In this chapter, learners will be introduced to the Orthopedic Excellence Series and the constructs of this series, including the Pain and Disability Drivers Management model. Learners will become familiar with common epidemiological terms and statistics that govern diagnostic accuracy and their clinical application.

In this chapter, learners will be introduced to terms that are helpful to understand when contemplating valuable information from a patient history, like incidence, prevalence, risk, and prognosis.

In this chapter, learners will gain a greater understanding of the language of diagnosis and explore the importance of screening, diagnostic accuracy, and quality of diagnostic accuracy studies.

In this chapter, learners will become familiar with the categories of outcome measures and the importance of these measures in performing a thorough patient interview as well as an assessment of treatment effect. Statistics such as minimal detectable change, measures of effect, and floor/ceiling effects will be discussed.

Musculoskeletal disorders are the second most common cause of disability. Chronic conditions continue to worsen, and despite millions of dollars in research and thousands of review and guidelines articles, patient-reported outcomes for those with musculoskeletal injuries have worsened. We now recognize that our lack of progress in achieving better treatment results is rooted in the fact that we have failed to focus on identifying and addressing the factors that really do influence patients’ outcomes. This chapter outlines why our outcomes have worsened and what domains are necessary to assess for better outcomes.

The Pain and Disability Drivers model was created to give clinicians an understanding of which domains influence pain and disability. Five domains are discussed: nociceptive, neuropathic, comorbidity, cognitive-emotional, and social/environmental. Within the five domains, learners will be exposed to subclassifications of conditions that influence severity. Interactions among domains is also discussed.

Nociception and pain are two distinct components. Nociception is the sensory nervous system's response to certain harmful or potentially harmful stimuli. On the other hand, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Nociception can cause the pain experience and is deserving of assessment. In this chapter, we describe key nociceptive triggers and associative examination methods for each.

Neuropathic pain arises as a direct consequence of a lesion or disease affecting the nerves or nervous system. Neuropathic pain may be associated with radiculopathy, myelopathy, and peripheral and/or central nervous system hypersensitivity. In this chapter, we describe the key neuropathic descriptors, tests, and measures used for assessment.

It is well described that comorbidities, sleep hygiene, and severe mental health illness are responsible for mediating health outcomes or worsening outcomes. These factors may influence both pain and disability. Conditions such as osteoarthritis are expected to continue to rise with an increasingly obese, sedentary, and aging population. Standard measurement of these factors should be as principal in a clinical examination as measuring vital signs. In this chapter, we describe key associative examination methods for each.

Much research has gone into understanding how moods and cognitions influence pain and disability outcomes. In fact, more than 5,200 peer-reviewed articles per year are published on this specific topic. Moods and cognitions can elicit a pain experience and can mediate outcomes. Moods and cognitions are particularly important when behaviors are changed in the individual. In this chapter, we describe key associative examination methods for cognitions and moods that influence pain and disability. We also discuss the challenges of medicalization of moods and how to reduce this risk in practice.

Social and environment factors remain the strongest and most elusive of outcomes mediators and moderators. Commonly called "social determinants of health," social and environmental factors can influence outcomes and health-related disability. There is a significant challenge associated with how to measure these factors. In this chapter, we describe key associative examination methods that are transferable for all cultures and populations.

This chapter will review the principles of therapeutic exercise and the physiological principles behind how exercise can facilitate tissue healing. Viewers will be introduced to terminology, including mechanotherapy, or the turning of movement into repair. Introduction of common tissue healing times and physiological adaptations will be discussed, including a discussion on mechanotherapy/mechanotransduction and how exercise promotes tissue repair.

This chapter will review exercise training principles, including progressive overload, specificity, variation, reversibility, and individualization. Recommendations and basic principles of resistance training in accordance with the American College of Sports Medicine are introduced, including training guidelines for strength, power, endurance, hypertrophy, and plyometric training. Progression in terms of duration, speed, distance, and repetitions will be discussed.

We will discuss the principle of "optimal loading," including characteristics of optimal versus suboptimal loading and tissue-specific loading factors. The POLICE principle is explained with regard to acute injury management.

This chapter will discuss clinical decision-making with regard to initiation, progression, and regression of exercise. Further phases of progression will be focused on extrinsic factors, such as change in stimulus or the environment in which the exercise is performed. A sample exercise progression program is provided to the viewer at the end of this chapter.

This chapter will introduce the viewer to a more holistic approach to exercise prescription that blends the technical domain with the cognitive-behavioral domain and methods for improving patient adherence to exercise.

