Movement Links Certification Material

 Movement Links Certification Material

What is the ideal scapula alignment?

- positioned between T2 and T7

- medial border parallel to spine

- distance between spine and border: 3 inches

- "hugs" thorax and resting 30 degrees anterior of frontal plane

What is the normal clavicle position?

AC joint should be higher than the SC joint.

What should you suspect if you see horizontal clavicles?

Suspect depressed position of scapula

(Confirm scapular depression if superior angle of scapula is lower than T2)

How do you test for scapular muscle tone deficiency?

If you can get more than 1st IP under the inferior angle

What should you suspect if you see scapular muscle tone deficiency?

Lower trapezius and/or medial scapular stabilizer insufficiency

What does deltoid flatness tell you?

Early sign of shoulder dysfunction and/or C4 lesion

What is a positive test for head-neck position and does a positive test indicate?

lateral view of the head-neck should be 90 deg. If greater than 90 deg = positive. This indicates insufficiency of deep neck flexors

What is the ideal humeral alignment?

- Humeral head no more than 1/3 anterior to the acromion

- Olecranon faces posteriorly

- horizontal cubital crease

What are possible deficits of the abdomen and what does it mean?

Infrasternal angle: If >100 deg = IO dominance. <75 deg = EO dominance. Normal = 90.

- Lateral groove: abdominal incoordination

- abdominal crease: most likely dominance of upper portion of rectus abdominus

- Rib cage protrusion: reduced diaphragm and abdominal activation contributing to decreased IAP regulation necessary for spinal stability

- "pseudohernia": lateral bulge of abdominal wall = can indicate transverse abdominus insufficiency

If you see VMO hypertrophy, what can that indicate?

Possible from activities requiring knee hypertension

What does a "twitching" patella mean?

Inadequate proprioception from feet

How does ITB tightness present in males and females?

Females: flat

Males: groove

What should you test if you see medial rotation of the arms?

- Tightness of pecs/lats

- scapular protraction

What are possible faults of the single limb stance test and what does it mean?

- Excessive pre-shift > 1 inch (lateral pelvic shift): inhibited/weak glutes

- contralateral pelvis drop: weak glutes

- contralateral hip hike: QL substitution

- pelvic rotation/femoral internal rotation: stiff/dominant TFL/IT band

- Excessive trunk sway or inability to balance

Single limb stance test for proprioception 30 seconds norms?

20-49: 24-29 seconds

50-59: 21 seconds

60-69: 10 seconds

70-79: 4 seconds

What are the possible gait corrections?

hands on hips (compression) or hands overhead: if better = impairment is trunk stabilization. If doesn't get better = more hip or lower quarter issues

walk backwards: if better = work on glute inhibition

if no change = look at hip flexor length & IAP

What is a common movement fault with AROM lumbar extension?

Excessive segmental extension or hinging (crease)

What does normal sidebending look like?

Gradual C-curve

Movement errors with sidebending?

Curve is not smooth

Pivot at a particular segment

Lateral translation before sidebending

Where do you block in sidebending to try to help decrease the patient's pain?

Block as close to the pain as possible (put your hands where the crease is going to be and pull towards you)

What are corrections you can perform with the partial squat?

1. give supination cue at the foot

2. give ER to the femur to act as glutes

3. give tactile cue at greater trochanter to posteriorly shift femur

What are common movement errors in the partial squat?

- excessive lumbar flexion or extension

- excessive femoral internal rotation/adduction medial collapse

- excessive or inadequate pronation

- knee coming past the toes = quad dominant stretegy or decreased glute performance

Knee extension movement test in sitting: + signs?

if you see femur internal rotation = could mean stiff TFL and/or medial hamstrings

Sitting hip flexion test: + signs?

Trunk shift = assessing stability of T/L junction

What should you be looking for in supine A/PROM hip flexion test?

assess abdominal stability in sagittal plane

pelvic rotation when feeling ASIS with thumbs

Straight leg raise (glide test): assessment and + signs?

