Why I like tests

Ok, let me clarify that I don’t necessarily like to take tests, I just like the data that I get from them.

When we test we get a baseline.  We find out where things stand right now.  This could be something as simple as taking your blood pressure or pulse, or your weight, or something more complex like a memory or math test.  We get a place to start from and more importantly, we can measure the effectiveness of anything we implement to change the test result in the future.

If you want to lose weight and you try eating differently for a week you can weigh yourself again and see if your plan worked.  If you don’t have information from a first test then you have no way to know if your efforts were effective.

When I race, I’m always trying to get faster.  One of the challenges of measuring this in a race is that each race is different.  I can try and use the same race from year to year but even on the same course  wind or rain or some other factor can the parameters enough to affect the outcome.

This brings up an important point about tests.  They need to be designed in such a way that the variables that could affect an outcome are minimized, and the test needs to measure what you think it is going to measure.

Going back to my racing example if I race a 3 mile race that is flat and then a month later race a 3 mile race over hills, if my time on the second race is slower does that mean that I didn’t get faster? If I race a flat 3 mile course and then race it again a month later but this time there is a strong wind and my time is slower is my training not working?  We can’t get a true answer because the test variables were too different, and even though I was evaluating the effectiveness of my training by racing the same distance, the test was too different to give me good data.

When I look at how someone moves, while I can get a good sense of how things are going just by looking at them walk, stand from sitting and climb a few steps this doesn’t give me all the information I need.  As I’ve discussed before, the body gets very used to doing what we ask (or don’t ask) it to do every day, but is this the best way to perform the task?  Are we potentially overusing a body part that then might get injured?  Just because you can perform these simple tasks, what happens if you try to do something out of your normal routine? Like yard work, a big day of shopping or even a long day of cooking?  If you are an athlete, how do I know you are ready to go back to your sport? Or if you want to start a new sport or activity, how can we assess that you won’t get hurt?

There are some well established and basic tests that we use in the clinic and that I use with any athlete that I work with.   I use them because I want to know how well you move now, and I want to have an objective way to measure your improvement.  I want to be able to know if what we are doing is working or if we need to try something different.  I want to know if you are ready to progress to something more advanced, and I want to know if I can safely send you back to your sport or job with minimal risk that you will get hurt.   I want you to be able to see and feel your improvement, or I may want to show you where you still need work.  I

Unfortunately I don’t think we test our movement like we should and could.  Using my example of blood pressure from above, when we go to the doctor for an annual checkup this is often the first thing that gets tested (usually just after we are weighed which may have an unintended effect on our BP).   If you have an abnormal reading, the doctor can immediately make a recommendation that can prevent a problem in the future.  You will usually follow up with the doctor again in a 3-6 month time frame to see if the recommendation is working.  Changes can be made if not.

But when do we ever look at movement?  And why isn’t this equally if not more important than getting my blood pressure tested?  I will give a specific but very typical example from a recent patient.   This individual is in his late 40s and has been an avid hiker for many years.  Last year after having some knee pain and undergoing arthroscopic knee surgery to take care of a small meniscal tear he found that he had couldn’t do some of his favorite hikes as he recovered from the surgery.  He therefore didn’t hike often and became more sedentary.  As winter came he became even less active as he found it even more challenging to get out in the colder weather.  When spring came he decided to try a little hiking but found that it was a struggle and now his other knee hurt.  So he never really got back to hiking over the summer.

He came to see me yesterday because his knee hurts now when he stands up from sitting, when he goes up and down stairs and even when he rolls over in bed.  He finds that he loses his balance very easily, tells me he has put on some weight and just really doesn’t do the things he likes to any more.

Over the course of his physical therapy this gentleman will  improvement in his balance, function and movement and have the option to return to his hiking if he wishes.  However, if he hadn’t actively sought treatment for his knee, which in his mind was surgery before his doctor suggested PT first, but instead decided to live with his knee pain, his function would likely have declined.

If it hurts to climb stairs he would likely avoid it decreasing his ability to get around.  If his balance is off he would likely avoid situations that challenged it, made it worse, and then been prone to falling.  If being sedentary was increasing his weight, it is likely that this would continue.  Being sedentary is linked with many health risk factors completely unrelated to being able to get around and he might find that these developed or worsened. He might find that he stopped doing things he liked to do because it was too hard to do them.  Ultimately, because one of the most effective ways to manage the problems associated with knee osteo-arthritis is through exercise, he may end up having to go through a knee joint replacement surgery.

Sound dramatic? It’s not really.  When I take the history of a new patient this type of decline is quite common.

What if say even 6 months ago he had come to see me for an evaluation of his movement as part of an “annual checkup”?  Using the functional movement tests I work with I would have found the physical elements that impaired his hip, knee and ankle movement, his balance and his ability to hike.  I would have given him a simple program to start with, I would have recommended a 3 month follow up retest to see if it was working, and I would have made changes if needed.

I might have saved him a lost summer of hiking, helped him be more active in general, kept some of his weight off and minimized or prevented the pain he is feeling now.

Something to consider…and, yeah, that’s why I like tests.