatment for a presenting patient.
5. Discuss the variables related to treatment progression.

Student Requirements: Appropriate clothing for student to act as a model for

both cervical and lumbar spine assessment and treatment.
Class Activities:
1. Demonstration of examination procedures for the lumbar spine incorporating
combined movements procedures.
2. Discussion of the reasoning underlying the combined movements examination
procedures for the lumbar region and the interpretation of responses.
3. Discussion of the biomechanical theory relevant to accessory and
physiological movements in combined positions.
4. Student performance of lumbar combined movements examination
procedures in pairs with feedback.
5. Demonstration of lumbar spine passive movement treatment procedures
using a combined movements approach.
6. Student performance of lumbar spine passive movement treatment
procedures in pairs with feedback.
7. Demonstration of examination procedures for the mid/lower cervical spine
incorporating combined movements procedures and discussion of the
reasoning underlying these procedures.
8. Student performance of mid/lower cervical combined movements examination
procedures in pairs with feedback.
9. Demonstration of mid/lower cervical spine passive movement treatment
procedures using a combined movements approach followed by student
performance of these procedures in pairs with feedback.
10. Review of the selection of an initial treatment.
11. Discussion of the variables affecting treatment progression.

Equipment: spines

Essential Reading:
Edwards, B.C. (1999). Manual of Combined Movements. (2nd ed.) Edinburgh.
Churchill Livingstone. Chapters 3 and 5.

Week 4

Title: Combined movements – Cervical spine

Aims: To further develop skills in undertaking the clinical examination and treatment
of a patient using a combined movements approach.

Learning Objectives: By the end of this lab session, the student should be able to:
1. Describe the structure of a physical examination of the
mid/lower cervical regions incorporating a combined movements examination
to highlight aspects of examination findings of the standard examination.
2. Interpret information gained from a combined movements examination and
describe the pattern of presentation.
3. Appreciate the differences in passive movement of both accessory and
physiological examination procedures for the mid/lower cervical
regions when performed away from the neutral position.
4. Select and perform an initial treatment for a presenting patient.
5. Discuss the variables related to treatment progression.

Student Requirements: Appropriate clothing for student to act as a model for

both cervical and lumbar spine assessment and treatment.
Class Activities:
1. Demonstration of examination procedures for the cervical spine incorporating
combined movements procedures.
2. Discussion of the reasoning underlying the combined movements examination
procedures for the cervical region and the interpretation of responses.
3. PHTY3040 Musculoskeletal Physiotherapy II – Course Manual 2010 48
4. Discussion of the biomechanical theory relevant to accessory and
physiological movements in combined positions.
5. Student performance of cervical combined movements examination
procedures in pairs with feedback.
6. Demonstration of cervical spine passive movement treatment procedures
using a combined movements approach.
7. Student performance of cervical spine passive movement treatment
procedures in pairs with feedback.
8. Review of the selection of an initial treatment.
9. Discussion of the variables affecting treatment progression.

Equipment: spines

Essential Reading:
Edwards, B.C. (1999). Manual of Combined Movements. (2nd ed.) Edinburgh. Churchill
Livingstone. Chapters 3 and 5.

Week 5

Title: Exercise prescription

Aims: To develop skills in the application of therapeutic exercise in the management
of specific musculoskeletal disorders of the upper and lower limbs.

Learning Objectives: By the end of this lab session, the student should be able to:
1. Demonstrate skills in exercise prescription for selected musculoskeletal
disorders common in clinical practice.
2. Demonstrate biomechanical knowledge of the correct limb positioning for
prescribed exercises.
3. Demonstrate skills in verbalising the rationale and treatment goals for
prescribed exercises.
4. Effectively instruct a patient to perform an exercise using correct
technique.
5. Progress an exercise program considering the components of
ROM/flexibility, strength, proprioception, and functional and sport specific
activity.

Student Requirements: Appropriate clothing to allow for freedom of movement.

Class Activities:
1. Small groups to work together to design an exercise program for a patient
based on a case scenario.
2. PHTY3040 Musculoskeletal Physiotherapy II – Course Manual 2010 52
3. Small groups to present their exercise program to the class with the
inclusion of:
 ▪ discussion of exercise program
▪ demonstration of exercises
▪ discussion of appropriate patient explanation of the exercises
▪ rationale/goals for the exercises chosen
▪ progression of the exercise program
4. Class discussion of the above issues following presentations of exercise
programs.

Equipment: mini-tramp, therbands and tubing, weights (hand weights 1 and 2 kg,
and velcro cuff weights), medicine balls (the heavy small ones), discs (AOK
duradisc), biofeedback (pressure), one long balance beam, 2 yellow boxes (one
large, one small 10cm, 2 exercise balls (55 and 65 cm), one walking stick

Essential Reading:
Hall, C. M. & Brody, L. T. (2005). Therapeutic Exercise: Moving Toward Function (2nd
ed.). Philadelphia: Lippincott Williams and Wilkins, pp. 35-46.

Kolt, G.S., & Snyder-Mackler, L. (Eds.). (2003). Physical Therapies in Sport and
Exercise. (pp. 301-304). Edinburgh: Churchill Livingstone.

Wilk, K. E., Meister, K., Andrews, J. R. (2002). Current concepts in the rehabilitation
of the overhead throwing athlete. The American Journal of Sports Medicine, 30(1),
136-151.

Jones, M. A. & Rivett, D. A. (2004). Clinical Reasoning for Manual Therapists.

Edinburgh: Butterworth-Heinemann, pp 180-193, 161-179.

