Special Tests Aren't So Special After All

A few of my students from one of the local DPT programs told me they had to learn 26 special tests for the knee. 26!!!!!! It is great to know tests to rule in and out various dysfunction/injuries. I certainly do ligamentous stress testing, and test for instability, if the subjective warrants it. It is ironic however, that special tests are placed LAST in the AAOMPT Fellowship program I teach in. That is if they are to be used at all. I remember being very frustrated at the typical knee patient I used to see as a new grad. Possibly medial and or inferior patellofemoral pain, full strength, full AROM/PROM, ligamentous stress tests and meniscal stress tests were negative. Now what? Ultrafixit? Look for impairments you can treat as a manual therapist, restricted ITB, hip flexors, weak gluteus medius. Screen the hip and ankle for joint dysfunction, which is more likely unless there is an actual knee derangement. Work on those impairments, and your knee patient with all special tests negative, except for perhaps an Ober's test, may just get better.
Another example is cervical compression and distraction. Why on earth would you do a provocation test such  as compression? That just tells you not to do it again, and arguably makes the patient wary of your touch. Distraction? I don't use mechanical traction, so those are another few tests that are useless. Repeated motion exams as taught by McKenzie and Passive Intervertebral Motion Testing both give you a direction for real, skilled treatment. It's also more likely your average uncomplicated cervical patient will get better, and with a lot less visits. The literature supports manual therapy + exercise for spinal conditions. Use your exam to lead you to which areas to use soft tissue and joint manipulation. In the end, if you are using special tests, reassess right after your manual therapy treatment to see if they're negative. Make them useful as a pre and post test measurement. If you decide to drop them off of most exams like I have, your exam will be shorter and more efficient.