Discharge Testing: Why I Didn’t Do It (But You Should)

I remember him vividly.

He was a cantankerous old farmer. You know the type. Rough and rugged exterior but would do anything for anyone at the drop of a hat. At 72, he was still working on the farm daily.

He’d had a total hip replacement (THR) and was resistant to physical therapy from the beginning. In spite of this, we’d developed a good relationship, and he progressed well. As we got closer to his regular work activities, I knew what should come next. But even though I knew what I needed to do, I couldn’t bring myself to do it.

It was time for his discharge testing.

I had been using the Selective Functional Movement Assessment (SFMA) throughout his rehabilitation, and his top tier was completely pain-free with the only dysfunctional pattern being his squat. He now needed a Functional Movement Screen and Y Balance Test. But I didn’t want to do it.

I have spent my career trying to inspire rehabilitation providers to complete systematic and rigorous discharge testing on their patients. I feel that this is how we improve rehabilitation and impact the lives of the people we treat. Yet this particular time, I was having trouble doing the very thing I champion.

Discharge Testing Avoidance

I am not the only one who didn’t perform adequate discharge testing. I was one of the researchers in a study of 469 soldiers who were injured and then missed time due to that injury. Once they were released to return to full duty, we tested them. We tested them on everything from simple movement patterns of the top tier movements of the SFMA to hop testing and 75 percent body weight carries. We then followed the soldiers for a year to see who got injured and used the data to develop the tests and standards for safe return to duty. While I believe the final results of this study will be impactful, the research team was stunned by some of our initial analyses.

When performing the simple movements of the top tier SFMA, 43 percent of soldiers had pain with at least one movement.

Let me say that again: Almost half of the soldiers who returned to duty had pain from simply turning their head, moving their shoulders, touching their toes, bending backward, or squatting.

Something is very wrong with this picture!

This problem of not testing at discharge is not limited to the military. Just in the past month, I have seen athletes who had ACL reconstructions, meniscectomies, and ankle sprains that were still lacking everything from simple ankle dorsiflexion ROM and bodyweight squatting ability through higher level hop testing. When asked about return-to-sport or discharge testing, they all said their physician, athletic trainer, or physical therapist performed minimal to no testing.

We can do better.

Why Aren’t We Testing?

All of this has caused me to reflect on why I didn’t do discharge testing. It turns out that three main issues were holding me back. READ THE ENTIRE ARTICLE HERE