Musculoskeletal Assessment
History
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This is the information gathering and recording phase of
the assessment.
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The history should give a clear idea of what the problem
is, how to treat the condition and how long it will take
for recovery.
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The history helps develop a rapport with the athlete,
determine the type of person the athlete is and
determines the athletes expectations and concerns about
the injury.
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History Questions
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Questions should be orderly and progress from one to
the other.
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Keep questions simple and relevant. Listen carefully
and clarify information.
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Use questions that will encourage cooperation and
confidence as well as keep the athlete calm and relaxed.
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Remain professional at all times.
Observations
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This is the looking phase of the assessment.
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Watch how the athlete moves.
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Is the athlete limping? Having difficulty removing shirt
or other clothing?
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Have female athletes in sports bra and shorts and male
athletes in shorts to enable you to look at entire person.
What to look for
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Posture
head position
shoulder position
back alignment
pelvis position
knee level
ankle and foot position
arches
Athletes willingness to move
body parts
Facial expressions as athlete
moves.
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Differences between left and
right sides of the body.
Deformity
Asymmetry
Muscle spasm
Muscle development
Muscle atrophy
Limb size; shape; colour;
temperature
Scars
Functional Tests
This phase of the assessment determines the type of structure
that is injured through active, passive and resisted testing.
The tissues are divided into contractile and inert.
Contractile tissues are; muscle belly, tendon and their
attachment to the periosteum. Tension may be applied to these
structures by stretching or by using resisted isometric
contraction.
Inert tissues are; ligament, capsule, fat pad, blood vessels,
cartilage, meniscus, nerves, skin. These structures hove no
inherent capacity to relax or contract. Tension may be applied
to these structures by stretching during a passive movement.
Active Movement
Active movements tell the therapist:
•The athlete=s willingness to move the joint;
•The athlete=s active range of motion;
•That the muscle can move the joint and body part;
•The quality of movement in the range of available
motion;
•How the joint surfaces are working or the state of the
joint.
Active Movement
How to test:
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Ask athlete to move the joint through as much of the
range as possible, noting where pain occurs in the
range;
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Measure or approximate the degrees of range of motion at
the joint;
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Compare the ranges to opposite limb where possible;
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Test each movement at the joint.
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Note any pain, location of pain, type of pain,
sensations, sounds or abnormal movement during
testing.
Active Movement
Results:
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Range of motion may be normal, limited or excessive
in any one, combination of or all range(s) of motion at
he joint.
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There may be pain throughout the range, at certain
points in the range or at the end of range. There may
not be pain in the range of motion.
Passive Movements
Passive movement tell the therapist:
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The state of the inert structures.
 Pain at the extremes of movement indicates; a
painful structure is stretched or being squeezed. A
painful arc indicates impingement.
 Limited range and painless indicates possible
symptomless osteoarthritis.
 Full range and pain free indicates no inert
structure involved.
Passive Movements
How to test:
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The therapist gently lifts the limb through the full
possible range of motion available without forcing
the joint. The athlete must be relaxed.
 Measure or approximate the degrees of motion
and compare to opposite limb.
 Test each anatomical range of motion.
Passive Movements
Results:
• The range of motion may be limited, normal or
excessive.
• Pain or muscle spasm may be present at any
point in the range.
• There may be pain, limitation or both in any or
all ranges of motion.
Resisted Isometric Contraction
Resisted testing tells the therapist:
The state of contractile structures and their nerve supply.
The degree of strength on a scale of 0-5;
Gone
0
no contraction felt.
Trace
1
can feel muscle tighten but no movement produced.
Poor
2
produces movement with gravity eliminated but can not
function against gravity.
Fair
3
can raise part against gravity.
Good
4
can raise part against gravity with outside resistance.
Normal 5
can overcome a greater amount of resistance than a good
muscle.
Resisted Isometric Contraction
How to test:
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Position athlete so the part being tested is in a neutral position.
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Stabilize the body part being tested, make sure athlete is
comfortable.
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Ask athlete to meet your resistance as you apply pressure against
the muscle group you want to test.
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Use slow gradual increase in pressure until a maximal contraction
is felt.
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Hold the contraction for five seconds and gradually relax.
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The limb should not move through any range of motion.
Resisted Isometric Contraction
Results:
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Strong and painless indicates no neurological deficit or
lesion involving the muscle or tendon.
 Strong and painful indicates no neurological problem.
There is a minor contractile tissue injury.
 Weak and painless indicates there may be some
interruption of the nerve supply to the muscle or there may
be a complete rupture of the muscle or tendon.
 Weak and painful indicates there may be a partial rupture
of tendon or muscle.
Special Tests
This phase of the assessment is used to test specific structures
that are suspected as injured after completing functional tests.
Special tests are also used to rule out the uninjured structures.
Eg. Tap test is used to rule out fracture and distal pulse check
is used to rule out artery interruption.
Palpations
Palpations are used to:
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Isolate the structures that are injured.
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Discriminate differences in tissue tension.
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Distinguish differences in tissue texture.
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Detect abnormalities in shape structure and type of
tissues.
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Feel temperature variations.
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Note abnormal sensations.