Dynamic Movement Screening
A functional guide to
observing and assessing movement
Contents
www.physical-solutions.co.uk
Table of Contents
Introduction
p3
Interpreting Movement
p5
Screening Classifications
p7
Posture Evaluation
p11
Gait Analysis
p15
The Dynamic Movement Screens
p18
General Screening Analysis
p37
Specific Screening Analysis
p39
Linking Findings Together
p56
The Next Step
p57
Physical Solutions Screening Form
p58
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Screening Functional Movement Patterns
Introduction
Historically, when evaluating a client beyond the cursory glance at their static posture
and gait, most objective measurements have been based on single plane isolated
movements. How far can you flex the shoulder? Can you touch your toes? Flexibility
and strength assessment was performed on an examination couch usually with an
attempt to isolate the muscle. Although useful, given that fundamentally the body knows
nothing of muscles but only movement patterns, the information gained may not always
tell the full picture.
At the other end of the spectrum, attempting to analyze a person while they are in
“sports motion” or a physical “skills” activity is a very difficult and complex task. This sort
of assessment understandably tends to be over-simplified and carried out and recorded
in terms of quantitative performance. What is your best time? What is your best
distance? What is your best score?
An alternative and complimentary approach to traditional assessment lies in breaking
down and observing movement in common patterns that are fundamental to life. We
can become familiar with observing and testing movement in this way and we are better
able to appreciate the asymmetries and imbalances that may exist and contribute to the
development of poor performance and chronic overuse injuries. These movement
patterns reflect the way the body truly functions in life in relation to gravity, ground
reaction forces and momentum. They are “foundation” or “primary” movements. Not
only are the joints and muscles working as a continuous system but they are controlled
by the neuromuscular system to ensure kinetic chain integration…it can sound complex
but in simplistic terms this is all that they were designed to do. Therefore a single leg
squat test tells us much more about the ability of the hip abductor's true functional ability
than a side lying, resisted hip abduction, graded 1-5 ever would.
In reality a movement screen could be any functional exercise or a component of a
functional exercise. While appearing daunting at first, once you have mastered using
the basic movement screens the options open to you are endless and allow you to
break down movement, identify the dysfunction and apply an appropriate exercise or
rehab strategy. You will also have a quick FUNCTIONAL test available to monitor your
chosen intervention’s progress.
The tests will be graded by the comparison between the left and right sides and the
ability to perform the entire movement successfully. An appreciation of the quality and
control of the movement will also be noted.
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Ultimately, by testing with purpose and with an aim to form a strategy to improve
movement quality, you can expect to not only decrease injuries but improve the base of
flexibility and stability upon which strength and power can be built to improve
performance.
What follows is a simple battery of tests that are designed to give the assessor a clear
impression of the functional movement qualities of their client. They are designed to
highlight both strengths and weaknesses within the kinetic chain and to reveal potential
faults and compensations.
The tests are:
• Easily reproducible
• Need minimal equipment
• Based on primal foundation movement sequences
• Applicable to all age groups and levels of fitness/ability
Variations of the tests outlined are already in use within the rehab and fitness industry
and it is clear that movement screening will become commonplace within these fields. A
great deal of credit needs to be given to innovative corrective exercise professionals
such as Gray Cook and Gary Gray who have taken an understanding of movement
screening to new levels.
What am I looking for?
Our approach to screening is all about asking and answering physical questions via
movement:
• Can they hold the start position? Can they make the finish position? How do they
make these transitions? What is their strategy?
• Have they the flexibility to make the shape?
• Have they the stability to get there?
• Do they show the correct timing of the movement sequence and can they
reproduce this?
• Are areas of regional inflexibility exposed by the movement demand?
• Are areas of regional weakness exposed by the movement demand?
• Do we see compensations elsewhere in the movement sequence due to these
faults?
• Do we see static postural observations revealing dynamic movement
consequences?
• And perhaps, above all, are these findings symmetrical or asymmetrical?
Straight away you may be thinking this seems a long list and a big call…how can this
process be made more accessible?
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How do I interpret the movements?
Answer these questions with exactly what you see and not what you assume you will
see.
• When performing the screen give a minimal demonstration and use minimal
language…don’t dictate how they should move, observe how they do move.
• Stand back and observe the global movement first. Get a feel for how the whole
kinetic chain is working and the sequence and timing it uses to achieve the
movement.
• Think in terms of movement success, failure and quality as well as expected
range.
• Does the gross movement start and end from a position of stability?
• Am I seeing comparable symmetry between left and right and upper and lower?
With any gross movement the whole is the sum of many parts. Hence screening can be
a remarkably accurate tool but it is not an exact quantitative science. We are not taking
precise goniometric measurements and we are not comparing isometric and
myographic readings. But we are making quality observations.
The big picture is made up of individual scenes.
Stand back, look at the whole movement and get comfortable with trusting what you
see. Think in terms of movement and think in your own language…
• “The left side seems to struggle with the pattern”
• “The whole leg seems out of synch”
• “That looks wooden from the hips up”
• “That looks so smooth and easy”
• “Something just isn’t right”
The last one is the big one and it’s the one that functional therapists, trainers and
educators have been chewing over for years! You want to find out exactly what that
something is…and usually quick.
Sit back first and pat yourself on the back because you’ve recognized and recorded that
something isn’t right…you’ve already got further than most in terms of true functional
assessment. Don’t dive into the temptation to over analyze the movement screen that
revealed this to you but carry on with the sequence of screens that you are comfortable
with. The “something” will be revealed, proved or disproved with this more expansive
approach. Repeating and revisiting screens you have already done may help you with
this process.
With experience in watching other people screen and doing your own screening with
clients and colleagues, you will get a sense of what a full range and correctly performed
individual screening movement looks like. You will develop an understanding of the
benchmark shapes and capabilities and deviations away from this benchmark will be
easier to recognize. Guidelines to help you will follow in this article.
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You already have a powerful tool in your understanding of recognizing movement
dysfunction. If, for example, the squat just doesn’t look right and your history taking and
knowledge of the client’s physical health leaves you with no concerns, then you may
proceed with a squat facilitation program based around corrective exercises with
confidence (Gray Cook has done some excellent work in this area). If you perceive
weaknesses in other more “global” issues such as balance, stability, timing or just plain
lunges etc, then again you have some great places to start building your functionspecific training program safe in the knowledge that you are addressing client-specific
needs. The screening movements themselves are stand-alone tests of primary
movement pattern ability or what can be termed foundation movements. If a client does
not show us great ability at these foundation movements, then they are already starting
from a point of disadvantage.
You can ask and answer a simple question such as “Can they perform the movement?”
You can ask and interpret a much more difficult question such as “How do they perform
the movement?”
Your initial findings may be in “generalist” but very useful terms. If we take the specific
components mentioned before, stability, flexibility, balance and strength, you will start to
see familiar presentations emerge. The following table is included only as a guide to
help you with these observations and the “classification” examples are Physical
Solutions' way of giving this simple recording structure. They are not definitive!!!
The dominant movement characteristics seen
when performing dynamic movement screens
Large range-of-movement, loose but not fluent.
Occasional loss of balance, screens not
performed reliably with same ranges or
symmetry. Loss of trunk control at end-ranges.
Sacrificing stability for mobility (flexibility).
Large range-of-movement, loose, rhythmical,
well-timed. No loss of balance, screens
symmetrical and reproducible. Good trunk
mobility and control at end-ranges. Efficient
stability and mobility (flexibility).
Poor range but can maintain balance within this
range. Wooden, not expansive patterns. Fixed
trunk postures, screens reproducible. Excessive
limb movement at end-range. Great sagital ability
but poor performance if transverse plane
(rotation) is enforced. Rigid and un-functional
stability at the expense of mobility.
Movement patterns are “shutdown” and unexpansive. Protective, poor range and frequent
loss of balance. Avoids end-range. Poor
movement “excursion”. Slow tempo. Poor
flexibility and poor stability.
Classification
Flexi-unstable
Flexi-stable
Stabi-inflexible
Unflexstable
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Clearly we would like to see our athletes and clients screen “Flexi-stable” and on the
other end of the scale the screening process actually gives you an opportunity to see
how the “Unflexstable” client starts from a position of major disadvantage. The
classifications can also give us some insight into movement dysfunction when we crossreference them with balance and “strength”.
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Employ a balance challenge such as the Single Leg Wall Touch or Balance
Reach to a Flexi-unstable and you may see end-range failure…they can get to
an impressively flexible end-range but they can’t “bring it back home” and
recover it reliably. At end-range (point of transformation) the movement chain will
give the impression that it progressively collapses or cannot re-gird itself.
The Stabi-inflexible is also in trouble at the end-range of his balance tests but
for different reasons. He doesn’t have the range of the flexi-unstable and he
comes to a more abrupt failure at his end-range. He literally “falls off” the
movement screen as his foot is pulled off the stance position by pushing past his
flexibility barrier (the movement failure is often seen distally at the
foot/ankle)…he has no where else to go without pulling himself outside his base
of support and outside it’s recoverable axis.
The Unflexstable approaches balance with a protective strategy. He shuts down
in both range and speed and tends to move in a piecemeal or “staccato” fashion
with poor timing. The movement screen fails early with a predictive or almost
“pre-prepared” dab of the free foot/hand.
The Flexi-stable “gets there and comes back”. His screens have great range
and timing and if they can improve they do so quickly with repetition.
Functional strength is difficult to quantify but possible to observe, especially when crossreferenced with the flexibility/stability classifications.
