End-Feel

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End-Feel

The end of each motion at each joint is limited from further movement by particular anatomical structures. The type of structure that limits a joint has a characteristic feel, which may be detected by the therapist performing the passive ROM. This feeling, which is experienced by the therapist as resistance, or a barrier to further motion, is called the end-feel

Purpose

A proper evaluation of end feel can help the examiner

• To assess the type of pathology present
• To identify the limiting structures and choose a focused and effective treatment
• Determine a prognosis for the condition
• And learn the severity or stage of the problem
• By determining if the pain or restriction is the main problem, the examiner can determine if a more gentle treatment should be given (pain predominating) or a more vigorous treatment (restriction predominantly).

Developing the ability to determine the type of end feel takes practice and sensitivity. When assessing passive movement, the examiner should apply overpressure at the end of the ROM to determine the quality of end feel ( the sensation the examiner "feels" in the joint as it reaches the end of the ROM ) of each passive movement.

Passive ROM, particularly towards the end of the motion, must be performed slowly and carefully when testing end feel. Secure stabilization of the bone proximal to the joint being tested is critical in preventing multiple joints and structure from moving and interfering with the determination of the end feel

To be sure that severe symptoms are not provoked. If the patient is able to hold a position at the end of the physiological ROM (end range of active movement) without provoking symptoms or if the symptoms ease quickly after returning to the resting position, then the end feel can be tested. Pain with pathological end feel is common ( if the patient has severe pain at the end range, end feel should only be tested with extreme care).

Classification

The most common classification used developed by cyriax, kaltenborn, and paris have described a variety of normal (physiological) and the abnormal (pathological) end feels.

The normal end feels are generally described as

• Hard: This is a "Bone-to-Bone" unyielding sensation that is painless. An example of normal bone -to-bone end feel is elbow extension

• Soft: There is a yielding compression (mushy feel) that stops further movement or gradual increase in resistance as muscle, skin and subcutaneous tissues are compressed between the body parts . Examples are elbow and knee flexion, which movement stopped by compression of the soft tissues, primarily the muscles

• Firm:

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References

Susan B.O'Sullivan, Thomas J. Schmitz, George D. Fulk. Physical Rehabilitation. 6th edition. F. A. Davis Company (2014).

David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier (2014).