How to Identify Pathological Movement - Part VI

Each of the Movement Tests (with the exception of the plank and side plank) we described is performed for multiple repetitions.  If you are unable to score every repetition and are only scoring one rep, then the score is based on the movement in which the most significant deviation is noted and which deviation is most pronounced.  Since many of these deviations become more pronounced with multiple repetitions, then it is the repetition(s) in which these become the most pronounced that are scored.  For example, in the Full Squat Test (FST), if the athlete has limited range of motion (60-90 degrees which would score him/her a 2/3) but a lateral shift of  >3” (which would result in a score of 1/3), then the score for the test would be based on the deviation resulting in the lower score (in this case 1/3 for the lateral shift >3”).  The philosophy behind this scoring method is that we want to reduce the magnitude of the deviations seen at their worst as well as those that are the most pronounced.  If an athlete presents with a lateral shift of 3 inches in the last 3 reps of the Full Squat Test (FST), then this is the area where we want to have the largest impact.  It is in the areas that have the greatest magnitude of deviation in which we can identify most significant risk of injury and which have a more pronounced impact on athletic performance.  Therefore using the Full Squat Test (FST) as an example, if the subject is able to perform 9 reps with a lateral shift of less than one inch but performs one rep with a lateral shift of >1 inch, the score for this test would be 2. 

For those tests in which the right and left are performed independently (Single Leg Squat Test & Side Plank test), then both the right and left are scored independently and compared to one another.  If you are scoring every rep, this will provide you with a clearer picture of variance right to the left.  This is referred to in the literature as limb symmetry index and if the variance is greater then 20%, we know this puts the athlete at greater risk for injury and performance issues.

Each test should be scored independently along with an explanation for the raw score.  For example:

• FST = 30/60 – 2” left lateral shift on 10/20 reps
• SLST = 48/60
• SLST R = 18/30 – hip adduction past midline right hip 6/10 reps
• SLST L = 30/30 – able to perform without deviation
• Plank – 22.5/30 with R hip drop at 45 seconds
• Side Plank R = 17.5/30 – 35 seconds – with R trunk rotation
• Side Plank L = 30/30 – 60 seconds

Total Score = 148/210 or 70%

R Score = 35.5/60 or 59%

L Score = 60/60 or 100%

Limb Symmetry Index = Lower score / Higher score = R Score / L Score = 35.5/60 = 59%

The best possible score on the MA is 210 points if each rep is scored independently.  The participant’s score is reported as XX/210.  Overall performance can be reported as raw score over total possible (148/210) or as a percentage (70%) as well as the limb symmetry index as a raw score over high score (35.5/60) or as a percentage (59%).

Pain

For all of the DMA tests described above, it is critical to determine if the athlete experiences pain during the testing as this will skew the results of the examination as well as the results obtained.  Many times, especially with the athletic population, pain will be denied even though they may be experiencing pain.  It is important to determine if this is the case due to the impact on the results of the assessment.  If they do experience pain, it is important to have them undergo a further orthopedic evaluation by a qualified health care professional (Medical Doctor, Certified Athletic Trainer, or Physical Therapist).  If pain is persistent enough to modify movement patterns or limit the athlete’s ability to perform these tests, then there is a high probability that the athlete will have pain with athletic activities and with a return to regular training.

Clearing Tests/Sport Specific Testing:

Part of the beauty of movement tests is that they can be implemented in any setting and with almost any population.  Whether they are performed as pre-participation physicals, on the field assessments, performance assessments or simply as a screening tool, you can get some valuable information from the movements you see.  With the advent of the MA, we have also come up with several sport specific tests that we use.  We use these tests for 2 specific reasons:

• Pre-participation Physical Clearing Tests – whether performing pre-participation physicals for high school, collegiate or professional athletes, efficiency of the testing protocols is absolutely essential.  Therefore, using the clearing tests can allow us to record some sport specific movements and immediately identify those that are at greatest risk and in need of further testing. During mass physicals, this then allows you to narrow down your group to make sure you are targeting those at greatest risk.  From an efficiency standpoint, this also prevents the movement screens from becoming a cumbersome addition to your physical process and preventing excessive wait times and prolonged physical process.
• Sports Specific Tests – with the addition of the sport specific tests (tests which incorporate movements that are specific to that sport) we can thoroughly assess the pathokinematics during sport specific movements and assess the impact of our treatment strategies on these specific movements.

