Finding the Weak Link- Movement Screening
David A. Hoyle, DPT, MA, OCS, MTC, CEAS
National Director of WorkStrategies
Select Medical Outpatient Division Family of Brands
Sports Medicine Services
Learning Objectives
 Finding the Weak Link- Movement Screening
 Learners will understand the appropriate use of full body
versus regional screening.
 Learners will be familiar with the common altered
movement patterns associated with hip dysfunction.
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Hip- Shoulder Analogies
 Shoulder
 Hip
 Rotator Cuff
 Deficiency leads to arthritis
 Tendinopathy precedes
 Rotator Cuff
 Deficiency leads to arthritis
 Tendinopathy precedes
bursal changes
 Tendinopathy is usually
degenerative
 Labral tears usually
degenerative
 Significant changes in
asymptomatic populations
increase with age
bursal changes
 Tendinopathy is usually
degenerative
 Labral tears usually
degenerative
 Significant changes in
asymptomatic populations
increase with age
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The role of the rotator cuff of the Hip
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Introduction to Movement
Dysfunction
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Who has influenced study of
movement dysfunction
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Fredrick Matthias Alexander
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John V. Basmajian
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German born physical education instructor
1883-1967
Your Health: A Corrective System of
Exercising That Revolutionizes the Entire
Field of Physical Education in 1934, and
Return to Life Through Contrology in 1945.
1921-2008
Muscles Alive- Their Functions Revealed by
Electromyography- 1962
Vladimir Janda
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Florence Kendall
– American Physical Therapist 1911-2006
– Muscles: Testing and Function With
Posture and Pain
Australian Born (1869) Actor
“Man’s Supreme Inheritance”- 1945
Joseph Pilates
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Shirley Sharman
– American Physical Therapist
– Diagnosis and Treatment of Movement
Impairment Syndromes
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Gary Gray
– American Physical Therapist
– “Lower Extremity Functional Profile”1995
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Gray Cook
– American Physical Therapist
– Movement- Functional Movement
Systems Functional Movement Screen-
Czechoslovakian Neurologist 1923-2002
First Book published on muscle function
and testing in 1949
– 16 books and 100’s of articles
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Development and Motor Control
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We are all born with movement synergies
(reflexive movement patterns)
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ASTNR
STNR
Grasp Reflex
Stepping Refex
Startle
Parachute
We overcome synergies by programming
new movement patterns. Motor
learning/motor control.
Movement screening assesses the motor
control that inhibits reflexive movement.
In times of stress and maximal effort we
tend towards reflexive patterns.
As a result of injury or illness motor
control can become inhibited resulting in
a return to reflexive patterning.
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Information Technology
• Hardware
– Strength
– Flexibility
• Software
– Motor Control
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• Motor Learning
• Motor Unit recruitment
Screening
Performance Based
Treatment Based
Flexibility
Strength
Movement
Pattern
Function
Movement
Pattern
Strength
Function
Flexibility
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Janda Muscle Imbalances
Tonic (Prone to Tightness)
Phasic (Prone to Weakness)
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Gastroc-Soleus
Hip Adductors
Hamstrings
Rectus Femoris
Iliopsoas
Tensor Fascia Lata
Piriformis
Erector-Spinae (thoraco-lumbar)
Suboccipital muscles
Quadratus Lumborum
Pectoralis Major & Minor
Latissumus Dorsi
Upper Trapezius
Levator Scapulae
Scalenes
Sternocleidomastoid
Peroneals
Tibialis Anterior
Vastus Medialis
Vastus Lateralis
Gluteus Maximus
Gluteus Medius
Transversus Abdominus
Multifidus
Rectus Abominus
Abdominal Obliques
Serratus Anterior
Rhomboids Lower & Middle
Trapezius
Deep neck flexors
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http://www.muscleimbalancesyndromes.com/what-is-muscle-imbalance/
Janda’s Lower Crossed Syndrome
• Lower-Crossed Syndrome (LCS) is also referred to as
distal or pelvic crossed syndrome.
• Tightness of the thoracolumbar extensors on the dorsal
side crosses with tightness of the iliopsoas and rectus
femoris.
• Weakness of the deep abdominal muscles ventrally
crosses with weakness of the gluteus maximus and
medius.
