In this post, we have given the idea while assesing kinetic chain. There are some key features that you should keep in mind.

    Here we’ll look at the why and how we assess.

Why do we assess?

1. Establish a baseline/starting point
2. Create realistic expectations
3. Discover the specific GOALS and NEEDS of each patient
4. Create individualized exercise programs that are systematic and progressive.

       If you are not assessing, you’re guessing.

Using the SOAP can be helpful for analyzing patient problems and determining the appropriate program design.  SOAP stands for:

1. Subjective
2. Objective
3. Assessment
4. Plan

Subjective information can be gathered by asking general health history and a health-risk appraisal.

• Occupation
• Lifestyle
• Medical history
• Previous injuries & surgeries
• Any major illness or medications
• Dietary habits & Exercise history  

Objective information typically involves data that we can quantify and use to evaluate progress.   This can include:

1. Weight/Height
2. Vital signs (blood pressure and pulse)
3. Body composition
4. Circumference measurements
5. Static posture analysis
6. Movement screen
7. Range of motion
8. Muscle testing
9. Upper body strength endurance (e.g., push-up test)
10. Lower body strength endurance  (e.g., wall squat test)
11. Sub Max VO2 (e.g., 3 minute step test)

These type of assessment helps from the Subjective and Objective information, which will ultimately be used to design an exercise plan.

Kinetic Chain Assessment

A kinetic chain assessment is designed to identify dysfunction within the human movement system which can be

1. Altered length-tension relationships of soft tissues (muscles, ligaments, tendons and fascia)
2. Altered force-couple relationships (compensatory movement)
3. Altered arthrokinematics (joint dysfunction)

Dysfunction in the human movement system will lead to:

Altered sensorimotor integration
Altered neuromuscular efficiency
Tissue fatigue and breakdown (cumulative injury)

What should you include while doing assessment of the Kinetic Chain  

[restrict]

1. Static postural assessment
   
2. Dynamic movement screen (e.g., overhead squat assessment)
3. Range of motion testing*
   
4. Manual muscle testing*

Static Postural Assessment

Professor Janda, said , identified predictable patterns of muscle imbalance where some muscles become shortened/overactive and others become lengthened/underactive. He labeled  as: Upper Crossed Syndrome, Lower Crossed Syndrome, and Pronation Distortion Syndrome.

The five kinetic chain checkpoints from static posture assessment:

1. Feet and ankles
   
2. Knees
   
3. Lumbo-pelvic-hip (LPHC) complex
   
4. Shoulders
   
5. Head/cervical spine

Upper Crossed Syndrome

Rounded shoulders and a forward head posture. This pattern is common in individuals who sit a lot on computer.

Here muscles are very much prone to shortened and lengthened in upper cross syndrome.

Shortened Muscles:

• Pectoralis major and minor, latissimus dorsi, teres major, upper trapezius, levator scapulae, sternocleidomastoid, scalenes

Lengthened Muscles:

• Lower and middle trapezius, serratus anterior, rhomboids, teres minor, infraspinatus, posterior deltoid, and deep cervical flexors.

Common injuries in upper extremity dysfunction: Rotator cuff impingement, shoulder instability, biceps tendonitis, thoracic outlet syndrome, headaches.

Lower Crossed Syndrome : Increased lumbar lordosis and an anterior pelvic tilt.

Shortened Muscles:

• Iliopsoas, rectus femoris, tensor fascia latae, piriformis, adductors, hamstrings, erector spinae, gastocnemius, soleus

Lengthened Muscles:

• Gluteus maximus, gluteus medius, VMO, transversus abdominus, multifidus, internal oblique, anterior and posterior tibialis
  Common injuries: Hamstring strains, anterior knee pain, low back pain.

Pronation Distortion Syndrome : Excessive foot pronation, genu valgus and poor ankle flexibility

Shortened Muscles:       

• Peroneals, gastrocnemius, soleus, iliotibial band, hamstrings, adductors, iliopsoas
  Lengthened Muscles: Posterior tibialis, flexor digitorum longus, flexor hallicus longus, anterior, tibialis, posterior tibialis, vastus medialis, gluteus medius, gluteus maximus

Common Injury Patterns:

• Plantar fasciitis, posterior tibialis tendonitis (shin splints), anterior, knee pain, low back pain.

Dynamic Movement Screen:

The Overhead Squat Assessment is designed to assess dynamic flexibility, core strength, balance and overall neuromuscular efficiency. This should be done with the static postural assessment, this should be a systematic process observed from the anterior, lateral and posterior positions.

These compensations can signify over and under active muscles, abnormal force-couple relationships and joint dysfunction during movement performance.

As you can see from our previous post on overhead squat  (CLiCK here)assessment, there are a number of compensations characterized by potentially over and underactive muscles. By integrating a range of motion and manual muscle testing, the precise muscles and joints can be isolated, streamlining the process and helping to make the program design more accurate and effective.

Range of Motion Testing

The range of motion assessment looks at the amount of motion available at a specific joint. Active range of motion occurs through voluntary contraction by the patient and can be observed through the overhead squat. Passive range of motion provides information about the joint play and end feel.


Regional Interdependence:

It is the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with an area of pain. For example, patient who complains of low back pain or discomfort may actually be suffering from dysfunction at the ankle, hip or knee joints. By focusing corrective exercise strategies at the most Dysfunctional Non-Painful movement impairments many common problems affecting the foot and ankle, low back, knees, shoulders and neck can be addressed in a clinical setting .

Manual Muscle Testing :

Muscle testing is an art and a science. There are a number of factors that can cause a muscle to test weak. Essentially, muscles must be properly activated by the nervous system in order to produce internal tension to overcome an external force. This gives clear idea where the misisng link is present. Its quantitative so it differs from one to another.

Things to remember :

Optimum program design involve:

1. Subjective information ( Health History)
   
2. An Analysis
   
3. Objective data
   
4. Static posture
5. Dynamic Movement Screen
   
6. The range of Motion Testing
   
7. Manual Muscle Testing
   
8. An Assessment 
   
9. Exercise selection 
   
10. Inhibit muscles
    
11. Lengthen muscles
    
12. Activate the muscles & Integrate the exercise to achieve a specific goal.

References

1. Kraemer, W.J. (1984). Exercise prescription: Needs analysis. Strength & Conditioning Journal, 6(5), 47-47.
   
   
2. Page, P., Frank, C., & Lardner, R. (2010). Assessment and Treatment of Muscle Imbalance: The Janda Approach. Champaign, IL: Human Kinetics.
   
   
3. Wainner, R. S., Whitman, J. M., Cleland, J. A., & Flynn, T. W. (2007). Regional interdependence: a musculoskeletal examination model whose time has come Journal of Orthopaedic & Sports Physical Therapy, 37(11), 658-660.

[/restrict]

click here for Register to know more…..