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: p244-245, 826-827
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Top hand held across chest with hand on bottom shoulder pulling down to
stabilize
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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
Functional Evaluation and Prague School Test (Part 1)
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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;80:941-­‐4. 2. Forward Plank Endurance Test
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Elbows under shoulders
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Hands together
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Forearms in a “V” position
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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;9:55-­‐61. Functional Evaluation and Prague School Test (Part 1)
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3. Trunk Flexor Endurance Testing: The V Sit - p832
4. Back Extensor Endurance Test: p244-245, 828-829
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Trunk extensors are normally in a 1.3:1 ratio with Trunk flexors
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In LBP subjects the ratio is 1:1
McGill S, Childs A, Liebenson C. 5. 1 Leg Balance Test: p248-249, 807-809
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Balance
Scoring:
– 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
Record time when:
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Hop
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Move foot
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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;31:172-­‐177 Functional Evaluation and Prague School Test (Part 1)
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6. Cranio-cervical flexion incoordination: p250-252, 872-873
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: 179-­‐185,1999. Jull GA. Deep cervical flexor muscle dysfunction in whiplash. Journal of Musculoskeletal Pain 8:143-­‐154, 2000. C0-C1
Chronic Neck Pain vs Asymptomatic Subjects:
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↓ activity in the deep neck flexor muscles
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Incr. activity of the superficial SCM muscles
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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. 2108-­‐2114. Functional Evaluation and Prague School Test (Part 1)
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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
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1. Diaphragm Test: p553-555
The Diaphragm test
Normal:
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The lower chest expands symetrically in a lateral direction
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Intercostal spaces widen
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Ribs must not be lifted!
Results of Inspiratory position of thoracic cage:
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Oblique diaphragm
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Failure of oblique abdominal muscle slings
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T/L overload
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Hyperlordosis
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Lower Cross Syndrome (Janda)
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Horizontal Axis of Diaphragm
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Why does depression of thoracic cage matter in both phases of breathing?
2. Intra-abdominal pressure test: p555-557
Initial position:
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Patient supine
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Triple flexion of the legs
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The lower legs supported
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Hip abduction corresponds to the width of the shoulders, slight external
rotation at the hips
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Intra-abdominal pressure test
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The therapist brings the patient’s chest passively into the caudal, expiratory
position
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Then the support is removed from under the patient’s legs
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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 -p630 4. Arm Lifting Test: p557,558
Dying Bug w/ Med Ball OH
5. Hip abduction Test:
Dysfunction:
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weak or feel low back
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Hip hike - QL OA
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Hip flexion - TFL OA
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6. Vele’s Forward Inclination:
Sign of Instability:
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L/P hinge
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Failure of toes to grip
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Asymetric grip
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