Thanks to Robert Kjemhus for suggesting this topic! All that travelling (four days of plane in 8 days of being away) left me without an idea for today. Thankfully a reader suggested 5 Things to Look For in an Evaluation.
1) asymmetry
- we know from FMS research that asymmetry predicts injury in more active individuals
- look to Phil Plisky's page which sums it up nicely along with some great blog posts
- look for asymmetry not only in the area of pain, but also above and below and even distal to this area
- that's why it helps to have a system like the SFMA
- check the movement both in WB and in NWB and actively and passively
- any motion deficit that is limited/painful actively, but improves significantly either in ROM or is not painful passively is a motor control/stability issue
2) motor control/stability
- read Movement by Gray Cook (only $9.99 - ebook) to learn more about this
- this is just another form of symmetry but does not respond that well to stretching
- if you are performing any kind of manual technique, and the ROM improves rapidly, and then just as quickly is lost, you are looking at a motor control problem
- this needs motor learning/stability, it's not a "length" issue
- many "tight" hamstrings are a perfect example of this
- common MC/S patterns
- cervical flexion/rotation painful/limited in WB active, full and painfree in NWB passive
- shoulder MRE painful/limited in WB, passive full motion, with less/no pain in passive
- unable to touch toes in standing MSF, active SLR limited/painful, passive SLR significantly better
- brush up on Breathing Pattern Disorders by reading The source by Leon Chaitow, now in second edition
- breathing can control many things, from core stability to tone regulation, to pH balance
- so you're looking at a wide range of things proper breathing can change, from ROM, to pain, to anxiety
- look for
- location of breathing
- should be diaphragmatic, with abdominal expansion, rib expansion laterally and posteriorly
- not initiated by accessory muscles with excessive sternal movement at rest
- rhythm
- should be steady
- with pause at end of inhale and exhale
- frequency
- try changing the frequency, deep and slow is not always appropriate
- often overbreathing causes many unexplained complaints and many cases I have worked on measuring with the Capnotrainer, the patient ended up needing more shallow and faster breaths with a pause at exhale, and occasionally inhale
- this changes pH within a minute or so, and can thus change symptoms rapidly
- previous posts dedicated to thoracic spine here and here
- the thoracic spine is often dysfunctional in movement, sometimes rapidly responding (motor control/stability) or true motion dysfunction/slow responding
- either way, it is often not painful and thus overlooked
- however you can help a lot of dysfunction by treating this area from
- cervicogenic HA/cervical pain
- frozen shoulder
- breathing pattern disorders
- lumbopelvic instability
- gait
- the list goes on
5) directional preference
- most areas of the body, those with discs/facets and those with just normal joint capsules have a directional preference when having pain and/or loss of motion
- finding the DP, which is often a motion contrary to what the patient is already doing normally leads to quick and easy self treatment, and good outcomes
- read previous post Rules for Resets for more info
- Here is my list of common resets from a course in 2013
Hope this review helps the newer clinicians out there and served as a good review. Had to write quickly with major jet lag, plus two of my little ones getting the flu the day I got back! Thanks for reading and please remember to vote!
If you haven't heard, Mike Reinold, Christopher Johnson and myself have decided to offer a live Q&A on Google Hangouts if we win the award for our categories for Therapydia's 2014 PT Blog Awards. Mike is up for best PT Blog, Chris, Best Video Blog, and myself, best Overall Blog. Please vote for us if you find our work helpful and take time to vote for the others who work hard to bring you knowledge.
PS. Mike Reinold will shave his head like Chris' and mine if we win! Bonus!
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