Faulty Movement Patterns
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1 Faulty Movement Patterns Functional Evaluation and Prague School Test (part 1) Instructor: Dr. Craig Liebenson, DC Quantitative Functional Capacity Evaluation: 1. Side Plank Endurance 2. Forward Plank Endurance 3. Trunk Flexor Endurance - V Sit 4. Back Extensor Endurance - Sorensen s Test 5. One Leg Standing Balance 6. Cervico-Cranial Flexion Incoordination 1. Side Plank Endurance Test: p , Top hand held across chest with hand on bottom shoulder pulling down to stabilize Lift hips off floor to create a straight line over the body length Failure if: Loss of straight back posture (height) (1 verbal warning given) Pain Pages: 1 of 8
2 Dysfunction: - <45 seconds - Asymmetry of > 5 sec. McGill S, Childs A, Liebenson C. Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normative database. Arch Phys Med Rehabil, 1999;80: Forward Plank Endurance Test Elbows under shoulders Hands together Forearms in a V position Bridge off floor w/ torso straight Failure if: Loss of straight back posture (height) (1 verbal warning given) Pain Dysfunction: Males <90s/ Females <60s McGill S, Belore M, Crosby I, Russell C. Clinical tools to quantify torso flexion endurance: Normative date from student to firefighter populations. Occupational Ergonomics 2010;9: Pages: 2 of 8
3 3. Trunk Flexor Endurance Testing: The V Sit - p Back Extensor Endurance Test: p , Trunk extensors are normally in a 1.3:1 ratio with Trunk flexors In LBP subjects the ratio is 1:1 McGill S, Childs A, Liebenson C Leg Balance Test: p , Balance Scoring: Record time when: Hop Move foot 2 trials EO (60s max) & EC (30s max) each leg Best score EO & EC is recorded If 60s EO or 30s EC is achieved test no 2nd test is performed Reach out & touch something with either hand Maribo T, Iverson E, Andresen N, Stengaard- Pedersen K, Schiottz- Christensen B. Intra- observer and interobserver reliability ofone leg stand test as a measure of postural balance in low back pain patients. Int Musc Med 2009;31: Pages: 3 of 8
4 6. Cranio-cervical flexion incoordination: p , Pts w/ headache or chronic neck pain were less able than asymptomatics to control progressively range of C0-C1 flexion. Jull G, Barret C, Magee R, Ho P : Further clinical clarification of the muscle dysfunction in cervical headache. Cephalgia 19: ,1999. Jull GA. Deep cervical flexor muscle dysfunction in whiplash. Journal of Musculoskeletal Pain 8: , C0-C1 Chronic Neck Pain vs Asymptomatic Subjects: activity in the deep neck flexor muscles Incr. activity of the superficial SCM muscles Reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles Falla DL, et al. Spine. October 1, 2004; Vol. 29, No. 19, pp Pages: 4 of 8
5 C0-C1 A positive test occurs with: Loss of pressure on cuff Start at 20 mmhg Progress to 22/24/26/28/30 Needle must remain still for 10 reps/10 seconds each No over activity of superficial neck muscles (SCM) No chin poking No breath holding Prague School Tests: 1. Diaphragm Test 2. IAP Test 3. Neck/Trunk Flexion Test 4. Arm Lifting Test 5. Hip Abduction 6. Vele s Forward Inclination Pages: 5 of 8
6 1. Diaphragm Test: p The Diaphragm test Normal: The lower chest expands symetrically in a lateral direction Intercostal spaces widen Ribs must not be lifted! Results of Inspiratory position of thoracic cage: Oblique diaphragm Failure of oblique abdominal muscle slings T/L overload Hyperlordosis Lower Cross Syndrome (Janda) Horizontal Axis of Diaphragm Why does depression of thoracic cage matter in both phases of breathing? 2. Intra-abdominal pressure test: p Initial position: Patient supine Triple flexion of the legs The lower legs supported Pages: 6 of 8
7 Hip abduction corresponds to the width of the shoulders, slight external rotation at the hips Intra-abdominal pressure test The therapist brings the patient s chest passively into the caudal, expiratory position Then the support is removed from under the patient s legs The patients holds this position actively Maintain co-contraction of deep muscles Hold exhalation position of ant-inf ribs during normal respiration 3. Trunk and Neck Flexion Test: p557 McGill/Janda variations -p Arm Lifting Test: p557,558 Dying Bug w/ Med Ball OH 5. Hip abduction Test: Dysfunction: weak or feel low back Hip hike - QL OA Hip flexion - TFL OA Pages: 7 of 8
8 6. Vele s Forward Inclination: Sign of Instability: L/P hinge Failure of toes to grip Asymetric grip Pages: 8 of 8
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