Studying for the Orthopedic Clinical Specialist (OCS) examination can be a tedious task and a bit overwhelming. Unlike the NPTE, many people who are preparing for the OCS have full time jobs, families, and other commitments to juggle. Plus, there are only a few high quality resources available to help one prepare for the exam and even fewer which provide practice quiz or test questions. For this reason, OPTIM has comprised a library of nearly 300 questions that can adequately prepare you the OCS examination! 

In this post, we will provide you with 5 questions that you MUST be prepared to answer while taking the OCS examination. With each question, consider the larger topic, background information, diagnostic accuracy (if appropriate), contextual factors, and more.  

**All answers provided at the bottom of this post!

Clinically, I have found the most success with lateral manipulations in patients who have adhesive capsulitis. ​These patients often have restrictions is multiple planes of motion and joint mobility is a primary impairment. Additionally, individuals with shoulder osteoarthritis, hypomobility, or end-range of motion restrictions are typically good candidates.

Be sure to ask about past shoulder injuries prior to performing the lateral shoulder manipulation. If the client has any history of shoulder dislocations or subluxations, DO NOT perform this technique.  Finally, be sure to address all of the causes of shoulder range of motion deficits as well. This includes assessing the thoracic spine, ribcage, scapulohumeral rhythm, and more! 

​-Jim Heafner PT, DPT, OCS

In many instances, there seems to be a disconnect between the home exercises and pain/symptoms. The prescription of various exercises, movements, or education should be viewed as the missing piece to help keep a patient out of pain. However, patients often have a negative viewpoint of their home program. Either patients are not associating their home program with less pain OR therapists are not providing confidence that the home program is a significant key to success. Something needs to change! 

When I educate my patients, I specifically tell them that the home exercise program should become part of their daily 'movement routine.' For example, I recently was working with a cyclist who sits at a desk for 8+ hours each day. I told him as long as he is sitting for long periods of time and wants to continue to bike, he needs to be performing thoracic mobility exercises on a daily basis. The amount of available movement in his thoracic spine is significantly limited and his current daily activities are doing nothing to improve that state. The reason he is experiencing pain is due to a lack of movement diversity. The home exercise program ensures that patients are regularly performing movements that desensitize the nervous system and minimize any threat to potentially painful activities.  

Most exercises are initially prescribed for pain management, mobility, or motor control.* Fairly quickly, the client's pain should decrease, the weak muscle should get stronger, and/or the joint should have more mobility. Once that goal is achieved, the home program can slow down. However, if one's life activities do not change, the same movement patterns will likely return and pain may return.

With my clients, initially I often have them perform their HEP anywhere from 1x/day to multiple times per day until symptoms resolve. Once pain is managed and the patient's primary impairments improve, then I gradually wean clients down to a more manageable routine. The tipping point happens when the patient's activities change. Using the example above, if this cyclist started doing yoga or other flexibility exercises, then he would not have to perform specific thoracic mobility exercises. Until that point, he should perform those exercises regularly. While there is no magical formula for decreasing HEP frequency, I recommend that therapists view the HEP as a maintenance program that should be performed until the patient changes certain life activities.

*If exercises are given for strength or power (low reps, high weight), the frequency should be adjusted. Typically strength and power is not given early in the plan of care.

What do I mean by redefining the HEP? My intent is to change the focus, direction, and importance of prescribing the home program. Why?
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First off, who likes homework? Not many people. From a neuro-lingustic programming standpoint, homework has been engrained in our brains to be a negative, boring, and seemingly pointless activity. For this reason, it is imperative that during the therapy session each prescribed exercise be linked to a positive change in the patient's symptoms. In the OPTIM COMT and Fellowship programs, we demonstrate this positive change through the asterisk sign. The asterisk sign gives me the power to show my patients that the treatment (typically manual therapy + exercise) created a positive change in their symptoms. Doing more of that same treatment at home will get them better!

​Second, exercise! Not the most popular subjects in certain parts of the country. Selling exercise is like attempting to sell ketchup popsicles (thanks Tommy Boy!). Exercise is generally viewed as tough, sweaty, and painful. People often have many preconceived notions surrounding the fitness culture. Selling it is not an easy task. 

Finally, a program! Trying to instill a new program into someone's day is near impossible. People are highly resistant to change. If the home program is not accessible and easily understand, it will likely not be performed appropriately or at all.    

1. Be Concise

• Not more than 3 exercises at a time

2. Be Specific

• Do not give a range or reps or sets
• Tell the patient exactly what they need to do

3. Logical

• Bridges, crunches, squats 25x; twice/day VERSUS
• Bridges 3x15, crunches 3x10, squats 1x25; 2-3x/day

4. Executable

• Must fit into their day easily; minimize barriers o Write is down on a prescription pad
• Video and take pictures on the patient’s phone 

For me personally, I take videos of the patient performing all of their home exercises on their phone. In the video, I outline sets, repetitions, frequency, and common things to look out for.

The current model of clinical education is insufficient. Unwarranted practice variation in our field is widespread and has enormous consequences. Our goal is to train the next generation of physical therapists to be expert clinicians in manual physical therapy. We strive to change the practice of physical therapy, develop leaders, and facilitate ongoing growth in physical therapist practice. 

OPTIM currently offers two programs, Certification in Orthopedic Manual Therapy (COMT), and a Fellowship in Orthopedic Manual Therapy (FAAOMPT). 

​Click here to see a list of our course locations! ​

Let's nip this question in the bud immediately. Yes, become a clinical specialist. Over the years, many people have questioned the need and/or benefit of becoming a physical therapy specialist. Common excuses include, "the exam material is outdated," "the exam does not test actual clinical knowledge,' among others. Put those comments to rest! If those are the only reasons to take the examination, then your probably doing it for the wrong reasons. 

Reasons to take a specialty examination:
1) Preparing for the examination requires months of studying and delving into a specific subject matter. It requires focus and dedication.
2) The exam material covers the highest quality research in the field (typically minus the last 12 months of research). This may be slightly different from daily clinical practice, but it is the best we have!
3) Become recognized as a regional expert in the field.
4) Studying each topic will allow thorough reflection regarding what is right and wrong with current clinical practice. 

"Eligible clients must:

• Be licensed a Physical Therapist in the United States

1. Must meet requirement Option A or Option B (below)

• Option A: Applicants must submit evidence of 2,000 hours of direct patient care as a licensed United States physical therapist (temporary license excluded) in the specialty area within the last ten (10) years, 25% (500) of which must have occurred within the last three (3) years. Direct patient care must include activities in each of the elements of patient/ client management applicable to the specialty area and included in the Description of Specialty Practice (DSP).
• Option B: Applicants must submit evidence of successful completion of an APTA accredited postprofessional clinical residency completed within the last 10 years that has a curriculum plan reflective of the Description of Specialty Practice: Orthopaedic Physical Therapy (DSP). Experience from residencies in which the curriculum plan reflects only a portion of the DSP will not be considered."

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The above information was taken from the 2017 OCS Exam Candidate Guide.

Want a program that has BOTH the clinical and didactic skills to prepare you for your speciality exam? Check out OPTIM Manual Therapy.
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OPTIM offers both a Certification in Orthopedic Manual Therapy (COMT) and Fellowship in Manual Therapy (FAAOMPT)! We emphasize current best evidence into clinical practice including paradigms like utilizing a bio-psycho-social approach, leveraging patient expectations, and purposeful interventions to provide excellent clinical outcomes. 

Currently, OPTIM offers courses in Houston TX, Dallas TX, Scottsdale AZ, and St. Louis MO (coming this September!)