H O P Evaluate Function

1. HOPEvaluate Function A look into ROM and functional testing…

2. Before ‘E’-Quick Review • H= History • Determine: • Cause of injury • Location of pain • Severity of pain • Pain anywhere else • Noises heard during injury • Kind of pain • Previous history or significant medical history

3. Before ‘E’-Quick Review • O= Observation • Look for: • Obvious deformity • Bilateral comparison • Signs of trauma (blood, swelling, bruising, skin discoloration, shock) • Guarding • Specific issues involving specific body part

4. Before ‘E’- Quick Review • P= Palpation • Feel for: • Anything in observation that you may be able to feel as well as see (swelling, temperature change associated with skin discoloration) • Crepitus (creaking or grinding feeling sometimes associated with broken bones) • Bilateral comparison • Specific anatomical landmarks for specific body parts

5. ‘E’= Evaluate Function • ROM • What is it? • Range of Motion • 3 kinds to look for • Active • Passive • Resistive

6. Active ROM • For any injury, when it comes to movement, ALWAYS ask the athlete to move the injured limb by themselves first!! • Reasons: • Less risk of more severe injury if athlete moves it on their own • You do not know athlete’s pain and you do not know athlete’s pain at certain points in motion • Sometimes athlete will realize they are more scared than injured and calm down after moving limb

7. Active ROM • If athlete is unable to move limb on their own, do NOT continue in ROM steps. Injury is either too severe to manipulate, or athlete is too scared/in too much pain to be evaluated. • During AROM, look for compensation in movement or abnormal movement • In most instances, a call to the parents and a trip to the doctor or hospital is appropriate. The less harm and pain you cause the athlete, the less chance you have of becoming liable for a more severe injury. • (Unless you don’t mind big messy lawsuits!)

8. Passive ROM • Depending on how well the athlete is able to move limb, you may assess the athlete’s motion using PASSIVE movements: • YOU are moving the athlete’s limb for them. • Tell athlete to be ‘dead weight’ or ‘go blah’ while you support the weight of the limb • Reasons: • By taking out the athlete’s muscles, you may be able to get better idea of specific injury (boney, ligamentous)

9. Passive ROM • Always take caution in performing movements for the athlete, and make sure that you communicate! • “Does this hurt? Tell me at any point in me moving it for you if you have pain. I will go slow through each motion so you can tell me the second it starts to hurt” • Reassure the athlete that you aren’t going to yank them through the motion. You will lose complete trust if you cause more injury!

10. Passive ROM • If the athlete is in severe pain, proceed with caution. Most times, when in doubt of severity of injury, just send athlete for doctor referral. • If pain isn’t too intense, or no pain at all, you can rule out fracture (usually, but not always), and may move on to the final ROM.

11. Results from Active and Passive ROM • AROM is typically less than PROM • If both AROM and PROM are equal and fall short of the expected range of motion, the athlete may have tight muscles or there may be adhesions restricting the motion • If muscular weakness is suspected (when AROM is less than PROM), you can usually continue to final ROM

12. Resistive ROM • Combination of Active ROM and manual resistance from tester (you). • Reasons: • You can sometimes pinpoint the location of the injury in the specific muscle, or determine the specific muscle involved if you use Resistive ROM. • Two types of RROM: • Full motion • Break testing

13. Resistive ROM • Full motion RROM: • Similar to Active ROM, only you, as the tester are applying STEADY pressure to athlete’s limb in the OPPOSITE direction they are attempting to move through the FULL RANGE OF MOTION • If athlete is moving in dorsiflexion, you are applying resistance to keep them in plantarflexion • This type of RROM can begin to narrow down where the pain is located, but not necessarily the muscle (many muscles perform a number of motions)

14. Resistive ROM • Break Testing: • Also known as manual muscle testing • Isolates individual muscles within their functional planes of motion • Performed isometrically to see if the athlete can overcome the force at that particular point in the motion • Looks choppy when performing, unlike Full Motion which is smooth and even pressure

15. Range of Motion Notes • Always important to stabilize joint you are attempting to move • Because: • If you don’t provide support, athlete may find another muscle to aid in movement which will throw off your eval • Providing support will also reassure the athlete that you are taking every precaution to keep them safe and in a controlled environment

16. Once ROM is Complete… • If athlete is performing ROM well or to your standards, you may move on to functional testing • Functional testing: • For some, functional testing may mean Activities of Daily Living • For others, it may mean sport specific testing

17. Activities of Daily Living • Consider an elderly patient who has recently recovered from a broken arm • Their activities of daily living will be completely different than that of an athlete or an active person • Example: Teaching the patient how to reach for a plate in the cupboard, or how to pick up an object off the floor • Consider a receptionist who is recovering from Carpal Tunnel Syndrome • Their activities of daily living may consist of learning how to ergonomically type or perform duties at desk all day

18. Sport Specific Testing • For athletes, it is incredibly important before returning to play that sport specific functions can be performed on the sideline. • Each sport has unique and specific movements and motions • Basketball: defensive slides, cutting, running backwards, boxing out, jumping • Football: cutting, 3 point stance, blocking, jumping, sprinting • Swimming: flutter kick, arm circles, turns and pushing off wall

19. Sport Specific Testing • By having athlete perform certain sport specific motions on sideline, you are reassuring both yourself and the athlete that they are able to compete • Use controlled environment, start out slow, break down certain more complex movements before throwing athlete back into action

20. Sport Specific Testing • Consider athlete with severely sprained ankle trying to return to soccer • Sport specific testing will involve things like: • Standing on one leg and balancing in place • Standing on one leg and doing touches with other leg • Hopping on one leg • Hopping from side to side on one leg • Jogging • Running • Sprinting • Running backwards • Shuffling sideways • Cutting • Kicking with light touches • Kicking long balls • Important part of rehab is incorporating equipment from sport back into exercises • Keeps athlete interested and can liven exercises up

21. Sport Specific Testing • Reasons: • You never never never throw an athlete back into a competitive event of any kind (practice/scrimmage/game) until you are sure they are able to withstand the spontaneous movements that occur within the sport • Mentally, the athlete will become stronger by seeing that they are able to perform movements on sideline before performing them during competition • Sometimes with stubborn athletes, you can prove to the athlete in a controlled environment that they may not be ready to return just yet

22. The End • Questions???