2008-07-11 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs, DPT

As I sit here to write this column, my brother called to tell me that he hurt his right knee again.

He is a mailman and walks between eight and nine miles per day. He has hurt this knee in the past with a quadriceps tendon tear and torn medial meniscus. As with many friends and family members, they ask about aches and pains at various family functions and parties throughout the year. These always include a history of the injury and what the pain feels like. Of course, they want to know what I think it might be. It is especially challenging to take a guess when you are being told the symptom over the phone and cannot even look at, let alone examine the body part in person.

My brother asked me how therapists and physicians could make a diagnosis without an x-ray or MRI. At the very heart of playing medical detective is having a working knowledge of the anatomy; the location and possessing the ability and skill to palpate ligaments, tendons muscles and joints is imperative.

Next, knowing the job of each of these structures is necessary. Lastly, knowing how to place a stress upon the soft tissue structure in question, while not injuring it or other nearby structures, is required.

For this column's purpose we will classify all soft tissue structure as being "contractile" or "non contractile" tissue. The "contractile" tissues are ones that either have the ability to or helps with contracting a muscle. These structures are mostly muscles and tendons, as tendons connect muscle to the bone. "Non contractile tissues" are composed of ligaments, cartilage, bone and other structure that do NOT contract.

If "Jane" tells me her shoulder is having pain when she raises her hand over head, it can be any structure that is painful. If I move her hand over her head and it is pain FREE, we can make a guess that the painful structure is contractile. Why? When she contracts the muscle it pulls on the tendon which pulls on the bone and it is painful. BUT if I take her through the same ROM but her muscles and tendons are relaxed and it is pain free, that means the same non contractile tissues i.e., ligaments are doing the exact same movement but are now pain free.

Finally, I might make that particular muscle and tendon contract, such as with an isometric contraction. That is a contraction of a muscle but the joint does not actually move. If the tendon or muscle is painful with contracting and the joint is not even moving, then we have confirmed that a contractile tissue, muscle or tendon has some pathology to it, either a muscle strain or tendonitis.

As with many things health related, it is crucial not to self diagnose, but to seek a medical doctor's opinion for a diagnosis. The information in today's column is to help you appreciate how health care professionals do what they do, not for Uncle Joe to diagnose your ankle pain.

Have a healthy and happy summer!!

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