Gathering place for osteopaths
What Are the Most Useful Osteopathic Tests?
What Are the Most Useful Osteopathic Tests?
Each of us will regularly use a number of tests when examining patients, each test having a part to play in providing a complete diagnosis. Tests also help to evaluate a patient’s response to treatment, as well as to serve as differential diagnosis during the initial consultation.
Some tests tend to be more reliable than others, and many tests in the teaching manuals are rarely used because they are forgotten in time.
Please think of some of the tests you like to use in practice.
• When and why do you use them?
• What is your rational in using one whilst excluding others?
• Do you conduct some tests all the time and with every patient?
I’ve listed three tests below that I regularly use with more or less every patient as they help me understand flexibility patterns, gait, specific areas of weakness and stress levels. I test them regularly and mark them as +/- and on an objective scale of 0-10 (high=excellent, low=poor)
I also ask the patient to provide their subjective input using the same criteria.
• Adam’s Test
This gives a simple visual test for pelvic symmetry and is used in functional or anatomical scoliosis assessment. In addition to the static test, which allows for the diagnosis of short leg conditions, the patient can be asked to conduct an active version of this test. Lateral flexion, flexion and rotation of the trunk on the pelvis may be a useful addition to diagnosing limited active range.
Adams test is a simple tool, which relies on visual parameters. Frequently it is helpful to assess the subject’s active ranges from a distance, as well as close up.
During the active assessment of flexion of the trunk on the pelvis, the assessor’s eyes are lined up horizontally with the Posterior Superior Iliac Spines, with their thumb positioned over the PSIS landmark.
A positive Adams is seen when the spinal column loses its vertical plane relative to the pelvis. The thoraco-lumbar spine produces a torsional deviation from the vertical. One side of the lumbar spine will produce a concavity, the other a convexity. The quadratus lumborum will be palpably shorter on the concave side.
In dynamic short leg conditions where the soft tissues are asymmetric due to factors such as fascial contraction, spasm or nerve irritation, the degree of asymmetry will change quickly over a few days when treatment commences.
In anatomical or fixed cases where contraction of tissues has occurred over time and with associated calcification and stenosis of adjacent joints, reversal is not anticipated.
• Fabre Patrick Test
The Fabre assessment is used in determining hip flexibility, and is also affected by the tension levels of the soft tissues, which support hip and knee function. The subject is in supine with each hip being assessed independently to allow comparative values.
Ask the subject to stretch the hip slowly towards hip flexion, abduction and external rotation, as this can add a dynamic component to the test. By then placing the soles of each heel together (contracting adductor longus and the posterior hip extensors) this action will lift the pelvis upward.
This additional procedure may be helpful to assess muscular co-ordination and tone, though it introduces a complexity to the basic test. By adding abdominal input to the primary active muscle groups being assessed, the assessor can gain an insight into the patient’s ‘core’ stability.
• Adrenal Stress Test
Osteopathic medicine acknowledges the viscero-somatic reflex pattern in common illnesses. When internal organs are subject to abnormal physiological stressors, they produce local as well as distal signs and symptoms via the ANS.
Frank Chapman in the 1930’s and latterly Irvine Korr and JM. Hoag researched and identified many of these reflex networks. These are now used in daily clinical practice to differentially diagnose and treat levels of tissue dysfunction, which had been initially identified as of simple musculoskeletal origin.
The Chapman’s reflex point for the adrenals is immediately overlying bi-laterally the 12th rib, on the costo-vertebral joint. It is situated immediately below the subcutaneous fatty and connective tissues, and attached to the lumbo-dorsal fascia, sacrospinalis and the medial side of quadratus lumborum.
Moderate pressure is applied to the point (in a slightly inferior to superior direction), initially to locate the point. Having located the point positively, then the practitioner needs to identify the degree of reflex spasm produced by the patient. A simple verbal response is obtained to confirm/deny tenderness.
A further level of pressure-induced tenderness may be elicited to provide the degree of adrenal fatigue. This can also be recorded as necessary.
Perhaps you had some unexpected responses and still don’t know what the underlying problem was, then please offer it up for discussion.
If this topic finds popularity we should be able to build up a compendium of practical tests, and share some useful clinical tips within the osteopathic community.
Each of us will regularly use a number of tests when examining patients, each test having a part to play in providing a complete diagnosis. Tests also help to evaluate a patient’s response to treatment, as well as to serve as differential diagnosis during the initial consultation.
Some tests tend to be more reliable than others, and many tests in the teaching manuals are rarely used because they are forgotten in time.
