Assessment Techniques

Question 1

What is selective tension?

Answer 1

An assessment method used in the diagnosis of tissue injury/pathology that involves isolating and stressing/applying tension to specific tissues to identify where pathology has occurred.

Tissues may be selectively tensioned through..
Passive Movement (E.G Joint ROM assessment)

Active Movement (E.G Patient is asked to actively plantarflex their ankle in OKC)

Resisted Movement (E.G Resisted isometric contraction/Muscle power testing in OKC)

You should first determine whether the injured structured is inert or contractile, once you have established this you can use the appropriate techniques to discern which structure(s) is (are) affected.

Question 2

Give examples of inert tissues

Answer 2

Bone

Cartilage

Joint Capsule

Ligaments

Bursa

Fascia

Neural Tissue

Fat

Question 3

How are inert structures assessed using selective tensioning?

Answer 3

Passive Movement:
Joint ROM - Pain affecting inert structures may be present on passive movement of a joint, particularly at it’s end range

Passive Stretching & Compression - A joint is assessed to it’s end range, putting a stretch on inert structures such as ligaments and fascia, this also helps stretch tissues overlying bones, bursae, joint capsules etc so they are easier to palpate. Compression is then applied to inert structures through palpation and squeezing, allowing you to determine what structures are injured/symptomatic

Typically resisted movements do not induce pain when only inert structures are pathological, as they lack the capacity to contract and relax

Question 4

Name some examples of contractile tissue

Answer 4

Muscle

Myo-Tendinous Junction (A composite region enriched in extra cellular matrix where muscle fibres attach to a tendon, every skeletal muscle has an MTJ and they are common locations for strain injuries in sport due as they act as an interface for force to be transmitted between muscles and tendons)

Tendon (The tendon’s main role is to transmit forces from the muscle to bone and absorb external forces to prevent injury to the muscle)

Teno-osseous Junction (The point where a tendon attaches to bone)

Question 5

How do you assess contractile tissue through selective tensioning?

Answer 5

Resisted Isometric Contraction - The joints are held in mid range as to not put strain on inert tissue and the patient exerts the tissue against the examiners resistance.

Active ROM Assessment - Patient actively moves a joint without resistance, pain can occur if pathological contractile tissue is involved in the joint movement. Range of motion may be reduced due to reduced tissue flexibility

Typically pain with resisted movement is highly associated with contractile tissue pathology rather than inert tissue pathology

Question 6

What can help you determine if an injury/pathology is more acute or chronic in nature when performing selective tensioning?

Answer 6

History Taking - Asking about the duration of symptoms and about inciting incidents of trauma can help you determine how long the structure has been pathological

Pain vs Restriction - While assessing active and passive movement, take note of whether pain or restriction is the predominating factor

If pain predominates, the condition is likely more acute

If restriction predominates, the condition is likely subacute or chronic