Hx Taking
Focused: |
Site - Where the pain is? Different site or local? Note their gestures |
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Onset - Spontaneous/gradual/sudden/traumatic? |
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Aggravating/relieving factors - Rest? Movement?posture? Have patient demonstrate movements/posture |
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Quality of pain - Character of pain in patient's own words as much as possible, if they can't, give them a list - Burning, deep, dull, aching, sharp,throbbing, stabbing |
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Radiation - Where the pain goes and what character it is? Different from local pain? |
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Severity - 1-10 scale, functional disability (outcome measure) |
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Time - length of time pain has been present - constant? intermittent? variable? 24 hr period? |
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Associated symptoms - Stiffness, Swelling, crepitus, locking, instability, weakness and neurological signs - did you notice any other symptoms come on at the time of your pain? |
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General Hx |
Systems review - Is the pain coming from a certain system? Check organs |
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Previous Health - previous trauma, operations, medical illnesses, investigations + treatment - similar past episodes/previous MSK disorders " Have you seen any other professionals about this? What did they do? Did it help?" |
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Other Potential precipitating factors - infections, illnesses, surgery + stress |
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Family Hx - Any joint/systemic diseases - ask about grandparents/parents + siblings |
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Social Hx - Work + Home life - how does this pain/symptom affect them at work/home? Hobbies affected? - Outcome measure/goals for the patient |
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Functional assessment - Loss of function? |
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Red Flags |
Clinical features - serious, uncommon conditions/diseases - requires URGENT evaluation - Tumours, infection, f#, neurological damage |
Yellow Flags |
Psychosocial + Occupational factors that could increased the risk of chronicity - Bournemouth Questionnaire (BQ) |
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Attitudes + Beliefs about pain |
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Behaviours |
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Compensation issues |
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Diagnostic + Treatment Issues |
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Emotions |
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Family life |
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Work Life |
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Physical Exam
Processes: |
LOOK, FEEL , MOVE, SPECIAL TESTS |
Palpation: |
Bony + Soft Tissue - Look for - Deformity, Warmth, Crepitus, Muscle Tone, shape + Size, Swellings, Tenderness |
ROM |
AROM, PROM, RROM - End Feel, stiffness, Pain, Crepitus, locking.
AROM + RROM - Muscular/contractile Tissue.
PROM = Non-contractile tissue |
Mechanical Sensitivity
- Neuromuscular Condition can be aggravated by various provoking factors |
- Classed as Low/Moderate/High |
- Effective Management Plan |
Questions: |
What Activity brings on the pain? |
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How long can the pt perform the activity before the onset of pain? |
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After onset - can they keep working, if so, how long for? |
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After stopping - How long does the pain take to settle? |
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Assessment Factors |
Nature of activity that provokes symptoms |
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Intensity of the pain provoked |
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Time Span between onset + Offset |
High Sensitivity (Strong Reactor)
Severe Pain - Provoked Easily |
- Rapid Onset of Pain during activity |
- Patient Ceases activity and pain occurs hours afterwards |
- Radiation of Pain is Common |
Rx: NOT RECOMMENDED FOR: Manipulation, Mobilisation, deep myofascial therapy
Recommended: Drug Therapy, PIR + Gentle Massage
Moderate Sensitivity (Mild Reactor)
- Definite Pain free period |
- Pain unusually Gradual Onset - Slow then builds up during activity |
- Patient ceases Activity |
- Pain stops after 1 or 2 hours after stopping activity |
Rx: Mobilisation + Moderate Myofascial therapy + less intense forms of manual therapy
Low Sensitivity (Weak Reactor)
- Long delay in onset of pain |
- Strenuous activity provokes it |
- Pain level rises slowly, patient can continues with the activity |
- When the patient stops activity - pain settles rapidly - within 15-30 minutes |
Rx: Any form of manual therapy - low chance of reaction
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