Orthopedic conditions often present as pain, weakness, stiffness, instability, or altered movement patterns. But symptoms are only the surface. A proper physiotherapy assessment digs deeper, aiming to:

• Identify the specific tissue or structure involved

• Understand the stage and severity of injury

• Differentiate between local and referred pain

• Determine the functional limitations

• Guide short- and long-term treatment goals

Without a detailed assessment, treatment becomes guesswork. And in physiotherapy, guessing is dangerous. It wastes time, erodes trust, and can worsen outcomes.

A good assessment is methodical. It follows a pattern that helps the physiotherapist think critically and avoid bias. Here’s the essential framework:

1. Subjective Examination (History-Taking)

This is more than just asking, “Where does it hurt?” The goal is to gather key insights about:

• Onset: Was the injury sudden or gradual?

• Mechanism: What activity caused or aggravated it?

• Pain Characteristics: Type, intensity, pattern, 24-hour behavior

• Functional Impact: What movements or tasks are limited?

• Past History: Any similar issues in the past? Surgeries?

• Red Flags: Night pain, unexplained weight loss, neurological symptoms, etc.

Effective history-taking sets the tone. It builds rapport, hones your clinical hypothesis, and saves time later.

2. Observation

Don’t underestimate what your eyes can tell you. Even before touching the patient, observe:

• Posture and alignment

• Swelling, bruising, or deformity

• Muscle wasting or asymmetry

• Movement patterns and compensations

This can give you early clues about chronicity, compensation, or protective guarding.

3. Palpation

Now comes hands-on assessment. Palpation helps confirm what you suspect:

• Temperature (inflammation)

• Tenderness (localization of pain)

• Muscle tone or guarding

• Bony landmarks and alignment

• Swelling or joint effusion

Use palpation to localize your diagnosis and narrow your focus.

4. Active and Passive Range of Motion (AROM & PROM)

Have the patient move the joint actively. Look for:

• Quality of motion

• Range available

• Pain or restriction points

• Compensations

Then perform passive movement to see if range improves when muscles aren’t involved. Compare both sides.

If AROM is limited but PROM is full, you may be dealing with a contractile (muscle/tendon) issue. If both are limited, the joint itself may be the problem.

5. Resisted Isometric Testing

This is your key to diagnosing contractile lesions (muscle or tendon). The technique is simple: resist the patient’s movement without allowing actual joint motion. You're testing:

• Strength

• Pain response

• Symmetry with the unaffected side

For example, pain with resisted wrist extension could indicate extensor tendinopathy (like lateral epicondylitis).

6. Special Tests

Special tests are designed to confirm or rule out specific conditions. Examples include:

• Lachman Test for ACL tear

• Neer’s Impingement Test for shoulder pathology

• FABER Test for hip or SI joint dysfunction

• Thompson Test for Achilles tendon rupture

The key? Use them to support, not replace your clinical reasoning.

7. Neurological Screening (If Needed)

For conditions involving spine or nerve-related symptoms, include:

• Reflex testing

• Dermatomal sensory testing

• Myotome strength testing

• Neural tension tests (e.g., SLR, Slump test)

This helps rule out radiculopathy, peripheral neuropathy, or spinal cord involvement.

8. Functional Assessment

Finally, observe the patient during functional tasks relevant to their goals walking, squatting, lifting, reaching. This bridges the gap between isolated joint assessment and real-world performance.

Orthopedic assessment is both science and art. Learn the structure, then sharpen your clinical eye. Ask the right questions. Pay attention to detail. Let the body tell its story and listen like a professional who knows exactly what to do with it.