You walk into the exam room and see a patient standing there just like this, What thoughts immediately flood your head ?
For me, I quickly start to juggle some things like, this:
- anterior-meniscofemoral impingement ? Are his first words going to be knee pain ?
- tibial tuberosity/osgood type traction issue due to quad dominance? Are his first words going to be knee pain?
-loss of ankle rocker? Are his first words shin pain or plantar foot pain?
- tibialis posterior tendinitis ? Is he going to point to the medial ankle gutter or lower medial shin as his pain area?
-likely anterior pelvis tilt (hence weak lower abdominals), weak glutes, low back pain ?
-hamstring tightness, cramps, pain, posterior knee pain?
Just rambling real fast this morning after seeing this picture on an old hard drive.
Train your brain to think fast, think of possibilities top to bottom, don't wait for your patient to tell you where their problem is.
I play this game when i ask all my patients to walk to the back of the office to my exam room. I am watching, thinking, mental gymnastics.
Our jobs are to solve puzzles, put meaningful pieces together, to solve problems.
I use the analogy of building a puzzle. You open the box, search out the straight peripheral edges, then clump together colors, patterns. Your history and examination and gait observation should be about a process of putting together the most likely clinical picture and puzzle. And then you start to execute. Sometimes you have to walk things back, but you have to start somewhere.
But, if you wait until you get into the room, wait for the patient to say, "anterior knee pain" to start your thinking, it is easy to get tunnel vision and forget all of the other possible pieces of the puzzle that might be playing into that anterior knee pain.
REmember this, how your client moves , poorly or well, is not the problem, it is just how they are moving with the pieces and patterns available to them or how they are avoiding patterns that are painful. How they move is not the problem, it is their strategy. It is our job to find out why they are moving that way, and if it is relevant to their complaint.
Start big, funnel to small.