Alfie Vente, RMT, IN TOUCH

Orthopedic assessments are important because it can help the therapist formulate a plan to assist clients in their healing. It is important to note that there are 10 steps to performing an effective assessment:

1. Observation by the therapist is very subtle. It can include observations of how a person walks, talks, sits, stands or even a motion like taking their jacket off. Some of the things you may see include an antalgic gait, carrying of one arm in an abnormal position, leaning to one side when they sit and even articles of clothing that may contribute to a persons condition such as shoes (are they high heels, do they look worn, etc).

2. After the person has filled out the case history it is time to ask a few questions. These will mostly be questions about their pain, such as, location, intensity, duration, frequency and characteristic (dull, achy, sharp shooting, stabbing, burning, etc.) At the onset what aggravates it, what makes it better, length of time and have they used any other therapies? Other questions that you may ask are: are you on any medications (this includes herbals and nutritional supplements)? Are there any foods you cannot eat? Do you have any other sensations other than pain and does the client have any previous injuries?

3. The postural assessment is next. The best way to assess a client's posture is to use a plumbline. The second best thing if you don't have access to a plumbline is by "eyeing" your client. All observations must be taken from 4 different views; two lateral views, anterior and posterior. Note of any gross observations such as shoulder heights, pes planus, genu varum or valgum etc. As mentioned above, the therapist should observe any gross malformations, changes and differences. You are not looking for minute observations such as a minimal height difference of shoulders.

4. Active free range of motion testing is to help the therapist determine the client's ability and/or willingness to move. This form of testing should be specific to a joint and its cardinal planes of movement such as flexion, extension, lateral rotation, medial rotation, abduction and adduction.

5-6. I put passive relaxed and active resisted testing together because it all depends on what you think might be causing the client's pain. Is it contractile tissues (muscles and tendons) or is it non-contractile (ligaments, joint capsule)? To determine what you should do first, consider what you think clinically might be the cause of a person's pain. The most painful of the two tests should be done last. The final anatomical movement that causes the person the most pain should be done last also. To give you an idea what your thinking process should be, consider someone who, from all your testing and questioning shows an injury to contractile tissues of the hamstrings. Your final test for this section should be active resisted knee flexion. The therapist should test bilaterally and above and below the given joint that is affected.

7. Specific muscle tests including length and strength testing, will help you to determine which specific muscles are affected. Length testing can also give you positional information about a body part or joint. For example, someone with very tight and shortened iliopsoas and rectus femoris muscles may show an anterior pelvic tilt.

8. Special tests are only used when steps 1-7 have not given you any good answers. Special tests help you determine if there are any compression syndromes such as carpal tunnel syndrome, they can also determine where along the length of the nerve/neurovascular bundle the compression may be arising from. Special tests can also help assess of any ruptures, such as, the drop arm test for a supraspinatus tear or Thompson's test for a tear of the Achilles tendon. Some special tests, such as, the vertebral artery test (it tests of any blood flow insufficiency to the brain) must be done in the beginning to help determine whether a client is fit enough to be treated.

9. Palpatory tests can help assess tone, texture, temperature and tenderness. They can be used before, during or after your treatment. It can give you clues as to what particular hydrotherapy should be used, and if there are any restrictions, adhesions or trigger points that need to be worked on.

10. As massage therapists we cannot diagnose but we can assess. After all of these steps are taken we must make some conclusions (not diagnoses). For example, on your intake form instead of writing down "the client has an Achilles tendon rupture," you may write "From my assessment it seems like this client may have a rupture of the Achilles tendon." From your assessments you should be able to determine whether a referral is necessary.