Assessments

[friendlypain]

Hey all,

Just an off the wall question but I have been thinking about this more and more lately and it is NOW starting to drive ME CRAZY.

I work with alot of athletes with specific needs in terms of treatments. I had it drilled into my head by my profs that no matter how screwed up their posture was, not matter how much adhesions were being plastered into their structures, not matter how much difference there is in hypertonicity of the same musles (ie: the psoas)... YOU DO NOT CHANGE IT. It will affect their performance. Which will cost me a job.

My assessment for my athletes is not the standard postural and strength assessments. I have them in the position of their sport and then assess them.

So.... my question is. Why do we do assessments based on the anatomical posture and what is the NORM? A person who sits at the desk is different from the mountain climber, who is different from the labourer, who is different from the pianist, who is different from a therapist, who is different from <insert gift or vocation here>.

Individually, the human body is flawed and we compensate for all our imperfections so that our biomechanics are sound (sort of). Should we not be doing assessments based on the position that our patients spend most of their day as opposed to standing straight with palms forward?

I have felt alot of frustration over self care not being followed and their employment contributing to their issues. I cant force these people to do their self care and I cant ask them to quit their jobs. So the only choice I have left is to treat them so they can be biomechanically sound in their job. I have started to assess people in the position they find themselves 8 to 10 hours a day.

Have I missed the point or am I on to something <sort of>? I would love your opinions.

Adamo

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[alophysio]

Hi Adamo,

I understand your frustrations. I am fairly flexible with my patients. I let them know where "ideal" is, why it is "ideal" and then show them how "ideal" fits into their functional activities.

...I have just come back from a course run by LJ Lee - sensational therapist btw!

So anyway, a point was made on the course about how much the bladder moves during a pelvic floor contraction and what is "normal". The point was that the range of "normal" was 2-32mm of movement. That's a large range. What really matters is whether or not the patient can *control* the movement correctly.

With respect to your assessment, I have always believed that what has been taught to us at undergrad is merely a staring point for our learning-for-life. Your functional assessment of their posture merely reflects the fact that you have evolved as a physio - into a better one. It is absolutely correct to assess in their functional positions.

Who cares if someone can control their thorax and pelvis in the anatomical position? What really matters is if they can control their joints and put them into the correct positions with the demands of sport - timing, specificity, stability, balance, symmetry, etc etc.

Go hard my brother in physio!!!!!:lol