Movement Science Exam 1 (Part 2) - SFMA & Gait

Performing the SFMA allows us to observe and assess what?

TQ

Movement patterns

What are the key characteristics and benefits of performing the SFMA? (5)

1) Observe/assess movement patterns

2) Standardized & evidence-based

3) May be performed by train health care provider or rehab/fitness professionals

4) Moves us beyond simply stretching tight spots & strengthening weak areas

5) Testing/re-testing allows measure and document change/progress

The SFMA begins with the top tier assessments. What are the next steps within the SFMA system (3)?

1) Top tier assessments

2) Breakout tests

3) Special testing

How do you categorize/score on of the top tier screens based on the scoring system? Which score do we care the most about or breakout first? Which scores do we care about the least or do not break out at all?

FN - Functional, No Pain

(LEAST IMPORTANT)

FP - Functional, Pain

DP - Dysfunctional, Pain

DN - Dysfunctional, No Pain

(MOST IMPORTANT)

What is any unlimited or unrestricted movement which meets criteria as defined?

Functional

What is any movement that does not meet all the criteria as defined?

Dysfunctional

What is any movement which reproduces symptoms, increases symptoms, or brings about secondary symptoms?

Painful

What are the 5 basic rules of the SFMA?

1) No warmup

2) If its there, it's there

3) Be picky

4) NO shoes

5) Monkey see Monkey do

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward, then the patient then tries to touch the chin to the sternum, keeping the trunk erect during the movement?

Cervical Spine Flexion

What are the 3 criteria resulting in a "dysfunctional" movement pattern for Cervical Flexion?

1) Cant touch sternum to chin

2) Non-uniform spinal curve

3) Excessive effort and/or lack of motor control

What are 2 common compensations observed with "dysfunctional" movement pattern of Cervical Flexion?

1) Thorax flexion

2) Hinging from lower cervical spine

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward. The patient then looks up, aiming the face parallel with the ceiling, and we use the line of their face as our reference line?

Cervical Spine Extension

What are the 3 criteria resulting in a "dysfunctional" movement pattern for Cervical Extension?

1) Not within 10 degrees of parallel

2) Non-uniform spinal curve

3) Excessive effort and/or lack of motor control

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward. The patient rotates the head as far as possible to the right and then left, and we use the nose-to-chin line as our reference line?

Cervical Spine Rotation

What are the 2 criteria resulting in a "dysfunctional" movement pattern for Cervical Spine Rotation?

1) Chin/nose not in line w/ mid-clavicle

2) Excessive effort and/or appreciable asymmetry or lack of motor control

What are 3 common compensations observed with "dysfunctional" movement pattern of Cervical Rotation?

1) Cervical extension/side-bend

2) Torso rotation

3) Shoulder elevation

What are 4 tips for testing cervical spine flexion, extension, and rotation?

1) Mouth remains closed

2) Observe from front & side

3) Do not coach the movement, simply repeat instructions if needed

4) Was there pain?

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward, where the person reaches back with one arm, trying to touch the inferior angle of the opposite scapula, and then the motion is repeated with the other arm?

Upper Extremity Pattern 1

What are the 2 criteria resulting in a "dysfunctional" movement pattern for Upper Extremity Pattern 1?

1) Does not reach inferior angle of scapula

2) Excessive effort and/or appreciated asymmetry or lack of motor control

What are 3 common compensations observed with "dysfunctional" movement pattern of Upper Extremity Pattern 1?

1) Radial deviation

2) Scapular winging

3) Two movements rather than one fluid movement

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward. The person then reaches overhead with the one arm in a "combing hair" motion, trying to touch the spine of the opposite scapula. Repeat the motion with the other arm?

Upper Extremity Pattern 2

What are the 2 criteria resulting in a "dysfunctional" movement pattern for Upper Extremity Pattern 2?

1) Does not reach spine of scapula

2) Excessive effort and/or appreciable asymmetry or lack of motor control

What are 3 common compensations observed with "dysfunctional" movement pattern of Upper Extremity Pattern 2?

1) Torso rotation

2) Cervical flexion and/or rotation

3) Opposite shoulder elevation

What are 4 tips for testing upper extremity pattern 1 & pattern 2?

1) Observe form back & side

2) Head position should remain unchanged

3) Do not coach movement

4) Was there pain?

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward. They then bend forward from hips reaching down to touch the ends of their fingers to the tips of their toes without bending their knees. Direct the patient to look down towards toes during the movement?

Multi-Segmental Flexion

What are the 5 criteria resulting in a "dysfunctional" movement pattern for Multi-segmental flexion?

1) Cannot touch toes

2) Sacral angle <70 degrees

3) Non-uniform spine curve

4) Lack of posterior weight shift

5) Excessive effort and/or appreciable asymmetry or lack of motor control

What is a common compensations observed with "dysfunctional" movement pattern of Multi-segmental flexion?

Knee bend

What are 7 tips for testing multi-segmental flexion?