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The Flexi-unstable may show great muscle strength tests on the examination
couch and isotonic installation, especially of the peripheral groups…quads,
hams, lats etc. Their central instability and availability of “unstable” range betray
this potential strength as the movement screen collapses or fails from proximal to
distal. This is best seen in the lunges and squats as the movement begins to fail
at mid-range. Observe it as a past half-way instability failure down into what
would be an impressive range.
The Stabi-inflexible is often a strong/athlete in every sense. Their problems lie
in expression of their available strength. They lift the weights, they can super set
the reps but they can’t transfer this into performance. Their times, distances and
scores are disappointing. They do not reach a clearly obvious potential. The
dynamic movement screens reveal this as a mechanical restriction of available
force/strength. The squat is restricted, cannot be fully loaded and is unreliable at
its disappointing end-range…they are down on their standing jump test and get
beaten in the air at football!!
The Unflexstable submits to gravity. Total body pronation may dominate what
lunge and squat range they have. They will try and assist with compensations
and trick movements such as hands on knees with lunges, sagital weight shifts in
squats and increasing their base size unnecessarily.
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•
The Flexi-stable, if conditioned and trained well, is totally in control of their own
body weight, mass and momentum. Timing and range of lunges and squats are
reliably reproducible. The point of transformation in screens is easily recovered
and reversed. Their strength is unrestricted in its physical expression.
The above classifications are a convenient way to clarify what you are observing as you
interpret movement screens as a whole. However, an even deeper understanding of
movement characteristics is possible.
Going into more depth
It’s relatively easy to see the big picture but it can seem harder to break it down further.
Any gross movement is a sequence of individual contributing regional movements
meshed together with perfect range, timing, force and control…something commonly
termed the “kinetic chain” performing at its coordinated optimum. It is possible to use
the movement screens to assess how these individual segments of movement perform
in a dynamic sense as opposed to standard isolated muscle group/joint length-tension
and strength testing. From studying the screens and experience you will get a feeling of
what should happen at a segmental level and from screening your client you will see
what actually happens. Your attention is now brought to individual body segments,
joints and even muscle groups as you observe them performing their role within the total
movement screen. Are they contributing to the movement’s success or failure?
This is one of the most contentious issues within movement screening studies. Some
may argue that it is not possible to accurately interpret regional movement with dynamic
screening at all. Some almost see this skill as an art form as they interpret the subtle
nuances of a movement as a critic analyzes a masterpiece. At Physical Solutions we
follow what is primarily a very conventional approach. Read around the literature, study
the work of the trailblazers in this field, go to the lectures and then screen a few
thousand people and you will notice something….patterns of dysfunction.
The body is a remarkable machine but sadly no more remarkable than your modern
automobile in terms of unreliability. The early Rover K series engine was known for
blowing head-gaskets. It was a great engine but it just blew them. Bad news for owners
but great news for mechanics because they know where to look first when one comes
spluttering into the garage. The body also has its favored weaknesses and faults…they
may have developed for different reasons but they are the same faults. By example,
tight external hip rotators may have been caused by hours of clerical posture or hours of
poor sprint training…two vastly different causes but exactly the same effect. The late
Vladimir Janda’s studies of muscle imbalances recognized distinct anatomical regional
syndromes of dysfunction highlighting the classic “length-tension”, inhibition and over
activity patterns around the pelvic girdle and the shoulder girdles. It is not within the
scope of this text to take on this huge topic but generally accepted examples can be
seen throughout the body and come in distinct patterns such as:
•
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Tight and over active agonists inhibit their sister antagonists.
Inefficient proximal stabilizers fail to support their distal “effectors”.
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A lack of range in one segment will cause a compensation in another.
You lose what you don’t use…regional weakness, loss of transverse plane
stability.
You abuse what you overuse…pattern overload and plane dominance.
Stability, flexibility, balance and strength are interdependent upon each other. A
fault in one will be at the cost of another.
The individual movement screens highlight different kinetic chain segmental
contributions and possible dysfunctions. In many, if not most of the cases that you
recognize, the screening movement is clearly faulty and there will be regional
dysfunctions that follow the probable patterns listed above. Things are beginning to slot
together now.
We almost come to a cross-roads at this stage of summarizing approaches to
movement screening:
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Do we go for a global movement “can they do it, can’t they do it” approach to our
screening procedure? This effectively “pass or fail” system gives us clear
parameters to act upon and its very strength is its simplicity.
•
Or do we delve deeper into the nature and quality of each of the movement
screens and take on the challenge of interpreting the wealth of information that
they can provide? It is difficult to make this decision without understanding the
challenge.
Interpreting the results
If you are new to dynamic movement screening a good strategy is to perform a test and
simply make notes on the following observations
Observations
• Note the overall quality of movement from in front, side-on and behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending or one direction to
the other direction.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening at the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
At this stage do not attempt to interpret the results; subsequent tests may confirm or
disprove an imbalance in a particular region. When you have built up an overall picture
from a variety of tests sit down and compare the notes and observations. These will
invariable show the same problems continually resurface i.e. the head is protracted with
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the squat and lunge, the right hip cannot extend with an anterior lunge or single leg
overhead reach, there is poor trunk stability on inline lunge and step over chair.
The more tests you use the more you will begin to see the client’s chosen movement
strategy. If one or two areas are continually a problem, then fundamentally, these areas
are worth tackling first with your corrective exercise strategy. It is quite likely that you
will have identified familiar patterns of dysfunction. Various experts in the field have
named and commented on these dysfunctions. Gary Gray uses the term ‘big rocks’ for
these classic findings and, for example, one of his quotes is ‘if in doubt get the hips out’
as he muses on the common patterns found in the lumbo-pelvic complex. Vladimir
Janda fired up the muscle imbalance field with his recognition of upper crossed, lower
crossed and layer postural imbalances. Your corrective strategy can then be quickly reassessed for success by repeating the screens.
We believe this approach is ultimately more effective at understanding movement
dysfunctions than simply following a “cookbook” approach i.e. ‘the knee deviates in
therefore strengthen the glut med’.
At Physical Solutions, when asking our clients to perform movement screens, we follow
a procedure of describing the movement with minimum cueing and also a purposefully
basic demonstration. Initially we are trying to ascertain what the client’s chosen
movement strategy is. If necessary we will then add more basic prompts to guide the
client towards the correct movement. We do not want to dictate to them how to perform
the movement as we are trying to assess how they would truly utilize this movement
within their own functional parameters.
If any screen produces pain or reproduces painful symptoms, other than endrange discomfort, then consider the screen to have failed and take appropriate
referral measures if indicated.
We have purposefully repeated a basic method of movement observation as it becomes
good practice to adopt a methodical approach that can become almost second nature
after repeating many client screens. HOWEVER, ALL DYNAMIC MOVEMENT
SCREENING IS UNDERPINNED BY:
Static Posture Evaluation
Prior to looking at a client’s dynamic movement a static posture evaluation should be
performed. This should be both in terms of casual observation of seated posture,
movement transitions and standing posture as you meet/interview/review the client and
also a standard evaluation in standing. It is best to observe the client with as little
clothing as acceptable and with shoes removed.
The static posture is a cue as to what you may expect to see in a dynamic movement.
We take our static postural build and trends into our dynamic movement. Alignment,
symmetry, muscle groups, tension, flaccidity, compensations etc…all can be observed,
both in their static and dynamic state. In terms of human function, to simply hold a
standing posture is a clear function of the kinetic chain…the ability to bipedal stand is a
unique reflection of homo sapien loco motor ability …”I stand therefore I am”. To simply
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stand I need great balance, anti-gravity strength, coordinated antagonist/agonist cocontraction etc. It is as dynamic as it is static. We call it static posture for obvious
reasons but we can be confident that it will reveal to us dynamic evaluation “cues”.
For optimal alignment in a static standing
position imagine a plumb line hanging down
from above the head, ideally a line would take
the following course through the body:
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Ear lobe
Through bodies of cervical vertebrae
Tip of shoulder/acromion
Split chest in half
Through center of lumbar spine
Just behind hip joint
Anterior section of knee
Just anterior to the ankle joint
Norris (2000)
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Ask the client to stand in their natural position with the feet level but slightly apart; stress
that this is the position they should feel most comfortable in. They should not try to
maintain a posture that they think is correct or what they think you want to see. From
here the assessor can note any potential imbalances or asymmetry between the left and
right of the body. It is worthwhile looking at the client from behind, the side and in front
and from a distance.
Make notes as you observe the gross structural landmarks.
Head
Deviated,
Forward head (protruding chin)
Shoulder/arms/
hands
Protracted or pointing in an anterior direction, palms
pointing backward/forward, whole arm internally rotated,
asymmetry.
Shoulder Blade
Winging i.e. lifted of the chest wall, protracted or elevated
towards the outside of the back
Spine
Kyphotic, lordotic, sway back. Scoliosis.
Hip/pelvis
Anteriorly/posterior tilted, retracted on one side, torsion.
Lateral shift.
Knee
Adducted, internally rotated, valgus, varus, recurvatum
Feet
Flattened, externally rotated, pronated, supinated
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Postural Classifications
Lordotic
Kyphotic
Swayback
Loss of spinal
curves
Norris, (2000)
It would be fair to say that these common postural types are associated with
recognizable patterns of dysfunction and muscle imbalance. These patterns are only a
“cue”…do not take them as a “given” at this stage. There follows a very generalized
summary of these possible dysfunctions:
Lordotic Posture
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Classic arched or ‘hollow back’ posture.
