In both the Thomas test and Ely's test, the muscle being stretched is the rectus femoris. The Thomas test assesses iliopsoas and rectus femoris length. By flexing the hip to 90 degrees and lowering the leg, it stretches both of these muscles. Ely's test specifically isolates the rectus femoris by having the patient lie on their side and raising their leg. This positions the hip in extension and knee in flexion, stretching just the rectus femoris.

1. PPT 237-BASIC ASSESSMENT SKILLS
TUTOR: JOHN AYAMGA
ST. JOHN OF GOD COLLEGE OF HEALTH, DUAYAW
NKWANTA

2. Course Objective
oAfter this course, you must be able to…
apply basic assessment techniques to
examine clients/patients to identify
their health needs and plan therapy or
make recommendations on the basis
of clinical reasoning

3. Course Content
Documentation & principles of
physical examination
Joint Mobility Assessment
Examination of Soft Tissues
Examination of motor and sensory
systems
 Special Tests

4. Documentation & principles of
physical examination
Basic Assessment of Pain
Neuro-therapeutic Techniques
Limb Length and Girth Measurement
Obesity, BMI and WHR
Interpretation of X-rays
Thoracic Mobility Assessment
Outcome measures

5. Documentation & principles of
physical examination
 S.O.A.P notes or documentation
a record of patient’s information and care in a
structured and organised way
An acronym that stands for
• Subjective
• Objective
• Assessment/Analysis
• Plan of care

6. Subjective examination
• Therapist asks patient relevant questions and
documents patient’s responses, E.g.
patient’s demographics,
PC (Present Complaint)
HPC(History of Present Complaint)
PMHx(Past Medical History), etc
Is it really important to know pt’s viewpoint about
his/her condition?

7. Objective examination
Involves observing, measuring, testing,
palpating and recording of findings by the
examiner
E.g. Information on observation/inspection,
measurement of ROM, special tests, reflexes,
MMT(Manual Muscle Testing), etc can only be
gathered by the examiner through these
procedure

8. Assessment /Analysis
Examiner’s analyses the various examination
components and forms an opinion on patient’s
condition
The reasoning behind the decisions taken and
analytical thinking behind the problem-solving
process
A prioritized problem list is generated with
impairments linked to functional limitations
Also, progress towards the stated goals is
indicated, and any factors affecting it that may
require modification of the frequency, duration or
intervention itself

9. Adverse and positive response, should be
documented in re-assessment, E.g.
 Ambulation not attempted today due to
patient’s report of fatigue, etc
Patient has been compliant with exercise
program which has resulted in increase in LE
strength,

10. Plan
 Involves
 short/long-term treatment objectives
 expected functional outcomes
 discharge planning
 treatment that the patient will receive based on his or
condition, etc.
 E.g. Objective
 To improve deltoid strength from 3 to 5 by the end of
2months
 Rx: Resisted shoulder abd with Theraband:10reps,
3x/session; increase strengthening exercise reps to 15;
attempt ambulation tomorrow, etc.

11. Why is documentation important?
–Provides health care worker of a
record of injury or treatment
–Provides supporting documents in
litigations
–Fosters inter-provider communication

12.  As secondary data for research
purposes
Longitudinal patient records
Billing/insurance/reimbursement
Documentation can be used for quality
assurance and improvement purposes.

13. Key aspects of documentation
 Must be accurate, clear, and reflect
specific services and events
 Use appropriate medical abbreviations
 Thorough, but not excessively wordy
 Document it before it vanishes from your
mind’

14.  Punctuation
Hyphen (-) can be confused with ‘minus sign’ or
‘negative’. It is used instead of the word ‘through’.
E.g.: 0 – 45o
Semi colon (;) is used in the subjective portion to
connect related statements. E.g. “Position of
comfort for sleep is on RT side; pain does not
awaken pt. at night.”
Colon (:) can be used instead of “is”. E.g. instead
of “AROM RT shoulder is 0-90o, write “AROM RT
shoulder: 0 -90o ”

15.  Correcting Errors and Signing S.O.A.P Notes
Never use correction fluid; errors should be
corrected by drawing a single line through the
error, then write ‘error’ above the mistake,
date it, and initial it.
All notes should be signed with your legal
signature (your last name and legal first name
or initials, followed by your status/designation

