WEEK 2 - objective exam and heat/cold therapy Flashcards
what are the components of an objective exam?
- Observation -> posture, gait pattern, gait aids, age,
- Functional movements -> gait, sit to stand, squat, jump, hop, run
- Range of movement -> active ROM + passive ROM
- Muscle tests
> strength
> length
> endurance
> power
> motor control - Palpation
- Special tests
- Nervous system
Clearing tests
what does observation involve in an objective exam?
- Begins from when you meet the patient / client in the waiting room
- Observe:
-> how they get out of the chair
-> how they walk
-> if they limp
-> if they are protective of a limb
-> age
-> general mobility including gait aids
-> how they take a jacket or jumper off
- Observe:
what does palpation involve in an objective exam?
- Temperature (Inflammation)
- Swelling/ oedema/ effusion (inflammation)
- Skin moisture (ANS dysfunction)
- Mobility of tissues -> do the soft tissues move easily or are they ‘stuck down’
- Tenderness on palpation
Ø Begin with a general palpation of the whole area then hone in on the structures that you think may be causing the problem
Ø Palpate from superficial to deep
Palpate all affected areas and areas that could refer to affected area.
what is involved in functional movement tests in an objective exam?
Ask a patient to activities that reproduce the pain or symptoms:
- Walking
- Running
- Up/down stirs
- Double leg squat or single leg squat
- Jumping or hoping
Patient specific activities.
what is AROM testing in an objective exam?
- Assessing the patients ability to do an actively move limb/ joint
- Ask for resting pain/ symptoms (Pain rating 1-10)
- Observe and measure range of motion with goniometer (or other method of measurement e.g. inclinometer or plurimeter)
- Observe the quality of movement
- Ask for the behaviour of pain through range -> pain rating and where the pain is worst
Consider if you want to apply overpressure
what is PROM testing in an objective exam?
- Physiological movements are movements people can perform voluntarily themselves
- Assess the passive joint range of motion
- Helps determine if the structure(s) at fault are muscle or articular (Joint)
- Ask for resting pain/ symptoms
- Therapist moves limb/ joint through ROM asking for pain and feeling for joint ‘end-feel’
Observe and measure passive ROM with goniometer
muscular system -> strength (isotonic) in an objective exam
- Manual muscle testing (MMT) using the oxford scale
- Strength through range of motion
- Grading system:
Ø GRADE 0: no muscle flicker
Ø GRADE 1: muscle flicker
Ø GRADE 2: can move limb through range of motion across gravity with the limb supported by therapist
Ø GRADE 3: can move limb through range of motion against gravity
Ø GRADE 4: can move limb through range of motion against gravity and moderate resistance by therapist
Ø GRADE 5: can move limb through range of motion against gravity and maximal resistance applied by therapist - Is a subjective measure
- Unreliable after grade 3
Limited by the experience and strength of tester (Therapist)
what is the Oxford grading scale?
Ø GRADE 0: no muscle flicker
Ø GRADE 1: muscle flicker
Ø GRADE 2: can move limb through range of motion across gravity with the limb supported by therapist
Ø GRADE 3: can move limb through range of motion against gravity
Ø GRADE 4: can move limb through range of motion against gravity and moderate resistance by therapist
Ø GRADE 5: can move limb through range of motion against gravity and maximal resistance applied by therapist
- Is a subjective measure
- Unreliable after grade 3
- Limited by the experience and strength of tester (Therapist)
muscular system - strength (isometric)
- Manual muscle testing -> isometric muscle strength
- Held at inner, mid and/or outer range depending on aim of testing
- Make or break test
Ø Make test: the therapist matches the persons strength
Ø Break test: the therapist overpowers (breaks) the persons strength - Uses 0-5 rating scale
Ø Grade 3 - can move limb through range of motion against gravity / can hold against gravity at the range of motion to be tested
Ø Grade 4 - can hold limb in position against gravity and moderate resistance
Ø Grade 5 - can hold limb in position against gravity and maximal resistance
muscular system -> endurance
- Muscle endurance / capacity tests
- Number of reps to fatigue
Normally use a metronome to set pace (e.g. single leg hamstring bridge/ calf raise)
- Number of reps to fatigue
muscular system -> power
- Power is the rate of force production
Not important for all patients, but is important to train for other patients such as athletes and people who require muscle power for their work or functional activities.
