1 2 Functional Assessment of The Lower Kinetic Chain UCSF Primary Care Sports Medicine Course San Francisco December 11 th, 2015 Michelle Cappello, PT, SCS, MSPT Ryan Sargent, MBA, MS, ATC Introduction & Thank You Dr. Anthony Luke Dr. Carlin Senter Jason Miyamoto, ATC Dr. Nirav Pandya Ryan Sargent, ATC 3 4 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 Our Mission To Protect and Advance The Mission 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 1
5 6 func tion Define Function 1. an activity or purpose natural to or intended for a person or thing. 2. perform Antonyms of Function Inactivity, idleness Sit: to rest with the body supported by the buttocks, to remain inactive 7 8 Our Mission To Protect and Advance the Health and Well-being of Children [people] The body is a motion machine; If it stops moving, it s systems slow down: muscular, lymphatic, digestive and circulatory Our Mission To Protect and Advance the Health and Well-being of Children [people] 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 2
9 10 Primal Natural Movements Primal Natural Movements Rolling Crawling Squat Lunge 11 12 Primal Natural Movements Primal Natural Movements 3
13 14 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 of growth Afferent Input joint position senses information Muscle Balance agonist/antagonist, tight/weak How & Why Move Reflexive / Automatic Activation ON/OFF, stabilize to mobilize Muscular Endurance coordination of movement patterns, posture Lower Crossed Syndrome www.jandaapproach.com 15 16 Structure vs. Function Functional Continuum Identify the Source vs. the Cause of symptoms Painful Limited Plan of care: training mobility vs. stability 4
17 18 Lower Quarter Screen Definition of Tests 1.Deep Squat 2.Single Leg Balance 3.Single Leg Squat 4.Hop for Distance 5.Front Plank/Push-up Test 19 20 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 = = = Deep Squat/Overhead Deep Squat Assess mobility of hips, knees, and ankles Overhead reach for thoracic spine and shoulders 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 5
21 22 Deep Squat Single Leg Balance Observe pelvic control for functional stability Indicator of balance strategies Single-leg stance indicative of mid-stance 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 23 24 GOOD Single Leg Balance Coaching Points BAD Assess Functional Strength Assess Balance Assess Dynamic Flexibility 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 Single Leg Squat Interpretation Poor Glute or Quad Strength Poor Balance Decreased Trunk Control 6
Single Leg Squat Coaching Points 25 Single Leg Hop for Distance 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 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 Start 26 Analysis Based on distance jumped Determine limb symmetry Quality is important Interpretation Karyn Haitz, Rebecca Shultz, Melissa Hodgins, Gordon O. Matherson, J Ortho Sports Phys Ther 2014. Relationship between asymmetry and limitations in jumping/landing in healthy athletes have < 9% difference. Mean values: Men 154.5 cm Women 121.2 cm 6m 27 28 4 Hop Test Sequence: Single-leg Hop Timed Hop Over a 6-m Course Triple Hop Crossover Hop Hop for Distance Coaching Points Hop Test Sequence Front Plank/Prone Bridge To assess static/isometric trunk endurance and control 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) 7
29 30 GOOD Front Plank/Push Up Coaching Points Drop Jump Lower Quarter Screen Deceleration Drop Jump Deceleration BAD Peak VIT Peak VIT Pre Testing Post Testing 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 8