Please think of some of the tests you like to use in practice.
• When and why do you use them?
• What is your rational in using one whilst excluding others?
• Do you conduct some tests all the time and with every patient?
I’ve listed three tests below that I regularly use with more or less every patient as they help me understand flexibility patterns, gait, specific areas of weakness and stress levels. I test them regularly and mark them as +/- and on an objective scale of 0-10 (high=excellent, low=poor)
I also ask the patient to provide their subjective input using the same criteria.
• Adam’s Test
This gives a simple visual test for pelvic symmetry and is used in functional or anatomical scoliosis assessment. In addition to the static test, which allows for the diagnosis of short leg conditions, the patient can be asked to conduct an active version of this test. Lateral flexion, flexion and rotation of the trunk on the pelvis may be a useful addition to diagnosing limited active range.
Adams test is a simple tool, which relies on visual parameters. Frequently it is helpful to assess the subject’s active ranges from a distance, as well as close up.
During the active assessment of flexion of the trunk on the pelvis, the assessor’s eyes are lined up horizontally with the Posterior Superior Iliac Spines, with their thumb positioned over the PSIS landmark.
A positive Adams is seen when the spinal column loses its vertical plane relative to the pelvis. The thoraco-lumbar spine produces a torsional deviation from the vertical. One side of the lumbar spine will produce a concavity, the other a convexity. The quadratus lumborum will be palpably shorter on the concave side.
In dynamic short leg conditions where the soft tissues are asymmetric due to factors such as fascial contraction, spasm or nerve irritation, the degree of asymmetry will change quickly over a few days when treatment commences.
In anatomical or fixed cases where contraction of tissues has occurred over time and with associated calcification and stenosis of adjacent joints, reversal is not anticipated.
• Fabre Patrick Test
The Fabre assessment is used in determining hip flexibility, and is also affected by the tension levels of the soft tissues, which support hip and knee function. The subject is in supine with each hip being assessed independently to allow comparative values.
Ask the subject to stretch the hip slowly towards hip flexion, abduction and external rotation, as this can add a dynamic component to the test. By then placing the soles of each heel together (contracting adductor longus and the posterior hip extensors) this action will lift the pelvis upward.
This additional procedure may be helpful to assess muscular co-ordination and tone, though it introduces a complexity to the basic test. By adding abdominal input to the primary active muscle groups being assessed, the assessor can gain an insight into the patient’s ‘core’ stability.
• Adrenal Stress Test
Osteopathic medicine acknowledges the viscero-somatic reflex pattern in common illnesses. When internal organs are subject to abnormal physiological stressors, they produce local as well as distal signs and symptoms via the ANS.
Frank Chapman in the 1930’s and latterly Irvine Korr and JM. Hoag researched and identified many of these reflex networks. These are now used in daily clinical practice to differentially diagnose and treat levels of tissue dysfunction, which had been initially identified as of simple musculoskeletal origin.
The Chapman’s reflex point for the adrenals is immediately overlying bi-laterally the 12th rib, on the costo-vertebral joint. It is situated immediately below the subcutaneous fatty and connective tissues, and attached to the lumbo-dorsal fascia, sacrospinalis and the medial side of quadratus lumborum.
Moderate pressure is applied to the point (in a slightly inferior to superior direction), initially to locate the point. Having located the point positively, then the practitioner needs to identify the degree of reflex spasm produced by the patient. A simple verbal response is obtained to confirm/deny tenderness.
A further level of pressure-induced tenderness may be elicited to provide the degree of adrenal fatigue. This can also be recorded as necessary.
Perhaps you had some unexpected responses and still don’t know what the underlying problem was, then please offer it up for discussion.
If this topic finds popularity we should be able to build up a compendium of practical tests, and share some useful clinical tips within the osteopathic community.
Tags: Abnormal Signs, Chapman's Reflexes, Clinical Assessment, Clinical Evaluation, Yellow Flags
Replies to This Discussion
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Permalink Reply by Jody Jakob on -
Hi Donald.....just a note about "tests"......whatever information they give which may or may not be reliable the simple act of putting the patient through a battery of tests has a great deal to do with establishing the healing bond between you and the patient.
The fact that you are in command, you are giving the instructions is perhaps the first step in allowing you the practitione into the patients physco-neurological system and the possiblity of change to occur. Remember the patient has come to you because in some way he is "out of control" and perceives that he needs your intervention.......you might call this the non-specific therapeutic effect as opposed to the specific technical intervention and of course they work in conjuction with each other.
