2016
Introduction to General
Assessment
Randy Ellingson
WCRMT
1/1/2016
Basic Practical
Introduction to General Assessment
1
INTRODUCTION TO GENERAL ASSESSMENT
Wellington College believes that its students are apart from other Massage Therapists because
of their practical assessment and treatment skills as well as their continued communication to
the client. This includes the explanation of assessment findings and acquiring consent before
proceeding with each aspect of the treatment plan. The following is a step by step guide that
students should become familiar with. It explains each component of the assessment and
treatment plan protocol and covers the very important aspect of acquiring consent.
1. Client History and Consultation
Introduce yourself to your client, explain the process and obtain consent. The client will fill out
a client history. You should begin the consultation with the information that pertains to the
client’s present condition and then continue to obtain clarification of the remaining medical
history. During the consultation, be sure to clarify items checked by the client on the client
history form. Ask relevant questions about the client’s complaint or aspects of the client history
that may lead you to areas of concern. Always remember the four points of clarification:
• What is the diagnosis or complaint?
• When did it begin or when was it diagnosed
• Treatment received by the client for the diagnosis or complaint to date
• Present status of the diagnosis or complaint
The following is a sampling of questions that may also be asked:
• Do you have any history of pain in this area?
• Where is the pain located?
• Does the pain tend to remain localized or do you find the pain refers to other areas?
• Did the pain result from some form of trauma?
• Did the pain originally come on suddenly or did it build up gradually?
• Does anything make the pain worse?
• How long has it persisted?
• Is the pain more severe in the morning or later in the day?
• Are there any positions which provide relief or are there any positions that make the
pain more severe?
• On a scale of 1 – 10, with ten being severe, where would you rate your pain at its worst?
• Using the same scale how would you rate it at this time?
Remember that not all clients will present with pain and questions may need to be adapted in
order to obtain clarification on the client’s condition.
The consultation component is to be taken seriously as it can go a long way in beginning to
formulate a treatment plan and should be used as such. Upon completion of the consultation
the therapist should already have some educated thoughts about the cause of the client’s
condition and about the direction of the assessment protocol. Consultations are very individual
and the therapist should develop their own style of question-asking throughout the course of
their implementation of this protocol.
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Introduction to General Assessment
2
The goal of consultation is to acquire enough direction and information to develop a focused
general assessment. At the end of the consultation process, the client should understand the
next steps in the procedure (ie, the assessment and treatment plan). Therapists must obtain
informed consent.
2. Check for Contraindications
Use the client history and consultation to identify and clarify any possible contraindications.
Identify possible modifications to the application of the massage treatment that may be
required.
3. Perform Screening Tests
When warranted, perform screening tests to rule out contraindications prior to commencing
further assessment to avoid causing further injury and/or unnecessary pain. Screening tests for
safety must always be performed prior to having the client perform motion testing of an area.
4. Perform General Assessment
General assessment procedures include visual inspection, motion assessment, and palpation
components. Therapists should use caution and consider the client’s subjective information to
prevent further injury to the client. The general assessment should begin at the area noted by
the client’s complaint. If there is an absence of a client complaint, the therapist would monitor
for any areas of gross asymmetry taking into consideration areas that may be affected by the
client’s occupation or daily activities. Remember the purpose of the general assessment is to
provide direction for areas requiring specific assessment. Inform the client of your findings
from general assessment and obtain consent before proceeding.
5. Conduct Specific Assessment of Areas Indicated
The first step of specific assessment is to perform screening tests. Screening tests help to
ensure that the treatment will be safe for the client and they also help isolate the possible
causes of a client’s complaint. Specific assessment should begin at the site of the client’s
complaint and move outward and away from the complaint. Therapists should inform the
client about the reason(s) for specific assessment testing and demonstrate how the testing will
be performed.
Therapists should note any positive findings of specific assessments. Do not try to pre-analyse
the client’s condition as this will lead to false readings. It is important to simply document what
the findings are and, at the end, come to a conclusion about the cause of the client’s complaint
and dysfunctions that may be impacting this complaint. Documentation in the objective section
of a SOAP note may be as follows: Knee Flexion AROM ≠rt / PROM ≠rt
Once you have concluded your specific assessment you would analyse your findings and come
to the conclusion you feel to be factors affecting your client’s condition. The documentation
under the analysis section of a SOAP note may be as follows: RT Quadriceps Hypertonicity
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Introduction to General Assessment
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6. Verify Findings/Analysis
After obtaining a conclusion, the therapist must verify it using an alternative assumption or
action that was not used in the assessment process. To continue with the above example, a
therapist may use Palpation Indicator of W3+ as a verification. Verification findings are
essential in reducing the chances of errors in conclusions.
Therapists should inform the client of the conclusions and establish the treatment plan that will
be implemented to address the conclusions. Once again, consent must be obtained before
proceeding.
7. Apply Extrinsic Techniques Applicable to the Condition and Reassess
Therapists should consider the effects and intents of the individual massage techniques and
select the most effective and appropriate techniques for the client’s condition(s) and
dysfunction(s). Be sure to adequately prepare the tissue both mechanically and neurologically
and through this preparation ready the client for the application of advanced techniques that
may be interpreted as more invasive.
Effective treatments do not involve isolated application of massage to one or two muscles that
require therapeutic intervention. Instead, effective treatments approach the dysfunction
through a more regional approach. For example, assume that a client presents with
hypertonicity in the Lt Quadriceps, Rt Multifidi at T7, and the Lt Trapezius Superior Fibres. In
this situation, massage would be applied to the entire back. During the general massage of the
back, the therapist would address the dysfunctional muscle with advanced techniques as he or
she moves between the different areas of the back. The therapist would always use the
techniques of general massage application to tie the treatment together. The advanced
techniques used in therapeutic interventions are of short duration often being only 30 – 90
seconds in length but repeated several times throughout the process. Through experience, it
has been demonstrated that tissues require at least 90 seconds of rest (and adapting) between
applications of advanced techniques. During this resting timeframe, the therapist will apply
Swedish Massage techniques to maintain the general therapeutic effect of a massage
treatment.
The client should be comfortable during the majority of a massage therapy treatment;
however, there may be times of discomfort during the treatment. This does not mean the client
should feel sustained pain or discomfort post-application of the massage. It is common for the
client to comment that the application “hurts but in a good way”. Remember that pain is a
result of trauma to the tissues and cells. If a muscle responds to that pain by contracting, it will
not be able to benefit from the therapeutic effect of massage. Continuing to apply a technique
that causes pain resulting in muscle contraction is counterproductive and will not assist the
therapist in obtaining positive results.