16. Do not use nickname
Also, spaces, Blanks or Empty Lines should not
be left between one entry and another, nor be
left within a single entry as these could
become areas in which another person could
falsify information already charted

17. Principles of examination
Examine the unaffected side first, especially
where there is a bilateral component
Examine AROM first, followed by PROM and then
ARROM (muscle strength testing)
Examine non-painful movements first before
painful movements
Apply over pressure with care at the limits of
AROM to determine the end feel and eliminate
the need for doing PROM

18. Repeat movements several times and observe for
any change in movement pattern and patient
symptoms.
 To apply resisted isometric Test, put the joint in
neutral position and hold test for about
5seconds.
 Notify patient that symptoms may be worsened
during or at the end of the assessment
 Refer patient to appropriate professional if
unusual signs and symptoms are noticed or
condition is beyond your scope.

19. JOINT MOBILITY EXAMINATION
 Normal joint ROM =
Normal physiological movement
+
Normal Accessory Movement
Difference b/n ROM and flexibility of a joint

20. EXAMINATION OF ACTIVE MOVEMENT
Active movement due to voluntary muscle
contraction
Even though active movement is usually
performed first, may be a contra-indication in
acute injuries and stages of tissue healing

21. EXAMINATION OF ACTIVE MOVEMENTS
In examining active movements
Demonstrate movement first
Allow patient to perform movement
Note quality of movement
Note pattern of movement
Observe any trick motion
Note the point in the ROM that pain occurs if
any

22. EXAMINATION OF ACTIVE MOVEMENT
Note whether the movement increases the
intensity and quality of the pain
Note any limitation of movement and its
nature
Apply overpressure at the end of AROM to see
if any symptom will occur

23. EXAMINATION OF PASSIVE MOVEMENT
Examiner moves a joint through its ROM while
pt is relaxed

24. Examining passive movement
What is the quality of movement?
 Is joint movement excessive or limited?
Is there any capsular pattern in movement?
If pain is present determine where it occurs
within arc of motion, its intensity and quality
What is the end feel?
Movement in associated joints?
ROM available?

25. 1. Is there capsular pattern in your assessment?
2. Is the knee joint capsule affected or the
source of the problem?

26. Assignment
1. Why you should examine unaffected side first
before affected side
2. Why examine AROM first before PROM
3. Why examine non-painful movements first
before painful movements
4. Why you should apply overpressure at the
end of ROM

27. Capsular pattern
1. Which of the following capsular patterns is
not correct for the associated joint?
a) flex>ext, elbow
b) Adduction>flex>med rot, shoulder
c) Flex>ext, knee
d) Plantarflex>dorsiflex, ankle

28. END FEELS
End feel is a sensation or feeling that you
detect when the joint is at the end of its
available PROM
Apply overpressure at the end of PROM to
detect the nature of endfeel
End feels could be normal or abnormal

29. NORMAL END FEELS
END FEEL Nature E.g.
Hard Bone contacting
bone
Elbow extension
Soft Soft tissue
contacting soft
tissue
Elbow flexion,
knee flexion
Firm Capsular stretch
Ligament stretch
Muscle stretch
Ext of MCP jt
Forearm sup
Hip flex with
knee extension

30. ABNORMAL END FEELS
END FEEL Nature E.g.
Soft examiner feels stiffness
that starts early during
movement and
gradually increases to
the end
Soft tissue edema,
synovitis, effusion
Firm joint movement occurs
freely at the beginning
but gets limited by
tissue restriction. Joint
ROM is drastically
reduced
Capsular shortening
Muscular shortening
Ligamentous
shortening
Hard/bone-to-bone examiner feels bone-
to-bone blockage
occurring before the
end of movement
OA, fracture, excessive
bone growth

31. Empty Examiner feels that
only pain stops the
movement from
continuing to the
end
Bursitis, joint
inflammation, etc
Springy block examiner feels
bouncing of
movement at the
point of limitation
torn cartilage in the
knee can block knee
movement
Muscle spasm Muscles involuntarily
contact to stop
passive movement.
Pain may occur
concurrently
Anterior shoulder
dislocation, acute OA
with knee muscle
spasm to protect
joint movement

