3
Chapter
DiagnosisTests of our aims of exercising Tests of our aims of exercisingParticular care is necessary when there is:
• severe feeling of sickness
• severe night pains
• spasms
• psychological problems
• no history of trauma or injury
• no known etiology
• conspicuous recent changes
• case history which indicates that exercise
could cause tissue damage; for example,
with fractured ribs be careful not to cause a
pneumothorax with exercise
• pain that does not improve with medication,
treatment, position, movement, or rest
• any doubt or the feeling that something is not
right.
We are not dealing with systemic diseases in this
book; nevertheless we should be aware that sys-
temic diseases could mimic neuromusculoskeletal
problems due to viscerosomatic reflexes or refer-
ral patterns of viscera. Particular care is necessary if
the case history shows related signs and symptoms
(Goodman & Snyder 200 0 ).
Sammut & Searle-Barnes (1998, p. 136) summa-
rize the important principles of examination:• understanding what has happened to the
various tissues that cause the symptoms
• understanding how the body has reacted locally
and globally to these changes, particularly
how these have affected the functions
• considering the predisposing and maintaining
factors for these tissues and functional changes.These aspects are helpful for developing appropriate
exercises, and changing harmful habits and everyday
activities.Tests of our aims of exercising
From the vast array of tests available we are giving
a brief introduction of those that relate particularly
to our aims of exercising. The tests indicate which therapeutic aims should be developed, maintained,
or reduced. The diagnostic outcome will lead to the
appropriate exercise prescription and help patients
to understand why these exercises were chosen,
how to perform them, and see the improvements
for themselves. Many tests are exercises as well,
and most exercises can also be considered as tests.
Therefore we will give suggestions for tests and
refer to suitable basic exercises or āsanas. As soon
as patients have developed mindfulness in their
approach to exercise, they will be able to see and
feel the changes more clearly.
For details of musculoskeletal examination there
are many publications to refer to, such as Magee
(1997), Sammut & Searle-Barnes (1998), and
Goodman & Snyder (2000). For tests referring to
motor abilities, see Lederman (2005, 2010).
We will mainly focus on active tests that are most
relevant for showing improvement through exer-
cise and can be understood, performed, and evalu-
ated by patients themselves, once the therapist has
taught them.
The baseline is the patient’s ability at the start
of the exercise treatment. All improvement is mea-
sured in relation to this baseline. This individual
approach is consistent with the traditional view
of yoga, meeting patients where they are. A sen-
sible objective is to tailor the exercise aims to the
patient’s needs and expectations, as far as possi-
ble. This subjective approach has been useful in the
authors’ exercise approach.
A non-specific but highly relevant factor indicat-
ing general health and stamina is the overall quality
of movement and willingness to move. Experience
has shown that any change in range of movement,
however small, can improve the patient’s function
and well-being. To judge this, mindfulness is funda-
mental. In itself mindful exercising is an important
basis for testing that patients can do themselves.
We have mentioned the importance of testing
in the initial diagnosis and observation of improve-
ment through exercising. Particularly important
for the patient is the motivation to continue exer-
cising. Therefore tests that enable patients to
judge their own improvement for themselves are
particularly relevant. With continued practice,
mindfulness and the ability to self-test will be
increasingly refined.