At KCP we guarantee that our aim is to identify exactly what has gone wrong – in other words, our primary goal is to provide an accurate diagnosis. Now that might be taken as a “given”, however a physiotherapists training, experience and post graduate qualifications will dictate just how well this process occurs. To absolutely understand an injury, a comprehensive examination needs to be completed. The subjective examination involves a sequence of questions which provide a guide to the anatomical structures involved in an injury. In some cases more than one structure may have been damaged during an accident. Understanding the exact cause or mechanism of injury is extremely helpful. The objective examination involves a sequence of physical tests ranging from passive range of motion, active range of motion, strength, special tests for ligaments or tendons, through to a neurological examination to assess for possible nerve damage. Assessment and treatment are closely connected, so the effect that treatment has on an injury may assist in determining a differential diagnosis for an injury. Every treatment involves assessment and reassessment in order to monitor progress.
Injuries occur on a continuum starting with an obvious traumatic event to a joint structure with a high threshold to damage, down to an anatomical structure which has a low threshold to injury making it possible for structural damage to be caused by a remarkably trivial event. In some cases it can be several hours or even days before you "click" that you have a problem. The more trivial the "mechanism of injury", the more we focus on underlying stiffness, weakness and biomechanical dysfunctions. When you repetitively complete an activity such as swimming or throwing, anatomical structures can be slowly stressed, however left unchecked, this can lead to potentially quite severe problems. Once assessed it may well be that a carefully structured period of isolated rest will allow the bone, ligament or tendon to regain its full strength or regenerate tissue.
People often do not request an assessment of a painful anatomical structure until it is affecting their function or has grown to a point where there is a constellation of symptoms. This can make injuries more challenging to treat because a simple problem can suddenly become difficult to manage. Other factors that can affect symptoms are stress and anxiety. Finally, while we encourage patients to google and learn more about their injury and the structures involved, it takes many years of study/experience to become proficient at injury diagnosis. It is therefore best to leave the final diagnosis to a professional who sees many patients and has a good understanding of musculoskeletal disorders.