MUSCULOSKELETAL SCREENING ASSESSMENT

PRESEASON MUSCULOSKELETAL SCREENING

BY CRAIG SEDGWICK, PHYSIOTHERAPIST

INTRODUCTION Musculoskeletal screening is a whole-body assessment used to highlight any problems that an athlete may have that could impact on their ability to perform to their maximum potential. It can be used as a preseason or training camp baseline or, in professional sport, as a prerequisite to signing a contract – in which case, the assessment should run in conjunction with that of a doctor’s examination, so that both medical and musculoskeletal aspects are covered. This article is based on the musculoskeletal assessment process undertaken when screening football players, but it can easily be adapted to the particular needs of any sport by giving a greater focus to the areas of the body placed under stress during functional movement. It is not intended to provide a debate on the reliability of screening tests, and those mentioned do not constitute an exhaustive list. Feel free to add any tests you find applicable and to discard the ones you do not.

SUBJECTIVE EXAMINATION The assessment process should start with a thorough subjective history – this is probably the most important aspect of the process. Information obtained should include the athlete’s name, date of birth, and previous medical history, investigations, medication and treatment. In particular, questions should be asked about current injuries and what, if anything, has been done to investigate and treat them. Details of practitioners involved in current or recent treatments should be obtained, together with the athlete’s written consent giving permission for those practitioners to be contacted. In practice, if there are current episodes of injury, then it is beneficial to start a new assessment procedure from scratch, as if the player had come to you with this particular problem. The practitioner should document aggravating and easing factors, and the type of pain and location. The practitioner should also rule out any serious pathologies and ‘red flags’ such as difficulties with micturition, faecal incontinence, loss of sensation around the anus and

PROBLEMS THAT COULD IMPACT ON MAXIMUM PERFORMANCE

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MUSCULOSKELETAL SCREENING IS USED TO HIGHLIGHT

Musculoskeletal screening can be used preseason as a baseline measurement or to highlight problems. It is a thorough head-to-toe assessment of the musculoskeletal system, comprising of a subjective history and an objective examination of all the major joints. It gives the clinician important information on the athlete’s readiness to compete.

genitalia, and progressive non-mechanical pain (1). For a full list of red-flag indicators, further reading is required.

OBJECTIVE EXAMINATION When a patient comes to you with a particular problem, the objective part of the examination is usually guided by what you have learned from the subjective part. You should be testing a hypothesis of what you consider the problem to be. However, with musculoskeletal screening of athletes, the objective part of the examination has a much wider focus, because you are seeking both to highlight potential problems and to establish a baseline for the future, and so all areas of the body are tested. Remember: you must always gain consent from the athlete, in writing, before commencing a physical examination (2).

GENERAL OBSERVATIONS When the player first enters the treatment room, observe closely how they move and their general appearance. This gives you an overall impression. Look at their face, gait and posture, especially in relation to asymmetry (2). This may highlight any further questions or tests that you wish to carry out. More local observation, including looking for bony deformity, swelling, muscle wastage or colour changes, may need to be carried out if the player reports a problem. Give particular attention to sites of previous injury. All findings must be documented and acted upon accordingly.

SPECIFIC JOINT ASSESSMENT Work in a set order – either from top to bottom or from bottom to top. This ensures that you don’t miss anything.

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