Hints in diagnosis for Manual Therapists

Here i will put in your hands some hints you should know and apply during assessing any patient.

1- Think globally not locally

Most of patients’ problems originate far away from their symptoms, you should know body correlations to treat the problem from it’s origin.

2- Diagnosis is a matter of applied anatomy ( Cyriax )

Your knowledge of anatomy and body relationships will guide you to the diagnosis

3- Be simple and treat what you find

This means any problem you need to solve it not the only one related to patient’s complain

4- Posture

Posture abnormalities will guide you the origin of patient’s complain

Examples for bad posture

a- Flat back posture

– Tight muscles : ( Hamstrings, Abdominals ).
– Weak muscles : (Hip flexors ).

b- Kypho-Lordotic Posture :

– Tight muscles : ( Suboccipital neck extensors, Hip flexors, Serratus anterior, Pectorals, Upper trapezius ( if scapulae are abducted ) .

– Weak muscles : ( Neck flexors, Upper thoracic spinae, External abdominal oblique, Mid and lower trap (if scapulae are abducted) ).

c- Swayback Posture :

– Tight muscles : ( Hamstrings, Internal abdominal obliques, Low back erector spinae, same side TFL )

-Weak muscles : ( Hip flexors, External abdominal obliques, Lower and mid trapezius, Deep neck flexors, Same side gluteus medius ).

d- Military Posture:

– Tight muscles : ( Low back, Hip flexors ).

– Weak muscles : ( Anterior abdominals ,hamstrings lengthen,then adaptively shorten).

 

5- Fascial tension

As it is know that our body consists of blood vessels, nerves and skeleton all are covered by fascia. So any fascial tension will affect the patient’s complain.

6- Gait observation ( analysis )

Gait is very important in diagnosis as it is the active function which reflects the patient’s  compensations to do it and pathomechanics which will guide you to the problem’s origin

Example for gait deviation ( pathomechanics )

Excessive foot pronation

Excessive foot pronation will lead to excessive tibial internal rotation, over loading on medial aspect of knee with excessive in femur internal rotation leading to pelvic tilt

At the end diagnosis of calculation of many things we should know and add to each other to treat the origin of patient’s complain not his symptoms.