Introduction and Concept of a Holistic Approach

■ Although there are dozens of books on physical assessment in orthopaedics, very few in fact tell the reader about the real "train of thought" that must go through the mind of the clinician when the patient comes for rehabilitation. Traditional books concentrate mainly on a cook-book type of regional approach to our skeletal system that has been taught for generations

■ But we all know that our body does not work this way!

■ Two of the chief functions of our musculoskeletal system are maintenance of posture and mobility. The body is not going to achieve this by seeing itself divided into isolated small regions as depicted in textbooks

■ Our musculoskeletal system is controlled by a central nervous system (CNS) that controls not only muscle tone and sequence of firing, but also patterns of muscle firing

■ The traditional way of teaching a regional approach works for medical students sitting for an examination. But it is less useful in real life. I prefer the "holistic approach" to physical assessment, which is much more appropriate

■ In this chapter, we will first talk about principles, then three very common case scenarios for illustration follow. The answers to the cases are not given in point form, but in essay format to highlight the "train of thought". The author hopes the reader will excuse him for doing this

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