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Movement Assessment Concepts

Written by Kento Kamiyama PT, DPT

Since my last post, I’ve had few people contact me asking about what type of correctives were implemented that resulted in a noticeable change in my friends Kettlebell Swing (watch video below).

First of all, thank you for those who read my blog!

Before I gave any correctives, I would like to note that a quick but effective breathing and movement assessment was performed in order for me to understand where to target.  I consistently tell my physical therapy students don’t just give correctives without a sound assessment.  As physical therapy students, we learned a lot about orthopedic testing but not enough on how to assess movement.

For most movement assessments, many of my concept has a heavy impact through SFMA/NKT/Gait and Shirley Sahrmann concepts.  For today’s post, I’m going to focus on some of the Shirley Sahrmann concepts since I believe its a great place to start.  If you have any interest, she has two great books on how to look at movement here and here.

One of the big concepts I believe that is important is the path of least resistance (NOTE:  I am not certain if this is solely a Shirley Sahrmann concept, I only refer to her since this is a concept I was first introduced through her book).   During movements, if the individual do not possess good mechanics, the body will choose the path of least resistance to perform the movement that is needed.  For example, if an individual attempts to squat but can not keep the knees tracking over the toes, they won’t just stop squatting.  They will either go into a knee valgus or varus in order to achieve the squat. Why?  The brain or the body will choose survival first before thinking about quality of movement.

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Path of least resistance repeated…does not mean good

Our brain and body is incredible, when the movement is difficult it will try to do its best to get things done.  We are wired to survive.  However, once that movement is over, the body should relax and recover from the compensation it created.  When we keep repeating these movements and sustained postures this can lead to trouble or pain (learn some pain science here) .  This is similar regarding chronic pain where the individual continues to feel the ‘perception of threat’ even though it might not be there anymore.  They repeat the ‘threat’ in their heads, in the movements case they repeat the movement.

For example, for my friends case.  If you look at his kettle bell swing, he tends to flex his lower C/S, extend his upper C/S and has a sway back like posture at the top of the swing.  To him, this is his path of least resistance.   When I did a quick toe touch and back extension assessment, he had a tendency to hyper extend his upper C/S and had difficulty flexing from the T/L junction.

As stated above, if the movement was only performed a few times, it won’t be in issue.   However, with repeated movements and sustained postures, this could not only lead to motor control issues but also to altered tissue characteristics causing impairment.  Luckily in this case, no tissue restriction were noted.

After the assessment, the correctives goals was to stabilize the area that moves too much and mobilize the area that doesn’t move too much.  Manual therapy can be utilized but necessary in this case.

With good assessment, a more focused correctives can be chosen making the effect two-fold.  For me, this also allows the patient have an understanding of how to control the factors producing their movements/symptoms and assume an active role in treatment and prevention.  This, hopefully leads to less dependents on passive treatments in the future.  I’m happy, their happy :).

Move better and feel better.

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