DACRB cheat sheet

Tissue healing phases drive dosing: inflammatory (0–7 days) uses protected motion and isometrics; proliferative (1–6 weeks) uses controlled loading and submaximal isotonic work; remodeling (weeks to months) uses progressive overload toward functional loads.

Strength adaptation requires load above roughly 60–70% of 1RM for trained tissue; endurance adaptation occurs at 40–60% 1RM with higher repetitions; power work uses 30–60% 1RM moved at maximal intended velocity.

The SAID principle (Specific Adaptation to Imposed Demands) mandates that exercise selection match the joint angle, velocity, contraction type, and energy system of the target function; non-specific loading yields non-specific adaptation.

Progressive overload variables, in order of typical manipulation: increase repetitions, then sets, then load, then reduce rest interval, then increase range or instability; change one variable at a time to isolate response.

Delayed-onset muscle soreness peaks 24–72 hours after unaccustomed eccentric loading; it is not a contraindication to continued submaximal movement and does not indicate structural injury.

Isometric exercise produces analgesia in tendinopathy when held 30–45 seconds at 70% of maximal voluntary contraction, repeated 4–5 times; the effect is immediate and short-lived, supporting multiple daily bouts.

Eccentric loading is preferred for tendinopathy remodeling because it imposes high tensile load with lower metabolic demand; 3 sets of 15 repetitions at 3 seconds per repetition is a common starting dose, progressed by adding load.

Motor learning rule: novel or painful movement patterns are trained with external focus, low load, and high repetition; once accurate, progression shifts to internal focus, increased load, and variability to build retention.

Functional outcome instruments must be condition-matched: Oswestry Disability Index or Roland-Morris for lumbar spine, Neck Disability Index for cervical spine, DASH or QuickDASH for upper extremity, LEFS for lower extremity; record baseline, re-measure at 2–4 weeks, and report change against the instrument's minimal clinically important difference.

Minimal clinically important difference anchors: Oswestry about 10 points, Neck Disability Index about 7 points, QuickDASH about 16 points, LEFS about 9 points; a change below the threshold is not evidence of meaningful improvement even if statistically significant.

The minimal detectable change sets the noise floor: a change smaller than the MDC cannot be confidently distinguished from measurement error and should not be reported as real improvement in a case study.

The International Classification of Functioning model organizes the case: body structure and function (range, strength, pain), activity (walking, lifting), participation (work, sport, caregiving), plus environmental and personal contextual factors.

Rehabilitation prognosis is set by the irritability classification: high irritability means symptoms provoked by low-load activity and slow to settle, favoring low-intensity, frequent, position-specific intervention; low irritability permits aggressive loading and functional progression.

Red-flag screening before every progression: unexplained weight loss, night pain unrelieved by position change, fever, history of cancer, saddle anesthesia, bowel or bladder change, progressive neurological deficit, and significant trauma warrant medical referral rather than exercise progression.

Return-to-activity criteria are criterion-based, not time-based: pain rated 2 or less out of 10 on provocation testing, symmetrical or near-symmetrical strength and range of motion, and successful completion of sport- or job-specific movement at full demand.

Work conditioning and work hardening differ in scope: work conditioning is a single-discipline physical program addressing strength and endurance; work hardening is interdisciplinary, includes simulated job tasks, and typically runs 4 or more hours per day with documented functional capacity evaluation.

Spinal manipulative therapy combined with exercise outperforms either alone for chronic low back pain in most trials; the exercise component is what sustains the manipulation's short-term neurophysiological and biomechanical effect.

Manipulation is contraindicated in unstable fracture, suspected aortic aneurysm, advanced osteoporosis with fracture risk, spinal infection, malignancy at the site, and progressive myelopathy; relative cautions include anticoagulation and severe inflammatory arthropathy.

Neuromuscular re-education for a hypertonic muscle uses reciprocal inhibition: activate the antagonist to reduce tone in the target muscle, then train the target through its newly available range before adding load.

Post-isometric relaxation for a restricted muscle: place the muscle at its lengthened barrier, perform a 20–30% effort isometric contraction for 5–10 seconds, relax, then move to the new barrier and repeat 3–5 times.

Proprioceptive training is layered from static to dynamic: bilateral static stance, then single-leg stance, then single-leg stance with eyes closed, then unstable surface, then perturbation and sport-specific reaction drills.

Cryotherapy reduces pain and edema for roughly 10–20 minutes of application and should not be applied over superficial nerves or areas with compromised circulation; heat increases tissue extensibility and is used before stretching, not after acute injury.

Therapeutic ultrasound at 1 MHz penetrates deep (about 3–5 cm) and 3 MHz is superficial (about 1–2 cm); continuous mode heats tissue, pulsed mode at 20% duty cycle is used for non-thermal effects.

Traction for cervical radiculopathy uses intermittent or static pull of roughly 10–15% of body weight to start, with symptom response during and after the session guiding progression; worsening or new neurological signs stop the trial.

The plan of care states the diagnosis, measurable goals, visit frequency, expected duration, and discharge criteria; a typical episode for uncomplicated mechanical low back pain runs 4–6 weeks with 6–12 visits, extended only when objective measures are still improving.

Visit frequency is titrated to stage: early phase 2–3 visits per week for education and load management, middle phase 1–2 per week for progression, late phase every 2–4 weeks for criterion testing and independence.

Therapy is stepped down, not stopped abruptly: taper frequency while shifting responsibility for exercise to the patient, and confirm independent performance with a written or video-supported home program before discharge.

Discharge criteria versus discontinuation criteria differ: discharge occurs when goals are met and the patient is independent; discontinuation occurs when the patient declines care, plateaus for 2–3 consecutive re-assessments, or is non-compliant, and each reason must be documented.

Referral triggers in a case study include absence of expected change by 2–4 weeks, neurological deterioration, new red flags, or failure to progress despite appropriate load; document the referral question and the findings that prompted it.

Interprofessional coordination requires a shared outcome measure and a common goal across providers; the chiropractor, physical therapist, and physician should exchange the same functional score and the same return-to-work target rather than parallel, conflicting plans.

Return-to-work progression uses graded hours and graded demand: start with part-time light duty matched to functional capacity, then increase hours, then increase load, with a documented threshold for stepping back if symptoms exceed a pre-set limit.

Case-study reporting follows a reproducible structure: presentation and history, examination findings with baseline outcome scores, diagnosis and prognosis, intervention with dose, re-assessment at defined intervals, outcome change versus MCID, and limitations of the single-subject design.