Accepted Manuscript The Double Knee Swing Test - a practical example of The Movement and Performance Matrix movement screen Warrick McNeill , Dip. Phyty. (NZ) MCSP PII:
S1360-8592(14)00080-1
DOI:
10.1016/j.jbmt.2014.05.008
Reference:
YJBMT 1136
To appear in:
Journal of Bodywork & Movement Therapies
Please cite this article as: McNeill, W., The Double Knee Swing Test - a practical example of The Movement and Performance Matrix movement screen, Journal of Bodywork & Movement Therapies (2014), doi: 10.1016/j.jbmt.2014.05.008. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
The Double Knee Swing Test - a practical example of The Movement and Performance Matrix movement screen
The editorial of this Prevention and Rehabilitation section of this Journal highlights the opinion that the use of movement screening may be useful in the prediction of re-injury risk (Mottram
RI PT
and Comerford 2008) but also that movement screening could prove useful for Pilates Teachers who work within the sphere of rehabilitation of low back pain sufferers, as a movement screen may help objectively to find subgroups of individuals with specific movement control failures so that equally specific exercise can be applied to the movement faults found. The editorial also suggests that two disciplines, circus and dance, already well
SC
known for their training that highlights movement control, balance, and strength are attempting to put into practice further movement control fundamentals by keeping abreast of new scientific thought. It was suggested in the editorial that adding Movement screening into
M AN U
the more generalised screens already in place may help tighten that focus still further by finding the actual movement faults requiring attention.
The Performance Matrix is an umbrella of movement screens designed specifically for an activity or sport, taking in to account the injuries typical of the activity and the movement peculiar to that activity. This means a new screen can be individualised to an activity. Some
TE D
tests could be chosen from a bank of tests already created or a new specific test could be developed and incorporated.
Another element of specificity is that the testing procedure looks at three factors within muscular
EP
movement control. The anatomical site, the direction of movement and the threshold of activity requiring control (Comerford and Mottram 2001, 2012). This is what is
AC C
meant by the use of the term matrix. A failure to control a movement is referred to as an uncontrolled movement (UCM) but first the movement has to be tested. Figure 1. The Performance Matrix Site:
Direction:
The anatomical area that is affected by an uncontrolled movement
The direction an uncontrolled movement may moves into e.g. flexion, extension, rotation, translation
Threshold:
Low threshold
vs. High threshold. Low threshold loads are loads easily
controlled
by low effort muscular recruitment,
primarily utilising the slow motor
unit.
Fundamentally these are postural loads. High threshold loading requires
speed or
strength to control them and are primarily targeting the fast motor unit.
ACCEPTED MANUSCRIPT
Within the test procedure the client needs to know that they are being tested on their ability to control a specific movement, be given a chance to learn the test movement, be able to practice the control of the movement for a few repetitions, be corrected as necessary and then perform the test - without feedback. Undue feedback such as the use of a mirror, or hands-on guidance from the individual being
RI PT
tested themselves or the examiner can increase the clients ability to pass the test which they may not have been able to do without the extra help. The scoring system asks a question, such as, Can you prevent side bending of the trunk? which provides for a yes or no answer. The Performance Matrix is an online screening tool, it is proprietary and the tester needs to
SC
have registered and undergo training, some of which can be provided on-line. As the performance matrix does not deal with pain any health or exercise practitioner from
M AN U
Physiotherapist to Gym instructor can be trained to run the tests
Once a battery of tests is complete the online tool provides a report identifying the faults found which enables the client to have a program of the most appropriate exercises prescribed that manage the specific faults. A score out of 50 is also provided (a low score indicates a better result) which helps with re-testing after intervention to assess for success.
TE D
This example, the Double Knee Swing Test can be found in The Foundation Matrix. The Foundation Matrix is a short testing procedure taking around 25 minutes to complete once the tester is familiar with the system. Being a short test there are only 10 tests, 5 tests of low threshold control (postural loading) and 5 tests of high threshold control (strength and speed).
EP
Each test is a short movement pattern, or choreography, that asks the tester to watch for 5 control points within that movement pattern. A larger screen such as a sports screen can
AC C
involve 20 tests and can add 5 tests of restriction and 5 sport specific tests, it takes longer to complete but gives more information. fig 2.
