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 Michelle Cappello, PT, SCS, MSPT Ryan Sargent, ATC Ryan Sargent, MBA, MS, ATC 3 4 Our Mission Objectives The Mission To Protect and Advance the Health and Well-being of Children Through Clinical Care, Teaching, and Research • 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 Photo by Tom Minczeski 86 Magazine Photo by Tom Minczeski 86 Magazine 1
5 6 Define Function Antonyms of Function func·tion Inactivity, idleness… 1. an activity or purpose Sit: to rest with the natural to or intended for a body supported by person or thing. the buttocks, to 2. perform remain inactive 7 8 Our Mission Our Mission To Protect and Advance the Health and Well-being To Protect and Advance the Health and Well-being of Children [ people ]… of Children [ people ]… • Slouching is depressing (2012 SF State) The body is a motion machine; • 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 If it stops moving, it’s systems • Immobility leads to further immobility – we lose our S curve in our spine and can’t absorb shock slow down: muscular, lymphatic, • Immobility leads to heart disease: the heart needs increased effort to pump blood that pools in the lower body digestive and circulatory • 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 How & Why Move Why you should do it? Afferent Input – joint position senses information • Ability to move in multi-planar directions as assessed via non-traditional testing. Muscle Balance – agonist/antagonist, tight/weak • Test provide qualitative and quantitative information Reflexive / Automatic • Activities in daily living Activation – ON/OFF, stabilize • Building blocks of movement in context of life & sport to mobilize • Relates to developmental mile stones in critical stages Muscular Endurance – of growth 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 Deep Squat/Overhead Deep Squat typically find an athlete in 1 of 3 positions when engaged with the ground • Purpose – Assess mobility of hips, knees, and ankles – Overhead reach for thoracic spine and shoulders • Procedure = – Overhead squat: Hold the dowel so that a 90 ° angle is formed at bilateral elbows when the dowel is just – Position the client/athlete so that they are standing with feet shoulder-width apart. 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 Test in these positions to test how stable and mobile they are so we know were to go in our training programs 5
21 22 Deep Squat Single Leg Balance • Purpose – Observe pelvic control for functional stability – Indicator of balance strategies – Single-leg stance indicative of mid-stance • Procedure – Raise opposite hip to 45 ° / knee to 90 ° – Stand on one leg – 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 Single Leg Balance Single Leg Squat Coaching Points • Purpose – Assess Functional Strength GOOD BAD – 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 6
25 26 Single Leg Squat Single Leg Hop for Distance Coaching Points • 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 Start – Jump Horizontally as far as possible – Hold landing position for 2 seconds • Analysis – Based on distance jumped 6m – 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 27 28 Hop for Distance Front Plank/Prone Bridge Coaching Points • Purpose – To assess static/isometric trunk endurance and control Hop Test Sequence • Procedure 4 Hop Test Sequence: – Prone on elbows • Single-leg Hop – Elbows shoulder width apart • Timed Hop Over a 6-m Course – Feet in narrow base without touching • Triple Hop – Elevate trunk so only forearms and toes are on the ground • Crossover Hop – 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 Front Plank/Push Up Lower Quarter Screen Coaching Points GOOD Drop Jump Deceleration Drop Jump Deceleration BAD Peak VIT Peak VIT Post Testing Pre 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
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