PICR of the femur: if hip/groin symptoms/pain are present during active hip flexion and/or knee flexion

if greater trochanter glides anteriorly or medially

Supine bent knee fall out: assessment and + signs?

abdominal stability in transverse plane

contralateral ASIS should not move more than 1/2 an inch before 50% of the available ROM

Curl-up movement test: assessment and + signs?

patient hooklying with PT hands underneath their heels

+:

- heel pressure decreases = hip flexor dominance

- anterior pelvic tilt

- trembling of muscles

Functional ankle dorsiflexion lunge test: assessment and + signs?

Normal: 4 inches from the wall with >35-38 degrees

= should be able to touch knee to wall

How do you test for piriformis end feel?

If it is above 60 degrees: longitudinal femoral compression with adduction and ER

If it is below 60 degrees: longitudinal femoral compression with adduction and IR

Prone knee flexion: normal test?

Knee flexes to 120 degrees without pelvic tilt, or lumbar rotation or extension

What are the common faults of the prone knee flexion test and what does it mean?

knee flexion <110 degrees: short quadriceps

Anterior pelvic tilt: stiff rectus femoris & deficient abdominal control

Pelvic rotation: stiff TFL + deficient abdominal control

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Prone hip rotation: normal test?

No pelvic movement in the first 50% of motion

What are the common faults of the prone knee rotation test and what does it mean?

limited rotation: imbalance between rotators + deficient abdominal control

Early pelvic motion: excessive lumbar movements

What is considered normal in the quadruped rock back test for LQ?

hips flex and lumbar spine remains flat

What are the common faults of the quadruped rock back test and what does it mean? (LQ)

Flexion of spine during first 50% of motion: long lumbar extensors, short/stiff rectus abdominus and hip extensors

Rotation of lumbar spine: paraspinal imbalance

Decreased hip flexion: short/stiff glute max & piriformis

Pelvic rotation: asymmetric short/stiff glute max & piriformis

What are the common faults of the quadruped rock forward test and what does it mean? (LQ)

marked extension at lower segments: excessive flexibility of spine + short hip flexors

What are the common faults of the sitting knee extension test and what does it mean? (LQ)

Lumbar spine flexes: hamstrings stiffer than lumbar spine + long lumbar paraspinals

Lumbar spine rotates: hamstrings stiffer than lumbar spine + unilaterally long lumbar paraspinals

Knee extends to <75 degrees: short hamstrings

Hip IR: short medial hamstrings + TFL dominance and inappropriately recruited

Ankle DF < 10 deg: short plantarflexors

What is considered normal for the siting knee extension test?

Lumbar spine remains flat and knee extends to within 10 degrees with hip flexed to 90 degrees and ankle DF at 10 degrees

What are the clinical definitions of anteversion and retroversion?

>15 degres IR = anteversion

< 5 degrees IR = retroversion

What is the normal sequence of prone hip extension movement pattern test?

Hamstrings --> glute max --> contralateral lumbar extensors --> ipsilateral lumbar extensors --> contra thoracolumbar extensors -> same side thoracolumbar extensors

Where are the 3 areas of proprioception?

- cervical spine

- pelvic girdle

- sole of foot

How do you perform post isometric relaxation?

take up slack to first barrier --> pt gently pushes 10-20% -> have pt breathe in and out --> take up further slack and repeat 3-5 times

How do you perform a post facilitation stretch?

Max hold at mid range for 7 seconds --> QUICKLY move to end-range and hold for 15 seconds -> rest for 20 seconds and repeat 5 times

What are the different ways to strengthen the foot intrinsics?

- x pattern around back of foot and toes with theraband

- manual correction into supination

- double heel raises with band

- forward lean practice

What are the 5 levels of abdominal strengthening?

Level 1 = marching

Level 2 = heel slide with return

Level 3 = marching with opposite foot hovering above the mat table

Level 4 = double heel slide

Level 5 = double knee extension without touching the mat table

What are the priciples of sensorimotor training?

- Posture: cervical, lumbar and foot positioning

- Proper breathing/IAP regulation

- Control: control center of gravity and eccentric movement

What are the criteria for normal scapular motion by the end of arm elevation?