Double knee swing description
ACCEPTED MANUSCRIPT
The Double Knee Swing Test is a non fatiguing test, so the load is body weight only. The online tool provides a video of the test that can be shown to the client so they can become familiar with what is required. There is a text description of the test s start position and a description of the test movement and finally the benchmark is identified. This identifies where the test movement should get to. It is imperative that the test movement gets to the
RI PT
benchmark position as any restriction that prevents attainment of the end position needs to be compensated for. The compensation may not be able to be controlled which would then be identified as a failure to pass this aspect of the test - thus defining the failure as an UCM. The Tester is required to answer the 5 questions about the control points before moving on to
SC
the next test. As a general rule the low threshold tests may take a little longer to complete as there is no
M AN U
fatigue element and the client may want to practice the moves, the high threshold tests are very tiring and too many practice attempts may prevent success in passing the
AC C
EP
TE D
tests.
The start position of this test moves from a parallel standing position to a small knee bend. See the description in Figure 2. and visually in Figure 3 and 4.
Figure 3 and 4. Moving from parallel standing into a small knee bend The test movement involves the knees swinging in tandem from side to side, rotating the femur in the acetabulum. The movement should be occurring at the hip and knee joints
ACCEPTED MANUSCRIPT
without compensation elsewhere in the kinetic chain. The benchmark dictates that the knees
RI PT
have to reach 20 degrees to each side.
M AN U
SC
figure 4 and 5, knee swing right and left
The movement analysis
Once the test has been adequately taught, but not overly practiced, a series of
TE D
questions are asked on the online form looking for specific sites and directions of uncontrolled movement. For example, in this test, one of the sites used in the testing is at the hip. A movement control issue might be highlighted where the hip extensors do not recruit adequately during the test and the client might move the trunk forward
EP
increasing flexion at the hip. This might not be an uncontrolled movement unless the client has had this movement pattern pointed out to them and given the chance to
AC C
correct this fault. If the client does then correct the movement fault it is not uncontrolled and the client passes this part of the test. On occasions the client may control the hip flexion tendency but swap it for another substitution pattern, so the tester then might need to make sure the client controls both movement faults. An uncontrolled movement needs to be proved to be uncontrolled before it is recorded as such. A key question related to this test asks if the client can prevent rotation at the pelvis or back during the rotary hip movements of the knee swing. Fundamentally this is a dissociation test, can the client hold one body section still while moving at another motion segment. The low back and pelvis are directly above the hip joint, and an
ACCEPTED MANUSCRIPT
individual to exhibit good movement health needs to be able to display control above (or below) the moving section. What might be visible to the tester is the fact that the pelvis just follows the direction that the knees swing to. The lumbo-pelvic rotation may start immediately the knees start to swing or rotation control might be exhibited during the early phase of the movement but before the knees get to the benchmark 20 degrees the rotation of the lumbo-pelvic becomes obvious. This is why reaching the
RI PT
benchmarks of the test are so important. If the client shows this lumbo-pelvic rotation which might only be one direction and not the other, and cannot control it consciously once it has been brought to their attention it is marked as an uncontrolled
SC
movement.
What might cause this uncontrolled movement? The fundamental reason is that the
M AN U
rotation controllers of the lumbo-pelvic region, primarily the obliques and the gluteals particularly those gluteals with an oblique fibre direction such as the gluteus medius posterior are not engaged enough to stop the lumbo-pelvic rotation. Remember this test is a low threshold test which looks at the controlling of non-fatiguing postural loads. So the control should be an easy recruitment to allow the control of the obliques and gluteals to be slow and smooth. In a situation where a client has often during sporting activities
TE D
selectively
superficial hip flexors muscles
favoured strengthening aspects of the
such as the very relevant to this situation, Tensor
Fascia Lata, (TFL), so that the TFL becomes restricted, making it extremely difficult for the obliques and gluteals to work in an easy low threshold manner to dissociate
EP
lumbo-pelvic rotation from hip rotation. The client therefore may look tense and appear to move like an automaton. Restrictions therefore may be a key reason for this
AC C
failure, however there may be adequate length in the superficial hip flexors and the problem will more likely be related to an under recruitment of the rotation controllers in this area.
