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Test, Treat, Retest | Boddicker Performance

Filed under: corrective exercise, Manual Therapy

Test, Treat, Retest

by on Jan 30th, 2011

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Recently I’ve had a few discussions about the frequency of assessment techniques. Depending on the scenario and specific motivations, assessment intervals vary, however, a systematic use of the Test, Treat, Retest principle is essential.

The Test, Treat, Retest model is frequently used in athletic development settings using movement quality screens, strength, power, speed, and other various measures that are taken at specific intervals throughout training to gauge effectiveness. Some look for improvement weekly or monthly, while other organizations and individuals may only retest after a number of months of training.

Likewise, the manual therapy community has long been influenced by individuals like Brian Mulligan, Geoffrey Maitland, James Cyriax, and David Butler who also advocate a Test, Treat, Retest approach both intrasession and intersession.

Test

Treatment becomes streamlined and far more effective following a systematic, global assessment of functional, structural, physiological, and psychological factors that allows you to collect the forest. Your system then must be flexible enough to allow consideration of the hierarchical nature of the issues at hand to allow you to see the forest for the trees, so to speak, and pick the right issue to treat first.

What the hierarchy is depends on your professional opinion and expertise. It could be the hierarchy offered in available assessment systems or one that you determine is unique to the individual. This requires you to hold strongly to your big rocks be they strength, mobility, movement quality, power, or pain.

Treat

Treatment is then commenced. The treatment, of course, is based off of an analysis of needs specific to the individual and his specific sport. Use of something like the Sport Specific Demands Analysis (Gambetta, 2007) can help drive this process in athletic development as can systems like the FMS/SMFA and PCA or any other form of specific assessment.

Retest

Following a period of treatment, you must retest to determine the effectiveness of your treatment for the specific individual. The assessment can be as complete as your initial testing process or only a specific, target variable in your hierarchy.

Determining Ideal Frequency

As I stated earlier, frequency of reassessment can be highly variable and depends a great deal both on practicality and science. Some qualities take longer to develop than others and often deloading to bring an athlete into condition for a test of acute performance is impractical in athletic development.

Bompa, for example, notes that flexibility improves from day to day, strength week to week, speed is month to month and work capacity is developed from year to year. Issurin and Viru note, too, that there are delays to peak of any particular biomotor ability and there are different rates of decay (2008; 1994). Understanding the physiology of each biomotor ability, their interactions, individual variability among athletes in their response to chronic loading and acute relieving syndromes, and the overarching goals of training will help dictate the appropriate time for retest.

Despite this variability in markers of athletic performance, I believe strongly that the duration in manual treatments and movement quality changes can and should be done much more frequently, and benefit can be gained by assessing both during a session and from session to session. In these cases, time is of the essence to either get a person back to training or to clear them for aggressive training and we must be certain that our interventions are providing value. This assessment frequency has been advocated by many big names in the therapy world and at a variety of joints both axial and peripheral and has been supported in the literature.

Research by Hahne and colleagues in 2004, for example, demonstrated that intra-session changes in mobility in multi-segmental flexion, left lateral flexion, SLR, and pain perception was able to determine improvements between sessions with a 95% confidence interval in the majority of the 53 subjects with back pain (2004). In the majority of subjects who experienced intrasession improvements in mobility and pain, they returned with even greater mobility and further decreased pain to the second session. This may be the result of contentedness, hope, and met expectations of individuals going to therapy as 74% of repeat visitors and 46% of first-time clients in therapy expect improvements during the first session or perhaps suggestive of a positive orthotropic response to therapy (Grimmer, 1999; J. Maitland, 2001).

Regardless of your area of expertise and specific goals, measuring progress is essential and should include application of the Test, Treat, Retest principle.

Respectfully,
Carson Boddicker
CB@BoddickerPerformance.com

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Leave a Comment »3 Comments
  • Mike T Nelson February 1, 2011

    Awesome!!!

    I agree! It is so sad to see how many people in the field do NOT to hardly ANY testing! Very scary.

    I agree that we are dealing with a crap ton of variability of nonlinear systems and I often joke that physiology is made of every “bad” engineering word (anisotropic, nonlinear, highly variable, etc)

    I think the goal is to use very simple, easy to use, tests to keep us pointed in the right direction–towards “better” I agree that depending on the quality we are developing, other tests do not need to be done all the time, BUT we should be able to do a simple test to make sure we are on course.

    For example, if I believe that moderate weight moved fast on the back squat will improve the overall linear speed of my football players, I will pick a timed sprint (say 100, 200m). I don’t need to test that every day. I need to test what I think will help each time—fast squats.

    So I hook up a tendo and measure their bar speed to make sure they are moving it fast.

    I would also want a test to tell if they should even squat that day! I could have them try and work up to the same or heavier load each and measure speed, but ideally I would want something that could accurately predict it; thus saving me time.

    After X weeks of my experiment, I have them do another timed run.

    I know this is not perfect as there are tons of variable that can change, but the point is to start testing now .

    Thoughts?

    Rock on
    Mike T Nelson PhD(c)

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