In this chapter, learners will evaluate the economic impact of cervical dysfunction and consider the prevalence/incidence of cervical pain and how this influences clinical practice. The overall burden of cervical pain is discussed in comparison to other musculoskeletal and nonmusculoskeletal conditions worldwide.

In this chapter, learners will discuss the imperative patient history elements of a neck examination and define which patient history components are affiliated with cervical pathology. Learners will also discuss the most common forms of self-reported patient outcome measures as well as their validity.

In this chapter, learners will identify the link between observation of posture and neck pain or dysfunction. Learners will also identify benefits of general observation of a patient’s expression of fear, anxiety, or distress.

In this chapter learners will identify the most prevalent red flags, germane during the cervical spine examination. The chapter will compare and contrast the purposes of each diagnostic test for sinister problems. Learners will also analyze the “triggers” that would prompt the use of a test for ruling out a condition and evaluate the benefit of performing these “ruling out” actions first within the examination. Lastly, learners will understand structural differentiation.

This chapter will synthesize the importance of the movement assessment and will contrast the goals of the three primary phases of the initial examination.

This chapter will evaluate the benefit of palpation as part of a dedicated clinical examination. Learners will also evaluate the benefit and types of manual muscle testing for the cervical spine.

In this chapter, learners will understand the language of diagnostic accuracy and will identify the most diagnostic cervical-oriented special tests. The purpose of the chapter is to apply the tests to the appropriate diagnoses for better patient management.

In this chapter, learners will recognize the more prevalent cervical pathologies seen in musculoskeletal practice. One of the key goals is understanding the etiology behind each of the pathologies and the prognosis of each.

The primary pain and disability drivers for the cervical spine include: 1) nociceptive pain elements, 2) neuropathic pain elements, 3) comorbidity pain and disability elements, 4) mood and cognitive pain and disability elements, and 5) social and environmental factors that influence disability. Each of the domains that is specific to the cervical spine is discussed.

This chapter reviews the techniques used to target pain relief or strength specifically toward the targeted region that is impaired within the cervical spine. The chapter will analyze the effectiveness of each technique for treatment within the local impairment classification.

In this chapter, learners will review the adjunctive techniques used to target the primary impairment and secondary contributors. Learners will analyze the effectiveness of each technique for treatment within the regional designation.

In this chapter, the focus is less on the impairment and more on motor control, proprioception, cognitions, behaviors, and whole-body conditioning. Learners will review techniques associated with lifestyle medicine, global management, and cognitive behavioral approaches.

In this chapter, which represents Case One, learners will evaluate a defined, comprehensive case and will explore key examination and treatment principles based on the Pain and Disability Drivers model, the best examination methods identified from previous coursework, and the best treatment options from previous coursework.

In this chapter, which represents Case Two, learners will evaluate a defined, comprehensive case and will explore key examination and treatment principles based on the Pain and Disability Drivers model, the best examination methods identified from previous coursework, and the best treatment options from previous coursework.

In this chapter, which represents Case Three, learners will evaluate a defined, comprehensive case and will explore key examination and treatment principles based on the Pain and Disability Drivers model, the best examination methods identified from previous coursework, and the best treatment options from previous coursework.

In this chapter, which represents Case Four, learners will evaluate a defined, comprehensive case and will explore key examination and treatment principles based on the Pain and Disability Drivers model, the best examination methods identified from previous coursework, and the best treatment options from previous coursework.

In this chapter, learners will evaluate the economic impact of thoracic dysfunction and consider the prevalence/incidence of thoracic pain and how this influences clinical practice. The overall burden of thoracic pain is discussed in comparison to other musculoskeletal and nonmusculoskeletal conditions worldwide.

In this chapter, learners will discuss the imperative patient history elements of a thoracic examination and define which patient history components are affiliated with thoracic pathology. Learners will also discuss the most common forms of self-report patient outcome measures as well as their validity.

In this chapter, learners will identify the link between observed posture and thoracic pain or dysfunction. Learners will also identify benefits of general observation of a patient’s expression of fear, anxiety, or distress.

In this chapter, learners will identify the most prevalent red flags germane to the thoracic spine examination. The chapter will compare and contrast the purposes of each diagnostic test for sinister problems. Learners will also analyze the triggers that would prompt the use of a test for ruling out a condition and evaluate the benefit of performing these “ruling out” actions first within the examination. Lastly, learners will understand structural differentiation.

This chapter will synthesize the importance of the movement assessment and will contrast the goals of the three primary phases of the initial examination.

