History: Hannah presents to physical therapy with complaints of low back pain that began two weeks ago. Hannah states that she was deadlifting with she felt a sharp pain in her lower back. Pain has decreased since her initial injury, but she still experiences pain with forward bending. No complaints of radiating symptoms.
Fundamental Patterns
Multi-Segmental Flexion
· What It Should Look Like: ability to touch toes with knees extended and uniform spinal curve while demonstrating adequate posterior weight shift
· What It Does Look Like: lacks uniform spinal curve; subjective complaint of pain
· Relevance: contributes to absorption, or flexion-rotation, pattern
Multi-Segmental Extension
· What It Should Look Like: ASIS clears toes and spine of scapula clears heels while demonstrating uniform spinal curve
· What It Does Look Like: spine of scapula does not clear heels; hinges at lumbar spine
· Relevance: contributes to propulsion, or extension-rotation, pattern
Multi-Segmental Rotation
· What It Should Look Like: pelvis and
spine each rotate 50 degrees with no spinal deviation
· What It Does Look Like: pelvis does not rotate 50 degrees; spinal flexion deviation;
right rotation more limited than left
· Relevance: contributes to flexion-rotation and extension-rotation patterns
Overhead Deep Squat
· What It Should Look Like: tibia and torso parallel; femur parallel with floor; no lateral deviation; hip, knee, and ankle aligned
· What It Does Look Like: positive torso angle; femur not parallel; right hip shift
· Relevance: contributes to flexion-rotation and extension-rotation patterns
Seated Tests
Hip Flexion Internal Rotation
· What It Should Look Like: 35 degrees actively and passively
· What It Does Look Like: right side limited actively and passively
· Why: tissue compliance
· Relevance: contributes to multi-segmental rotation pattern
Hip Flexion External Rotation
· What It Should Look Like: 45 degrees actively and passively
· What It Does Look Like: left side limited actively and passively
· Why: tissue compliance
· Relevance: contributes to multi-segmental rotation pattern
Modified Thomas Test
· What It Should Look Like: femur parallel with table with 90 degrees of knee flexion
· What It Does Look Like: femur not parallel; knee not at 90 degrees; left more limited than right
· Why: tissue compliance
· Relevance: contributes to multi-segmental extension pattern
Supine Tests
Double Knees to Chest
· What It Should Look Like: 120 degrees of hip flexion (proximal thigh touches abdomen)
· What It Does Look Like: no limitations
· Relevance: contributes to multi-segmental flexion and overhead deep squat patterns
Straight Leg Raise
· What It Should Look Like: 70 degree actively and 80 degrees passively
· What It Does Look Like: both sides limited actively and passively
· Why: tissue compliance
· Relevance: contributes to multi-segmental flexion pattern
FABER
· What It Should Look Like: knee within two fists of table
· What It Does Look Like: left side limited with and without core assist
· Why: tissue compliance
· Relevance: contributes to multi-segmental extension and overhead deep squat patterns
Quadruped Tests
Lumbar Lock Thoracic Extension-Rotation
· What It Should Look Like: 50 degrees actively and passively
· What It Does Look Like: right side limited actively
· Why: neuromuscular control
· Relevance: contributes to multi-segmental extension and multi-segmental rotation patterns
Prone Tests
Hip Extension Internal Rotation
· What It Should Look Like: 35 degrees actively and passively
· What It Does Look Like: right side limited actively and passively
· Why: tissue compliance
· Relevance: contributes to multi-segmental rotation pattern
Hip Extension External Rotation
· What It Should Look Like: 45 degrees actively and passively
· What It Does Look Like: left side limited actively and passively
· Why: tissue compliance
· Relevance: contributes to multi-segmental rotation pattern
Kneeling Tests
Closed Chain Dorsiflexion
· What It Should Look Like: 40 degrees actively and passively
· What It Does Look Like: right more limited than left; subjective complaint of pinching in front of ankle on both sides
· Why: joint dynamics
· Relevance: contributes to overhead deep squat pattern
Summary
In order to create a movement diagnosis, we must marry the patient’s subjective complaints with our own objective findings. While examining the fundamental patterns, we were able to identify that the multi-segmental flexion pattern was painful for Hannah. This is important because we want to avoid movements that may provoke the symptoms that Hannah is currently experiencing. In addition, we see a consistent pattern that Hannah presents with deficiencies that coincide with the extension-rotation right pattern, or propulsion up and across the midline to the right (highlighted in chart).
For these reasons, we would assign a movement diagnosis of extension-rotation right.
*Disclaimer: Evaluation was adopted from the Selective Functional Movement Assessment.