For instance, she only has an 8 degree difference in prone hip internal rotation, not 14 degrees as the CPR indicates is it's most powerful predictor.  She has had trouble squatting, but also climbing stairs.  Rising from the seated position on the floor is worst, but not so much from a normal chair.  She doesn't have overt LBP, but does have "stiffness".  Yet, to me (even before this article hit my mailbox) I found her biggest indicator suggesting the lumbar needed attention was her loss of lumbar extension ROM and lumbar twisting.  

I started treating her low back on the 2nd visit and by the 5th visit, she no longer had constant thigh pain nor had "shin splints" when running.  

Was there a CPR there? 

Nope. 

There was a CER.

A clinical experience rule.   One I learned the hard way, to the peril of many patients over the years and many sessions of inefficient care.   I never overlook the patient's spine as a generator of symptoms, even if the patient emphatically denies having a problem with it.  Once I adopted this habit, my clinical practice has never been the same, and my outcomes improved substantially.

Clinicians who've been around a long time, have been observant and engaged in clinical trial and error have likely intuitively known and developed their own CPRs.   They intuitively know what will work in which circumstances. 

At best CPRs are a new pathway for further defining and rightfully claiming our role as primary musculoskeletal managers in the health care continuum.

At worst, they document clinical phenomenon that most old-school chiropractors have already observed for decades, but never bothered to write up.  

On the road to becoming an expert clinician in your career you will at some time have to learn to identify sub-groups of patient classifications quickly and know where to begin treatment for maximum results in the shortest amount of time, while expertly managing the patient.  One thing common to many experts is that they have either designed or learned to use a systematic approach to handling various problems because they learn that a system yields the results and that leads them to clinical certainty. This is a topic for another conversation and we’ll leave it until then. 

Until then imagine having an effective system for handling non-surgical shoulder problems, whereby you know what to do in every session, with every problem, with every patient.  What if you no longer got stumped by a shoulder, but instead were completely confident, sure of yourself, and invoked trust and confidence in your patients and peers?   Would that be of value to you? 

If so, then you simply must register for this shoulder seminar. 

Today.

Take Your Ability to Treat Shoulder Pain to the Next Level!

• What is inverse C7-T1 function and why must you know about it when treating the shoulder?

• What rib has been shown to intrinsically cause shoulder pain and how do you handle that?

• What tests produce the highest level of certainty (when combined) to help diagnose shoulder pain?