When you suffer from pain or restriction it’s often not a single joint that is the issue. We have to ask the question – Why is this joint, structure, tendon, muscle loading so poorly, and leading to this dysfunction? To answer this we need to take a step back, think outside the box and look at the big picture of how your body is working in your repeated every day-to-day movements and behaviours. This is a step that is often over looked by many therapists and is an integral part in resolving these issues in the long term.
Lets use the example of low back pain. We need to, of course, assess and begin to understand what the underlying source of the pain is. Tight muscles in your back are often painful but are usually only a guarding or compensatory symptom that occurs to reduce range of motion and limit any further damage occurring. Just simply getting a massage of your lower back may just be releasing the one thing that is stopping your back from getting worse. If we don’t understand why those muscles are becoming protective than we, as therapists, are missing due diligence and that temporary relief may only be short lived.
So how do we understand what is actually the root problem of the issue? Movement and posture assessment is the answer. We know with specific postures we have certain muscles that have a propensity to become shortened and overactive and therefore other muscles that become lengthened and underactive. This creates a less than optimal posture that increases loading through joints and tissues. From here we can assess movements and patterns to see how your motor control, in conjunction with these adaptive changes in muscle length tension relationships, are compensating and thus leading to increased loading through your painful structures. It is surprising how often you can treat a lower back and abolish all symptoms of pain for it to return a week later because a client has tight calves leading to compensations throughout the body every step they take. It is only when we address these other compensations which lead to increased loading can we change someone’s long-term outcomes.
In this article we are focusing on one test that is very simple to use and something that I challenge you to try yourself at home. It does take training and a skilled eye to pull apart the intricacies of this test – however, I’m sure it will highlight some limitations to your movement that you weren’t previously aware of.
The set up:
Give yourself some space in front of a mirror or set a camera up to film you – starting from front on. A side shot and shot from behind will be needed as well.
- Feet shoulder width apart, ensure your second toe (next to your big toe) is pointing straight ahead – this may feel unnatural already.
- Now point your arms up in the air, so they drive up past your ears – this will put your Latissimus Dorsi (Lats) on tension.
Keeping your arms up sit down into a squat as deep as you can. Ensuring that you are moving backwards through your hips as if sitting down in a chair.
We are interested in whether your joints move as we expect them to or do they shift or collapse as we wind up tension through various tissues.
We need to understand what is 'normal' so that we can understand what is not. Here is a quick checklist of what we might see.
- Did your feet start to turn out as you sat into your squat?
- Did the arch of your foot collapse as you moved deeper into your squat?
- Did you feel that one or both your knees collapsed in toward each other, or did they bow out away from each other?
- Did your hips shift more in one direction than another?
- If you drew a line through your shin-bone (tibia) and your torso when looking from side on, do those two lines intersect? If so we are flexing too much from the hip and that could be a limitation from your ankle or your hip musculature.
- Do your arms fall forward as you move down?
- Have you lost your normal standing posture as you’ve moved down into the squat?
- If you put a 3cm book under the heel of both your feet, do any of these compensations go away? Does it feel a whole lot easier?
- If you drop your arms to point straight out in front of you is it a whole lot easier? Does it remove any compensation?
If you had pain to begin with, did it feel better with either of those last two steps?
This test can quickly illustrate abnormal loading patterns and the great news is we can correct these with the right corrective exercises and release exercises. Stay tuned for a self-help tutorial on problem solving these dysfunctional movements that you may see and you can have a go at fixing these on your own. Alternatively to have more guidance and an in depth assessment please book a session here.