On 9/6/99, Murray Maitland<[log in to unmask]> wrote:
<<For example, let's start with an orthopaedic problem: gastrocnemius
rupture. The complete rupture is missed on occassion and yet the clinical
tests are quite conclusive. I don't understand if this approach is
appropriate.
As another example, a peripheral nerve impingement such as long thoracic
nerve would also be difficult to assess without specific muscle tests of the
serratus anterior.
In the two situations here I have gone from a top down approach but in the
clinic it is usually a bottom up method. I would attempt to deduce the
anatomical region of interest by differentiating related unaffected and
affected structures. It seems as if the approach here is not much different
in terms of the overall goal. >>
***As stated in the earlier comments by at least two of us, these cases offer
good examples where isolation tests may certainly have value in clinical or
pathological situations. If some muscle is ruptured in a linked system,
there is no doubt that isolating which muscle is damaged is entirely
relevant. However, if no such trauma is evident from pain, swelling or
severe disruption of movement, the use of isolation testing simply because
one suspects 'muscle' weakness or 'imbalance' in an athlete, becomes a less
definitive tool.
Even though such isolationist tests may identify which component in a linked
chain may be implicated in some neuromuscular pathology, it will not
necessarily give definitive information about what may be happening in actual
complex movements or where the joint acceleration has nothing to do with the
muscle being tested.
As is well known, torque or acceleration about a joint may be due to the
action of a muscle which does not span the joint concerned or even serve as a
classical 'prime' mover, assistant mover etc. (e.g. Zajac F & Gordon M
Determining muscle's force and action in multi-articular movement Exerc
Sport Sci Revs 1989, 17: 187-230).
Dr Mel C Siff
Denver, USA
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