Practical part (Structural diagnosis of mechanical dysfunction):

Mechanical dysfunction in humans refers to abnormalities or impairments in the mechanical

functioning of the musculoskeletal system, which includes the bones, muscles, tendons,
ligaments, joints, and related structures. These dysfunctions can lead to pain, reduced
mobility, and functional limitations. The structural diagnosis of mechanical dysfunction

in humans involves the assessment and identification of physical and anatomical

abnormalities or issues within the musculoskeletal system.

I- Screening examination:
1- Gait analysis: Observe the functional capacity of gait: The length of stride, heel
strike, toe off, pelvis tilt, arm swing, and adaptation of shoulder.
2- Static postural analysis: The practitioner visually assesses the individual's posture
from different angles, typically including front, side, and back views. The patient should be
standing in a relaxed, upright position with minimal clothing to allow for a clear view of their
body:
• Alignment of key landmarks: the ears, shoulders, hips, knees, and ankles. These
points are compared to each other to identify any misalignments or deviations.
• Symmetry: Are the shoulders level? Are the hips at the same height? Is there an
equal weight distribution between the left and right sides of the body?

• Spinal curves: This includes assessing the cervical (neck), thoracic (mid-back),
and lumbar (lower back) regions of the spine. Abnormalities such as excessive kyphosis
(rounding of the upper back) or lordosis (exaggerated inward curve of the lower back) may
be noted.
• Pelvic tilt and rotation: The position of the pelvis is assessed in terms of tilt
(anterior or posterior) and rotation (left or right).
• Lower extremities: The practitioner examines the alignment of the knees, legs,
and feet. Common issues include genu valgum (knockknees) or genu varum (bowlegs),
pronation or supination of the feet, and other lower limb deviations.
• Head and neck position: The position of the head in relation to the neck and
shoulders is assessed.
» After that, the practitioner does a combined palpation and observation for the
anatomic level: e.g. level of acromion process, iliac crest, and grater trochanter on
both sides.
3- Functional observations (Dynamic screening): Ask the patient to perform
specific movements or tasks to assess how their posture affects functional activities:
Trunk mobility (trunck side pending (from sitting and standing), rotation, flexion from
standing, head & mobility (neck flexion, extension, rotation , and side bending), arm

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 raise, lower limb movement as straight leg raise, and squatting. Report any pain or
discomfort, functional limitation, or compensatory strategy.
N.B: It is important if the patient cannot do the motion active then passive, then
passive accessory (e.g. gliding) to figure out if the limitation is from muscle, ligament
or joint issues.
4- Breathing and rib cage position: The individual's ability to take a full breath and
the position of the rib cage are assessed. Breathing patterns can be influenced by
posture.

2- Segmental definition: This approach involves focusing on individual spinal segments or

joint levels to identify and address dysfunction or pathology. During a segmental
assessment, the healthcare provider examines each spinal segment or joint level
individually. They assess factors such as range of motion, joint mobility, muscle tone, and
any signs of dysfunction or pathology. The goal is to pinpoint the specific area where a
problem or restriction exists.

Soft tissue layer palpation

Palpation of soft tissue layers involves using the hands to feel and evaluate various
soft tissue layers in the body, including muscles, fascia, tendons, ligaments, and other
connective tissues. It is a valuable diagnostic and therapeutic tool for assessing
musculoskeletal conditions, identifying areas of dysfunction, and guiding appropriate
treatment interventions. It requires skill, experience, and a thorough understanding of
anatomy and physiology.
Here's how soft tissue layer palpation is typically performed:
Patient positioning: The patient is usually positioned in a way that allows the
practitioner easy access to the area being assessed. This might involve lying on a
treatment table, sitting, or standing, depending on the location of the soft tissue being
examined.
Examination and observation: Before palpation begins, the practitioner often visually
inspects the area to look for any visible signs of swelling, bruising, skin discoloration, or
abnormalities that may provide initial clues about the condition.
Gentle palpation: The practitioner begins with gentle palpation, using the fingertips or the
palm of the hand to lightly explore the surface of the skin and underlying soft tissues. This
initial contact helps identify areas of tenderness or changes in tissue texture.

Layer-by-layer assessment: The examination typically progresses through the various

soft tissue layers:
1. Skin: The outermost layer is assessed for temperature, moisture, and
texture. The qualities of the skin, its roughness, etc. are assessed by slowly stroking
the skin systematically with flattened hands. The consistency of tissue can be
assessed by using displacement tests, the lifting test, and skin rolling test.
 2. Subcutaneous tissue: This layer contains fat and connective tissue
(fascia). Gently increase the pressure until you sense the deep fascia. Normally it is
smooth, firm, and contiguous. Palpation can detect areas of swelling, edema,
restrictions, areas of tightness, or excessive subcutaneous fat.
3. Muscles: Increase your pressure gently to reach the muscle and move your
hands transversally and longitudinally. The practitioner evaluates muscle tone,
tenderness, and any areas of muscle spasm or tightness. Muscle palpation can
help identify trigger points or knots within the muscle.
4. Tendons: Slowly course down the muscle until you feel changes in the tissue
so you will reach the musculo-tendinous junction and move little bit you will feel the
tendon (normally it is smooth, rounded, and firm). These structures are assessed for
integrity, pain, and any signs of inflammation or damage.
5. Ligaments and bone.

Reproduction of symptoms: The practitioner may use palpation techniques to

reproduce the patient's symptoms. If a specific movement or pressure reproduces the
patient's pain, it can help pinpoint the source of the problem.
Treatment: Depending on the findings, the practitioner may use various manual
therapy techniques, such as massage, stretching, myofascial release, or joint
mobilization, to address soft tissue restrictions, improve circulation, and alleviate pain or
dysfunction.