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Myopain Seminars is pleased to collaborate with International Manual Therapy Seminars and welcomes Jack Stagge, PT, OCS, FAAOMPT to teach the two-day course “The Upper Quarter Pain Puzzle; Peripheral Neuropathic Syndromes in Orthopedic & Sports Medicine Patients (Upper Quarter)” on November 14 and 15, 2015 in Bethesda, MD.


Upper Quarter Pain Puzzle CourseThis two-day lab course will present concepts of differential diagnosis and treatment of patients with upper extremity radicular symptoms pioneered by Bob Elvey P. T., GDMT. Emphasis will be placed on precise physical evaluation of neural, articular, and muscular tissues in order to allow for specific treatment of each. This precision evaluation allows for differential diagnosis of upper arm and arm pain syndromes with regard to the cervical spine, thoracic outlet, glenohumeral joint and peripheral nerves. Treatment of pain syndromes of neural origin will be explained and demonstrated along the lines of neural tissue biomechanics and physiological concepts. This course will cover well-recognized disorders commonly encountered by the physical and occupational therapist. Such topics as “frozen shoulder,” CRPS, carpal tunnel, thoracic outlet, and other peripheral neuropathies and their treatment will be discussed. Neurogenic pain syndromes, associated neuropathic and neurogenic pain syndromes, including a review of new research into the treatment of CRPS I and CRPS II, will also be presented. Real patient examinations, videos, case presentation, and lab practicums will be used to further allow for application of the material into the participant’s daily practice.




The workshops are designed for physical therapists, occupational therapists, and physicians.

All participants are expected to participate in the hands-on portion of the course. By registering for this course, participants agree to practice the various examination and manual treatment techniques on each other.

Prior to the course, all participants must sign a waiver (view sample waiver) absolving Myopain Seminars, International Manual Therapy Seminars, the program directors, and the instructors of any liability in the event of injury.


  1. Participants will gain an understanding of the mechanisms by which neural tissue may in itself be a pain source.
  2. Participants will gain an understanding of how neural tissue, when it is a pain source, may cause widespread effects.
  3. Participants will gain knowledge of neural tissue dynamics.
  4. Participants will gain an understanding of how dysfunction may occur when Normal neural tissue dynamics is prevented by pain.
  5. Participants will gain knowledge of physical examination techniques of neural tissue for its dynamic and functional compliance.
  6. Participants will gain knowledge of the role neural tissue may play in conditions commonly evaluated and treated by physical therapists and manual medicine practitioners. This knowledge will allow for specificity of diagnosis and prevent treatment errors.
  7. Participants will gain knowledge of physical treatment techniques directed towards neural tissues.
  8. Participants will gain knowledge of postulations as to the remedial effect of physical treatment techniques of neural tissues.
  9. Participants will gain an understanding for caution in implying that neural tissue is the cause of a disorder and in the treatment of neural tissue.
  10. Participants will gain knowledge of differential diagnostic techniques in neuromusculoskeletal disorders.
  11. Participants will be able to differentially determine whether neurogenic syndromes are the cause or the central driver of diagnostic findings


Note: The actual times may vary with each program at the discretion of the instructor. Coffee breaks are provided; meals are on your own.

Day 1 8:00-8:15 Introduction
History of Discovery
8:00 am-5:15 pm 8:15-8:30 Patient Profiles
8:30-9:00 Orthodiagnosis Types
Compliance vs. Noncompliance
6 Signs of Neural Contribution
9:00-10:00 Neuropathology

  • Anatomy
  • Pain/Distalization
  • Neurogenic Rheumatica
  • Research-The Inflamed Nerve Root
  • Mechanical Injury
  • Neurojargin/CRPS
  • Compressive/Inflammatory
  • Research into Inflammatory Neuritis
10:00-10:15 Break
10:15-10:30 Peripheral Afferent Sensitization
10:30-11:00 Evaluation

  • Subjective:  Pain Diagrams
  • Descriptions of Pain
11:00-11:15 Objective:  Standard Neuro

