NY Times health blog has a series of “Think Like a Doctor”. Most don’t relate to PT at all but this one was interesting as it relates to gait, proximal weakness and difficulty with stair negotiation.
To read the diagnostic process, go here.
To read the answer, go here.
The moral here is that if this individual arrives in your clinic (say Direct Access); the clues do not match up. Refer out. Here, a “specialist’s specialist” was consulted. Did I get it right…no! I did have a case similar to this probably two years ago but the patient was around 65. We never got a true diagnosis.
Dr. Religioso has a pretty cool video of cervical manipulation in slow-mo on his blog here. It is interesting to see this much motion, especially with such good form by the practicioner. Makes you think that if you are not manipulating upper cervical spine segements but instead focus on, say C3-4, then you are probably getting the upper segments to move. Goes away from your thoughts to shy away from upper cervical spine?