........on a personal note, I'm having a lovely easy Sunday and wouldn't you know it!....a bloodly patient calls up with an urgent problem.......I'm off in 15 minutes to cure the sick and make the lame to walk again. It ain't much but it pays the rent!!
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Permalink Reply by david rodway on -
"Fabre Patrick Test"?
I dont think so. It was a test devised by Patrick and is properly called Patrick's Faber Test. FABER being an acronym for Flexion , ABdcuction and External Rotation (might be clearer if he had called it the FLABER test, but presumably chose not to as F for flexion would not be confused with E for extension, as say A for Abduction could be A for adduction. F AB and ER are the position the hip is moved into, the operator then pushing on the ASIS on that side. Pain indicates an SI or hip problem. Fabre Patrick test ? - no such thing.
Very good idea for a discussion group, by the way.
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Permalink Reply by Julia Spivack on
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I diagnose by palpation of the IVM
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Permalink Reply by Tom Greenfield on -
Would you say that you conduct an IVM 'test' routine, e.g. check the motility of the sacrum between the ilia, degree of flexion and extension at the SBS etc., or do you just get a felt sense of the patient as a whole?
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Permalink Reply by Jody Jakob on
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That's cool but might you add a few move details?
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Permalink Reply by Edward Muntinga on -
Spinal Dura Tension Test
Patient: supine
DO: @ head of patient
Handhold: DO cupping head around posterior part of foramen magnum (insertion of spinal/cranial dura)
Action:
- slight pull/traction cephalad along the spinal chord (feels like a tube)
- DO should be able to feel possible tensions along the spinal chord
- this gives info of where the dura might have adhesions and if there are vertebral lesions somewhere
The more you perform this "test", the more you feel!!! (as with every test :-)
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Permalink Reply by Daniel Thomas on -
When I do this test/technique I have had several patients say "Oh, I can feel where the doctor gave me my epidural", which I find quite useful.
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Permalink Reply by david rodway on
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further to a previous posting - what tests are people finding most useful for distingushing SI problems from other problems and for determining the nature of the problem?
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Permalink Reply by Scott Pender on -
Hello,
I am a final year student and have a question for all my esteemed learned (hopefully soon to be) colleagues :)
This may point out an ignorance/naiveity on my part but if you don't ask you won't know, so...
My question is:
We have oodles of different tests with which to build a 'picture' of what we percieve to be dysfunctional (including history etc), however it occured to me that (and some of you may do this - I don't know so please bear with me) why not, as part of the examination (already verbally extracted) ask the patient to put themselves into a position which aggravates/reproduces their symptoms (not as straight forward for viscero-somatic symptoms I guess)? From there the practitioner can ascertain which tests "fit the picture" and can further test/palpate etc.
For example: if the patient had right sided LBP and performed a right ERS motion to reproduce the pain the practitioner already knows that extension, side bending and rotation to the right side (quadrant test) is positive.
I guess this can be done 'imaginatively' during the case history but at least during the exam palpation can be applied at the same time.
Does this make sense? Is it too simplistic? OR is it because the learning environment is very structured/segmented that I haven't come across it yet?
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Permalink Reply by Tom Greenfield on
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That's the essence of being a good practitioner rather than just relying on a 'set routine' of tests.
It gets easier to improvise and adapt in diagnosis and treatment when freed from the constraints of being a student, but the real skill is keeping it going.
However it's also not hard to fall into a habit or pattern rather than listening carefully to each patient and treating them as an individual.
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Permalink Reply by Owen on -
I think this is a good point and in the physical examination we should really be exploring the aggravating and relieving factors and be thinking about the levers involved and the tissues this is likely to stress/ ease. pg523 of orthopedic physical assessment 5th ed by Magee has a table along these lines.
Also I like tests that find positions of ease for example thoracic outlet relief position:
pt seated with arms folded, practioner lifts elbows to elevate shoulders for up to 30 seconds this provides spsce for the neurovascular bundle entering in the arm. Relief of Pins and needles, pain etc indicates thoracic outlet compression.
Scapular assistance in abduction
Manually assist the scapula into forward rotation when pt reports shoulder pain on abduction. If this alleviates pain it suggests sub acromial impingement with possible scapula control issues.
In patients with this picture who also report pain on passive abduction I apply traction to the GH with the pt supine, if this improves symptoms I may want to direct some treatment at 'decompressing' the GH also working on the muscles which may be pulling the humerus superiorly.
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Permalink Reply by david rodway on
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Faber test, not fabere (see above)
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