Physiotherapy Assessment
Physiotherapy Assessment
This domain tests hypothesis-driven examination: history taking, observation, palpation, range of motion, muscle testing, neurological screening and outcome measurement.
Core rules
- Start with a hypothesis and let each test confirm or refute it; random test batteries waste time and mislead.
- Pain history with SOCRATES: site, onset, character, radiation, associations, timing, exacerbating and relieving factors, severity.
- Goniometry: use consistent bony landmarks and the same starting position each time; record active and passive range separately.
- Manual muscle testing uses the Oxford 0–5 scale. Grade 3 completes range against gravity only; grade 4 holds against moderate resistance; grade 5 is normal. Do not record 4+ without defined resistance.
- Clear the joint above and below, and screen the relevant neurological level with dermatomes, myotomes and reflexes.
- Select at least one validated, responsive outcome measure at baseline so change can be demonstrated.
Worked example
A 35-year-old runner reports medial knee pain. Rather than testing only the knee, examine hip abduction control, ankle dorsiflexion and foot posture, then perform goniometry of knee flexion, quadriceps strength, and meniscal and ligament tests chosen for their pre-test probability. Reasoning: proximal control and distal mobility both alter knee load; combining findings narrows the differential before treatment is chosen. Reassess with the same measures after four weeks.
Traps
- Not clearing joints above and below the symptomatic region.
- Inconsistent goniometry landmarks between sessions.
- Confusing MMT grade 3 with grade 4.
- Performing special tests without considering pre-test probability.