The tests that we use are as follows:

• Jump Stop Test: during this test the subject is asked to sprint (starting from standing position) a distance of 10 yards (30 feet) and perform a jump stop.  They are recorded during the running phase as well as the jump stop.
• During this test, we are looking for:
• Pathokinematics
• Asymmetries
• Rational: during this test we are assessing mechanics during both sprinting and during the jump stop phase.
• Sport specific testing – as a sport specific test, this will provide us with a visual guide to the impact that our treatment strategies have on this particular movement.
• Clearing test – as a clearing test, this will allow us to identify those that are at greatest risk by how they present compared to all the subjects tested.
• Assessing Sprint cycle:
• Stride length – is there a variance
• Trunk – is there excessive forward flexion throughout or excessive trunk rotation
• Midstance – is there a trendelenburg on the stance leg, adduction or internal rotation at the knee
• Swing through – is there a circumduction with, decreased DF, knee contact
• Heel strike – where does initial contact occur, is there excessive pronation
• Assessing Jump Stop:
• Jump – what are the mechanics at push off
• Landing – what are mechanics and is it a hard or soft landing
• Sports – sports that these are commonly used with include:
• Basket Ball
• Volleyball
• Soccer
• Pole vaulting
• L – Test: during this test, the subject is asked to sprint 10 yards (30 feet) then cut off to the right.  This test is repeated again with cutting to the left.
• During this test, we are looking for:
• Pathokinematics
• Asymmetries
• Rational: during this test, we are assessing the mechanics during both the sprinting and during the cutting motion to the right and left.  There is also a comparison of the right side to the left for asymmetries. 
• Sport specific testing – as a sport specific test, this will provide us with a visual guide to the impact that our treatment strategies has on this particular movement.
• Clearing test – as a clearing test, this will allow us to identify those that are at greatest risk by how they present compared to all the subjects tested.
• Assessing Sprint cycle:
• Stride length – is there a variance
• Trunk – is there excessive forward flexion throughout or excessive trunk rotation
• Midstance – is there a trendelenburg on the stance leg, adduction or internal rotation at the knee
• Swing through – is there a circumduction with, decreased DF, knee contact
• Heel strike – where does initial contact occur, is there excessive pronation
• Assessing cutting motion:
• What are the mechanics with the rapid change in direction
• Sports – sports that these are commonly used with include:
• Basket Ball
• Volleyball
• Soccer
• Football
• Lacrosse
• Baseball
• Single Leg Squat Test: this test is used as clearing test only for our female athletes.  During this test, the subject is asked to perform 10 single leg squats as described above in the MA.  This test is repeated again on the opposite side.
• Assessing: during this test, we are assessing the mechanics similar to what we are doing in the MA.  There is also a comparison of the right side to the left for asymmetries. 
• Clearing test – as a clearing test, this will allow us to identify those that are at greatest risk by how they present compared to all the subjects tested.  This is only used as a clearing test for our female athletes as we have seen some common associations with failure of this test with increased risk for injury in the after mentioned sports.
• Sports – sports that these are commonly used with include:
• Basket Ball
• Volleyball
• Soccer
• Pole vaulting
• Scoring: The clearing tests are scored in the following manner with the exception of the SLST (which is scored according to scoring above):
• Scoring of the clearing tests are done in the following way
• 3 – no deviations noted
• 2 – notable deviations or compensation, need for further testing
• 1 – deviations/pain resulting in fall, pain or inability to perform, need for further testing

Primarily, these tests are used for clearing purposes as well as a base line measurement to assess the impact of our treatment or training strategies.  They are designed to assess the entire kinetic chain and when combined with Dartfish technology, provide you with a way to objectively measure these movements.  This will assist you in determining where movement is breaking down and more importantly how to address this with a training protocol. 

Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis and author of a college textbook on this subject.  He serves as the National Director of Sports Medicine for Physiotherapy Associates, is a Safety Council Member for USA Cheer National Safety Council and associate editor of the International Journal of Athletic Therapy and Training.