Elements of functional testing

Ch 3 Part 3

Dr Mazhar
03066980980
 Differentiating articular and extra-
articular dysfunction
• Distinguishing contractile and non-contractile
elements
• The contractile elements = muscle with its
tendons and attachments.
• Non contractile elements = bones, joint
capsules, ligaments, bursa, fasciae, dura
mater, and nerves.
 Non-contractile Dysfunction
• Active and passive movements produce or
increase symptoms and are abnormal in the
same direction and at the same point in the
range.
• Passive joint play movements produce or
increase symptoms and are abnormal.
• Resisted movements are symptom free.
 Contractile Dysfunction
• Active and passive movements produce or
increase symptoms and are abnormal in
opposite directions.
• Passive joint play movements are normal and
symptom free.
• Resisted movements produce or increase
symptoms.
• Interpretation less clear in the spine.
1) Some subtle contractile tissue lesions remain
painless during active spinal movements;
2) Resisted tests unreliable … spinal muscle
contraction can produce symptomatic joint
compression in underlying dysfunctional
joints.
3) Active movement in the spine cannot be
localized to a single mobile segment.
 Differentiating muscle shortening
from muscle spasm
• A shortened, tight muscle = firmer, less elastic
end-feel,
• muscle spasm = more elastic and less soft
end-feel, increased muscle reactivity.
• "hold-relax" muscle relaxation maneuver
• spasm … relax sufficiently, range increase
• A shortened muscle …range increase with
sustained stretching
 Translatoric joint play tests
• Traction, compression, and gliding in all of the
translatoric directions
• Attempt to direct joint play movement forces
primarily toward a particular joint … affect the
entire mobile segment.
• Easiest to feel in resting position.
 Two ways of testing joint play
1) Without fixation:
• Apply vibrations, oscillations, or small
amplitude joint play movements with
palpation of the joint space.
• Used for screening prior to fixation technique
2) With fixation:
• Fixate one joint partner and move the other
through the fullest possible range of joint play
movement.
• Feel for changes in the resistance to the
movement through Grade II, past the first stop,
and into Grade III for end-feel.
• whether there is normal movement quality
through the range and if there is hypo- or
hypermobility.
 Traction and compression tests
• General translatoric (linear) movements ..Affect
several segments or an entire spinal region.
• Segmental traction and compression tests are
technically very difficult to perform.
• Symptoms with spinal traction tests in the normal
resting position, use three-dimensional
positioning to find the actual resting position and
reevaluate the patient's response to traction.
• Small, mono-segmental spinal muscles may also
be affected by the traction test if they are very
shortened or tight.
• If a general spinal compression test produces
complaints, limit further evaluative techniques
causing joint compression.
• If compression tests in the resting position are
negative, and if no other tests of function
provoke or increase the patient's complaint,
compression tests should also be performed in
various three-dimensional positions.
• Articular lesion.
• Test joint compression separately and before
resisted tests, since resisted movements also
produce joint compression.
 Gliding tests
• Gliding tests joint structures and specific
direction of joint movement restrictions.
• Test in the joint's resting position and outside
the resting position.
• Segmental joint play is primarily evaluated
with translatoric gliding, comparing one
mobile segment with neighboring segments.
• There should be no significant mobility
differences in adjacent segments.
• First assessed by palpating between two
vertebrae during a rapid oscillatory movement
parallel to the treatment plane in the
intervertebral disc joint.
• Followed with a slower and more thorough
assessment of joint play gliding range and
end-feel in all directions.
 Resisted movements
• Directly evaluate neuromuscular integrity, the
contractile elements, and, indirectly, the status of
associated joints and vascular supplies.
• There are some restriction in spine ….
• Overlapping nerve supplies in the spinal muscles
do not allow isolation of single muscles for
strength testing or symptom localization
• Second, spinal muscle contractions produce
compression in underlying joints
• So evaluate joint status separately.
• Three general methods for resisted tests:
1. Manual muscle testing
2. Machines
3. Specific functional maneuvers
• Cyriax…a resisted test must elicit a maximal
muscle contraction while the joint is held still
near its mid-position (resting position).
• Not allowing movement during a resisted test
will help eliminate the joint as the source of
pain
• Compression tests should be performed
before the resisted test.
Cyriax interpretation of resisted tests:
• Painful and strong=minor lesion of a muscle or
tendon
• Painful and weak=major lesion of a muscle or
tendon
• Painless and weak=neurological lesion or
complete rupture of a muscle or tendon
• Painless and strong=normal
 Passive soft tissue movements
• Two major types of passive soft tissue movements:
❑ Physiological and accessory movements.

Physiological movements (muscle length and end-feel)

• Performed by moving a limb or bone so that muscle
attachments are moved maximally apart (lengthened).

• Use combined movements to achieve maximal tissue

lengthening.
 Physiological movements (muscle
length and end-feel)
• Soft tissue end-feel during lengthening is
important to differentiate joint from soft
tissue dysfunction and to determine the type
of soft tissue dysfunction.
• Like muscle spasm has less firm end feel than
contracture
• Joint restriction can also limit muscle
lengthening.
 Accessory soft tissue movement
• Tests the elasticity, mobility, and texture of soft
tissues.
• Passively manipulating soft tissues in all
directions.
• Localized changes in soft tissue texture, for
example, scar tissue, edema, adhesions, and
muscle spasm.
• Involves manually moving muscles in transverse,
oblique, and parallel directions in relation to the
muscle fibers.
 Additional tests
• Includes assessment of coordination, speed,
endurance, functional work capacity, and work
site ergonomic evaluations.
• Make these test simple and practical.