H O P Evaluate Function A look into ROM and functional testing…

Before ‘E’-Quick Review H= History H= History Determine: Determine: Cause of injury Cause of injury Location of pain Location of pain Severity of pain Severity of pain Pain anywhere else Pain anywhere else Noises heard during injury Noises heard during injury Kind of pain Kind of pain Previous history or significant medical history Previous history or significant medical history

Before ‘E’-Quick Review O= Observation O= Observation Look for: Look for: Obvious deformity Obvious deformity Bilateral comparison Bilateral comparison Signs of trauma (blood, swelling, bruising, skin discoloration, shock) Signs of trauma (blood, swelling, bruising, skin discoloration, shock) Guarding Guarding Specific issues involving specific body part Specific issues involving specific body part

Before ‘E’- Quick Review P= Palpation P= Palpation Feel for: Feel for: Anything in observation that you may be able to feel as well as see (swelling, temperature change associated with skin discoloration) Anything in observation that you may be able to feel as well as see (swelling, temperature change associated with skin discoloration) Crepitus (creaking or grinding feeling sometimes associated with broken bones) Crepitus (creaking or grinding feeling sometimes associated with broken bones) Bilateral comparison Bilateral comparison Specific anatomical landmarks for specific body parts Specific anatomical landmarks for specific body parts

‘E’= Evaluate Function ROM ROM What is it? What is it? Range of Motion Range of Motion 3 kinds to look for 3 kinds to look for Active Active Passive Passive Resistive Resistive

Active ROM For any injury, when it comes to movement, ALWAYS ask the athlete to move the injured limb by themselves first!! For any injury, when it comes to movement, ALWAYS ask the athlete to move the injured limb by themselves first!! Reasons: Reasons: Less risk of more severe injury if athlete moves it on their own Less risk of more severe injury if athlete moves it on their own You do not know athlete’s pain and you do not know athlete’s pain at certain points in motion You do not know athlete’s pain and you do not know athlete’s pain at certain points in motion Sometimes athlete will realize they are more scared than injured and calm down after moving limb Sometimes athlete will realize they are more scared than injured and calm down after moving limb

Active ROM If athlete is unable to move limb on their own, do NOT continue in ROM steps. Injury is either too severe to manipulate, or athlete is too scared/in too much pain to be evaluated. If athlete is unable to move limb on their own, do NOT continue in ROM steps. Injury is either too severe to manipulate, or athlete is too scared/in too much pain to be evaluated. During AROM, look for compensation in movement or abnormal movement During AROM, look for compensation in movement or abnormal movement In most instances, a call to the parents and a trip to the doctor or hospital is appropriate. The less harm and pain you cause the athlete, the less chance you have of becoming liable for a more severe injury. In most instances, a call to the parents and a trip to the doctor or hospital is appropriate. The less harm and pain you cause the athlete, the less chance you have of becoming liable for a more severe injury. (Unless you don’t mind big messy lawsuits!) (Unless you don’t mind big messy lawsuits!)

Passive ROM Depending on how well the athlete is able to move limb, you may assess the athlete’s motion using PASSIVE movements: Depending on how well the athlete is able to move limb, you may assess the athlete’s motion using PASSIVE movements: YOU are moving the athlete’s limb for them. YOU are moving the athlete’s limb for them. Tell athlete to be ‘dead weight’ or ‘go blah’ while you support the weight of the limb Tell athlete to be ‘dead weight’ or ‘go blah’ while you support the weight of the limb Reasons: Reasons: By taking out the athlete’s muscles, you may be able to get better idea of specific injury (boney, ligamentous) By taking out the athlete’s muscles, you may be able to get better idea of specific injury (boney, ligamentous)

Passive ROM Always take caution in performing movements for the athlete, and make sure that you communicate! Always take caution in performing movements for the athlete, and make sure that you communicate! “Does this hurt? Tell me at any point in me moving it for you if you have pain. I will go slow through each motion so you can tell me the second it starts to hurt” “Does this hurt? Tell me at any point in me moving it for you if you have pain. I will go slow through each motion so you can tell me the second it starts to hurt” Reassure the athlete that you aren’t going to yank them through the motion. You will lose complete trust if you cause more injury! Reassure the athlete that you aren’t going to yank them through the motion. You will lose complete trust if you cause more injury!

Passive ROM If the athlete is in severe pain, proceed with caution. Most times, when in doubt of severity of injury, just send athlete for doctor referral. If the athlete is in severe pain, proceed with caution. Most times, when in doubt of severity of injury, just send athlete for doctor referral. If pain isn’t too intense, or no pain at all, you can rule out fracture (usually, but not always), and may move on to the final ROM. If pain isn’t too intense, or no pain at all, you can rule out fracture (usually, but not always), and may move on to the final ROM.

