This is fantastic! One question: when you talk about "an examination of the nearest spinal segment" does this mean a full exam? active, passive, resisted?
Hi! With clearing tests we normally mean active range of movement with over pressure to investigate… and then if you find that this reproduces symptoms you may look to dive in further 🙏🏼
Perhaps my misunderstanding, however my tutor said that if someone had knee pain I have no reason to assess the ankle, the hip yes. My understanding of this being clarified with the justification that pain can be referred down but not upwards. In the case of the hip, referring pain down to the knee is further backed by the obturator nerve ending before the knee? Is this nerve only involved with the key muscles involved in movement around the hip? I am confused as surely the neural networks spread in and around their respective nerve axons. If you have any information to clear up my muddled head I would be grateful, and better still evidence to support the above and below spreading and neuro, not located anything in my search so far. Thank you
Hi! Very good question and astute reasoning. Yes as a general rule it is of course the joint above which refers pain. Firstly I’ll just answer your ankle question- yep as a general rule I would agree that it is not that useful, however the foot and ankle is important for the knee- one example is let’s say pea planus, this creates medial rotational torsion at the tibia and can be involve in developing knee pain so there is some utility there
With the Obturator nerve it is that in 95% of people it is the predominant supply of sensation to the hip joint capsule. So when you have a hip pathology like osteoarthritis the pain is referred down the supplying nerve which ends before the knee in the case of the obturator. Nothing is ever absolute but keep it simple because it all can be very quickly unnecessarily overcomplicated with discussions around crossover of femoral, sciatic nerve different distributions in different people etc. just see this as a general rule that’ll really help in real world practice I.e pain goes thigh but stops before or around the knee? Probably the hip, better assess that and see if the pain can be reproduced there as we know the obturator is the sensory supply to the hip joint in 9/10 people. That way we keep it simple. You mentioned motor of which of course obturator supplies medial muscles like the adductors, sciatic hamstrings and femoral quads, but when referring to the pain bit at hips we are talking about which nerve supplies sensory fibres to the joint itself Hope that helps!! Jack
This is fantastic! One question: when you talk about "an examination of the nearest spinal segment" does this mean a full exam? active, passive, resisted?
Hi! With clearing tests we normally mean active range of movement with over pressure to investigate… and then if you find that this reproduces symptoms you may look to dive in further 🙏🏼
I am physio from Ethiopia , you are unique
Thank you so much! 🙏🏼
Perhaps my misunderstanding, however my tutor said that if someone had knee pain I have no reason to assess the ankle, the hip yes. My understanding of this being clarified with the justification that pain can be referred down but not upwards. In the case of the hip, referring pain down to the knee is further backed by the obturator nerve ending before the knee? Is this nerve only involved with the key muscles involved in movement around the hip? I am confused as surely the neural networks spread in and around their respective nerve axons. If you have any information to clear up my muddled head I would be grateful, and better still evidence to support the above and below spreading and neuro, not located anything in my search so far. Thank you
Hi!
Very good question and astute reasoning. Yes as a general rule it is of course the joint above which refers pain.
Firstly I’ll just answer your ankle question- yep as a general rule I would agree that it is not that useful, however the foot and ankle is important for the knee- one example is let’s say pea planus, this creates medial rotational torsion at the tibia and can be involve in developing knee pain so there is some utility there
With the Obturator nerve it is that in 95% of people it is the predominant supply of sensation to the hip joint capsule. So when you have a hip pathology like osteoarthritis the pain is referred down the supplying nerve which ends before the knee in the case of the obturator. Nothing is ever absolute but keep it simple because it all can be very quickly unnecessarily overcomplicated with discussions around crossover of femoral, sciatic nerve different distributions in different people etc. just see this as a general rule that’ll really help in real world practice I.e pain goes thigh but stops before or around the knee? Probably the hip, better assess that and see if the pain can be reproduced there as we know the obturator is the sensory supply to the hip joint in 9/10 people. That way we keep it simple.
You mentioned motor of which of course obturator supplies medial muscles like the adductors, sciatic hamstrings and femoral quads, but when referring to the pain bit at hips we are talking about which nerve supplies sensory fibres to the joint itself
Hope that helps!!
Jack