Specific Testing

Movement assessment

Lesion present in contractile tissue:

• Pain will occur on active motion in one direction and on passive motion in the opposite direction. Thus a muscle strain would cause pain both on active contraction and passive stretch.
• The specific location of the lesion within the musculotendinous unit cannot be specifically identified by the isometric contraction.

Lesion of inert tissue

• Pain will occur on active and passive movement in the same direction.

• A sprain of a ligament will result in pain whenever that ligament is stretched either through active contraction or passive stretching.

• It is not possible to identify a specific lesion of inert tissue by looking at movement patterns alone.

Active movement

Movement assessment should begin with active range of motion (AROM).

A complaint of pain on active motion will not distinguish contractile pain from inert pain, so the athletic trainer must proceed with an evaluation of both passive and resistive motion.

An athlete who seems to be pain free in each of these tests throughout a full range should be tested by applying passive pressure at the endpoint.

Passive movement

1. When assessing passive range of motion (PROM) the athlete must relax completely and allow the athletic trainer to move the extremity to reduce the influence of the contractile elements.

2. Particular attention should be directed toward the sensation of the athlete at the end of the passive range.

Normal Endpoints

• The athletic trainer should categorize the "feel" of the endpoints as follows.

1. Soft-tissue approximation-soft and spongy, a gradual painless stop (e.g., knee flexion).

2. Capsular feel-an abrupt, hard, firm endpoint with only a little give (e.g., end- point of hip rotation).

3. Bone to bone-a distinct-and abrupt endpoint when two hard surfaces come in contact with one another (e.g., elbow in full extension).

4. Muscular-springy feel with some associated discomfort (e.g., end of shoulder abduction) .

Abnormal Endpoints

1. Empty feel-movement is definitely beyond the anatomical limit, and pain occurs before the end of the range (e.g., a complete ligament rupture).
2. Spasm-involuntary muscle contraction that prevents motion because of pain; should also be called guarding (e.g., back spasms).

3. Loose-occurs in extreme hypermobility (e.g., previously sprained ankle).

4. Springy block-a rebound at the endpoint (e.g., meniscus tear).

Resisted motions

1. The purpose of resisting movement is to evaluate the status of the contractile tissues.

2. The athlete is asked to perform an isometric contraction near the midrange of movement to avoid a position in which there is pinching of other inert structures around the joint.
3. It should also be mentioned that muscular contraction is under neural control; thus lesions of the nervous system may affect the strength of muscular contraction.

   
Neurological examination

The neurological examination usually follows manual muscle testing. It consists of five major areas: cerebral function, cranial nerve function, cerebellar function, sensory testing, and reflex testing. In cases of musculoskeletal injury that does not involve head injury, it is generally not necessary to assess cerebral function, cranial nerve function, and cerebellar function. The athletic trainer should concentrate instead on sensation testing and reflex testing to determine involvement of the peripheral nervous system after injury.

Cerebral function

• Tests for general cerebral function include questions that assess general affect, level of consciousness, intellectual performance, emotional status, thought content, sensory interpretation (visual, auditory, tactile), and language skills.

Cranial nerve function

• The function of the twelve cranial nerves can be quickly determined by assessing the quality of the following: sense of smell, eye tracking, imitation of facial expressions, biting down, balance, swallowing, tongue protrusion, and strength of shoulder shrugs.

Cerebellar function

• Because the cerebellum controls purposeful coordinated movement, tests such as touching finger to nose, finger to finger of examiner, drawing alphabets in the air with the foot, heel-toe walking, and others will determine dysfunction.

Sensory testing

• As the examination progresses, the examiner scrutinizes the variance, if any, in sensation from one side of the body to the other or on the same side.
• Superficial sensation is commonly tested with a pin, and deep pain may be elicited by squeezing the muscle of the specific body part. 

Reflex testing

The term reflex refers to an involuntary response to a stimulus. In terms of the neurological examination there are three types of reflexes: deep tendon reflexes, superficial reflexes, and pathological reflexes.

A deep tendon reflex

• caused by stimulation of the stretch reflex (Chapter 3) and results in an involuntary contraction of a muscle because of stretch of its tendon.
• deep tendon reflexes can be elicited at the tendons of the biceps, brachioradialis, triceps, patella, and Achilles.

Superficial reflexes

• are elicited by stimulation of the skin at specific sites, which produces a reflex muscle contraction.

• include abdominal cremasteric, and plantar.

Pathological reflexes

• are also superficial reflexes.

• The presence of a pathological reflex indicates a lesion in the cerebral cortex; an absence indicates integrity.
• Babinsky's sign, in which stroking of the lateral plantar surface produces extension and splaying of the toes, is an example of a pathological reflex.

Special tests

• Special tests have been designed for almost every body region as means for detecting specific pathologies.
• They are often used to substantiate what has been learned from other testing.
• For example, special tests are commonly used to determine ligament stability, impingement signs, tightness of specific structures, blood circulation, muscle imbalance, and body alignment discrepancies.

Testing Joint play

• Joint play refers to that movement, found in diarthrodial joints, that is not voluntary but accessory, being revealed by specific stresses applied by the examiner.

• A joint that has lost its joint play is dysfunctional, leading to pathology.

Functional evaluation

• The functional evaluation of an athlete may be performed early in the initial examination or be made to determine whether or not rehabilitation has been successful.
• It is an important factor that precedes the return to full sports participation.
• A functional evaluation proceeds gradually from little stress to one that mimics the actual stress that would normally come from full sports participation.
• The major concern is whether the athlete has regained full strength, joint stability, and coordination and is pain free.  A lack of anyone of these abilities may be a factor in excluding the athlete from his or her sport.