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Physical Therapy: A Game of a Few Degrees

11/23/2015

1 Comment

 
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Last week, I wrote about the importance of assessing segmental mobility, even with the lack of evidence for our ability to do so. Some of the research says segmental mobility and SIJ assessment have both poor inter- and intra-rater reliability, suggesting we shouldn't waste our time with it. This can be detrimental to the patient as the slight differences may be important for directing our treatment. As I've said before, without these kinds of assessment skills, diagnoses like a fallen cuboid may be missed.

Even if the research hasn't been supportive of our abilities to do segmental assessment, we shouldn't give up on our efforts to find a more effective method. Could the lack of support be due to lack of training in standard physical therapists? Lachman's test requires the therapist to notice a difference of a couple millimeters in order to assess the integrity of the ACL, yet the test has extremely high diagnostic accuracy. Why is it we are presumed to be able to notice these small differences and not others? It is likely due to a lack of training. Physical therapists out of school are used to assessing joints with large amplitude forces that blow through one joints available range and moves into another - negating the findings typically. The smaller differences may play a larger role.

I returned to this topic, yet again, because of a recent discussion I had with some physical therapists in Optim's online mentoring program. Between each course we have several sessions where the participants present a case they have been working on and feedback is given from the mentors and other classmates. One of the issues during the early stages of the COMT program is that there isn't a consistency in assessment between all the therapists. One clinician may list hip and knee ROM as WNL (within normal limits). While this may be true, the therapist may have not been thorough with their exam and missed some subtle differences that may impact treatment. For example, when treating knee pain, often there is a loss of just a couple degrees of knee ext on the involved side that if treated appropriately, may completely eliminate the pain. The same applies to every joint, especially when considering treatments like repeated motions or manipulations. I don't typically use a goniometer in my measurements because I feel like I focus too much on aligning the arms and stop paying attention to the actual motion. The most important finding in my opinion are those small asymmetrical losses of mobility, as it can be the key to your treatment.

-Chris


Looking for OCS preparation? Not only does Optim COMT offer plenty of orthopaedic and manual training, but Optim provides tons of clinical pearls for the examination, including regular quizes that simulate questions for the OCS. Be sure to follow Optim Manual Therapy for regular updates!
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Like this post? Then check out the Insider Access Page for advanced content! And check out similar posts below!
Addressing Spinal and Neural Restrictions
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Gross Mobility vs Segmental Mobility Assessment
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1 Comment
Chad
11/24/2015 11:42:40 am

Great article about motion assessment! I feel exactly the same when assessing patents in regards to spending time on gonio motion. I was recently evaluating a patient with cervical pain w/ involved shoulder issues.

I spent a large amount of time assess gonio in both & got caught up in the cumbersomeness of documenting & aligning the gonio... then I realized "hey lets perform low grade upper thoracic manual & reassess" --> My patient's pain dec. significantly & rom was nearly WNL after manual compared to 90/90 in flex/abd of the shoulder. That example in my opinion is truly what an eval should consist of rather than MMT & ROM measurements. Cheers!

-Chad

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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • 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