The qualitative rating of movement is a common clinical practice and it comes in various guises. For example, practitioners may observe clients’ ‘preferred/natural movement patterns to interpret whether a specific goal or clinical outcome has relevance to how the person moves. In contrast, individuals may be assessed via cognitive movement control tests, which set specific criteria in terms of ‘how’ a movement task is to be achieved. The protocols differ yet, as highlighted within Dingenen et al. (2018), they can happily co-exist.
The notion that movement can be assessed to inform on the likelihood of injury is a central assumption to The Performance Matrix (TPM) approach. Representing a battery of multi-joint, cognitive movement control tests, TPM can be perceived as revealing movement behaviours that clients are unaware of; as in, every time they cross the road, the step up to the curb is accompanied by a falling forward of the trunk towards the front stance leg. The pelvis and thigh approximate; and the individual consistently employs a strategy of ‘relative hip flexion’. Cognitive movement control tests ask the question; ‘can you prevent this if you choose to?’.
If the answer is ‘no’, the individual is displaying a loss of movement choice (LMC), an operational definition for test failure (Mottram & Blandford, 2020). While stepping up to the curb may represent a task during many individual’s daily activity, the presence of LMC can also arise under tasks characterised as fast and/fatiguing. The Performance Matrix seeks to determine whether the LMC appears under low threshold (slow, non-fatiguing tasks) or during high threshold (requiring rapid deceleration or fatiguing effort) tasks. The presence of a high threshold LMC may not compromise performance but also be linked to a recurrent injury event.
Here we provide an example of a high threshold test informing on a hip flexion LMC, that sits within The Performance Matrix battery;
Fast Feet Change (Mischiati et al., 2015)
Notes on testing: what to look for
While multiple testing items are considered within this example, here we focus on just two; hip flexion, and foot inversion. During the test set up, notice the four-foot lengths employed by the model. Also, rather than aiming to achieve height, place focus on the rapidity of the foot change; this should be ‘stamp’ rather than an a gently cushioned landing. The abrupt ‘stamp’ will impose the challenge of decelerating the multiple regions against the fast ground contact. The heel raise, held for a 5 s duration, considers the ability to limit the ball of foot peeling away, as the foot begins to invert. With respect to ‘hip flexion’, does the individual lean forward from the trunk, or struggle to hold the depth? Both are indicative of a high threshold, hip flexion, LMC. Plus, observe whether the rear leg consistently abducts; this could be linked to range of motion limitations around the ipsilateral hip; preventing this may also reveal distinct changes in the alignment of the pelvis and trunk (lateral flexion/side-bend).
Thoughts on relevance
If you are working with a population who perform a large volume of lower body strength training, this test may offer excellent insight on their consistent adoption of a hip flexion strategy. Let’s be clear, no ‘movement strategy’ is inherently a problem or to be avoided. If there is an issue with movement, then this may be associated to the inability to alter; invariance may be the problem. No ‘shape’ is to be demonised. With respect to the test above, if a particular individual is prone to calf, hamstring, or knee injuries, this test may reveal there is a compromised ability to use the hip during propulsion type tasks (running), and those other regions are contributing to such an extent as to become vulnerable. Learning to gain the ability to choose to use hip flexion (or foot inversion) or not is the goal.
References
Dingenen, B., Blandford, L., Comerford, M., Staes, F., & Mottram, S. (2018). The assessment of movement health in clinical practice: A multidimensional perspective. Physical Therapy in Sport, 32, 282-292.
Mischiati, C. R., Comerford, M., Gosford, E., Swart, J., Ewings, S., Botha, N., ... & Mottram, S. L. (2015). Intra and inter-rater reliability of screening for movement impairments: movement control tests from the foundation matrix. Journal of sports science & medicine, 14(2), 427.
Mottram, S., & Blandford, L. (2020). Assessment of movement coordination strategies to inform health of movement and guide retraining interventions. Musculoskeletal Science and Practice, 45, 102100.
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