SUBJECTIVE COORDINATION TESTS Movement Pattern Patient Position Instruction Hip extension Prone, feet off the Keeping

your leg table, head turned straight, slowly lift NB. Look at first to a comfortable your leg in the air position 10 of extension amount of hip extension that should be present when walking Keeping your leg straight, slowly lift your leg straight in the air

Pass - Sequence of muscle contraction 1) Ipsi hamstring 2) Ipsi glut max (can fire 1st) 3) Contra lower erector spinae 4) Ipsi lower erector spinae 5) Contra upper erector spinae 6) Ipsi upper erector spinae - Axis of rotation in the hip o Hip raises in a smooth arc to 30 degrees of abduction before the iliac crest shifts superiorly (hip hike) Agonist- Glut med, min Antagonist- adductors Stabilisers- QL Synergist- TFL Neutraliser- piriformis

Hip Abduction NB. Note that the arc is 30 from neutral the patient starts in adduction. Important for lateral stabilisation of pelvis in gait.

Side lying with bottom leg bent for support Top leg in line with torso

Trunk flexioninterplay between psoas and abs.

Supine with slight knee flexion and heels contacting bench

Keeping your arms forward, slowly curl up like a sit up

The scapula clear the table 5cm before the feet lift from the table

Fail o Delay of glut firing o Weak agonist = glut max o Overactive agonist = psoas and rec fem o Overactive synergist = hamstrings o Overactive stabiliser = erector spinae o Muscle activation above T8 (severe fail) o Axis of rotation in lumbar spine (over stress of lumbars when walking) o Rehab goals relieve excess stress on lumbar spine o Flexion of hip (with or without external rotation) = tight TFL o Torso rotation posteriorly = tight psoas o Early hip hike = tight QL o Ext rot of the foot with no hip flexion = piriformis o Wobbling of leg = weak glut med - Indicative of poor stabilization during the One Leg Stance of the gait cycle - causes increased lateral shearing forces on the spine The feet lift from the table before the scapula clear = poor coordination of anterior trunk stabilizers, results in increased requirement from post musculature (tight lumbar erector spinae) and hip flexors (psoas). L flexion restriction. Draw bridge sign- instead of curling there is an anterior pelvic tilt with either a flattened

Shoulder Abduction NB. Make sure ptnt relaxes shoulder between lifts

Seated, elbow flexed to 90 degrees

Slowly raise your arm to you side

Shoulder abducts to 60 BEFORE shoulder elevates. First 30-60 pure glenohumeral rhythm, stabilised by upper traps, then scapula rotationinf angle moves laterally. Scapula should stay against Tx cage Agonist- Mid/lower traps Synergist- upper traps/lev scap and rhomboid

Neck Flexion Supine NB. Watch that ptnt is curling with chin, not trunks Push up Starts in prone position, hands under shoulders

Slowly bring your chin to your chest

Keeping your knees in contact with the ground, slowly push your body up

Nice smooth arc with chin going towards chest (in first 10 degrees) Agonist- DNF Antagonist- sub occ. Synergist- SCMs Scapula are stable with minimal movement and no winging

L lordosis or an increase L curve. o Excessive contraction at 30-45 - over activity of upper traps and levator scap - Increased load on the cervical spine - Can indicate a G-H jt problem o Scapula moves superiorly lev scap hypertonicity o Scapula moves sup and med rhomboid hypertonicity o No scap rotation upper traps hypertonic and lower and mid traps weak o Winging serratus ant weakness Chin jutting within first 10 of motion - Inhibition of DNF compensated with overactive SCM/tight suboccipitals - Poor Co-C1 function (proprioceptive disaster!) Shoulders retract, protract, elevate or wing - Leads to poor stabilization of the shoulder girdle with unstable motion of the upper extremity; Overstress of neck and rotator cuff mm; use of one arm over the other - Tight pecs Winging, kissing scap- weak serratus Elevation- OA upper trap and lev scap. Excess protraction/ ant tilt- OA pec minor

Subjective Coordination Test (Vleemings) Active Straight Leg Raise

Patient Position

Instruction Raise one leg slowly, keeping your knee straight

Pass

Fail

Supine

Pelvis should remain neutral. C/L EO Abs and I/L IO Patient should be able to squat to 90 degrees with torso remaining upright and heels on the ground

Squat

Standing, feet shoulder width apart, feet flat

Lunge

Standing initially

Veles foot reaction

Bare feet,

Take a larger than normal step forward, and then get your back knee to touch the ground Lean forward from

