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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 healthcare professions on evidence-based clinical practice. The process of evidence-based practice is outlined 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. Also, intervention strategies based on the best available evidence will have a greater likelihood of success with the least associated risk.

TABLE I-1The Process of Evidence-Based Practice

The goal of every clinician should be to enhance patient/client satisfaction, increase efficiency, and decrease unproven treatment approaches. 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 method works all of the time. For any intervention to be successful, an 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. Please go to, for 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]

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