Testing Movement Quality - The Role of Movement Patten Screening Tests

For athletes, fluid and unrestricted movement is critical for both optimal performance and to minimize injury. Unfortunately, most athletes seldom consider the importance of proper movement.  It is more common to think in terms of ‘what muscle am I stretching or strengthening’, as opposed to ‘what movement am I training’.... or in the case of bad form, ‘which poor movement am I creating?’  Remember, practice makes permanent.  Only perfect practice makes perfect. 

For anyone that has spent any time around infants or young children you know that many developmental milestones are related to movement.  Learning to roll over, crawl, stand upright, walk, climb, and run are all important events in a child’s life.   With each of these stages the infant is not only getting bigger and stronger but is developing motor programs, which can be thought of as little software programs being installed onto the giant hard drive we call the brain.   These programs are how the body learns to move and interact within its environment.

Through the years as we grow and develop our bodies continue to refine and build these motor programs into a set of basic movement patterns which form the basis for all complex movements throughout life.  In fact, even as we look at the seemingly infinite ways the body moves with sports such as golf, swimming, baseball, or track and field, all of these movements are really just combinations and subtle varieties of a base set of movements.  For example, running is a combination of a 1 Leg Squat and a Lunge.  To throw a fastball we are using the Lunge, Twist, and Push patterns. 

This manner of organizing movements actually simplifies things.  From a clinical perspective, instead of testing and evaluating an infinite variety of movements to identify mechanical problems that may be compromising performance or creating an injury we are able to focus our assessment on the basic movement patters that are most pertinent to each athlete or injury pattern.  Since these basic patterns from the foundation for more complex movements, problems seen during these basic patterns will also carry over into sport specific movements.  For example, a runner who demonstrates an instability at their hip or knee during a lunge or 1 Leg squat will display a similar problem during the stance phase of their running stride (this carry-over has actually been proven by recent research (1)). These patterns also need to be considered from a training perspective, and should be worked into strength and exercise programs, i.e. ‘train movements not muscles’.

A Word of Caution

Keep in mind that although these basic movement patters are extremely sensitive in detecting movement problems and muscle imbalances, they are not always able to discern exactly which muscle or joint is responsible for the dysfunctional pattern.  This is because the movements are simultaneously testing the coordinated function of various body segments.  A problem such as a restricted joint or a tight muscle anywhere along the chain can create a dysfunctional movement pattern. However problems at different areas will often create similar looking patterns, especially to the untrained eye.  In the clinic we are often able to break the dysfunction pattern down further to zero in on the key problem with additional tests, but this can get a bit complicated and is beyond the scope of this particular post.  Therefore, when describing the tests (we will look at the 1 Leg Squat and lunge Tests in this post, I will save the other for upcoming articles) I will try to discuss the most common problems that cause the various movement dysfunctions, but keep in mind these are not necessarily a definitive list.  Also keep in mind that although there is really only one ‘normal’ pattern, there are numerous subtle varieties of dysfunction patterns that are possible based on the underlying muscle or joint problems, or combinations of problems.  Again, I will present the most commonly seen patterns of dysfunction.

The Lunge Test (Figures 1 & 2)

The first basic movement pattern we will look at is the Lunge Test.  This pattern is seen with walking as well as running (including any sport that involves running, not just distance running). To perform this test, begin in a relaxed standing position and lunge forward while bending your trail knee towards the floor.  The length of your step should be approximately the length of your leg.  Do this in front of a mirror or have someone help you note your body position during the end position of the lunge movement.  A normal test is one in which your hip and knee are aligned overtop of your foot (seen from the front view), and your trunk remains upright with your knee at or almost to the floor (seem from the lateral view)

There are several dysfunction patterns that are commonly seen with the lunge.  From the front view, the knee will often shift inward, disrupting the normal alignment of the lower extremity.  This is most often caused by weakness of the posterior hip muscles (gluteus maximus, piriformis/deep external rotators).  Other common patters seen are a forward trunk lead, or failure to keep the lead foot flat on the ground. A trunk lean is usually due to tight hip flexors (this blocks the normal extension of the hip joint so the trunk must lean forward to get the thigh back behind the body), or alternatively, weakness of either the gluteus maximus or hamstring (both of these muscles must work to hold the pelvis and trunk upright, so if they are weak the trunk will fall forward as a continuation of its forward momentum.

With respect to the lead foot, if the heel lifts off the ground it is often a sign of a tight ankle.  Lifting the heel allows the lower leg to pivot over the toes instead of the ankle, allowing the knee to continue its forward motion.  However, this pattern can also occur with a weakness of the glute or hamstring muscles.  In this case the body is using the ankle to decelerate the body as it cannot use a weak glute or hamstring.  Another sign of this is when the body pushes back out of the lunge position the toes will stay on the ground longer than the heel. Normally the foot should lift off all at once and the push back should be crisp and easy. 

1 Leg Squat Test

The second basic movement pattern we will look at in this post is the 1 Leg Squat.  This pattern can be easily recognized in a number of daily activities (walking, climbing stairs) and athletic actions (running, jumping, cutting manoeuvres).  Basically any situation where one foot is on the ground and the other is in the air can be linked to this pattern

To perform the 1 Leg Squat Test, simply begin in a standing position, raise one knee into the air so you are balancing on one leg (referred to as your stance leg), and then squat down toward the floor.  You should do this in front of a full length mirror so you can see you pelvis and stance leg as you do this.  A normal test is one in which the pelvis remains level or slightly elevated on side opposite the stance leg, with the hip, knee, and foot staying aligned over one another.  Any deviation from this position is an indication of dysfunction.  

When pelvis drops on the side opposite the stance leg it is most commonly caused by a strength or coordination problem in the lateral hip muscles (particularly the gluteus medius or gluteus minimus) on the stance leg side, or a problem in the lateral abdominal muscles on the free leg side.  The other common cause of this pattern is a mobility restriction in the calf and ankle.  Basically as the ankle reaches its end range of motion the hip and trunk drop down in an attempt to lower the body further towards the floor (i.e. the pelvic drop is compensating for the restricted ankle).

The other common dysfunction pattern seen with the test is a collapse of the entire lower extremity.  This is similar to the dysfunctional pattern seen in the front view of the Lunge Test. This pattern often results form a strength or coordination problem in the posterior hip muscles (piriformis/deep external rotator group, gluteus maximus), but can also stem from weak lateral hip muscles, or a collapsed arch in the foot.

What's Next...

Hopefully this post helped you to not only understand the importance of proper movement patters, but also in helping you test your own movement patters for common patterns of dysfunction.  If you tests looked clean great... but if not, remember problems seen with these tests are likely to cause problems with respect to performance and efficiency, as well as with injury, so get any problems fixed asap.  I presented only 2 patters here... I will include the remaining tests in upcoming posts, so stay tuned.

References

1) Whatman, C., Hing, W., & Hume. (2011). kinematics during lower extremity functional screening tests. Are they reliable and related to jogging? Physical Therapy in Sport, 12, 22-29.