It is assumed a proper case history was taken and a basic examination conducted beforehand. This will often include active, passive and resisted ranges of motion.

A) Testing

• Performed like any other orthopedic test you are familiar with
• They are all based on the patient’s response
• You have to listen, look and feel for that
• Even more so you have to encourage the patient to give an honest response and look into their eyes if possible
• The number of tests far exceeds those found in any orthopedics and neurology text (bone, entheses, fascia, tendons, ligaments, joint capsules, muscle, dermis, subdermis, scar tissue and collagen, blood vessels, lymph vessels, nerves)
• We’ll use the straight leg raise and a teres major test as examples:

Example 1: Straight Leg Raise (SLR)

1. Initially proceed with caution and not necessarily to end range.

2. Hold for a few seconds initially, always looking for the patients response.

3. Pause for a few seconds, again waiting for a response to any physiological change.

4. Repeat the procedure going a little farther this time (with the patients permissions).

5. We always ask for ongoing consent during each procedure.

6. During the test not only do I listen for a verbal response but feel their body for spasms, etc (as much of my body as possible is against theirs so as to best feel for changes) and I try to look into their eyes.

7. If the condition worsens or an abnormal response is elicited, you should immediately stop and re-assess the patient.

Note: This test is passive motion. The practitioner could start with active motion testing and even include resistance testing.

Example 2: Teres Major

1. Same as above.

2. Include long axis traction.

3. The test varies according to the patient’s response.

Scope of Practice

• You are responsible for staying within your scope of practice.

• For example, loading a hip in abduction when an insufficiency fracture in the neck of the femur is present. This procedure is in the scope of practice of an orthopedist but probably not in yours.

• For example, my positioning involves a lot of body contact in order to better feel for a response. Some of these positions may cross boundaries in your profession and therefore are not in your scope of practice.

B) Treating

• This is the repeated application of a previous test that showed a positive outcome (increased ROM, less pain, a warming sensation, improvement in function). Assessment and treatment work together and now an assessment can be made as such:

  • What test to use (epidemiology)?
  • What structures are we loading?
  • Panacea?