Clearance tests and pain provocation rules
Purpose of clearing tests
Clearing tests are pain provocation tests used with three FMS patterns. They are not scored as separate items. If a clearing test reproduces pain, the associated pattern is scored 0. For the other four patterns, pain reported during the movement itself is a 0. The examiner must ask about pain before, during, and after each movement.
The three clearing tests
- Shoulder impingement clearing test (after Shoulder Mobility): place the hand on the opposite shoulder and raise the elbow. Pain = 0 for Shoulder Mobility.
- Spinal extension clearing test (after Trunk Stability Push-Up): from prone, press the chest up while keeping the hips on the floor. Pain = 0 for Trunk Stability Push-Up.
- Spinal flexion clearing test (after Rotary Stability): from quadruped, rock back toward the heels with the arms extended. Pain = 0 for Rotary Stability. For Deep Squat, Hurdle Step, Inline Lunge, and Active Straight-Leg Raise, there is no separate clearing test; pain during the pattern makes that pattern 0.
Worked example
A patient has a shoulder mobility distance of 10 cm, which would be a 3. The examiner performs the shoulder impingement clearing test, and the patient reports a sharp anterior shoulder pain. The Shoulder Mobility score becomes 0. A second patient performs a perfect trunk stability push-up but reports low-back pain during the spinal extension clearing test. The push-up score becomes 0. A third patient has no pain with the rotary stability movement but pain with the spinal flexion clearing test; the Rotary Stability score becomes 0.
Traps
- Scoring a 1 for pain instead of 0.
- Skipping clearing tests because the movement looked good.
- Not asking about pain during the movement.
- Confusing which clearing test belongs to which pattern.
- Failing to document pain location and referral.