Examination methods in rehabilitation, 14.12.2020
Mgr. Veronika Mrkvicová
Department of Physiotherapy and Rehabilitation –  MU  MF
Movement patterns

Topics
1.Evaluation of Movement Patterns
2.Janda's Basic Movement Patterns (6)
3. Hip Extension
4.Hip Abduction
5. Trunk Curl-Up
6.Cervical Flexion
7. Push-Up
8.Shoulder Abduction
9.

Evaluation of movement patterns - introduction
§Classic muscle strength testing involves providing a resistance against the characteristic
movement of the tested muscle. Strength is tested along the structural lines of origin and
insertion.
§
§Functional movement is never isolated because it is produced by several muscles acting as prime
movers, synergists, or stabilizers that coordinate together.
§
–In addition, functional strength does not require maximal activation; rather, muscle onset and
timing are more important.
–Hence, classic manual muscle strength testing does not provide sufficient or reliable information
about the recruitment of all the muscles involved in functional movement.

Evaluation of movement patterns - introduction
§While manual muscle testing (MMT) is an important tool, it gives clinicians little more than a
quantification of weakness.
§Muscles that are tested as strong (grade 5) during MMT may actually be inhibited when performing a
coordinated movement pattern.
§On the other hand, muscles that are tested as weak during MMT may only be inhibited.
§Janda described this as pseudoparesis (Janda 1989).
§He suggested that there are 3 characteristics of pseudoparesis:
1.hypotonia,
2.a score of 4 out of 5 during MMT,
3.delayed onset or absent EMG.

Evaluation of movement patterns
§According to Janda, movement pattern analysis is more reliable than studying pain when assessing
functional pathology because pain is very subjective.
§Movement patterns are examined immediately after the postural assessment so that touch or
facilitation by the clinician does not influence any motor patterns.
§When observing movement patterns, the clinician should focus not only on the strength of the
movement but also, and more importantly, on the sequencing and activation of all the synergists
involved in the movement.
§In this respect, the initiation of the movement is more important than the final phase or
completion of the movement.

Evaluation of movement patterns
§Understanding the quality and control of the movement pattern is imperative, as these
characteristics may contribute to or perpetuate adverse stresses on the spine and other structures.
§Although movement and activation patterns are individualized due to variability in motor control,
both typical and abnormal patterns can be observed.
§We focus on Janda's six basic movement patterns and their tests; these tests provide the clinician
with valuable information regarding a patient's preferred movement strategy.

Janda's Basic Movement Patterns
§Janda identified six basic movement patterns that provide overall information about a particular
patient's movement quality and control:
§
1.hip extension,
2.hip abduction,
3.curl-up,
4.cervical flexion,
5.push-up,
6.shoulder abduction

Janda's Basic Movement Patterns
§Janda offered several important guidelines to follow when assessing these movements:
§The patient should disrobe as much as possible so that the clinician may visualize all parts of
the body.
§ The clinician should provide minimal verbal cues so that the patient's preferred movement pattern
may be observed.
§The clinician should not touch the patient at all, as touch can be facilitatory.
§The patient should perform each movement slowly over three trials.
§Some patients do not need to perform all six tests at once; the clinician should decide which
tests are indicated based on the postural analysis and history.

Janda's Basic Movement Patterns
§Each test has a typical motor response as well as clinical indicators of functional pathology.
§While Janda considered the firing order of these movements to be an important clinical sign, he
also noted that the compensatory patterns observed during these movement tests are more valuable
for diagnosis.
§The beginning of the movement is the most important for information on motor control.
§The clinician should observe both the left and right sides for comparison.
§Muscle or limb trembling during these tests is considered a positive finding, indicating weakness
or fatigue.

1. Hip Extension Movement Pattern Test
lahbru_1


1. Hip Extension Movement Pattern Test
§During the terminal stance of the normal gait cycle, the hip extends to the trailing limb posture
of 10° of apparent hyperextension.
§There are 5° of backward pelvic rotation that contribute to these 10° of hyperextension.
§ The functional significance of this trailing limb posture is that it allows the body to advance
past the stable limb for forward progression.
§Stiff or short hip flexors may reduce the available range in the hip and force the body to move
the axis of rotation from the hip joint to a proximal point, namely the lumbar spine, in order to
get the necessary forward progression.