In this example test there are 5 questions of movement control offered. The tester may need to get the client to perform the test several times to make sure the clients movement control skill has been appropriately tested and the uncontrolled movements have been found. Once the movement test observations have been entered into the online tool the next test can be selected.
ACCEPTED MANUSCRIPT
Conclusion This description of the Double knee swing test is designed to show the process of performing
RI PT
a movement test and how observation can be used to score a test. How to manage the findings is not the role of this description but elements of it have been described elsewhere (Comerford and Mottram 2012, McNeill 2014a, 2014b).
Movement testing can be revealing but Comerford and Mottram (2012) recommend that the
SC
whole kinetic movement system is analysed to avoid selective testing giving an incomplete or
M AN U
biased result.
Acknowledgements
Thanks to Movement Performance Solutions, for allowing the use of the Double knee swing test from the Foundation Matrix and for reproduction of all figures/images. All images kindly supplied by the copyright holders Movement Performance Solutions from
References
EP
TE D
their website www.theperformancematrix.com
AC C
Comerford, M., Mottram, S., 2001. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man. Ther. 6 (1), 3e14. Comerford, M., Mottram, S., 2012. Kinetic Control: the Management of Uncontrolled Movement. Churchill Livingstone, Elsevier. McNeill, W. 2014a. Editorial. Pilates: Ranging beyond neutral. Journal of Bodywork and Movement Therapies. 18, 119-123 McNeill, W. 2014b. Pilates: Ranging beyond neutral - A practical discussion. Journal of Bodywork and Movement Therapies. 18, 124-129
ACCEPTED MANUSCRIPT
Mottram, S., Comerford, M. 2008. A new perspective on risk assessment. Physical Therapy in Sport. 9 40-51
Warrick McNeill, Dip. Phyty. (NZ) MCSP Physioworks, 4 Mandeville Place, London W1U 2BG, UK
RI PT
Author
AC C
EP
TE D
M AN U
SC
Tel.: +44 7973 122996. E-mail address: [email protected]
S1360-8592(14)00080-1
DOI:
10.1016/j.jbmt.2014.05.008
Reference:
YJBMT 1136
To appear in:
Journal of Bodywork & Movement Therapies
Please cite this article as: McNeill, W., The Double Knee Swing Test - a practical example of The Movement and Performance Matrix movement screen, Journal of Bodywork & Movement Therapies (2014), doi: 10.1016/j.jbmt.2014.05.008. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
The Double Knee Swing Test - a practical example of The Movement and Performance Matrix movement screen
The editorial of this Prevention and Rehabilitation section of this Journal highlights the opinion that the use of movement screening may be useful in the prediction of re-injury risk (Mottram
RI PT
and Comerford 2008) but also that movement screening could prove useful for Pilates Teachers who work within the sphere of rehabilitation of low back pain sufferers, as a movement screen may help objectively to find subgroups of individuals with specific movement control failures so that equally specific exercise can be applied to the movement faults found. The editorial also suggests that two disciplines, circus and dance, already well
SC
known for their training that highlights movement control, balance, and strength are attempting to put into practice further movement control fundamentals by keeping abreast of new scientific thought. It was suggested in the editorial that adding Movement screening into
M AN U
the more generalised screens already in place may help tighten that focus still further by finding the actual movement faults requiring attention.
The Performance Matrix is an umbrella of movement screens designed specifically for an activity or sport, taking in to account the injuries typical of the activity and the movement peculiar to that activity. This means a new screen can be individualised to an activity. Some
TE D
tests could be chosen from a bank of tests already created or a new specific test could be developed and incorporated.
Another element of specificity is that the testing procedure looks at three factors within muscular
EP
movement control. The anatomical site, the direction of movement and the threshold of activity requiring control (Comerford and Mottram 2001, 2012). This is what is
AC C
meant by the use of the term matrix. A failure to control a movement is referred to as an uncontrolled movement (UCM) but first the movement has to be tested. Figure 1. The Performance Matrix Site:
Direction:
The anatomical area that is affected by an uncontrolled movement
The direction an uncontrolled movement may moves into e.g. flexion, extension, rotation, translation
Threshold:
Low threshold
vs. High threshold. Low threshold loads are loads easily
controlled
by low effort muscular recruitment,
primarily utilising the slow motor
unit.
