This text is designed as clinical reference to develop knowledge of the examination, diagnosis and classification of uncontrolled movement (motor control dysfunction) and the management of movement dysfunction.
It will help the therapist:
- Develop clinical skills in the assessment and retraining of movement control
- To use movement control tests to identify uncontrolled movement
- To classify uncontrolled movement into diagnostic subgroups
- Access a large range of motor control and movement retraining strategies
- Develop an assessment framework that will provide a diagnosis of dysfunction, pain sensitive tissues and pain mechanisms
- Use a clinical reasoning framework to prioritise clinical decision making
- Provides detailed explanation of evidence and research underpinning motor control dysfunction and movement retraining
- Unique subclassification system of musculoskeletal disorders and pain
- Region specific testing -step by step instructions for assessment, diagnosis, classification and treatment using Movement Performance Solutions unique system
- Highly illustrated with clear step by step instructions for treatment of Lumbar, Cervical and Thoracic Spine, Shoulder and Hip
This text is designed as clinical reference to develop knowledge of the examination, diagnosis and classification of uncontrolled movement (motor control dysfunction) and the management of movement dysfunction. It will help the therapist: Develop clinical skills in the assessment and retraining of movement control To use movement control tests to identify uncontrolled movement To classify uncontrolled movement into diagnostic subgroups Access a large range of motor control and movement retraining strategies Develop an assessment framework that will provide a diagnosis of dysfunction, pain sensitive tissues and pain mechanisms Use a clinical reasoning framework to prioritise clinical decision making Provides detailed explanation of evidence and research underpinning motor control dysfunction and movement retraining Unique subclassification system of musculoskeletal disorders and pain Region specific testing -step by step instructions for assessment, diagnosis, classification and treatment using Movement Performance Solutions unique system Highly illustrated with clear step by step instructions for treatment of Lumbar, Cervical and Thoracic Spine, Shoulder and Hip
Front cover 1
Kinetic Control 2
Copyright page 5
Table of Contents 6
Preface 8
Foreword 10
Acknowledgements 12
Reviewers 12
Section 1 14
Chapter 1 Uncontrolled movement 16
Understanding movement and function 16
Movement faults 16
Identification and classification of UCM 18
Symptoms 18
Disability 18
Dysfunction 19
Recurrence 19
Risk of injury 19
Performance 20
A model for the assessment and retraining of movement faults 20
Alternative therapies 20
The assessment and management of UCM 22
The clinical reasoning process 23
The 10 point analysis and clinical reasoning framework for UCM 23
1 Classify the site and direction of UCM 23
2 Relate UCMs to symptoms 24
3 Relate assessment findings to disability 24
4 Identify the UCM and restrictions 24
5 Management plan for UCM and restrictions 25
6 Relate pain mechanisms to presentation 26
7 Consideration of tissues or structures contributing to symptoms 27
8 Assess for environmental and personal factors 27
9 Integrate other approaches or modalities 27
10 Consider prognosis 28
Clinical reasoning in a diagnostic framework 28
1 Diagnosis of movement dysfunction (site and direction of uncontrolled motion) 29
2 Clinical diagnosis of pain-sensitive or pain-generating structure(s) 29
3 Clinical diagnosis of presenting pain mechanisms 29
4 Evaluation and consideration of contextual factors 29
The disablement assessment model 30
References 32
Chapter 2 Muscle function and physiology 36
Introduction: MOVEMENT CONTROL 36
Analysis of muscle function 36
Stabiliser and mobiliser function 36
Implications of stabiliser–mobiliser characteristics 37
Local and global function 37
Implications of local and global characteristics 38
Functional efficiency 39
Functional classification of muscle roles 41
Muscle characterisation 41
Muscle function: primary role 44
Single task-specific muscles 44
Multitasking muscles 44
Motor recruitment 44
The motor unit 44
Low versus high threshold recruitment 45
Functional implications of recruitment within stabiliser and mobiliser roles 47
Stabiliser roles and slow motor unit recruitment 47
Mobiliser roles and fast motor unit recruitment 47
Muscle stiffness 47
Low threshold recruitment and timing 48
Pain and recruitment 49
Recruitment dysfunction: inhibition and dysfacilitation 50
Altered strategies in a dysfunctional situation 50
Sensation of effort, afferent input and recruitment 51
The dysfunction loop 52
Muscle recruitment training 52
Low threshold recruitment dominance 52
High threshold recruitment dominance 53
Clinical guideline for recruitment training 53
Retraining low threshold recruitment dominance 53
Retraining high threshold recruitment dominance 53
References 54
Chapter 3 Assessment and classification of uncontrolled movement 56
Classification of subgroups in neuromusculoskeletal pain 56
Classification based on movement dysfunction 57
Relative stiffness – relative flexibility 58
Movement control dysfunction 59
Movement impairments 60
Motor control impairments (MCI) 60
Uncontrolled movement (UCM) and pain 61
The development of motion restrictions in function 61
A proposition for the aetiology of UCM 62
Integrated model of mechanical movement dysfunction 65
