Are General Orthopedic Screens A Missing Tool in Your Toolbox?

I remember back in physical therapy school we used to do balance screens for the elderly in our community.  It was such an awesome idea.  We could easily assess risk of falls in our elderly patients and give some easy exercises to follow to reduce their risk of a potentially fatal fall.  You could literally save someone’s life in this situation.

Since working with mostly athletes and very fit people with injuries I’ve gotten away from the idea of screening athletes.  Not that it isn’t beneficial but I’m mostly treating people in pain or coaching people with no pain.  We’d do the occasional FMS screen at our local highschool but that was about it.  However, listening to a podcast from the British Journal of Sports Medicine from Dr. Kristian Thorborg got me thinking.  (If you haven’t checked out BJSM and their podcast then do so immediately.  It’s must read content for therapists)

Dr. Thorborg was talking about injury prevention in athletes.  The athletes he generally works with are field sport athletes.  They’re commonly dealing with injuries to areas like the hamstrings and groin.  What they do is periodically perform orthopedic evaluations with these athletes to see if people are experiencing any low level symptoms that could develop into larger issues later.  One example they gave was an adductor squeeze test to see if the groin is having any issues.

It got me thinking.  The athletes I see do generally have injuries in common.  I see a lot of:

  • Shoulder Impingement
  • Patellofemoral Pain Syndrome
  • Femoral Acetabular Impingement
  • Extension or Flexion Based Low Back Pain

Because of this when I write training programs I’ll incorporate exercises in to help prevent these issues and am very conscious of exercise selection and prescription to avoid these issues.  I try to best understand the mechanisms of injury our athletes are seeing so we can be smart about things like mobility prescription, modification etc.  What I don’t do as regularly as I could is recommend more orthopedic screening for people before they start a training program or for athletes regularly throughout the course of the year.

The major reason I went to physical therapy school in the first place was because almost every single one of my clients as a personal trainer had some sort of pain issue or nagging injury they were dealing with.  I wanted to know how to help these people.

Trouble is, people are usually not vocal about these issues.  They work through these problems and never go to a therapist until it stops them from continuing (and sometimes they’ll keep training despite having to heavily modify and major frustration).

The other aspect is that sometimes people are dealing with such low levels of pain or discomfort they don’t think twice about what’s going on.  However, sometimes these issues grow to a point where it’s tough to fix them.

An ounce of prevention is worth a pound of cure

– Benjamin Franklin

If we can screen these athletes and give them some prevention then I think we’d be really helping to promote overall health and longevity for these folks.

Let’s pick an imaginary patient and a hypothetical physical therapy examination as an example:

42 year old male with occasional complaints of shoulder pain with overhead pressing

  • Positive subacromial impingement testing
  • Resisted scaption 4/5 and slightly painful
  • Resisted external rotation 4/5 without pain
  • Moderate overhead mobility limitation coming from thoracic spine, pec and lat stiffness
  • Pain and tenderness to palpation of the posterior shoulder

Now, this person wouldn’t typically come in to see me until they’re shoulder was really starting to hurt and limit what they can do in the gym.  You can also make the argument that this person may never get to that point.  However, I think we could really help this person.  Some intervention ideas for this person from off the top of my head are:

  • Standard rotator cuff and scapular stability program
  • Self thoracic mobilizations over roller
  • Soft tissue work (Foam roller or ball) to the lats and pecs with pain free stretching for overhead motion
  • Lacrosse ball work to posterior shoulder
  • Advice on exercise modifications when shoulder is painful
  • Advice on volume management throughout the year to keep the shoulder happy

We might be able to save this person from unnecessary pain, frustration, surgery and expensive medical bills.

For the athlete this is a no brainer as well.  Most high level Crossfit Games athletes I see are already dealing with some pain.  It’s just normally not bad enough to stop them from training.  They do whatever is in their power to continue training.  If we can find and correct these issues before they become major problems we’d prevent a lot of headaches and frustration from both the athletes and their coaches.  This would realistically only require us to get our hands on these people 2-4 times per year for a general orthopedic screen where we figure out these issues early.  I think we’d have a big impact on their long term health.  This is especially important for physical therapists who work with a sports team.  It would also be a major value addition for new members joining a gym.  It’s really just another way therapists can be a powerful ally for these people.

I guess my major point is this.  If you aren’t already recommending people come in for a regular check-up for physical therapy then it is probably smart that you start.  As therapists we get so caught up in actually treating people in pain we forget the power of prevention and how effective we can be as a profession (I know I’m guilty of this).

Big Ben Was a Smart Man,

Dan Pope DPT, OCS, CSCS, CF L1

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