The Deep Line as Patrick states, consists of the following:

Posterior tibialis > interosseuos membrane > Knee capsule > adductor hiatus > intermuscular septum > femoral triangle > psoas > anterior longitudinal ligament > diaphragm > pericardium > mediastinum > parietal pleura > fascia prevertebralis > scalenes

Patrick goes on to explain how breathing plays a very important role in the function of this line and provides some excellent strategies for correction and progression.

This got me thinking…

Often times I will use the Bunkie Testing method to assess the various lines throughout the body. I wrote a piece about the Bunkie Test late last year and it can be viewed here. Kevin Neeled also wrote a piece and shot some video on how and why this testing method may play an important role in kinetic linking for hockey players. You can read that here.

As mentioned last fall, the Bunkie Test consists of tests for the following

• Anterior power line
• Medial stabilizing line
• Lateral stabilizing line
• Posterior stabilizing line
• Posterior power line

Do we truly know that we’re testing each of the above? Who knows, but based on Patrick’s article, I think we need to revisit the test and see how we can start testing the DEEP FRONT LINE. That is, the Deep Stabilizing Line. Maybe we can’t. But perhaps we can. I am not trying to reinvent the testing method here. I am simply seeing a flaw in the testing procedure and am now looking for a way to improve it. Joe Heiler of Sports Rehab Expert recently invited me to do an interview and discuss the Bunkie Method of Testing. I hope to do this interview in July so maybe I’ll have some answers by then.

Perhaps there are other ways to test this. I can’t remember off the top of my head right now so if you can think of one, make sure you let me know.

When a patient does present with “dysfunction” of this Deep Front Line, aside from attacking their breathing patterns, I progress to improving their rolling patterns as well. Generally, I will work the supine to prone rolling pattern to improve this line and specifically target the right arm / left leg or left arm / right leg combinations as needed. Carson Boddicker has written several pieces on these topics, one of which is a must read.  For an introduction, make sure you read Core Competencies. Mark Young makes a good argument about testing the roll, but personally, I think quality is more important than quantity in this case…but that’s just my opinion!

Progression from here would be to the Dead Bug tract (not dissimilar to Patrick’s videos) and onward to chops and lifts (thanks Mike) and beyond to really attack their stabilizing function. Check out Nick Tumminello’s video of the Vertical Pallof Press for anterior stabilization (to combat lumbar extension).

Lots of info to digest here and certainly plenty of hot links to click on. So thanks to Patrick, Mike, Kevin, Mark, Carson, Nick, and Perry for unknowingly being participants in this post!

Related posts:

1. The Bunkie Test Although the assessment and treatment of myofascial and kinetic...
2. Minimizing Hip & Groin Injuries Considerations for minimizing hip and groin injuries in activity and...
3. Flexion Endurance Testing: V-Sit vs Plank Comparing the V-sit flexion endurance test vs the front plank...

Related posts brought to you by Yet Another Related Posts Plugin.

The above question is just one reason why I am looking forward to the 7th Interdisciplinary World Congress on Low Back and Pelvic Pain. Among other “questions”, answers (or at least directions) to the above will be addressed throughout this congress. Here’s a look at the preliminary program.

What are your thoughts on the above question?

Related posts:

1. Deep Thoughts Some good reads that I have come across in the...
2. Flexion Endurance Testing: V-Sit vs Plank Comparing the V-sit flexion endurance test vs the front plank...
3. 2010 Spinal Control Symposium – Toronto McGill, Moseley, Hodges, Reeves...

Related posts brought to you by Yet Another Related Posts Plugin.

Also make sure to check out the following posts as scapular dyskinesia may play a role in both:

• Neurovascular Problems in the Athlete’s Shoulder
• Rotator Cuff Tears: Predictive Factors for Management

Related posts:

1. Rotator Cuff Tears: Predictive Factors for Management This review was recently posted on ResearchReviewService.com and integrated the...
2. The Shoulder in Sport The Shoulder in Sport: Management, rehabilitation, and prevention Andrea Fusco,...
3. The Rotator What is it? A device that can be used in...

Related posts brought to you by Yet Another Related Posts Plugin.

The Functional Movement Screen (FMS) is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS readily identifies functional limitations and asymmetries. These are issues that can reduce the effects of functional training and physical conditioning and distort body awareness.

The FMS generates the Functional Movement Screen Score, which is used to target problems and track progress. This scoring system is directly linked to the most beneficial corrective exercises to restore mechanically sound movement patterns.

