The objective examination

• The objective examination

  • Observation
  • Functional demonstration
  • Active movements
  • Passive movements
  • Accessory movements
  • Muscle tests
  • Palpation
  • Special tests
• Observation:

  • Formal and informal
  • Functional deficits
  • Abnormalities
  • Asymmetries
  • Gait
• Observation - Look for:

  • Muscle wasting
  • Swelling
  • Scars
  • Skin changes
  • Bony alignment
  • Positional deformities
• Functional Demonstration or Quick Test

  • Ask patient to perform their aggravating movement
  • Detection of abnormal/antalgic movement patterns
  • Objective markers
• Active/passive physiological movements

  • Look to reproduce symptoms
  • Consider structures stretched/compressed
  • Willingness to move
  • Pain at rest and SIN (severity, irritability, nature)
• Active/passive physiological movements

  • Range of movement
  • Pain
  • Behaviour
  • Limiting factor
  • Quality of movement
  • End feel -normal/abnormal
• Active/passive physiological movements

  • Over pressure
  • Combined movements
  • Sustained
  • Rapid movements
  • Move under compression
• Passive ROM

  • If active ROM was restricted test passively
  • Look for difference in Range of motion
  • Assess end feel
  • Assess for quality/crepitus etc
• Muscle testing

  • Groups before individual muscles
  • Isometric testing
  • ? Reproduction of pain
  • Through range testing
  • Grading of strength
  • Weakness or inhibition
  • Length and strength
• Accessory movements

  • Integral part of joint movement
  • End feel needs to be established
  • Postero-anterior
  • Antero-posterior
  • Transverse, medial/lateral
  • Longitudinal, caudad/cephalad
  • Rotation, internal/external
• Palpation

  • Temperature
  • Hyperhidrosis (sweating)
  • Swelling/deformity
  • Tenderness (hyperalgesia)
  • Crepitus - soft tissues or joints
  • Fibrotic changes
• Other tests

  • Proximal/distal joints
  • Spinal contribution
  • Special tests
  • to differentiate between structures
  • to aid with diagnosis
  • Nerve involvement - Motor/ Sensory/ Reflexes/ neurodynamic (provocation)
• Neural Provocation (dynamic) tests

  • Ability of nervous system to be subjected to tensile loading
  • Tests nerves, connective tissues, associated blood vessels
  • Test / retest after treatment
• Neural provocation tests

  • Positive findings:
  • Reproduction of symptoms
  • Change of symptoms with distant movement
  • Different response from “normal”
  • Main nerves tested:
  • Sciatic
  • femoral
  • median
  • radial
  • ulnar
  • May help confirm link between spine and symptoms