The pelvis is tilted forward with probable lengthening and weakness of the
abdominals and gluteals and shortening and tightening of the hip flexors and
lumbar extensors.
Hamstrings may be over-active and inefficient through full range.
Compensatory upper imbalances are common (so called Kypho-lordotic posture).
Sway Back
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Classic ‘slouched’ posture.
The hip joint is pushed forward so that the greater trochanter lies anterior to the line
of gravity.
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Lengthening of the hip flexors, but often inefficient over-activity as the body
effectively hangs on the hip ligaments, anterior structures and eccentrically
“excitable” hip flexors..
Over-active rectus abdominus.
Inhibited gluteals.
Kyphotic Posture
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Round shouldered or curved back.
There is tightness in the pectorals and anterior shoulder structures and lengthening
in the lower trapezius and serratus anterior.
Compensatory forward head posture and short, dominant upper cervical
extensors.
The static assessment has now started to bring attention to muscle groups. Think of
these observations in terms of what “overlays” the body structure. Your attention is now
drawn to muscle bulks, shapes, obvious increases and decreases in resting tone and
visual landmarks. Symmetry…if there are two are they where they should be, do they
look equal? Is the soft tissue hollow where it should be rounded or vice versa? As with
many “physical” observations there are common findings that can be often noted and
can commonly be systematic in their presentation but, again, do not take them as a
“given”.
Postural Morphology
Common findings in anatomical ascending order:
Flat, hypotonic feet (pronated) or “fired up” rigid feet (supinated). Clawed toes.
Over-active prominent peroneals. Prominent visually tight Achilles Tendon.
Hypertrophied Tib. Anterior.
Over-developed and bulbous vastus medialis.
Visible Ilio Tibial Band.
Hypertrophy and bulky distal half of the hamstrings.
Often correlates with inhibited flaccid gluteals with uneven gluteal creases.
Hollowing at the upper lateral gluteals (glute med. atrophy)
Low lumbar paravertebral asymmetry. Multifidi wasting. Uneven lumbar skin
creases. Prominent hinge point crease.
Blowing of the lateral abdominal wall.
Over active upper rectus. Lateral flaccidity. Prominent elevated low rib cage.
Lower traps and rhomboid insufficiency and lack of bulk. Scapula winging,
asymmetry.
Upper traps convex, overactive, bulk. Levator notch. Upper cervical extensor bowstringing tension.
Pectoral hypertrophy, banding. Nipple level asymmetry.
Prominent sterno-cleido-mastoids. Assymetrical head carriage.
Deltoid flattening and angularity.
Bicep increased tone.
Chin to neck angle reduced.
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These postural “cues” give a strong marker for areas of interest that we will be
observing closely with the dynamic movement screens. They are, in a sense, predictive
and as was mentioned previously, the findings and implications of a static postural
evaluation may be reflected in dynamic movement performance. However, it cannot
be emphasized enough that these are not recipes of definitive “cause and effect”.
The whole point of movement screening is to accurately assess a client’s individual
structural and movement characteristics. The following basic examples are simply
guidelines only:
Postural Observation
Rigid high arched foot (supinated)
Visually tight Achilles and prominent
soleus bulk
Gluteal flaccidity or wasting
Lumbar extensor over-activity
Anterior medially rotated glenohumeral joint with low trapezius
wasting.
Forward head posture and thoracic
kyphosis
Potential Dynamic Implication
Poor shock absorption and harsh
loading in lunges. Balance issues.
Lack of “release” of the lower limb.
Restricted functional dorsi-flexion.
Restricting squat and posterior lunge
ability…limb “bale out”.
Poor lower limb pronation
control…medial collapse on squat
and lunges. Pelvic instability on step
testing.
Retained lordosis during movement.
Inability to get “through” hip
extension…loss of ROM. Inhibited
ineffective abdominal stability.
Poor overhead raise range. Elevation
of the scapulae early in movement
cycle…poor timing.
Poor wall rotation range, single leg
stance instability in the transverse
plane.
These are only six examples. Many of these presentations of weakness, restriction and
over-activity will correspond to recognized postural dysfunctions and overload patterns.
Some may be injury-specific or compensatory. However, none are definitive.
Evaluation of Gait
No movement screen would be complete without an observation of gait…..our most
fundamental movement pattern.
Free joint mobility and appropriate muscle force increases walking efficiency. As the
body moves forward, one limb typically provides support while the other limb is
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advanced in preparation for its role as the support limb. The gait cycle (GC) in its
simplest form is comprised of stance and swing phases.
To analyze gait without the use of motion analysis and slow motion video can appear a
daunting prospect. The body will rapidly compensate for pathologies in order to achieve
motion and do so in the most energy-efficient manner. To simply ask the client to walk a
few steps up and down and expect to diagnose an abnormality is wishful thinking.
First, ensure the client is wearing the minimum amount of clothes necessary and view
them with both shoes on and shoes off. You will need a decent amount of space so that
the client can walk for 15-20 feet before the need to turn. Have them walk up and down
a few times before you attempt to analyze their gait. This will enable them to relax into
their normal gait pattern and prevent the cat walk poseur.
Fundamentally within a gait cycle, muscle function is designed to eccentrically control
the rate of pronation throughout the limb and assist in absorption of the ground reaction
forces, before stabilizing lengthening and re-loading into supination prior to the
concentrically driven toe-off. How successfully is your client achieving this process?
Before you dive into specific areas get a general feel on how they choose to move. Do
they look smooth and coordinated? Do they dominate in one particular plane i.e.
excessive frontal plane motion or a lack of movement in the transverse plane? Is there
an obvious limp? Are they heavy walkers or light on their feet? These obvious
characteristics may be all you are able to see, in which case appreciate that the rest of
the dynamic movement screen will break down movement patterns into more
manageable units and ‘sniff out’ imbalances. However you can start to refine your
analysis by focusing in on specific regions as seen with the static postural screen. In
ascending order:
Foot and ankle
Knees
Lumbo-pelvic
shoulder
head
Do the feet flatten? Do they turn out?
Does the foot slap down? Do they
heel-lift early?
Genu varum? Genu valgus? Does the
knee hyperextend?
Asymmetry? Increased lordosis?
“Blown” abdominals? Hip hikes?
Trendlenburg?
Protracted? Elevated? Symmetrical?
Forward head posture? Tilted?
Many of the above observations have been discussed in the static postural screen
however it is worth highlighting what may be seen with specific muscle weakness.
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Uncompensated calf weakness results in diminished mid stance control of the
forwardly rotating tibia. Calf hypomobility/tightness or over-activity, curtails tibial
advancement early through mid stance, the observation is often knee
hyperextension. Other compensatory maneuvers include reducing step speed
and step length.
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With mild pre-tibial weakness, foot slap occurs at heel strike. With more
extensive dorsiflexion weakness, foot drop and toe drag are observed during
swing phase. Compensation is achieved through circumduction of the ipsilateral
limb, increased ipsilateral knee and hip flexion and possibly hip hiking to “clear”
the weak side. Each of these tendencies assists in swing-phase toe clearance.
Of these compensations, circumduction is the most energy-efficient and most
commonly observed technique for dorsiflexor insufficiency. Note this exact same
pattern of compensation can occur due to structural lack of dorsi-flexion/eversion.
•
Quadriceps weakness diminishes knee control and deficits in stance are most
pronounced. External forces tend to hyperflex the knee and a variety of
compensations are employed to preserve stability in weight bearing. Apparent
quadriceps weakness may often be attributable to poor lumbo-pelvic stability.
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Hip abductor weakness results in pelvic instability during stance. External forces
(i.e., torso mass and momentum) lead to frontal plane rotation about the
ipsilateral hip joint. This tilt is normally resisted by eccentric contraction of
ipsilateral hip abductors (i.e., gluteus medius, minimus). Shifting the torso over
the ipsilateral hip joint in mid stance (Trendelenburg gait) minimizes the force
required by the hip abductors.
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Excessive anterior pelvic tilt with poor shock absorption at heel strike can
implicate gluteal weakness, lower abdominal weakness and poor core control.
This can be retained throughout the gait cycle.
Analyzing gait is potentially a difficult task but, as with all of movement screens, through
repeated observations certain common patterns will emerge. Because gait is so
fundamentally significant, it makes it the most natural movement screen and can
potentially give us information regarding the client’s further movement characteristics.
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The Physical Solutions Dynamic Movement Screens
Note: We suggest referring to the accompanying video library for visual presentations of
each of the following movements (videos in the library are identified using the same
name as each movement section name).
Squat with overhead raise
The squat is a classic fundamental primal movement and a good place to start. The
addition to the basic squat is to ask the client to concurrently lift the arms fully overhead
while performing the movement. This will begin to highlight upper extremity dysfunction
and possible faults in the relationship between upper and lower extremity.
Squat characteristics
• Symmetrical movement pattern.
• Load to unload throughout the chain.
• Creates a dichotomy at the lumbo-pelvic junction.
• Control of center-of-gravity over a stable base in the sagital plane.
• Requires flexibility in the upper and lower extremities while maintaining proximal
stability.
Starting position
End-range position
Description of basic instruction:
• Feet approximately shoulder-width apart.
• Hands wide grasp stick; keep arms/elbows straight throughout movement.
• Descend as far as possible keeping heels on ground and return.
Already you may have gained a wealth of useful information; they may look great;
smooth movement with no imbalances or asymmetries. While maintaining the arms
vertically above the head they are able to descend fully onto their haunches, showing
correct spinal posture with the feet straight ahead and heels on the ground. If not, make
notes from the following observations
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending.
