Assessment: Altered movement behavior is often hiding in plain sight
5
Body posture is a key aspect of spinal health. The astute movement therapist is able to read the body for the clues it offers about altered function in the postural/movement system. Seeing “the wood for the trees” is a practiced art.
In both sitting and standing, the body gives clues about the likely quality of movement control. Essentially we are interested in the “line of the body” (how the major units of mass are organized in postural alignment) and its kinematics (the shape it carves in movement). We are also keen to read the muscle contours and shape of the body axis, which give clues about the quality of inner support and control mechanisms.
The quality of movement, however, is of prime interest. We need to know: how it happens; where it starts; how it sequences through the body, and its ease and integration with breathing.
This is a whole body approach. Understanding the continuous body-wide nature of the fascial system helps see the interconnectedness of dys/function and symptoms.
However, in the clinic you will usually be dealing with a regional problem, such as neck pain, where you would look for possible features of the shoulder crossed syndrome, and examine the head and shoulder FPs, control of the center, and breathing before deciding on a relevant, appropriately staged, specific exercise program. Needless to say, you would also be advising on pelvic position for sitting well.
In a class situation you will be working with the whole body and the functional movement relationships between regions and their interaction with the center. This is further developed in Chapters 7 and 8.
The following is a clinical assessment battery: a guide to what to look for and possibly test. Treat it as a reference rather than thinking that you need to do all the tests with each client.
Noticing signs of the clinical syndromes, inferior tethers, and other features of altered movement behavior described in Chapter 3 gives clues as to the likely movement strategy the client will adopt in the tests below, and also helps hone your observational and cueing skills in a class situation.
The “failed movement test” becomes the exercise therapy. But there are likely to be many!
When observing movement in both the formal tests and during a class, it is important that you can begin to identify the “key” missing patterns: those which, when reinstated, will improve the quality of the movement.
With practice you will be able to prioritize which of the fundamental patterns need to be reestablished first. In addition, you will want to ascertain which functional movements are required most, so that the relevant patterns can be drilled for improved function.
Assessment algorithm
Initial assessment
Observation
Your first contact with a client is usually with them sitting, fully dressed, as you get their story. This is an important observation time where they will not realize what you are doing, so it can yield valuable information.
Note:
• their habitual sitting postures, readiness to move, level of arousal, etc.
• their breathing pattern – when dysfunctional, the shoulders and/or upper chest lift on inhalation and a notable gasping may be apparent when they speak
• any breath holding in some of the specific tests.
Standing assessment
Observation
For formal observation to be informative, the patient needs to be in their underwear. Diagnosis is based upon simple observation of postural alignment, body shape, muscle contours, and the quality of spinal stabilization and movement in simple movement tests.
If a test movement does not reproduce pain, that does not mean it is normal. Aberrant movement will more than likely cause pain sooner or later. If pain is reproduced, it shows the system is indeed struggling. To repeat: it is the quality of control that is important.
Patients in each pelvic crossed syndrome subgroup exhibit distinct features of kinesiopathological movement creating predictable stresses on the spine.
The following assessment guide includes the most common tests and possibilities you may observe and find
Side view: informs the quality of sagittal alignment (see Ch.3):
• Evidence of pelvic crossed syndromes? Subgrouping will provide further clues as to what to expect in movement and will guide exercise choice.
• Evidence of the shoulder crossed syndrome?
From behind: observe the body shape, muscle contours and limb positions. Active muscles are bulky with...
