How to detect false positive resisted tests?

False Positive Functional Tests Against Resistance in Musculoskeletal Examination

Functional tests against resistance are widely used in musculoskeletal (MSK) assessments to identify pain-generating structures—especially tendons, muscles, and joint-related tissues. However, these tests are not without limitations. False positives, where a test provokes symptoms unrelated to the target structure, are a common clinical challenge and can lead to misdiagnosis or unnecessary interventions.

Common Causes of False Positives

1. Poor Patient Positioning or Technique
   • If the patient is not properly stabilized, other muscles may compensate or overload, creating discomfort not due to the intended structure.
     
     
2. Referred Pain
   • Cervical spine or neural tissue irritation can cause pain in distal areas (e.g., arm or shoulder) during resistance tests, even when the local tissues are healthy.
   • A resisted wrist extension test might provoke forearm pain in a patient with cervical radiculopathy, mimicking lateral epicondylitis.
     
     
3. Over-Sensitivity or Central Sensitization
   • Patients with chronic pain or heightened central sensitivity may experience pain during minimal resistance due to altered pain processing, rather than local tissue damage.
     
     
4. Co-contraction or Anticipatory Guarding
   • In patients fearful of movement or pain, protective muscle co-contraction may lead to a painful response that is not reflective of tissue pathology.
     
     
5. Fatigue or Overuse
   • In athletic or post-rehabilitation patients, mild discomfort during resistance testing might simply reflect recent overuse or fatigue, rather than injury.
     
     

Clinical Implications

• Context Matters: A single positive resistance test should not be used in isolation. Always interpret it in the context of patient history, symptom pattern, and other clinical findings.
• Compare Sides: Testing the unaffected side helps distinguish between expected effort-related discomfort and abnormal pain.
• Use Complementary Tests: Combine resistance testing with passive range-of-motion, palpation, and neurodynamic assessments to clarify the source of symptoms.
  
  

Conclusion

False positives in resistance-based functional tests are a common but manageable issue in MSK examination. By recognizing their causes and interpreting them in clinical context, practitioners can avoid diagnostic errors and tailor more accurate, patient-centered treatment strategies.