MUSCULOSKELETAL ASSESSMENT FUNCTIONAL ASSESSMENT By Kesh Patel MSc and Suzanne Patel PhD


THE RATIONALE Functional assessment of the kinetic chain fulfils an important objective for preventative and rehabilitative physical therapy, as well as performance enhancement (3,4,5). Within this framework, the term ‘functional’ suggests an approach that is centred around the proprioceptive and multi-planar demands of occupation, recre- ation or sport, and can use a range of muscle and joint assessment tools. Although muscle and joint testing may play a pivotal role in identifying which component in the kinetic chain is implicated in a neuro-musculoskeletal pathology, these tests alone will not nec- essarily give definitive information about what may be happening during complex movements patterns (6).


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Because the kinetic chain is constantly moving and reacting to both its internal and external environment, an approach that seeks to assess these qualities may prove more useful than isolated assessment of muscles and joints alone. Isolated joint testing may offer useful information about range of motion and capsule con- straints while manual muscle testing can provide a subjective assessment of strength and length. However, these approaches may only be warranted in the presence of trauma or underlying pathol- ogy and may not reflect how these structures function during movement. All functional movement involves multi-articular joint action and recruitment of specific muscle synergies. This is further supported by the observation that a single muscle group can per- form a stabilising and mobilising role around a joint, and that mus- cles that don’t span a particular joint can still produce joint move- ment (7). These observations justify an approach that is based on the assessment of movement.


FOUNDATIONS OF KINETIC CHAIN ASSESSMENT Assessment of the kinetic chain should be approached from a per- spective of efficacy and simplicity, focusing on three important aspects of structure and function (see Figure 1): ■ joint alignment


www.sportex.net 19 - PART 1


Optimal performance in any activity is the result of an integration of structure and function, to produce the most efficient move- ment pattern (1,2). All movement patterns can be considered functional if they fulfil the desired objective of movement. However, an outcome that is kinetic chain efficient and thus biomechanically optimal, is an important objective for the individ- ual. For effective rehabilitation or performance enhancement, it is important to consider the anatomical and physiological role of muscles and how these factors contribute to movement, in terms of ability and efficiency. With this in mind, the structure and function of the kinetic chain can be effectively evaluated and this information used to assess efficiency of movement during func- tional activity. Kinetic chain assessment can subsequently provide a solid foundation for accurate exercise prescription for reha- bilitation or performance enhancement. This article is the first of two that explores kinetic chain assessment. Part one will dis- cuss the rationale behind functional assessment of the kinetic chain. Part two which will appear in the July issue will introduce a number of assessment tools that can be used in clinical practice.


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