• Note the degree of stability with which the movement is performed
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Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Anterior lunge with overhead reach
The lunge is another fundamental primal movement. Various tests will be based around
the lunge but altered in direction and with the use of additional components, in order to
highlight various movement chains and expose segmental dysfunction.
Lunge characteristics
• Dynamic load to unload with weight transfer.
• Can be biased towards any plane.
• Challenges lumbo-pelvic stability and flexibility.
• Requires strength and stability in the lower extremity.
• Overhead reach requires flexibility in the anterior sling system.
Description of basic instruction:
• Simple forward lunge just over normal stride length.
• As lunge is carried out, raise stick overhead with straight arms to end-range.
• It is not necessary to touch-down rear knee.
• Immediately push out of the lunge and return to standing with the stick lowered.
• Repeat alternates.
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Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Posterior lunge with overhead reach
Foot position with the posterior lunge can give some indication of any potential
restrictions in two of the ‘big rocks’: the ilio-psoas and calf muscle groups. Both are
eccentrically loaded during the test and any tightness can be highlighted. The influence
of these upon the whole anterior sling system is also challenged.
Lunge characteristics
• Dynamic load to unload with weight transfer.
• Can be biased towards any plane.
• Challenges lumbo-pelvic stability and flexibility.
• Requires strength and stability in the lower extremity.
• Overhead reach requires flexibility in the anterior sling system.
Description of basic instruction:
• Simple backward lunge just over normal stride length.
• As lunge is carried out, raise stick overhead with straight arms to end-range.
• It is not necessary to touch-down rear knee but encourage whole of rear foot to
be on ground.
• Immediately push out of the lunge and return to standing with the stick lowered.
• Repeat alternates.
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Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
Inline lunge (with stick held along spine)
With the inline lunge we are now pre-positioning the feet within a narrow base in order
to expose pelvic and lower extremity dysfunctions. The stick serves the added purpose
off maintaining a neutral position in the spine. This position will also test the ability to
internally rotate at the hip joints.
Inline characteristics
• Narrow base specifically challenges frontal plane stability
• Internal rotation at the hip joints
• Challenges lumbo-pelvic stability and flexibility
• Maintain rear foot alignment on return from lunge
Start position
End-range position
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Description of basic instruction:
• Feet “in-line” on a line marker.
• Feet far enough apart to allow rear knee to touch behind front heel on lunge.
• (Observe if rear foot can maintain this position even before lunge)
• Stick in contact with back of skull, spine and between glutes; arms ext./int.
rotation to hold stick.
• Keep spine vertical and in contact with stick as lunge is performed…prompt knee
to fall behind front heel and to touch floor.
• Immediately return from lunge to in-line stance.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
Squat with rotation line touch
This is an essential functional movement in terms of compound “anti-gravity” loading of
the whole body with an emphasis on the transverse plane. It replicates generalized
lifting technique with a multiple challenge to flexibility and chain loading.
Squat/rotate characteristics
• Asymmetrical squat pattern.
• Ability to internally rotate at the “lead” hip joint and load the external rotators.
• Ability to release and pronate the trail leg.
• Spinal coupled rotation and flexion with a thoracic rotation emphasis.
• Full protracted loading of shoulder girdle.
• Load to unload throughout the chain in an asymmetrical pattern.
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Starting position
End-range position
Description of basic instruction:
• Feet shoulder-width apart, line bisects middle of feet (instep).
• Prompt to touch line at side of foot with opposite hand.
• Prompt to keep feet flat on floor and not to be rotated.
• Observe initial strategy.
• If necessary, prompt to deep bend knees as movement is carried out.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
Balance Reach /multidirectional leg reach
From a single leg balance, the opposite leg is reached out to barely toe-touch in multidirections (if the reach leg is planted onto the floor the test becomes a lunge). A simple
star pattern can be placed on the floor with the use of masking tape. The test indicates
the ability of a single leg to load when driven in multiple directions and the counterreaction of the upper chain to this load. It can indicate deficits throughout the lower
extremity chain.
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Balance reach characteristics
• Ability to control center-of-gravity over a modified small base.
• Ability to load throughout all the joints in the lower extremity.
• In particular, demonstrates the loading strategy at the knee joint.
• Initiates and challenges chain stability reaction in multiple planes.
• Isolates stance lumbo-pelvic stability.
Starting position
Vector point touches
Description of basic instruction:
• Single foot stance in middle point of star if used.
• Reach with elevated foot along selected line (or plane if not using star) and just
feather-touch it down onto line/floor and then immediately return to start position.
• Allow arms etc to help balance reaction.
• Encourage greater range as screen progresses.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
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Balance reach /multidirectional hand reach
From a single leg balance stance, the opposite hand is required to touch-down in multidirections. A simple star pattern can be placed on the floor with the use of masking
tape. This test will require a significantly greater degree of loading through the hip joint
and will test the ability of the hip to load and unload in all directions.
Balance reach with hand characteristics
• Ability to load in flexion through the hip in multiple directions when the hand is
used as the drive force.
• Ability to recover into full chain extension and back to starting posture.
• Control and recovery of center-of-gravity direction and center-of-mass height
over a modified small base.
• Posterior chain/sling flexibility.
• Particularly requires accurate sequencing for success.
Description of basic instruction:
• Single foot stance in middle point of star if used.
• Reach with opposite hand to stance foot along selected line (or plane if not using
star) and just feather-touch it down onto line/floor and then immediately return to
start position.
• Allow arm and leg counter-balance etc to help balance reaction.
• Observe initial strategy; may be necessary to prompt knee and hip flexion.
• Encourage greater range as screen progresses.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending.
• Note the degree of stability with which the movement is performed.
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Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
Multidirectional lunge
Using the star pattern on the floor, the client will be asked to lunge along each vector
and return with the foot of the lunge leg facing forward (the test can be repeated with
the foot of the lunge leg turning out along the line of the vector). The test highlights the
ability of the lower extremity to load and unload in a lunge pattern in multiple directions.
Multidirectional lunge characteristics
• Tri-plane lunge ability.
• Highlights flexibility and strength throughout the lower extremity during a
functional primal movement.
• Ability to control transfer of their center-of-gravity outside the base of support,
recapture and return.
• Opportunity to challenge force absorption and force production movement
strategy.
Description of basic instruction:
• A more “freestyle” lunge screen in multi-directions.
• Stance foot remains fixed and oriented forwards.
• Lines and lead foot strike position will dictate certain lunge criteria i.e. posterior
diagonal lunge with foot fall following line would create external rotation at both
hips (see second picture above) but lateral lunge with foot fall remaining oriented
anterior and bisecting line would dictate lead hip is internally rotated (see first
picture above).
• Multiple planar challenges are possible.
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Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from descending to ascending.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
Hip internal and external rotation
The ability to rotate into internal and external rotation at the hip is vital in order to
function optimally at the highest level. Unfortunately this motion is often restricted
leading to compensations elsewhere in the chain. Various tests can be used to
highlight dysfunction: the first is a test of restricted movement and the second is a test
of motion AND control of that motion.
Hip internal and external characteristics
• Tests the amount of hip rotation in a weight bearing position.
• Highlights the ability of the lower extremity to pronate and supinate at each joint.
• Highlights the kinetic chain reaction above and beneath the hip joint once its
range has been “used up”.
Test 1
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Description of basic instruction:
• Start with feet shoulder-width apart facing forward.
• Lift one foot and maintain single leg stance.
• Keeping the stance leg facing forward, rotate around that hip to toe-touch with
the opposite leg at the extreme of internal rotation and then external rotation.
Test 2
Stand in single leg stance with the opposite knee flexed to 90 degrees at the hip and
knee. A dowel rod can be held across the back at the level of the PSIS’s. Rotate the
elevated leg around the stance leg to maximal internal rotation and then to external
rotation.
Observations
• Note the overall quality of movement from in front, side-on and behind.
• Note the symmetry of movement.
• Note the point of transformation from rotation to return.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
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Step-over test
This test looks at the ability to stabilize through the lumbo-pelvic area in single leg
stance while the opposite leg is taken through a tri-plane movement pattern. A
challenge to functional dynamic stability highlighting the oblique sling systems.
Step-over characteristics
• Single leg balance.
• Stance lumbo-pelvic stability.
• Lead leg open chain flexibility.
Description of basic instruction:
• Item chosen for step-over should be approximately height of client's knee
joint…i.e. chair, stool, stacked steps etc.
• Stance foot is one foot's distance to the side of the center of object.
• Other foot to be lifted over the object without touching it and feather-touched
down in front of it, then immediately lifted and returned to feather-touch behind.
• Movement continually repeated.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from touch-down to return.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
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Wall rotation variations
This is an easily reproducible test that can reveal the ability of the entire body to both
supinate and pronate from the ground up throughout the chain. In this case the total
body supination/pronation is driven primarily via the transverse plane. The test is
initially performed in bilateral stance then repeated in single leg stance.
Wall rotation characteristics
• Ground up supination/pronation throughout the chain.
• Total body compound rotation range-of-movement.
• Momentum capture and recovery in single leg stance.
• Dynamic balance.
Bilateral stance
Single leg stance
Description of basic instruction:
• 1) Stand heels against wall, then measure off and stand one foot's distance from
wall.
• Feet hip-width apart.
• Arms bent 90 degrees at elbows, index fingers pointed.
• Rotate around, keeping elbows by side, to touch wall with both index fingers.
• Repeat on opposite side.
• 2) Set up as above then stand on one leg.
