As a physical therapist, testing has been ingrained in me since PT school. I learned that the initial evaluation process should involve testing of specific parts of the body, such as the joints, muscles, and nerves. The results of these tests would then play a role in guiding my treatments. Basically it gave me a starting point.
While I knew that assessing was important, I had no idea that it would eventually become a game changer when it comes to clinical outcomes. "Testing and retesting" is something I now do with every client at every session. In fact, I often do it in between every exercise and manual therapy technique administered, so that I can check how the client responds to each intervention. This information is vital to their success.
I am fortunate to be able to spend a full hour with each client individually at every session. This level of one-on-one attention allows me to focus and critically think about what I'm going to do next to get them moving and performing at their very best.
In PT school, I was taught how to manually test almost every skeletal muscle in the human body based on a strength score of 0-5. Known as manual muscle testing, this protocol is intended to determine where someone may have weakness in an isolated muscle or muscle group. However, since we rarely function in isolation, this testing has serious limitations.
I also learned how to test the range of motion (ROM) of almost every joint in the body. I would break out my handy-dandy goniometer to measure degrees of motion and see if the joint was being restricted in some shape or form.
Passive range of motion (what we do to you) versus active range of motion (what you can do on your own) can provide valuable information. A discrepancy between the two can help us determine if the problem is coming from a joint mobility restriction versus a stability motor control deficit. A joint mobility restriction simply means that the joint itself is restricting the body part from achieving full ROM. Usually a manual technique or a self-mobilization can help improve or resolve it. Meanwhile, stability motor control is a fancy term that looks to see how a particular joint is able to maintain control by coordinating the way the surrounding muscles and nervous system work together to complete a given task. This task can be as simple as asking you to raise your arm overhead as high as you can. A deficit or onset of pain will help determine my course of action.
Any PT can talk all day about strength and ROM until they're blue in the face. We have been honing our skills with these tests and measures for years, especially for the insurance companies. These companies always want to know the strength and ROM of each body part associated with the injury or complaint. We have been conditioned to document these numbers at the initial visit and with every progress note up until discharge.
When I got introduced to Redcord and the Neurac testing, I started to question why these things mattered so much to insurance companies? After all, a person can have full ROM and 5/5 strength but still be in a ton of pain. Does this mean that the client needs to be discharged? Of course not, but to some insurance companies, the criteria can be subject to a peer review and potentially discharged if their function is not improving? Because of this awful scenario, I would lose a lot of clients to insurance discharge. This is just one of many reasons why I decided to go into a cash-based model. But that's a blog for another time.
So I started to really focus on the Neurac testing protocols for 4 main reasons:
1. It has a scoring system. Similar to manual muscle testing (MMT), the Neurac testing also has a scoring system. But, unlike MMT which tests just one muscle (or muscle group) at a time, this type of testing assesses how you control movements across multiple chains of muscles (myofascial chains). The scoring ranges from 0 to 3.
The scoring criteria for Neurac testing is much more sensitive than MMT. For example, one of the Neurac tests involves controlling your full body weight into a single-leg side plank in the unsteady ropes. Not too many people can do this without assistance from the bungee cords. This test seems to provide much more useful information than manually testing their hip abductors in isolation (in an open-chain environment), where most people can easily achieve a score of at least 4 out of 5. As a physical therapist, I also find this to be a far more efficient way of testing strength, once you get an eye for what you are looking for.
Keep in mind that the point of administering Neurac tests isn't to just pass the test. Rather it is to help identify "weak links" that contribute to pain and movement limitations in sports and everyday activities.
2. It is functional. If insurance companies are going to get on my case for not improving function than function is what I am going to give them. So the testing in itself is functional. All Neurac tests are body weight-bearing tests where you have to control your core and coordinate chains of muscles to complete a task. They are also functional in the sense that the results of the tests can often have a positive effect on the deficits identified during the movement screen. We apply a movement screen for all of our clients. One of the movements we assess is single-leg stance. So for example, if a client’s single leg stance is poor on the left, we might find their Neurac testing into side-lying hip abduction (the test I mentioned above) on the left to be 0F or 0D. These scores mean they can do the movement with bungee assist (0F) but cannot do it correctly without bungee assist (0D). The results of the test alone can improve the single leg stance when we retest them in the movement screen. This type of intentional or purposeful testing is in itself functional because we are always assessing weak links to see if it will change the movement or the function in the movement screen. It is also functional in that all tests involve all 3 planes of movement (frontal, sagittal and transverse) just like in real life.
