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“The very first step towards success in any occupation is to become interested in it.”


—Sir William Osler (1849–1919)


Until the beginning of the last century, knowledge about the mechanism of healing and the methods to decrease pain and suffering were extremely limited. Although we may scoff at many of the interventions used in the distant past, many of the interventions we use today, albeit less radical, have still to demonstrate much more in the way of effectiveness. That may soon change with the recent emphasis within many health-care professions on evidence-based clinical practice. The process of evidence-based practice is presented in Table I-1. When combining clinical expertise with the best available external clinical evidence, clinicians can make informed decisions regarding patient management, including the selection and interpretation of the most appropriate evaluation procedures. In addition, intervention strategies that are based on the best available evidence will have a greater likelihood of success with the least associated risk.1,2

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Table I-1. The Process of Evidence-Based Practice

The goal of every clinician should be to enhance patient/client satisfaction, increase efficiency, and decrease unwarranted treatment approaches.2 The management of the patient/client is a complex process involving an intricate blend of experience, knowledge, and interpersonal skills. Obtaining an accurate diagnosis requires a systematic and logical approach. Such an approach should be eclectic, because no single approach works all of the time. For any intervention to be successful, accurate diagnosis must be followed by a carefully planned and specific rehabilitation program to both the affected area and its related structures. In this book, great emphasis is placed on the appropriate use of manual techniques and therapeutic exercise based on these considerations. Electrotherapeutic and thermal/cryotherapeutic modalities should be viewed as adjuncts to the rehabilitative process. This book contains numerous video clips of manual techniques and therapeutic exercises, which the reader is encouraged to view. The following icon is used throughout the text to indicate when such clips are available. [VIDEO]

1. Sackett DL, Rosenberg WM, Gray JA, et al.: Evidence based medicine: What it is and what it isn’t. BMJ 312:71, 1996.  [PubMed: 8555924]
2. Schroder JA: Manual therapy and neural mobilization: Our approach and personal observations. Orthopaedic Pract 16:23, 2004.

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