NASM Clinical Movement Analysis (PDF, 411K)

April 26, 2018 | Author: Medina Babic | Category: Human Leg, Foot, Anatomical Terms Of Motion, Dance Science, Joints
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CLINICAL EVALUATION & TESTING

Darin A. Padua, PhD, ATC, Column Editor

Clinical Movement Analysis to Identify Muscle Imbalances and Guide Exercise Christopher J. Hirth, MS, ATC, ATC, PT, PT, PES • University o North Carolina, Chapel Hill



OVEMENT is an essential component o  daily lie and athletic athleti c perormance. Human movement is inuenced by an individual’s individual ’s structural alignment, muscle exibility, muscle strength, and nervous system coordination o  muscle responses to a changing environment. Observation o human movement can be used to develop strategies or prevention o injuries and enhancement o athletic perormance.1-3 The Overhead Squat Squa t Test Test can be used to qualitatively assess an individual’s overall movement patterns. The results o this test can then be related to goniometric measures (muscle exibility) and manual muscle testing (muscle strength) streng th) to develop a comprehensive view o the individual’s movement characteristics. 1 The inormation can provide the basis or therapeutic exercise recommendations or stretching o potentially overactive and tight muscles and or strengthening strengtheni ng o underactive and weak musculature. mu sculature. To To optimize unction, the individual should be progressed to an integrated unctional exercise program. 1 The purpose o this report is to explain how to set up and use the Overhead Squat Test with associated measures o  muscle length and strength. Common movement patterns observed during perormance o the Overhead Squat Test will be explained, along with exercise recommendations or one compensation pattern.

Overhead Squat Test Setup The Overhead Squat Test involves a two-legged squat with the arms raised overhead (see Figure 1). The athlete is instructed to (a) stand with eet hip-width to

fms a ss f 5 b-gg sqas a Figure 1 t nva fms a f 3 ms. t nan vws  nva fm  an, aa, an s vw  assss f  , kn vags, xssv fwa nk an, ams fang fwa, an f nan.

shoulder-width apart, (b) toes pointing straight ahead, and (c) arms raised above the head. From this start position, the athlete is instructed to squat down as i sitting in a chair. The observation is made rom three views: anterior, lateral, and posterior (Figure 1). Ater perorming 5 squats or the anterior ant erior view, the athlete perorms 5 squats or the lateral view and 5 squats or the posterior view. The clinician notes the movement pattern characteristics by recording whether or not a particular characteristic was identifed during perormance o the test (Table 1). © 2007 Human Kinetics · ATT 12(4), pp. 10-14

10  July 2007

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Table 1. Movement Pattern Characteristics

View

Movement Pattern Item

Anterior 

Toe Out Yes

Table 2. Potentially Overactive/  Tight Musculature and Underactive/Weak Muscles

No

Faulty Movement Pattern

Potential Overactive Muscles

Potential Underactive Muscles

Toe out

Soleus

Medial Gastrocnemius

Lateral Gastrocnemius

Medial Hamstrings

Biceps Femoris

Gluteus Medius

Tensor Fascia Latae

Gluteus Maximus

Knee Moves Inward (Valgus) Yes

Lateral

No

Arms Fall Forward Yes

No

Excessive Forward Trunk Lean Yes

Posterior 

No

Flattening of Medial Longitudinal Arch Yes

No

Gracillis Popliteus Knee moves inward (Valgus)

Overhead Squat Observations Anterior View: Observations made rom the anterior view o the overhead squat are ocused at the eet and knees. A common compensation at the eet is the oot turning outwardly (toe-out; Figure 2). When observing or the presence o toe-out, the clinician should assess the position o the frst metatarsophalangeal (MTP)  joint in relation to that o the medial malleolus. The 1st MTP joint will align with the medial malleolus in a normal oot, whereas the frst MTP joint will appear lateral to the medial malleolus with oot turn-out. Table 2 lists potentially overactive/tight muscles and

Excessive orward trunk lean

Arms all orward

Hip Adductors

Medial Gastrocnemius

Biceps Femoris (short head)

Medial Hamstrings

Tensor Fascia Latae

Gluteus Maximus

Lateral Gastrocnemius

Gluteus Maximus

Vastus Lateralis

Vasus Medialis

Soleus

Anterior Tibialis

Gastrocnemius

Posterior Tibialis

Hip Flexors

Erector Spinae

Latissimus Dorsi

Middle Trapezius

Pectoralis Major

Lower Trapezius

Pectoralis Minor

Rhomboids

Coracobrachialis

Posterior Deltoid Rotator Cu 

Flattening o medial longitudinal arch

Normal

Foot Turns Out (Toe Out)

Figure 2 psn f t-o s n w  2n maasaanga  jn as wa an aas aa   ma mas.

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Peroneus Longus

Posterior Tibialis

Peroneus Major

Lower Trapezius

Peroneus Tertius

Medial Gastocnemius

Lateral Gastrocnemius

Gluteus Medius

Biceps Femoris Tensor Fascia Latae

 July 2007  11

underactive/weak muscles that have been associated with this compensation.1 Compensations at the knee involve inward or outward movement. Inward movement o the patella over the frst MTP joint (toward the midline o the body) during the squatting movement creates valgus stress at the knee (Figure 3). Table 2 lists potentially overactive/tight musculature and underactive/weak muscles that have been associated with this compensation.1  Lateral View: Observations made rom the lateral view include the lumbo-pelvic hip complex (LPHC) and upper body positions. Two common compensations are excessive orward leaning and arms alling orward. The trunk should remain parallel to the lower leg during the descent phase o the squat. I the two imaginary lines do not remain parallel, orward leaning is excessive (Figure 4). During perormance o the Overhead Squat Test, the arms should be held over the head in an elbow-extended position and parallel to the torso. I the arms move orward in relation to the torso, the observation is designated as “the arms alling orward” (Figure 5). Table 2 lists the potential tight/overactive and underactive/weak musculature associated with these movement compensations.1  Posterior View: Observations made rom the posterior view include the positions o the eet and the lumbo-pelvic hip complex. Normally, the calcaneus should stay parallel with the lower leg; however, a

Normal

Excessive Forward Trunk Lean

Figure 4 psn f xssv fwa an s n wn  nk s n aa  b aa w  w g ng  sn  as f  sqa.

