During the active movement examination, request the patient to move the joint under investigation in various directions. It should take place without manual support from the examiner. If necessary, the examiner can demonstrate the movements. These movements should be performed with the left and right side at the same time.
Tell the patient to avoid making compensatory movements. If a movement is limited, a patient will often try to camouflage this by moving other joints at the same time. Encourage the patient when they are attempting these movements. The maximum range of motion is often greater after encouragement than the spontaneous range of motion in the absence of encouragement. Possible reasons for this are fear of pain, loss of kinaesthesia due to a prolonged period of inactivity, or aggravation of the complaint.
Pay attention to the space around the patient. This should be large enough to ensure that each movement can be made without hindrance.
The following aspects should be noted during this examination:
- The maximum range of motion (to be measured/estimated in degrees from the neutral anatomical position).
- Pain – is there pain in the final position or is there a painful arc/painful movement phase, prior to and followed by a painless movement phase, or is the entire range of motion painful? (Offer regular enquiries into the nature, localisation and possible radiation of pain).
- The willingness to move (due to the pain symptoms).
- How the movement proceeds (suppleness).
- Compensatory movements.
- Occurrence of crepitations, crunching, cracking sounds (discoid menisci, snapping hip).
- Left/right differences.
All anatomical structures part of the musculoskeletal system, can cause complaints during active movement tests if they are damaged. Therefore, the active movement examination indicates in which direction the cause of the complaint must be sought and not which structure is damaged.
If no abnormal findings are made in a certain direction of movement, it is not necessary to test that direction of movement during the passive movement examination. The same applies to the isometric muscle tests. However, the following situations form an exception to this rule:
- If hypermobility is suspected, the passive examination will provide extra information.
- If a minor muscle/tendon lesion is suspected, which did not cause any symptoms during active treatment (mild tendonitis), the muscle tests and the passive movement examination can provide additional information.