Make your assessments more Global, the importance to restoring non-dysfunctional movement – says Tammy Emmins, BSc MSST

AssessmentsSometimes what presents to us in clinic as a simple injury may have hidden global problems, as the route cause. A simple groin strain for example may have many implications for an athlete but unless a good subjective and objective examination takes place the global issues could easily go undiagnosed.

Clearing the joint above and below the identified symptomatic area will aid the practitioner in finding the dysfunctional patterns, which in this case can lead to the contralateral lumbar region.

A typical finding would be an elevated illiac crest on the opposite side to the groin strain, this is an indicator that the Quadratus Lumborum (QL) may be short. This could be tested by a muscle length test, as stated in Chaitow (2013), which would be a side bend to the same side as the groin strain. The opposite QL would also be tested to give a benchmark of the normal range for the client. The adductors would also be checked for the passive, active and resisted range of movement comparing the injured and non-injured limb. The expectation would be that the client would experience more pain in active range of movement, however there may also be pain in passive end range abduction and resisted adduction dependent of the severity of the injury.

Some typical treatment for the above presentation may include Soft Tissue Release (STR) and Muscle Energy Techniques (MET). Chaitow (2013) has developed and integrated approach to treating soft tissue which is named: Integrated Neuromuscular Inhibitory Technique (INIT), this is a combination of MET, positional release and neuromusclar technique (NMT). It is very effective in treating the QL and would be a technique of choice when dealing with this presenting complaint. The adductors treatment would combine the use of passive and active STR with a Reciprical Inhibition (RI) MET. The client would then be re-assessed in the painful or dysfunctional movement to ensure a change has taken place, the change could be increased range and or decreased pain in movement.

Further treatment would depend on whether this was a acute traumatic injury or a chronic condition that has built over time. It would be wise at some point to look at more functional movement like gait to ensure this is not the underlying pathology. Thinking globally allows you to add the pieces to the puzzle and to ensure the client has every chance of success to free, easy and non-dysfunctional movement.

Chaitow, L. (2013) Muscle Energy Techniques (Advanced Soft Tissue Techniques) 4th ed. Churchill Livingstone