Extracting meaningful information from the sports physio objective assessment…
I remember it well in my University days…
…the big emphasis on the objective evaluation was “diagnosis, diagnosis, diagnosis”.
Whether that’s right or wrong, that’s one thing.
But, the reality of the situation is, especially for sports physios or therapist working in private practice with a person in front of us that expects quick long lasting results, is that we need the objective assessment to be more than this just a diagnosis.
What we need to do with the sports physio objective assessment is to be able to extract meaningful information that we can use to help bridge the gap between where the patient/athlete is now, and where they want to get to.
So, besides the obvious of ruling anything sinister out, the primary goal of objective assessment for us with the Pro Sport Academy Therapy Mentorship is to provide meaningful information that we can put to use straight away in the form of rehab and/or treatment rather than every patient is getting the same exercises and we 'hope for the best' regardless of what the objective assessment shows.
Bridging the Gap In The Sports Physio Objective Assessment
When we are focusing on a mindset of diagnosis, diagnosis, that’s not bridging the gap between where they are now and where they want to get to.
All that tells us is: where they’re at now (if that)…
What I like to do, when I focus my mind on the objective assessment is strive to gain meaningful information that’s going to help me decide the appropriate treatment and rehab plan.
That also includes the peripheral tissues I may choose to attempt to influence positively with hands-on treatment if necessary or whether I need to use a more hands-off approach.
So, when I look at a general movement, I’m always thinking, “What does this mean? What information can I get here to help me bridge that gap?”.
Compare this when I first started and I pretty much just went through the motions of looking at all these objective assessment movements without any true thought process or ability to extract meaningful information.
Extracting useful information from our objective assessment is critical for sports physiotherapists who need to make quick and safe changes in the pain and movement output and then ensure that the athlete or patient can tolerate the loads that will be upon their system in the coming days and months.
Without this meaningful information and understanding what tissues need to go through a graded exposure program, we are mostly throwing sh%t at the wall and hoping something sticks...
Practical Application: The Toe Touch Test
The majority of therapists will use the ‘toe touch test’ at some point of their day...
You might say to the patient, “Okay, bend forward, touch your toes” for example.
Now, we can get a lot of meaningful information there and then give us clues about some potential problems or perceived threats that that person may be experiencing with this one simple test with a slight change in our outlook on this test.
One of the most useful pieces of information that we can get is when that person has a conscious experience of pain, or some perception of tightness, or an unpleasant sensation in general…
The point where they can feel the unpleasant sensation can give us clues about where the forces transmit through the body is struggling to "self-organise" potentially contributing to this unpleasant conscious experience.
Now, don’t get me wrong here, no two movements will ever be the same, but in every movement, there will be both active and passive forces to deal with about an instantaneous axis of rotation at various points in the action.
So for example, when I’m about to touch my toes, and I’m feeling the pain straight away on my lower back, the question is should my lower back be absorbing the majority of forces in the initial part of the movement?
Is this absorbing of forces potentially leading to "prediction errors" or "perceived threats" from the brain and ultimately contributing to this conscious perception of an unpleasant experience?
...the big questions is: Why are the lower back tissues sending messages, or if you want to call it ‘prediction errors’, all the way up to the higher centres?
We have a conscious experience of this unpleasant sensation in the lower back area at this part of the movement yet when I’m about to bend forward; there’s a lot of other tissues that should be absorbing forces, both actively and passively.
So, why is it that the lower back is absorbing the forces here, which is contributing potentially to this conscious perception of pain, tightness, discomfort, or whatever the patient is absorbing?
So, the next question would be, well if the low back should not be absorbing the majority of forces at this point of the movement, what should be?
...this MAY give us clues about the potential tissues that are doing or not doing their jobs or maybe some that are not tolerating forces very well at all.
An understanding of the directions of forces about an instantaneous axis of rotation may give us clues to cross reference to that patient's story and offer further insight into some previous motor adaptions to the noxious stimulus and/or pain.
Another Example With The Toe Touch Test
So let's look at another scenario, the patient is completely pain-free on the way down to touch their toes, but then they feel the sensation -- this unpleasant experience -- on the initial ascent back up again.
Now, on the way back up, the interplay between the active and passive forces is going to be different than on the way down.
This information can also help us differentiate again between peripheral tissues that we may want to further evaluate in our objective assessment rather than just sticking our elbow in a QL muscle or dry needling that glute medius regardless of the information that is in front of our eyes in the objective assessment.
There are so many clues in the objective assessment to help us clinically reason where to start with our treatment and rehab plan if we just take a step back and change our mindset.
Focusing on Getting Meaningful Information From Your Objective Assessment
So, I hope you can see that having this kind of mindset of an emphasis on a diagnosis will be very, very limiting for us.
If you’re focusing on gaining meaningful information, asking the right questions, joining these assessments and movement outputs together with the patient or athletes story, then this can be precious to us to help us make quick and long lasting positive changes to the patients/athletes movement output or pain experience.
Just by thinking slightly different and avoiding the temptation to just go through the movements for the sake of it can be very very valuable.
So then, once we have a hypothesis of some potential peripheral tissues (if any) contributing to the pain/movement output, the remainder of your objective assessment can be even more unique to the person to identify meaningful information from where the patient is now, and where we want to help them get to.
Where do we want to hep the patient get back to should be very, very important to you in not only dictating the assessment that you’re going to do, but also the rehab and the treatment.
What we want to avoid is this generic “going through the motions”...
...just performing the assessments, not getting any meaningful information and just focusing on the diagnosis that will then be accompanied by a set of genetic ‘go to treatment or rehab exercises’.
Reflect on Your Objective Assessment
So this is just something to keep in mind and something I am working hard with instilling in the ProSport Academy Mentorship group at the moment.
It is worth reflecting on your objective assessment, not being too worried about the diagnosis to a point, (obviously again assuming that we need to rule out red flags - that should go without saying).
We need to start focusing on meaningful information, as opposed to an emphasis on the things that don’t matter – they’re not going to influence the patient too much, anyways but rather potentially instil self-limiting beliefs and behaviours in both the patient and therapist.
So, that’s it for me this week. As always, thanks for reading.
If you want to know more about this kind of sports physio approach (that has stood me the test of time for the best part of 9 years now), you can pick up my free e-book, “7 Steps to Clinical Excellence”, where I go through the seven big lessons that I’ve learned the hard way, in both professional sport, and private practice.
You can request access to that below, and I’ll get it straight to you, and you can start learning more about this way of looking at the body, which I've used in professional sport and private practice consistently over the last nine years…