After applying extrinsic techniques, perform re-assessment to identify results obtained. If
needed, proceed to apply intrinsic techniques.
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Introduction to General Assessment
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8. Apply Intrinsic Techniques and Reassess
Intrinsic techniques require client participation. Again, consent from the client must be
obtained prior to the application of intrinsic techniques. Therapists must explain and possibly
demonstrate the intrinsic technique to the client.
If needed, intrinsic techniques (muscle energy techniques) are applied following the application
of extrinsic techniques. These techniques are primarily targeted to neurological structures.
There are times when we may incorporate intrinsic techniques instead of extrinsic techniques
such as if a dysfunction cannot be treated through normal extrinsic therapeutic intervention,
such as in skin conditions, muscle tears, etc. We may also use a muscle energy technique to
reduce general splinting of muscles in preparation for therapeutic interventions.
9. Conclude the Appointment
Upon the final stage of your treatment provide the client with clear home care activates that
may assist their healing process. These may include stretching, exercise plans, ice applications,
nutritional or psychological counselling. Be sure to address re-booking with the client.
10. Documentation
Proper documentation must be completed for each client after every treatment.
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Basic Practical
Introduction to General Assessment
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THE TOWER SYSTEM
As you will come to understand in a short time, one consideration of our type of treatment is
that of the Tower System. Wellington College believes that the problems which arise in the
body are often the result of an issue that originated elsewhere; often in the pelvic region of the
body. Because this is so often true, we have established the Tower System.
The pelvis is often considered to be the base of the tower and it acts as the central attachment
site for muscles from above and below. For this reason dysfunctions of the pelvis can have a far
reaching impact on the body.
If we were to draw a line across the crests of the innominate bones to the point just past the
Greater Trochanter, and then draw a line from each Greater Trochanter to the external
Occipital protuberance located we would create a triangle. As we can see, if the base of our
triangle is on a particular angle, it will have an affect higher in the back (spine). One of the
reasons this occurs is because the body has an amazing ability to compensate for structural
abnormalities and traumas.
Anther Steindler calls attention to the principal of the "path of least resistance". In essence, this
means the body will rearrange its posture in order to adapt to a deformity or a functional
deficiency to allow the least amount of muscular effort expenditure to maintain function. The
equilibrium in the head and the sight of the human eye function best when the head is on a
horizontal plane, so the body will compensate to prevent the loss of this plane.
Returning to the tower, we will come to realize that if the base of our triangle or tower is not in
a horizontal plane with the one side of the base lower, then the shoulder on the opposite side
will be affected as well as the tissues along the way.
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Introduction to General Assessment
6
There is also a secondary triangle below the Pelvic crest with its apex being on midline between
the client’s feet. Here we can see that dysfunctions in the legs and ankle can transmit up to
through the Pelvic base out of alignment. As a result these dysfunctions may then continue
onward to higher levels in the back.
Lastly we consider a third triangle. This triangle has its apex pivoting on the apex of the first
triangle we described. Its base is positioned through the sphenoid or the orbits of the eyes. The
two apexes balancing on one another show how sensitive this area is to dysfunctions in the rest
of the body. The apexes meet at the Atlantal Axial articulation and, as a result, this articulation
is often called the “headache joint”.
How does this happen?
Let’s assume, for example, that the Piriformis muscle of the client is in a state of contraction. As
it contracts, it will draw the Sacrum to the side, causing a possible pinching of the nerve arising
from that level but also causing the client to tip to the side. In order to prevent the client falling
over, the muscles along the spine at a higher level will contract on the opposite side, creating
balance. In addition, the pressure on the nerve roots will release. In theory, this would take
care of the problem but the body always overcompensates and draws the client too far in the
opposite direction causing muscles to contract higher up the spine to stabilize. As this process
creeps up the body it’s as if it climbs a tower, thus the term Tower System.
The well-trained therapist understands that the cause of the pain indicated by the client may
not be the area closely adjacent to it; rather the original cause may be far removed from where
the pain appears. As the contractions travel up the spine we can easily see that many problems
and uncomfortable conditions can arise along the way. Those conditions, which arise because
of an ailment but are not the direct cause of the problem, are called SECONDARY
PATHOLOGIES; the originating cause is called the PRIMARY PATHOLOGY.
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Basic Practical
Introduction to General Assessment
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ASSESSMENT PROTOCOL
Wellington College follows the ART Principle of Assessment:
A Asymmetry
R Range of Motion
T Tissue Texture Abnormality
Asymmetry Asymmetry is the inspection of the body noting any discrepancies
from one side to the other. Normally one side of the body should
be a relative mirror image of the other; however, when
dysfunction occurs it often presents itself as asymmetry.
Range of Motion When directed by asymmetry or complaint, a Wellington
Therapist will try to isolate the muscles causing the dysfunction
through the application of APR Motion Testing:
A – Active Range of Motion (client performing the motion)
P – Passive Range of Motion (therapist performs the
movement without client involvement)
R – Resisted / Strength Testing (client is requested to
generate the motion while the therapist resists the
movement, comparing strength of the musculature)
Tissue Texture Abnormality Tissue Texture Abnormality is the monitoring of tissues through
palpation and evaluating the findings to the Wellington Scale of
0- 5. Tissue Texture Abnormality also takes into consideration
the skeletal alignments and alterations to tissue masses.
Through the application of these skills the Wellington Therapist will confidently develop the
ability to evaluate the client’s conditions and perform the appropriate treatment to establish a
pain-free and normal functioning ability in the client’s articulations and muscles.
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Basic Practical
Introduction to General Assessment
8
GENERAL ASSESSMENT
When a client enters the treatment room, the concern of the therapist is often, "Where do I
start?" Wellington College has developed a general assessment protocol to assist the therapist
in determining the primary areas of dysfunction. This general assessment protocol is the
combination of assessment found in Greenman's, “Principles of Manual Medicine”,
Hoppenfeld’s, “Examination of the Spine and Extremities” and “The Osteopathic Manual of
Examination and Treatments and Soft Tissue Manipulation”. This assessment protocol is
designed to provide the therapist with the guidance needed to decide which areas require
more specific assessment.