  • Lab Tests
11:15-11:45 Posture/Active Dysfunction Information Demo
11:45-12:00 Elvey – Anatomy Video
12:00-1:00 Lunch
1:00-1:15 Posture/Active Demo
1:15-2:00 Posture/Active Lab
2:00-2:15 Demo Passive
2:15-3:15 Lab Passive Techniques
3:15-3:30 Break
3:30-3:45 Demo on Neural Palpation/Tender Points
3:45-4:45 Lab
4:45-5:00 Review
5:00-5:15 Patient Presentation
5:15 Adjourn
Day 2 8:00-8:15 Questions
8:00 am – 4:30 pm 8:15-8:30 Review
8:30-8:45 Demo Specific Signs of Local Dysfunction
8:45-9:30 Lab
9:30-9:45 Putting it all together=Diagnosis
9:45-10:00 Break
10:00-10:15 Treatment concepts
10:15-10:30 Manual Treatment Demo
10:30-11:30 Lab
11:30-11:45 Demo Home Programs
11:45-12:15 Lab
12:15-1:15 Lunch
1:15-2:00 “Real” Patient Evaluation
2:00-2:15 Discussion of Findings
2:15-2:30 Treatment Sequencing
2:30-3:00 Postulations for Treatment Effect
3:00-3:15 Indications and Contra indications
3:15-3:30 Further Considerations
3:30-3:45 Results of Patient Treatment Study
3:45-4:00 Patient Presentation
4:00-4:30 Conclusions/Questions
4:30 Adjourn


  1. Allen, Roger. Pressure desensitization effects on pressure tolerance and function in patients with Complex Regional Pain Syndrome. Orthopaedic Practice Vol. 16;4:04 Pages 13-16 , 2009.
  2. 2006 Azavedo, Edward. The effects of total and REM sleep deprivation on laser-evoked potential threshold and pain perception, Pain vol. 152, pgs. 2052-2058, 2011
  3. Coronado, R. Thermal and Pressure Pain Sensitivity in Patients with Unilateral Shoulder Pain. Comparison of Involved and Uninvolved Sides. Journal of Orthopedic and Sports Physical Therapy. Vol. 41(3),pp 165-173, 2011.
  4. Davis, D. Scott. Upper Limb Tension and Seated Slump Test. The False Positive Rate Among Healthy Young Adults without Cervical or Lumbar Symptoms. Journal of Manual and Manipulative Therapy. Vol. 16, Number 3, 2008.
  5. Fernandez-De-Las-Penas, C. Specific Mechanical Pain Hypersensitivity Over Peripheral Nerve Trunks In Women With Either Unilateral Epicondylalgia or Carpal Tunnel Syndrome. Journal of Orthopaedic and Sports Physical Therapy. Vol. 40, Number 11 Nov. 2010, pp. 751-760
  6. Freynhagen, Use of pain Detect in neuropathic patients, Current Medical Research and Opinion: vol.22, 2011
  7. Haanpaa, Maija. Diagnosis and Classification of Neuropathic Pain. Pain, Clinical Updates. Vol XVIII, Issue 7 pp.1-5, Sept. 2010,
  8. Hall, Toby.   Reliability, validity, and diagnostic accuracy of palpation of the sciatic, tibial, and common peroneal nerves of low back related leg pain. Manual Therapy; 14(6) December 2009; Pages 623-629
  9. Nee, R.J. , Jull G., et al, Validity of Upper Limb Neurodynamic Tests for Detecting Peripheral Neuropathic Pain. JOSPT Vol. 42, Number 5, May 2012
  10. Quinter, John L. A critical evaluation of the trigger point phenomenon. Rheumatology Dec. 3, 2014. Pgs. 270-278.   2014
  11. Dommerholt, J & Gerwin, R, D., 2015. A critical evaluation of Quintner et al: Missing the point. J Bodywork Movement Ther, 19, 193-204.