Relieve Low Back Pain | Reduce Low Back Pain | Canada's Leading Authority in Human Movement | Dev Chengkalath

Range of Motion (ROM)

The range of motion of a joint is typically tested in 3 ways.

I’ll be restricting my post to the first two, which are active and passive ranges of motion.

The final range testing is done through what’s termed joint play. This is done by the physiotherapist using very specific movements of joints when they’re held in specific test positions and will give information on the integrity of the joints’ ability to glide on each other properly.

Active ROM is tested by asking you to move through as much range of motion that you can.

For example, if I were to test your shoulder’s active ROM, I’d simply ask you to lift your arm straight overhead as far as you can. I could further differentiate between shoulder flexion (straight overhead from in front of you), shoulder abduction (lifting your arm overhead from the side) and shoulder extension (moving your arm backwards and up).

While fairly easy to test, I don’t find active ROM appropriate for all areas of the body and very seldom test the lower back for active ROM. I prefer to teach a majority of my clients (especially those looking to relieve low back pain) to minimize lumbar spine movements.

Passive ROM is tested typically at the end of active ROM, and usually only if there are deficits in the available range when completed actively. This gives us a baseline level of knowledge on how far your joints are actually able to move (total range) and how far you’re able to move within that range (available range).

Strength Testing

As with ROM testing, strength testing can take o many forms but I’ll just highlight a few here today. These are: manual muscle tests (MMTs), resisted isometric movements (RIMs) and functional movement tests/screens.

MMTs can be used to test specific muscle groups by placing those muscles in specific test positions and then challenging them. This gives the physiotherapist key information on how well a certain muscle or muscle group may be functioning.

Overhead Squat Test

RIMs are tests designed to compare the function of contractile tissues (e.g. muscle) with the function of inert or non-contractile tissue (e.g. ligaments). In the proper RIM test position, contractile elements (along with nerves) are challenged. Inert tissue, should not. This allows the the physiotherapist to distinguish between damage to inert tissue (ligament sprains) or damage to contractile tissue (strains of the muscle).

Functional movement tests/screens are based on taking you through specific movements to see how you do. These can include many different positions or exercises such as squats, lunges, push ups, or planks. The results of these tests give information on qualities such as balance, control, body awareness, strength, coordination, injury risk and many others.

In fact, a failed functional test could very well become your treatment exercise!

Special Tests

The last of the tests are called special tests. These are designed to test very specific outcomes and in the hands of a skilled clinician can yield important information that may help elucidate a physiotherapy diagnosis. Some examples of these tests include ligament stability tests (e.g. Lachman’s  test for the ACL), nerve or vascular tests (e.g. Roos stress test for thoracic outlet syndrome) and specific injury tests (e.g. Neer’s test for shoulder impingement).

So there you have it, a brief outline of the information gathering process.

While these tests are important in their own right, it’s just as important to look at the whole clinical picture which includes the medical history, the observation and the results of the physical examination. By the end of this week, I’ll put it all together and show you how all this information forms the basis of a treatment plan.

Yours in movement.

Dev Chengkalath

Over the next couple weeks, I’ll take you through a general physiotherapy assessment to figure out what you’ve been doing to beat up your back for so long and what you can do about it.

• In part one, I’ll detail the often ignored importance of a basic medical history.
• In part two, which will be posted in a few days, I’ll delve into the first component of the physical assessment: observation
• In part three, to follow next week, I’ll discuss physical testing.
• In part four, I’ll outline some potential treatment options.
• And in part five, I’ll outline what you need to do to stay out of pain.

So stick around for the next couple weeks and stop beating up your back!

Part 1: Medical History

While this component of the assessment may seem a bit mundane, it’s probably one of the most important aspects of the whole process.

My clients come in thinking they’re going to get answers. The first thing they get are questions. Lots of them!

This is where my clients always wonder why I’m asking them so many open ended questions, or whether or not those questions have anything to do why they’ve come to my clinic to see me. This is also where they wonder, sometimes out loud, why they’re paying me to “chat” with them instead of treating them!

Believe it or not, your medical history will almost always give clues as to the cause and extent of any of your mobility problems. As I’ve stated numerous times before, without knowing the nature of the root cause of your physiotherapy issues, it’s almost impossible to resolve them.

This remains the case with relieving low back pain as well.

Not only does your medical history help with ruling out red flags or serious pathology that require medical intervention, it’ll also give me the clues that I need to figure out what you’ve done, how you’ve done it and potential methods on how we can fix it.

This could be something as simple as you telling me that you work 60 hours a week sitting at a computer or hunched over a drafting table.

It could be you describing what time of day the pain is better or worse.

It could be you just stating, in your own words, what types of activities are easy or challenging for you.

Or it could be you simply describing the type or quality of your pain and discomfort.

And these questions are just the first steps. Gathering all the pertinent information from the medical history sets the foundation for your physiotherapy assessment that follows.

What may seem simple or innocuous to you might actually be the clue that opens up another direction of questions and queries, all intent on helping you find your path to pain free living.

Yours in movement.

Dev Chengkalath