Common Injuries

Welcome to the Tissues Specific Common Injuries course and congratulations for investing in your own education! In this course we will help you be able to identify tissue specific causes of pathology that can be applied to a many conditions throughout the body, and that your patients deal with every day! By keeping a few key concepts in mind you will be better able to find the true cause of pathology rather than just addressing the symptoms and hopefully get better results & improve your practice.

We will focus on a variety of conditions by tissue type and by the end, you should be able to successfully recognize and assess these conditions. You will also learn that your assessment can be therapeutic and improve the efficiency of your patient visits, how to use evidence based treatment goals & techniques for the condition.

As in all clinical encounters we will follow the HIP-MNRS principle (History, Inspection, Palpation – Motion, Neurovascular scree, Referred pain & Special tests) to ensure a thorough understanding the patient presentation, correct identification or the pathology(s) and evidence informed, appropriate management best practices. – You can follow along with the textbook or just use digital media in any combination or individually as you choose – we do recommend that take you advantage of the questions provided, as it will make your final exam that much easier.

Let’s have some fun and get better at what we love doing… ?


Throughout this course, you’ll find icons in the margins that will call your attention to certain types of information. Here is a list of the icons you will see:

Basics (definition, etiology, demographics)

Assessment (History, SSx, physical exam)

Management (general & specific)

Home Care, Follow-up & Prognosis

Contraindication & Precautions

ProTips (clinical pearls & practice building)


101 General HIP-MNRS

Length: 30 minutesComplexity: Easy

General to Specific - General history and assessment should ALWAYS be completed before the specifics are investigated. A baseline of function is a good starting point for a variety of reasons: The baseline established serves as a reference point to mark progress. People often get discouraged when they feel things are not progressing or fell [...]

102 HIPMNRS Detailed History

History – for the purpose of this lesson we will use the mnemonic LOC-Q-SMAT (LMNOPQRST is also often used) – History clinic forms – click here ProTip The true clinical value of any patient history system is derived from the questions it contains & not the mnemonic used to recall it.  It matters little what [...]

103 Outcome Markers & Pain Assessment

By using outcome markers you can measure treatment goals and validate the success of your care (you can show the patient what you are doing is working!). Outcome markers are used to monitor patient progression and provide treatment goals. Any parameter that has the ability to be proven valid, reliable, and can be objectively measured has [...]

104 Visceral Pain Referral

Practitioners must realize that there are many different types of pain referral patterns that can trick you into treating manifestations of a condition and not realizing the true cause of the pathology. For example: Thoracic Outlet Syndrome (TOS) can cause numbness and tingling into the hand. If you just treated the hand you would not [...]

105 Inspection, Posture & Gait

Inspection Basic inspection, posture and gait analysis provide clinicians with foundational information about the patient’s current state. By observing the patients face, body language, and movement, many specifics of their condition can be revealed. From pain avoidance postures to fatigue and depression, most conditions have physical manifestations you can see and palpate. During Inspection look for: [...]

106 Palpation

We all know palpation is one of the most important parts of any exam or therapeutic interaction. Numerous studies show excellent interexaminer reliability for the palpation of bony & soft tissue tenderness (palpation is one of the best tools a clinician can use). However, it is crucial that permission to perform a hands on exam [...]

107 Motion Assessment

Motion is life – your body is designed to move. With a lack of motion there are many ailments that may develop; postural issues (upper cross syndrome), diabetes, obesity, depression, and the list grows with every new study on the topic. Many professionals claim sitting is the new smoking. ROM assessment is a key underlying [...]

108 Muscle Testing

An accurate & objective measurement of muscle strength is useful for many reasons, including the following: Neurologic screen - assessment of muscle strength also assesses motor nerve function Diagnostic aid - helps clinician identify specific muscles that are weak or damaged Therapeutic aid - creates an objective measure of progress through a treatment plan & [...]

109 Neurovascular Screen

Neurovascular symptoms are very important to take note of and chart. Realise that AROM and muscle testing are also partly neurologic exams (nerves make muscle work). Typical neurologic symptoms consist of numbness, tingling, muscle weakness and shooting electrical type pain. Vascular symptoms include overly cold or warm tissue, bruising, pulse or blood pressure changes and [...]

