Screening Tests

General

  • Determines if pain is something within our scope of practice or not

  • Depending on the area of pain we may find there is many causes:

    • Damage to internal structures

    • Damage to ligaments

    • Muscles that act upon the joint

    • Soft tissue damage

Valsalva Test

  • Indication: Neck/back pain

  • Check: For herniated discs

  • Application: Verbal

    • Ask the client if they have pain during bowel movement

    • Bearing down causes an increase in disc pressure forcing pulposus lateral

  • Positive Result: Avoid deep massage to the area

Slump Test

  • Indication: Neck/back pain

  • Check: For herniated discs

  • Application:

    • Have the client take the spine into flexion beginning at the cervical & including the thoracic

    • Have them then try to elevate one leg with the knee extended

  • Positive Result:

    • Herniated disc at that level

    • Elevation of the right leg usually causes left-side pain

    • Avoid deep massage to the area

Homan’s Test

  • Indication: Pain in the calf

  • Check: Possible thrombosis

  • Application:

    • Flex knee to disengage hamstrings and gastrocnemius

    • Dorsiflexion of ankle to stretch posterior compartment

  • Positive Result: Avoid massage to the area

  • Deep Vein Thrombus

    • DVT is a serious condition that occurs when a blood clot forms in a vein located deep inside your body

    • A blood clot is a clump of blood that is in a gelatinous, solid state

    • Deep vein blood clots typically form in the thigh or lower extremities, but may also develop in other areas of the body

Vertebral Basilar Insufficiency Test (VBI Test)

  • Indication: Neck massage

  • Check: For VBI

  • Application: Verbal

    • Do you have trouble extending your neck & looking over your shoulder?

  • Application: Active

    • Have the patient fully extend the neck

    • Introduce full rotation to on side & hold this position for 10 seconds

    • Bring back to neutral

    • Repeat on the other side

Positive Results: Fainting, dizziness, spots, blackouts

  • Avoid treating the neck in an extended & rotated position

  • Vertebral Basilar Insufficiency

    • Veterbrabasilar arterial system is located at the back of the brain & includes the vertebral & basilar arteries. These arteries supply blood, oxygen, & nutrients to the vital brain structures, such as your brainstem, occipital lobes, & cerebellum

    • Causes for Restriction:

      • Damage to arteries

      • Atherosclerosis

      • Vertebral Alignment

    • Over time plaque can narrow & block arteries preventing blood from reaching vital organs

    • If the artery is compromised movements of the head can cause the artery to reduce blood flow intermittently this can generate the following symptoms:

      • Vertigo/ Dizziness/ Fainting/ Nausea & or pain

  • Vertebral Basilar Artery

    • Passes through the vertebral foramen

    • It turns medial above C1 to enter the foramen magnum of the skull

Distraction Test

  • Indication: Neck pain (or joint pain)

  • Check: For ligament stretching or tearing

  • Application for Cervical:

    • Contact the skull under the Occiput or if needed under the occiput & chin

    • Elevate head toward the ceiling

  • Positive: Pain generated indicates a tear in ligaments

  • Ligament Damage

    • Articulations are stabilized by the ligaments travelling from one bone to the next across the joint

    • The role is to restrict ROM in a particular direction

    • Normally, ligaments only play a role in the final range of that particular motion

    • Have minimal blood supply to & one of the issues is that they become strained or torn through excessive force

    • Use Distraction Tests to see if there is an indication of tearing or stretching which loss of stability in the joint

Compression Test

  • Indication: Neck pain (or joint pain)

  • Check: For herniated discs, nerve compression, or joint incongruences

  • Application for Cervical:

    • Head maintained in a neutral position

    • Straight-down pressure is applied to the top of the skull

  • Positive Result:

    • Pressure recreates clients’ symptoms by forcing pulposus out of herniation

    • The same principle is applied to any articulation indicating internal joint damage

  • Furthermore

    • All articulations have internal structures

    • They can range from the articular cartilage in almost all joints to the meniscus, such as in the knee

    • Damage to these structures may result in pain & irritation

    • To assess if this is the cause of the pain, we incorporate a compression test. It applies pressure between the two bones, making up the articulation.