Principles of assessment of UCM 66
Neutral training region 66
Clinical assessment of UCM 67
Movement control rating system (MCRS) 67
Testing for the site and direction of UCM 68
Example of dissociation in ‘series’ 68
Example of dissociation in ‘parallel’ 68
Indications to test for UCM 69
Movement control test procedure 70
Using the MCRS 70
Rating interpretation 71
References 73
Chapter 4 Retraining strategies for uncontrolled movement 76
Rehabilitation management and retraining 76
Management overview 76
Therapeutic exercise 77
The site and direction of UCM 80
Retraining in control of the site and direction of UCM 80
Progression of training the site and direction of UCM 82
Management of symptoms using retraining control of the UCM 82
Key principles in the retraining of motor control patterns 83
Motor unit recruitment 83
Cognitive awareness 84
The effect of posture on retraining 84
Challenges in retraining neuromusculoskeletal dysfunction 84
Integration into functional tasks and activities 85
Personality and behavioural traits for motivation and compliance 87
Red dot functional integration 88
Low load (facilitatory) proprioceptive stimulus 88
Integrative dissociation 88
Other approaches 88
Use of training tools/equipment 89
Manual therapy 89
How long does training take? 90
Movement control retraining 90
Conclusion 90
References 91
Section 2 94
Chapter 5 The lumbopelvic region 96
Lumbopelvic tests 95
Introduction 96
Changes in movement and postural control in the lumbopelvic region 96
Reliability of movement observation 97
Efficacy of treatment to retrain control of lumbopelvic UCM 97
Diagnosis of the site and direction of UCM in the lumbar spine 98
Identifying site and direction of UCM at the lumbar spine 99
Segmental and multi-segmental uncontrolled motion in the sagittal plane 99
Segmental UCM 99
Multisegmental UCM 100
Clinical examples 100
Lumbar extension UCM 100
Lumbar flexion UCM 101
Movement and postural control at the sacroiliac joint (SIJ) and pelvis 101
Identifying UCM at the SIJ and pelvis 101
Testing for UCM – review of principles 103
Lumbopelvic tests for uncontrolled movement 103
Lumbar flexion control 103
Flexion control tests and flexion control rehabilitation 103
Observation and analysis of lumbar flexion and forward bending 104
Description of ideal pattern 104
Movement faults associated with lumbar flexion 104
Relative stiffness (restrictions) 104
Relative flexibility (potential UCM) 104
Indications to test for lumbar flexion UCM 105
Tests of lumbar flexion control 106
T1 Standing: trunk lean test (tests for lumbar flexion UCM) 106
Test procedure 106
Lumbar flexion UCM 107
Rating and diagnosis of lumbar flexion UCM 107
Correction 107
T2 4 point: backward push test (tests for lumbar flexion UCM) 110
Test procedure 110
Lumbar flexion UCM 111
Rating and diagnosis of lumbar flexion UCM 111
Correction 111
T3 Crook: double bent leg lift test (tests for lumbar flexion UCM) 113
Test procedure 113
Lumbar flexion UCM 114
Rating and diagnosis of lumbar flexion UCM 115
Correction 115
Multifidus facilitation 115
Static diagonal: isometric opposite knee to hand push 115
Static diagonal heel lift: isometric knee to hand push + 2nd heel lift 116
Alternate single leg heel touch: (Sahrmann level 1) 116
T4 Sitting: forward lean test (tests for lumbar flexion UCM) 119
Test procedure 119
Lumbar flexion UCM 119
Rating and diagnosis of lumbar flexion UCM 120
Correction 120
T5 Sitting: chest drop test (tests for lumbar flexion UCM) 122
Test procedure 122
Lumbar flexion UCM 123
Rating and diagnosis of lumbar flexion UCM 123
Correction 123
T6 Sitting: double knee extension test (tests for lumbar flexion UCM) 126
Test procedure 126
Lumbar flexion UCM 126
Rating and diagnosis of lumbar flexion UCM 127
Correction 127
T7 Stand to sit: ischial weight bearing test (tests for lumbar flexion UCM) 129
Test procedure 129
Lumbar flexion UCM 129
Rating and diagnosis of lumbar flexion UCM 130
Correction 130
Lumbar flexion UCM summary 132
Tests of lumbar extension control 133
Extension control tests and extension control rehabilitation 133
Observation and analysis of lumbar extension and backward arching 133
Description of ideal pattern 133
Movement faults associated with lumbar extension 133
Relative stiffness (restrictions) 133
Relative flexibility (potential UCM) 133
Indications to test for lumbar extension UCM 134
Extension load testing prerequisites 134
Back flattening on wall – standing (prerequisite) 135
Ideal 135
Dysfunction 135
Recruitment dysfunction 135
Mobility dysfunction 135
Correction 135
Co-activation of lateral abdominals and gluteals – prone (prerequisite) 135
Ideal 135
Dysfunction 136
Recruitment dysfunction 136
Correction 136
Tests of lumbar extension control 137
T8 Standing: thoracic extension (sway) test (tests for lumbar extension UCM) 137
Test procedure 137
Lumbar extension UCM 137
Rating and diagnosis of lumbar extension UCM 138
Correction 138
T9 Standing: thoracic extension (tilt) test (tests for lumbar extension UCM) 141
Test procedure 141
Lumbar extension UCM 142
Rating and diagnosis of lumbar extension UCM 142
Correction 142
T10 Sitting: chest lift (tilt) test (tests for lumbar extension UCM) 145
Test procedure 145
Lumbar extension UCM 146
Rating and diagnosis of lumbar extension UCM 146
Correction 146
T11 Sitting: forward lean test (tests for lumbar extension UCM) 150
Test procedure 150
Lumbar extension UCM 151
Rating and diagnosis of lumbar extension UCM 151
Correction 151
T12 4 Point: forward rocking test (tests for lumbar extension UCM) 153
Test procedure 153