Although the College provides the students with the full general assessment protocols, we want
you to understand that you will incorporate only those components that are relevant to your
client’s complaint. It is intended to assist you in determining what areas of the body will require
further investigation through specific assessment. At no time is general assessment to be
considered a determinant in what is causing a client’s complaint. Once you have concluded that
a particular area requires closer evaluation, your general assessment skills will only become
redundant. For example, if during the general assessment, the asymmetrical shoulder height
indicates that the Scapula and GH require specific assessment, you don’t need to further
investigate other indicators that would also tell you to assess the Scapula and GH. It has already
been determined.
The best tool to use to determine where to start (other than the client’s complaint), is to
quickly scan the client from all sides. Then picture the client in your mind; the areas that stand
out in your recall are great places to commence your assessment.
Initially Phillip Greenman’s 10 Step Screening Protocol will be presented so that the therapist
may begin to formulate a general assessment plan. As each area of the body is presented,
instruction on the general assessments that refer to that particular area will be discussed.
When all components of the body are completed, time will be spent on correlating the general
assessments into one fluent assessment process.
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Introduction to General Assessment
GAIT
POSTURE
1. Posture View
a. Shoulder Level; Low on
b. Iliac Crest; Low on
c. Greater Trochanter Height; Low on
d. Head; Side-bent to
e. T-Spine Paravertebral Fullness
f. L-Spine Paravertebral Fullness
2. Lateral View (Plumb Line)
a. Cervical Lordosis
□Increased
b. Thoracic Kyphosis
□Increased
c. Lumbar Lordosis
□Increased
STANDING SPINE SIDEBENDING
STANDING FLEXION TEST
□Negative □Positive
SEATED FLEXION TEST
a. Pelvis: Positive
□Equal
b. Sacrum: Positive
□Equal
c. Lumbar Spine Paravertebral Fullness
d. Thoracic Spine Paravertebral Fullness
SEATED UPPER EXTREMETIES TEST
Restricted
SEATED TRUNK ROTATION
Restricted
SEATED TRUNK SIDEBENDING
Restricted
SEATED CERVICAL MOTION
a. Backward Bending Restriction
b. Forward Bending Restriction
c. Rotation Restriction
d. Sidebending Restriction
THORACIC CAGE MOTION
a. Upper Ribs
Inhalation
□L □R
b. Middle Ribs
Inhalation
□L □R
c. Lower Ribs
Inhalation
□L □R
LOWER EXTREMITIES TEST
□Yes
□No
Area of client`s complaint
Associated area(s) determined through general assessment
□ Normal
□Abnormal
□Left
□Left
□Left
□Left
□Left
□Left
□Right
□Right
□Right
□Right
□Right
□Right
□Normal
□Normal
□Normal
□Left
□Decreased
□Decreased
□Decreased
□Right
□Left
□Right
□Left
□Left
□Left
□Left
□Right
□Right
□Right
□Right
□Left
□Right
□Left
□Right
□Left
□Right
□Yes
□Yes
□Left
□Left
□No
□No
□Right
□Right
Exhalation
Exhalation
Exhalation
□Up
□L □R
□L □R
□L □R
□No
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Basic Practical
Introduction to General Assessment
ASSESSMENT OF GAIT
Assessment of gait is the first visual assessment you perform. The client doesn`t need to be
undressed completely for the assessment of gait, but the shoes should be removed. Monitor for
exaggerated asymmetry as the client walks eight steps toward you and eight steps away from
you. Repeat this process twice. Time required for the assessment of gait should be only one to
two minutes. The following points should be taken into consideration:
Leg Swing
• Does the leg swing more laterally on one side?
o This would indicate dysfunction in the hip (Coxa)
 Often due to the weakness in the Gluteus Medius muscle
• Do they swing the leg forward in an exaggerated motion?
o This would also indicate dysfunction in the hip (Coxa)
 Often due to the weakness in the Gluteus Maximus muscle
• Do they tend to take shorter steps with one leg?
o This would indicate a dysfunction of the Pelvis, Sacrum or lower extremity
 Often the dysfunction is in the opposite leg or hip
• When the foot is elevated from the floor in a non-weight-bearing or swing phase, does it
tend to be rotated medially or laterally?
o This would indicate a rotational dysfunction in the hip
• Does their foot tend to scuff on one side?
o This would indicate dysfunction of the lower leg anterior or posterior compartments
• Do they tend to have a heavy heel strike?
o This would indicate dysfunction of the Pelvis, hip or knee of the opposite leg
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Basic Practical
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Neck Position
• Is the neck extended forward?
o Indicates dysfunction of the cervical or upper respiratory structures
Arm Swing
• Does the arm swing in an exaggerated motion?
o This would indicate dysfunction of the shoulder girdle
Torso
• Is the client flexed forward in an exaggerated motion?
o This would indicate spinal, low back or abdominal dysfunctions
• Are they erect in an exaggerated motion?
o This would indicate disc problems
• Are they side bent to one side?
o This would indicate upper thoracic problems or if they are rotated in one direction it
would indicate lower thoracic problems
Shoe Wear
Evaluate the shoes the client most commonly wears. It is best if they have been worn for at
least one to two months.
• Shoe worn on medial or lateral heel
o Indicates hip dysfunctions
• Arch wear
o On the lateral arch indicates Varus strain of the knee
o On the medial arch indicates Valgus strain of the knee
o On the ball of the foot indicates dropped Metatarsal arch or Tibial dysfunction
o On the tip of the shoe indicates weakness of the anterior compartment
Once you have completed your assessment of gait the next step would be the standing
assessment procedure.
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STANDING ASSESSMENT
Provide the client with a gown which opens to the
posterior. Explain that in order to perform an
initial assessment, the back and extremities should
be exposed. The gown should be loose fitting with
long ties in the back. The length should be no
greater than just above the knee. Instruct the
client to remove the bra (if this is within her
comfort level) but leave on the underwear. Leave
the room as the client prepares. Another
alternative is to ask the client to bring along and
wear shorts that do not extend beyond the knee.
Upon your return, instruct your client to close
their eyes and take two steps forward followed by
two steps backward and come to a comfortable
position, keeping their eyes closed until they are
instructed to open them. Their feet should be a
comfortable distance apart and arms hanging at
their sides. Do not direct the client to adjust their
position to be in a specific stance but rather emphasize that they
be comfortable. Once the client is standing in front of you, you
may proceed noting the areas as shown in the diagrams.
