Segmental mobility assessment is a technique that is taught in school, but at a very basic level. Not much time or reasoning is put into it, so new graduates have difficulty seeing value nor identifying noticeable differences with it. I've written before about how advanced manual training allows clinicians to become more precise with the segmental assessments and how new grads typically assess too large a range, leading to inaccurate assessments. This unfortunately has been discredited with studies saying we cannot be precise with our manual skills, however, these studies typically just use "experienced clinicians" and not clinicians with advanced manual training.
I decided to return to this discussion after one of Optim COMT's mentoring sessions last night. One of the participants asked what the point was in trying to identify the source of the symptoms. In our program, we like to present a variety of approaches, which includes repeated motions and a standardized mobility exam. The techniques can be an incredibly useful tool in facilitating a thorough examination and effective treatment. That being said they may have limitations and being able to identify a segmental component may be essential to getting the patient 100% better. For example, many standardized exams to not look at the foot/ankle more than gross AROM. Without segmental assessment, a fallen cuboid may be missed and without manipulation will not improve.
In no way am I saying to ignore the benefits of standardize exams and repeated motions as treatment, but you will likely have patients that do not respond to these global approaches. Even though some research says we cannot be specific with our assessments or manual treatments, there is something to be said about trying to narrow your range of effect to the region of restrictions. For example, likely hypomobility will be noted in the CT junction, but we may not be able to find the exact segment. However, if we just look at cervical extension and ignore any segmental assessment at all, we may end up mobilizing a hypermobile region, which can lead to worse symptoms. Don't be so quick to disregard the potential benefits of manual segmental assessment and determining the affected structure, it may play a role in getting the patient 100% better.
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