• This pattern of imbalance creates joint dysfunction,
particularly at the L4-L5 and L5-S1 segments, SI joint,
and hip joint.
• Specific postural changes seen in LCS include anterior
pelvic tilt, increased lumbar lordosis, lateral lumbar shift,
lateral leg rotation, and knee hyperextension.
– If the lordosis is deep and short, then imbalance is
predominantly in the pelvic muscles;
– If the lordosis is shallow and extends into the thoracic area,
then imbalance predominates in the trunk muscles (Janda
1987).
http://www.muscleimbalancesyndromes.com/janda-syndromes/lower-crossed-syndrome/
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Janda Muscle Imbalance
• With postural/muscle
imbalance joints are not
in an optimal position.
• Muscles also are not in
an optimal position.
• Example
– GH instability
– PFPS
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http://www.muscleimbalancesyndromes.com/what-is-muscle-imbalance/
Janda’s Recommended Eval
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History
Postural Assessment
Balance Assessment
Gait Assessment
Movement Pattern Assessment
Manual Muscle Testing
Muscle Length Assessment
Soft Tissue Assessment
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Posture, Balance, and Gait
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Postural Imbalance
• Opposing muscle groups affect joint position in
an adverse way.
– Tightness (hypertonicity) of one muscle(s) and
abnormal lengthening (hypotonicity) of it’s reciprical
muscle(s).
– May cause stress about a joint.
• (Iliac tightness and glut med/max inhibition causing SI jt
stress)
– May cause problems up or down the kinetic chain.
• Glut med/min inhibition and TFL hypertonicity causing
patellofemoral dysfunction.
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Buttock Region
• Look at:
– Size and Symmetry
– Shape
• Rounded
• Not Hanging or Flattened
– sign of inhibition.
• Related to
– SI jt dysfunction on the
ipsilateral side
– Ipsilateral hypertonicity
of:
• Iliacus
• Piriformis
• Recuts abdominis
– Contralateral glut med
inhibition/weakness
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Thigh
• Hamstrings
– Hypertrophy with glut
max inhibition and
ipsilateral thoracolumbar
paraspinal hypertonicity.
• Adductors
– Prox 1/3
• Normal shallow S-Curve
• Deep S-Curve or Adductor
notch indicates
hypertonicity of the one
joint adductors
(Pectineus)
• Associate with
– LLD, lateral shift and hip
jt dysfunction.
– Hip Abductor Weakness
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Spinal Extensors
• Hypertrophy/Hypertoni
city
– Weak or inhibited glteals
– Poor deep stabilizers
– Hyper lordosis
• Horizontal Groove
– Segmental
hypermobility.
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Pelvic Tilt/Abdominal Wall
• ASIS height
– Pelvic Tilt
– Anterior
• Short Leg
– Tight/hypertonic
Adductors
• ITB tightness
• Glut Med weakness
• Abdominal Wall
– Upper and Lower
Quadrants
– Left vs. Right
• Lateral Rectus Groove
– Hypertonic Obliques
– Weak Rectus
• Lateral Bulge of
abdominals
– TA hypotonicity
• Elevated Rib Cage
– Faulty Breathing
Pattern.
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Quad and ITB
• Tightness
– Associated with Ant tilt
of ilium.
– Identified through
lateral groove of the
thigh.
– Associated with weak
Glut Med and hip
external rotators.
– Contribute to a
superior lateral shift of
the patella.
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High Activation/Hypertonic Muscle
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Higher resting muscle tone
Lower irritability threshold
Inhibits the muscles reciprical muscle.
Relaxation of a tight/hypertonic muscle can
lead to immediate strength gains of it’s
reciprical muscle.
• Continuous hypertonicity of one muscle can
lead to muscular/postural imbalance.
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Evaluation of Movement
Patterns
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Traditional Testing
Strength has traditional been
tested:
Functional Movements are:
• Isometrically
• Maximum “Make” or “Break
Testing”
• Attempt to “isolate” muscle
function.
• Primary emphasis on force
production
• Occasionally Isometric but
generally dynamic.
• Rarely require maximal force.
• Never occur in isolation.
• Quality and control are often
more important than maximal
output.
• Sequencing of movement and
muscle activation determine
quality. (0nset and timing)
– Grade (0-5 or zero-normal)
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Key Observations of Evaluation of
Movement Patterns
1. Firing order of muscles
2. Compensatory patterns of movement
3. Initiation of movement as an indication of
“motor control”.
