PHYSICAL EXAMINATION

& Guidelines for

prescription
 OBJECTIVES
1. ASSESS

2. DIAGNOSE

3. TREAT
 HISTORY TAKING
• Take a HISTORY
– What is the patient’s chief complaint?
– Pain?
• Where? When? How bad? What is it like?
• What makes it better?
• What makes it worse?
– Acute Injury vs. Chronic
– Progression of Symptoms?
 HISTORY TAKING: Background
Information
• Any Previous Injuries
• Past Surgical History
• Past Medical History
• Medications
• Allergies
• Social History
– Work situation (laboring type job?)
– Home situation
STEPS in the PHYSICAL EXAM

• Inspection
• Palpation
• Range of motion
• Neurovascular assessment
• Special tests
 INSPECTION
What do you see?
• Alignment (neutral? valgus? varus?)
– Knees, hindfoot, forefoot
• Foot shape: Flatfoot? High arched?
Normal?
• Toe shape: Clawed, Hammer, Mallet toes?

• Swelling? Masses?
• Discoloration?
• Scars? / Cuts? / Abrasions?
Plantar callosities? / Ulcers?
 PALPATION
• Where does it hurt? What
do you feel?
• Surface Anatomy is key!!
• Pathology can be accurately
localized
• Ligaments, Bones, Tendons hurt
where they are injured
• Neuropathy is the exception!
 RANGE OF MOTION
Accurately assess range of motion
COMPARE with contralateral side
NEUROVASCULAR ASSESSMENT

• Nerve Function
– Sensation
– Reflexes
– Motor Strength
• Vascular Status
 NEUROVASCULAR ASSESSMENT

SENSATION
– Light touch
– 2 point discrimination
– Vibration sense
• Neuropathy
– Loss of 5.07 monofilament sensation
– Loss of “protective” sensation
NEUROVASCULAR ASSESSMENT

REFLEXES

• Ankle Reflex
NEUROVASCULAR ASSESSMENT

MOTOR STRENGTH
• Graded 0-5
5 = Full strength
4=
3 = Antigravity
strength
2=
1 = Flicker
0 = No
 GAIT ANALYSIS

OBJECTIVES

• Identify the phases of gait and

perform a functional gait analysis.
 GAIT ANALYSIS
PHASES OF GAIT

Toe Off Heel Rise Flatfoot Heel Strike

SWING PHASE STANCE PHASE

 GAIT ANALYSIS
ASYMETRY Does one side have:
?
• Decreased stride length?
• Decreased stance time?
• Increased trunk shift?
• Increase or decreased foot progression angle?
• Abnormal heel to toe progression?