muscular system -> muscle length
- The length of a muscle can affect the range of motion of a joint
- A short/ tight muscle will restrict joint movement -> short/tight quads muscles will restrict how much the knee will flex
- Muscles create most force in mid-range -> if muscles short/tight cant generate optimal force production
Important to test single joint and double/multi joint muscles -> e.g. gastrocnemius vs soleus / quadriceps muscles vs rectus femoris
nervous system -> neurosgemental
- Segmental neurological testing:
Ø Dermatomes
Ø Myotomes
Ø Deep tendon reflexes
Ø Clonus
Babinski
nervous system -> neurodynamic
- Neurodynamic testing
- Testing the length and mobility of the peripheral nerves
- Upper limb
Ø Base test -> median nerve / general
Ø Ulnar nerve test
Ø Radial nerve test
Ø Median nerve test - Lower limb
Ø Passive straight leg raise test (pSLR) -> sciatic nerve
Ø Slump -> sciatic nerve
Prone knee bend -> femoral nerve
special tests -> pain provocation
- Tests specific to the injury / condition that you have hypothesised
- You may want to briefly provoke (reproduce) the patients pain to confirm your hypothesis
E.g. hip impingement test for articular hip problems
- You may want to briefly provoke (reproduce) the patients pain to confirm your hypothesis
special tests -> joint integrity tests
- Specific tests to determine joint stability
- Conduces if joint instability is suspected or to ‘clear’ joint instability as a contributing factors
E.g. if an ACL injury is suspected in the knee -> anterior draw test / Lachman’s test / pivot shift test
- Conduces if joint instability is suspected or to ‘clear’ joint instability as a contributing factors
special tests -> specific for diagnosis
- There are specific special tests for certain injuries/conditions which have high diagnostic validity
- These tests should be included to rule in or rule out (clear) the injury / condition
E.g. for patella tendinopathy -> single leg squat on a decline board will reproduce pain
- These tests should be included to rule in or rule out (clear) the injury / condition
clearing tests
- Joints/ regions above and below can refer to or contribute to the pain/ symptoms the patient is describing
- Test the joint / region above and below to clear these areas as contributing factors
- Or, if you find an issue in the areas above or below, you will need to address these are well
Ø E.g. a stiff ankle joint can contribute to knee and hamstring problems
E.g. the low back and gluteal region can refer to the posterior thigh and present like a hamstring injury
what is cold therapy?
the application of cold or ice to an injured area used to manage the inflammatory process, blood flow, initial swelling, secondary injury and pain. / aiding recovery
when would you use cold therapy?
- Acute injuries
- Post surgery
- Pain
- Pain due to muscle spasm
- Spasticity
- Change muscle responsiveness
- Inflammation
Oedema and joint effusions
what are the phsyicolgical metabolic effects of cold therapy?
- slows down / reduces metabolism -> decreases cell oxygen needs, decreases inflammatory mediators, less tissue damage
- decreases cell permeabilities to outward filtration - limits oedema fomatrion
what are the physiological circulatory effects of cold therapy
CUTANEOUS:
- immediate vasoconstriction
- decreased blood to skin = decreased condition of heat to surface
- increased viscosity - decreased blood flow
DEEPER:
- reduced bleeding
- oedema reduction
neurological effects of cold therapy?
decreases nerve conduction velocity:
- initial cold sensation disappears
- numbness sets in
- deep ache
pain effects of cold therapy?
- reduced nerve conduction and sharp pain
- reduced metabolic activity - decreased cell damage - decrease produced of irritants
- decreased oedema and inflammation
