Pre-participation screenings are vital to determine a baseline for fundamental movement in an athlete or individual. Instead of only using information that can exclude someone from activity, a thorough screening will allow the tester to decrease the chance of injury, enhance performance, and improve the quality of life. By capturing fundamental movements on video, we can pin point biomechanical abnormalities and deficits. Understanding how a person is moving on an arthrokinematic and osteokinematic level will help us understand why they move the way they do.
The functional movement screen FMS is one evaluation tool that attempts to assess the fundamental movement patterns of an individual… The FMS is comprised of seven patterns that require a balance of mobility and stability. These patterns are designed to provide observable performance of basic locomotor manipulative and stabilizing movements... The tests place the individual in extreme positions where weaknesses and imbalances become noticeable if appropriate stability and mobility is not utilized.
Out of four possible scores where three is the best score possible, a low score of two was given to the subject because although he was able to complete the movement he compensated in some way to perform the fundamental movement. Along with assessing deep squat and hurdle steps we also observed gait analysis from a posterior and lateral view on a treadmill.
Proper functional movement during a deep squat includes the upper torso remaining parallel with the tibia or toward vertical, the femur reaching below horizontal, knees aligning over the feet, as well as the dowel aligning over the feet. When observing the deep squat the upper torso remained parallel with the tibia while the femur, knees, and dowel all failed to stay in the proper alignment. During the deep squat we observed unequal arm spacing while the subject held the dowel. This inequality is potentially due to left shoulder hypertrophy as well as a right arm that presents longer than the left. These two abnormalities correlate to the findings during the preliminary assessment. It should be noted that left shoulder hypertrophy is an unusual finding due to the fact that the subject is right arm dominant. The right arm could be presenting longer due to left shoulder musculature being tighter. This over-development and tightness could cause the shoulder to pull the arm more superiorly than the under-developed right shoulder.
When in the deep squat stance the subject presents with an everted right foot. While squatting, the right knee flexes before the left and the hip appears to be in excess abduction. All three lower extremity joints are affected during the squat because they are all kinetically linked. The subject suffered a right ankle sprain which left his talocrural and subtalar ligaments lax; this could help determine why the foot is everted on the right yet not on the left. While we consider the premature knee flexion and excess hip abduction to be due to a longer right leg, all leg length discrepancy tests had negative findings. Although the subject describes himself as right leg dominant, the knee flexion and extension strength tests presented the left leg to be stronger. Premature knee flexion can be explained due to this underdevelopment of right knee muscle strength.
Proper functional movement during a hurdle step calls for the hips, knees and ankles to remain aligned in the sagittal plane, minimal to no movement in the lumbar spine and the dowel and bar to remain parallel. When observing the hurdle step all three components were not met. From the anterior view both feet presented as everted, the right and left knee and hip externally rotated and abducted during the forward step. During return step both feet remained everted while the right and left knee and hip internally rotated and adducted. The preliminary testing did not reveal any obvious intra subject abnormalities however when compared to proper fundamental movement he presented bilaterally unsound biomechanics.
When viewing the hurdle step laterally, foot eversion can be clearly noted. Since the lateral view was only taken from right sagittal view, only right knee and hip movement could be compared to the anterior view. There is lumbar spine movement during both forward step and return step that can be interpreted as more than minimal. The preliminary assessment noted slight lumbar lordosis in the subject; this could account for the excess lumbar motion. The subject also seemed to shift his center of gravity to the right during left leg hurdle step while during right leg hurdle step his center of gravity remained equal through the sagittal plane. This unequal center of gravity could be linked to the aforementioned shoulder abnormalities. When the dowel shifted and dropped towards the right, the center of gravity also shifted to compensate for the increase in mass on the right side.
There are multiple biomechanical errors that correlate to the deep squat and hurdle step assessment, when compared to the lateral and posterior gait analysis videos. When observing the lateral gait analysis video the subject’s right foot was found to clear higher and quicker than the left foot during the toe off and swing phase. Also, the right knee presented with more fluid movement than the left during the gait cycle. We believe these factors are due to a leg length discrepancy, however as previously stated there were no obvious discrepancies noted during the preliminary assessment. The subject exhibits further right leg abnormalities upon viewing the posterior gait analysis video. There is external rotation of the right foot accompanied by slight supination. The subject also presents with right calcaneal valgus which is most noted during mid-stance. This observation does not correlate with the preliminary assessment measurements, which indicate that the subject exhibited excessive calcaneal valgus of the left subtalar joint. Therefore, we could not make any conclusions about the discrepancy, except for the fact that the previous right ankle injury could be a potential factor. There was noted right hip hiking during the right swing phase of the subject’s gait. This observation can help to explain why the right foot cleared higher and faster than the left during the toe off and swing phase.
Throughout this assessment we believed that there would be an obvious right leg discrepancy. Although the preliminary measurements gave no indication of a discrepancy, the functional movement tests indicated that there is a right leg length discrepancy. There is no way to be certain of this finding without obtaining an X-ray of both legs so a more accurate leg length measurement can be made.
Works Cited
Cook, Gray, PT, OCS, Lee Burton, MS, ATC, and Hoogenboom Barb, PT, EdD, SCS,
ATC. "Pre-participation Screening: The Use of Fundamental Movements as an Assessment
of Function- Part 1." North American Journal of Sports Physical Therapy 1.2
(May 2006): 62-72.
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