3. It highlights chains of muscles. When is isolating a muscle ever really taking place in real life? So is manual muscle testing really functional? In my mind, it's not. Carla Stecco said, “If the muscular insertions into the fascia are studied singularly, they have little significance, whereas if analyzed together or sequentially they gain an anatomical and physiological importance.” Meaning that when you look at muscles by themselves it provides you with little information about function. However when you look at how chains of muscles work together as one, it gives you way more information about how someone actually moves.
I cannot tell you how many times I have manually muscle tested the gluteus maximus and got a 4+ or 5 score. This means, according to the manual muscle testing rules, that there is nothing wrong with that muscle group. But when you test them in the ropes that glut becomes a functional mess.
Most people fail miserably in the supine pelvic lift test. This test is basically a single-leg bridge performed in the ropes with bungee assistance given at the waist. Most people will score a 0 out of 3 which means there is a weak link within that biomechanical chain. They are unable to lift their pelvis up to a level position without help from the bungees. You will see all types of compensation, from hiking their hip on the uninvolved side to pushing down more on the opposite shoulder. This test and exercise highlights the "functional back line" which is a fascial connection that runs from the glut to the opposite shoulder or latissimus dorsi. If your glut is not firing correctly, it can affect the entire chain of muscles involved in that movement. Poor glut activation can even eventually lead to an injury of the shoulder, due to poor coordination of the muscles with increased strain on the rotator cuff muscles. Poor testing performance becomes so obvious that even a family member watching can see it's not working properly. But that same glut tested normal during the break test or manual muscle test; and it might otherwise be ignored in the treatment care plan.
4. It looks at inner versus outer muscle groups. Neurac has two types of testing: global myofascial chain tests and local motor control tests. I've already spoken in depth about the global myofascial chain testing. Basically these tests look at how groups of muscles work together to complete a task. These “global” muscles are the outer muscles that you can clearly see, like the gluts, quads, hamstrings, and abdominals. These muscles are made to turn on to complete a task and then turn off. A lot of clients including athletes that we test are globally strong, meaning that they use their outer muscles to do everything. This kind of compensation pattern will eventually catch up with you and it will show its evil self by presenting with pain, stiffness and weakness to name just a few.
Oftentimes someone with this presentation will need to focus on deep core activation or “local” motor control exercises to sort of re-balance their inner versus outer muscles. This leads me to the second type of testing which is very unique to what we do at Activcore. We have a way to assess how the deep muscles are functioning. Unlike the global muscles that are supposed to turn on for a specific task, these local muscles are supposed to be working all the time to provide postural control and joint stability. For instance, those deep muscles in your neck are working while you read this blog. Or your deep core muscles are supporting your sitting posture while you sit in an unsupported chair. These local muscles have a lot of receptors thus making them extremely important in all functional movements. These muscles, such as the transverse abdominis, will lose its connection to the brain or will show a delay in its firing pattern in the presence of pain or dysfunction. This will force our outer global muscles to have to work harder and longer. They simply aren't built for that.
These are just a few of the reasons why I fell in love with Neurac testing. It just flat out gives you more information when the body is put under mechanical load or stress in a (bungee) supported, pain-free environment. It can tell you how a certain muscle is working with other muscles. It can tell you if a movement is painful. It can tell you if there is a coordination issue. It can tell something about the relationship of your inner and outer muscles and how that affects functional movements like the bending forward to touch your toes.
When someone can’t touch their toes we always blame the hamstrings but the issue can be related to the local stabilizing muscles of the lower back not allowing the spine to segmentally flex... thus putting more stress on the hamstrings. Now what physical therapist would be able to see all these things? There are some but not many out there. And, for sure, there aren't many that have the time to do what we do at Activcore when you come in for an evaluation. If you're interested in getting tested in the ropes, simply contact us.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
You can learn more about this topic by visiting our Redcord page.