4. Comparison of left and right.
5. Muscle trembling is an indication of a lack of
control or weakness or fatigue.
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Guidelines for Testing
• Be able to visualize parts of the body being
tested.
• Use minimal verbal cues as not to influence
movement patterns but rather to reveal
“preferred patterns” of movement.
• Avoid tactile cueing.
• Perform multiple trials in a slow enough
manner to reveal control and consistency (3-6
trials).
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Recommended Movement Patterns and
Strength Assessments
Janda’s Six Movements Patterns
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Hip Extension
Hip Abduction
Curl-up
Cervical Flexion
Push-up
Shoulder Abduction
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Janda’s Six Movement Patterns
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Test 1
Hip Extension Movement Pattern Test
 Purpose- Observe the preferred
movement recruitment pattern of
the hamstrings, gluteus maximus,
spinal extensors, and shoulder
musculature.
 Test- Patient lies prone with arms
at side, head neutral, and feet
over end of the table in neutral
hip rotation. Patient is asked to
slowly lift their leg towards the
ceiling.
 Preferred Pattern- hamstrings,
gluteus meximus followed by
contralateral erector spinae and
last ipsilateral eractor spinae.
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Hip Extension Movement Pattern Test
 Typical Abnormal Compensations
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Over activation of the hamstrings and
erector spinae and delayed or absent
contraction of the gluteus maximus
 Worse substitution is when the
thoracolumbar extensors or even the
shoulder muscles initiate the movement
with delayed or absent gluteus maximus
contribution.
 Inability to maintain knee extension is a
sign of hamstring dominance.
 Hyperlordosis and anterior pelvic tilting.
 Other Considerations
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Hypertrophy of the hamstrings and
thoracolumbar extensors.
 Atrophy of the gluteus maximus.
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Test 2
Hip Abduction Movement Pattern Test
 Purpose-provides direct
information about the quality of
the lateral muscular pelvic brace
and indirect information about
the stabilization of the pelvis in
the frontal plane.
 Test- Pt is sidelying with bottom
leg flexed and top leg in a neutral
position in line with the trunk. Pt
lifts leg toward the ceiling.
 Preferred Pattern- Hip abduction
of 20 degrees without any hip
flexion or internal or external
rotationwith a stable trunk and
pelvis.
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Hip Abduction Movement Pattern
Test
 Typical Abnormal Compensations
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Tensor mechanism substitution- hip
abduction is combine with flexion due
to the combined action of the Tensor as
a hip flexor and abductor.
 Quadratus Lumborum substitution- Hip
abduction is initialted by contraction of
the QL before 20 degrees of hip
abduction resulting in a lateral pelvic tilt
or hip hike. Role of QL changes from
pelvic stabilizer to primary mover
 Other Considerations
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Tightness of ITB
 Atrophy of Gluteals
 Poor results of SLB test.
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Test 3
Trunk Curl-up Movement Pattern Test
 Purpose- Tests the interplay
between the iliopsoas and the
abdominals.
 Test- Patient is in supine hooklying. The patient rounds the
upper trunk until the inferior
angle of the scapula are off the
supporting surface.
 Preferred Pattern- The
abdominal muscles contract and
shorten falexing the spine and
posteriorly tilting the pelvis.
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Trunk Curl-up Movement Pattern
Test
 Typical Abnormal Compensations
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Performed preferentially with hip flexion with maintenance of the lordosis and anterior
pelvic tilting. Minimal flexion of the upper trunk is noted.
 Other Considerations
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Kendall advocated using two tests one for the lower and one the upper abdominals.
• Upper abdominals- Upper rectus and internal obliques with curl-up.
• Lower abdominals- external obliques and lower rectus abdominals with double leg
lowering.
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Single Leg Stance Test
 Purpose- Test for overall compensatory movements.
 Test- Patient is standing on one foot with the other
foot by the side but not touching the stance leg.
 Preferred Pattern- The abdominal muscles contract
and shorten flexing the spine and posteriorly tilting
the pelvis, the shoulders and hips remain over the
knees.
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34
Single Leg Stance Test
 Typical Abnormal Compensations
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Stance hip adducts, trunk moves outside the pelvis or opposite hip drops.
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