1. Hip Extension Movement Pattern Test
§The hip extension movement test is analyzed clinically to determine the patient's preferred
recruitment pattern.
§The sequencing and degree of activation of the hamstrings, gluteus maximus, spinal extensors, and
shoulder musculature are observed.
§To perform this test, the patient lies prone with the arms at the sides and the feet hanging over
the table to allow for neutral leg rotation
§The patient's head should be placed in neutral a position. The patient is asked to lift the leg
slowly toward the ceiling.
Prone Lying Hip Extension Test
https://dl.dropboxusercontent.com/u/45755853/fewpointpronehipextension/index.html

1. Hip Extension Movement Pattern Test
§Normally, the gluteus maximus as well as the contralateral lumbar erectors activate early in the
movement.
§Janda suggested that a normal pattern of activation during prone hip extension:
1.the gluteus maximus followed by
2.the hamstrings followed by
3.the contralateral erector spinae followed by
4.the ipsilateral erector spinae.

1. Hip Extension Movement Pattern Test
1.The most common sign of a faulty movement pattern is over activation of the hamstrings and
erector spinae and delayed or absent contraction of the gluteus maximus.
2.The poorest pattern occurs when the thoracolumbar extensors or even the shoulder muscles initiate
the movement delayed or absent the gluteus maximus contribution. Clinically, this pattern is
observed as an anterior pelvic tilt with hyperlordosis in the lumbar spine as the patient lifts the
leg into extension. Mechanical and compressive stresses in the lumbar spine are the result.
http://cfile7.uf.tistory.com/image/214C1B43558E653A181D3E

1. Hip Extension Movement Pattern Test
3.An inability to maintain knee extension during the test should also be noted, as this observation
may suggest hamstring dominance over the gluteus maximus.
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§Positive findings during this test are associated with hypertrophy of the hamstrings and
thoracolumbar extensors as well as atrophy of the gluteus maximus during postural analysis.
http://cfile7.uf.tistory.com/image/214C1B43558E653A181D3E

1. Hip Extension Movement Pattern Test
§Occasionally, this faulty movement pattern overflows into the upper quarter and may be an
underlying cause of neck pain. Clinicians should watch the contralateral insertion of the
latissimus dorsi on the humerus for activation during hip extension. Such activation suggests poor
spinal stabilization that is compensated for by a reverse action of the latissimus via the
thoracolumbar fascia.
§Increased activity of the upper trapezius during the hip extension test is a sign of poor
prognosis.

2. Hip Abduction Movement Pattern Test
lahbok_1

http://www.clinicalexams.co.uk/coxa-vara.asp

2. Hip Abduction Movement Pattern Test
§During the loading response phase of the gait cycle, the lower fibers of the gluteus maximus,
hamstrings, and adductor magnus act eccentrically to counteract the hip flexion torque; thus, the
hip joint is stabilized with minimal trunk flexion.
§In addition, the TFL, posterior gluteus medius and minimus, and upper fibers of the gluteus
maximus contract eccentrically to stabilize the pelvis in the frontal plane.
§The result is that during midstance of the gait cycle, the pelvis is stabilized by the hip
abductor group counteracting a strong varus (adductor) torque, thus preventing a hip drop or
lateral shift of the pelvis.

Hip Abduction Test
2. Hip Abduction Movement Pattern Test
§The hip abduction test provides direct information about the quality of the lateral muscular
pelvic brace and indirect information about the stabilization of the pelvis in the frontal plane
during gait.
§This test is performed with the patient lying on her side with her bottom leg in a flexed
position. The top leg is placed in a neutral position, in line with the trunk.
§The patient is instructed to lift the leg toward the ceiling
https://dl.dropboxusercontent.com/u/45755853/fewpointhipabduction/index.html

2. Hip Abduction Movement Pattern Test
§The prime movers for hip abduction are the gluteus medius, gluteus minimus, and TFL, while the
quadratus lumborum and abdominal muscles stabilize the pelvis during limb movement.
§The normal pattern of hip abduction is abduction to about 20° without any hip flexion or internal
or external rotation and with a stable trunk and pelvis – in other words, abduction without any hip
elevation or trunk rotation.
http://cfile10.uf.tistory.com/image/22591B40558E65612CDB8B

2. Hip Abduction Movement Pattern Test
§Typically, the first sign of an altered movement pattern is the tensor mechanism of hip abduction
facilitated by a tight TFL. Instead of pure hip abduction in the plane of the trunk, the movement
is combined with hip flexion due to the TFL's dual action as a hip flexor and abductor.
§
http://cfile10.uf.tistory.com/image/22591B40558E65612CDB8B
Positive findings during the hip abduction test are associated with tightness of the IT band and
atrophy of the gluteal muscles on the ipsilateral side during postural analysis and a failed
single-limb stance test.