32. EXAMINATION OF SOFT TISSUES
Contractile tissues
muscle, tendon, bony attachment and nerve
supply
 Active movement test
pain during active movement but not passive
movement shows that contractile tissue is
having the problem

34.  Passive Movement Test
Pain that worsens with passive stretch of a
contractile tissue may indicate contractile
problem

35.  Resisted Isometric Test (test position)
Pain worsens or presence of weakness or both
when this test is applied indicates contractile
tissue involvement

37. Summary of Results of Resisted
Isometric Test
RESULTS
TEST
STRONG
AND
PAINLESS
STRONG
AND
PAINFUL
WEAK
AND
PAINFUL
WEAK
AND
PAINLESS
RESISTED
ISOMETRIC
TEST
contractile
tissue is
normal
minor
lesions in
contractile
tissue.
Eg.
1o strain,
tendonitis,
minor
avulsion #s,
etc
severe lesion
Eg. Fracture
Neurological
problems
Eg. complete
tenton or
muscle tear,
PIP, SCI,
weakness 2o
CVA, etc

39. Test positions for the following joints:
1. Test position of elbow for triceps
2. Test position of knee for quadriceps
3. Test position of hip for gluteals
4. Test position of ankle for dorsiflexors
5. Test position of shoulder for shoulder
elevators

40. Non-contractile or inert tissue
ligaments, joint capsule, Cartilage, bursae, etc.
Passive stretch of a non-contractile tissue will
provoke pain if there is a lesion or injury.
NB:
Resisted isometric test does not provoke pain
that is coming from inert tissues except where
these tissues are being compressed during the
test
In non-contractile tissue examination, pain
USUALLY occurs close to the end of joint ROM

41. Summary of Results of passive movement
tests for Inert Tissues
FULL JOINT
MOV’T W/O
PAIN
LIMITED JOINT
MOV’T WITH
PAIN IN ALL
DIRECTIONS
Limited JT
MOV’T WITH
PAIN OR
EXCESSIVE JT
MOV’T IN
SOME
DIRECTIONS
LIMITED JOINT
MOV’T W/O
PAIN
PASSIVE
MOVEMEN
T TEST
Normal
inert
tissues
Entire joint
is affected.
Eg.
Capsulitis,
Arthritis,
etc
Involvemen
t of some
inert
tissues but
not others.
Eg. sprains,
bursitis,
local
capsular
adhesion,
Abnormal
bone-bone
block
maybe
present, Eg.
OA,
abnormally
healed #s,
etc

42. Examination myofascial adhesions
&muscle tightness
Causes of restricted play (myofascial
restriction )
Soft tissue trauma
Repetitive exposure to poor postures
Soft tissue immobilisation
Restricted scar tissue
Adaptive muscle shortening
etc

43.  Adaptive changes
Myofascial adhesions
Muscle tightness/shortness

44.  Myofascia
-Functional joints allows normal play and
they are maintained by fascial tissues
Restricted play

45.  Consequences of Myofascial Adhesions
Movement restrictions
Postural distortions
Chronic pain (myofascial pain syndrome)

46. Examination of Myofascial
Adhesions/Tightness
Use finger pads to stretch skin in all directions
No fascial restrictions or adhesions if skin
glides freely over the fascia
Adhesion is found where there is decreased
gliding between skin and the underlying fascia

48. Body parts like knuckles, Elbow or other tools
are usually used to apply deep compressive
traction forces to break myofascial adhesions

49.  Examination of Muscle length
Used to determine whether the muscle length
is too short or tight to permit normal range of
motion or the muscle length is too stretched
allowing too much ROM
If muscles are found to be short, stretching
techniques and in some case surgery are
needed to lengthen them

50.  Practical Session
• Myofascial examination
• Muscle length examination
Pectoralis
Triceps
 hamstrings (Sit-and-Reach test)
Rectus femoris (Ely’s Test)
Iliopsoas + rectus femoris (Thomas Test)
Gastrocnemius + soleus (Ankle Dorsiflexion Test)

51. Triceps

52. Pec Minor tightness

53. Pectoralis major

54. Sit and reach test for hamstring and
low back muscles

56. Examination of Iliopsoas length

57. Examination of iliopsoas length cont.

58. Rectus femoris

59. Gastrocnemius tightness

60. Which muscle is being stretched in
both cases?