Fundamentally these are postural loads. High threshold loading requires
speed or
strength to control them and are primarily targeting the fast motor unit.
ACCEPTED MANUSCRIPT
Within the test procedure the client needs to know that they are being tested on their ability to control a specific movement, be given a chance to learn the test movement, be able to practice the control of the movement for a few repetitions, be corrected as necessary and then perform the test - without feedback. Undue feedback such as the use of a mirror, or hands-on guidance from the individual being
RI PT
tested themselves or the examiner can increase the clients ability to pass the test which they may not have been able to do without the extra help. The scoring system asks a question, such as, Can you prevent side bending of the trunk? which provides for a yes or no answer. The Performance Matrix is an online screening tool, it is proprietary and the tester needs to
SC
have registered and undergo training, some of which can be provided on-line. As the performance matrix does not deal with pain any health or exercise practitioner from
M AN U
Physiotherapist to Gym instructor can be trained to run the tests
Once a battery of tests is complete the online tool provides a report identifying the faults found which enables the client to have a program of the most appropriate exercises prescribed that manage the specific faults. A score out of 50 is also provided (a low score indicates a better result) which helps with re-testing after intervention to assess for success.
TE D
This example, the Double Knee Swing Test can be found in The Foundation Matrix. The Foundation Matrix is a short testing procedure taking around 25 minutes to complete once the tester is familiar with the system. Being a short test there are only 10 tests, 5 tests of low threshold control (postural loading) and 5 tests of high threshold control (strength and speed).
EP
Each test is a short movement pattern, or choreography, that asks the tester to watch for 5 control points within that movement pattern. A larger screen such as a sports screen can
AC C
involve 20 tests and can add 5 tests of restriction and 5 sport specific tests, it takes longer to complete but gives more information. fig 2.
Double knee swing description
ACCEPTED MANUSCRIPT
The Double Knee Swing Test is a non fatiguing test, so the load is body weight only. The online tool provides a video of the test that can be shown to the client so they can become familiar with what is required. There is a text description of the test s start position and a description of the test movement and finally the benchmark is identified. This identifies where the test movement should get to. It is imperative that the test movement gets to the
RI PT
benchmark position as any restriction that prevents attainment of the end position needs to be compensated for. The compensation may not be able to be controlled which would then be identified as a failure to pass this aspect of the test - thus defining the failure as an UCM. The Tester is required to answer the 5 questions about the control points before moving on to
SC
the next test. As a general rule the low threshold tests may take a little longer to complete as there is no
M AN U
fatigue element and the client may want to practice the moves, the high threshold tests are very tiring and too many practice attempts may prevent success in passing the
AC C
EP
TE D
tests.
The start position of this test moves from a parallel standing position to a small knee bend. See the description in Figure 2. and visually in Figure 3 and 4.
Figure 3 and 4. Moving from parallel standing into a small knee bend The test movement involves the knees swinging in tandem from side to side, rotating the femur in the acetabulum. The movement should be occurring at the hip and knee joints
ACCEPTED MANUSCRIPT
without compensation elsewhere in the kinetic chain. The benchmark dictates that the knees
RI PT
have to reach 20 degrees to each side.
