If you do not regularly use a repeated motion exam as part of your evaluation, you should! Here are 5 reasons why.
1) It's easy
- many clinicians take offense to simple, why? Easy is better!
- not everything needs to be right on right, left on left, 10 special tests, palpation for position or motion
- how easy is it to ask someone to perform simple osteokinematic (physiologic) motions several times to assess it's affect on symptoms, motion, function?
- you have three options, remains better, remains worse, no effect - that's it
- easy also means the same motion or position can be repeated by the patient at home to self treat, you can't say that for many passive manual therapy techniques
- easy also leads to repeatable, meaning...
2) It's reliable
- This has been studied several times in the past, after getting flack for such a simplistic approach that did not involve palpation, PIVM, etc... The McKenzie Institute had no choice but to prove the method
- you only are looking at movement, repeated movement and position's effect on Sx location, intensity, and ROM
- you have 3 possible classifications
- derangement (the rapid responders) - up to 87% should fall into this category
- dysfunction (the slow responders) - the not quite 13%
- postural - where only changing/improving posture completely gets rid of their complaints (to me falls into rapid responder - so I discount it)
- when a movement or position rapidly change complaints - it's a derangement
- when movements or positions do not rapidly change and their is end range pain that does not remain worse, it's a dysfunction
3) It has built in testing - that patients can also easily replicate
- no (not so) special tests needed!
- example, repeated cervical protraction increases Sx, but do not remain worse as a result, repeated cervical retraction centralizes headache, decreases neck pain and remains better as a result
- the direction that improves the complaints is the directional preference (DP), something that most joints have
- each visit you can easily do test-retest within the visit before and after movement, positions, and/or adjacent manual techniques (my cheats to get the patient to be more compliant)
- plus you can tell them centralization and rapid response on day 1 normally leads to good prognosis - especially if you maintain it up to visit
- this makes them more responsible for their own condition
4) It leads you to treatment
- after you find the DP, roll with it and get the patient to move in it, or sustained hold it repeatedly throughout the day
- the directional preference gives you several options to perform the motion in loaded/unloaded positions
- if the patient finds the movements uncomfortable and you suspect they may not be compliant or anxious to perform, that's where OMPT comes in!
- do IASTM, joint mobs, neurodynamics, etc... to make the self treatment more comfortable
5) It gives the patient a HEP
- as stated above, it's more difficult to use a traditional OMPT approach, perform several passive mobilizations or manipulations, the patient feels better then says, "But how do I do this at home?"
- the same motions that you used to test the patient that lead you to find the DP are also the HEP
- this is intrinsically valuable to the patient as they can easily repeat what you did with most of the time no variation needed!
- the HEP in MDT is EVERYTHING! It's the reason why patients improve faster, sustain the improvements even in long term studies
- they are also taught built in self assessment that tells them when to double down on their HEP
- i.e. if repeated flexion in standing is painful, and repeated extension in standing is blocked, double down on your repeated extension in standing/lying to regain extension for a few days, then check repeated flexion
- if hip/knee pain returns, check sidegliding in standing, if there is a loss to the involved side, double down on SGIS against the wall for a few days
- this empowers them and they know you are just a phone call away should they need more help
- patients often still call for an eval, but I have often gotten the response, "Because of the self treatment, I knew to keep doing SGIS until I was able to get in on Monday, and I'm already 50% better after the flareup!"