Functional Assessment of The Lower Kinetic Chain Dr. Anthony Luke - - PowerPoint PPT Presentation

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Functional Assessment of The Lower Kinetic Chain Dr. Anthony Luke - - PowerPoint PPT Presentation

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1 2 Introduction & Thank You Functional Assessment of The Lower Kinetic Chain Dr. Anthony Luke Dr. Carlin Senter UCSF Primary Care Sports Medicine Jason Miyamoto, ATC Course San Francisco December 11 th , 2015 Dr. Nirav Pandya

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Functional Assessment of The Lower Kinetic Chain

UCSF Primary Care Sports Medicine Course San Francisco December 11th, 2015

Michelle Cappello, PT, SCS, MSPT Ryan Sargent, MBA, MS, ATC

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Introduction & Thank You

  • Dr. Anthony Luke
  • Dr. Carlin Senter

Jason Miyamoto, ATC

  • Dr. Nirav Pandya

Ryan Sargent, ATC

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Objectives

  • Define Function in the context of athletic movement

skills

  • To present and demonstrate five functional movement

the clinician can use in the office.

  • To provide value to data from these five functional tests

and how to apply it to the patient’s plan of care

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The Mission

Our Mission To Protect and Advance the Health and Well-being of Children Through Clinical Care, Teaching, and Research

Photo by Tom Minczeski 86 Magazine Photo by Tom Minczeski 86 Magazine

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Define Function

func·tion

  • 1. an activity or purpose

natural to or intended for a person or thing.

  • 2. perform

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Antonyms of Function

Inactivity, idleness… Sit: to rest with the body supported by the buttocks, to remain inactive

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Our Mission To Protect and Advance the Health and Well-being

  • f Children [people]…

The body is a motion machine; If it stops moving, it’s systems slow down: muscular, lymphatic, digestive and circulatory

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  • Slouching is depressing (2012 SF State)
  • Poor digestion: squished organs is like stepping on a garden hose
  • Compression: Slumped sitting adds 175% more intradiscal pressure
  • vs. standing. Shallow breathing – diaphragm is a spinal stabilizer
  • Immobility leads to further immobility – we lose our S curve in our

spine and can’t absorb shock

  • Immobility leads to heart disease: the heart needs increased effort to

pump blood that pools in the lower body

  • So, Straighten up & MOVE

Our Mission To Protect and Advance the Health and Well-being

  • f Children [people]…
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Primal “Natural” Movements

Rolling Crawling Squat Lunge

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Primal “Natural” Movements

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Primal “Natural” Movements

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Primal “Natural” Movements

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What Is Functional Testing? And Why you should do it?

  • Ability to move in multi-planar directions as assessed

via non-traditional testing.

  • Test provide qualitative and quantitative information
  • Activities in daily living
  • Building blocks of movement in context of life & sport
  • Relates to developmental mile stones in critical stages
  • f growth

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How & Why Move

Afferent Input – joint position senses information Muscle Balance – agonist/antagonist, tight/weak Reflexive / Automatic Activation – ON/OFF, stabilize to mobilize Muscular Endurance – coordination of movement patterns, posture

Lower Crossed Syndrome www.jandaapproach.com

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Structure vs. Function

Functional Continuum Identify the Source vs. the Cause of symptoms Painful Limited Plan of care: training mobility vs. stability

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Lower Quarter Screen

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Definition of Tests

1.Deep Squat 2.Single Leg Balance 3.Single Leg Squat 4.Hop for Distance 5.Front Plank/Push-up Test

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Standing Dynamic Functional Positions

typically find an athlete in 1 of 3 positions when engaged with the ground

= = =

Test in these positions to test how stable and mobile they are so we know were to go in our training programs

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Deep Squat/Overhead Deep Squat

  • Purpose

– Assess mobility of hips, knees, and ankles – Overhead reach for thoracic spine and shoulders

  • Procedure

– Position the client/athlete so that they are standing with feet shoulder-width apart. – Overhead squat: Hold the dowel so that a 90°angle is formed at bilateral elbows when the dowel is just above the head. – Have client press the dowel overhead until bilateral elbows are extended. – Instruct client to gradually descend into a squat position with bilateral heels on the floor and the dowel extended maximally overhead.

  • Analysis of optimal movement

– Upper torso parallel with tibia – Femur below horizontal – Knees aligned over feet – Down aligned over feet

  • Interpretation of movement faults

– Limited mobility – Strength deficit in quads or gluteals

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Deep Squat

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Single Leg Balance

  • Purpose

– Observe pelvic control for functional stability – Indicator of balance strategies – Single-leg stance indicative of mid-stance

  • Procedure

– Stand on one leg – Raise opposite hip to 45°/ knee to 90° – Arms at side

  • Analysis of optimal movement

– Look for excessive pelvic shift – Note pelvic unleveling – Excessive shaking or rotation of knee or ankle

  • Interpretation of movement faults

– Inhibition or weakness of lateral pelvic stabilizer – Over-dominance of hip medial rotators – Poor proprioception

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Single Leg Balance Coaching Points

GOOD BAD

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Single Leg Squat

  • Purpose

– Assess Functional Strength – Assess Balance – Assess Dynamic Flexibility

  • Procedure

– Stand on single leg – Keep Trunk and Upper Body Upright – Squat down as far as possible

  • Analysis (Qualitative)

– Watch for excessive knee flexion – Note loss of balance or uncontrolled motions

  • Interpretation

– Poor Glute or Quad Strength – Poor Balance – Decreased Trunk Control

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Single Leg Squat Coaching Points

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Single Leg Hop for Distance

  • Purpose

– Functional lower extremity test – as part of a Hop Test sequence as described by Noyes. Noyes FR, Barber SD, Mangine RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991; 19: 513– 51 – Assess overall single lower extremity power, balance and control as it relates to limb symmetry

  • Procedure

– Keep hand placement consistent – i.e. hands on hips, behind the back, free – Jump Horizontally as far as possible – Hold landing position for 2 seconds

  • Analysis

– Based on distance jumped – Determine limb symmetry – Quality is important Karyn Haitz, Rebecca Shultz, Melissa Hodgins, Gordon O. Matherson, J Ortho Sports Phys Ther 2014.

  • Interpretation

– Relationship between asymmetry and limitations in jumping/landing in healthy athletes have < 9% difference. – Mean values: Men 154.5 cm Women 121.2 cm

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Hop for Distance Coaching Points

Hop Test Sequence

4 Hop Test Sequence:

  • Single-leg Hop
  • Timed Hop Over a 6-m Course
  • Triple Hop
  • Crossover Hop

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Front Plank/Prone Bridge

  • Purpose

– To assess static/isometric trunk endurance and control

  • Procedure

– Prone on elbows – Elbows shoulder width apart – Feet in narrow base without touching – Elevate trunk so only forearms and toes are on the ground – Maintain shoulder, hips, and ankles in a straight line – Hold until fatigued, record time

  • Analysis

– Record time until athlete is no longer able to hold position

  • Interpretation

– Significant decreased time in those with back pain – Mean Values in seconds: – Clients without back pain = 72.5 s, Clients with back pain = 28.3 s (pain generated at 15 seconds)

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Front Plank/Push Up Coaching Points

GOOD BAD

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Lower Quarter Screen

Post Testing Pre Testing

Drop Jump Drop Jump Deceleration Deceleration Peak VIT Peak VIT 31

Questions?

Ryan Sargent, MBA ATC Program Manager of Athlete Development rsargent@mail.cho.org Michelle Cappello, PT, SCS Clinical Director Sports Medicine Center for Young Athletes mcappello@mail.cho.org