Mild, Moderate or Severe?

Hi guys, hope everyone’s placements are going well.

I did my second placement in musculoskeletal outpatients. Of all the areas in physiotherapy, musculoskeletal is the one I find most interesting, and at the moment is the area I would like to work in once graduated. It seems that the general consensus amongst the fourth years is that the musculoskeletal practical is the most daunting due to the large amount of knowledge required, and hence the large amount of study prior (+++).

I was lucky enough to have musculoskeletal as my three week practical in third year and as a result had less difficulty than those who were being exposed to it for the first time. However, I did find I had some difficulty when it came to PPIVMS and PAIVMS. You may recall (or not?) from Musculoskeletal Science 351 that when it came to recording the findings of your PPIVMS and PAIVMS assessment that we were taught to record it as normal, hypomobile or hypermobile. At the Curtin Clinic on campus, stiffness (hypomobility) at a segment is graded and recorded as mild, moderate or severe (denoted by one, two or three horizontal lines). I personally liked this method of recording as it can help guide your treatment in those who have widespread stiffness by allowing you to select one or two segments that may be stiffer than the rest. However, I was continually finding that whenever my supervisor checked my PPIVMS and PAIVMS, her opinion of the grade of stiffness was different to mine. Because of this I found myself re-assessing each segment numerous times in order to get my grading correct, and probably seemed incompetent and lacking confidence to the patient in the process. I became disheartened (sniff sniff) by this until another student pointed out to me that the grading was subjective, and even if you were to have 100 physiotherapists assess the same person, while the general findings may be the same, their opinions of the grade may vary. From that point on I was much more confident in my assessment of PPIVMS and PAIVMS, and my assessment was much more efficient.

So for those who are currently on their musculoskeletal placement, or those who have theirs next semester and are asked to record in the same way, it may help to bear in mind that the grading is subjective, so don’t get too caught up in this! It is more important that you are able to recognise normal vs. hypomobile vs. hypermobile. Generally, if a segment/s is stiffer than others it is obvious.

Have a good week…