The physical assessment offers your therapist the opportunity to get a good overview of your physique and to observe any potential areas that might warrant additional attention in the treatment.
Factors the therapist will be looking for are:
Posture
You will be asked to stand in a neutral position with feet hip width apart, facing forward. How are you standing and holding your body? Are you in any discomfort? Is your body symmetrical or are there areas of tension or unbalanced development? Are you aware of any imbalances? If asked to adjust yourself, what do you notice about how your body feels and what you need to do to get into a symmetrical position? Are you in any pain or discomfort? What are you doing consciously or unconsciously to relieve the pain?
The therapist will look at your anterior (front) posterior (back) and sagittal (side) facings to get a full picture of the way you carry yourself.
Range of movement
The therapist will ask you to perform some movements, either by yourself or with their help or resistence. Range of movement or ROM tests measure your anatomical range – how much movement your joint could achieve if everything was healthy – and pathological range – any problems that are limiting your range of movement.
Active movements are movements you control yourself. Passive movement is where you relax and the therapist moves your body part for you. Resisted movement will involve the therapist using their hand or arm to try to block your movement, demonstrating the strength or any pain level when you contract the appropriate muscles without allowing the joint to move.
What are ROM tests looking for?
Pain or discomfort indicates where the therapist might want to pay attention during your treatment. If your injury relates to a joint or a muscle, these tests will indicate whether or not it is safe to proceed with soft tissue techniques – joint problems without associated muscle discomfort may not benefit from soft tissue work and you may need to be referred for treatment by another specialist. If you have painful or restricted muscles, soft tissue may help.
Passive tests which indicate pain may demonstrate that the problem is joint based. Active tests indicate function of the muscle, and pain in active tests are a better indicator of muscle injury.
Swelling
Acute injuries usually generate swelling or odema around the affected area. Sometimes the swelling is not exactly in the injured area but is nearby in an area of the body that fluid collects in. Two weeks after an acute injury, if you are still experiencing swelling, you may have chronic inflammation in an injured area. Acute injuries may be exacerbated by soft tissue work so the therapist may need to avoid an area affected if your injury is very recent.
Temperature of the tissue and variations in muscle bulk are further indicators of muscle injury. The therapist will look for scars and scar tissue, adhesions (tight “knots” in muscles), history of prior injuries, fatty deposits or any other signs they might need to pay attention to when treating you.
The therapist will ask you for subjective observations: How do you feel?
They will also make objective observations and make notes on what they find so they can refer back to them after treatment.
Landmarks the therapist is looking for:
– Vertex of the skull above symphysis menti, jugular notch, infrasternal angle, symphysis pubis
– Are your eyes and ears level?
– How sharp is the angle of your shoulders? Are they elevated?
– Level of your scapula and clavicles
– Distance of your shoulder girdles from the midline
– Level of your hips
– Angle to your knees and ankles: Are you bow legged or knock kneed? Are your ankles aligned correctly?
– Talus and calcaneum alignment
Some parts of your body may be symmetrical and move freely, whereas there may be other areas that are resistant and asymmetrical. Everyone has some minor asymmetries but differences in your individual physique will show up within your ideal range.