To perform standing assessment you may wish to incorporate a
plumb line. This is a string hanging from the ceiling with a weight
on it. The plumb is placed on the midline of the client in each of
the views to assist in picking up on abnormal posture. Symmetry
should be present throughout the body; any asymmetries
indicate dysfunction and warrant closer inspection. Note that
when performing your inspection you may find many minor
discrepancies that are not impacting the client. The assessment
is seeking out asymmetries that are great enough to affect the
client’s daily activities or generate pain. A good rule to follow is if
you are questioning whether asymmetry is present or not, this
usually indicates it’s not present enough to have any impact on
the client.
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Basic Practical
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Although we would normally be guided by the client’s area of complaint, we have provided the
description here for training purposes commencing from the feet upward.
Foot Position
• Is one foot more anterior or more posterior than the other?
o This indicates imbalances in the lumbar spine
• Is their stance exaggeratedly wide?
o This would indicate dysfunction in the thoracic spine
• Medial or lateral foot position?
o This would indicate dysfunction of the hip or knee
• Is there a dropped metatarsal or longitudinal arch?
o This would indicate an imbalance of the ankle and knee
Knee
•
•
•
•
Do the knees appear to be bowed in or bowed out?
o This would indicate Valgus or Varus strain
Is the knee exaggeratedly flexed?
o This would indicate tight hamstrings
Does the knee appear to be more extended?
o This would indicate weakness of hamstrings
Is the Tibial Sulcus deep or shallow?
o This would indicate dysfunction of the tibia
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Pelvis
• Is the innominate crest lower on one side?
o This would indicate anatomically short leg or Pelvic
dysfunction
Prior to commencing your assessment of the pelvis you need to
remove any indications of an anatomical short leg. This is
indicated by assessing the innominate crest heights and the
heights of the top of the greater trochanter (GT). If you find that
the innominate and the GT are both lower on the same side then
this would be a positive sign for an anatomical short leg. Before
proceeding you must eliminate this discrepancy by placing
magazines or papers under the short limb until the Pelvis is level.
•
Is there a positive standing flexion test?
o This would indicate pelvic imbalance
 The standing flexion test is performed by palpating the inferior angles of
the PSIS. Once you have isolated them reduce pressure and have the
client bend forward as you monitor the motion. If one side appears to
travel a greater distance this is a positive sign for standing flexion on that
side.
• A positive sign indicates either a dysfunction on that
corresponding side of the pelvis or hypertonicity of the
hamstrings on the opposite side.
Coxa Articulation
• Are the greater trochanter level asymmetry?
o Indicate hip imbalances
o If this is found with a coinciding low innominate it indicates an anatomical short
leg
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Lower Extremity Test
Once you have completed the visual inspection of the lower extremities, you may instruct the
client to squat by bending their knees. Have them try to maintain their heels on the floor. Note
the following:
• Does the client favour their weight to one side going down or up?
o This would indicate there is a dysfunction on the favoured leg
• Does the client favour one leg over the other?
o This would indicate an asymmetrical strength of the quadriceps
• Do the heels maintain contact with the floor or does one elevate?
o This would indicate calf dysfunction of the elevating leg
Lumbar
• Is there an increased lordotic curve?
o Exaggerated lordosis indicates flexion dysfunction
• Is there a decreased lordotic curve
o This would indicate extension dysfunction
• Does their Lumbar spine appear to be bent to one side?
o This would indicate vertebral dysfunction or sacral torsion
• Are the lateral folds of the waist asymmetrical?
o This would indicate group dysfunction of the lumbar spine
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Spine
• Is paravertebral fullness present? Paravertebral fullness is indicated by one side of the
spine appearing to be visually higher or more prominent than the other.
o This would indicate vertebral dysfunction in that area.
• When the client is bent forward does there appear to be any flat spots along the spine?
o This would indicate segmental vertebral dysfunction at that level
• Are there any lone pimples or skin blemishes on the back?
o This would indicate a nerve root entrapment at that level of the spine
Lower Thoracic
• Does the client appear to be rotated on one side more than the other? This may be
monitored by the position of the hands in relationship to mid line. (Have the client cross
arms over chest to assist in visualizing asymmetry)
o If exaggerated rotation is present this would indicate dysfunction of the T-9 to T12 area.
Upper Thoracic
• Is there any exaggerated side bending of the client? This is monitored by comparing the
levels of the tips of the fingers when the hands are resting at the side.
o If asymmetry is found, then dysfunction in the upper thoracic should be
considered.
Ribs (Motion) - The ribs are assessed in four positions:
1. Upper Ribs
Place your one hand on the upper anterior thoracic cage and the other on the posterior
thoracic cage. Instruct your client to breathe normally as you monitor the rise and fall of
the rib cage.
If one side rises asymmetrically to its mate, an inhalation restriction is indicated of the
pump handle type.
If the ribs appear to fall asymmetrically, an exhalation restriction of the pump handle
type is indicated.
2. Middle Ribs
Place your hands on the upper axilla and again instruct your client to breathe normally.
Your contact should be to the lateral aspect of the rib cage. Instruct the client to take in
a breath and let it out.
If one side appears to elevate asymmetrically to its mate, an inhalation restriction of the
bucket handle type is indicated.
If the ribs appear to fall asymmetrically, an exhalation restriction of the bucket handle
type is indicated.
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Basic Practical
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3. Repeat this procedure by slipping your hands down the side of the client to monitor the
lower ribs.
4. The 11th and 12th ribs are assessed by standing behind the client and resting the web of
your thumb and index finger along the length of the rib; one hand on each side. Instruct
the client to breathe normally. As they inhale, the ribs should expand laterally. As they
exhale the ribs should move medially in a calliper motion.
a. Restriction of the rib to move medially would indicate an exhalation restriction.
b. Restriction of the rib to move laterally would indicate an inhalation restriction.
Shoulder
•
•
•
Standing behind the client note the levels of the Acromion Process or upper-border of
the Scapula
o Asymmetry would indicate an elevation or depression dysfunction
Monitor the vertebral boarder of the Scapula. Is there any asymmetry indicated by the
boarder being more prominent on one side? This is referred to as winging of the
Scapula.
o This would indicate dysfunctions of the Rhomboids and the Serratus Anterior
Is there any asymmetry in the position to the inferior angle of the scapula?
o This would indicate scapular rotation dysfunction
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Introduction to General Assessment
Upper Extremity Test
As we have noted earlier many tests will appear very similar and be given different names. This
can be confusing to the student. For example, the upper extremity test would appear to be the
same test as the painful arc test; however, on closer inspection we see that the painful arc test
only evaluates the motion of the arm through the abduction action, whereas the upper
extremity test looks at this along with many other possible indicators.
