MANUAL THERAPY [SHS.

405]
M AMMAR AKBAR
PHYSIOTHERAPIST
 CONTENT
 Principles of function testing

 Assessing quantity of movement

 Measuring rotatoric movement with a device

 Manual grading of rotatoric movement

 Assessing quality of movement

 Quality of movement to the first stop

 End-feel: quality of movement after the first stop

 TESTS OF FUNCTION
 A test of function enables you to see, hear, and
feel the patient's complaints.

 Symptoms and signs that emerges from tests of

function differentiate the nature of the structures
involved in the dysfunction.
 TESTS OF FUNCTION
 Active and passive rotatoric (angular) movements:
Identify:
 Location
 Type
 Severity of dysfunction.
Standard (Anatomical, Uni axial) movements
Combined (Functional, Multi axial) movements

 Translatoric Joint play movements:

 Further differentiate articular from non articular lesions;
Identify directions of Joint restrictions by:
Traction
Compression
Gliding
 TESTS OF FUNCTION
 Resisted movements:
 Test neuromuscular integrity and status of
associated joints, nerves and vascular supply.
 Grading
 Passive soft tissue movements:
 Differentiate joint from soft tissue dysfunction and
the type of soft tissue involvement.
Physiological movements
Accessory movements

 Additional tests
PRINCIPLES OF FUNCTION
TESTING
 PRINCIPLES OF FUNCTION TESTING

 Be specific when asking the patient about

symptoms during the examination.

 Ask the patient to describe the character and

distribution of their symptoms.

 Note if a particular movement provokes the

primary complaint.
ASSESSING QUANTITY OF
MOVEMENT
 ASSESSING QUANTITY OF MOVEMENT
 Examine the range of motion for each standard
and combined movement first by observing the
active movement.

 Continue the same movement passively with

overpressure.

 Compare the range of active movement with the

same passive movement.
 ASSESSING QUANTITY OF MOVEMENT
 The results of this test may reveal :

 Hypo mobility
‘movement less than established norms’

 Hyper mobility
‘movement greater than established norms’

A joint can be hypo mobile in one direction

and hyper mobile in another.
 ASSESSING QUANTITY OF MOVEMENT
 Can implicate a capsular pattern or significant
muscle shortening.

Hypo mobility or Hyper mobility are only

pathological findings if they are associated
with symptoms and a pathological end-feel.
 MANUAL GRADING OF ROTATORIC
MOVEMENT (0-TO-6 SCALE)

 Range of motion may be tested manually and

classified using the following scale:
 1.half or more than half …….2.less than half
MANUAL GRADING OF ROTATORIC
MOVEMENT (0-TO-6 SCALE)
ASSESSING QUALITY OF
MOVEMENT
 ASSESSING QUALITY OF MOVEMENT
 See and Feel quality of movement.

 Passive movement quality is best assessed

throughout an entire range of movement to the
first significant stop.

 Repeat each passive movement at different

speeds to reveal various types of restrictions.
 ASSESSING QUALITY OF MOVEMENT
 Quality of movement to the first stop:

Passive movements should be free, smooth, and

independent of the speed with which they are
carried out.

Quality of movement after the first stop:

Sense end feel

 END FEEL

the sensation imparted to your hands at the limit of

the available range of movement.

 Test end-feel with a slight additional stretch

after the first significant stop of a passive
movement.

 Two types:
 Rotatoric End feel

 Joint Play End feel

 NORMAL PHYSIOLOGICAL END-FEEL
 Each joint movement has a characteristic end-
feel, depending on the anatomy of the joint and
the direction of movement tested.

 Soft:
A soft end-feel is characteristic of soft tissue
approximation (e.g., knee flexion) or soft tissue
stretching (e.g., ankle dorsiflexion).
 NORMAL PHYSIOLOGICAL END-FEEL
 Firm:
A firm end-feel is characteristic of capsular or
ligamentous stretching.
 (e.g., medial or lateral rotation of the humerus
and femur).

 A normal capsular end-feel is less firm (firm "-")

and

 A normal ligamentous end-feel is more firm

(firm "+").
 NORMAL PHYSIOLOGICAL END-FEEL
Hard:
A hard end-feel occurs when bone or cartilage meet
(e.g., elbow extension and flexion).

Normal end-feels are pain free.

Thank You