• Rotate around to touch wall with left hand at chest height and then rotate around
to touch wall with right hand. (i.e. internal and external rotation about the stance
hip.
• To further challenge balance and momentum capture ask the client to perform
each rotation 3 times in succession without dabbing down the elevated foot.
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Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation from touch to return.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
Postural wall hold
This test is used to identify dysfunctions and limitations in the upper extremity. While
maintaining a neutral spine and pelvic position imbalances and range-of-movement
limitations can be exposed above. With the wall as a reference point, symmetry is easy
to compare and compensation easy to see.
Postural wall hold characteristics
• Pectoral, latissimus and shoulder girdle/joint range-of-movement.
• Shoulder girdle orientation under load.
• Spinal reaction to upper chain loading and vice-versa.
• Stability compensations.
Description of basic instruction:
• Again, stand one foot's distance away from the wall.
• Sit back against the wall, slightly flex knees, engage head, scapulae and pelvis
against wall.
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•
•
•
Move both arms flat against the wall and into a crucifix position with elbows bent
to 90 degrees, fingers spread wide, back of hands against wall.
Return back to starting position.
Elevate both arms overhead, thumbs interlinked, elbows straight, try and get
backs of hands flat to wall.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the body posture at spine, shoulders and neck/head as the full range is
reached and held.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
Overhead posterior reach
This movement performed from a single leg stance will examine the flexibility
throughout the entire anterior chain/sling system. In particular, it will identify any
restrictions in the hip flexor and the lumbo-pelvic reaction to any limitation.
Post O/H reach characteristics
• Sagital plane restrictions in the anterior sling system.
• Ability to load through the anterior sling system; in particular control of hip
extension via the hip flexor.
• Posterior drive of mass and momentum.
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Description of basic instruction:
• Measure off and stand 2 foot's distance from wall.
• Stand on one leg.
• Reach back and overhead with opposite straight arm to touch wall behind and
then return to single leg stance.
• Repeat 3 times off each leg.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation at touch to recover.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
Repeat on other side
With the following additional screens, Physical Solutions uses a measure
tape permanently affixed to wall and floor. This is a great tool and can be
used for many purposes such as height records, vertical and horizontal
jump measuring and other flexibility criteria.
Compound Flexibility
These are two examples of a great technique to assess and compare functional total
body flexibility. Functional flexibility is a reflection of the ability of linked muscle groups
to co-lengthen…total chain or sling, flexibility. Sport and athletic function requires
integrated rather than isolated end-range flexibility and stability, hence the value of this
type of screen.
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Lateral Compound Flexibility
Description of basic instruction:
• Outside foot at right angle to floor tape, foot also flat to floor.
• Lateral reach and lunge along the tape line and to the wall tape.
• Just touch the tape.
• Client must not lean against wall but must be able to “get there and come back”.
• Work outside foot along tape until threshold is found and recorded.
• Compare left distance with right.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of foot positioning.
• Note the quality of the point of transformation at touch to recover.
• Note the degree of stability with which the movement is performed.
Anterior Compound Flexibility
Another total flexibility screen that is observable in terms of quality and also definitively
measurable. The posterior and upper muscular chains/slings are targeted in this case.
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Description of basic instruction:
• Anterior and posterior feet are aligned on the floor tape.
• Above example is left foot back, right hand touch to tape. Same side hand touch
can also be assessed.
• Just touch the tape.
• Client must not lean against wall but must be able to “get there and come back”.
• Work rear foot along tape until threshold is found and recorded.
• The distance recording is taken from the tip of the big toe.
• (a further recording can be the distance between both big toe tips…i.e. full
stabilized stride).
• Compare left distances with right.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of foot positioning.
• Note the quality of the point of transformation at touch to recover.
• Note the degree of stability with which the movement is performed.
Push-up with rotation
The push-up is a traditional exercise but can be used to assess scapular and shoulder
girdle stability with a symmetrical upper limb activity and also with integration of lumbopelvic stability in the sagital plane. It places the upper extremities in a closed chain
position which will expose potential scapular winging (instability) and dysfunction.
The subsequent rotation will require additional control through a single shoulder girdle
and test trunk stability in the transverse plane. The ability to load into this position is vital
for full upper chain loading.
Push-up with rotation characteristics
• Closed chain symmetrical shoulder motion.
• Sagital plane trunk stability.
• Transverse plane trunk stability.
• Anterior shoulder and chest flexibility.
(If the client is unable to maintain a full push-up position, perform a push-up from all
fours.)
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Description of basic instruction
• Place one hand against the wall then measure out 4 hand widths along the floor
tape.
• Assume a push-up position.
• Perform one push-up then rotate towards the outside hand lifting this up and
round to touch the wall tape overhead.
• Return to start position.
• Turn to the opposite direction and repeat on this side.
Observations
• Note the overall quality and range-of-movement from in front, side-on and
behind.
• Note the symmetry of movement.
• Note the point of transformation at touch to recover.
• Note the degree of stability with which the movement is performed.
Start to observe more detail in specific regions
• What is happening at the head and neck?
• What is happening the shoulders and arms?
• What is happening at the spine and pelvis/hips?
• What is happening at the knees?
• What is happening at the feet?
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Analysis of the screens
The screens demonstrated will provide a comprehensive analysis of the client's chosen
movement patterns for a variety of functional movements and others that will target
specific ‘big rocks’ where deficits are commonly seen. At first it may seem bewildering to
identify dysfunctions particularly when you bear in mind there may be multiple problems.
At this stage, step back and work through the following list making notes of what you
see or feel. These are the broad observations not the specifics of each test.
Start and finish positions
‘If you start from a poor posture you will finish in poor posture’ is a well-known quote
used by many educators. Use the start position to identify the client’s adopted choice of
static posture. Have they succumbed to gravity? Does the head protrude forward? Are
they kyphotic in the spine? Which way does the pelvis tilt? Are the knees straight and
level? What are the feet doing? Conversely, they may stand straight and balanced. The
starting position will give you a good indication of what to expect with the movement
screens and how successful they may well be, i.e. with a flexed kyphotic spine we may
see decreased rotation evident on the wall rotation test. Again, at this stage, you do not
need to try to interpret the findings but be aware of them and see if they are born out
with the subsequent tests. It is no coincidence that we tend to associate the best
athletes with a good base posture; this is their foundation for movement.
Symmetry of movement
An obvious comparison can be made between the right and left sides at all stages of the
movement sequence. Simple comparison of symmetry can be most revealing. For
example, often an old injury or operation may be responsible for a restriction in the
chain or a compensation else where in the chain i.e. following an ankle sprain the client
failed to regain full motion in the sub-talar joint and subsequently is unable to pronate
effectively on that affected side. This process highlights the importance of obtaining a
full past medical history although it is often the case that they only recall an old injury
when prompted by your observations.
Conversely, asymmetry can be a great indicator of potential for injury and an equally
great lead into reasons for poor athletic performance.
Do they have the flexibility?
Simply put… ‘can they make the shape required’ …this will be a common observation;
the client will struggle to obtain the shape or position demanded by the screen due to
flexibility issues within the chain. Again, simply make a note of the observations and
see if a pattern develops with further testing e.g. during the squat the foot turns out and
this is seen again on the rear foot with a posterior/backward lunge.
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Do they have the stability?
Simply put… ‘do they have the control of the motion required’ …again you may well find
the client is unable to hold a position or there is an obvious loss of motion form. i.e. the
knee drives in or out with a lunge or the pelvis drops on single leg balance tests.
Stability throughout the chain can only come from having a stable base. Proximal
stability supports and enhances distal mobility, so weakness observations may give us
an indication of the ‘core control’ of the client. This also extends to hip stability, which is
tested with balance reach and lunge tests. Weakness in this essential ‘powerhouse’ of
the body will have a knock on effect not only to the rest of the lower extremity but also to
the shoulder and arm.
Timing
All efficient movement patterns have a relative timing. This is the correct sequencing of
the components that make up that movement pattern and involves complex interplay
between the articular, muscular and neural systems. Proprioceptive input from the vast
network of receptors feeds into the system to ensure a coordinated smooth pattern of
movement that starts and finishes at the correct time. Individual segments within the
whole sequence can be mal-timed or even absent. In crude observational terms you
have two extremes… are you dealing with a ‘motor moron’ who has a poor appreciation
of efficient movement or does the client have the graceful movement sequences of a
high level athlete?
Compensations
This is one of the most revealing aspects of dynamic movement screening and one of
the most difficult to observe with other forms of musculo-skeletal assessment. In
general terms the body will do everything possible to achieve the desired movement
required. Therefore, to adjust for a deficit in one part of the chain, other areas in the
body will compensate in order to get the movement done. A simple example would be
the lumbar spine hyper extending on a posterior overhead reach to compensate for a
tight hip flexor and an inability to extend the hip. A more subtle example would be
observing a lack of ability to load the right shoulder girdle into protracted reach with an
internal rotation wall touch and recognizing the left foot's inability to get out of pronation
as setting up a pronatory “hold” on total body rotation loading above it as a potential
contributing cause.
At this stage you already have a wealth of information and, even if you go no further,
you have plenty of places to start improving your client’s ability.
• Can I improve their posture?
• They are not symmetrical and the old ankle injury needs addressing.
• They are weak throughout the left side.
• There is tightness in the calf, hip, shoulder.
• Their balance and coordination is poor.
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You could begin to address these deficits with a program and be reassured you are
justified via movement analysis. Simply retest at intervals to note any improvement or
need for program review.
