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.
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!
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