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Advanced Functional Assessment of Musculoskeletal Dysfunction – A Practical Method for Manual Medicine Practitioners

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Advanced Functional Assessment of Musculoskeletal Dysfunction – A Practical Method for Manual Medicine PractitionersCourse Description
The musculoskeletal (MSK) system is a functionally unified matrix with complex neurological and structural components interacting to provide the best level of function available at each moment. Gravitational stress and the absorption of reaction forces from movement impose ongoing mechanical, neurological and metabolic loads on the system. Connective tissues, the somatic and autonomic nervous systems, and the other available adaptive mechanisms (cellular, metabolic, endocrine, behavioural, etc.) have to respond to these loads appropriately.

Advanced Functional Assessment of Musculoskeletal Dysfunction – A Practical Method for Manual Medicine PractitionersAs a result of the significant adaptive potential contained in the MSK system and related physiological systems, movement dysfunctions created by repetitive demands can exist and be clinically undetected for a long period of time. Symptoms such as pain, weakness, restricted and abnormal motions, and decreased performance become apparent only when the net adaptive potential of any part of the system reaches a functional or structural limit. Therefore, the ability of a clinician to evaluate the neuromusculoskeletal system, and to identify the most relevant adaptations involved in the presenting dysfunction, determines the clinician’s ability to design effective individualized treatments aimed at restoring the lost adaptability.

Advanced Functional Assessment of Musculoskeletal Dysfunction – A Practical Method for Manual Medicine PractitionersThis experiential course is designed to provide participants with the knowledge and skills necessary to perform a competent functional assessment of patients with sports injuries and/or common musculoskeletal problems. Participants will learn a practical methodology to:

• conduct clinical analysis by examining the musculoskeletal system functionally through the visual analysis of motion, the integrated examination of motor and sensory function, and the manual assessment of joint and soft tissue mechanics.
• functionally organize the information obtained during the functional assessment process.
• design functional treatment plans based on a functional assessment.

This program is referred to as “experiential” because every day of the course the instructor conducts functional assessments of live patient cases with sports injuries and/or common musculoskeletal problems. In addition, participants will have ample opportunity for hands-on practice of all of the functional assessment techniques presented during the live case demonstrations.

Advanced Functional Assessment of Musculoskeletal Dysfunction – A Practical Method for Manual Medicine PractitionersCourse Learning Objectives and Outcomes
At the end of the weekend each of the course participants shall:
1. Understand the functional evaluation of pain and nociception in sports injuries and common musculoskeletal problems.
2. Understand the functional assessment of joints in sports injuries and common musculoskeletal problems.
3. Understand the process of assessing motor function in sports injuries and common musculoskeletal problems.
4. Understand the process of assessing soft tissue mechanics in sports injuries and common musculoskeletal problems.
5. Know how to evaluate sports injuries and common musculoskeletal problems functionally and multi-dimensionally.
6. Understand how to select the most appropriate therapeutic interventions for each level of dysfunction commonly found in sports injuries and common musculoskeletal problems.

Advanced Functional Assessment of Musculoskeletal Dysfunction – A Practical Method for Manual Medicine PractitionersCurriculum Summary
Friday
Workshop 1: Assessing Pain, Nociception, and Mechanosensitivity of the Peripheral Nervous System
a) Review list of specific questions for history taking (requires a personal review of the one page summary of pain contributors as provided with handouts)
b) Review the sequence of events of a functional examination process and discuss with your partner best timing for assessment of peripheral nervous system sensitivity
c) Dermatomal examination: pinch roll test (on paravertebral and peripheral tissues), scratch test (on paravertebral skin)
Goals: identify dermatomal allodynia (mechanical) and/or hyperalgesia
d) Peripheral nerves examination: simple palpation of peripheral nerve trunks and neurodynamic testing (median n., ulnar n., radial n., superficial peroneal n., tibial n., sural n.)
Goals: Identify mechanosensitivity of peripheral nerves and differentiate it from other sources of nociceptive information within the peripheral tissues

Workshop 2: Assessing Myotomes and Sclerotomes, and Integrated Tissue Tension
a) Myotomal sensory examination: simple palpation (superficial & deep) and layer palpation of muscles (taut bands, knots) Goals: identify hyperalgesia and trigger points
b) Myotomal motor examination: motor testing (isometric, eccentric, concentric), repeated motion (selective plane and range)
Goals: to identify motor inhibition and fatigability
c) Sclerotomal sensory examination: precise palpation (tenoperiosteal regions vs periosteum vs peripheral nerves)
Goals: identify areas of sclerotomal hyperalgesia
d) Integrated joint, muscle and connective tissue tension examination: active and passive range of motion (directional restrictions)
Goals: identify lines of tension from joints, muscles and connective tissues

Saturday
Workshop 3: Functional Assessment of Shoulder and Elbow Regions

Goals: to practice the sequential and directional examination of the selected areas in order to identify arthrokinematic problems, peripheral nervous system problems, and myotomal and sclerotomal problems.

Test performed: will include (as needed) AROM, PROM, surface anatomy palpation, joint anatomical and functional integrity examination, dermatomal palpation, peripheral nerves palpation, myotomal and sclerotomal palpation, motor testing, directional tissue tension examination, relevant spinal segmental examination, and sports specific assessment.

Workshop 4: Functional Assessment of Knee and Ankle Regions
Goals: to practice the sequential and directional examination of the selected areas in order to identify arthrokinematic problems, peripheral nervous system problems, myotomal and sclerotomal problems.

Test performed: will include (as needed) AROM, PROM, surface anatomy palpation, joint anatomical and functional integrity examination, dermatomal palpation, peripheral nerves palpation, myotomal and sclerotomal palpation, motor testing, directional tissue tension examination, relevant spinal segmental examination, sports specific assessment.

Sunday
Workshop 5: Functional Assessment of Hip and Pelvic Girdle

Goals: to practice the sequential and directional examination of the selected areas in order to identify arthrokinematic problems, peripheral nervous system problems, myotomal and sclerotomal problems.

Test performed: will include (as needed) AROM, PROM, surface anatomy palpation, joint anatomical and functional integrity examination, dermatomal palpation, peripheral nerves palpation, myotomal and sclerotomal palpation, motor testing, directional tissue tension examination, relevant spinal segmental examination, sports specific assessment.

Workshop 6: Functional Assessment of Gait, and Other Global and Complex Movement Patterns
Goals: to learn to visually identify normal gait cycle phases and common abnormalities; to practice additional testing (motor, directional tissue tension exam) in order to correlate visual and palpatory findings; and, to practice the same sequence for other body areas and for complex movements such as throwing or hitting a golf ball.

Test performed: visual biomechanical analysis of gait and other complex movements. Manual examination as needed.

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