I have seen several patients this month already who present with what can only be described as “goofy” symptoms. By this I mean symptoms that don’t seem to add up. For example, yesterday I evaluated a gentleman who’s primary complaint was of non-specific general knee pain that he really had a hard time describing. He had previously had an MRI and x-rays, and has been evaluated by an orthopedic surgeon. The physician found nothing wrong with his knee. Structurally, he is intact and his joint surfaces are good. He is 42 years old.
His painful knee demonstrates slightly more laxity than the uninjured knee when the ACL is stressed, but not enough to account for his complaint. This stress test is not painful or even abnormal. He has no point tenderness, and his meniscus checks out under both compression and with torque.
The functional movement screen identified a few interesting facts:
- He has restriction of his calf length
- He has world class restriction of his hamstrings
- He has restriction of his quads
- His hip Abductions and Adductors are also restricted
- His hip rotators are restricted
The theory we perform a functional movement screen against is this:
You stand on a stable foot
You have a mobile ankle
Stable shoulder girdle
Well this fellow demonstrates restriction of his calf (ankle ROM is functionally less) – which transfers movement demands to his next motion segment – his knee.
His hip is grossly restricted, and while he does have some core instability, it is knee that is painful.
So, there you have it. We picked up several areas of restriction in the functional movement screen that would otherwise not make themselves clear to us in evaluating his knee. The functional screen allows me as the therapist to find a starting point in his rehab. I like to think of the process as a reorienting of the health status “compass” such that the day-by-day movement patterns we teach lead the person to a healthier state over time. Clearly something is wrong with this gentleman’s knee. He went to a surgeon after all, and even after being told that all is well, he still sought my help.
The functional movement screen gives us a starting point. It is the very best evaluation tool I have used in my career. You can read more about this approach here.