Section 4: Planning the physical examination

International Framework for Examination of the Cervical Region

Necessity for planning

A process of interpreting the data from the patient history and defining the main hypotheses is essential to an effective physical examination[1][2]. Hypothesis generation from the history and refining, re-ranking and rejecting of these hypotheses in the physical examination is necessary to facilitate optimal clinical reasoning in OMT[3]. Therefore careful planning of the physical examination is required. In particular for this framework, the possible vasculogenic (cervical arterial) contribution to the patient’s presentation needs to be clearly evaluated from the patient history data.

Are any further patient history data required?

An important component of planning is the identification of any further patient history data that may be required. That is, are there any gaps in the information obtained? Is the quality of the information obtained sufficient?

Decision-making regarding the physical examination

Based upon the evaluation and interpretation of the data from the patient history, the physical therapist needs to decide:

  • Are there any precautions to OMT?
  • Are there any contraindications to OMT?
  • What physical tests need to be included in the physical examination?
  • What is the priority for these physical tests for this specific patient? This is to inform decisions regarding the order of testing and to determine which tests should be completed at the first visit.
  • Do the physical tests need to be adapted for this specific patient?

References

  1. Maitland G, Hengeveld E, Banks K, et al (Eds)(2005). Maitland's Vertebral Manipulation, 7th Edn, Elsevier Butterworth Heinneman, Edinburgh.
  2. Petty NJ (2011). Neuromusculoskeletal Examination and Assessment: A Handbook for Therapists (Physiotherapy Essentials), 4th edn, Churchill Livingstone, Elsevier, Edinburgh.
  3. Jones MA, Rivett DA (2004). Introduction to clinical reasoning. In M.A. Jones and D.A. Rivett (eds.), Clinical Reasoning for Manual Therapists. Butterworth-Heinemann: Edinburgh 3-24.