2. Hip Abduction Movement Pattern Test
§The poorest movement pattern is observed when the hip abduction is initiated by contraction of the
quadratus lumborum before 20° of hip abduction, resulting in a lateral pelvic tilt or hip hike. In
this case, the role of the quadratus lumborum changes from pelvic stabilizer to prime mover.
Alterations observed in hip abduction can cause excessive stresses to the lumbosacral segments and
hip during gait.
§
http://cfile10.uf.tistory.com/image/22591B40558E65612CDB8B

3. Trunk Curl-Up Movement Pattern Test
lahchr_7


3. Trunk Curl-Up Movement Pattern Test
§During the trunk curl-up, the abdominal muscles contract and shorten, thus flexing the spine. The
upper trunk rounds, the lower back flattens, and the pelvis tilts posteriorly. The upward movement
is completed when the scapulae clear the table.
§During this phase, the heels should remain in contact with the table.
§After the curl-up phase is completed, the hip flexors become dominant in further curling the spine
into a sit-up position.
Trunk Curl-Up Test
https://dl.dropboxusercontent.com/u/45755853/fewpointtrunkcurlup/index.html

3. Trunk Curl-Up Movement Pattern Test
§The trunk curl-up test estimates the interplay between the iliopsoas and the abdominal muscles.
With the patient supine, the clinician analyzes the patient's preferred way of curling up.
§If the curl-up is performed with adequate abdominal contraction,
a flexion or kyphosis of the upper trunk is observed.
§However, if the movement is performed primarily with the hip flexors, curling of the upper trunk
is minimal and an associated anterior tilt of the pelvis may be observed.

3. Trunk Curl-Up Movement Pattern Test
§The patient can also perform the curl-up test with the examiner placing his hands under the
patient's heels to detect early loss of pressure. If a loss of heel pressure is detected before the
end of the curl-up, the test is positive, indicating the dominance of the hip flexors over the
abdominal muscles.
http://cfile26.uf.tistory.com/image/27107140558E657E0F55E7

3. Trunk Curl-Up Movement Pattern Test
§This test has caused confusion and misinterpretation by some individuals describing a Janda crunch
or Janda sit-up in which the patient performs the trunk curl while isometrically contracting the
hamstrings. Janda suggested placing the hands under the patient's heels to detect heel elevation
rather than provide resistance to knee flexion. Therefore, there is no such exercise as the Janda
crunch, as some individuals have advocated.
http://cfile26.uf.tistory.com/image/27107140558E657E0F55E7

4. Cervical Flexion Movement Pattern Test
krcni_3


4. Cervical Flexion Movement Pattern Test
§The primary deep flexors of the head and cervical spine are the longus capitis, longus colli, and
rectus capitis anterior. Cervical spine and head flexion are also assisted by the SCM and anterior
scalenes.
§A proper movement pattern would entail cervicocranial flexion throughout the test.
§The cervical flexion test estimates the interplay between the deep cervical flexors and the
synergists, namely the SCM and anterior scalenes.
http://cfile27.uf.tistory.com/image/2352F543558E659A1574D5
https://www.youtube.com/watch?v=bi6Ug91A2BI

4. Cervical Flexion Movement Pattern Test
§Surface EMG recordings of the SCM and direct recording of the deep neck flexor activity have
demonstrated a disturbance in synergistic movement in patients with idiopathic neck pain and
patients with neck pain after whiplash injury. Impairments in the strength and endurance needed by
the deep neck flexors for segmental control and support are compensated for by increased activity
in the superficial SCM and anterior scalene. This finding is particularly true with patients
experiencing recurrent headaches.
http://painclinic.co.in/images/whiplash1.jpg

4. Cervical Flexion Movement Pattern Test
§This test is positive when the chin or jaw juts forward at the initiation of the movement.
§A jutting chin or jaw suggests a dominance of the SCM and scalenes over the weaker deep cervical
flexors.
§A forward head posture indicates weak or inhibited deep cervical flexors.
http://aibolita.com/uploads/posts/2015-06/94qv-97.jpg

4. Cervical Flexion Movement Pattern Test
§If the pattern is unclear, the clinician places 1 or 2 fingers against the patient's forehead to
apply a slight resistance to the movement. This allows the clinician to detect any anterior
translation of the cervical segments, which would confirm inadequate stabilization by the deep
cervical flexors.
http://at.uwa.edu/mmt/CapCerFlex.jpg

