This is something that I am always thinking about in the clinic. It arose again today when I was assessing a shoulder injury…functional assessment versus non-functional assessment. The simple answer is probably that both are essential in a good assessment, but there is far more to it than that.
There are bound to be times when the bias will be one way or the other. For example, if it is an overuse type injury, where it is predominently a movement dysfunction cause I would favor the functional assessment and would spend more time on this as the more traditional orthopaedic assessment would probably no yield much information about the root cause of the injury, however, it is helpful in the diagnosis of the injured tissue. In contrast to this, I would be far more inclined to start with the traditional assessment in an acute/traumatic injury scenario as it would give me the essential information about the injured tissue and therefore play a major role in the treatment plan.
I guess because of my background I am more comfortable with the functional assessment, I can see where the limitations are and go for the root cause in a movement dysfunction scenario. This probably leaves me less adept at the more traditional assessment, something I will be rectifying…as long as I stick to my CPD plan.
As I described in the above examples, the bias of traditional and functional assessment probably rests in the type of patient you have infront of you. However, one of the advantages I see in the functional assessment is that it is more useful as an ongoing tool throughout the treatment. As described in Functional Therapy you are able to work elsewhere in the body with injury to help the injured tissue, this is something that is more tricky with the orthopaedic tests as they only give you local tissue/joint information and not a picture of the person as a whole. Therefore, even with acute/traumatic injuries a good functional assessment will help you see where the restrictions in proximal and distal joint are and allow you to work on them. This is very useful when you are unable to work directly with an injury.
Where a functional assessment may fall down is in the precise diagnosis of an injury as they are unlikely to be accurate/sensitive enough to identify the injured tissue as there will simply be too much going on to isolate the area.
For the example I saw in the clinic today was a classic because you need to find out exactly what is injured, is it muscular, articular etc. Particularly in the shoulder this is more complex than at many other joints because of its structure and function. It is one of the most mobile joints in the body and therefore relies more on muscular stability rather than the bony stability. Also, the testing of the shoulder is relatively tricky because of the low reliability and sensitivity of the tests.
In this type of case it often comes back to the onset of the injury, traumatic or gradual. however, after the diagnosis the functional assessment really comes into its own whether it was an over-use or traumatic injury.