Treating Function, Not Pain

One of the biggest mistakes many novice clinicians make is focusing too heavily on the site of pain. While the site of pain needs to be address for pain management purposes, many times the cause of the dysfunction is not the location of pain. For example if a patient presents with medial sided knee pain, the knee should not be the primary joint addressed. The clinician should rely more heavily on the cause of the problem which is likely at the core, hips, or ankles. In other words, instead of treating the painful region, focus on the region that is not functioning properly. 

How do you assess the cause of the dysfunction?
First, perform specific functional movement tests including gait assessment, squat, lunge, and others. Next perform specific local biomechanical assessments of the joints surrounding the pain. Using the knee example above, during  the evaluation have the patient perform the functional movements, then perform a gross AROM and strength screening of the lumbar spine, hip, and ankle. If you notice that the patient's knee moves into adduction and internal rotation during the squat & they have a positive trendelenburg while ambulating, you know you want to check the strength of the posterior gluteus medius on that side. If the patient is lacking dorsiflexion range of motion during their squat, assess dorsiflexion AROM and talocrural joint mobility. Using this same principles, if the patient exhibits normal ankle dorsiflexion during the squat, there is likely no need to check dorsiflexion range of motion. They demo'ed normal mobility functionally, it is a waste of time to assess the isolated movement. This leads to over testing and finding minute impairments unrelated to the cause of the dysfunction. 

With every functional deficit you see, perform specific local biomechanical tests to triangulate your findings. 

Please let me know if you would like more examples of functional deficits I often find that assist with my local testing.

-Jim    

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