Musculoskeletal Physiotherapy
What is tested
Pattern recognition and safe, evidence-based loading for common musculoskeletal presentations, plus post-operative precautions that cause real harm when broken.
Core rules
- Examination sequence. Observation → active range → passive range → resisted isometric → special tests → neurovascular screen. The Cyriax selective tissue tension approach uses these to identify the painful structure.
- Maitland grades. I–II for pain-dominant, irritable joints; III–IV for stiffness; reassess after each grade.
- Posterior total hip replacement. No flexion beyond 90°, no adduction past midline, no internal rotation until the surgeon clears - this prevents dislocation.
- Tendinopathy. Progressive loading is the intervention: isometrics for pain modulation, then heavy slow resistance or eccentric work, 3–4 sessions weekly for around 12 weeks.
- Frozen shoulder. Irritability governs dose: in the pain-predominant phase use gentle range and avoid aggressive stretching; in the stiff phase use sustained stretch and mobilisation.
- Low back pain. Stay active; bed rest beyond 1–2 days worsens outcome. Screen for red flags, then reassure and load.
- ACL. The Lachman test is the most sensitive clinical test; rehabilitation is criterion-based (quadriceps strength symmetry, hop tests), not calendar-based.
Worked example
Day 5 after a posterior-approach THR, the patient wants to pick a sock from the floor. Reasoning: bending forward from standing combines hip flexion beyond 90° with adduction - two precautions at once. Instead teach the golfer's lift with the operated leg extended behind, use a long-handled dressing aid, and sit to dress the operated leg first. Document the education and check it back.
Traps
Treating a positive special test as a diagnosis (many have modest specificity); forgetting to examine hip and lumbar spine when the knee hurts; stretching an acutely irritable frozen shoulder; giving vigorous deep friction massage to an anticoagulated patient without checking.