Musculoskeletal Interventions and Procedural Techniques
What the candidate must know
Interventions should be matched to the patient's stage of healing, irritability, and goals. Know the evidence for manual therapy (best as an adjunct within a multimodal plan), dry needling, joint mobilization grades (Maitland I–V), and thrust manipulation precautions. Understand exercise prescription principles: specificity, overload, progression, and load management. Know dosage parameters for common modalities and their evidence limitations. For tendinopathy, understand progressive loading and the shift away from passive modalities as primary treatment.
Traps
- Assuming manipulation is contraindicated in osteoporosis broadly; know the actual precautions (e.g., severe osteoporosis, malignancy, instability, anticoagulation) and screen accordingly.
- Over-relying on passive modalities (ultrasound, TENS) as stand-alone treatment.
- Confusing mobilization grades: Grades I–II for pain modulation, Grades III–IV for mobility/stretch.
- Ignoring load management in tendinopathy-rest alone does not resolve it.
Rule of thumb
Match intervention intensity to irritability: low-irritability patients tolerate higher-grade mobilization and loading; high-irritability patients need pain-modulating grades, positioning, and graded exposure.
Worked example
A patient with lateral elbow tendinopathy and high irritability: begin with isometrics and pain-free activity modification rather than aggressive eccentric loading. Progress to heavy slow resistance as irritability declines.