- scapula elevates but only slightly (6-10 deg)

- acromion should be aligned with C6-C7

- Scapula upwardly rotates to about 60 degrees

- Inferior angle reaches approximately to the midline of thorax

- scapula posteriorly tilts to 10 deg

Possible impairments for downwardly rotated scapula?

long upper traps or serratus anterior

short/stiff levator scapula & rhomboids

Short deltoids & supraspinatus

Possible impairments for depressed scapula?

long upper trapezius

Possible impairments for abducted scapula?

short serratus anterior

short/stiff scapulohumeral muscles

long rhomboids & traps

Possible impairments for adducted scapula?

short = rhomboids & traps

long serratus anterior

Possible impairments for winging/tilt scapula?

short/stiff scapulohumeral mm

short pectoralis minor

weak serratus anterior

rib hump

flat thorax

Possible impairments for elevated scapula?

short upper traps, levator scapula, rhomboids

Possible impairments for superior humerus?

short deltoids

insufficient rotator cuff

Possible impairments for anterior humerus?

stiff posterior capsule

long supscapularis

pectoralis dominance

Possible impairments for insufficient upward rotation/abduction of scapula in shoulder elevation?

short/stiff rhomboids

long serratus anterior

Possible impairments for excessive scapular elevation in shoulder elevation?

dominant upper trapezius

Possible impairments for scapular winging in shoulder elevation?

short/weak scapulohumeral muscles

long/weak serratus anterior

Possible impairments for winging in return from shoulder elevation?

short scapulohumeral mm

dominant pec minor

scap-hum mm not elongating as rapidly as thoraco scap mm

What is normal for shoulder ER test?

should not see scapular adduction in the first 35 degrees of shoulder ER

What are common faults of the shoulder ER test and what does it mean?

early scapular adduction: rhomboids are dominant/poor control of shoulder ER

Humeral head moves: posterior deltoid more dominant than infraspinatus and teres minor

What are common faults of the shoulder abduction test?

early girdle elevation with less than 60 degrees of humeral movement

Increased humeral internal rotation

What is normal for supine ER with shoulder 90/90?

90 degrees with good PICR

What are common faults of the supine IR with shoulder at 90/90?

<70 degrees: short/stiff infraspinatus & teres minor

Scapular anterior tilt: external rotators stiffer than lower traps

Anterior glide of humerus: laxity of anterior joint capsule

What are common faults of the supine ER with shoulder at 90/90?

<90 degrees: short teres major/subscap/pec major

Anterior or superior glide of humerus: stiff ER muscles, laxity of anterior joint capsule

What is normal for supine IR with shoulder 90/90?

70 degrees with good PICR

What are common faults of the prone IR with shoulder at 90/90?

<70 degrees: short/stiff infraspinatus & teres minor, posterior deltoid

Scapular anterior tilt: long/weak lower traps

Anterior glide of humerus: laxity of anterior joint capsule, stiff/short teres minor, infraspinatus, posterior delt

Scapular elevation: dominant upper traps

What are common faults of the prone ER with shoulder at 90/90?

<90 degrees: short teres major/subscapularis

Anterior or superior glide of humerus: laxity of anterior joint capsule, dominant posterior deltoid (note extension of arm)

Scapular abduction: long/weak traps and rhomboids

Scapular depression: dominant lower traps and lats + timing problem with GH external rotators

What is considered normal for the quadruped rock back test (UQ)?

Head and neck remain level

Scapula remain in constant position on thorax with upward rotation and abduction as the shoulder flexes

What are common faults of the quadruped rock back test and what does it mean (UQ)?

Prominent levator scapulae: levator scap is dominant as neck extensors

Cervical spine/head extends: short/dominant levator scap

Rotation of CS and head: same side levator scap is short, opposite side upper traps are dominant

Shoulder girdle elevates: short/stiff levators, upper traps, rhomboids + long/weak lower traps

Shoulder girdle depresses: short/stiff latissimus dorsi

Excessive scapular abduction: short/dominant serratus anterior + long/weak lower trapezius

Not enough scapular upward rotation: short/stiff rhomboids

What is considered normal for the quadruped rock forward test?

Scapula stays flat on the thorax

What are common faults of the quadruped rock forward test and what does it mean?

Winging: long/weak serratus anterior

Increased scapular adduction

Increased upper trap activation

What is considered normal for shoulder flexion in quadruped?

