Top 5 Fridays! 5 Reasons Why You Should Be Using a Repeated Motion Exam

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

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

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!"