Guest Blog by: Todd Riddle, DC, CCSP, RKT, CSCS
I am huge advocate of proper patient assessment. And, it’s encouraging to see an uptick in the number of rehab professionals that are using some sort of system to classify patients in order to recommend the right treatment. Whether it’s MDT, SFMA, FMS or a variety of other systems, it is happening. That’s the good news; the bad news is that far too many practitioners still have no solid system of analysis.
There are a few blogs coming down the pipeline about the broader topic of assessment and diagnosis, but this is a quick reminder about how we can easily screen for hyper-mobility. For most patients, my standard evaluation will include a forward bending/toe touch test. When appropriate, it is quite literally one of the first motions I look at. For one simple reason. Most use the forward bend to assess hypo-mobility, but for many patients it may also open the door to a to screen for hyper-mobility. Generally speaking, if a patient can touch their palms flat to the ground without any warm-up or stretching, that’s a good indication to keep looking for more signs. Now, there will be those patients who may actively work on flexibility through yoga or some other activity, but it’s still worth investigating them as well if they can plant their palms on the ground.
This simple check becomes a gateway to perform Beighton Hypermobility Screen/Score. In total, there are five movements that give a general score, out of nine points, about the likelihood of hyper-mobility.
- Passive dorsiflexion of the 5th MCP beyond 90 degrees (one point per finger)
- Passive hyperextension of the knee beyond 10 degrees (one point per knee)
- Active forward flexion (knees extended fully) so that palms touch the floor (one point)
- Passive apposition of the thumb to the flexor side of the forearm (one point per thumb
- Passive hyperextension of the elbow beyond 10 degrees (one point per elbow)
While the system is open to a fair amount of interpretation about what the threshold score is to indicate hyper-mobility; many use between 4 and 6 points out of nine as the indicator. I tend to favor using 4 points myself. Regardless of how you interpret the score, it’s still a valuable tool for catching joint laxity and potentially requiring further testing for other congenital conditions like Ehlers-Danlos.
Why is this important? Any specialist that performs manual therapy to joints most certainly should be aware of the potential for joint laxity before doing higher level mobilizations or manipulation. This simple screen can ensure patient safety, improve quality of care and improves your overall level of assessment.
Dr. Todd Riddle is the Director of Education for Southeast Sports Seminars and serves as a lead instructor for FAKTR and Dynamic Tape courses. To learn more about Dr. Riddle and view his upcoming course schedule, click here.