COLUMN BUSINESS TALK Functional musculoskeletal assessment T How assessment builds your practice BY ANTHONY LOMBARDI oo often, chiropractors label a patient’s condition in a way that does not provide specific information about the nature of their dysfunction. Terms like bursitis, tennis elbow, jumpers knee – even more general terms like low back pain, neck pain, and sciatica do little to define the nature of the injury. Seven years ago I created (and started using) a functional musculoskeletal assessment system to help me assess, classify, and treat muscle-and joint-related injuries. In turn, my business practice exploded. The key to this system and to clinical success, is locating muscle motor or neuromuscular inhibition in muscles that stabilize skeletal girdles (scapular/ pelvic). Muscles tend to “shut-off” or become inhibited for three reasons triggered by different forms of noxious stimuli: Trauma or repetitive strain injury • (RSI) • Pain Changes in the joint (arthritis/car-• tilage tears) my assessment approach because Nijs’ lower extremity beginning with the conclusion that motor inhibition might femur. prevent effective motor retraining indi-Sedory et al. (2005) 3 concluded that rectly tells us that proper rehabilitation muscle groups in the proximal girdle of of our patient will not occur unless the kinetic chain of movement were motor inhibition is revealed and cor-associated with strength deficits in distal rected before actively retrain-Bullock-Saxton By determining joint injuries. ing the impaired muscle. et al. (1994) 4 noted the influ-where the ence of distal joint injury on By determining where the dysfunctions muscle activation of proximal dysfunctions are, we can then are, we can muscles of the pelvic girdle. make the appropriate treat-make the ment decisions to restore This research was combined appropriate with contemporary ideas to function and adaptability in treatment our patients’ musculoskeletal formulate an assessment sys-decisions tem that would encompass the systems. to restore tissues involved around the My assessment approach focuses on the skeletal founda-function and girdles, which are the centers tions of the musculoskeletal adaptability. kinetic movement. system which include: Vertebral column UPPER AND LOWER BODY • SCANS • Scapular girdle A patient’s chief complaint determines Pelvic girdle • which body scan(s) I perform to assess My goal is to assess the stability, their range of motion, stability, and lo-strength and range of motion of the cation of motor inhibition along the skull and extremities in relation to those skeletal foundations. For example, if the patient presents foundations. Hamill (2006) 2 described the girdles as foundations of human with anterior shoulder pain, I will In the Clinical Journal Of Pain (2012), 1 movement. This is because the shoulder perform the upper body scan. If the Nijs determined that nociception is and pelvic girdles protect and serve as patient presents with left sided low back most often processed without conscious adaptable attachment sites for muscles pain, the lower body scan will be per-thoughts. Therefore, in many cases, of the upper and lower extremities. formed. Typically, upper body muscu-neither patients nor clinicians are aware The skull is supported by muscles loskeletal complaints will prompt you to of the interaction of the motor inhibi-and soft tissue that anchor to the verte-perform upper body scans and lower tion. Chronic nociceptive stimuli result bral column (c-spine), while the scapu-body scans will be performed for lower in cortical delay of the motor output, lar girdle anchors itself to the skull, body injuries. thus creating reduced activity of the vertebral column (c-spine) and hu-The ultimate goal is to comfortably painful muscles. In addition, Nijs argues merus of the upper extremity. The ver-learn scans so that they can be com-that nociception-induced motor inhibi-tebral column (t-spine/l-spine), which pleted in clinical practice within two to tion might prevent effective motor re-has soft tissue, attaches to the pelvic gir-three minutes. training. This is of particular interest in dle that anchors to structures in the Here is a case study: A 42-year-old female presents with L lateral elbow DR. ANTHONY LOMBARDI has presided over 103,000 patient visits in 14 years of practice at pain of four months’ duration. She is a Hamilton Back Clinic (hamiltonbackclinic.com). Educational Materials are available at exstore.ca and competitive tennis player and has had acupuncturemotorpoints.com to modify her stroke to compensate for 22 Canadian Chiropractor June 2018 www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor June 2018: Page 22
