Tuesday, August 5, 2008

The Young, the innocent, & the functional movement screen

If you take the train (patella), Elizabeth is the 3rd stop on the northeast corrirodor railroad (trochlear groove) between New York & Trenton. But if the train is late getting to a stop, who's to blame? Do we blame NY? Trenton? Somewhere in between?

...every ATC has this annoying scenario. You're busy taping before a game and at the last minute, " my (fill in the blank) hurts!"

How long has it been bothering you?

About 2 weeks.

So now my hands are tied up, up I want to help this kid.

In this case, it's a knee. He points to his left patella, along the inferior medial border. No time, or room, to evaluate them on the table. "When do you do that irritates it the most?".

When I get into my 3 point stance.

I ask him to show me his stance, and I notice he goes into an unusually wide stance. Next, I go to my fuctional movement screen. I ask to see his squat. Same thing. He goes into an unusually wide, toed out stance. I ask him to narrow it, point his toes forward, and squat again. The foot abducts, the heel comes off the floor, and the knee internally rotates and abducts. I ask him to go into a R, then L, SLB. I get a pronated L foot. I ask my student AT to check the computer for this athlete's injury history. Bingo. An unresolved ankle sprain 2 years ago. Came in for first aid, then I never saw him again.

How can I help him? Next, I give him a sheet of 1/4" felt, and ask him to place it logitudinally on the medial border of his left foot. I instruct him to go into a hip width stance, and squat again. He says it is about 90 percent better. Now, I ask my student AT to give him the slant board, and while I'm taping, show him how to do self ankle mobes. I make him a felt insert for his shoe to control his pronation. I ask him to repeat the squat.

Pain free!

Of course, we have a lot more work to do. What would be the next step? The young one is the athlete, of course. But who is the innocent? The train (weak VMO? Tight lateral retinaculum?), or the track? Where on the track would you look? I chose Trenton (the foot), but where would you look next?


JH said...

Personally I would look at the hip. The ankle still needs some more work to addres the lack of dorsiflexion but I would be curious to see what the hip is doing or not doing.

SportsPeformanceGuy said...

I agree look at the hip. Have the athlete squat a few time and look first at the hip. This will give you a good indication muscular imbalnces related to glut, abductors, and adductors. This will inturn lead to looking further down the chain and his knee, and of course his calf function. Also if squat depth is an issue place a 2x4 under his heelp had have him squat again. This will tell the relationship of the his gastroc/soleus length.

JH said...

I would look at the hip differently. I wouldn't put him on a 2X4 because that actually will re-emphasize the lack of dorsiflexion he already exhibits. I would wanty to know what the SL squat would tell me, what the SL stance with opening and closing the hip would tell me. I might use his nonweightbearing foot as a driver to challenge the hip in multiple planes or I might use his arms as the driver in the same manner. Simply I would just be interested in what the hip will allow and what it won't allow from a movement perspective. Of course I would see how the foot and knee respond as well. I would also like to note where his places his center of gravity with various movement challenges.