Diagnosis

  • The diagnostic framework represents a paradigm shift from static structural evaluation to dynamic functional analysis. It is predicated on the axiom that "function prioritizes pain over structure."

    • A. Visual Inspection: The "Concave" Theory

  • FBT practitioners identify concavities (depressions or indentations) on the body surface as critical markers.
  • Clinical Maxim : "Every concavity possesses a clinical history."
  • Significance : These depressions indicate regions where tissue mobility has been compromised due to ECM fibrosis. They are often the "roots" where sensitized nociceptors trigger protective tension elsewhere.
  • Key Landmarks : Critical hubs include the MAA (base of skull/cervical), the UA (upper abdomen), and the L-S (lumbosacral) junction.

    • B. Sensory Examination Protocol

  • To localize latent sensitization not yet perceived as pain, FBT utilizes a stratified manual protocol:
  • Pinpoint Tenderness (PPT) : Sharp instrument assessment for epidermal/dermal sensitization.
  • Skin Stretch Test (SST) : Horizontal traction to identify sensitization specifically within the SAT layer.
  • Pinch & Roll (P&R) : Lifting and rolling skin to detect sensitization extending to deep fascia and Deep Adipose Tissue (DAT).
  • Tenderness (Td) : Deep palpation for muscle layer sensitization.

    • C. Dynamic Evaluation: Passive Stretch Tests (PST)

  • The PST is the cornerstone of diagnosis. The examiner mobilizes joints to their physiological end-range to assess for provoked pain or resistance in distant regions. All passive physical examination tests involving range of motion can be used, but among the key tests used in FBT are:
  • N-F/E (Neck Flexion/Extension) : Identifies sensitized "roots" in the posterior neck (MAA) referring to the lumbar spine.
  • PAT (Passive Abduction Test) : Assesses scapulothoracic mobility; limitations suggest sensitization in the upper trapezius or lateral trunk.
  • TR (Trunk Rotation) : Identifies imbalances in the External Obliques (EOA), often correlated with knee pathology.
  • Patrick’s Test (FABER) : Evaluates pelvic/hip integrity; positive results indicate sensitized inguinal or adductor tissues.

    • D. Documentation

  • Metrics : ROM is quantified in degrees or FB/HB (finger/hand breadth).
  • Positive Signs (+) : Defined as pain triggered anywhere in the body during the movement, not just locally.
  • Diagnostic Analogy : FBT diagnosis is not akin to photographing a parked car; it is analogous to test-driving the car and turning the steering wheel (PST) to identify exactly where the noise originates and which brake is seized.