Lumbar extension UCM 154
Rating and diagnosis of lumbar extension UCM 154
Correction 154
t13 Crook: double bent leg lower test (tests for lumbar extension UCM) 157
Test procedure 157
Lumbar extension UCM 158
Rating and diagnosis of lumbar extension UCM 158
Correction 158
Oblique abdominal facilitation 159
Static diagonal: isometric opposite knee to hand push 159
Static diagonal heel lift: isometric knee to hand push + 2nd heel lift 159
Alternate single leg heel touch: (Sahrmann level 1) 160
t14 Prone: double knee bend test (tests for lumbar extension UCM) 162
Test procedure 162
Lumbar extension UCM 162
Rating and diagnosis of lumbar extension UCM 163
Correction 163
t15 Prone (table): hip extension lift test (tests for lumbar extension UCM) 166
Test procedure 166
Lumbar extension UCM 166
Rating and diagnosis of lumbar extension UCM 167
Correction 167
t16 Standing: hip extension toe slide test (tests for lumbar extension UCM) 170
Test procedure 170
Lumbar extension UCM 171
Rating and diagnosis of lumbar extension UCM 171
Correction 171
Lumbar extension UCM summary 172
Tests of lumbopelvic rotation control 175
Lumbopelvic rotation (asymmetrical/unilateral) control tests and rotation control rehabilitation 175
Observation and analysis of lumbopelvic rotation ± side-bend 175
Description of ideal pattern 175
Movement faults associated with lumbopelvic rotation 175
Relative stiffness (restrictions) 175
Relative flexibility (potential UCM) 175
Indications to test for lumbopelvic rotation UCM 176
Tests of open chain rotation control 177
T17 Supine: single heel slide test (tests for lumbopelvic rotation UCM) 177
Test procedure 177
Lumbopelvic rotation UCM 178
Rating and diagnosis of lumbopelvic rotation UCM 179
Correction 179
External oblique abdominal recruitment 181
Internal oblique abdominal recruitment 181
t18 Supine: bent knee fall out test (tests for lumbopelvic rotation UCM) 182
Test procedure 182
Lumbopelvic rotation UCM 182
Rating and diagnosis of lumbopelvic rotation UCM 184
Correction 184
External oblique abdominal recruitment 184
Internal oblique abdominal recruitment 184
T19 Side-lying: top leg turn out test (tests for lumbopelvic rotation UCM) 187
Test procedure 187
Lumbopelvic rotation UCM 187
Rating and diagnosis of lumbopelvic rotation UCM 188
Correction 188
External oblique abdominal recruitment 188
Internal oblique abdominal recruitment 188
T20 Prone: single hip rotation test (tests for lumbopelvic rotation UCM) 191
Test procedure 191
Lumbopelvic rotation UCM 192
Rating and diagnosis of lumbopelvic rotation UCM 192
Correction 192
External oblique abdominal recruitment 194
Internal oblique abdominal recruitment 194
T21 Prone: single knee flexion test (tests for lumbopelvic rotation UCM) 196
Test procedure 196
Lumbopelvic rotation UCM 196
Rating and diagnosis of lumbopelvic rotation UCM 197
Correction 197
T22 Prone (table): hip extension lift test (tests for lumbopelvic rotation UCM) 199
Test procedure 199
Lumbopelvic rotation UCM 199
Rating and diagnosis of lumbopelvic rotation UCM 200
Correction 200
t23 Sitting: single knee extension test (tests for lumbopelvic rotation UCM) 202
Test procedure 202
Lumbopelvic rotation UCM 202
Rating and diagnosis of lumbopelvic rotation UCM 203
Correction 203
Tests of closed chain rotation control 205
t24 Crook lying: single leg bridge extension test (tests for lumbopelvic rotation UCM) 205
Test procedure 205
Lumbopelvic rotation UCM 205
Rating and diagnosis of lumbopelvic rotation UCM 206
Correction 206
T25 Standing: thoracic rotation test (tests for lumbopelvic rotation UCM) 209
Test procedure 209
Lumbopelvic rotation UCM 210
Rating and diagnosis of lumbopelvic rotation UCM 210
Correction 210
T26 Standing: double knee swing test (tests for lumbopelvic rotation UCM) 213
Test procedure 213
Lumbopelvic rotation UCM 214
Rating and diagnosis of lumbopelvic rotation UCM 214
Correction 214
T27 Standing: trunk side-bend test (tests for lumbopelvic rotation UCM) 219
Test procedure 219
Lumbopelvic rotation UCM 220
Rating and diagnosis of lumbopelvic rotation UCM 221
Correction 221
t28 Standing: pelvic side-shift test (tests for lumbopelvic rotation UCM) 223
Test procedure 223
Lumbopelvic rotation UCM 224
Rating and diagnosis of lumbopelvic rotation UCM 224
Correction 224
Rotation (unilateral) UCM summary 226
References 227
Chapter 6 The cervical spine 232
Introduction 232
Cervical spine muscle function 232
UCM in the cervical spine 233
Introduction to rehabilitation for cervical spine dysfunction 233
Identifying UCM in the cervical spine 234
Diagnosis of the site and direction of UCM in the cervical spine 234
Identifying the site and direction of ucm at the cervical spine 234
Cervical spine neutral: positioning cervical, scapula and temporomandibular neutral 236
• Guideline to assess and reposition low cervical neutral 236
• Guideline to assess and reposition upper cervical neutral 237
• Guideline to assess and reposition scapula neutral 237
• Guideline to assess and reposition temporomandibular joint (TMJ) neutral 237
Cervical spine tests for UCM 238
Cervical flexion control 238
Observation and analysis of neck flexion 238
Description of ideal pattern 238
Movement faults associated with cervical flexion 238
Relative stiffness (restrictions) 238
Relative flexibility (potential UCM) 238
Asymmetry 238
Tests of low cervical flexion control 239
T29 Occiput lift test – nodding (tests for low cervical flexion UCM) 239
Test procedure 239
Low cervical flexion UCM 240
Rating and diagnosis of cervical flexion UCM 240
Correction 240
