Introduction

We Won’t (and Will) Cover

To start, let’s talk about what types of assessment tests are out there and why we won’t waste time on some of them. It is easier to discuss why we won’t learn certain tests to better understand what we WILL focus on for the remainder of this course.

Pain-producing tests

We’re starting with one of the most common types of assessments. How often do you go see a physician and they ask “Does it hurt if I do this?” and then they perform a pain-reproducing movement? Pretty often, right? Well, you won’t learn to do this, except in a few rare situations.

“But, why not??? This is how doctors do it, so it must be right?” Because it isn’t that effective in developing a treatment plan. Sure, it shows you how to reproduce their complaint, but beyond that, what did you learn?

Has it told you where it hurts? Yes. Big deal. How much does that help? You already knew that if you performed a good Subjective part of you assessment (more about this later).

Always remember: Pain is just a symptom. It does little to tell us WHY it is hurting there, just that it does hurt.

You can massage the painful area and give them some relief. However, this pain reduction will likely be brief because you are treating a symptom and not the cause of the problem.

Also, do we really want to start our session causing our client pain? I sure don’t. If a new client walks in and the first thing they get from my hands touching them is an increase in pain at their site of complaint, how does that effect our working relationship?

Now, if one of the movement

Subjective tests (“Symptom Tests”)

Neurological tests

Ligament laxity tests

Out of scope for massage therapists

If is question, REFER!

We will focus on

  • Postural Assessment
  • Muscle Shortening/tightness
    • AROM
    • PROM
  • Muscle weakness tests
    • Why? Show us how a massage can’t fix everything
    • Focus on muscle activation
  • Movement Assessments
    • Identify muscle imbalances and movement dysfunction/compensation

Why Assess

  • Find the cause!
  • Improve results
  • Increase efficiency
  • Improve your understanding of soft tissue
  • Increase business – build a reputation as someone who identifies the problem

The Story of Dizzy Dean

In my youth, I was a huge baseball fan. I played all the time, knew the stats of all the Detroit Tigers, and even read books about historic players. The story of a bad toe ending a baseball player’s career always stuck with me and has become a great example of proper injury management.

Back in the 1930’s, one of the top pitchers in baseball was a man named Dizzy Dean (http://www.wikipedia.org/wiki/Dizzy_Dean). In the 1937 All-Star Game, a ball was hit back at him, striking him in his left foot, fracturing his great toe.

In those days, medical support for athletes was limited, and players didn’t have the big contacts with guaranteed money they have today. So, Dizzy was forced to “suck it up” and continue pitching.

The problem was, the broken toe hurt Dizzy every time he stepped forward when throwing a pitch. Imagine trying to plant your foot forcefully to provide a solid base of support. This pain caused Dizzy to alter his throwing mechanics, resulting in long-term injury to his throwing shoulder.

Think about it. The injury was relatively minor and as far away from his shoulder as possible. Yet, it reduced his effectiveness as a pitcher and shortened his all-star career. If there was a sports medicine professional at the time, they should have spent their efforts on treating his big toe instead of his shoulder.

What I take from this? First, no injury is trivial. Second, consider the effect the injury will have on body mechanics during the assessment.

Course Goals

  • Change the way you look at the muscles
  • Teach you easy, effective assessment techniques

What Should We Assess?

As therapists, we can perform assessment tests to identify if a specific muscle is holding in a shortened position. Also, we can assess a movement to determine if the primary muscle involved in that movement (the agonist) is weak. Weakness in the agonist will force the assisting muscles (the synergists) to work harder to take over the movement. This is referred to as synergistic dominance.

When the synergistic muscles take over a movement, injuries arise. This is because these muscles are not designed to handle such a workload. Further, they often cannot properly hold the joint in a stable position during the movement, causing not only muscle injury, but potential damage to the joint.

If possible, use many tests to confirm or disconfirm, rather than use one test as a decision-maker.