Biomechanics and musculoskeletal assessment
As part of working in private practice I regularly visit online forums for patients with common conditions – such as plantar fasciitis, Morton’s neuroma and shin splints.
I frequently read statements similar to “my friend said I need a biomechanics assessment” or “you need to go to the musculoskeletal clinic” or “find someone to do a musculoskeletal assessment”.
Great buzz words that sound impressive and potentially complicated – but what do they actually mean? What is involved?
As a professional who does both musculoskeletal and biomechanical assessments I know what they mean to me, but what do they mean to my patients?
Certainly, when your pain is a mystery and it isn’t getting better, you need to see someone who has a special interest and intimate understanding of the form and function of the body. It can sound like there’s some mystical excitement and curiosity about the process but these assessments can provide the answer to your problems.
What is the difference between musculoskeletal and biomechanical?
These are primarily focussed on the diagnosis and treatment of a condition.
Your clinician will identify the region of the body affected and then palpate (manually explore) the structures in that area to see if they can reproduce the pain. Once identified, and depending on the level of pain, they can then test the joints, muscles and tendons supporting it to see how normal function has been affected.
Musculoskeletal assessment typically involves taking a clinical history, clinical assessment with palpation, clinical tests and may utilise diagnostic tests such as imaging, injections and trial interventions.
Conditions that are likely to benefit most from a musculoskeletal assessment are:
- Plantar fasciitis and heel pain
- Morton’s neuroma and metatarsalgia
- Achilles tendinitis
These are more movement focussed and look at the way that your appendage/limb/body moves and functions.
It doesn’t necessarily look for the specific anatomy causing pain but the interaction of your body as a whole, the idea being that more global information can be integrated to identify the mechanical source of your pain.
A biomechanical assessment may involve the use of gait and movement analysis and occasionally force plates and in-shoe pressure analysis (however this is rarely required). Conditions that lend themselves to biomechanical assessments are:
- Shin pain (shin splints)
- Recurrent stress fractures
- Tendon pain when running
- Knee pain
- Hip pain
When is each used?
This is where science and art meet.
Musculoskeletal assessment tends to be used to inform the need for a biomechanical assessment.
The musculoskeletal assessment looks to present a diagnosis for the pain, identify what may be related to and causing that pain, and then to strengthen or offload associated structures reducing pain and promoting healing.
Biomechanical assessment focuses in on the movements of the body and how they might cause pain.
Biomechanical assessment is most effective when one gets the same recurring pain that is not due to lifestyle choices or where the pain that you get is not enough to stop the activities you enjoy (such as running) but is enough to reduce that enjoyment.
What is the outcome of each assessment type?
Well, the outcomes can be quite similar. The recommendation following either assessment can include
- Semi-bespoke or prescribed bespoke orthotics
- Rehabilitative stretches and exercises.
- Footwear advice or modifications
- Prescription medication
- Advice on taping and braces
- Gait re-training.
Does it matter which assessment you book for?
Only if the clinic you go to labels them differently, however the clinician that you see should be able to perform both and direct your appointment as required.
It tends to be that the majority of people have an appointment that combines both, depending on time. This allows for components of each to be used as is necessary.
My advice however would be that starting with an initial consultation with a specialist and then allowing them to guide you in the direction will give you the best results.
About Jeremy Ousey MSc MCPod
Jeremy Ousey is an HCPC registered Podiatrist and CASE qualified sonographer.
Having worked in podiatric surgical units, physiotherapy and multi-disciplinary practices, he takes a multi-faceted and patient-centred approach to care. With a bachelors in Podiatry, postgraduate degrees in podiatric sports medicine and medical ultrasound and a masters in the theory of podiatric surgery he allows evidence to guide his treatment plans.
Jeremy lectures on heel pain, extra-corporeal shockwave therapy, musculoskeletal examination, treatment of the foot and ankle including management of ankle sprains and verruca needling.
His interests are in the surgical management of skin lesions, nail surgery, musculoskeletal and biomechanical evaluation, acute and chronic sports injuries, tendinopathies, diagnostic ultrasound and surgical management of foot and ankle pathology
If you would like any more information or to book an appointment with Jeremy then please call Maidenhead Podiatry & Chiropractic Clinic on 01628 773588 or email firstname.lastname@example.org