NPTE Studycast | Physical Therapy

In this episode, we dive into the highly anticipated 2025 revision of the Clinical Practice Guidelines for Hip Pain and Mobility Deficits—Hip Osteoarthritis, published by the APTA Academy of Orthopaedic Physical Therapy. Join us as we explore the latest evidence on how to best classify, examine, and treat patients living with mild-to-moderate hip OA. We break down the updated recommendations for manual therapy, specific exercise dosing, patient education, and a brand-new "Level A" recommendation

PCL Injury — NPTE Cheat Sheet What it is: Injury to the posterior cruciate ligament from excessive posterior translation of the tibia — often from dashboard impact or falling on a flexed knee. Classic signs: Posterior sag sign Posterior knee pain Difficulty descending stairs Instability (less dramatic than ACL) Dashboard injury mechanism Rule-in test: Posterior Drawer Test (NPTE’s favorite) Rule-out clues: Immediate swelling → ACL Locking/catching → Meniscus Medial tenderness → MCL

ACL Tear — NPTE Cheat Sheet What it is: ACL failure from excessive anterior tibial translation — basically the tibia tries to run off and the ACL can’t hold the line. Classic signs: Pop Immediate swelling (1–2 hours) Pivot / cutting mechanism Instability Difficulty weight-bearing Rule-in test: Lachman test — NPTE’s #1. Rule-out clues: Slow swelling → Meniscus Posterior sag → PCL Medial pain → MCL NPTE trap: Delayed swelling means NOT ACL. Best treatment: Early ROM, quads, swell

Meniscus Tear — NPTE Cheat Sheet What it is: Injury to the medial or lateral meniscus — the knee’s shock-absorbing cartilage — often caused by twisting or deep flexion. Classic signs: Joint line pain Locking or catching Clicking Delayed swelling (24–48 hours) Pain with squatting/twisting Rule-in test: McMurray test (NPTE’s go-to) Rule-out clues: Immediate swelling → ACL Posterior sag → PCL Medial tenderness → MCL NPTE trap: Locking/catching = meniscus, even if the question tries

BPPV — NPTE Cheat Sheet What it is: Otoconia displaced into a semicircular canal (ear crystals where they shouldn’t be). Classic signs: Brief vertigo (<60 sec), triggered by position changes, upbeating torsional nystagmus, no hearing loss. Rule-in test: Dix-Hallpike. Rule-out clues: Long-lasting vertigo, neuro deficits, hearing symptoms → think neuritis/Ménière’s. NPTE trap: Nystagmus >60 seconds = NOT typical BPPV (think cupulolithiasis). Best treatment: Epley every. single. time. Mock q

SHOW NOTES — Red Flags for Cancer (Cheat Sheet) What it is: Non-mechanical symptoms raising suspicion for malignancy. Classic signs: Night pain Unexplained weight loss Constant, deep ache No mechanical pattern History of cancer Rule-in test: None — this is a screening cluster. Rule-out clues: Pain that changes with movement or position. NPTE trap: Night pain + weight loss = refer immediately. Best treatment: Medical referral, not PT.