Five repetitions of a certain movement can make things worse, better, or have no effect. Same with fifty reps. Same with five hundred reps. That's the point of repeated movement testing: you don’t know if all someone needs for his orthopedic disorder is movement in one direction until you thoroughly investigate. Unless things are getting worse, you typically don’t have your definitive answer in just fifty reps. Too often people get these convoluted treatments for their orthopedic, movement-based disorders, when they just need someone who can figure out which movement they need based on how their symptoms and movement change with various movements. If a patient needs a specific movement to fix his problem, we say he has a directional preference.
Here are some examples of repeated directional preference movements I use for both testing and for treatment: loaded elbow flexion, unloaded knee extension, cervical right lateral flexion with overpressure, ankle dorsiflexion mobilization, lumbar sustained left side glide, shoulder internal rotation with belt overpressure, wrist extension with radial deviation, loaded hip external rotation. There are dozens of other ones. I use an algorithm based on the verbal history and physical exam to decide which movement to test, how long to test it for, and which movement to change to if needed. If clinicians and patients abandon a movement because there is no obvious positive change with fifty reps, they may be abandoning the movement prematurely - repeated means repeated.-- Laura
You’re assessing, assessing, assessing to arrive at a diagnosis. And then even when you think you have the diagnosis, you’re assessing, assessing, assessing to make sure you’re on the right track.
I want a plan that helps; that goes without saying. But when you’re figuring things out, you want to know about any and all effects - helpful, harmful, or indifferent. In order to get to the helpful plan, we need to understand what’s going on, which importantly includes knowing what tests and/or treatment strategies have no effect or which ones make you worse.
If a repeated movement has no effect, that might make me think there’s more likely a tissue problem instead of a joint problem. Or that we have a joint problem that needs more force, or a different direction. If repeated movement in a particular direction makes things worse, then it is more likely you have a joint derangement, and now we have information about which direction would be helpful. Knowing that something we test has a negative impact (on pain, movement, etc.) is just as powerful as knowing something has a helpful impact.
All of these pieces - all of these effects of repeated movement tests combined with the verbal history and physical baselines (as well as any other necessary diagnostic tests) - help us understand what’s going on. There are dozens of these puzzle pieces, by the way! And the faster we know what’s going on, the faster we can hone in on the treatment you need. -- Laura
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