What the heck is functional testing? The concept of functional testing, is growing increasingly popular as a means of examination of movement faults in athletes. Identification of flawed movement patterns can allow the therapist to address these flaws with corrective exercises.
First, to define “Functional“: (thanks Wiki-dictionary)
In good working order.
- Useful; serving a purpose, fulfilling a function:That sculpture is not merely artistic, but also functional: it can be used as a hatrack.
- Only for fuctional purposes, notably in architecture: A functional construction element generally must meet higher technical but lower aesthetical requirements.
- (medicine) Of a disease, such that its symptoms cannot be referred to any appreciable lesion or change of structure; opposed to organic disease, in which the organ itself is affected.
I love that this definition encompasses structure, architecture, purpose, and working order. Just as we wish our legs to be!
Now, a bit of sports medicine background: there has always been, and will always be competition between professions dealing with athletes. The MD (medical doctor), PT (physical therapist), ATC (athletic trainer) have been battling it out for decades over territory: the id, ego and insecurity of each professional visible and palpable to the astute observer.
In training, as well as in initial residency years, the ability of a PT or resident MD to determine the correct diagnosis of a clinical condition (shoulder pain, knee pain etc) conditions would rest on the ability to memorize, then reproduce 8 or 10 of the 250 clinical tests which had been developed to that point. Underscoring the insecurity of the practitioners was the fact that most of the tests were named not after the structures involved; being female, and quite secure in myself, that would be my methodology: ie rotator cuff impingement test A, B, or C confirming impingement of the rotator cuff, meniscal test 1, 2 or 3 confirming a torn meniscus. Rather, these tests have been named after the MD who brought this test to popularity ie: Appley’s meniscal (compression: my italics for emphasis on the structure involved, kind of helpful for memorization process and functional use) test , Mc Murrays (pinching and trapping the torn meniscus) test, Thomas (anterior hip muscle length) test.
Not only are these test names confusing to remember (unless you had me name them in the first place!), but they give little understanding to the clinican about what the actual problem is. Confounding the problem is the statistical analysis of these diagnostic tests: comparing these tests against “gold-standards like findings under arthroscopic examination) will indicate how some tests if “specific”, can increase the likelihood of a positive diagnosis, whereas if they are “sensitive”, are conversely less likely to be specific, but can effectively rule the condition out. Confused? So was I for most of my career-in-training. To make this point clear, here we have a one act play in which a runner visits her orthopedist.
Runner: “Hi Doc, thanks for seeing me today”
Doc: “No problem Miss runner, what seems to be the issue?”
Runner: “Well, my knee is clicking and locking and giving way when I put weight on it. I am concerned about whether I can continue running especially as I have a hilly race coming up in a month”.
Doc: (after a bunch of twisting and bending maneuvers on the plinth) “Well you have a positive Apleys compression, but a negative Mc Murrays test. That test being less specific than Apleys but more sensitive increases the chance of you having a torn medial meniscus”
Runner: “Hmm, what does that mean for my running?”
Doc: “I can either give you a cortisone injection, anti-inflammatories, or surgery. Which do you want?”
Runner: “I really want to run, do I have any other options?”
To wit: assessment should be based on function, not solely on a string of clinical tests. This is where Runners Lab comes in. At this point, there is little evidence that meniscal tears (or many other lower extremity pathologies for that matter) can effectively be remediated solely by injection, surgery or drugs. The majority of injuries have at their basis, subtle biomechanical changes which, repeated and uncorrected over time, result in tissue injury at a cellular or microscopic level, progressing ultimately to a macroscopic level. Currently, there is some progress in the identification of cellular markers of tissue matrix breakdown for cartilage, which at some point in the distant future, may be picked up with a routine tissue biopsy from the joint synovial fluid. Right now, the most sophisticated process to identify structural (macroscopic) damage is an MRI, which most insurances will not cover unless you are about to have surgery. Not much use if you are a month out from a race and not willing to go under the knife.
Thus, the concept of testing the function of the limb becomes more important, using specific tests designed to reproduce the stresses required in the sport in question. Biking, Running, and even walking appear to be simple uni-planar activities, but in reality are activities requiring stability in multiple planes, with complex motor control, muscular endurance and power requirements. At Runners Lab, we will use digital gait analysis to create a frame-by-frame review of your running pattern. Biomechanical evaluation will use functional tests to determine the strength, power and co-ordination of your core, trunk and leg muscles. Exercise physiologist evaluation of a training program can identify training errors which compound or create the problem. Clinical tests will allow potentially problematic structures to be identified. These tests in conjunction with functional tests, will provide a more practical guideline to the injured athlete, with development of a prognosis, plan of action and recommendations for follow up. Runners Lab will combine gait analysis with functional testing and training evaluation to get you out of the doctor’s office, and onto the road! You will leave RunnersLab with a list of your “issues”, a video analysis of your running, a summary of the brainstorming from three professionals with a long history of managing athletes, and a plan of action to get you going and keep you going!
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