Why Your Physio Does All Those Things – Testing Your Muscles, Reflexes and Feeling
After the subjective examination (the question and answer session) the physiotherapist needs to move on to the objective examination, in other words they need to test your bodily structures to see which one or several of them are implicated in your problem. One of the important aspects of this is the neurological examination, a vital part of checking that your nerve pathways are working correctly and that there is nothing seriously amiss in your nervous system. As the nerves conduct impulses to do with muscle contraction, feelings, joint position sense and circulatory control, the physiotherapist will concentrate on testing these as they are possible.
Muscle power is often lessened in painful conditions, perhaps due to lack of use of the part or that it is painful to contract the muscle, and the physio will test the muscles around the affected area to check for this. They will record this as part of the plan for later strengthening. However, in some cases where a specific nerve is affected, such as in sciatica, the testing may reveal very specific weakness related to that nerve and this helps with the diagnosis as it should fit in with other findings. The physio will typically resist the muscles as you try to perform the movement requested and grade the strength on the Oxford Scale of 0 to 5 out of 5.
Some muscles, such as the calf and perhaps the quadriceps and buttocks, are too powerful to test with the arms and the physio will ask you to perform a movement against your bodyweight such as going up on tiptoe repeatedly on one leg. Reflex testing performs a similar function. Muscle reflexes are the muscles reaction to being suddenly stretched, which is to contract. So when the physio hits your tendon at the knee this stretches the quadriceps which reacts by contracting, which is the reflex movement. Not all muscles have a reflex which is easily accessible but the physiotherapist may test yours to check the nerves are conducting properly at the biceps, triceps, knees and ankles.
Reflexes can be absent as part of normal, or can be very brisk and reactive. The physio will look for a reflex which is less pronounced than on the affected side, or more pronounced than usual. Feelings can also be affected by nerve difficulties and the physio may test light touch by touching your skin to compare the feelings of one side to the other.
Author: Jonathan Blood-Smyth