STABILITY ASSESSMENT BOX 1: QUICK TESTS FOR GMED/GMAX

It is possible to gain an impression of a patient’s Gmax/Gmed function quite simply. Weight bearing tests are gen- erally more effective for a quick impression than formal muscle test- ing, as you can see the effect of a weakness throughout the kinetic chain from foot through to trunk, and even as far as the shoulder.

1. STATIC KNEE DIP The patient takes up a stride stance, with the back heel raised. They lower their back knee towards the floor. (Figure 8 and Figure 9) As they do this, watch for: ■ Alignment of hip, knee and ankle: if the knee drifts medially, poor Gmax control is allowing the femur to rotate.

■ Alignment of the shoulders: if one armpit ends up lower than the other, the latissimus dorsi on that side is overactive.

■ Alignment of the pelvis in the frontal plane: the pelvis should not tip downwards on one side (indica- tive of Gmax and Gmed problems).

■ Alignment of the pelvis in the sagittal plane: the patient should be able to maintain a neutral lum- bar spine and deepen their hip flexion, rather than falling into anterior pelvic tilt and lumbar extension.

2. STEP UP The patient places one foot on a step. Pressing down, they lift their body up onto the step until the stance knee is straight. (Figure 10 and Figure 11) As they do this, watch for: ■ Alignment of hip, knee and ankle: if the knee drifts medially, poor Gmax control is allowing the femur to rotate.

■ Alignment of the shoulders: if one armpit ends up lower than the other, the latissimus dorsi on that side is overactive, implying a weak- ness in Gmax.

■ Alignment of the pelvis in the coronal plane: the pelvis should not tip downwards on one side (indicative of Gmax and Gmed problems).

Figure

Figure 8: Static dip

Figure 11: Step up with loss of pelvic

and knee alignment

12: Knee lift

3. STANDING KNEE LIFT The patient stands in front of you with feet close together. They lift one knee. (Figure 12 and Figure 13) As they do this, watch for: ■ Trunk remaining fairly vertical over pelvis: minimal tipping to one side or the other.

Figure 10: Step up

■ Arm pits remaining level ■ Pelvis not sagging out to one side, indicating poor Gmed activity.

■ No tipping backwards to help the knee up, indicating poor inner range hip flexor strength.

Figure 9: Static dip with loss of pelvic and knee alignment

Figure 13: Poor knee lift

16 www.sportex.net