Movement Based Assessment and Treatment

theory proposed by shirley sahrmann

- repeated movements can be used a part of functional testing

- repeated movements can be used to produce desired increases in joint flexibility, muscle length, and muscle strength as well as to train specific patterns of movement

components of assessment used to observe quality of movement

- speed of movement

- amount of movement

- symmetry of movement

- control

- symptom alteration

observation - speed of movement

time to complete a task

observation - amount of movement

amplitude, excursion, ROM of movement required to complete an activity

observation - control

smoothness, coordination, stability, sequencing, timing initiation

observation - symptom alteration

guarded, shortness of breath, pain alteration

kinesio-pathological model

pathology

- most overuse syndromes follow this model

- there are repeated movements or sustained postures associated with work or recreation that result in pain and/or pathology

- we expect to make desirable changes in joint flexibility, muscle length, and muscle strength with regular exercise

- we should expect that repeated motions or sustained positioning will induce undesirable changes

examples of pain generators

- overactive neural drive

- local neural irritability

- soft tissue and trigger points

different types of soft tissue imbalances

- antagonist imbalance

- synergist muscle imbalance

- muscle length imbalance

- compensatory relative flexibility

describe the concept of antagonist muscle imbalance

not all muscle groups acting at a given joint should have the same strength but there is an ideal strength ratio of muscle groups

describe the concept of synergist muscle imbalance

- regular exercise does not ensure equal hypertrophy and activation of all synergists

- relative weakness of synergists is frequently found

- common examples include lower traps, gluteus maximus and post gluteus medius

describe the concept of muscle length imbalance

- muscles become weaker when held in a lengthened position

- muscles weakened by stretch will be weak but not painful against resistance

- postural alignment controlled by imbalanced muscle will be abnormal

describe the concept of muscle length induced weakness

- assess muscle strength in a shortened and lengthened position

- the lengthened muscle will have much more difficulty contracting in a shortened position

- suggests retraining is necessary involving a lighter load in a shortened position

common muscle length imbalances in scapular adductor synergists

short rhomboids, long lower trap

common muscle length imbalances in GH medial rotator synergists

short pectoralis major, long subscapularis

common muscle length imbalances in trunk flexors that tilt the pelvis in a posterior direction

short rectus abdominis, long external oblique abdominis

common muscle length imbalances in hip abductor synergists

short TFL, long posterior gluteus medius

what is described below?

When one muscle group is hypertrophied and hence stiffer than a neighboring muscle group, the more flexible joint will be more susceptible to excessive movement. Because of the inter-segmental variations in the spring like behavior of muscles, increased stiffness of one muscle group can cause compensatory movement at an adjoining joint that is controlled by muscles with less stiffness.

compensatory relative flexibility

describe the altered recruitment patterns of the TFL, anterior gluteus medius, posterior gluteus medius, and gluteus minimus during hip abduction

the TFL, anterior glut med, and glut min are more dominant than the posterior glut med

during MMT of the posterior glut med, the patient will substitute by hip internal rotation and flexion

describe the altered recruitment pattern of the pectoralis major and subscapularis during humeral internal rotation

- the pectoralis major is more dominant

- excessive flexibility of the humeral head into anterior glide is further exaggerated by the contraction of the pectoralis major

when is altered recruitment patterns most apparent

during eccentric activity

compensation during a concentric motion suggests

weakness

compensation during eccentric motion suggests

recruitment issues