M AN U
SC
figure 4 and 5, knee swing right and left
The movement analysis
Once the test has been adequately taught, but not overly practiced, a series of
TE D
questions are asked on the online form looking for specific sites and directions of uncontrolled movement. For example, in this test, one of the sites used in the testing is at the hip. A movement control issue might be highlighted where the hip extensors do not recruit adequately during the test and the client might move the trunk forward
EP
increasing flexion at the hip. This might not be an uncontrolled movement unless the client has had this movement pattern pointed out to them and given the chance to
AC C
correct this fault. If the client does then correct the movement fault it is not uncontrolled and the client passes this part of the test. On occasions the client may control the hip flexion tendency but swap it for another substitution pattern, so the tester then might need to make sure the client controls both movement faults. An uncontrolled movement needs to be proved to be uncontrolled before it is recorded as such. A key question related to this test asks if the client can prevent rotation at the pelvis or back during the rotary hip movements of the knee swing. Fundamentally this is a dissociation test, can the client hold one body section still while moving at another motion segment. The low back and pelvis are directly above the hip joint, and an
ACCEPTED MANUSCRIPT
individual to exhibit good movement health needs to be able to display control above (or below) the moving section. What might be visible to the tester is the fact that the pelvis just follows the direction that the knees swing to. The lumbo-pelvic rotation may start immediately the knees start to swing or rotation control might be exhibited during the early phase of the movement but before the knees get to the benchmark 20 degrees the rotation of the lumbo-pelvic becomes obvious. This is why reaching the
RI PT
benchmarks of the test are so important. If the client shows this lumbo-pelvic rotation which might only be one direction and not the other, and cannot control it consciously once it has been brought to their attention it is marked as an uncontrolled
SC
movement.
What might cause this uncontrolled movement? The fundamental reason is that the
M AN U
rotation controllers of the lumbo-pelvic region, primarily the obliques and the gluteals particularly those gluteals with an oblique fibre direction such as the gluteus medius posterior are not engaged enough to stop the lumbo-pelvic rotation. Remember this test is a low threshold test which looks at the controlling of non-fatiguing postural loads. So the control should be an easy recruitment to allow the control of the obliques and gluteals to be slow and smooth. In a situation where a client has often during sporting activities
TE D
selectively
superficial hip flexors muscles
favoured strengthening aspects of the
such as the very relevant to this situation, Tensor
Fascia Lata, (TFL), so that the TFL becomes restricted, making it extremely difficult for the obliques and gluteals to work in an easy low threshold manner to dissociate
EP
lumbo-pelvic rotation from hip rotation. The client therefore may look tense and appear to move like an automaton. Restrictions therefore may be a key reason for this
AC C
failure, however there may be adequate length in the superficial hip flexors and the problem will more likely be related to an under recruitment of the rotation controllers in this area.
In this example test there are 5 questions of movement control offered. The tester may need to get the client to perform the test several times to make sure the clients movement control skill has been appropriately tested and the uncontrolled movements have been found. Once the movement test observations have been entered into the online tool the next test can be selected.
ACCEPTED MANUSCRIPT
Conclusion This description of the Double knee swing test is designed to show the process of performing
RI PT
a movement test and how observation can be used to score a test. How to manage the findings is not the role of this description but elements of it have been described elsewhere (Comerford and Mottram 2012, McNeill 2014a, 2014b).
Movement testing can be revealing but Comerford and Mottram (2012) recommend that the
SC
whole kinetic movement system is analysed to avoid selective testing giving an incomplete or
M AN U
biased result.
Acknowledgements
Thanks to Movement Performance Solutions, for allowing the use of the Double knee swing test from the Foundation Matrix and for reproduction of all figures/images. All images kindly supplied by the copyright holders Movement Performance Solutions from
References
EP
TE D
their website www.theperformancematrix.com
AC C
Comerford, M., Mottram, S., 2001. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man. Ther. 6 (1), 3e14. Comerford, M., Mottram, S., 2012. Kinetic Control: the Management of Uncontrolled Movement. Churchill Livingstone, Elsevier. McNeill, W. 2014a. Editorial. Pilates: Ranging beyond neutral. Journal of Bodywork and Movement Therapies. 18, 119-123 McNeill, W. 2014b. Pilates: Ranging beyond neutral - A practical discussion. Journal of Bodywork and Movement Therapies. 18, 124-129
ACCEPTED MANUSCRIPT
Mottram, S., Comerford, M. 2008. A new perspective on risk assessment. Physical Therapy in Sport. 9 40-51
Warrick McNeill, Dip. Phyty. (NZ) MCSP Physioworks, 4 Mandeville Place, London W1U 2BG, UK
RI PT
Author
AC C
EP
TE D
M AN U
SC
Tel.: +44 7973 122996. E-mail address: [email protected]
