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.
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.
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.
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.