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Picture

4 Quick Clinical Shortcuts

1/23/2016

3 Comments

 
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In last weeks post, I wrote an article about being a PT in a busy clinic. A portion of the post discussed simplifying one's treatment session by being efficient in the clinic. I briefly mentioned a few shortcuts I take during my examination to minimize my objective testing.

Disclaimer: I understand people may not agree 100% with every point. They should be used as a guideline. In addition to the shortcuts, I use clinical reasoning and individual patient presentation to guide my plan of care. In the end I care most about decreasing pain and improving movement quality.

Picture
Clinical Shortcuts:
1. Heel Walk and Toe Walk vs. full dermatome and myotome screening. I do not perform a full neurological screening on all low back pain patients. If a patient presents with low back pain without radicular symptoms, I will quickly assess myotome strength by watching them heel walk and toe walk. This assessment shows L4 and S1 strength while assessing general balance. I generally perform this screening immediately after watching their gait pattern. If they have any difficulty performing the movements, I break out a full neuro screen.
2. Squat/SL squat vs. gluteus medius testing. While the MMT for gluteus medius strength is preferred, when I am busy, I quickly look at overall function first. If the patient's lower extremity moves into adduction and internal rotation during the squat, I know the strength or motor control of the glut med is not adequate. This assessment provides me with the rationale to prescribe glut strengthening exercises.
3. CT junction hump vs. CT segmental mobility assessment. If a patient presents with a dowagers hump, I immediately know they have mobility deficits in the CTJ and upper thoracic spine. The CTJ is extremely important for normal shoulder, cervical, and thoracic mechanics. If this postural hump is present, I know CTJ will be a top region of focus.  
4. Thoracic kyphosis vs. testing low trapezius strength. Thoracic kyphosis and shoulder dysfunction go hand-in-hand. When someone has increased thoracic kyphosis, the mid scapular muscles are placed in a lengthened position. In general, lengthened muscles are also inhibited. I can immediately infer that someone with increased thoracic kyphosis needs lower trapezius and middle trapezius strengthening. Always strengthen the lengthened muscle before stretching the shortened structure! 

I discuss these concepts and more in my 2017 ebook, The Guide to Efficient Physical Therapy Examination! 
​-Jim

3 Comments
chad
1/25/2016 11:04:01 am

I like this post, I would love to see part 2; good stuff!

Reply
Brady Sandercock
1/27/2016 07:48:15 am

As a physical therapy student, the more clinical pearls that I can learn during the initial evaluation which would help save treatment time the same day the better!

Reply
Glenn
1/27/2016 08:24:10 am

Thank you for creating this post Jim! As a PT student as well, I would also agree with Chad and Brady.

Reply



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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
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    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test