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When a client reports pain, there are some questions you can ask to help find the cause of the pain. These questions can be remembered by the letters of the alphabet, OPPQRST.
O - Onset
What were you doing when the pain first occurred? Often this question in itself will tell you the cause of the pain.
P - Provoke, Palliate
What makes the pain better? What makes it worse? This can give clues to the cause of the pain and can also guide you in your treatment.
Q - Quality
What is the quality of the pain? Is it dull, sharp, burning, aching, throbbing, etc.? Different qualities have different meanings. Dull pain tends to be chronic, sharp pain is more acute. Throbbing pain may be vascular, as in a migraine headache. Burning pain may be from muscle tears or nerve irritation.
R - Radiation
Does the pain travel anywhere from where you feel it most? This can indicate pressure on a nerve root.
S - Severity
Does the pain stop you from any activities?
T - Time
How long does the pain last when you have it? Are there times of the day when it is worse?
When a client reports pain around a joint the pain may be from the muscle or tendon, or it may be from the joint capsule. There are some simple tests to help determine the cause of the pain.
With joint injuries, or with inflammation in the joint or joint capsule (arthritis), any movement that takes the joint through a range of motion will cause pain. This includes passive and active range of motion, but doesn’t include resisted (isometric) testing. Resisted testing will not cause pain because there is no movement in the joint.
Muscle or Tendon Injury
Passive range of motion will not cause pain, as the muscle is not being used. The exception would be if the muscle is being stretched during passive range of motion. Active or resisted movement will cause pain because the muscle is being used.
Muscle and Joint Injury
In some traumatic injuries all tissues will be affected, in which case any testing will cause pain.
This is a general guide to testing. There are more specific tests for each area of the body, testing individual muscles.
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