However, as you become proficient in this process, further information can be obtained
from the individual screens. It may be necessary to become comfortable in your ability
to regionalize rather than globalize your observations of the individual screen
Further specific findings
Squat to overhead
•
•
•
•
•
•
Is the test performed with symmetry?
Can they load evenly through the ankle, knee and hip joints?
Look for the spinal angle mirroring the tibial angle.
Can they maintain the arms overhead throughout the sequence?
Does the pelvis remain stable throughout?
Do the feet turn out or heels lift up?
This is a closed chain symmetrical test that can identify deficits throughout the kinetic
chain. From the bottom up, the flexibility of the calf muscles are assessed. Can they
fully dorsiflex the ankle joint while keeping the heels down and toes forward? Restriction
in this muscle group may cause the heels to lift up and turn out; the foot may also
pronate excessively in order to decrease the amount of muscle length needed.
A block or restriction in any of lower extremity joints will be identified by a ‘glitch ‘in the
movement or inability to fully load. This may simply be an old injury, bony block, arthritic
joint and therefore require further investigation or referral to the appropriate source.
The pelvis is caught in a dichotomy: can it maintain a neutral position or is it pulled
anteriorly by tight erector spinae and a weak core? Does it tuck under too early or too
far, at the late stage into posterior tilt, possibly suggesting short and dominant gluteals
or hamstrings?
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Moving up the chain, the shoulders and arms may well get dragged forward during the
movement. As the pelvis tilts back, the latissimus muscle will be put on stretch and, if
shortened, will pull the arms forward and into internal rotation.
A protruding head posture may be seen as a result of prolonged poor posture coupled
with upper crossed syndrome muscle imbalance.
Poor tibial excursion, hips “over-flexing” to compensate, creating a strikingly horizontal
spinal angle. Terrible form shown by a “stabi-inflexible” professional football player!
Picture 3 shows a student at her end-range!…“all locked up with no place to go”.
Anterior lunge with overhead reach
•
•
•
•
Can they load smoothly and with control through the ankle, knee and hip joints?
Can they perform the lunge and return to the starting position without loss of
balance?
Are they able to elevate the arms above the head with the required relative
timing?
Does the pelvis remain in a neutral position as the lower extremity loads and the
arms elevate?
As the weight is transferred forward onto the lunge leg any restrictions in the ankle,
knee or hip joints will be exposed. Distance reached can also be compared between
right and left legs to ascertain any deficits.
The back foot is allowed to rise onto the toes but the front lunge leg should remain
straight ahead, heel down allowing ankle dorsi-flexion. The front knee should drift
slightly into medial deviation as it releases into pronation. Hip weakness or poor
proximal stability may cause excessive medial deviation of the front knee joint well
inside the foot and an inability to return to the upright position with control.
Gluteal/piriformis dominance or ilio-tibial band tightness may cause the opposite lateral
deviation of the front knee.
If there is inadequate flexibility around the pelvis caused by hip flexor, adductor,
piriformis or hamstring tightness the pelvis may pull into excessive anterior or posterior
rotation; further tests can specifically examine which of these may be the limiting factor.
40
Driving the arms above the head limits the ability of the hip to load and will increase the
amount of control required at the knee joint. Furthermore it will lengthen the hip flexors
exposing tightness in this muscle group. Throughout this the pelvis must maintain a
neutral position enhancing proximal stability.
With overhead arm elevation, flexibility in and around the shoulder complex and
potential reactive spinal compensations will be assessed. Excessive pelvic anterior
shear due to tight or dominant lats and pecs firing up the thoraco-lumbar fascia can be
seen with this screen. Further examination with the postural wall hold may well clarify
this.
Great ranges and form but loss of anterior stability as the front leg collapses excessively
to the inside by this “flexi-instable” elite youth footballer.
Posterior lunge with overhead reach
•
•
•
Can they lunge backwards with simultaneous elevation of the arms overhead?
Do they have the flexibility and control to load evenly through the calf?
Do they have the flexibility in the hip flexor and stability in the core to maintain a
neutral pelvis?
Posterior lunge with overhead reach will offer a chance to observe the ability to load
through the back leg calf and then gauge the reaction of the anterior chain to this load.
As the leg is driven backward the toes load first before the calf controls the descent of
the heel and dorsi-flexion at the ankle joint. If there is restriction in this group the foot
may well turn out as the body attempts to compensate for this. A tight or dominant hipflexor may also cause the whole leg to “bale out” to external rotation as it is placed
behind.
The calf group and the hip flexors are closely allied. If there is restriction in one group,
the other group is also often found to be tight. This test requires adequate flexibility in
both and again this may be confirmed by squat to overhead and posterior overhead
reach.
41
Similar observations as made with the posterior overhead reach can be made and
similar pelvic and shoulder girdle flexibility/stability issues will be observed as in the
anterior lunge with overhead reach.
A semi-pro footballer shows us how a lower limb type screen can reveal upper limb
dysfunction as he is forced into neck flexion, poking chin and upper limb lack of range
and distortion. On the right a great example of rear foot “bale out”.
Inline lunge (with stick held along spine)
•
•
•
Can they maintain the vertical spine angle?
Can they descend fully and return to the start position without compensation or
rear foot bale-out?
Closely observe frontal plane stability.
Similar observations can be made to the anterior lunge screen, however this in-line
screen presents more of a targeted challenge to stability and segmental alignment as
the narrow base foot stance and spinal posture are pre-positioned.
Restrictions around the hip and poor core control may see a forward lean of the trunk or
an obvious increase in lumbar lordosis when compared with stick position…the pelvis
being pulled into anterior shear.
Poor ability to control the center-of-gravity over the narrow base will show as instability
in the frontal plane and excessive frontal plane pelvic drift.
Gluteal weakness may be exposed by excessive medial drift of the front knee, with the
floor line being a good marker to gauge this by.
Simply holding the start position with sufficient stride distance will be difficult if there is
calf or hip-flexor shortening/dominance and in this case return from the lunge will be
accompanied by a “baling out” of the rear leg, with the foot being pulled obliquely from
the line.
An excessive poking chin/forward head posture can also be seen against the stick as a
marker.
42
Complete loss of spinal angle with the flexion seen mainly at the hips. The anterior view
shows a medial “collapse” of the front leg. The whole screen displays a functional
instability.
?
Multi-directional lunge
Similar criteria to above are observed but can be further challenged in all planes of
movement.
It is particularly useful to repeat the lunges on alternate legs to seek out asymmetries.
Of special note is the ability to perform anterior lunges apparently easily but to struggle
with the transverse plane vectors, a classic general finding in poorly conditioned or
balanced athletes.
A good example of asymmetry in the lead leg on a simple anterior lunge in a very strong
athlete.
Balance reach/multidirectional leg reach
•
•
•
•
Can they control single leg stance?
Can they control displacement of the center-of-gravity smoothly and with control?
Highlights the preferred pronatory loading pattern of the stance leg.
Specifically, can they pronate in all three planes at the knee joint?
The start position of single leg stance with hands on hips is a simple challenge of
balance ability and control of the pelvis, further highlighting gluteal or core weakness.
43
With the opposite leg reaching along the following vectors
• Anterior
• Antero-medial
• Medial
• Posterior-medial
• Posterior
• Posterior-lateral
The loading or ability to pronate throughout the lower extremity is assessed. Touchdown distance reached can be compared between the two sides.
A tight or restricted calf muscle will limit dorsiflexion on the stance leg. The ability of the
sub-talar joint to ‘unlock’ and pronate will be assessed, particularly with the anteromedial and medial balance reach. A rigid supinated foot will appear unstable when
asked to pronate and the client may well lose balance or have restricted touch-down
reach (excursion).
The ability of the knee to load in all three planes is assessed. Following meniscal or
ligament disruption, pronation of the knee with an antero-medial balance reach test is
often limited or poorly controlled and can highlight a possible weakness that may be
exposed in more dynamic activity/sport.
Finally, hip control is assessed and we may see the pelvis dropping, as with a
Trendlenburg sign or the trunk tilting over the stance leg, as with a reverse
Trendlenburg.
Single leg stance screens are always an indicator of the ability to control motion at the
core and pelvis.
A national elite tennis player shows us how he has fantastic range and the strength and
athletic ability to “get there” on both sides but observe the asymmetry, pronatory
collapse and stability compensations off the right leg. Range at the expense of
stability…an injury indicator at all levels.
44
Link this screen with this athlete's previous multi-directional lunge shots. Note how his
right leg instability creates a subtle trunk asymmetry and distortion and the need to look
down for feed-back this time. The right leg falls into internal rotation and the pelvis tilts
to the left. A great example of how screens can “talk” to each other in revealing
dysfunction.
A young footballer is comparing his medial anterior reach by toe-touch sliding weights
along the vectors. He will get a visual appreciation of range.
Balance reach/multidirectional hand reach
•
•
•
Can they control single leg stance?
With hand reach, do they need to counter balance with the non-stance leg?
Are they able to reach in multiple directions smoothly and under control without
loss of balance?
The start position of single leg stance with hands on hips is a simple challenge of
balance ability and control of the pelvis, further highlighting gluteal or core weakness.
With the opposite hand reaching along the following vectors
• Anterior
• Antero-medial
• Medial
• Posterior-medial
• Posterior
• Antero-lateral
• Lateral
45
The loading, or ability to pronate and supinate, throughout the lower extremity is
assessed in particularly at the hip joint. Touch-down distance reached can be compared
between the two sides.