Instruct your client to bring their arms in a straight line from the side of their body over their
head so that the dorsal of the hands come in contact. This is performed with as little deviation
from plumb line as possible. Recall that the plumb line is an imaginary line drawn through the
middle of the ear, the point of the shoulder, the Greater Trochanter, and the lateral condyle of
Femur and ends just anterior of the lateral Malleoli.
•
•
•
•
•
Note the distance from the ear to the brachia
o Asymmetry indicates glenohumeral dysfunction
Note any asymmetry in hand position over the head
o This would indicate rotational dysfunction of the glenohumeral joint
Is the elbow more bent on one side than the other?
o This would indicate biceps, brachialis or deltoid dysfunction
Are the arms anterior or posterior of midline?
o This would indicate extension restrictions or flexion restrictions of the
glenohumeral joint
Note the position of the inferior angle of the scapula
o Asymmetry indicates scapular rotation dysfunction
At this point, you may incorporate active ROM for the shoulder by instructing the client to
perform the following movements: abduction, adduction, flexion, extension internal rotation
and external rotation
• Note any asymmetrical range
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Basic Practical
Introduction to General Assessment
Arm Hang
Note the position of the arms as the client is in the standing position. The arms are used in the
following ways to maintain balance.
• An abducted arm
o indicates side bending of the spine to the opposite side
• Bilateral anterior arm
o Indicates an over extended spine or lumbar dysfunction.
• Bilateral posterior arms
o Indicates an over flexed or exaggerated flexed position of the lumbar.
• Unilateral arm position with one arm forward of midline
o Indicates spinal rotation dysfunctions in lower thoracic,
• Asymmetry in hand rotation indicates
o Rotational dysfunctions of the GH or Supination Pronation dysfunctions of the
forearm.
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Basic Practical
Introduction to General Assessment
SEATED ASSESSMENT
You would now have your client seat themselves on a stool. The client should be positioned so
that the femur is parallel to the floor with the hip and knees at 90°. The feet should be flat on
the floor comfortably supporting the knees so that the client does not feel out of balance. We
use the seated portion for further assessment of range of motion.
The following tests could be performed:
Valsalva Test (Eliminate the possibility of herniated discs)
This test requires the client to bear down as if they are having a bowel movement. We suggest
that you simply ask your client if this procedure in their normal daily activity results in the pain
increasing.
• A positive answer indicates the possibility of a herniated disc
Tissue Drag
Place one finger on each side of the spinous process. Gently drag your fingers down the spine.
Note the resistance of the tissue (drag on your fingers). Is it exaggerated at a particular level?
• This would indicate a vertebral dysfunction at that level
Red Flash
Perform a second pass down the spine this time with your fingers slightly lateral of that for
tissue drag. Increase your pressure slightly. Note any areas where the tissue following shows an
exaggerated reflective hyperaemia after your pass.
• This would indicate a dysfunction of the muscle tissue at that level
Skin Irritations and Lone Pimples with No Head
During your visual inspection of the back, look for any lone pimples or areas of dry skin.
• These often indicate a dysfunction vertebra at that level
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Basic Practical
Introduction to General Assessment
Seated Flexion Test (For Pelvic Motion)
Palpate the inferior angles of PSIS and instruct your client to
bend forward as far as possible allowing their arms to come
between their legs. Note if one PSIS appears to move a greater
distance than its mate.
• If the exaggerated motion corresponds to that found in the
standing flexion test, this would indicate a dysfunction in the
pelvis on the side that appears to have the greater motion.
• If there is no asymmetry on seated but there was asymmetry
on standing this would indicate hamstring hypertonicity
affecting the standing flexion test
o The hypertonicity would be in the hamstring opposite
the positive standing flexion test side
• If you find that on the seated flexion test there is a positive
sign but on standing flexion there was symmetry this would
indicate the possibility of a sacral dysfunction
o Perform the Seated Flexion for Sacral Motion
Seated Flexion Test (For Sacral Dysfunction)
Adapt the seated flexion test for the sacrum by
placing your thumbs in the Sacral Sulcus to monitor
sacral motion. This is achieved by altering your
thumb contact. From the inferior angle of the PSIS
flex your interphalangeal joint so that the tip of the
thumb rests along medial edge of the PSIS. Now
move your thumbs slightly superior (approximately
1 cm) until you feel a slight softening in the tissue.
This should place your thumb tips in the sacral
sulcus located at the sacral base as it disappears
under the PSIS. Instruct the client to bend forward.
Normally as the client bends forward the sacrum should move away from the innominate in an
anterior direction causing the sacral sulcus to appear to become deeper bilaterally.
• If you find only one side of the sacral base moving forward this indicates a sacral
dysfunction
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Basic Practical
Introduction to General Assessment
Active Range of Motion Testing
Be aware that different levels of the spine are better suited to provide different motions. This
shows the results of the facets shape between vertebra and the structure of the intervertebral
disc along with the natural curvatures of the spine.
The following is your guide to spinal motion:
Sacrum Motion is primarily nutation and counternutation combines with
torsioning
Lumbar Spine Primarily flexion and extension with limited side-bending or rotation
Lower Thoracic Primarily rotation and side-bending
Upper Thoracic Primarily side-bending and rotation
Cervical Freely moveable
At this point we want to note that normally motion of the spine is a combination of vertebrae
moving together, however, a single vertebral misalignment can have a major impact on spinal
motion.
Lumbar Assessment
Have the client place their hands behind their head. This position locks the upper thoracic and
isolates movement to the lumbar spine. Instruct the client to side-bend on each side and then
to rotate to each side.
• Note any asymmetrical motion
Thoracic Assessment
Instruct your client to position their arms crossed over their chest and perform side-bending to
both sides and rotation to both sides.
• Note any asymmetrical motion
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Basic Practical
Introduction to General Assessment
Cervical Assessment
Ensure any indications of disc dysfunctions or arterial restrictions are eliminated before
proceeding.
Vertebral Basilar Insufficiency (VBI)
Ask the client if they have any symptoms of nausea, headaches or faintness if they look over
their head and to the side such as shoulder checking in car or looking up in the sky. This
indicates a restriction of the Vertebral Artery and caution must be implemented when moving
the cervical spine.
If the client has no symptoms proceed with the test as follows:
• Instruct the client to take their head into full extension and then add in rotation at that
point
• Hold the fully extended and rotated position for 10 seconds monitoring for any symptoms
• A positive sign means that when addressing the neck do not apply the combination of
extension and rotation which may compress the artery
Compression Test
The compression test is used to evaluate
internal structure of the articulation. This can
include menisci, articular cartilage or in the
case of the spine it can indicate disc damage.
