Severity

Original Editors - Kris Porter

Top Contributors - Kim Jackson, Kris Porter and Rucha Gadgil  

Use the following categories simply as means to attempt to understand how irritability is gauged. The assimilation of painful special tests will continue to erode the reliability and validity of the biomechanical examination, therefore a gentle and appropriately sequenced examination strategy is critical for accurate data gathering.

High Irritability

Very easy to exacerbate with poor tolerance for tissue loading, perhaps even indirect loading from associated structures. Mechanical examination can be confusing and misleading. This patient’s optimal loading zone has narrowed substantially. Key movements, and relevant activities are limited significantly. Symptoms may come on immediately, or may be severe the next day. The symptoms generally have a lingering component secondary to the chemical involvement at the tissue level. This patient requires tactics that carefully control dosage, generally with education and offloading principles being a cornerstone of early intervention.

To increase the tissue tolerance and optimal loading zone, steroids, NSAIDs, and modalities are generally effective.

Moderate Irritability

This condition is generally easy to exacerbate, but with specific motions and forces at the local tissue level. The symptoms are also more easy to abate and have a clearer mechanical response with less lingering (chemically oriented) symptoms. This patient will respond much faster than the patient with high irritability to mechanical treatment directed at restoring normal mechanics. Therefore, the examination strategy can be more vigorous and the biomechanical examination will reveal more clear information. Often, this patient has a combined mechanical/chemical pain generator but is mechanical dominant and therefore appropriate mechanical protective strategies can effectively reduce symptoms. This patient can still participate in most ADL’s although pain may be experienced during the more challenging ones but can still be completed but with modifications, limitations and/or mild to moderate symptoms.

They may have a partial response to anti-inflammatories and inflammation based treatments, but this will not be the most effective intervention for this patient.

Low Irritability

This patient is difficult to flare up, and it can be completely abated with anti-inflammatories OR mechanical protection. Generally, both strategies are NOT necessary to stabilize and nearly completely reduce symptoms. This patient has minimal functional limitations but may not have returned back to the general populace.

The examination strategy should be aggressive to clear associated structures, and the dosage should be working towards increasing tissue capacity and widening the optimal loading zone through biomechanical intervention.