H O P Evaluate Function

HHOOPPEvaluate FunctionEvaluate Function

A look into ROM and A look into ROM and functional testing…functional testing…

Before ‘E’-Quick ReviewBefore ‘E’-Quick Review

H= HistoryH= History Determine:Determine:

Cause of injuryCause of injury Location of painLocation of pain Severity of painSeverity of pain Pain anywhere elsePain anywhere else Noises heard during injuryNoises heard during injury Kind of painKind of pain Previous history or significant medical Previous history or significant medical

historyhistory

Before ‘E’-Quick ReviewBefore ‘E’-Quick Review

O= ObservationO= Observation Look for:Look for:

Obvious deformityObvious deformity Bilateral comparisonBilateral comparison Signs of trauma (blood, swelling, bruising, Signs of trauma (blood, swelling, bruising,

skin discoloration, shock)skin discoloration, shock) GuardingGuarding Specific issues involving specific body partSpecific issues involving specific body part

Before ‘E’- Quick ReviewBefore ‘E’- Quick Review

P= PalpationP= Palpation Feel for:Feel for:

Anything in observation that you may be Anything in observation that you may be able to feel as well as see (swelling, able to feel as well as see (swelling, temperature change associated with skin temperature change associated with skin discoloration)discoloration)

Crepitus (creaking or grinding feeling Crepitus (creaking or grinding feeling sometimes associated with broken bones)sometimes associated with broken bones)

Bilateral comparisonBilateral comparison Specific anatomical landmarks for specific Specific anatomical landmarks for specific

body partsbody parts

‘‘E’= Evaluate FunctionE’= Evaluate Function

ROMROM What is it? What is it?

Range of MotionRange of Motion

3 kinds to look for3 kinds to look for ActiveActive PassivePassive ResistiveResistive

Active ROMActive ROM

For any injury, when it comes to For any injury, when it comes to movement, movement, ALWAYSALWAYS ask the athlete to ask the athlete to move the injured limb by themselves first!!move the injured limb by themselves first!! Reasons:Reasons:

Less risk of more severe injury if athlete moves it on Less risk of more severe injury if athlete moves it on their own their own

You do not know athlete’s pain and you do not know You do not know athlete’s pain and you do not know athlete’s pain at certain points in motionathlete’s pain at certain points in motion

Sometimes athlete will realize they are more scared Sometimes athlete will realize they are more scared than injured and calm down after moving limb than injured and calm down after moving limb

Active ROMActive ROM If athlete is unable to move limb on their own, If athlete is unable to move limb on their own,

do NOT continue in ROM steps. Injury is do NOT continue in ROM steps. Injury is either too severe to manipulate, or athlete is either too severe to manipulate, or athlete is too scared/in too much pain to be evaluated. too scared/in too much pain to be evaluated. During AROM, look for compensation in movement During AROM, look for compensation in movement

or abnormal movementor abnormal movement

In most instances, a call to the parents and a In most instances, a call to the parents and a trip to the doctor or hospital is appropriate. trip to the doctor or hospital is appropriate. The less harm and pain you cause the athlete, The less harm and pain you cause the athlete, the less chance you have of becoming liable the less chance you have of becoming liable for a more severe injury.for a more severe injury. (Unless you don’t mind big messy lawsuits!)(Unless you don’t mind big messy lawsuits!)

Passive ROMPassive ROM

Depending on how well the athlete is Depending on how well the athlete is able to move limb, you may assess the able to move limb, you may assess the athlete’s motion using PASSIVE athlete’s motion using PASSIVE movements:movements: YOU are moving the athlete’s limb for them. YOU are moving the athlete’s limb for them.

