Why We Do A Systems Review


Most people don’t know what to expect from their first physical therapy evaluation. They may wonder: Will it just be a bunch of questions? Will I have to exercise? What am I supposed to wear?

The truth is that it differs. However, there is something that most, if not all, initial evaluations, no matter the health care profession, include a subjective history and an objective analysis of your body.

The subjective analysis of a patient involves a thorough line of questioning about the condition that brought them in to therapy. The clinician will then look at how the patient’s body moves while afflicted by the condition and take measurements. From there, a systems review is performed, taking into consideration both the subjective and objective parts of the initial assessment.

Typically, some specific questions are asked in order to assess the likelihood that the pain is coming from a non-musculoskeletal source or to determine if there is an additional, unknown, condition.

For example, a patient with neck pain may complain of stiffness. While this is often associated with osteoarthritis, it can also be associated with vertebrobasilar insufficiency (VBI), a vascular issue that affects the blood flow to the brain. Should it go undiagnosed, the patient would be at risk for a stroke. In order to help rule out these sorts of issues, we ask specific questions about the pattern of the pain or any other odd symptoms.

Additionally, we try and use some objective measures to assess the patient’s odds of having an undiagnosed condition. Going back to the VBI example, history of symptoms is the most important aspect, but taking heart rate and blood pressure measures can help as well. For other conditions, we may do some special analyses or test for anomalies.

It is essential that all health care practitioners, including physical therapists, perform a systems review. Due to the variety of presentations a condition can have and how similar two completely different issues can appear, we must perform regular screenings of each body system.

So how does this affect you? Do not be surprised if your therapist asks questions that may seem unrelated to the condition you’re visiting for. Often, there are connections between the systems that can be correlated; the heart can refer pain to the left shoulder, the kidney to the lower back, the thyroid to the neck, etc. There are many different referral patterns for each organ, so make sure you notify your physical therapist of any symptoms you are experiencing. They may not be as unrelated as they appear.

At Foothills Sports Medicine, our goal is to get you back to doing the things that you love. For a free injury assessment with on of our highly trained physical therapists, fill out our appointment request form!


Chris Fox

PT, DPT | North Scottsdale Location