From the Research
Yes, resisted strength testing is a valuable clinical tool for differentiating between bone, joint, tendon, and muscle pain. When a healthcare provider applies resistance to a specific movement and evaluates both strength and pain response, they can gather important diagnostic information. Muscle pain typically worsens when the affected muscle contracts against resistance, while bone pain usually remains constant regardless of muscle activity. Joint pain often increases with passive movement rather than resistance testing. Tendon problems are particularly revealing during resistance testing, as they typically cause pain when the associated muscle contracts against resistance, especially at the tendon's attachment site. This assessment works because each structure responds differently to mechanical stress - tendons transfer muscle force to bone, muscles generate force, joints permit movement between bones, and bones provide structural support. For example, if wrist extension against resistance causes pain at the lateral elbow, this suggests tennis elbow (lateral epicondylitis), a tendon problem. This simple clinical test requires no special equipment and can immediately guide treatment decisions and further diagnostic testing, as supported by the principles outlined in 1.
Key Points to Consider
- Muscle pain worsens with resisted movement
- Bone pain remains constant regardless of muscle activity
- Joint pain increases with passive movement
- Tendon problems cause pain with resisted movement, especially at the attachment site
- Each structure responds differently to mechanical stress, allowing for differentiation between bone, joint, tendon, and muscle pain
Clinical Application
Resisted strength testing can be used to guide treatment decisions and further diagnostic testing. For instance, if a patient presents with elbow pain, resisted wrist extension can help determine if the pain is related to a tendon problem, such as tennis elbow. This information can then be used to inform treatment decisions, such as physical therapy or further imaging studies, as discussed in 2.
Limitations and Future Directions
While resisted strength testing is a valuable clinical tool, it is not without limitations. Further research is needed to fully understand the diagnostic accuracy and reliability of this test, as well as its application in different clinical contexts, as noted in 3 and 4. However, based on the current evidence, resisted strength testing is a useful diagnostic tool for differentiating between bone, joint, tendon, and muscle pain, and should be considered a part of a comprehensive clinical evaluation, as supported by the principles outlined in 1 and 2.