FUNCTIONAL ASSESSMENT JOINT ALIGNMENT

shoulder girdle spine lower extremity

MOVEMENT ABILITY

bending and lifting pushing and pulling spinal motion

MOVEMENT EFFICIENCY

muscle action speed of movement muscle strength and endurance sequencing of body segments

maintenance of centre of gravity over base of support

OUTCOME

To obtain information about how the kinetic chain aligns itself with respect to gravity, and how this potentially influences muscle length

Figure 1. Functional assessment of the kinetic chain

■ movement ability ■ movement efficiency. These qualities can be subjectively, yet effectively assessed without the need for complex biomechanical equipment and should pre- dominantly take place in the upright standing position. Although the characteristics of movement ability and efficiency are subtly intertwined during complex movement, both are dependent upon optimal joint alignment, as dictated by the length-tension rela- tionships of muscles. Joint alignment is commonly observed against a plumb line in a standing position, and can provide useful infor- mation regarding existing muscle length and how this can conse- quently affect movement ability and efficiency (8).

THE ‘FOUNDATIONS OF MOVEMENT’ Many individuals have attempted to break down and sim- plify human movement, each lending their own insights. Through the early 20th century, the work of prominent physical educators such as FM Alexander, Moshe Feldenkrais, Joseph Pilates and Milton Trager was instru- mental in this development. These concepts were further supported by the ideas of Rudolph Laban, Irmgard Bartenieff and Thomas Hanna, whose work is reflected in the current approaches adopted by pioneers such as Gary Gray, Paul Chek and Gray Cook.

In this audio, Kesh Patel briefly discusses the movement continuum model, and how it can be used to simplify our understanding of movement with respect to assessment.

JOINT ALIGNMENT Although the body is rarely static, an understanding of joint align- ment will provide useful information on how the body organises itself in preparation for movement. The primary observation during this assessment is the observation of the major joint axes with respect to a plumb line in the mid-frontal and mid-sagittal planes (5).

If a deviation in joint alignment away from the plumb line exists to an excessive degree, a prior assumption can be made about poten-

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tial changes in muscle length and how this may affect movement ability. If necessary, these changes in length can be confirmed by manual muscle testing. In practice however, it is important to con- sider that a moderate degree of muscle shortness may not neces- sarily produce any significant changes in movement efficiency. For example, the presence of gastrocnemius-soleus tightness in a jump- ing athlete may result in the heels rising (or greater hip flexion) during a squat assessment. However, during a ballistic movement, such as a box-jump, there may be optimal movement efficiency. This may be partly due to the elastic properties of muscle tissue com- bined with the inherent motor skill the athlete already possesses.

In this instance, an expected outcome based on the results of joint alignment alone may lead to stretching of the calf muscles. However, this may have an undesired impact on a kinetic chain that already possesses good movement efficiency and so highlights the importance of specificity during assessment. Of particular impor- tance during observation is alignment of the leg with particular ref- erence to the knee, ankle and sub-talar joint.

As the feet are the first structures to receive ground reaction forces during movement, additional assessment of these joints with

CLINICAL PERSPECTIVE: JOINT ALIGNMENT Optimal alignment of the kinetic chain is fundamental to well-being involving sound skeletal structure, soft-tissue integrity and proper neuromuscular control. The fact that we spend most of our time in the upright position justifies an approach that observes this position during assessment. Although the kinetic chain is rarely still for any period of time, a brief observation of static alignment in standing can yield useful information about muscle length that may consequently affect movement ability and efficiency.

In this audio, Kesh Patel explores the assessment of joint alignment with respect to the shoulder girdle, the spine and the lower extremety and how the outcome relates to movement.

www.sportex.net OUTCOME

To ascertain whether the kinetic chain is able to perform a given movement irrespective of muscle and joint action

OUTCOME To understand how the kinetic chain

coordinates movement of body segments via muscle activity and joint position