Normal

Arms Fall Forward

Figure 5 psn f ams fang fwa s n wn  ams a n manan aa   nk.

Normal

Foot Turns Out (Toe Out)

Figure 3 psn f kn vags s n wn  aa mvs nwa ng  sn as f  sqa an aa ma av   ga .

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July 2007

common compensation seen at the eet is pronation. During the descent phase o the Overhead Squat Test, the clinician may observe attening o the medial longitudinal arch, along with eversion o the calcaneus in the rontal plane (Figure 6). Table 2 lists the potential tight/overactive and underactive/weak musculature associated with this movement compensation. 1

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the Overhead Squat Test can be trained in a single session to reliably perorm this assessment.

Exercise Recommendations

Normal

Foot Pronation

Figure 6 psn f f nan s n wn  aans aas v av   w g.

Reliability of the Overhead Squat Test Intra-rater reliability o observations recorded during subject perormance o the double-leg overhead squat motion was assessed in a group o 20 subjects (11 emales, 9 males). Photographs were obtained by a digital camera rom anterior, posterior, and lateral views at the point o maximum knee exion. A certifed athletic trainer with no previous experience in scoring the Overhead Squat Test examined the digital photographs rom all views and determined i the ollowing movement pattern characteristics were present: (a) toe-out (anterior view); (b) inward knee movement (anterior view); (c) excessive orward trunk lean (lateral view); (d) arm all-orward (lateral view); (e) medial longitudinal arch attening (posterior view). Analyses were perormed on two occasions separated by 48 hours. Prior to analyzing the digital images, the rater underwent a standard instructional training program. Intra-rater reliability was assessed by calculating the Kappa coefcient between scores rom the two assessment sessions or each movement characteristic. The Kappa coefcient values ranged rom .85 to 1.0 or all movement patterns, except right toe-out (Kappa = .76) and let oot toe-out (Kappa = .75). The fndings suggest that the Overhead Squat Test is a reliable tool or identifcation o aulty movement patterns. Furthermore, individuals without previous experience scoring

Athletic therApy todAy

The inormation provided by the Overhead Squat Test, along with associated measures o muscle length and strength, can help the clinician to design an appropriate intervention program. A treatment approach that has been clinically eective involves stretching o overactive/tight muscles, strengthening o underactive/weak muscles, and utilization o exercises that incorporate unctional movement patterns. 1 For example, an individual who exhibits inward knee movement while perorming the overhead squat may have overactive/ tight hip adductors, with the gluteus medius underactive/weak. The clinician could utilize an inhibition technique or the hip adductor complex, such as rolling on a oam roller (Figure 7). Oten there are tender points in these muscles that are painul when pressure is applied. Placing constant pressure on the tender points or 30 seconds is thought to decrease muscle spindle activity in the overactive muscle. The next step would be to stretch the inhibited muscle (Figure 8). In this case, one could perorm a standing hip adductor stretch or 20-30 seconds. Once the overactive/tight muscle group is inhibited/lengthened, the ocus would be directed to activation o the weak gluteus medius. Hip abductor muscles may play a vital role in controlling knee valgus motion, especially in emale athletes.4 An isolated resistive movement pattern could be used to increase activity in the weak muscle (Figure 9). The last component o the intervention would involve activation o the gluteus medius in a unctional movement pattern, such as lateral tube walking (Figure 10). This treatment approach can be utilized to address the various compensation patterns identifed by the Overhead Squat Test.1

Figure 7 inbn f   as fm sng sf-mfasa as n a fam .

 July 2007  13

Figure 8 lngnng f  f 

Figure 9 isa avan an sngnng f   abs

Figure 10 ingan f  

a g fm sng sa sng.

fm ng a s ng sng g f.

abs n a fnna mvmn an fm ng aa b wakng

In conclusion, the Overhead Squat Test can be a useul or identifcation o movement dysunction. This results o this test can be related to clinical measurements o muscle length and strength to develop a corrective exercise plan to improve movement patterns and possibly reduce the potential or musculoskeletal injury. 

References 1. Clark M, C orn RJ, Lucett S. Corrective Exercise Specialist . Calabasas, CA: National Academy o Sports Medicine; 2005.

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July 2007

2. Ford KR, Myer GD, Hewett TE. Valgus knee motikon dur ing landing in high school emale and male basketball players. Med Sci Sports Exerc. 2003;35(10):1745-1750. 3. Yu B, McClure SB, Onate JA, Gus kiewicz KM, Kirkendall DT, Garrett Jr. WE. Age and 7 gender eects on lower extremity kinematics o youth soccer players in a stop-jump task. Am J Sports Med. 2005;33(9):13561364. 4. Hewett TE, Myer GD, Ford K, R. Anterior cruciate lig ament injuries in emale athletes, 10 Part 1. Mechanisms and risk actors.  Am J Sport  Med. 2006;34:299-311. Chris Hirth

is a lecturer in the department o Exercise and Sport Science at the University o North Carolina–Chapel Hill. He also serves as a Sta Athletic Trainer and Physical Therapist at the James Taylor Campus Health Service.

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