1) Observe from side

2) Foot position should remain unchanged

3) Knees remain straight

4) Patient touches floor in front of their toes, instruct to only touch toes

5) Cervical spine should not be extended

6) Do not couch movement

7) Pain?

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward. The patient then raises their hands into full shoulder flexion, with the elbows extended and in line with the ears. Have the patient push their hips forward and bend backward as far as possible, making sure the hips go forward an the arms go back simultaneously. Direct the patients to look up towards hands during movement?

Multi-segmental extension

What are the 5 criteria resulting in a "dysfunctional" movement pattern for Multi-segmental extension?

1) Upper extremity does not achieve or maintain 170

2) ASIS does not clear toes

3) Spine of scapula does not clear heels

4) Non-uniform spinal curve

5) Excessive effort and/or lack of motor control

What is a common compensations observed with "dysfunctional" movement pattern of Multi-segmental extension?

Greater than 5 degrees of knee flexion

What are 5 tips for testing multi-segmental extension?

1) Observe from front & side

2) Foot position should remain unchanged throughout the movement

3) If arms do not start in proper start position, test already dysfunctional

4) Do not coach movement

5) Pain

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward and arms relaxed to the sides. The patient then rotates the entire body (hips, shoulders, and head) as far as possible to one side while the foot position remains unchanged. Have the patient return to starting position and then rotate to the other side?

Multi-Segmental Rotation

What are the 3 criteria resulting in a "dysfunctional" movement pattern for Multi-segmental rotation?

1) Pelvis rotation <50 degrees

2) Torso rotation <50 degrees

3) Excessive effort and/or lack of symmetry or motor control

What are 4 common compensations observed with "dysfunctional" movement pattern of Multi-segmental rotation?

1) Hip and/or knee flexion

2) Spine and/or pelvis deviation

3) Protraction/retraction of shoulder girdle

4) Loss of foot/ankle position

What are 4 tips for testing multi-segmental rotation?

1) Observe from back

2) Foot position should remain unchanged

3) Do not coach movement

4) Pain?

Which SFMA top tier test is when the patient assumes the starting position by standing erect with feet together and toes pointing forward and arms relaxed to the sides of the thighs. Have the patient flex their knee so their foot comes off the ground. The patient maintains full upright posture balancing only on their one leg for at least 10 seconds. Repeat with eyes closed for 10 seconds. Repeat test with opposite leg.

Single-Leg Stance

What are the 4 criteria resulting in a "dysfunctional" movement pattern for Single Leg Stance?

1) Eyes open <10 seconds

2) Eyes closed <10 seconds

3) Loss of height

4) Excessive effort or lack of symmetry or motor control

What are 3 common compensations observed with "dysfunctional" movement pattern of Single-leg stance?

1) Pelvic deviation

2) Flail arms

3) Moves original foot position

What are 2 tips for testing single-leg stance?

1) Expect 50% increase in sway with eyes closed

2) Pain?

Which SFMA top tier test is when the patient assumes the starting position by placing their feet together and arms out in front of their body. The feet should be in the sagittal plane (toes pointing straight ahead). Have the patient slowly descend as deeply as possible into a squat position, allowing their arms to remain out front. The squat position should be assumed with the heels on the floor and head and chest facing forward. If they break parallel (hips below knees) at the bottom of the squat, now have them lower their arms to touch their fists on the floor within their footprint. They should maintain sagittal plane throughout movement?

Arms Down Deep Squat

What are the 4 criteria resulting in a "dysfunctional" movement pattern for Arms Down Deep Squat?

1) Hips do not break parallel

2) Cannot reach fists to ground within footprint

3) Loss of sagittal plane alignment

4) Excessive effort, weight shift, or motor control

What are 3 common compensations observed with "dysfunctional" movement pattern of Arms down deep squat?

1) Ankles externally rotated

2) Heels lift off ground

3) Falls over

What are 4 tips for testing arms down deep squat?

1) Observe from front and side

2) Foot position unchanged

3) Knees allowed to move outward during squat

4) Do not coach movement

5) Pain?

What type of dysfunction is present when the underlying mobility to complete the desired movement is present, but because of an input or processing problem the coordination of the movement is not demonstrated?

Stability motor control dysfunction

What is a decrease of limitation in full range of motion?

Motor control dysfunction

What is figuring out dysfunction and non-painful movements and diving deeper into those to narrow down further the area of concern called?

Breakout

What are the 3 logic steps utilized during the breakout?

1) Remove body parts

2) Change stability requirements

3) Active versus passive motion

T/F: Mobility dysfunctions will stay consistent no matter what accommodation you make

TQ

TRUE

T/F: You should inspect the individual components of gait all at once when doing a gait analysis to be the most effective and efficient.

TQ

FALSE

-- individual components should be inspected ONE AT A TIME

What makes up one full gait cycle?

