Functional Assessments

in Athletes

James T. Kurtz, DC DACBSP, DACRB, CSCS, CES, PES

• Diplomate of American Chiropractic Board of

Sports Physicians

• Diplomate of American Chiropractic Rehabilitation

Board

• Certified Strength and Conditioning Specialist

• Corrective Exercise Specialist

• Performance Enhancement Specialist

Purpose of Functional

Assessments

• “Great clinicians perform

assessments to uncover the

cause of pain, then work to

eliminate the cause first,

followed by an intervention to

reduce the risk of reoccurrence

and enhance the robustness of

the patient.” - Stu McGill, Phd

• Every system in the body

requires movement for optimal

function and performance. We

are looking at how the body

moves.

Biomechanical Assessments

• Detect MSK abnormalities

that put athlete at risk of injury

• Virtually any athletic task can

become a test

• Provides feedback regarding

kinetic chain dysfunctions and

clue to compensatory

patterns i.e. joint dysfunction,

pain, soft tissue dysfunction

• Prevent injuries?

• Aid in development of a

comprehensive rehab plan

• Look at motor control,

flexibility, strength,

proprioception

• Elimination of intrinsic

faults prior to coaching

technique, training, or

rehab

• Assess progress

Assessment

• What are you going to

assess?

• What type of athlete are

you going to assess?

• What functions are most

important to their sport,

activity, or position?

• What are of major

importance? What are of

minor importance?

Micro vs Macro Tissue Injuries

• Macro: Positive ortho tests and imaging

• Micro: Negative ortho tests and imaging,

edema?

• Assessment tools need to be sensitive and

specific enough to detect micro tissue injury.

• History, palpation

Fascia

• Definition: all

collagenous fibrous

connective tissues

that can be seen as

elements of a body-

wide tensional force

transmission network

(First Fascia Research

Congress)

A whole body,

continuous, 3-D,

viscoelastic matrix of

structural support.

Anatomy Trains by Thomas Myers

Regional Interdependence

Wainner, Whitman, Cleland, Flynn. Regional interdependence.Journal of Ortho Sports

Physical Therapy 2007 37(11):658-660.

• The concept that seemingly unrelated

impairments in a remote anatomical region may

contribute to or be associated with the patient’s

primary complaint.

• When challenged the human body will always

sacrifice quality over quantity of movement.

Mobility-Stability Continuum

• Michael Boyle and Gray Cook

- Joint-by-joint training theory

or Mobility Stability Continuum

• Ankles, knees, hips, lumbar

spine, thoracic spine, cervical

spine, TMJ

• Joints with greatest natural

ROM = mobile

• Joints with limited ROM in at

least one plane = stable

All joints are multi-plane in

nature, but for stability/mobility, if

there is one primary motion, then

it is considered stable.

Mobility and Stability must

coexist to create efficient

movement in the human body.

They usually occur naturally.

Mobility-Stablity Model

Sitting is the new smoking

Mobility-Stability Model Compensation and incorrect body mechanics caused by

inadequate mobility and stability can produce poor efficiency,

require more energy, and increase the chance of dysfunction.

Hips Core T-spine

Sloppy

Stiff Stiff

Poor mobility can force stable segments to become mobile

segments. i.e. limited hip ROM can cause lumbar spine to become

unstable. The L-spine will sacrifice stability to obtain more motion.

This abnormal motion in the lumbar spine can be one of the primary

reasons for disc and facet injuries in the lower back.

Clinical Audit

Process

1. CC (chief complaint)

2. AI (activity intolerance)

3. MS (mechanical

sensitivity)

4. AMC (abnormal motor

control)

5. Re-set and/or training

6. Reassessment

Hip Hinge

Combined flexion and

compression is the quickest way

to injure the disc.

Adams MA, Hutton WC. Gradual disc prolapse. Spine

1985; 10:524-31.

Wade KR, Robertson PA, Thambyah A, Broom ND.

How healthy discs herniate: a biomechanical and

micro structural study investigating the combined

effects of compression rate and flexion. Spine 2014

Jun 1;39(13):1018-28.

Spinal Hinging

• The amount of recovery between

episodes of spinal hinging, also,

plays a role in whether load

exceeds tissue tolerance. When

tissue tolerance is exceeded, injury

occurs to the internal lamellae of

the annulus of the lumbar disc and

progresses outward.

• Inner layers of annulus are free of

nociceptive neurons. Pain is not

felt until compromise reaches well-

innervated/vascularized outer

layers of the disc or the resultant

disc bulge produces mechanical

pressure on the nerve roots.

Hip Hinge Genetics largely determine how

often and how much of this activity

can be tolerated before injury

occurs.

Battié MC, Videman T, Levälahti E, Kaprio J. Genetic and

environmental effects of disc degeneration by phenotype

and spinal level: a multivariate study. Spine (Phil PA

1976).2008 Dec 1;33(25):2801-8.

Videman T, Gibbons LE, Kaprio J, Battié MC.Challenging

the cumulative model:positive effects of greater body mass

on disc deneration.Spine J.2010 Jan;10(1):26-31.

In disc patients, often see tendency

to hinge excessively in the lumbar

spine vs the hips with forward

bending activity.

