Elements of Function Testing

Tests of function
 A. Active and passive rotatoric movements
 B. Translatoric joint play movements
 C Resisted movements
 D. Passive soft tissue movements
 E. Additional tests
Active Movements
 Active movements provide indication of dysfunction:
 Location
 Type
 severity
Passive Movements
 Passive movements provide information about

 Quality of movement
 End feel
Passive Movements
 Passive movements help in differentiating between lesions
involving
 contractile
 or non-contractile elements
Assessing Quantity of Movement

 The passive part of the movement is not started at the zero

position ,but begins where the active moment stops
Grading of Movement
(0-6 scale)
• 0 = No movement (ankylosis)
• 1 = Considerable decreased movement
Hypomobility • 2 = Slight decreased movement

• 3 = Normal
Normal

• 4 = Slight increased movement

• 5 = Considerable increased movement
Hypermobility • 6 = Complete instability
Assessing Quality of movement
 Ability to see and feel movement quality is of special
significance
 Slower passive movements are more likely to reveal joint
restriction
 More rapid movements can trigger abnormal muscle
reactivity
 Quality of movement to the first stop
 End feel : Quality of movement after the first stop
 Normal physiological end feel
 Pathological end feel
Pathological End Feel
 Scar tissue ------ firmer, less elastic end feel
 Muscle Spasm ------- more elastic and less soft end feel
 Connective tissue(fascia, capsules, ligaments)
firmer, less elastic end feel
 Intra- articular swelling – boggy end feel
 Hyper mobility/ligamentous laxity ---softer end feel than
normal
 Empty end feel
 Contraindicated – hard, inelastic end feel
 Passive movement is greater than active
movement
Painful arc
 Pain occurring anywhere in the range of active and/or

passive movement which is preceded and followed by no pain

is called a painful arc.
Coupling And Non coupling movements
 Coupled Motion
‘phenomenon of consistent association of one motion
(translation or rotation) about an axis with another motion
about a second axis’
Rotation of the spinal column is always coupled with
sidebending with the exception of the atlanto-axial joint. The
coupled rotation can be in the same direction as sidebending
(e.g. sidebending right, rotation right) or in opposite
directions (e.g. sidebending right, rotation left)
Capsular pattern
 When entire capsule is shortened then it is called capsular
pattern.(Cyriax)
 capsular pattern manifests itself as a characteristic pattern of
decreased movements at a joint.
 When expressing the capsular pattern, a series of three or
four movements are listed in sequence.
Capsular pattern
 EXAMPLE:
 shoulder
 external rotation
 abduction
 Internal rotation
Capsular pattern
 A capsular pattern is usually present when the entire capsule
is affected
 But limitation of movement due to capsular shortening does
not necessarily follow a typical pattern.
Differentiating articular and extra-articular
dysfunction
 Cyriax provides one model for distinguishing contractile

(muscle) lesions from non contractile (e.g., joint) lesions by

comparing responses to various tests of active and passive
movement.
 Contractile and Non-Contractile Elements

Contractile elements
 Muscles with tendons and attachments
Non contractile elements
 Bones
 Joint capsules
 Ligaments
 Bursae
 Fasciae
 Dura mater
 and Nerve roots.
Non contractile Dysfunction
 Active and passive movements produce or increase symptoms
and are restricted in the same direction and at the same point
in the range.
 Example: Active and passive external rotation of the
 shoulder is painful and/or restricted at the same degree of
range.
 Passive joint play movements produce or increase symptoms
and are restricted.
 Resisted movements are symptom free.
Contractile Dysfunction
 Active and passive movements produce or increase
symptoms and are restricted in opposite directions.
 Example: Active external rotation of the shoulder is
painful and restricted as the affected muscle contracts;
passive external rotation is pain free and shows a greater range
of movement; passive internal rotation is painful as the affected
muscle is stretched.
 Passive joint play movements are normal and symptom free.
 Resisted movements produce or increase symptoms.
Differentiating muscle shortening from
muscle spasm
 A shortened, tight muscle imparts a firmer,
less elastic end-feel, while muscle spasm produces a more
elastic and less soft end-feel.