5. Push-Up Movement Pattern Test
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5. Push-Up Movement Pattern Test
§The push-up test examines the quality of dynamic scapular stabilization.
§When the patient performs the test properly, the scapula abducts and upwardly rotates as the trunk
is lifted upward during the push-up.
§There is no associated scapular elevation.
http://f.tqn.com/y/exercise/1/0/U/d/pushup2.jpg

5. Push-Up Movement Pattern Test
§The push-up test is performed with the patient lying in a prone position with the legs extended in
preparation for performing the push-up movement from the feet. The clinician observes the quality
of scapular and torso movements and notes any deviations from the ideal push-up movement.
http://www.thefitpost.com/wp-content/uploads/thefitpost029.jpg

5. Push-Up Movement Pattern Test
§The force-coupling action of the serratus anterior and trapezius is imperative to provide the
proper scapular movement, with the scapular synergists contributing to its stability.
§Weakness of the serratus anterior becomes evident when the patient displays winging of the scapula
or excessive scapular adduction or is unable to complete the range of scapular motion in the
direction of abduction.
§Dominance of the upper trapezius and levator scapulae is demonstrated by excessive shoulder
elevation or shrug.
http://www.coretraining.cz/wp-content/uploads/2014/08/%C5%A1patn%C3%BD-klik.jpg

5. Push-Up Movement Pattern Test
§The lowering of the body from the maximum push-up position is more sensitive in detecting
excessive scapular rotation, elevation, tipping, winging, adduction, or abduction because of the
eccentric loading on the muscles.
§The type of impaired scapular motion detected depends on the dominance of the associated
synergists involved in the push-up movement pattern.
§
http://www.behejsrdcem.com/files/width/670/100/klik-standard.jpg

5. Push-Up Movement Pattern Test
§This test is quite challenging, as it requires adequate strength and endurance of the arm and
torso muscles to maintain the erect posture of the body.
§If the patient is unable to perform this test with straight legs, she may perform the test with
bent legs.
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§Scapular winging, gothic shoulders, levator notch, and excessive bulk of the pectoral muscles
observed during postural analysis indicate that the clinician should include the push-up test to
confirm the muscular imbalances associated with the UCS described by Janda.
http://power20method.com/wp-content/uploads/2015/10/1t_slow_pushup.png

6. Shoulder Abduction Movement Pattern Test
als-shoulder-2


6. Shoulder Abduction Movement Pattern Test
§The shoulder abduction test examines the coordination of the shoulder girdle muscles, namely the
deltoids, rotator cuff muscles, upper trapezius, and levator scapulae.
§Shoulder abduction in the frontal plane consists of synergistic abduction, scapular upward
rotation, and scapular elevation.
shoulder abduction from 90 to 180 degrees

6. Shoulder Abduction Movement Pattern Test
§The shoulder abduction test is performed with the patient in a seated position with the arms at
the sides and the elbows flexed in order to control undesired rotation.
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§Shoulder abduction comprises three major actions: abduction in the glenohumeral joint, upward
rotation of the scapula, and elevation of the scapula.
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http://cfile30.uf.tistory.com/image/233EC346558E65B70DD177

6. Shoulder Abduction Movement Pattern Test
§Activation of the contralateral upper trapezius is normal for stabilization. The decisive point of
this movement pattern is at 60° of shoulder abduction, where there is an associated scapular
elevation. Any noticeable elevation of the shoulder girdle before 60° of shoulder abduction is
positive for incoordination and impairment of the force couples among the muscles involved in
shoulder abduction.
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§Repeated or sustained shoulder girdle arm movements may overstress the spinal structures.
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http://cfile30.uf.tistory.com/image/233EC346558E65B70DD177

6. Shoulder Abduction Movement Pattern Test
§Possible causes of excessive scapular elevation during shoulder abduction are an overactive upper
trapezius and levator scapulae.
§Initiation of shoulder abduction via shoulder girdle elevation, as is seen in patients with frozen
shoulder syndrome, is also considered pathological.
§The worst scenario observed is contralateral lateral side bending of the trunk to initiate
shoulder abduction. This movement pattern indicates severe weakness of the rotator cuff or deltoid
and shortness or overactivity of the contralateral quadratus lumborum.
§Hypertrophy of the upper trapezius and atrophy of the deltoid and posterior rotator cuff are
associated with positive findings.
§In addition, the shoulder abduction test commonly is associated with the observation of a gothic
shoulder or levator notch during postural analysis.

e-sources, literature
1.Phil Page: Assessment and Treatment of Muscle Imbalance
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Thank you for your attention J
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