There is much debate about the usefulness of Clinical Prediction Rules. Rather than just being another commentary about how great or not the research is, I want to share with you my interpretation of the lumbar CPR for thrust manipulation. Let's forget about the Fear Avoidance Belief Questionnaire, like anyone really administers that. If you take a good history or simply pay attention to your patient tells you, you know how they would score.
Many clinicians think their patient does not fit if they report chronic complaints. If it is an acute exacerbation of a complaint they have had for years, but it is episodic, call it acute! If they have pain below the knee, do something about it! Use MDT (McKenzie), treat the neural container, or anything you find effective to centralize it. If both of the patient's hips have limited IR, mobilize them! Chances are they'll have lumbar stiffness, so that's not normally a problem.
Make them fit the rule. That's how you make the CPR work for you. It doesn't work as well with all patients, or those with true chronic conditions, but it opens up some possibilities for patients and helps to speed their recovery. Sometimes you can make that square peg fit into the round hole.
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