[Archive – March 29, 2011]
Become part of a pan-professional referral network of providers committed to the functional approach by joining the International Society of Clinical Rehabilitation Specialists and
How to use the Functional Assessment to guide the rehab process
IDENTIFY ACTIVITY INTOLERANCES – goals of care
IDENTIFY MECHANICAL SENSITIVITIES (Painful movements or markers)
IDENTIFY ABNORMAL MOTOR CONTROL (Painless dysfunction)
Ends & Means
The key to management is assess movement patterns and find those which are either painful or dysfunctional. Reducing painful movements is the first goal of treatment. Often the most effective treatment is the one which treats the painless dysfunction.
For instance, knee pain during single leg squat would be the treatment goal. If the hip abduction movement pattern is faulty remediating that would be the means of care.
The principle of assessing & correcting is fundamental to rehabilitation. Pr Janda said “time spent in assessment will save time in treatment.” Eric Cressey has an excellent DVD from an athletic developmentperspective on this topic.
Gray Cook, PT’s system also has the same focus:
On p115 of his new book he says –
- Set a movement path baseline
- Locate and observe the movement problem
- Use corrective measures aimed at the problem
- Revisit the baseline
Clinical Audit Process (CAP)
Any correction of dysfunction that is found on re-assessment to reduce the patient’s mechanical sensitivity is automatically prescribed. Naturally, it is best if the correction is with exercise, so that the prescription can be self-care. Whenever, possible as McKenzie teaches self-care should precede passive care so the patient can become empowered.
The CAP is a key to reducing pain behavior in patients suffering from persistant pain. The patient is usually fearful & avoidant of movement. They are hypervigilent about their pain and threatened by many activities. To reduce the “threat value” of pain the patient should have “graded exposures” to fearful stimuli under the instruction of their rehab provider. When painless dysfunction is trained and function improves in most instances the patient will experience that their mechanical sensitivities are actually lessened.
By following the CAP the patient is enabled to reduce their fear-avoidance beliefs and this in turn reduces their pain threshold. As activity tolerance improves, pain threshold drops and the hold chronic pain has on the patient begins to loosen.
Progressing patients & athletes from Stability to Functional Training
Following functional assessment we find the exercise challenge that is safe, but also challenging and functional for the patient to perform. Our goal is to remyelinate new neural patterns which will enhance not only our patients confidence (self-efficacy), but their motor control skill. To achieve this we must work at the “limit of our patients’ capability”.
The exercises may start on the floor to “groove” a pattern such as the plank. But, it should then progress to more functional movements.