Physical therapy
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Direct access to physical therapist services is permitted by law in the majority of states and across all practice settings. Ohio enacted such legislation in 2004; however, it was unknown how direct access had affected actual clinical practice. ⋯ Implementation of a direct access physical therapist practice model is evident in Ohio. Factors related to reimbursement and organizational policy appear to impede the process.
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The alar ligaments are integral to limiting occipito-atlanto-axial rotation and lateral flexion and enhancing craniocervical stability. Clinical testing of these ligaments is advocated prior to the application of some cervical spine manual therapy procedures. Given the absence of validation of these tests and the potential consequences if manipulation is applied to an unstable upper cervical spine segment, exploration of these tests is necessary. ⋯ Both side-bending and rotation stress testing result in a measurable increase in length of the contralateral alar ligament. This finding is consistent with mechanisms that have been described to support their use in clinical practice.