Our value as physical therapists lies largely on our capacity to assess, analyze and correct movement impairments. As many of our posts have discussed, multiple factors may contribute to movement aberrations, predisposing us to compensate in various ways and develop overuse or acute musculoskeletal injuries. Therefore, a through assessment beyond range of motion and manual muscle testing is needed. As like-minded folks, Direct Performance physical therapists have made it our mission to advance the art and science of PT from basic movement and pain assessment to high –level functional, often sport-specific termination points. In other words, when working with us, you won’t be spending much time doing leg raises and bolster supported knee extension exercises, although they may briefly be essential to restoring painless motion.
One recent case I treated involved a cross country runner with anterior L knee pain, beginning insidiously several weeks ago. The pain only occurred after approximately 1.5 miles (5K is his typical competitive distance). Palpation exam was unremarkable. Distally, he had plenty of foot and ankle ROM, neutral non-weight bearing alignment and weight bearing transverse plane (viewed from behind) movement during walking and running gait (slow motion analysis was used). Lower extremity strength was full noted with manual muscle testing. However, our movement assessment (SFMA) revealed dysfunctional and nonpainful left>right multisegmental rotation deficit and right>left single limb stance deficit and overhead squat. Rotation breakout revealed hip rotation motor control deficits and overhead squat revealed bilateral valgus collapse at knees. Hip motor control deficits were also observed during SLS breakout in ½ kneeling and quadruped. Additionally, during lateral step down maneuver, left>right valgus collapse was evident.
Beginning with PNF contract-relax “resetting” techniques to improve active hip rotation ROM, we have implemented appropriate corrective exercises to correct motor control deficits. We have emphasized single limb closed-chain training to reduce compensatory tendencies and for sport specificity. Additionally, we have recommended pre-running drills to reduce the braking force associated with his heel strike in front of the body and his reduced hip extension (vs vertical excursion) noted on the left lower extremity vs. the right.
The combination of SFMA guided intervention with additional sport specific mechanical running analysis, has led to elimination of pain during several runs (up to 6miles!) in the last 1-2 weeks (he began working with us approximately 3 weeks ago). He has resumed cross country practice and we are optimistic about his return to full capacity. Utilizing valid and concise movement assessments improved our ability to find impairments that can be treated.