Results from Active and Passive ROM AROM is typically less than PROM AROM is typically less than PROM If both AROM and PROM are equal and fall short of the expected range of motion, the athlete may have tight muscles or there may be adhesions restricting the motion If both AROM and PROM are equal and fall short of the expected range of motion, the athlete may have tight muscles or there may be adhesions restricting the motion If muscular weakness is suspected (when AROM is less than PROM), you can usually continue to final ROM If muscular weakness is suspected (when AROM is less than PROM), you can usually continue to final ROM

Resistive ROM Combination of Active ROM and manual resistance from tester (you). Combination of Active ROM and manual resistance from tester (you). Reasons: Reasons: You can sometimes pinpoint the location You can sometimes pinpoint the location of the injury in the specific muscle, or determine the specific muscle involved if you use Resistive ROM. Two types of RROM: Two types of RROM: Full motion Full motion Break testing Break testing

Resistive ROM Full motion RROM: Full motion RROM: Similar to Active ROM, only you, as the tester are applying STEADY pressure to athlete’s limb in the OPPOSITE direction they are attempting to move through the FULL RANGE OF MOTION Similar to Active ROM, only you, as the tester are applying STEADY pressure to athlete’s limb in the OPPOSITE direction they are attempting to move through the FULL RANGE OF MOTION If athlete is moving in dorsiflexion, you are applying resistance to keep them in plantarflexion If athlete is moving in dorsiflexion, you are applying resistance to keep them in plantarflexion This type of RROM can begin to narrow down where the pain is located, but not necessarily the muscle (many muscles perform a number of motions) This type of RROM can begin to narrow down where the pain is located, but not necessarily the muscle (many muscles perform a number of motions)

Resistive ROM Break Testing: Break Testing: Also known as manual muscle testing Also known as manual muscle testing Isolates individual muscles within their functional planes of motion Isolates individual muscles within their functional planes of motion Performed isometrically to see if the athlete can overcome the force at that particular point in the motion Performed isometrically to see if the athlete can overcome the force at that particular point in the motion Looks choppy when performing, unlike Full Motion which is smooth and even pressure Looks choppy when performing, unlike Full Motion which is smooth and even pressure

Range of Motion Notes Always important to stabilize joint you are attempting to move Always important to stabilize joint you are attempting to move Because: Because: If you don’t provide support, athlete may find another muscle to aid in movement which will throw off your eval If you don’t provide support, athlete may find another muscle to aid in movement which will throw off your eval Providing support will also reassure the athlete that you are taking every precaution to keep them safe and in a controlled environment Providing support will also reassure the athlete that you are taking every precaution to keep them safe and in a controlled environment

Once ROM is Complete… If athlete is performing ROM well or to your standards, you may move on to functional testing If athlete is performing ROM well or to your standards, you may move on to functional testing Functional testing: Functional testing: For some, functional testing may mean Activities of Daily Living For some, functional testing may mean Activities of Daily Living For others, it may mean sport specific testing For others, it may mean sport specific testing

Activities of Daily Living Consider an elderly patient who has Consider an elderly patient who has recently recovered from a broken arm Their activities of daily living will be completely different than that of an athlete or an active person Their activities of daily living will be completely different than that of an athlete or an active person Example: Teaching the patient how to reach for a plate in the cupboard, or how to pick up an object off the floor Example: Teaching the patient how to reach for a plate in the cupboard, or how to pick up an object off the floor Consider a receptionist who is recovering from Carpal Tunnel Syndrome Consider a receptionist who is recovering from Carpal Tunnel Syndrome Their activities of daily living may consist of learning how to ergonomically type or perform duties at desk all day Their activities of daily living may consist of learning how to ergonomically type or perform duties at desk all day

Sport Specific Testing For athletes, it is incredibly important before returning to play that sport specific functions can be performed on the sideline. For athletes, it is incredibly important before returning to play that sport specific functions can be performed on the sideline. Each sport has unique and specific movements and motions Each sport has unique and specific movements and motions Basketball: defensive slides, cutting, running backwards, boxing out, jumping Basketball: defensive slides, cutting, running backwards, boxing out, jumping Football: cutting, 3 point stance, blocking, jumping, sprinting Football: cutting, 3 point stance, blocking, jumping, sprinting Swimming: flutter kick, arm circles, turns and pushing off wall Swimming: flutter kick, arm circles, turns and pushing off wall

Sport Specific Testing By having athlete perform certain sport specific motions on sideline, you are reassuring both yourself and the athlete that they are able to compete By having athlete perform certain sport specific motions on sideline, you are reassuring both yourself and the athlete that they are able to compete Use controlled environment, start out slow, break down certain more complex movements before throwing athlete back into action Use controlled environment, start out slow, break down certain more complex movements before throwing athlete back into action

Sport Specific Testing Consider athlete with severely sprained ankle trying to return to soccer Consider athlete with severely sprained ankle trying to return to soccer Sport specific testing will involve things like: Sport specific testing will involve things like: Standing on one leg and balancing in place Standing on one leg and balancing in place Standing on one leg and doing touches with other leg Standing on one leg and doing touches with other leg Hopping on one leg Hopping on one leg Hopping from side to side on one leg Hopping from side to side on one leg Jogging Jogging Running Running Sprinting Sprinting Running backwards Running backwards Shuffling sideways Shuffling sideways Cutting Cutting Kicking with light touches Kicking with light touches Kicking long balls Kicking long balls Important part of rehab is incorporating equipment from sport back into exercises Important part of rehab is incorporating equipment from sport back into exercises Keeps athlete interested and can liven exercises up Keeps athlete interested and can liven exercises up

Sport Specific Testing Reasons: Reasons: You never never never throw an athlete back into a competitive event of any kind (practice/scrimmage/game) until you are sure they are able to withstand the spontaneous movements that occur within the sport You never never never throw an athlete back into a competitive event of any kind (practice/scrimmage/game) until you are sure they are able to withstand the spontaneous movements that occur within the sport Mentally, the athlete will become stronger by seeing that they are able to perform movements on sideline before performing them during competition Mentally, the athlete will become stronger by seeing that they are able to perform movements on sideline before performing them during competition Sometimes with stubborn athletes, you can prove to the athlete in a controlled environment that they may not be ready to return just yet Sometimes with stubborn athletes, you can prove to the athlete in a controlled environment that they may not be ready to return just yet

The End Questions??? Questions???