Thoracic and lumbar spine remain still

What are common faults for shoulder flexion in quadruped and what does it mean?

Rotation of the thoracic spine is greater than 1/2 an inch with shoulder flexion = POOR ABDOMINAL CONTROL

What are the common faults of the scapular test at 0 deg and at 90 deg (pushing against the wall)?

Increased scapular anterior tilt

Increased scapular internal rotation

Increased scapular downward rotation

If your patient has pain with shoulder flexion AROM, what are some corrections you can perform?

Assisted upward rotation

Assisted posterior tilt

What is considered normal for the posterior shoulder mm length test?

elbow should cross to at least midline without scapular movement

What is considered normal for the pectoralis major mm length test?

shoulder elevation to 135 deg for sternal and 90 deg for clavicular

Should be able to touch arm to table

Clare says =

Sternal = 10-15 degrees below table at 135 abduction

Middle = 30 degrees below table at 90

Clavicular = "arm should hang freely below table" in extension

What is considered normal for the biceps short head mm length test?

Elbow should fully extend with forearm pronation without any movement of the shoulder joint

What are common faults for the active arm elevation test?

Before 120 degrees of shoulder elevation:

- T/L extension

- rib flare

What is considered normal for the head flexion movement pattern test?

O-A nodding + cervical flexion

What are common faults for the head flexion movement pattern test?

- early chin jutting during the first 10 degrees

- SCM prominence

- trembling of mm

- rib flaring/elevation

What are the norms for the deep neck flexor endurance test?

Males: 38.9 +/- 20/1 seconds

Females: 29.4 +/- 13.7 seconds

How do you find the end-feel for the upper trapezius?

Flexion --> sidebend away -> rotate towards the side being stretched

How do you find the end-feel for the levator scapulae?

Flexion --> sidebend away -> rotate away from the side being stretched

If you see a crease in the shoulder with lower trap performance testing, what does it mean and how do you fix it?

Rhomboids trying to compensate by going into shoulder IR = thumb up testing for more ER

What is considered normal for the push-up test?

minimal to no movement of the scapulae until the end of the push-up into scapular abduction

What are positive findings for the push-up test?

- scapular adduction "kissing scapula"

- scapular elevation

- scapular internal rotation (winging)

What are the criteria for sway back? Possible impairments?

shoulders >2" posterior to greater trochanter

Infrasternal angle: Normal, IO dominant, EO dominant

Normal 90 degrees

>100 degrees: short IO (dominant), long (insufficient) EO

<75 degrees: short (dominant) EO

What are the possible impairments for sway back posture?

Possible impairments: long EO, short RA and IO

What is the criteria for paraspinal assymetry? Possible impairments?

>1/2" difference when measured from 2" lateral from spinous process

What are the possible impairments for paraspinal assymetry?

- hypertrophied paraspinals

- spine rotated to prominent side

- scoliosis

Pelvis normal alignment

Normal: line between ASIS and PSIS within 15 degrees of horizontal line

Pelvis Anterior Pelvic tilt criteria and possible impairments?

ASIS 20 degrees lower than PSIS

Possible impairments: long EO, short hip flexors

Pelvis Posterior Pelvic tilt criteria and possible impairments?

ASIS 20 degrees higher than PSIS

Possible Impairments: short abdominals, long iliopsoas

Pelvic rotation criteria and possible impairments?

ASIS on 1 side anterior to the other side

Possible Impairments: TFL short on side toward which pelvis is rotated (MR)

Pelvic lateral tilt: hand position to check, criteria, impairments associated with high and low side

web-space on hand of iliac crest

1 iliac crest is >1/2" higher than the other

Possible Impairments: high side = long abductor mm; low side= short hip abductor mm

Hip joint: assessment from lateral view, criteria for flexed/extended hip

Angle made between line bisecting pelvis and line bisecting femur (locate greater trochanter)

Flexed >10 degree hip flexion

possible impairments: shoft hip flexors

Extended >10 degrees hip extension

possible hip flexors long illiopsoas; short hams

What are possible impairments for knee hyperextension?

possible impairments:

- weak quads

- inadequate ankle dorsiflexion

- insufficient glute strength

- joint hypermobility

- habitual standing habit

What does a thickened achilles tendon indicate?