This chapter will evaluate the benefit of palpation as part of a dedicated clinical examination. Learners will also evaluate the benefit and types of manual muscle testing for the thoracic spine.

In this chapter, learners will understand the language of diagnostic accuracy and will identify the most diagnostic thoracic-oriented special tests. The purpose of the chapter is to apply the tests to the appropriate diagnoses for better patient management.

In this chapter, learners will recognize the more prevalent thoracic pathologies seen in musculoskeletal practice. One of the key goals is geared toward understanding the etiology behind each of the pathologies and the prognosis of each.

The primary pain and disability drivers for the thoracic spine include: 1) nociceptive pain elements, 2) neuropathic pain elements, 3) comorbidity pain and disability elements, 4) mood and cognitive pain and disability elements, and 5) social and environment factors that influence disability. Each of the domains specific to the thoracic spine is discussed.

This chapter reviews the techniques used to target pain relief or strength specifically toward the targeted region that is impaired within the thoracic spine. The chapter will analyze the effectiveness of each technique for treatment within the local impairment classification.

In this chapter, learners will review the adjunctive techniques used to target the primary impairment and secondary contributors. Learners will analyze the effectiveness of each technique for treatment within the regional designation.

Within this chapter, the focus is less on the impairment and more on motor control, proprioception, cognitions, behaviors, and whole-body conditioning. Learners will review techniques associated with lifestyle medicine, global management, and cognitive behavioral approaches.

In this chapter, which represents Case One, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.

In this chapter, which represents Case Two, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.

In this chapter, which represents Case Three, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.

In this chapter, which represents Case Four, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.

In this chapter, learners will evaluate the economic impact of lumbar dysfunction and consider the prevalence/incidence of lumbar pain and how it influences clinical practice. The overall burden of lumbar pain is discussed in comparison to other musculoskeletal and nonmusculoskeletal conditions worldwide.

In this chapter, learners will discuss the imperative patient history elements of a low back examination and define which patient history components are affiliated with lumbar pathology. Learners will also discuss the most common forms of self-reported patient outcome measures, as well as their validity.

In this chapter, learners will identify the link between observation of posture and lumbar pain or dysfunction. Learners will also identify the benefits of general observation of a patient’s expression of fear, anxiety, or distress.

In this chapter, learners will identify the most prevalent red flags germane to the lumbar spine examination. The chapter will compare and contrast the purposes of each diagnostic test for sinister problems. Learners will also analyze the triggers that would prompt the use of a test for ruling out a condition, and evaluate the benefit of performing these “ruling out” actions first within the examination. Lastly, learners will understand structural differentiation.

This chapter will synthesize the importance of the movement assessment and will contrast the goals of the three primary phases of the initial examination.

This chapter will evaluate the benefit of palpation as part of a dedicated clinical examination. Learners will also evaluate the benefit and types of manual muscle testing for the lumbar spine.

In this chapter, learners will understand the language of diagnostic accuracy and will identify the most diagnostic lumbar-oriented special tests. The purpose of the chapter is to apply the tests to the appropriate diagnoses for better patient management.

In this chapter, learners will recognize the more prevalent lumbar pathologies seen in musculoskeletal practice. One of the key goals is geared toward understanding the etiology behind each of the pathologies, and the prognosis of each pathology.

The primary pain and disability drivers for the lumbar spine include: 1) nociceptive pain elements, 2) neuropathic pain elements, 3) comorbidity pain and disability elements, 4) mood and cognitive pain and disability elements, and 5) social and environment factors that influence disability. Each of the domains specific to the lumbar spine is discussed.

This chapter reviews the techniques used to target pain relief or strength specifically toward the region that is impaired within the lumbar spine. This chapter will analyze the effectiveness of each technique for treatment within the local impairment classification.

In this chapter, learners will review the adjunctive techniques used to target the primary impairment and secondary contributors. Learners will analyze the effectiveness of each technique for treatment within the regional designation.

Within this chapter, the focus is less on the impairment and more on motor control, proprioception, cognitions, behaviors, and whole-body conditioning. Learners will review techniques associated with lifestyle medicine, global management, and cognitive-behavioral approaches.

In this chapter, which represents Case One, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.

In this chapter, which represents Case Two, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.

In this chapter, which represents Case Three, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.

In this chapter, which represents Case Four, learners will evaluate a defined, comprehensive case. Learners will explore key examination and treatment principles based on the Pain and Disability Drivers Management model, the best examination methods identified from previous coursework, and the best treatment options identified from previous coursework.