This test provides an opportunity to assess the ability to load through the hip in all 3
planes and the eccentric control of the calf, hamstring and back musculature. As the
client reaches forward at the hip joint the whole of the posterior chain must decelerate
the motion, stabilize and then be able to return the body to the upright position.
Training of these muscle groups in this particular way is severely neglected in regular
gym programs and hip weakness will commonly be identified by these tests. Poor
eccentric loading control as the center-of-gravity is displaced forward may lead the
client to lose balance or be unable to return to the start position.
The upper limb reach also examines the protraction/retraction shoulder girdle ranges.
For example, with a lateral reach off left leg stance, full right shoulder girdle protraction
is required. This is a great test of posterior spiral chain (X-factor) ability as the left
gluteals and right lat. dorsi. Load into their full movement coupling relationship.
Both photos taken without moving the camera show an obvious asymmetry. The image
on the left shows a comfortable flexion of the right knee, a good range along the anteromedial vector and an efficient spinal posture. The image on the left reveals a
significantly reduced range, the left knee braced higher into extension, a corresponding
kyphotic curve within the spine reflected in an alteration in head carriage and most
surprisingly, a need to stabilize on the left leg with the left forearm against the thigh.
This was a very interesting case and with further screening, subjective history and
traditional testing it was found that he had extreme instability around the left hip and
lumbo-pelvis.
Hip internal and external rotation
•
•
•
Do they have the ability to internally and externally rotate at the hip joint with the
leg in a closed chain stance position?
Do they have the ability to control, capture and recover this motion?
Can the foot provide adequate pronation and supination to set up the reaction
above?
46
A number of the movement screens will explore the ability to rotate at the hip joints. This
is a common area where dysfunction can occur and, due to the importance of this
region for efficient function, it needs to be examined closely and multi-dimensionally.
This screen will drive rotation from the ground up. The ability of the foot to pronate and
supinate will be assessed. A persistently supinated foot is a poor shock absorber and
makes it more difficult to load throughout the entire chain into the correct pronation.
Conversely a persistently over-pronated foot has “no where else to go” and is an equally
poor shock absorber and can “hold off” the whole lower limb's ability to get out into force
producing supination .
Limited internal rotation at the hip is a common finding and these clients will often have
tight hip flexors and may demonstrate this by walking in external rotation. Internal
rotation is an important part of pronation and loading at the hip joint. With this limited,
the client will be unable to take advantage of the strength and power derived from the
hip in dynamic function and is at an increased risk of injury and compensation
elsewhere in the chain.
With the opposite leg flexed to 90 degrees and used as a marker, we can now see the
ability of the hip to control loading into internal rotation. This will highlight the ability of
the external rotators to eccentrically lengthen. Again, in function, these are a major
source of dynamic stability and power production and are often weak but go un-noticed.
On the opposite end of the movement chain, this screen will also highlight external
rotation at the hip as the opposite leg rotates outward. Control of this motion is via the
anterior short adductor/hip flexor complex and again, this motion is often deficient but
goes un-noticed.
A young footballer shows us he has great external rotation about his right hip but very
restricted internal rotation. In the toe-touch test he shows us his compensation strategy
of “baling” the right foot out into external rotation and employing excessive femoral
adduction and trunk leaning in order to “get there”. On further testing and manual
examination it transpires that this was a case of lack of pelvic/gluteal stability and not
structural lack of range-of-movement.
47
Step-Over Test
•
•
•
•
“Pylon” balance on stance side.
Lower limb pronation and supination patterns.
3D pelvic stability, control of pelvis orientation.
Minimal trunk lean.
We are looking for an adaptable single leg stance base with a pelvis that raises, swivels
and drops appropriately in all 3 planes of movement.
The stance foot should pronate on the posterior touch-down with the tibia and knee
following this movement and releasing to the inside medially. Conversely, on anterior
touch-down, the stance foot should supinate, taking the tibia and knee with it to the
outside laterally. Joint restrictions and bio-mechanical faults may be exposed by a
restriction in these patterns.
The hip is driven by these movements into external rotation with posterior touch-down
and internal rotation with anterior touch-down. A tight or dominant stance side gluteal
group may restrict the int. rotation with compensations seen as excessive knee flexion
and a tendency to lean back to make touch-down.
Weak stance side gluteals may show as an inability to elevate the opposite side of the
pelvis and clear it during step-over. Excessive weakness or a lack of stability at the
stance lumbo-pelvis may cause a noticeable trunk lean in the frontal plane over the
stance leg (the reverse Trendelenberg Sign). A strong controlled lumbo-pelvis/core sees
the trunk elongating on the stance side, keeping more vertical and keeping the centerof-gravity over the stance leg. Indications of the efficiency of the oblique slings,
ipsilateral hip adductors, contra-lateral quadratus lumborum can also be noted in terms
of pelvis frontal plane elevation control.
Difficulty in clearing the step-over leg may reveal hip muscular/articular restriction. Note,
a tight/dominant hip-flexor on the stance side may restrict pelvic extension and anterior
touch-down ability on the opposite step-over side.
In terms of balance ability, it is expected that most clients should achieve 3 continuous
cycles of this screen without needing to dab the foot or stabilize. Further challenge the
client and his progress with this screen by asking for more distance on the touch-downs.
Some client’s movement strategy with this screen will be to use trunk forward/backward
counter-balance. Modify their approach by prompting to keep the trunk vertical
throughout the movement…this often reveals compensations and weaknesses that
were hidden.
48
Two entirely different strategies to achieve the same screen…both equally
dysfunctional. On the left a shocking combination of stance pronatory collapse, pelvic
instability and compensations due to lack of range in an “unflexstable” client. On the
right a rigid lumbo-pelvic strategy produces almost a reverse Trendelenberg. Both of
these clients exhibited poor balance skills and an inability to complete this screen
successfully.
Wall rotation variations
•
•
•
•
•
Which segments contribute most to rotation and which contribute least?
Compare supination mechanics on one side of the body to pronation mechanics
on the other.
Test transverse plane single leg stance balance…a cornerstone of athletic
function.
Observe if foot mechanics assists or holds-back the chain above.
Observe if any spinal rotational hypomobility influences the lower chain.
Is the actual range there to perform the screen? The upper spine and pelvis should
show disassociation, with the shoulders overtaking the pelvis in terms of relative
rotation. The arms should not need to excessively reach to make the wall. Do any of
these segments show restriction or, conversely, does the thoracic spine show hypermobility?
Observe how the “lead” rotation side girds into total chain supination to provide the
foundation to rotate around. Expect the “trail” side to release into pronation at
foot/ankle/knee/hip. Does the lead side fail and stay in pronation and does the trail side
fail and remain held in supination. This is another screen that can help highlight hip
dysfunction especially in terms of internal and external rotation.
Single leg stance balance control in this transverse plane is often neglected in
assessment, yet it is an essential component of athletic function and a cornerstone of
many sporting techniques (throwing, hitting, kicking etc). Look at the above
supination/pronation mechanics in terms of momentum control. Expect to see a slight
decrease in rotation range in single leg stance but this should not be excessive…the
49
contribution of the hip is reduced as its muscle groups have to co-contract to maintain a
stable core.
Always carefully assess and expect high standards with the internal rotation single leg
stance wall touch…it cannot be stressed enough how important dynamic internal
rotation loading and unloading at the hip and lumbo-pelvis is to successful athletic
function.
Our “unflexstable” client shows us how he tears his knees, hips and ankles apart with
marked knee hyper-extension, and almost total lack of lumbo-pelvic disassociation.
Our rigid client also shows us a range asymmetry on that same right side as he can’t
get “round” that right hip.
Postural Wall Hold
•
•
•
•
Can they complete the full range required?
Does the spine arch into compensation?
Palpate for tightness.
Pain as an indicator of end-range.
Inability to complete the full range of external shoulder rotation with abduction could
indicate tight or dominant pectoral group, anterior\rotator cuff restriction or a capsular
pattern of restricted motion. Old, or current, sub-acromial impingements may also be
exposed.
50
A hypo-mobile thoracic kyphosis will significantly restrict range of both arm positions.
Palpation of the tension within the pectorals and lats in relation to thoracic position will
help distinguish this.
A protruding head posture at end-range may be seen as a result of prolonged poor
posture coupled with upper crossed syndrome muscle imbalance.
This is a useful screen to expose tightness in the thoraco-lumbar fascia and over-active
dominant lumbar extensors. Potential core weakness may also be indicated. In both
arm positions, the lumbar spine may fire into, or be “dragged” into, excessive lordosis,
with the wall providing a reference point to gauge this by.
This screen can induce pain responses at end-range. This may be indicative of
conditions such as shoulder impingement or facet impaction in the lumbar
spine…appropriate measures or referral should be taken.
No range, no way!! Note how the lumbar spine is also forced into lordosis
Overhead posterior reach
•
•
•
•
Can they control single leg stance with posterior weight displacement?
Have they got the flexibility in the anterior sling system to load overhead
throughout the chain?
Are they restricted in the hip flexor limiting hip extension?
Are they excessively loading in the lumbar spine?
This is another pattern that is neglected in training but often required in sport, i.e.
overhead tennis serve, volleyball spike or catching a ball overhead.
From single leg stance the center-of-gravity is displaced posteriorly as the client
reaches backwards overhead. The anterior sling system is now required to have the
flexibility to allow this motion and secondly to have eccentric control of this motion.
51
The most common restriction is seen in the hip flexors; tightness within this muscle
group will restrict the ability of the hip to extend, which, in turn, throws the required
motion further up the chain to the lumbar spine. Continual hyperextension at these joints
can lead to symptoms of low back pain and potentially stress fractures in the younger
athlete.
