Conducting A Quick And Easy Functional Lower Extremity Exam Of An Athlete
The art of doing a musculoskeletal exam on an athlete is really about utilizing simple tests in order to provide insights into the highly complex nature of human movement. There are many perspectives and philosophies on how to best examine the lower extremity.
As podiatrists, we often look at things from the ground up and combine static exams like joint range of motion (ROM) and manual muscle testing with a dynamic (or functional) walking or running exam. Our training and license obviously focus on the structures distal to the knee, but if we do not examine and appreciate the influence of the proximal structures and the complexities of neuromuscular coordination or assess the patient in static and dynamic conditions, we are not being thorough enough.
The static and functional components of the exam are equally important and complementary in terms of the information they provide about the patient. The static exam is useful for assessing range of motion, deep tendon reflexes and muscle strength. The static exam includes closed chain and open chain tests, which isolate segments while they are unloaded or loaded. The dynamic exam is useful for assessing functional range of motion, neuromuscular coordination and muscle endurance. The dynamic exam allows us to assess the segments as they work together in a system under loading.
Given that most podiatrists are well versed in static tests of the lower extremity and gait examinations, let us take a closer look at quick, useful dynamic tests that one can easily add to a normal assessment without dramatically increasing the time required. Some of the tests are purposely redundant and allow us to pick up on subtle movement deficits. The tests do not require measurement tools but one can score or even videotape them to assess in more detail or review with the patient as needed.
Why Perform Functional Tests?
One of the most interesting aspects of the dynamic exam is that patients can often feel their deficit before the examiner points it out to them. This is very useful in that it helps them understand the underlying issues that may be contributing to their injury and also helps them buy into and comply with the treatment plan. Another benefit is that because the tests are so simple, many patients will test and retest themselves to monitor their own progress during treatment. This can serve as its own positive feedback loop to reinforce healthy behaviors.
An additional benefit of functional testing is that it allows for better communication and more detailed physical therapy and certified athletic trainer referrals. Our physical therapy colleagues appreciate and often are pleasantly surprised when we offer detail about deficits we have identified in clinic prior to the referral. A skilled physical therapist is an important part of the athlete’s treatment team and it is important to send patients to someone who is trusted and can provide the training necessary to help the athlete.
As a disclaimer, the exercises to follow are by no means the only functional tests to consider and there are variations of each of these tests. As with all aspects of practice, clinicians should utilize the exam techniques that best mesh with their experience, practice philosophies and the unique needs of any given patient.