I remember thinking years ago how odd it seemed that people’s joint pain (often occurring for no known reason) would be addressed by simultaneously stretching muscles, moving joints, strengthening other muscles, and changing posture (plus ice, heat, US, etc). It didn’t seem logical that all of those pieces fell perfectly into disarray, leading to pain.
Does it make more sense that joint immobility and muscle tightness and weakness led to the impingement, or that the impingement led to those findings? What I find more rational is that a joint impingement, a joint derangement, or, simply put, a joint that’s a bit stuck occurs because, well, joints are mobile things and these things happen. The most obvious example is you unknowingly sleep in a certain position and you wake up with stuck neck joints. Or your shoulder joint gets impinged because you repeatedly move in a new way starting tennis again. Or your low back gets deranged because you sit in the exact same position in your office chair for hours a day. These factors and others can easily lead to minor (fixable!) joint disruptions. In fact, most of these examples, especially the neck scenario, will resolve with daily movement (and possibly a little rest) on their own - no doctors or other help needed.
I deduce in the clinic if a joint is impinged/not moving optimally by repeatedly moving joints and gauging the effect. I don’t rely on “impingement tests.” I secondly don’t believe in the value of imaging except for a small minority of cases. It’s much more likely that the bony configuration of your joint (eg shoulder acromion or hip acetabulum) has been that way, if not your entire life, then most of your life, and therefore this new pain is due to new factors.
To address it, in contrast to the stretching, strengthening, and movement I alluded to above, we look for the specific joint movement that unpinches the joint. It’s typically one that is not regularly performed in the person’s daily life. The theory as to why these things occur is that it’s normal for joints to get a bit stuck if you don’t move them in a variety of directions or if you spend the majority of your time in one uninterrupted direction. They’re so common that most self resolve, but I see the stubborn ones. -- Laura
Orthopedic special tests (OSTs) are clinical tests to aid with diagnosing. For example, there are tests that assess the integrity of the ACL, the presence of tendinopathy in the elbow, tears in the rotator cuff muscles, and problems with the meniscus. They usually name a structure that is the problem. But do they?
While I believe there are some OSTs that are helpful diagnostic tools (like the Lachman test for the ACL), most are not. In fact, I rarely use them to help with diagnosing a person’s problem because of this lack of validity. And, as I’ve said before, most problems are due to function, not structure, anyhow.
For instance, say I perform the empty can OST (which indicates a supraspinatus problem) and get a positive test, meaning it reproduces the person’s shoulder pain and/or tests weak. Then the patient does repeated movements of the neck and the test changes to negative. Does the empty can really tell me there’s a problem with the supraspinatus? Maybe indirectly, but it’s not the part (source) of the problem that needs to be addressed. Does it make sense that neck mechanics can influence how it feels when you push down on someone’s outstretched arm? Of course. -- Laura
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