Special Tests recently has been put to the weigh side with the decrease on the emphasis of a patho-anatomical diagnosis and the growth of a movement based diagnosis. However, Special Tests can easily be used for more than just a specificity and likelihood ratio of a certain pathology (although this is very important). Here are a few extra ways to utilize special tests in your practice:
1. Most several Special tests are provocational in nature, as in a positive findings typically produces pain. Often this pain is the patient's chief complaint/ reproduction of pain. These provocational tests can be triplanar and functional positions as well. Therefore, special tests are a great tool that can be used to retest after your interventions/resets! ROM, strength, and movement assessments like the SFMA are great as well but a quick pre/post test of a Special Test will also add value to the patient that you can remove painful stimuli that are in once aggravating positions or postures. Sometimes the patient seeing an improved mobility or going from a DN to FN on the SFMA isn’t enough. They want to see an improvement in certain provocational positions, often seen with Special Tests.
2. However, not all Special Tests are provocational. Take for example the ‘scapular assistive test’ (SAT). This is a great test to assess motor control, where you look at how pain is affected with improving kinematics. Several Special like the SAT can demonstrate “instability”, whether in the shoulder, low back (great resource here) of another joint. Instability Special tests improve our motor control deficits working diagnosis seen with movement assessments and can improve our clinical decision making. Specifically, Special Tests can add what segments and patterns are involved with the motor control deficits previously found. Also, they may assist in providing a more appropriate intervention/ corrective exercise for motor contol deficits.
Lets use the SAT as an example again. Say you find a motor control deficit with your SFMA breakout in the shoulder with ER motion. The SAT clearly adds the large influence the scapula is playing in that motor control issue. This can lead to a more useful intervention like the sharmann wall slide with pattern assist.
Another example would be finding a motor control deficit with flexion breakout and then utilizing the prone instability test. This would add value and confidence to your motor control working diagnosis. This also allows the clinician to know the issues involved with the low back and the benefits of glut stability. This may lead to doing exercises in quadruped with resistance or pattern assist to utilize the correct mechanics. Hopefully you're starting to see that Special Tests can lead to a better corrective exercise.
3. Several, maybe all, Clinical Prediction Rules utilize Special Tests in the cluster. And CPRs have better outcomes. Taking this one step further, a cluster of special tests can add sensitivity and specificity to your patient response model as well thereby improving your outcomes. Special tests, like the arc of impingement, catch sign, aberrant motions like gower’s, etc. are inherently built into movement assessments, so we should use them to add to our clinical decision making. What I tell my interns is were trying to collect as much data as possible on the first visit that lead us to the best possible intervention and game plan. Intervention A may have 4 check marks while intervention B has 6 checkmarks. I feel more confident utilizing intervention B. And my confidence in intervention B may have been won over by just a couple of Special Tests. So Special Tests can add insight into your patient response model, not be separate from your movement diagnosis.
4. Correlating Special Tests with your movement assessment improve the amount of resistance and load needed for an intervention. Specifically, they can provide an accurate starting position for your progression if you utilize the 4x4 matrix. If a special test is found to be positive in standing then we know to start patients in a less loaded and difficult position.