110 Special Tests Intro

Special tests are used to help rule in (specific) or rule out (sensitive) pathology, there are a variety that fall into this category (remember SPecific tests rule IN = SPIN, and SeNsitive test rule OUT = SNOUT). Below is a list of more common special tests: Orthopedic tests (provocative positional tests designed to challenge specific [...]

111 Clinical Prediction Rules

Clinical Prediction Rules (CPRs) are designed to improve clinical decision making and assist practitioners in differential diagnosis, prognosis and treatment planning. CPRs provide practitioners with powerful diagnostic information from the history and physical examination that may serve as an accurate decision-making surrogate for more expensive diagnostic tests. In many cases a good history & physical [...]

112 Indications & Contraindications

Uses, Indications & Effects of Manual Therapy A USE is the purpose of the technique(s) used for a given situation or condition. For example, if we know that effleurage increases blood flow to an area, it would be appropriate to use effleurage when a patient presents with a condition of poor circulation. An INDICATION is [...]

113 Treatment Options

In practice, there are many different treatment options. Within your scope of practice, it is usually better to progress from least invasive to most invasive and superficial to deep.  Try conservative care therapies before progressing to more risky and potentially harmful treatment. Below is a table showing some of the options available: Least Invasive                                             Basic [...]

114 Tissue Healing & Treatment

It is important to know what stage of healing a patient is in prior to initiating treatment. The stages of healing and treatment goals are shown below. Wound & Hemostasis (bleeding) If it is a superficial wound, consider topical antimicrobials (Calendula, Polysporin) Avoid medications, botanicals, vitamins & minerals that affect clotting or prolong bleeding time. [...]

115 Basic Treatment Protocol

Treatment plans must be specifically tailored for each individual patient. A general rule is to progress through increasing levels of difficulty as tolerated by the patient. Numerous factors can influence progression through treatment (severity of injury, age, diet, aerobic fitness, general health, mind set, etc...). ProTip Be SMART when setting goals for yourself or patients [...]

116 Muscle Spasm

Basics Most of us have experienced a spasm, whether it has been a ‘stitch’ in your side or a cramp in your calve or sole of the foot. Chances are you have had a patient that has complained of repeated spasms, or one that just hasn’t gone away. It is important to identify the cause [...]

117 Muscle Strain

Basics Muscle strains are relatively common injuries that result in mild to severe fiber tearing. Fortunately muscles have an excellent blood supply and physical medicine providers have many tools available for their treatment in all stages of injury (acute, subacute, and chronic) ProTip Many people confuse the terms ‘strain’ and ‘sprain’ – Remember Strain = [...]

118 Ligament Sprain

Basics Ligament sprains are relatively common injuries that result mild to severe fiber tearing. Sprains occur when ligaments surrounding a joint are forced beyond their normal ROM. Because of a lower blood supply, ligaments usually take longer to heal than muscles. ProTip Many people confuse the terms ‘strain’ and ‘sprain’ – Remember Strain = Muscle [...]

119 Tendonitis

Basics Tendonitis is inflammation of a tendon and surrounding sheath. It often co-exists with other muscle pathologies including muscle strain and other muscle imbalances. Causes of tendonitis include: • Mechanical: repetitive loading of tendon resulting in microscopic degeneration → fibroplasia within tendon → scar tissue • Vascular: tendon degeneration occurs as a result of focal [...]

120 Arthritis – Cartilage Injury

Basics Arthritis (Osteoarthritis, OA, or DJD) is progressive degeneration and loss of articular cartilage, subchondral bone and joint capsules of synovial joints. It is estimated that 80-90% of the population have radiographic evidence of osteoarthritis by age 65, although only 60% of those will have symptoms. Lifelong moderate use of normal joints does not appear [...]

121 Subluxation & Dislocation

Basics It is important to know the difference between a dislocation and a subluxation: Dislocation (luxation) – a complete loss of contact of the articular surfaces Subluxation – a partial loss of contact of the articular surfaces Subluxation as defined by the world health organization (WHO): A lesion or dysfunction in a joint or motion [...]

122 Fractures

Basics A fracture is a break in the continuity of a bone. They usually occur from a single traumatic event or repetitive microtraumas. Conditions that weaken bone (osteoporosis, cancers) will predispose to fracture. Fractures are usually treated with immobilization (splint or cast). Biomechanical changes and soft tissue compensations that arise from this can be helped [...]

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