Tell athlete to be ‘dead weight’ or ‘go blah’ while Tell athlete to be ‘dead weight’ or ‘go blah’ while you support the weight of the limbyou support the weight of the limb

Reasons:Reasons: By taking out the athlete’s muscles, you may be By taking out the athlete’s muscles, you may be

able to get better idea of specific injury (boney, able to get better idea of specific injury (boney, ligamentous)ligamentous)


Always take caution in performing Always take caution in performing movements for the athlete, and make movements for the athlete, and make sure that you communicate!sure that you communicate! ““Does this hurt? Tell me at any point in Does this hurt? Tell me at any point in

me moving it for you if you have pain. I me moving it for you if you have pain. I will go slow through each motion so you will go slow through each motion so you can tell me the second it starts to hurt”can tell me the second it starts to hurt” Reassure the athlete that you aren’t going Reassure the athlete that you aren’t going

to yank them through the motion. You will to yank them through the motion. You will lose complete trust if you cause more injury!lose complete trust if you cause more injury!


If the athlete is in severe pain, If the athlete is in severe pain, proceed with caution. Most times, proceed with caution. Most times, when in doubt of severity of injury, when in doubt of severity of injury, just send athlete for doctor referral. just send athlete for doctor referral.

If pain isn’t too intense, or no pain at If pain isn’t too intense, or no pain at all, you can rule out fracture all, you can rule out fracture (usually, but not always), and may (usually, but not always), and may move on to the final ROM.move on to the final ROM.

Results from Active and Results from Active and Passive ROMPassive ROM

AROM is typically less than PROMAROM is typically less than PROM

If both AROM and PROM are equal and fall If both AROM and PROM are equal and fall short of the expected range of motion, the short of the expected range of motion, the athlete may have tight muscles or there athlete may have tight muscles or there may be adhesions restricting the motionmay be adhesions restricting the motion

If muscular weakness is suspected (when If muscular weakness is suspected (when AROM is less than PROM), you can usually AROM is less than PROM), you can usually continue to final ROMcontinue to final ROM

Resistive ROMResistive ROM

Combination of Active ROM and Combination of Active ROM and manual resistance from tester (you). manual resistance from tester (you). Reasons:Reasons:

You can sometimes pinpoint the location You can sometimes pinpoint the location

of the injury in the specific muscle, or of the injury in the specific muscle, or

determine the specific muscle involved if determine the specific muscle involved if

you use Resistive ROM. you use Resistive ROM. Two types of RROM:Two types of RROM:

Full motionFull motion Break testingBreak testing


Full motion RROM:Full motion RROM: Similar to Active ROM, only you, as the Similar to Active ROM, only you, as the

tester are applying STEADY pressure to tester are applying STEADY pressure to athlete’s limb in the OPPOSITE direction athlete’s limb in the OPPOSITE direction they are attempting to move through the they are attempting to move through the FULL RANGE OF MOTIONFULL RANGE OF MOTION If athlete is moving in dorsiflexion, you are If athlete is moving in dorsiflexion, you are

applying resistance to keep them in plantarflexionapplying resistance to keep them in plantarflexion This type of RROM can begin to narrow down This type of RROM can begin to narrow down

where the pain is located, but not necessarily the where the pain is located, but not necessarily the muscle (many muscles perform a number of muscle (many muscles perform a number of motions)motions)


Break Testing:Break Testing: Also known as manual muscle testingAlso known as manual muscle testing

Isolates individual muscles within their Isolates individual muscles within their functional planes of motionfunctional planes of motion

Performed isometrically to see if the athlete Performed isometrically to see if the athlete can overcome the force at that particular can overcome the force at that particular point in the motionpoint in the motion

Looks choppy when performing, unlike Full Looks choppy when performing, unlike Full Motion which is smooth and even pressureMotion which is smooth and even pressure

Range of Motion NotesRange of Motion Notes

Always important to stabilize joint Always important to stabilize joint you are attempting to moveyou are attempting to move Because:Because:

If you don’t provide support, athlete may If you don’t provide support, athlete may find another muscle to aid in movement find another muscle to aid in movement which will throw off your evalwhich will throw off your eval

Providing support will also reassure the Providing support will also reassure the athlete that you are taking every precaution athlete that you are taking every precaution to keep them safe and in a controlled to keep them safe and in a controlled environmentenvironment