Start w/ heel contact of one foot, ends with another heel contact of the SAME foot

Which primary phase/period of a normal walking gait cycle is when the foot is on the floor, makes up 60% of the gait cycle, and is further divided into early, middle, and late subphases (equal duration)?

TQ

Stance Phase (0-60%)

Which primary phase/period of a normal walking gait cycle is when the leg is swinging forward, making up 40% of the gait?

TQ

Swing Phase (60-100%)

From what percent of the normal walking gait cycle does double stance occur? What is the total percent?

Double stance from 40-60%; 20% total

What are the 7 individual components/phases of the normal gait cycle in order?

1) Heel strike (0%)

2) Foot flat (10%)

3) Mid stance (30%)

4) Push off (50%)

5) Toe off (60%)

6) Mid-swing (80%)

7) Heel strike (100%)

What is an additional phase that is present in the running gait cycle?

Airborne phase

What are the 3 major determinants of gait?

TQ

1) Slight knee flexion (20 degrees)

2) Pelvic list/drop

3) Posterior pelvic rotation

What are the major determinants of gait attempting to minimize?

TQ

Center of mass (CoM) movement and overall energy expenditure

What is the consequence of exaggerated knee flexion in gait?

Metabolically expensive!

- high caloric cost, 50% more oxygen consumption

During pelvic list/drop, is it the stance leg hip or the swing leg hip that drops downward? Why?

Pelvis drops downward on the opposite side (swing leg hip)

- minimizes vertical movement of CoM (energy efficient)

- Controlled by gluteus Medius

How much lateral movement/translation is normal during pelvic list/drop?

TQ

up to 1 inch of lateral translation

What mechanism helps to dissipate braking forces? How?

Posterior Pelvic Rotation

- when swing leg hits ground, pelvis rotates posteriorly to dissipate forces created form heel hitting ground; helps reduce energy expenditure by minimizing movement of CoM

What direction do the talus and calcaneus each move during pronation/eversion of the subtalar joint?

Pronation

(talus moves w/ a medial rolling action upon the calcaneus)

How many degrees of 1st ray (MTP) dorsiflexion is considered normal during walking gait?

TQ

>60 degrees

Why is extension of the big toe so important?

Allows the plantar fascia to support the weight of the foot during weight-bearing actions (Windlass Effect)

- Produces a "rigid lever"

How many degrees of ankle dorsiflexion are considered normal?

about 40 degrees

(only need 10-20 degrees during normal gait)

What plane of motion do the upper gluteus maximus fibers control?

FRONTAL PLANE motion

What plane of motion do the lower gluteus maximus fibers control?

SAGITTAL and TRNASVERSE plane motions

During single-leg stance, body weight creates tensile and compressive strains on the femoral neck, so the _________ play a role in controlling the femur to help resist that.

Glutes

What are the keys to gait evaluation? (2)

1) Dissect with precision and be specific

2) Inspect individual components! (single out isolated events during gait cycle as they occur in one specific plane of motion)

What are the key areas to evaluate in gait evaluation basics? (8)

1) Arm swing in sagittal and transverse plane

2) Hip flexion/extension and trasnverse plane (anteversion/retroversio)

3) Knee flexion/extension and frontal plane (valgus/varus)

4) Ankle mortise in sagittal plane (dorsiflexion/plantar flexion)

5) Calcaneus in the frontal plane (eversion/inversion)

6) Forefoot in frontal plane (pronation/supination)

7) First ray (MTP) in sagittal plane (extension/dorsiflexion)

8) Toe-in/out in transverse plane (internal/external rotation)

What should we do as a double-check for gait analysis findings?

Breakout into motion palpation????

(UNSURE on this one)

What are the 12 common dysfunctions that may be present during gait assessment?

1) Asymmetrical arm swing or excessive elbow flexion (usually result of something from the hips, pelvis, or lower extremity)

2) Excessive center of mass vertical movement

3) Excessive contralateral hip drop (>4-6 degrees) or lateral translation (> 1 inch*)

4) Inadequate hip extension (<10 degrees*)

5) Excessive femoral anteversion (internal rotation) and adduction (leading to knee valgus)

6) Excessive knee valgus (medial collapse/drift)

7) Excessive or inadequate knee flexion during midstance

8) Excessive toe-out (external rotation)

9) Inadequate ankle dorsiflexion

10) Excessive subtalar (calcaneal) eversion from heel strike to end of mid-stance phase

11) Excessive forefoot (mid-tarsal) pronation

12) Inadequate first ray dorsiflexion (extension)

T/F: You can make treatment implications based on gait analysis alone

TQ

FALSE

What is the first thing to look at when assessing a running injury?

TQ

Individual training logs in conjunction w/ running experience (because most people progress/jump into it too quickly w/o letting body adapt)

What types of injuries are high-arched runners most susceptible to suffering? (2)

TQ

High arches hit ground harder and pronate thorough very small ranges

- More bony injuries (stress fractures) and more injuries along their outer foot/leg (IITBS, ankle spainrs)