A Suggested Evaluation Order | Modern Manual Therapy Blog

A Suggested Evaluation Order

Regular readers know how much I favor using a systems approach to the ones taught in traditional PT school and OMPT programs.

Terminology review post here.

You would also know that I highly recommend the SFMA to help you find asymmetries in mobility and motor control/stability in areas distal to the proximal complaint. For the proximal area of complaint, there's MDT and it's repeated motion exam.

To summarize

  • MDT - one of the fastest, easiest ways to put out the fire
  • SFMA - helps you clean up piles of dried embers and burning leaves all around the fire site that may re-ignite the proximal fire or contribute to a future fire elsewhere
So we're got these two great systems, but which order in your evaluation should you use them in? The easiest answer you do not want to hear is, "It depends..." Pattern recognition or patient presentation leads me to start with one over the other, but I would say for the most part, you should run a SFMA on the patient, then a repeated motion exam around the area of their complaint.

Here is a perfect example of why. Patient is a 60 something yo female, very fit, regularly doing yoga, pilates, working out, and travelling around the world, hiking, etc... She came in for this current presentation with complaints of insidious onset of limited shoulder ROM and pain around the lateral upper arm.

Shoulder Patterns looked like
Left LRF - DP

Right LRF: FN next rep upon cuing

Left MRE DP - sev loss
I did not take a picture of her right MRE, but it was FN. After looking at cervical retraction and sidebending to the left and right, we see the common pattern of loss of loading to the involved side.
Cervical retraction and SB Right: FN

Cervical retraction and SB Left: FP
I categorize this still as loss of ability to load the involved (left) side, because it is not full and pain free passively, full passive motion is important for any area. However, after just 30 reps of cervical retraction with end range loading, and a few hold relaxes to the cervical spine to reduce end range discomfort, we had...

When are you going to work on my shoulder? Oh wait, forget it...

MRE still DP, but improved - this is normally tougher to restore
This was just a quick example to show, if you do your MDT repeated motion exam first, it's a treatment, and some asymmetries that were there previously may have improved. For the most part, unless someone is terrible pain with high fear avoidance, or just had acute injury, I recommend SFMA first, then MDT second.

Keeping it Eclectic...


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