T30 Thoracic flexion test (tests for low cervical flexion UCM) 243
Test procedure 243
Low cervical flexion UCM 243
Rating and diagnosis of cervical flexion UCM 244
Correction 244
T31 Overhead arm lift test (tests for low cervical flexion UCM) 246
Test procedure 246
Low cervical flexion UCM 246
Rating and diagnosis of cervical flexion UCM 247
Correction 247
Test of upper cervical flexion control 250
T32 Forward head lean test (tests for upper cervical flexion UCM) 250
Test procedure 250
Upper cervical flexion UCM 251
Rating and diagnosis of cervical flexion UCM 252
Correction 252
T33 Arm extension test (tests for upper cervical flexion UCM) 255
Test procedure 255
Upper cervical flexion UCM 255
Rating and diagnosis of cervical flexion UCM 256
Correction 256
Cervical extension control 258
Observation and analysis of neck extension 258
Description of ideal pattern 258
Movement faults associated with cervical extension 258
Relative stiffness (restrictions) 258
Relative flexibility (potential UCM) 259
Asymmetry 259
Tests of upper cervical extension control 260
T34 Backward head lift test (tests for upper cervical extension UCM) 260
Test procedure 260
Upper cervical extension UCM 260
Rating and diagnosis of cervical extension UCM 261
Correction 261
T35 Horizontal retraction test (tests for upper cervical extension UCM) 265
Test procedure 265
Upper cervical extension UCM 265
Rating and diagnosis of cervical extension UCM 266
Correction 266
Tests of mid-cervical extension (translation) control 268
T36 Head back hinge test (tests for mid-cervical translation/extension UCM) 268
Test procedure 268
Mid-cervical uncontrolled forward translation during extension 268
Rating and diagnosis of cervical extension UCM 269
Correction 269
T37 Chin lift hinge test (tests for mid-cervical translation/extension UCM) 272
Test procedure 272
Mid-cervical uncontrolled forward translation during extension 273
Rating and diagnosis of cervical extension UCM 273
Correction 273
Control of unilateral movements – rotation (± side-bend) 276
Observation and analysis of natural neck rotation 276
Description of ideal pattern 276
Movement faults associated with cervical rotation 276
Relative stiffness (restrictions) 276
Useful guidelines for differentiation between articular and myofascial restrictions 277
Relative flexibility (potential UCM) 279
Control of unilateral movements – side-bend 280
Observation and analysis of natural neck side-bending 280
Description of ideal pattern 280
Movement faults associated with cervical side-bend 281
Relative stiffness (restrictions) 281
Guidelines for differentiation between articular and myofascial restrictions 281
Relative flexibility (potential UCM) 282
Tests of rotation/side-bend control 283
T38 Head turn test (tests for rotation/side-bend UCM) 283
Test procedure 283
UCM during rotation 284
Rating and diagnosis of cervical rotation/side-bend UCM 284
Correction 284
T39 Head tilt test (tests for rotation and/or side-bend UCM) 289
Test procedure 289
UCMs during side-bend 290
Rating and diagnosis of cervical rotation/side-bend UCM 290
Correction 290
T40 Upper neck tilt test (tests for rotation/side-bend UCM) 294
Test procedure 294
Low cervical side-bend UCM 294
Rating and diagnosis of cervical rotation/side-bend UCM 295
Correction 295
T41 Lower neck lean test (tests for rotation/side-bend UCM) 298
Test procedure 298
Upper cervical side-bend UCM 298
Rating and diagnosis of cervical rotation/side-bend UCM 299
Correction 299
Cervical stability dysfunction summary 302
References 303
Chapter 7 The thoracic spine 306
the Thoracic spine 305
Introduction 306
Changes in movement and postural control in the thoracic spine 306
Diagnosis of the site and direction of UCM in the thoracic spine 306
Linking the site of UCM to symptom presentation 306
Thoracic tests for UCM 308
Thoracic flexion control 308
Thoracic flexion control tests and flexion control rehabilitation 308
Movement faults associated with thoracic flexion 308
Relative stiffness (restrictions) 308
Relative flexibility (potential UCM) 308
Indications to test for thoracic flexion UCM 308
Tests of thoracic flexion control 309
T42 Standing: back flattening test (tests for thoracic flexion UCM) 309
Test procedure 309
Thoracic flexion UCM 310
Rating and diagnosis of thoracic flexion UCM 310
Correction 310
T43 Sitting: head hang test (tests for thoracic flexion UCM) 313
Test procedure 313
Thoracic flexion UCM 313
Rating and diagnosis of thoracic flexion UCM 314
Correction 314
t44 Sitting: pelvic tail tuck test (tests for thoracic flexion UCM) 317
Test procedure 317
Thoracic flexion UCM 318
Rating and diagnosis of thoracic flexion UCM 318
Correction 318
t45 Sitting: bilateral forward reach test (tests for thoracic flexion UCM) 321
Test procedure 321
Thoracic flexion UCM 322
Rating and diagnosis of thoracic flexion uncontrolled movement 322
Correction 322
Thoracic flexion UCM summary 322
Thoracic extension control 325
Extension control tests and extension control rehabilitation 325
Indications to test for thoracic extension UCM 325
Tests of thoracic extension control 326
T46 Standing: bilateral overhead reach test (tests for thoracic extension UCM) 326
Test procedure 326
Thoracic extension UCM 327
Rating and diagnosis of thoracic extension UCM 327
Correction 327
t47 Sitting: head raise test (tests for thoracic extension UCM) 329
Test procedure 329
Thoracic extension UCM 330
Rating and diagnosis of thoracic extension UCM 330
Correction 330
t48 Sitting: pelvic tail lift test (tests for thoracic extension UCM) 332
Test procedure 332
Thoracic extension UCM 333