> 5 degree asymmetry, predictor of injury.

Malliaras, Pl, Cook, J.C., Kent, P. 2006. Reduced ankle dorsiflexion range may increase risk of patellar tendon injury

among volleyball players. Journal of Science and Medicine in Sports, 9, 304 - 309.

Fong, C.M. et al. 2011. Ankle dorsiflexion ROM and landing mechanics. Journal of Athletic Training. 46, 5.

Macrum, E, et al. 2012. Effects of limiting ankle dorsiflexion ROM on lower extremity kinematics and muscle-activation

patterns during a squat. Journal of Sport Rehabilitation, 21, 144.

Ankle Dorsiflexion Test

Overhead

Squat Test

Overhead

Squat Test

Overhead

Squat Test

Single Leg Squat Test

• Pass = 3, Pain = 0

• Can’t squat to 30 deg

knee flexion (1)

• Knee valgus (med to gr

toe)(1)

• Lumbar spine flexion (2)

• Anterior patellar shear (2)

• Trendelenberg sign (2)

• Hyperpronation (2)

Knee Valgus

• Dysfunctional movement

mechanics —> joint

stress and soft tissues of

kinetic chain

• Excessive rear foot

eversion and hip adduction

are risk factors for

patellofemoral joint pain

Barton, C. J., Levinger, P., et al 2012. The

relationship between rearfoot, tibial, and hip

kinematics in individuals with patellofemoral pain

syndrome. Clinical Biomechanics, 27, 702-705.

Single Leg Bridge

• Pelvic drop or rotation (1)

• Can’t maintain full hip

extension (2)

• Thighs don’t remain

parallel (2)

Side Bridge Endurance Test

• Mean endurance times for

healthy men and women =

84.5 s

• According to McGill,

asymmetry of > 15s could be

predictor of LBP.

McGill SM, Childs A, Liebenson C.Endurance times

for stabilization exercises:clinical targets for testing

and training from a normal database.Arch Phys Med

Rehabil 1999;80:941-944.

Flexor Endurance Test

• Normative data for men and

women = 134 secs

McGill, S.M. et al. (2010) Comparison of two

methods to quantify torso flexion

endurance. Occupational Ergonometrics, 9:

55-61.

Back Extensor Test • Normative data for men and

women = 173 secs

Biering-Sorenson,F.(1984) Physical

measurements as risk factors for low back

trouble over a one year period. Spine, 9: 106-

119.

• Teenagers with LBP have

stronger flexors and weaker

extensors compared to controls

Bernard, J.D., Boudokhane, S., et al. 2013.

Isokinetic trunk muscle performance in pre-teens

and teens with and without back pain. Annuals

of Physical and Rehabilitation Medicine, 57(1),

38-54.

Prone Plank Endurance Test

• Test duration should equal 100 secs

for both men and women

Strand S, Hjelm J, Shoepe T, Fajardo M, Norms for an

isometric muscle endurance test, J Human Kinetics.2014

Mar27;40:93-102.

Van Dillen, L.R., Bloom, N.J. et al, 2008 Hip

Rotation ROM in people with and without LBP

who participate in rotation-related sports. Physical

Therapy in Sports, 9, 72-81.

Hip Rotation

Side-to-side asymmetry

prevalent in those with LBP in

rotational sports

Hanging Scapular Clocks

Ida Portal

Kneeling Chop

Single Leg RDL

Pallof Press

Bear

Bird Dog

Hip Abduction Test

Single Leg Balance

Hamstring to quadricep

strength ratio has been shown to

be predictive of ACL injury in

female athletes.

Quad/Ham Ratio

Myer, G. D., Ford, K. R., et al 2009. The

relationship of hamstring and quadriceps

strength to ACL injury in female athletes.

Clinical Journal of Sport Medicine, 19, 3-8.

ER: IR ratio is predictive of in-

season shoulder injury in

baseball pitchers.

Shoulder Rotation

Strength Ratio

Byrum, L. R., Bushnell, B. D., et al. 2010.

Pre-season shoulder strength

measurements in professional baseball

pitchers identifying players at risk for

injury. The American Journal of Sports

Medicine, 38, 1375 - 1382.

• Predicting, preventing, and rehabilitating

hamstring injuries.

• Test-re-test reliability higher for bilateral

testing compared to unilateral testing.

• Athletes with a hamstring strain in the

previous 12 months still show a significant

weakness on the injured limb, despite

“successful” rehabilitation.

• Nordbord test has good reliability and is

able to identify those who have suffered

previous hamstring injury within a 12

month time period.

Opar et al. A novel device using the nordic hamstring exercise

to assess eccentric knee flexor strength: A reliability and retrospective

injury study.J ortho sports phys thera 2013;43(a):636-640.

Nordic Hamstring Exercise

Hamstring Strengthening

• A substantial portion of

hamstring strain injuries in

running occur in the long

head of biceps femoris.

• Nordics have been found to

reduce hamstring strain

injuries

• The Nordic exercise, highest

eccentric EMG of any of the

10 exercises tested.

Jim Kurtz

jkurtz@nwsportsrehab.com