Evaluation Process

Learn all about Orthopedic Manual Physical Therapy's history, evaluation process, treatment philosophy, and training philosophy.

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Evaluation Process of OMPT

Finding the source of your pain

The comprehensive approach taken by the OMPT program investigates the relationship between the symptomatic complaints and the mechanism behind the provoking movement patterns. The evaluation is done in order to systematically find the functional impairment and give understanding to the characteristics of the structures involved. Due to the complexity of the body the therapist first generates a differential diagnoses list. This is a list of possible diagnoses that would be consistent with the patient’s symptoms as reported from the history. Irrelevant diagnoses are sequentially eliminated through the use of localization testing.

The philosophy developed by Evenjth and expanded on by Krauss localizes regions, structures, and/or segments. Localization works on the principle of provocation and alleviation of the specific symptoms the patient presents to the clinic with. Therefore replicating or linking signs from the objective testing done by the therapist to the symptomatic movement complaint. Specific detail about the region and structure is interpreted as it is examined. Regional testing is performed if the pain is broad in nature and travels across multiple areas of the body. In order to differentiate regions within the body, the application of the testing either applies or relieves an applied force on one region in order to rule out uninvolved regions.

For example, if there is pain in the base of the neck and into the shoulder, it could be from either of the two regions. If the patient reproduces the painful movement and the therapist applies a stress such as traction to the neck while the patient is in pain and the pain doesn’t change, this would indicate the shoulder could be the involved region. Then the shoulder should be further tested more from that point on.

At this point, the relevant region has been linked to the symptoms and the therapist continues to examine the structures and/or the segments involved (if dealing with the spine) in order to find the primary tissue involved to help determine a working diagnosis. The structures could include muscle, tendon, ligament, cartilage, joint capsular tissue, neural (nerve) and/or soft tissue. Again the primary structure is identified by the replication or alleviation of the specific symptoms. Examination of these impairments looks at the quality of tissues, such as muscle fiber length and feel, nerve irritation, and translatoric joint play. Joint play is precise testing that evaluates the motion that occurs within the joint. This includes characteristics of gliding and rolling within the joint that lead to the primary motion of functional movement.

For example, pain in the shoulder could be from the joint, nerve and/or muscle. Pulling on the humerus separates glenohumeral joint and could lengthen the muscles in the muscles around the shoulder, therefore if pain is reproduced, the therapist would think the joint is not involved and if the nerve testing is negative the therapist concludes it could be the muscles and continues with muscle testing.

Throughout the differentiation process more than one structure may concurrently be involved. Therefore the therapist looks at the specific impairment of that structure as it correlates to the primary structure, function and symptoms. This method of testing gives insight into the symptoms surrounding the whole body.