Rating and diagnosis of thoracic extension UCM 333
Correction 333
T49 Standing: bilateral backward reach test (tests for thoracic extension UCM) 336
Test procedure 336
Thoracic extension UCM 337
Rating and diagnosis of thoracic extension UCM 337
Correction 337
Thoracic extension UCM summary 339
Thoracic rotation control 340
Thoracic rotation control tests and rotation control rehabilitation 340
Indications to test for thoracic rotation UCM 340
Tests of thoracic rotation control 341
t50 Sitting: head turn test (tests for thoracic rotation UCM) 341
Test procedure 341
Thoracic rotation UCM 342
Rating and diagnosis of thoracic rotation UCM 342
Correction 342
t51 Sitting: pelvic twist (swivel chair) test (tests for thoracic rotation UCM) 344
Test procedure 344
Thoracic rotation UCM 345
Rating and diagnosis of thoracic rotation UCM 345
Correction 345
T52 Standing: pelvic side-shift test (tests for thoracic rotation UCM) 347
Test procedure 347
Thoracic rotation UCM 348
Rating and diagnosis of thoracic rotation UCM 348
Correction 348
t53 Standing: one arm wall push test (tests for thoracic rotation UCM) 350
Test procedure 350
Thoracic rotation UCM 351
Rating and diagnosis of thoracic rotation UCM 351
Correction 351
T54 4 Point: one arm lift test (tests for thoracic rotation UCM) 353
Test procedure 353
Thoracic rotation UCM 354
Rating and diagnosis of thoracic rotation UCM 354
Correction 354
t55 Side-lying: lateral arm lift test (tests for thoracic rotation UCM) 357
Test procedure 357
Thoracic rotation UCM 358
Rating and diagnosis of thoracic rotation UCM 358
Correction 358
T56 Side-lying: side bridge test (tests for thoracic rotation UCM) 360
Test procedure 360
Thoracic rotation UCM 360
Rating and diagnosis of thoracic rotation UCM 361
Correction 361
Thoracic rotation UCM summary 361
Thoracic and rib respiratory control 363
Thoracic and rib respiratory control tests and respiratory control rehabilitation 363
Indications to test for thoracic respiratory UCM 363
Tests of thoracic and ribcage respiratory control 364
t57 Standing: apical drop + inspiration test (tests for thoracic respiratory UCM) 364
Test procedure 364
Thoracic respiratory (apical ribcage elevation) UCM 365
Rating and diagnosis of thoracic respiratory UCM 365
Correction 365
t58 Standing: anterior costal lift + expiration test (tests for thoracic respiratory UCM) 367
Test procedure 367
Thoracic respiratory (costal ribcage depression) UCM 368
Rating and diagnosis of thoracic respiratory UCM 368
Correction 368
t59 Standing: abdominal hollowing + expiration test (tests for thoracic respiratory UCM) 370
Test procedure 370
Thoracic respiratory (costal ribcage depression) UCM 370
Rating and diagnosis of thoracic respiratory UCM 371
Correction 371
Thoracic respiratory UCM summary 373
References 373
Chapter 8 The shoulder girdle 376
the Shoulder girdle 375
Introduction 376
Scapula function and glenohumeral joint stability 376
Changes in shoulder muscle function 377
Identifying UCM at the shoulder girdle 377
Diagnosis of the site and direction of UCM at the shoulder girdle 378
Linking the site of UCM to symptom presentation 378
Identifying site and direction of UCM at the scapulothoracic and glenohumeral joints 378
Scapula and glenohumeral joint neutral training region 378
Inferior anterior glenoid (IAG) 380
Segmental translatatory and global range specific UCM 382
Segmental translatatory UCM 382
Global range-specific UCM 382
Shoulder girdle tests for UCM 383
Shoulder medial rotation control 383
Observation and analysis of shoulder medial rotation 383
Description of ideal pattern 383
Movement faults associated with glenohumeral medial rotation 383
Relative stiffness (restrictions) 383
Relative flexibility (potential UCM) 384
Indications to test for shoulder medial rotation UCM 384
Test of shoulder medial rotation control 385
t60 Kinetic medial rotation test (KMRT) (tests for scapula and glenohumeral UCM) 385
Test procedure 385
Rating and diagnosis of shoulder girdle UCM 385
Correction 385
An alternative position for retraining the KMRT 387
Shoulder lateral rotation control 389
Observation and analysis of shoulder lateral rotation 389
Description of ideal pattern 389
Movement faults associated with glenohumeral lateral rotation 389
Relative stiffness (restriction) 389
Indications to test for shoulder lateral rotation UCM 390
Test of shoulder lateral rotation control 391
t61 Kinetic lateral rotation test (KLRT) (tests for scapula and glenohumeral UCM) 391
Test procedure 391
KLRT Part 1 391
KLRT Part 2 392
Differentiation between scapular and glenohumeral contributions to apparent restricted range 392
Scapular UCM 392
Glenohumeral UCM 392
Shoulder girdle control dysfunction 392
Rating and diagnosis of shoulder girdle UCM 392
Correction 392
Shoulder flexion control 398
Observation and analysis of shoulder flexion 398
Description of ideal pattern 398
Movement faults associated with arm flexion 398
Dysfunctions of scapulothoracic control 398
Dysfunctions of glenohumeral control 400
Indications to test for shoulder flexion UCM 400
Test of shoulder flexion control 401
T62 Arm flexion test (tests for scapula and glenohumeral UCM) 401
Test procedure 401
Rating and diagnosis of shoulder girdle UCM 401
Correction 403
Shoulder abduction control 404
Observation and analysis of shoulder abduction 404
Description of ideal pattern 404
Movement faults associated with arm abduction 404
Dysfunctions of scapulothoracic control 404
Dysfunctions of glenohumeral control 405
Indications to test for shoulder abduction UCM 405