Once ROM is Complete…Once ROM is Complete…

If athlete is performing ROM well or If athlete is performing ROM well or to your standards, you may move on to your standards, you may move on to functional testingto functional testing

Functional testing:Functional testing: For some, functional testing may mean For some, functional testing may mean

Activities of Daily LivingActivities of Daily Living For others, it may mean sport specific For others, it may mean sport specific

testingtesting

Activities of Daily LivingActivities of Daily Living Consider an elderly patient who has Consider an elderly patient who has

recently recovered from a broken armrecently recovered from a broken arm Their activities of daily living will be Their activities of daily living will be

completely different than that of an athlete completely different than that of an athlete or an active personor an active person

Example: Teaching the patient how to reach for a Example: Teaching the patient how to reach for a plate in the cupboard, or how to pick up an object plate in the cupboard, or how to pick up an object off the flooroff the floor

Consider a receptionist who is recovering Consider a receptionist who is recovering from from Carpal Tunnel SyndromeCarpal Tunnel Syndrome

Their activities of daily living may consist of learning Their activities of daily living may consist of learning how to ergonomically type or perform duties at desk all how to ergonomically type or perform duties at desk all dayday

Sport Specific TestingSport Specific Testing

For athletes, it is incredibly important For athletes, it is incredibly important before returning to play that sport before returning to play that sport specific functions can be performed on specific functions can be performed on the sideline.the sideline. Each sport has unique and specific Each sport has unique and specific

movements and motions movements and motions Basketball: defensive slides, cutting, running Basketball: defensive slides, cutting, running

backwards, boxing out, jumpingbackwards, boxing out, jumping Football: cutting, 3 point stance, blocking, Football: cutting, 3 point stance, blocking,

jumping, sprintingjumping, sprinting Swimming: flutter kick, arm circles, turns and Swimming: flutter kick, arm circles, turns and

pushing off wallpushing off wall


By having athlete perform certain By having athlete perform certain sport specific motions on sideline, sport specific motions on sideline, you are reassuring both yourself and you are reassuring both yourself and the athlete that they are able to the athlete that they are able to compete compete Use controlled environment, start out Use controlled environment, start out

slow, break down certain more complex slow, break down certain more complex movements before throwing athlete movements before throwing athlete back into actionback into action

Sport Specific TestingSport Specific Testing Consider athlete with severely sprained ankle trying to Consider athlete with severely sprained ankle trying to

return to soccerreturn to soccer Sport specific testing will involve things like:Sport specific testing will involve things like:

Standing on one leg and balancing in placeStanding on one leg and balancing in place Standing on one leg and doing touches with other legStanding on one leg and doing touches with other leg Hopping on one leg Hopping on one leg Hopping from side to side on one legHopping from side to side on one leg JoggingJogging Running Running SprintingSprinting Running backwardsRunning backwards Shuffling sidewaysShuffling sideways CuttingCutting Kicking with light touchesKicking with light touches Kicking long ballsKicking long balls

Important part of rehab is incorporating equipment from Important part of rehab is incorporating equipment from sport back into exercisessport back into exercises Keeps athlete interested and can liven exercises upKeeps athlete interested and can liven exercises up


Reasons:Reasons: You never never never throw an athlete back into a You never never never throw an athlete back into a

competitive event of any kind competitive event of any kind (practice/scrimmage/game) until you are sure they (practice/scrimmage/game) until you are sure they are able to withstand the spontaneous movements are able to withstand the spontaneous movements that occur within the sportthat occur within the sport

Mentally, the athlete will become stronger by Mentally, the athlete will become stronger by seeing that they are able to perform movements on seeing that they are able to perform movements on sideline before performing them during competitionsideline before performing them during competition

Sometimes with stubborn athletes, you can prove to Sometimes with stubborn athletes, you can prove to the athlete in a controlled environment that they the athlete in a controlled environment that they may not be ready to return just yetmay not be ready to return just yet

The EndThe End

Questions???Questions???

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H O P Evaluate Function