MUSCULOSKELETAL ASSESSMENT

respect to pronation/supination may provide valuable information about static joint stress, as well as potential structural stress dur- ing gait.

The outcome of joint alignment assessment is to obtain information regarding potential changes in muscle length that may affect move- ment. A detailed evaluation of alignment is rarely required with a focus instead on observation of overall alignment in relation to the major support systems - the shoulder girdle, spine, and lower extremities.

MOVEMENT ABILITY Movement ability can be defined as the ability to perform or com- plete a given movement pattern and can be assessed via the visual observation of a number of movements. As many functional move- ment patterns can be broken down into the smaller movements of bending, pushing/pulling and trunk rotation, observation of these movements will provide a good starting point for assessment (9,10). These movements can be assessed via observations of squatting/lunging, scapulohumeral rhythm and spinal motion. If required, these patterns can be assessed in combination to simulate various activities of daily living and sport, using additional loads if required. Always consider that there are a number of different ways to perform a particular movement without pain or injury. Being able to perform a movement does not necessarily indicate optimal effi- ciency with respect to the demands of functional performance. For example, a squat may not always be performed with optimal joint alignment and efficiency, even in the absence of pain.

Assessment of movement ability can often be facilitated by draw- ing on the past experiences of the individual to elicit the desired motor programme. For example, an individual may not know what a lunge is, yet when asked to step over an object on the floor, will invariably perform a lunge movement. Finally, assessment of move- ment ability should include the use of appropriate loads where nec- essary, in order to simulate any functional demands of daily living or sport (2). The addition of external loads may further exaggerate any tendencies towards faulty movement patterns. The outcome of movement ability assessment is to ascertain whether an individual is able to perform a given movement, irrespective of muscle action and joint position. This will include observations of the basic move- ment patterns of bending, pushing/pulling and trunk rotation, with the addition of load where necessary and provides a foundation from which movement efficiency can be observed.

CLINICAL PERSPECTIVE: MOVEMENT ABILITY The objective of observing whether an individual is capable of performing a basic movement pattern is an important step towards building an information database about an individual’s movement ability. All human movement comprises of a few basic patterns, which can be assessed simply. Once the therapist obtains this information it can be used to effectively observe more complex patterns. The question of movement efficiency is one that follows once ability has been qualified.

In this audio, Kesh Patel discusses why it’s important to assess movement ability with respect to basic movement patterns of bending/lifting, pushing/pulling and trunk rotation.

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MOVEMENT EFFICIENCY Movement efficiency can be defined as the ability of the kinetic chain to move and remain balanced while experiencing the mini- mum amount of stress (10). The aim of this assessment is to observe whether: ■ the movement is carried out at a speed that is functional to the demands of performance ■ the kinetic chain can maintain optimal balance over its base of support during movement ■ there is optimal sequencing of joint and muscle action to trans- fer force effectively through the chain with minimal stress.

The movements chosen for assessment will usually consist of com- plex movements that are made up of combinations of bending, pushing/pulling and trunk rotation. Special consideration should be made of an individual’s performance environment, taking into account surface conditions (stable vs unstable), open/closed chain compatibility (double vs single leg), and sensory deprivation (for example, limited vision). All of these factors will affect an individ- ual’s ability to maintain optimal balance over their base of support during movement (11,12).

During activities of daily living and sport, muscles function through the entire spectrum of concentric, eccentric and isometric contrac- tion. With this in mind, assessment should also include the degree to which these contractions contribute to movement. This should also include assessment of relevant muscle co-contraction patterns during movement, for example the contribution of isometric co- contraction of the abdominal wall to the efficiency of a loaded over- head lift. Functional capacity, or strength-endurance may also be assessed relatively simply through the use of appropriately loaded tests performed over longer durations, such as the continuous squat test, which may provide useful information about an indi- vidual’s efficiency over time. In these instances, it is important to consider that the functional demands of a given activity may involve high repetition, prolonged isometric muscle contraction, or combinations of both; assessments may be modified to incor- porate these elements.

Speed is also an important consideration as there is always a peri- od of acceleration and deceleration during movement (13). Therefore, when observing joint and muscle action, the variations in performance speed that occur with a given task, as well as the significance of these speeds on the forces acting on the body, should be considered. For example, lifting a 5kg weight quickly may require more force generation than lifting a 10kg weight slowly. This further highlights the importance of simulating appropriate speeds during assessment.

Another factor that should be considered when assessing move- ment efficiency is the involvement of proximal and distal body segments and their contribution to the overall coordination of movement. For example, scapula mobility significantly enhances shoulder girdle function in rotational sports such as tennis or golf (14). In this instance, an observation can be made of the sequencing of the thoracic spine and the shoulder girdle during a simulated rotation pattern.

Finally, assessment of movement efficiency should extend to observations of the lower extremity in transferring ground reac-

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