Test of shoulder abduction control 406
T63 Arm abduction test (tests for scapula and glenohumeral UCM) 406
Test procedure 406
Rating and diagnosis of shoulder girdle UCM 406
Correction 406
Shoulder extension control 409
Observation and analysis of shoulder extension 409
Description of ideal pattern 409
Movement faults associated with extension 409
Dysfunction of scapula-thoracic control 409
Dysfunctions of glenohumeral control 410
Indications to test for shoulder extension UCM 410
Test of shoulder extension control 411
T64 Arm extension test (tests for scapula and glenohumeral UCM) 411
Test procedure 411
Rating and diagnosis of shoulder girdle UCM 411
Correction 411
Other useful dissociation movements for the shoulder girdle 415
UCM and presentation with impingement and instability 417
Correction 417
Retraining suggestions and options 417
References 425
Chapter 9 The hip 428
The hip 427
Introduction 428
Changes in muscle function around the hip 428
UCM at the hip 429
Diagnosis of the site and direction of ucm in the hip 429
Linking the site of UCM to symptom presentation 430
Identifying site and direction of UCM at the hip 430
Segmental translatatory and global range-specific uncontrolled motion 430
Segmental translatatory UCM 430
Global range-specific UCM 430
Examples 433
Hip flexion UCM 433
Hip extension UCM 433
Hip medial rotation UCM 433
Hip lateral rotation/abduction UCM 433
Hip adduction UCM 433
Hip tests for UCM 434
Hip sagittal motion control 434
Observation and analysis of sagittal hip flexion and bending 434
Description of ideal pattern of forwards bending 434
Movement faults associated with hip UCM in forwards bending 434
Relative stiffness (restrictions) 434
Relative flexibility (potential UCM) 434
Description of ideal pattern of backward rocking (hands and knees 4 point kneeling) 435
Movement faults associated with hip UCM in backward rocking 435
Relative stiffness (restrictions) 435
Relative flexibility (potential UCM) 435
Description of ideal pattern of supine passive hip flexion 435
Description of ideal pattern of small knee bend (SKB) 435
Sagittal movement faults associated with hip UCM in the SKB 436
Relative stiffness (restrictions) 436
Relative flexibility (potential UCM) 436
Hip and lower quadrant sagittal alignment evaluation 436
Ideal sagittal alignment 437
Dysfunction 437
Hip flexion control tests and flexion control rehabilitation 438
Indications to test for hip flexion UCM 438
Hip flexion control tests 439
t65 Standing: vertical trunk single leg squat test (tests for hip flexion UCM) 439
Test procedure 439
Hip flexion UCM 439
Rating and diagnosis of hip flexion UCM 440
Correction 441
t66 Standing: single foot lift test (tests for hip flexion UCM) 443
Test procedure 443
Hip flexion UCM 443
Rating and diagnosis of hip flexion UCM 444
Correction 444
T67 Standing: spinal roll down test (tests for hip flexion UCM) 446
Test procedure 446
Hip flexion UCM 447
Rating and diagnosis of hip flexion UCM 447
Correction 447
T68 Side-lying: single leg abduction test (tests for hip flexion UCM) 450
Test procedure 450
Hip flexion UCM 450
Rating and diagnosis of hip flexion UCM 451
Correction 451
Hip flexion UCM summary 451
Hip extension control 453
Movement faults associated with hip extension 453
Modified Thomas test 453
Relative stiffness (restrictions of hip extension) 453
Relative flexibility (potential UCM) 454
Hip extension control tests and extension control rehabilitation 454
Indications to test for hip extension UCM 454
Hip extension control tests 455
T69 Standing: thoracolumbar extension test (tests for hip extension UCM) 455
Test procedure 455
Hip extension UCM 455
Rating and diagnosis of hip extension UCM 456
Correction 456
t70 Standing: single knee lift + anterior tilt test (tests for hip extension UCM) 459
Test procedure 459
Hip extension UCM 460
Rating and diagnosis of hip extension UCM 460
Correction 460
t71 Standing: single knee lift + knee extension test (tests for hip extension UCM) 463
Test procedure 463
Hip extension UCM 464
Rating and diagnosis of hip extension UCM 464
Correction 464
Hip extension UCM summary 465
Hip rotation control 467
Observation and analysis of hip rotation and trunk turning 467
Description of ideal pattern 467
Movement faults associated with hip rotation 467
Relative stiffness (restrictions) 467
Relative flexibility (potential UCM) 467
Assessment of relative hip rotation range 468
Movement faults 468
Assessment of rotation dysfunction at the hip 468
Lower quadrant rotational alignment evaluation 468
Ideal rotational alignment 469
Dysfunctions 469
Correcting neutral rotational alignment of the small knee bend (SKB) 470
Hip medial rotation control tests and medial rotation control rehabilitation 470
Indications to test for hip medial rotation UCM 471
Hip medial rotation control tests 472
T72 Standing: single leg skb test (tests for hip medial rotation UCM) 472
Test procedure 472
Hip medial rotation UCM 472
Rating and diagnosis of hip rotation UCM 473
Correction 473
T73 Standing: one leg skb + trunk rotation away test (tests for hip medial rotation UCM) 476
Test procedure 476
Hip medial rotation UCM 476
Rating and diagnosis of hip rotation UCM 477
Correction 477
t74 Side-lying: top leg turnout lift test (tests for hip medial rotation UCM) 480
Test procedure 480
Hip medial rotation UCM 480
Rating and diagnosis of hip rotation UCM 481
Correction 481
Hip medial rotation UCM summary 481
Hip lateral rotation/abduction control tests and lateral rotation/abduction control rehabilitation 483
Indications to test for hip lateral rotation/abduction UCM 483