Typically indicative of previous ankle/foot injuries

What are the three shapes of the heel and what does it mean?

Rounded: normal

Quadratic: posterior center of gravity

Pointed: anterior center of gravity

What is the relevance of anterior and posterior center of mass in standing (not the foot)?

Anterior: stresses lumbar spine into extension and increases paraspinal activity which further increases compresses forces onto lumbar segments

Posterior: overuses anterior musculature

How do you confirm hypertrophied vs rotated segments?

With sidebending

Hypertrophied: contralateral side bending is limited

Rotated group dysfuntion: ipsilateral side bending is limited

What structure is implicated in a pronated foot? What is a possible impairment?

longitudinal arch flattened

possible impairments: long posterior tib

What does a rigid foot do during a partial squat? What are possible impairments?

Supinated

does not flatten during partial squat

possible impairments: decreased DF range

*should see flattening for shock absorption

Hammer toes occur at what joint in the toes? possible impairments?

PIP joint flexion

Possible impairments: toe flexor and extensor short; tend to keep COM posterior during sit-stand

What are the criteria for a normal partial squat? (knee position)

NORM = knee flexes 45 degrees with heel on ground; knee over 2nd toe

Single leg stance NORM

no change in pelvic tilt or rotation

What is occuring if there is lateral trunk flexion with SLS? What are the possible impairments?

SB towards stance leg

possible impairments: weakness of stance hip abductors, weak and long stance hip abductors

What is occurring if there is hip adduction with SLS? What are the possible impairments?

trendelenburg

possible impairments: weak glutes

What is occurring if there is posterior rotation in the transverse plane (femoral internal rotation) in SLS? What are the possible impairments?

long and weak hip LR, stiff/ dominant TFL-ITB (short MR)

What should a normal forward bend look like?

70 degrees hip flexion

Hip flexion should preced lumbar flexion

Final position: 20 degrees of flexion in lumbar spine; reversal of curve

What does it mean if there is a decreased reversal of curve during lumbar flexion? What tests would you do to confirm?

possible impairment:

short lumbar extensors

hypomobile spinal segments

TESTS: mobs, HF length, hip extension mvt test, IAP test

What are the norms for lumbar flexion - hip flexion angle for men and women? What does it mean if the angle is too large?

men: <75 degrees; possible impairments = short/stiff lumbar extensors, hypomobile hips

Women: <85 degrees; possible impairments = long trunk, higher COM

>100 degrees; possible impairments = long hams/ hip extensors, possible hypermobility

What does it mean if the ischial tuberosities shifts posteriorly >5 inches from the heel in forward bending?

Hypomobile ankle joint/tight calves

short hamstrings

neural tension/gliding dysfunction

Return from FWB NORM

movement initiated with hip extension

What does it mean if a patient returns from FWB primarily initiated by the spine and not the hips?

short lumbar extensors, short hip flexors

What does it mean/what impairments might be present if a patient returns from FWB with hip sway?

Marked DF, forward sway of hips with lumbar extension

*will usually see upper trunk lined up behind hips when returned to normal stance

Possible impairments: weak hip extensor muscles

Rotation NORM

Symmetrical rotation of about 30 degrees between T8-T11

Supine knee to chest NORM

hip flexes 120 degrees before spine moves

What could it mean if supine knee to chest is <120 degrees?

short/stiff Gmax

What could it mean if supine knee to chest is >120 degrees or sacrum lifts off of the table?

long lumbar paraspinals + stiff hips

What is an impairment possible during AROM lumbar extension? What would you test for if this occurred?

occurs from hinged point (pivots at the horizontal crease)

Possible impairments:

- Hypomobile spinal segments above or below hinged point

- short hip flexors

- stiff/short paraspinals

- impaired trunk muscle coordination

What does normal sidebending look like?

Symmetrical curve thorughout LS with most SB occuring in lower thoracic spine

SB Decreased ipsilateral SB***??

Spine rotated to prominent side (increased paraspinal bulk) = short/stiff paraspinals

SB increased ipsilateral SB***???

spine rotated to same side

What does normal straight leg raise look like?