Spine should drop straight down with the knee

Movement of pelvis on opposite side to leg raise, and/or flaring of the ribs/ribcage on the homolateral side. Related to weak internal oblique chains o Heels lift up short soleus/gastrocnemius o Torso leans forward Glut max/Torso coordination issues Weak abs/tight upper back Knees- anterior=patellofemoral shear Valgosity- weak/inh gluteals allows i.r Lspine- excess flexion= tight post hip capsule or weak/inh L erectors Increased lordosis- tight erectors, psoas and poor ant stab. Anteversion of the hip = tight adductors Knee roll/hip abduction = weak hip internal rotators e.g. (synergists) TFL, vastus medialis Foot pronates = weak tibialis anterior No reaction or diminished in one foot-

Findings related to which movement pattern Trunk flexion - Psoas and Lx erectors tight Trunk flexion - Psoas and Lx erectors tight - Gastroc lengthening

Trunk flexion - Psoas and Lx erectors tight Hip abduction (knee roll) Veles foot reaction

Equal reaction of toe

testproprioception/balance Wall Angel- Mid T mobility screen and postural screen

Overhead reach- Mid T mobility screen

standing, look straight ahead Stand with back against the wall, bottom and head touching wall, feet slightly forward. Shoulders and elbows at 90. Stand with back against wall, bottom and shoulders touching.

ankles. Pr demo. 1.Try to flatten your back 2. nod your chin in. 3. Practitioner overpressure.

flexion bilaterally. Flatten back etc with no pain.

decrease proprioception and weak transverse arch of foot. Unable to flatten- T ext. Restriction Unable to place hands flat- tight pec minor/maj and subscap Unable to tuck chin- tight s.o and SCM. Upper C flex rest.

test Hip Extension Shoulder abduction

Observe posture and instruct to raise arms overhead.

No increase in kyphosis when arms raise.

Objective/Endurance Functional Tests One leg standing proprioception (Can be done from age 4 upwards age of gross motor maturity) Very sensitive test good for grading improvement Repeated Squat

Patient Position

Instruction Bring your foot up so its in line with you opposite knee without touching it, and then close your eyes Squat until your thighs are parallel with the floor, and

Normal No. Repetitions Hold for 10 secs

Lumbopelvic hyperextension- lack anterior core stab. T ext Rx and OA Lumbar erectors FHC- may have OA SCMs and scalene Hands dont reach wall- reduced GH ROM, short Lat dorsi, ant scapula tilt. Fail Cant hold for 10 secs Excessive wobbling Poor proprioception CNS, joints. Note any pelvic shift glut med/min weak -Hip abductors tight - Piriformis and QL tight o o o o Looks at quad strength. Antagonist = hamstrings

Shoulder abduction Upper and lower abdominal strength Trunk flexion MP

Findings related to which movement pattern

Standing, focused on a point ahead. Barefoot (but can repeat with shoes on to see the effect of the shoe) Feet hip width apart, lightly supported

Average is around 30 Max = 50

Trunk flexion - psoas and Lx erectors tight

(holding table)

Repeated curl

Supine, hooklike position. Practitioner stabilises above ankles Prone, ASIS in line with top of couch, Dr supporting midcalf Sidelying resting on bottom elbow. Bottom leg bent and hip flexed. Body in straight line. Supine, head off the couch supported by Dr. in horizontal plane Supine, hook lying position, with ankle stabilisation

Static Back Extension (Sorensons)

continue to squat once every 2-3 secs Slowly slide your palms (thenars) up your legs to the tops of your knees, and repeat once every 2-3 secs Hold horizontal position (allow for only one correction) Lift Pelvis off couch as high as you can and hold for as long as you can. Hold your head in this position once I take my hands away

Average is around 30 Max = 50

2 mistakes

Trunk flexion

2min normal 4min max

Tests erector spinae

Trunk flexion

Side Bridge endurance test

90 secs.

Pt can hold for 90 secs.

Hip abduction

Julls DNF Test

Kendalls upper abdominal strength test

Sit up in this position

Holds head in same o Chin juts forward horizontal plane for 4 o Head lifts or drops back (be secs without shaking. prepared to catch) o Excessive shaking o Overactive SCMs and suboccipitals Graded out of 5. 2- poor unable 3- fair arms outstrectched 4- good arms crossed 5- normal arms

Neck Flexion

Trunk flexion movement pattern

Kendalls Lower abdominal strength test

Supine, flatten lumbar lordosis, 90 hip flexion and knees extended

behind head Lower your legs to Graded out of 5. the table while 2- poor unable to keeping your low flatten back back flat. 3- fair lordosis forms at 90- 45 4- good lordosis forms at 45- 0 5- normal no increase in lordosis.