For the cervicals, place your hand on the top
of the head with the forearms placed along
the side of the head and apply an inferior
directed pressure. If any pain or symptoms
are recreated, this indicates a possible
herniated disc.
As the neck is so mobile it is important not to aggravate the condition. If you find severe
hypertonicity and loss of motion in the neck avoid over-working the area until the client can be
cleared by someone with greater knowledge and skill. This could be a senior practitioner or a
member of the medical field.
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Basic Practical
Introduction to General Assessment
Note that the compression test can be adapted for any articulation and will take on many
names however the principles of the test remain the same.
Adaptations to the Quadrant Test.
The compression test can be adapted to assist in determining if pain is a result of facet
dysfunctions in the spine.
Cervical Adaptation – introduce slight rotation to one side to the first limit of
rotation. At this point you will apply a downward force as described in
compression test above. There should not be any exaggerated sidebending when
performing the test.
•
If pain is recreated on either side of the spine this
is a positive finding for Facet dysfunction,
•
You must repeat the process to the opposite
direction.
* Do not over-compress the joints when performing the test. Approach
the condition with caution especially if a client has a history of cervical
pain.
Lumbar Adaptation – with the client seated have them lock their fingers together
behind their head. Place your hand on the superior boarder of the scapula of the
side to be assessed. Introduce rotation to the point of restriction. Now compress
straight down with as little sidebending as possible.
•
If pain is recreated on either side of the spine this
is a positive finding for facet dysfunction,
•
You must repeat the process to the opposite
direction.
Thoracic Adaptation – with the client seated have them drop their arm loosely at
their side. Place your hand on the superior boarder of the scapula of the side to
be assessed. Introduce slight extension of the spine to the point of restriction.
Now compress straight down.
• If pain is recreated on either side of the spine this is
a positive finding for facet dysfunction,
• You must repeat the process to the opposite
direction.
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The material contained in this document is not to be considered complete without the lecture component. Revised 2016.
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Basic Practical
Introduction to General Assessment
Decompression Test
Once internal joint structures have been eliminated as the cause the next tissue group to
consider is the ligaments. The Distraction Test separates the joint surfaces apart increasing
strain on the ligament. Regeneration of pain would indicate strain or tearing of the ligament or
joint capsule. For the cervical spine, place one hand on each side of the mandible so that the
heels of the hands hook under the mandible at TMJ area. Apply a gentle upward traction.
• If pain results it indicates dysfunction of the ligaments or musculature. You can
proceed with massage but be aware that there may be ligament damage.
The decompression test can be adapted for any articulation and will take on many names
however; the principle of the test remains the same, that being increasing strain on the
ligaments.
Visual Inspection
Standing in front of the client while the client maintains the eye closed position note the
position of the chin.
• Any deviation if the chin from midline indicates dysfunction of the upper cervical spine.
Standing behind the client have them close their eyes and take a deep breath in and out. Now
assess the distance from the ear to the acromioclavicular articulation.
• Any asymmetry indicates dysfunction in the cervical spine.
Active Range of Motion
Cervical active range of motion should now be performed. You may want to place a finger on
the Acromioclavicular Joint on both sides of the body as a reference. Have the client;
• Rotate their head in both directions.
• Touch their ear to their shoulder.
• Look towards the ceiling as far as possible
• Bring their chin to their chest as far as possible.
o Note any restricted ranges of motion. This would indicate cervical dysfunction.
* If you have not done so already or if the client notes back pain associated with sitting then
you should incorporate your range of motion testing for the spine at this point. Note it is
sometimes a good idea to perform spinal motion assessment in both standing and seated.
Maintain contact with the client when performing spinal motion assessments as the client may
adapt the motions by moving other body parts.
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Basic Practical
Introduction to General Assessment
Elbow Assessment
Instruct your client to bilaterally flex and extend their elbows
• Noting any asymmetrical range.
Forearm Assessment
Instruct your client to flex their elbow and turn their hands palm up and then instruct them to
turn their hands palm down. The therapist should stabilize the elbow during this procedure to
assure movement is occurring in the forearm.
• Note any asymmetry of supination or pronation.
Wrist Assessment
Instruct your client to perform the following movements: Flexion, extension, adduction (Ulnar
Deviation), and abduction (Radial Deviation),
• Noting any asymmetric motion.
This completes the seated portion of the general assessment.
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Basic Practical
Introduction to General Assessment
SUPINE ASSESSMENT
The balance of the assessment is performed on the table so the client can be instructed to
disrobe and lay supine on the table underneath the sheet. Maintain the client’s modesty by
leaving the assessment area for a few minutes to wash your hands.
Instruct the client to lie face up on the table in the supine position. Assessment in the supine
position is focused to the lower extremities and lumbar regions at this stage of training but will
expand to the upper extremities as your skills increase. At all times assure that the modesty of
your client is maintained.
Well Leg Test
You should perform the well leg test to eliminate the possibility of herniated disks. This is
performed by grasping the client’s ankle on the non-painful leg and lifting it off the table to a
maximum of 60° or until irritation is felt in the lumbar spine or radiating into the opposite leg.
• This would indicate a herniated disc on the opposite side of the spine to
the leg that is being elevated.
o A positive sign means that there is the POSSIBILITY of a herniated
disc but it is not a definite. Proceed with caution to perform your
massage but instruct the client to bring this to a physician’s
attention if it is a recent injury.
Straight Leg Adaptation
Often performed in conjunction with the well test is the straight leg test. This test is
performed to the leg that has the irritation or radiating pain. Elevate the painful leg to the
point where the radiating pain is re-created. The therapist takes a deep breath to slightly
reduce the tension on the leg without actually moving it. Next the therapist introduces
dorsiflexion of the foot.
• If the pain returns or increases it is a positive sign for true sciatica or
irritation to the sciatic nerve.
o Proceed aware of these findings as there may be many causes for
it including tight hamstrings; impingement of the nerve along its
path; inflammation of the sciatic nerve.
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Basic Practical
Introduction to General Assessment
Patrick Test
This test indicates dysfunction in the pelvis or sacrum. It is performed by placing the client’s leg
in the figure four position with the sole of the foot contacting the medial aspect of their
opposite knee. The therapist places one hand on the client’s knee and the other on the
opposite ASIS. Apply a gentle pressure on the knee.
• Increase in pain indicates sacral dysfunction.
•
You may also note the distance from the knee to the table when no
pressure is applied to the knee.
o Asymmetry would indicate a pelvic dysfunction on the side with
the greater distance between the table and the knee.
Femoral Assessment Anteversion / Retroversion
When a client is in the supine position we want to evaluate the position of the feet. Normally
the foot should rest between the 10:00 and 2:00 positions. If the foot is not in this position the
following could be the cause:
•
Excessive Internal Rotation – may indicate Femoral Anteversion (the femoral
shaft is positioned medially rotated to the femoral neck). This may cause nock
knees
.
•
Excessive External Rotation – Femoral
Retroversion (the femoral shaft is positioned
laterally rotated to the femoral shaft). This
may cause bow leggedness.
Unfortunately there is nothing in our scope to correct
these conditions.
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Basic Practical
Introduction to General Assessment
Figure Eight Assessment
We can also incorporate a general assessment of the knee structures through the application of
the figure eight assessment. This is a challenging exam tool and will take some time to master.
Place the client’s ankle between your thighs and apply adequate pressure to hold it there. The
level of the table should be the same as the level you are grasping the ankle. Place one hand on
each side of the knee joint. By moving your legs and your arms simultaneously, move the knee
through a figure 8 pattern.
• Note any discrepancies of motion from one leg to the other which would indicate
possible ligament or meniscus irritation.
Foot and Ankle
The final step in the supine assessment at this level is range of motion of the foot. Instruct your
client to actively perform the following movements: Medial rotation, lateral rotation, plantar
flexion, dorsiflexion, inversion and eversion.
• Note any restricted ranges of motion.
This completes the supine assessment and the next step
requires the client to turn face down into the prone position.
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Basic Practical
Introduction to General Assessment
PRONE ASSESSMENT
Skin Rolling
Beginning at the base of the spine, try to gently pick up the skin, over the spine, between your
thumb and index finger. Gently begin to roll the skin between your fingers as you move up the
spine. Note any areas where skin rolling becomes more difficult.
• This indicates a vertebral dysfunction at that level.
Paravertebral Fullness Test
Monitor for any areas in the vertebral gutter that appear asymmetrical. Palpate along the sides
of the spine just laterally to the spinous process. Any hypertonicity should be noted on your
assessment sheet.
• This indicates hypertonicity of the multifidi and deeper muscles possibly
resulting in segmental vertebral dysfunctions. Indicate the side and the vertebral
level of your findings.
Move your hands so that one travels each side of the spine over the erector spinae.
• Again note the level and side of hypertonicity found in your assessment as this
may indicate dysfunctions of the erector spinae resulting in group dysfunctions
of the spine.
Apley’s Compression Test
Flex the client’s knee to 90°. Place your hand on the heel of the client and your forearm running
down the foot. The other hand should stabilize the tibia and fibula above the ankle. Rotate the
tibia medially and laterally applying a downward pressure. Note any irritation
• This indicates meniscus problems.
Apley’s Decompression Test
Maintain the knee at 90°. Grasp the tibia and fibula with both hands just superior to the ankle.
Stabilize the femur with your knee. Apply a superior traction to the ceiling and rotate the tibia
medial and lateral. Note any pain or irritation
• Indicates ligament dysfunctions.
This completes our general assessment procedure.
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Basic Practical
Introduction to General Assessment
Evaluation Sheet
On the following four pages you will find our example of an evaluation sheet. This will allow you
to check your findings and act as an important reference later in your treatment plan. Using a
clip board, place the assessment sheet close at hand to check off your findings.
You should only note those findings which are positive and definite. If you have to look more
than three times for an asymmetry that discrepancy is not sufficient enough to note.
Mark on the check list as follows:
• Note any abnormal positioning by noting the side which is exaggeratedly
abnormal.
• For range of motion, note the side that had limited range of motion, you can also
note the degree of range lost in comparison bilaterally.
We have provided a guide here for documenting range of motion loss in words:
Midrange
Severe loss
60 degrees
Range pre-treatment
Moderate loss
30 degrees
Range post Treatment
Mild loss
Normal Available Range
Terms to describe loss of Range
Mild Loss – less than 30 degrees
Moderate loss -- 30-60 degrees of loss
Sever loss – 60 -90 degrees of loss
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32
Basic Practical
Introduction to General Assessment
Once you have completed your general assessment you will know the primary areas of
dysfunction in your client. This will help you in two ways:
1 If you are performing relaxation massage you can focus the application to the
areas indicating imbalances to give your client the greatest relief.
2. If you are performing therapy the general assessment will speed up your specific
assessment by directing you to the areas showing imbalance.
Note that on the assessment sheet gives you the opportunity to assess one client on four
separate occasions. For practice purposes, we expect that student therapists perform general
assessment on every client. In reality, we do not expect that you perform general assessment
at every treatment. Instead, general assessment should be conducted once per year and at the
end of a specific treatment series prior to releasing your client.
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Basic Practical
33
Introduction to General Assessment
Client Name ________________________________________ File number____________
Client History completed [] yes
Assessment of Pain
Date and treatment number
Where is the pain located?
Does it radiate or remain localized?
Does anything make the pain worse?
Is the pain worse in the morning or in the
afternoon?
Did the pain result from a direct trauma?
Did the pain come on suddenly or was it a
gradual build up?
How long has it persisted?
Do you have any history of pain in the
area?
Does anything give you relief?
On a scale of 1 - 10 where would your rate
pain normally?
On a scale of 1 - 10 where would you rate
pain now?