80 degrees hip flexion, Greater trochanter maintains a constant position (PICR)

SLR with greater trochanter moves ant/posterior impairments

stiff posterior capsule, short hams

What are the possible impairments if a patient demonstrates femoral internal rotation with SLR?

Long and insufficient iliopsoas

Long and stiff external rotators

What does normal hip abduction/ bent knee fallout asses?

assesses abdominal stability in the transverse plane

What does a failed bent knee fallout pelvic rotation look like? What are the potential impairments?

pelvis (contralateral ASIS) rotates >1/2" during the first 50% of LE motion

Impairments: abdominal control deficiency (IO and contralteral EO)

Assessment of pelvic tilt, should consist of what 2/3 findings?

1. increase or decrease in the depth of the lumbar curve

2. marked deviation from the horizontal line between ASIS and PSIS

3. increase or decrease in hip joint angle with neutral knee joint alignment.

What are the 3 criteria for femoral internal rotation when assessing the alignment of the femur?

1. bulk of medial HS more posterior than lateral HS

2. palpate femoral condyles (should be in the same plane) - medial condyle more posterior

3. Popliteal crease (should be horizontal), oblique angle

popliteal crease: what's normal and if there is an oblquity what are the deviations observed during specific phases of the gait cycle?

normal is horizontal or slight downward slope

Excessive obliquity = femoral internal rotation during loading response in gait OR excessive tibial external rotation during knee flexion in swing phase

3 Main phases of degenerative disorders of the spine

Temporary dysfunction, segmental instability/hypermobility, hypomobility

What is the path of instantaneous center of rotation (PICR)?

a point about which a rigid body rotates about a given instant of time. A major determinant is the forced couple action on the joint. Equal and opposite forces.

What is a MSI (Movement System Impairment)

An alteration in the precision of motion is an impairment. Syndrome because multiples impairments contribute to the altered motion.

What is an MSI diagnosis?

Named for movement direction or alignment that most consistently elicits symptoms and when corrected, reduces symptoms.

What muscles of the tonic system?

FLEXORS: prone to tightness

What muscles of the phasic system?

EXTENSORS: prone to weakness and inhibition

What movements are consistent with tonic chain/muscles of the upper quarter?

flexion, IR, adduction, pronation

What movements are consistent with phasic chain/muscles of the upper quarter?

extension, ER, abduction, supination

What movements are consistent with tonic chain/muscles of the lower quarter?

PF, IV, hip flexion, IR, adduction

What movements are consistent with phasic chain/muscles of the lower quarter?

DF, EV, hip extension, ER, abduction

Upper crossed syndrome

TONIC: tight pecs, suboccipitals, UT, levator; PHASIC: weak/inhibited DNF, MT and LT, serratus.

What are the most common sites of joint dysfunction with upper crossed syndrome?

Most common sites of jt dysfunction = C0-C1, C4-5, Shld, T4

Lower crossed syndrome

TONIC: tight hip flexors and Thoraco-lumbar extensors; PHASIC: weak/inhibited abdominals and gluts.

What are the most common sites of joint dysfunction with lower crossed syndrome?

Most common sites of jt dysfunction = L4-5, L5-S1, SI, Hip

Lower crossed syndrome A

Imbalance of hip musculature, associated with hip pathology, deeper short lordosis

Lower crossed syndrome B

Imbalances of abdominal and lumbar muscles, associated with thoraco-lumbar pathology, shallow long lordosis

What is functional joint centration and what is it's purpose?

Dynamic neuromuscular strategy that leads to the optimal joint position that allows for the most effective mechanical advantage. Allows for optimal load transference across the joint and along the kinetic chain.

Posture

The "speech" of the brain. Adopted in any position, is a reflection of the neuromuscular status of the person. Directs the clinician to appropriate joint mobility, muscle length, or strength tests to confirm what is observed in a static position.

What do you look for when using the baseline static approach in assessing posture?

base of support (WB areas), alignment, symmetry, soft tissue "folds and creases", muscle tone.

What is a stiff muscle?

muscle can be taken passively into FULL length (ROM) but has increased resistance, may also have trigger points

What is a short muscle?

Muscle does not reach full length when taken passively, may also have increased resistance and trigger points.

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