Hip lateral rotation/abduction control tests 484
t75 Standing: single leg high knee lift test (tests for hip lateral rotation/ abduction UCM) 484
Test procedure 484
Hip lateral rotation/abduction UCM 485
Rating and diagnosis of hip rotation UCM 485
Correction 485
t76 Standing: one leg skb + trunk rotation towards test (tests for hip lateral rotation/ abduction UCM) 488
Test procedure 488
Hip lateral rotation/abduction UCM 488
Rating and diagnosis of hip rotation UCM 489
Correction 489
T77 4 Point: bent knee hip extension test (tests for hip lateral rotation/ abduction UCM) 492
Test procedure 492
Hip lateral rotation/abduction UCM 493
Rating and diagnosis of hip rotation UCM 493
Correction 493
t78 Bridge: single leg lift test (tests for hip lateral rotation/ abduction UCM) 496
Test procedure 496
Hip lateral rotation/abduction UCM 496
Rating and diagnosis of hip rotation UCM 497
Correction 497
Hip lateral rotation/abduction UCM summary 497
Hip adduction control 499
Observation and analysis of hip adduction and weight transfer 499
Description of ideal pattern 499
Movement faults associated with lateral weight shift 499
Relative stiffness (restrictions) 499
Relative flexibility (potential UCM) 499
Hip adduction control tests and adduction control rehabilitation 500
Indications to test for hip adduction UCM 500
Hip adduction control tests 501
T79 Single leg stance: lateral pelvic shift test (tests for hip adduction UCM) 501
Test procedure 501
Hip adduction UCM 502
Rating and diagnosis of hip rotation UCM 502
Correction 502
Hip adduction UCM summary 503
Femoral forwards glide (femoral head anterior translation) control 505
Hip forwards glide control tests and forwards glide control rehabilitation 505
Indications to test for hip forwards glide UCM 505
Hip forwards glide control tests 506
T80 Supine: active (vs passive) straight leg raise test (tests for hip forwards glide UCM) 506
Test procedure 506
Hip forward glide UCM 507
Rating and diagnosis of hip rotation UCM 507
Correction 507
T81 Prone: active (vs passive) prone leg lift test (tests for hip forward glide UCM) 510
Test procedure 510
Hip forward glide UCM 511
Rating and diagnosis of hip rotation UCM 511
Correction 511
t82 Supine: active (vs passive) ‘FIGURE 4’ turnout test (tests for hip forward glide UCM) 513
Test procedure 513
Hip forward glide UCM 514
Rating and diagnosis of hip rotation UCM 514
Correction 514
Hip forward glide UCM summary 514
References 516
Index 518
A 518
B 519
C 519
D 521
E 522
F 522
G 524
H 524
I 526
K 527
L 527
M 528
N 530
O 531
P 532
R 533
S 536
T 543
U 544
V 545
W 545
Uncontrolled movement
The key to managing movement dysfunction is thorough assessment. This includes the determination of any uncontrolled movement (UCM) and a comprehensive clinical reasoning process by the clinician to evaluate contributing factors which influence the development of UCM. This first chapter details the concept of UCM and the clinical reasoning process which is the framework for assessment and rehabilitation.
Understanding movement and function
Normal or ideal movement is difficult to define. There is no one correct way to move. It is normal to be able to perform any functional task in a variety of different ways, with a variety of different recruitment strategies. Optimal movement ensures that functional tasks and postural control activities are able to be performed in an efficient way and in a way that minimises and controls physiological stresses. This requires the integration of many elements of neuromuscular control including sensory feedback, central nervous system processing and motor coordination. If this can be achieved, efficient and pain-free postural control and movement function can be maintained during normal activities of daily living (ADL), occupational and leisure activities and in sporting performance throughout many years of a person’s life.
The movement system comprises the coordinated interaction of the articular, the myofascial, the neural and the connective tissue systems of the body along with a variety of central nervous system, physiological and psycho-social influences (Figure 1.1). It is essential to assess and correct specific dysfunction in all components of the movement system and to assess the mechanical inter-relationships between the articular, myofascial, neural and connective tissue systems. This chapter will describe a systematic approach to evaluation of the movement system and identification of the relative contributions of individual components to movement dysfunction.
Figure 1.1 Inter-related components of the movement system
Movement faults
Identifying and classifying movement faults is fast becoming the cornerstone of contemporary rehabilitative neuromusculoskeletal practice (Comerford & Mottram 2011; Fersum et al 2010; Sahrmann 2002). In recent years clinicians and researchers have described movement faults and used many terms to describe these aberrant patterns. These terms include substitution strategies (Richardson et al 2004; Jull et al 2008), compensatory movements (Comerford & Mottram 2001a), muscle imbalance (Comerford & Mottram 2001a; Sahrmann 2002), faulty movement (Sahrmann 2002), abnormal dominance of the mobiliser synergists (Richardson et al 2004; Jull et al 2008), co-contraction rigidity (Comerford & Mottram 2001a), movement impairments (Sahrmann 2002; O’Sullivan et al 2005) and control impairments (O’Sullivan et al 2005; Dankaerts et al 2009). All of these terms describe aspects of movement dysfunction, many of which are linked to UCM.