This movement will also test the ability to extend through the thoracic spine. Sedentary
activity often leads to a flexed rounded posture and loss of extension is common. Triplane motion of the thoracic spine is vital for efficient balance and is essential to preload and ‘switch on’ the abdominals.
In order to efficiently utilize the abdominals they must be lengthened first in order to load
eccentrically before unloading concentrically. If, with the above test, the hip, thoracic
spine and shoulder have sufficient flexibility then control of this motion will be
demonstrated with smoothly “timed” total body extension via eccentric action of the hip
flexors and abdominals. ‘Switching on’ the abdominals with this action is a key
component of athletic function.
Our semi-pro footballer is forced to send that head poking even further forward and
blows his chest but he can get “through” his hip flexor and his stance leg is comfortably
flexed.
The spinal and lumbo-pelvic rigidity has carried through three screens now with this
client. He can’t get through his hip flexor at all. His flexible calf allows him to make the
dorsi-flexion/tibial angle to get there but you can see it his knee that is taking the flexion
“hit” as very little else contributes to his total body extension.
52
Squat with rotation line touch
•
•
•
•
•
•
Can they get through the loaded internal rotation of the lead leg?
Does the trail leg release into pronation?
Do they employ a successful hip flexion strategy or do they overcompensate with
spinal flexion?
Does the whole spine couple into spinal rotation?
Can the shoulder be fully loaded under the head?
The feet should tilt on a longitudinal axis but should show no torsion about a
vertical axis.
It has often been stated that flexion-rotation is the cause of back injury which is
surprising when considering it is a perfect example of total kinetic chain function and is
so common-place in all dynamic function. The fact that it is neglected in both terms of
assessment, training and rehab is even more surprising. This test is easily reproducible
and can reveal information on a client's movement selection and potential movement
dysfunction.
An initial “straight knee”, hip dominant flexion can reveal how the client is unhappy with
coupling true flexion and rotation together…an un-effective protective strategy. The
movement will show poor relative timing.
Poor range and release of the hips will demand that the spine compensate and
contribute “too much” to the whole screening pattern…it is this that puts the spine at
risk.
Spinal hypo-mobility and, in particular, loss of thoracic rotation, will lead to poor range.
The knees are now at risk of torsional stress in order to compensate to “get there”. In
this case to complete the screen the feet release into rotation or are dragged off the
testing line.
In the picture on left, his center-of-gravity stays well within his base and the movement
is completed successfully with a strong neutral spinal posture. On the right, the range is
similar but he has to outwardly rotate the whole right leg with the left lower leg driven
inwards. To make the movement, the spine compensates into right side-bending and
increased flexion, especially in the thoracic area.
53
Push-up with rotation
•
•
•
•
•
Can they maintain a neutral spine while performing a push-up?
Is there winging of one or both scapulae?
Is the head excessively flexed or extended?
Are they able to smoothly rotate to open up one arm while maintaining correct
alignment?
Do restrictions in the anterior chest prevent them from opening up fully?
This is a difficult but valid test, more frequently used in athletic populations. If clients
do not have the control to open up to full rotation without collapsing assess them
purely on the push-up and the many variations there-of. Simple leg extension from
quadruped can be observed with similar criteria to the “push-up with rotation”.
The push-up will require sagital plane trunk stability while performing a symmetrical
upper limb exercise. Weakness of the posterior chest wall may result in the scapula
appearing to wing or fan out. This may be a unilateral or bilateral finding.
The trunk should be maintained in a neutral and stable position throughout the test.
Inability to maintain this may result in the back dropping into extension/lordosis, with
possible low lumbar impingement type discomfort. Conversely, the client may adopt
a position with the hips “jack-knifed” higher in the air to avoid stabilizing through a
weak core or enforced by overactive hip-flexors.
As they rotate through the trunk and open up one arm, a high degree of stability is
required in the single arm now in contact with the ground. Poor proprioceptive
control in the shoulder joint will be exposed.
Tightness through the anterior shoulder joint and chest wall, or pectoral dominance,
may prevent full rotation and the ability to touch the wall tape.
An example of scapula winging, with the medial border of the scapula elevated
bilaterally but clearly worse on the right side. This young gymnast had extreme glenohumeral hyper-mobility and had suffered recurrent dislocations.
54
The same gymnast displays a great example of what gleno-humeral hyper-mobility
looks like in a functional test. Performing an overhead posterior reach…no need to flex
at the knee, no need to open out the hip flexor, no need to even employ spinal
extension….compare with the two previous examples of overhead reach and you now
see 3 different strategies for the same reproducible movement.
55
Linking Screens and Findings Together
Inline Lunge
Wall Internal Rotation
Plain Squat
Client: 50 year old ex-international equestrian competitor. History of equestrian falls
and an old low back injury. Still competing at high level. Current problem is right, low
grade, medial knee pain.
Inline Lunge: Note right leg forward collapse medially (follow clothing lines). Whole of
right side “compresses” with right side forward as lumbo-pelvic stability is lost. Also note
head position pulled into flexion.
Wall Internal Rotation: Loss of control; can get to the wall but struggles to stabilize on
return. Uses a strategy of reaching back into excessive lumbar extension.
Plain squat: Performed without overhead raise. This time the findings are not subtle at
all. Right knee collapses to the “inside” (medially). Pelvis distorts into a frontal plane tilt,
lower on the right. Ankle follows knee into excessive pronation at end-range squat. It
was performed pain-free until final 10% of range (mild medial knee pain) and on
transition to rising the knee deviated further inwards momentarily. On joint and muscle
testing, there are no abnormalities at the foot/ankle and calf lengths are even.
The screens suggest a possible weakness in the right gluteal group and loss of control
of femoral movement in all three planes during dynamic weight bearing. The screens
also show how this dysfunction manifests itself within the movement chain, with the right
knee effectively “taking the hit” through no real fault of its own. Clinical testing of the
right knee showed chronic medial laxity. Further functional testing and subsequent
exercises did reveal reduced stability around the right hip and a clear functional strength
asymmetry between right and left gluteal groups. There was no obvious structural
problem with the right hip.
Rehabilitation and treatment directed at this knee is unlikely to succeed unless the hip
muscular imbalance and stability weakness is attended to. In this case the primary
cause of the imbalance was not clear, although her previous history of falls and a
tendency to sit “strong” on one side of the saddle when schooling horses as a young
woman was cited. It is likely that her previous low back injury may also have inhibited
this right gluteal group.
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The Next Step
This manual has summarized an approach to dynamic movement screening. Initially the
assessment is approached in terms of movement only and the reaction and
interventions that are decided upon from this screening process will also be in terms of
correcting and improving this movement. Going deeper into the specific analysis, it was
seen how accurate assessment of more isolated chains of movement, muscle groups
and segmental body areas can be made and, again, exercise interventions can be
ascertained from interpreting these findings.
Once familiar with the screening process and comfortable with observing movement on
these terms, it is easy to see that Gary Gray’s often used phrase “the test is the
exercise and the exercise is the test” is indeed true. Any movement could be considered
a screen, especially if the analysis of this movement follows the previous guidelines.
It is not within the scope of this text to fully outline these interventions. We all have our
own skills and professional specialties in exercise technique, applications and program
design. We have performance-based training, postural techniques and rehabilitation
skills. Some may be proponents of one type of stretching technique, others may favor
another, etc. Essentially it doesn’t matter as movement screening is a process of
movement dysfunction assessment and the subsequent corrective exercises that stem
from this assessment do not have to be strictly protocol driven. This sort of assessment
helps you to write the menu but it’s up to you to choose the recipes. The potential
ingredients could be:
•
•
•
•
•
•
•
•
•
•
Facilitate and strengthen weak and inhibited muscle groups.
Stretch and down-regulate over-active and short muscle groups.
Correct muscular asymmetries and imbalances.
Shift length tension relationships.
Postural correction.
Postural and dynamic stability training.
Neuro-motor training, Sensor-motor training.
Correcting faults in relative timing and movement sequencing.
3 dimensional dynamic flexibility.
Specific foundation flexibility/stability/strength requirements.
Recognizing where all of the above fit into a relevant client-specific training or
rehabilitation program is made much easier with prior screening of functional movement
patterns.
57
Dynamic Movement Screen_____________________________
NAME:
Movement Screen
Squat with
overhead raise
Inline Lunge
Anterior Lunge
Overhead Reach
Posterior Lunge
Overhead reach
Squat Rotation
Line Touch
Postural Wall
Hold...Crucifix and
Overhead
Wall Touch
Rotations
Overhead
Posterior Reach
Hip Int/Ext
Rotation in Stance
DATE:
Pass
Inc.
Fail
Comments/Asymmetry
R leg forward:
L Leg forward:
R leg forward:
L Leg forward:
R leg forward:
L Leg forward:
To Right:
To Left:
Crucifix 90/90:
Overhead:
R + L Bilat:
R stance Int:
Ext:
L stance Int:
Right:
Ext:
Left:
Test 1:
Right:
Left:
Test 2:
Right:
Left:
Push-up (with
rotation?)
Step-over
Balance
multidirectional
reach…foot
Balance multidirectional
reach…hand
Multidirectional
lunges
Lateral compound
flexibility
Anterior
compound
flexibility
Right:
Left:
Right stance:
Left stance:
Right stance:
Left stance:
Right stance:
Left stance:
To Right:
To Left:
R leg forward:
L Leg forward: