Photo courtesy: http:/www.horizonservicesinc.com

If anyone has ever performed any plumbing work, they know the importance of the system working right when the water is running!  The setup is much more than the old saying of hot water on the left, cold on the right and shit doesn’t go uphill…especially when things go wrong.    The pipes look great upon inspection after completing your work if no leaks or drips, but this static picture is not the purpose.  Fixing a pipe without re-checking the system with the water running is ineffective. In other words, an idle, stagnant plumbing structure is useless.

The plumbing industry is very similar to the physical therapy industry.  Performing a re-assessment of the work that you did is useless without an active movement re-assessment component.

One of the frameworks behind examining an individual with musculoskeletal complaints is to find the concordant sign, then re-assessing that sign.  If Maitland trained, this is synonymous with comparable sign.  Dr. Joseph Brence recently wrote a very good blog post on constantly re-assessing.  For a review, the concordant/comparable sign refers to:

a combination of pain, stiffness and/or spasm which the examiner finds on examination and considers to be comparable with the patient’s symptoms (Maitland, 1991 course manual)

That is to say, the reproduction of the familiar symptom(s) that brought the patient to your office.  For me, there are two main ways to find the concordant sign: through palpation (MTrPs, alignment, tone, position, PPIVMs/PPAVMs) and through a movement appraisal (ROM, squat, sit-stand transfer, bridging, MMT, etc…whatever is the familiar symptom).

There are on occasions where a palpatory re-assessment suffices, but to really know that you changed the system for the better, you must do more than assess pain pressure threshold and other less reliable palpatory means.   It is an obligation to re-check the altered movement pattern through some type of activity appraisal.  This can be in addition to a manual re-assessment. You need to know that you actually showed a real within-visit change while limiting bias with your re-assessment.

Therefore, make sure your foundation of re-assessing is through movement appraisal, but other steps leading to an overall decision making can include palpatory measures.

 

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From teaching entry level students in the clinic, sometimes they do not re-assess the movement as they are apprehensive that after the intervention, the concordant sign may not be better.  Do not let this be the case.  If your intervention did not work, no worries, find another one that will!  The leak, if you will, may be somewhere else.  You will not know where until you get the water moving again by performing a movement-appraisal re-assessment. It takes going back to the drawing board to re-examine, treat, then re-examine again.  We all miss at times, but experience and reflection will get you the results you and the patient deserve.

 

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