In a way, Eric Browning, MPT, wants to predict the future.

Six months ago, he began administering a musculoskeletal exam aimed at identifying areas of the body that could cause eventual pain. The test grew from the therapist's desire to put injury prevention in the hands of his patients.

Avoiding a Pain in the Neck

Browning is co-owner of Keith Physical Therapy in Oklahoma City, OK, with Thomas Keith, PT. He is also an adjunct faculty member at the Oklahoma University Health Sciences Center for Physical Therapy. He first thought of his technique after clients told him how pleased they were with the comprehensive evaluation he gave them. But instead of examining individuals when they already had an injury or issue, he thought, why not screen them beforehand?

"I love my job, and I love treating people," Browning told ADVANCE. "I don't like that people hurt and injure themselves. I understand that happens. What I would really like to prevent is the insidious onset pain."

Going a step further, Browning focused on giving patients something they could take home in the form of a risk assessment. The report would allow clients to monitor potential problem areas and engage in the appropriate exercises or activities on their own.

"I thought it would be that much better if I could put information in their hands," Browning said. "Part of what a physical therapist does anyway is educating the patient. But if I can give them something better than just a general handout, if I give them something that is about them, it would be both educational and very motivational."

Targeting the Right Population

Browning said the general population can benefit from his exam. But it's targeted more to fit, active people, those with hyper-mobility syndrome, expectant mothers and corporate America. The last two groups often struggle with low-back and neck pain, Browning said. The therapist has also seen complaints of hip pain or previous shoulder injuries among his clients. However, since he hopes the exam can actually foreshadow problems, Browning welcomes people without pain to visit him as well.

"Somebody doesn't have to have an issue to come see me," he said. "They may come in and say, 'I've never had pain in my life. I just want to know if I'm at risk for that and, if so, in what area and what do I need to do about it.'"

Browning also hopes his exam can help fitness trainers integrate information on problem areas into clients' workouts.

Getting It On Paper

When patients come in for the musculoskeletal exam, Browning first asks them to fill out an intake form. The paperwork allows individuals to answer questions specific to their work and recreation habits. This information can indicate initially whether the person may be prone to certain pain issues or injuries. Browning then reviews their past and present medical history to ensure he doesn't need to refer the client to a specialist.

The therapist then takes their height, weight, blood pressure and other statistics. Then, patients engage in a short, timed test of cardiovascular endurance, and Browning measures flexibility and strength. Throughout the exam, Browning checks the client's static and dynamic balance, gait and spinal alignment. He may also assess their shoe wear.

"When I do the exam, I'm doing special testing on the entire body, and the way I kind of determine whether they're at risk is if it looks like a duck and walks like a duck and quacks like a duck, it probably is a duck," he said.

He or an assistant then plugs the information into a computer to create a risk analysis. The formula uses a baseline to determine if the client performs below average in certain areas based on height and weight. The entire exam takes 45 minutes to an hour.

Educating the Client

Browning provides patients with written and graphic versions of the results, along with literature from the American Physical Therapy Association. In addition to supplying information on areas of the body to monitor, the assessment suggests exercises for these high-risk areas. Browning arranges to call or e-mail the client for a follow-up evaluation in six months.

"When they look at their risk analysis, the areas of high risk are where I spend time," he explained. "If they have a high risk for shoulder pain, I'm going to tell them how to lower the risk."

So far, Browning has used the musculoskeletal exam on about 40 clients. He hopes to conduct research on the accuracy of his method once he's assessed between 300 and 400 patients. He would also eventually like to offer the exam in its computer-based form to other physical therapists.

"I plan to try to piece together risk and what appears to be occurring in the population for females, males, [certain] ages. If there's a pattern, I want to figure it out," he said. n

For more information on the musculoskeletal exam, visit www.keithpt.com

Lauren Fritsky is assistant editor at ADVANCE and can be reached at lfritsky@advanceweb.com

PT Can Prevent Low-Back Pain

In August, Spine (Volume 33, Number 16) published findings indicating active physical therapy for patients with acute low-back pain is linked to "better clinical outcomes, decreased use of prescription medications, MRI and epidural injections and lower health care costs than passive physical therapy," according to a press release issued by the APTA. Low-back pain will affect between 60 and 80 percent of Americans during their lifetime.

The study included a retrospective review of 471 patients, ages 18 to 60. More than a quarter received active physical therapy, which included much exercise, while the remaining received non-adherent care, which included ultrasound, electrical stimulation and other passive techniques. The first group experienced greater improvement in function and a decrease in pain intensity, along with fewer physical therapy visits, a shorter duration of care and lower charges for physical therapist care. They were more likely to experience a successful physical therapy outcome.

-Lauren Fritsky