Gait
Leg Swing
Exaggerated Forward Motion
Lateral Swing
Restricted Step
Foot Rotated Lateral
Foot Rotated Medial
Foot Scuff
Heal Strike is Heavy
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
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Rt [] lt[]
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Rt [] lt[]
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Rt [] lt[]
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Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
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Basic Practical
Arm Swing
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Introduction to General Assessment
Exaggerated Medial Motion
Exaggerated Lateral Motion
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Neck Position Extended Forward
Forward []
Forward []
Forward []
Forward []
Torso
Exaggerated Flexion
Exaggerated Extension
Side Bent to
Torso Rotated to
Yes []
Yes []
Rt [] lt[]
Rt [] lt[]
Yes []
Yes []
Rt [] lt[]
Rt [] lt[]
Yes []
Yes []
Rt [] lt[]
Rt [] lt[]
Yes []
Yes []
Rt [] lt[]
Rt [] lt[]
Shoe Wear
Medial Heal
Lateral Heal
Medial Arch
Lateral Arch
Ball of Foot
Tip Of Shoe
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
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Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Foot Position More Anterior
More Posterior
Medial Rotated
Lateral Rotated
Exaggerated Width of Stance
Dropped Metatarsal on
Dropped Longitudinal on
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
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Rt [] lt[]
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Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Knee
Valgus
Varus
Full in Posterior
Tibial Sulcus Shallow
Tibial Sulcus Deep
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
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Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Pelvis
Higher on
Standing Flexion Positive
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Coxa
Greater Trochanter Elevated on
ROM Restriction of:
Flexion on
Extension on
Abduction on
Adduction on
Internal Rotation on
External Rotation on
Rt[] Lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
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Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Standing Assessment
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Basic Practical
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Introduction to General Assessment
Lower Extremity Test
Favours weight to
Relies on Strength of
Heel elevated from floor on
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
[]
[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
______
[]
[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
______
[]
[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
______
[]
[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
______
Lower Thoracic Exaggerated Flexion
Exaggerated Extension
Paravertebral Fullness on
Level
Torso Rotated to
Skin Blemish
Level
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
___
Rt [] lt[]
Rt [] lt[]
____
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
___
Rt [] lt[]
Rt [] lt[]
_____
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
____
Rt [] lt[]
Rt [] lt[]
_____
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
____
Rt [] lt[]
Rt [] lt[]
____
Upper Thoracic Exaggerated Flexion
Exaggerated Extension
Paravertebral Fullness on
Torso Side bent to
Skin Blemish
Level
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
___
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
_____
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
_____
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
____
Ribs Restricted Range of
Inhalation Pump-handle on
Level
Inhalation Bucket Handle on
Level
Exhalation Pump-handle on
Level
Exhalation Bucket Handle on
Level
Inhalation Restriction of Calliper
Exhalation Restriction of Calliper
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
_______
Rt [] lt[]
Rt [] lt[]
Lumbar
Exaggerated lordosis
Decreases Lordosis
Side Bent to
Paravertebral Fullness on
Exaggerated Fold on
Flat Spots along spine
Level
This material may not be copied or referred to in any way without the expressed written consent of W.C.R.M.T. Inc.
The material contained in this document is not to be considered complete without the lecture component. Revised 2016.
Basic Practical
Cervical
36
Introduction to General Assessment
Positive VBI
Positive Compression
Positive Decompression
Exaggerated Flexion
Exaggerated Extension
Ear Closer to Shoulder on
[]
[]
[]
[]
[]
Rt [] lt[]
[]
[]
[]
[]
[]
Rt [] lt[]
[]
[]
[]
[]
[]
Rt [] lt[]
[]
[]
[]
[]
[]
Rt [] lt[]
Shoulder Elevated on
Scapula Winged on
Inferior Angle more lateral
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Upper Extremity Test
Distance from Ear to Arm Greater on
Dorsum of Hand Rotated on
Elbow Bent on
Arm Anterior on
Arm Posterior on
Inferior Angle More Medial on
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Shoulder Range of Motion Restricted in
Upward Rotation on
Downward Rotation on
Adduction on
Abduction on
Flexion
Extension
Internal Rotation on
External Rotation on
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Arm Hang
Abducted on
Adducted on
Flexed on
Extended on
Internally Rotated on
Externally Rotated on
Plumb line
Posterior View Spine
Lateral Deviation
Level ____
Rt [] Lt[]
Level ___
Rt [] Lt[]
Level ____
Rt [] Lt[]
Level ___
Rt [] Lt[]
This material may not be copied or referred to in any way without the expressed written consent of W.C.R.M.T. Inc.
The material contained in this document is not to be considered complete without the lecture component. Revised 2016.
Basic Practical
37
Introduction to General Assessment
Lateral View
Ear
Acromion Process
Lumbar Apex
Palm of Hand
Greater Trochanter
Lateral Condyle of
Femur
Lateral Malleoli
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post[]
[]Ant [] Post
[]Ant [] Post
[]Ant [] Post
[]Ant [] Post
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
Ant [] Post []
[]Ant [] Post
[]Ant [] Post
Seated Examination
Positive Valsalva
Tissue Palpation
Tissue Drag
Red Flash
[]
Level ____
Level ____
[]
Level ____
Level ____
[]
Level ____
Level ____
[]
Level____
Level____
Seated Flexion Test for Pelvis - Positive on
Seated Flexion Test for Sacrum positive on
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Lumbar Restricted (Arms Behind Head)
Rotation
Side Bending
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Thoracic Restricted (Arms Across Chest)
Rotation
Side Bending
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Cervical Range of Motion
Flexion
Extension
Rotation
Side Bending
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Elbow Range of Motion Restriction of
Flexion on
Extension on
Forearm Range of Motion Restriction of
Supination
Pronation
Wrist Range of Motion Restriction of
Abduction
Adduction
Flexion
Extension
This material may not be copied or referred to in any way without the expressed written consent of W.C.R.M.T. Inc.
The material contained in this document is not to be considered complete without the lecture component. Revised 2016.
Basic Practical
38
Introduction to General Assessment
Supine Assessment
Herniated Disk
Straight Leg Positive on
Rt [] lt[]
Level ____
Rt [] lt[]
Level ____
Rt [] lt[
Level ____]
Rt [] lt[]
Level
____
Patrick Test
Distance From Knee to Table greater on
Irritation in sacrum on
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Rt [] lt[]
Level ____
Side ____
_________
Level ____
Side ____
Level ____
Side ____
Level ____
Side ____
__________
Level ____
Side ____
Level ____
Side ____
Level ____
Side ____
__________
__
Level ____
Side ____
Level ____
Side ____
Level____
Side ____
________
_
Level____
Side ____
Level____
Side ____
Rt [] Lt []
Rt [] Lt[]
Rt [] Lt []
Rt [] Lt[]
Rt [] Lt []
Rt [] Lt[]
Rt [] Lt []
Rt [] Lt[]
Foot
Medially Rotated on
Laterally Rotated on
Plantar Flexion Restricted on
Dorsiflexion Restricted on
Inversion Restricted on
Eversion Restricted on
Prone Assessment
Paravertebral Fullness
Hypertonicity at
Knee Integrity
Apley’s Compression on
Apley’s Decompression
This material may not be copied or referred to in any way without the expressed written consent of W.C.R.M.T. Inc.
The material contained in this document is not to be considered complete without the lecture component. Revised 2016.