The focus of this text is to describe UCM and explore the relationship of UCM to dysfunction in the movement system (Comerford & Mottram 2011). Movement dysfunction represents multifaceted problems in the movement system and the therapist needs the tools to relate UCM and faults in the movement system to symptoms, recurrence of symptoms and disability. Skills are required to analyse movement, make a clinical diagnosis of movement faults and apply a patient-specific retraining program and management plan to deal with pain, disability, recurrence of pain and dysfunction.
Sahrmann (2002) has promoted the concept that faulty movement can induce pathology, not just be the result of it; that musculoskeletal pain syndromes are seldom caused by isolated events; and that habitual movements and sustained postures play a major role in the development of movement dysfunction. These statements have been fundamental in the development of the movement dysfunction model. Clinical situations which have a major component of movement dysfunction contributing to pain include: postural pain; pain of insidious onset; static loading or holding pain; overuse pathology (low force repetitive strain or high force and/or impact repetitive strain); recurrent pain patterns; and chronic pain.
It is important to identify UCM in the functional movement system. It is our hypothesis that the uncontrolled segment is the most likely source of pathology and symptoms of mechanical origin. There is a growing body of evidence to support the relationship between UCM and symptoms (Dankaerts 2006a, 2006b; Luomajoki et al 2008; van Dillen et al 2009). The direction of UCM relates to the direction of tissue stress or strain and pain producing movements. Therefore it is important in the assessment to identify the site and the direction of UCM and relate it to the symptoms and pathology. The UCM identifies the site and the direction of dynamic stability dysfunction and is related to the direction of symptom-producing movement. For example, UCM into lumbar flexion under a flexion load may place abnormal stress or strain on various tissues and result in lumbar flexion-related symptoms. Likewise, uncontrolled lumbar extension under extension load produces extension-related symptoms, while uncontrolled lumbar rotation or side-bend and/or side-shift under unilateral load produces unilateral symptoms.
Identification and classification of UCM
Figure 1.2 illustrates the link between UCM and pain. Abnormal stress or strain that exceeds tissue tolerance can contribute to pain and pathology. The relationship between UCM and pain/pathology will be explored further in Chapter 3.
Figure 1.2 Uncontrolled movement: the link to pain and pathology
In this text the identification and classification of movement faults are described in terms of site and direction of UCM. These movement faults will be discussed in Chapter 2 in relation to changes in motor recruitment and strength (Comerford & Mottram 2001b, 2011). Scientific literature and current clinical practice are linking the site and direction of UCM in relation to symptoms, disability, dysfunction, recurrence, risk and performance (Figure 1.3).
Figure 1.3 Factors relating to the site and direction of uncontrolled movement
Symptoms
Symptoms are what the patient feels and complains of and include pain, paraesthesia, numbness, heaviness, weakness, stiffness, instability, giving way, locking, tension, hot, cold, clammy, nausea and noise. The treatment of symptoms is often the patient’s highest priority and is a primary short-term goal of treatment.
Pain is frequently one of the main symptoms that the patient presents with to the therapist and is inherently linked to movement dysfunction. Contemporary research clearly demonstrates that individuals with pain present with aberrant movement patterns (Dankaerts et al 2006a, 2009; Falla et al 2004; Ludewig & Cook 2000; Luomajoki et al 2008; O’Sullivan et al 1997b, 1998). Research has demonstrated a consistent finding: in the presence of pain, a change occurs in recruitment patterns and the coordination of synergistic muscles. Individuals with pain demonstrate patterns of movements that would normally be used only in the performance of high load or fatiguing tasks (e.g. pushing, pulling, lifting weights) to perform low load non-fatiguing functional tasks (e.g. postural control and non-fatiguing normal movements). Clearly UCM is a feature of many musculoskeletal pain presentations and identifying and classifying these movement faults is essential if therapists are to effectively manage symptoms by controlling movement faults.
Disability
Disability is the experienced difficulty doing activities in any domain of life (typical for one’s age and sex group, e.g. job, household management, personal care, hobbies, active recreation) due to a health or physical problem (Verbrugge & Jette 1994). Movement faults are related to disability. For example, Lin et al (2006) demonstrated that changes in scapular movement patterns (in particular a loss of posterior tilt and upward rotation) correlated significantly with self-report and performance-based functional measures indicating disability. The relationship between disability and movement faults has been identified in many other fields of physical therapy (e.g. neurological and amputee rehabilitation). Indeed, in relation to gait dysfunction, management and retraining of UCM is a key factor in rehabilitation of people with lower limb amputations using a prosthesis (Hirons et al 2007).
Reduction of disability is the primary long-term goal of therapy or rehabilitation. Disability is individual and what one person considers disability another person might consider exceptional function. For example, an elite athlete’s disability may be a function that most people do not have the ability to do, do not want to do or need to do. Movement dysfunction, however, can affect a person’s ability to function independently and therefore...
| Erscheint lt. Verlag | 15.6.2012 |
|---|---|
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Naturheilkunde |
| Medizin / Pharmazie ► Pflege | |
| Medizin / Pharmazie ► Physiotherapie / Ergotherapie | |
| ISBN-10 | 0-7295-7907-7 / 0729579077 |
| ISBN-13 | 978-0-7295-7907-0 / 9780729579070 |
| Haben Sie eine Frage zum Produkt? |
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