Further Reading:
Townsend, H., Jobe, F., Pink, M., Perry, J. (1991) Electromyographic analysis of the
glenohumeral muscles during a baseball rehabilitation program. The American
Journal of Sports Medicine, 19(3), 264-272.

Moseley, J. B., Jobe, F. W., Pink, M., Perry, J., and Tibone, J. (1992) EMG analysis of
the scapular muscles during a shoulder rehabilitation program. The American Journal
of Sports Medicine, 20(2), 128-134.

Week 8

Title: Biomechanics in sport

Aims: To develop the skills necessary to assess and analyse running gait and sport
specific movements.

Learning Objectives: By the end of this lab session, the student should be able to:
1. Apply the components of gait to running.
2. Recognise differences in the analysis of walking and running.
3. Observe asymmetries during running gait that may predispose a runner to
injury.
4. Recognise and describe the phases of overhead throwing (and apply to
sport such as the tennis serve or overhead volleyball serve).
5. Describe proper positioning of the cyclist and recognise asymmetries
 during cycling that may predispose the cyclist to injury.
6. Describe the phases of the swimming stroke (freestyle) and recognise
abnormalities that may predispose the swimmer to injury.

Student Requirements: Bring running shoes and be prepared to run or cycle.

Class Activities:
1. Tutorial on analysis of running gait, analysis of cycling, analysis of
2. overhead throwing.
3. Class to break into groups for analysis of sport activity:
▪ Running on treadmill
▪ Running on flat surface
▪ Overhead throw or tennis serve
▪ Cycling
▪ Freestyle swimming (video)

Equipment: treadmill, bicycle and bicycle trainer, tennis racquets, tennis balls,
digital video camera mounted on rolling cart and connected to television or data
projector so can be viewed by class, laptop and data projector to viewing digital
video

Essential Reading:
Johnson, J. J., Gauvin, J., Fredericson, M. (2003) Swimming biomechanics and injury
prevention: New stroke techniques and medical considerations. The Physician and
Sportsmedicine, 31(1), 41-46.

Lefever-Button, S. (2001). Cycling. In Sports Injury: Prevention and Rehabilitation,

Shamus, E. and Shamus, J., eds. New York: McGraw-Hill, pp 459-483.

Fleisig, G. S., Barrentine, S. W., Escamilla, R. F., and Andrews, J. R. (1996)

Biomechanics of overhead throwing with implications for injuries. Sports Medicine
21(6), 421-437.

Further Reading:
Shapiro, C. (2001). Swimming. In Sports Injury: Prevention and Rehabilitation,
Shamus, E. and Shamus, J., eds. New York: McGraw-Hill, pp 103-154.

Mann, R. A., Hagy, J. (1980) Biomechanics of walking, running and sprinting. The
American Journal of Sports Medicine, 8(5), 345-350.

Pink, M., Perry, J., Browne, A., Scovazzo, M., Kerrigan, J. (1991) The normal
shoulder during freestyle swimming: an electromyographic and cinematographic
analysis of twelve muscles. The American Journal of Sports Medicine, 19(6), 569-
573.

Week 10

Title: On-field management of sports injuries

Aims: To develop skills in the acute management of sporting injuries.

Learning Objectives: By the end of this lab session, the student should be able to:
 1. Log roll an injured athlete on to a spine board while manually stabilising
the neck.
2. Perform a standard evaluation for concussion.
3. Perform an acute knee assessment, including performing a Lachman’s test
on the ground.
4. Perform selected manual conveyance techniques.

Student Requirements: Appropriate attire to participate in the lab outdoors, and

lie on grass.

Class Activities:
1. Tutorial demonstration followed by practice of:
▪ Spine board transfer
▪ Manual conveyance
▪ Concussion assessment
▪ Acute knee assessment
2. On-field case scenarios

Equipment: spine board and straps, neck collar, long leg knee brace

Essential Reading:
Starkey, R., Ryan, J., (2002). Evaluation of Orthopedic and Athletic Injuries (2nd ed.).
Philadelphia: F. A. Davis Company. Pages on on-field evaluation in each section:19-
22, 25, 180-184, 239-241, 298-301, 420-423, 484-488, 516-517, 564-565, 606-608,
637-650, 664-666, 678.

Further Reading:
Brukner, P. & Khan, K. (2007). Clinical Sports Medicine (3rd ed.). Sydney: McGraw-
Hill, pp.789-802.

MacAuley, D., Best, T. (2002) Evidence-based Sports Medicine. London: BMJ Books,
pp66-82, 97-116, 117-131.
 PHTY3100 CLINICAL REASONING
WORKSHOPS
Title: Clinical reasoning sessions.

Aims: To develop specific clinical reasoning skills required to effectively assess and
treat a variety of patients in a variety of clinical settings.

Learning Objectives:
By the end of the series of clinical reasoning sessions, each student should be able to:
1. Demonstrate an understanding of the clinical reasoning underpinning the
2. selection of assessment and treatment in a particular case scenario.
3. Demonstrate an understanding of the multidisciplinary approach to the
4. management of patients with complex musculoskeletal disorders.
5. Discuss relevant lifespan, gender, cultural, legal and ethical consideration in
6. the management of patients with musculoskeletal disorders.

Class Schedule:
Week 2 Ankle cases
Week 3 Knee and hip cases
Week 4 Shoulder cases
Week 5 Low back pain cases
Week 8 Neck pain cases
Week 10 Persistent pain cases

Class Activities:
In depth discussion of the assessment and treatment of patient cases.