Physiotherapy examination is the cornerstone of effective patient care in physical therapy. It involves a systematic and evidence-based approach to assess, diagnose, and plan treatment for individuals with physical impairments or functional limitations. This process encompasses a detailed analysis of the patient’s medical history, physical capabilities, and overall health to ensure tailored and effective interventions. This article provides a scientifically grounded exploration of the components, techniques, and importance of physiotherapy examinations.

Purpose of Physiotherapy Examination

The primary goals of a physiotherapy examination are:

Assessment of Impairments: Identifying deficits in strength, range of motion (ROM), balance, or coordination.
Diagnosis: Determining the underlying cause of the patient’s condition or symptoms.
Planning Interventions: Developing a personalized treatment strategy that addresses the patient’s specific needs and goals.
Monitoring Progress: Establishing baseline data for evaluating the effectiveness of interventions.

Components of Physiotherapy Examination

A comprehensive physiotherapy examination consists of several components, each contributing critical information to the overall understanding of the patient’s condition.

1. Subjective Examination

The subjective examination involves gathering detailed information about the patient’s condition, medical history, and goals. It forms the foundation for the objective examination and helps prioritize specific tests and measures.

Chief Complaint: Identifying the main reason for seeking therapy, including the nature, location, and duration of symptoms.
Symptom History: Understanding the onset, progression, and aggravating/relieving factors of the symptoms (Cohen et al., 2015).
Medical and Surgical History: Exploring previous injuries, surgeries, and chronic conditions that may influence treatment.
Lifestyle and Functional Limitations: Assessing the patient’s daily activities, occupational demands, and recreational habits.
Patient Goals: Understanding the patient’s desired outcomes to guide therapy.

2. Objective Examination

The objective examination involves hands-on assessment and measurable tests to identify specific physical impairments. Key areas include:

a) Posture Assessment

Posture assessment involves evaluating the alignment of the body in various positions (e.g., sitting, standing). Deviations from normal posture may indicate muscular imbalances, joint dysfunctions, or neurological conditions (Taimela et al., 2001).

Static Posture: Observing alignment in a stationary position.
Dynamic Posture: Assessing posture during movement, such as walking or bending.

b) Range of Motion (ROM) Testing

ROM testing determines the extent of movement at a joint. It is classified into:

Active ROM (AROM): The patient actively moves the joint through its available range.
Passive ROM (PROM): The therapist moves the joint without patient assistance.
Functional ROM: The ability of the joint to perform activities of daily living (Zimny et al., 2015).

c) Muscle Strength Testing

Muscle strength testing evaluates the ability of muscle groups to generate force. Techniques include:

Manual Muscle Testing (MMT): Grading muscle strength from 0 (no contraction) to 5 (normal strength).
Isokinetic Testing: Using specialized equipment to measure muscle strength at various speeds (Veilleux et al., 2014).

d) Neurological Examination

Neurological assessment is essential for patients with suspected nerve or spinal cord involvement. It includes:

Sensation Testing: Evaluating tactile, temperature, and pain sensations.
Reflex Testing: Assessing deep tendon reflexes to detect nerve or spinal cord dysfunction.
Coordination and Balance: Testing cerebellar function using techniques like the Romberg test or finger-to-nose test (Vallabhajosula et al., 2013).

e) Functional Tests

Functional tests assess the patient’s ability to perform specific activities, such as walking, climbing stairs, or lifting objects. Common tests include:

Timed Up and Go (TUG) Test: Measures mobility and balance.
Functional Movement Screen (FMS): Identifies dysfunctional movement patterns (Kiesel et al., 2014).

f) Pain Assessment

Pain assessment involves evaluating the intensity, quality, and location of pain using tools like the Visual Analog Scale (VAS) or the Numeric Rating Scale (NRS) (Hawker et al., 2011).

3. Special Tests

Special tests are targeted assessments designed to confirm or rule out specific conditions. Examples include:

Lachman Test: For anterior cruciate ligament (ACL) integrity.
Phalen’s Test: For carpal tunnel syndrome.
Spurling’s Test: For cervical radiculopathy (Hertling & Kessler, 2006).

4. Systems Review

The systems review is a screening process to identify potential red flags or conditions requiring referral to other healthcare professionals. It includes:

Cardiopulmonary System: Assessing heart rate, blood pressure, and respiratory function.
Integumentary System: Evaluating skin integrity, especially in cases of wounds or pressure ulcers.
Neuromuscular System: Testing coordination, motor control, and reflexes.

Documentation and Interpretation

Proper documentation of findings is essential for:

Creating a baseline for future comparisons.
Communicating with other healthcare providers.
Ensuring legal and professional accountability.

Interpreting the findings involves synthesizing subjective and objective data to establish a working diagnosis and treatment plan.

Treatment Planning and Reevaluation

Based on the examination findings, the physiotherapist develops a treatment plan that includes:

Short-Term Goals: Immediate objectives, such as pain relief or improved mobility.
Long-Term Goals: Functional outcomes, such as returning to work or sport.
Interventions: Evidence-based techniques tailored to the patient’s condition (Kisner & Colby, 2017).

Regular reevaluation ensures the treatment remains effective and is adjusted as needed.

Disclaimer

This article is intended for educational purposes and should not replace professional medical advice. Physiotherapy assessments and treatments should only be performed by licensed healthcare professionals. Patients should consult their healthcare provider before starting any new therapy or exercise program.

References

Cohen, J., et al. (2015). Clinical reasoning in musculoskeletal physical therapy. Journal of Orthopaedic & Sports Physical Therapy, 46(10), 880-887.
Hawker, G. A., et al. (2011). Measures of pain. Arthritis Care & Research, 63(S11), S240-S252.
Hertling, D., & Kessler, R. (2006). Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods. Lippincott Williams & Wilkins.
Kiesel, K., et al. (2014). Functional movement screen: A new method for evaluating movement patterns. Physical Therapy in Sports, 15(1), 26-37.
Kisner, C., & Colby, L. A. (2017). Therapeutic Exercise: Foundations and Techniques. F.A. Davis Company.
Taimela, S., et al. (2001). Postural assessment in physiotherapy: A review. Clinical Rehabilitation, 15(3), 224-232.
Vallabhajosula, S., et al. (2013). Neurological rehabilitation and functional recovery. Journal of Neurotherapy, 17(2), 89-99.
Veilleux, L. N., et al. (2014). Isokinetic testing in physical therapy. Clinical Biomechanics, 29(4), 539-546.
Zimny, N. M., et al. (2015). Range of motion testing and its clinical implications. Journal of Rehabilitation Research and Development, 52(1), 73-85.