Exercise professionals monitor the FMS score to track progress and to identify those exercises that will be most effective to restore proper movement and build strength in each individual. (…cont’d)

The Selective Functional Movement Assessment (SFMA) is a series of 7 full-body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known musculoskeletal pain. When the clinical assessment is initiated from the perspective of the movement pattern, the clinician has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main musculoskeletal complaint, but contribute to the associated disability. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides the clinician to the most dysfunctional non-painful movement pattern, which is then assessed in detail. This approach is designed to complement the existing exam and serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of movement into musculoskeletal practice. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain. (…cont’d)

To describe the above in layman’s terms, the FMS is a screen to identify who may be at risk based on their presenting movement patterns. Why they are at risk is not the objective here, it is simply a filter. On the other hand, the SFMA is an assessment tool aimed at determining one’s cause of pain.

If you are interested in learning more about these systems and especially how to apply them in a clinical / rehabilitation setting, I urge you to join Sports Rehabilitation Expert.

Related posts:

1. Assess and Correct: A Review On Friday, I finally received my DVD copy of Assess...
2. Zygapophyseal Joint Pain Patterns: Part 1B (Cervical Spine) A study testing the reliability of their pain charts by...
3. Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation is...

Related posts brought to you by Yet Another Related Posts Plugin.

• The data from this study came from two sources (firefighters and kinesiology students).

• The main objective of this study was to assess the relationship between the V-sit test and the plank test for torso flexion endurance.

• The pearson correlation was r=0.34 (low correlation) as well as the r-squared value. It almost seems obvious that these two wouldn’t correlate well as they are two totally different positions.

I think the main reason McGill did this study was because people were using the PLANK test in place of the V-SIT to test flexion endurance (which has plenty of data correlating poor endurance times with low back disorders).

• The moral of the story is to use the V-sit when doing your tests for flexion endurance.

• He also cautioned against “training the test” due to the high compressive loads.

I do not have an image of the V-Sit test but can send you a copy of the full article if you would like. Just reply below with your email and I’ll shoot it over.

Related posts:

1. Dr. Stuart McGill in Toronto A recent publication by Dr. McGill and an upcoming course...
2. Core Values (NY Times) Dr. Stu McGill demonstrates some "early" phase low back and...
3. Thinking About Thoughts Cognitive aspects of treatment of lumbopelvic pain. From the upcoming...

Related posts brought to you by Yet Another Related Posts Plugin.

FOOT AND ANKLE

Pes Planus

During the movement screen, we examine your foot to determine if the movement in your foot is optimal.  Specifically, the most common type of dysfunction in the foot that can lead to energy leaks is a pes planus.  Pes planus, or flat feet, is a very common finding among the general population.  When dynamically tested, individuals with pes planus will exhibit turning out of their feet and a collapse of the main arch of their feet (longitudinal arch).  This finding can also contribute to the other findings within the movement screen.

Limited Dorsiflexion

This finding represents a limitation ankle joint’s range of motion.  Specifically, it means that the top of the foot does not get as close to the shin as it should while being loaded such as while performing a squat.   What this means is that those who have limited dorsiflexion in their ankle are likely make up for this lack of range by compensating somewhere else to get to the same depth of a squat.  Often times, people will use their backs predisposing them to injury due to overuse/misuse, or they may simply not be able to achieve the same range of movement while performing the specific movement in question.

External Foot Flare

This finding represents turning out of the foot while under dynamic load.  This may be a result of poor foot posture stemming from over pronation or pes planus.

KNEE

Dynamic Valgus

This finding represents the knees inability to maintain its dynamic integrity (position during movement) while under load.  What we see is a collapsing medially (inward) of the involved knee representing poor control, weakness of the hip musculature, and/or poor foundational support from poorly controlled foot motion.

Sagittal Control

This concept represents the importance of muscular control of one’s knee while under dynamic load.  What we see at times is a “shimmy” in the knee while the patient attempts to control knee movements such as a single leg squat.  This can represent poor muscular control and coordination  of the knee, hip and foot musculature.

LUMBOPELVIS AND HIP

Where your spine and hip attaches to your pelvis

Hip Hinge

This finding represents the correct way to perform a squat and generally to “bend at the hips”.  A good “bend” is initiated at the hip and not the low back where, as the name implies, you literally hinge your movement at your hips.  Those who cannot perform this movement and tend to favour bending through their back are predisposed to developing low back pain and poor performance, because instead of using their legs they use their spines to lift. Correcting this movement yields tremendous improvements for patients or athletes in terms of low back pain and performance.

Hip Mobility

This finding represents your hip range of motion in flexion, extension, internal and external rotation, and all combined movements of the aforementioned ranges. As a car needs lubricant to function properly you need hip mobility to keep your hips, low back and knees functioning properly. Tightness in the hips lead to stress and strain into joints that can create many musculoskeletal conditions that overtime can easily lead to arthritis in the previously mentioned sites. Sitting and our normal activities of daily living reduce our hip mobility. Therefore to be able to achieve your full athletic potential combined with staying injury proof requires you to constantly maintain proper hip mobility.

Hip Strength Quality

This finding examines the strength and ease of movement the athlete or patient displays during the various movements assessed. It is seen during low load testing as the depth the individual is able to achieve for example during the squat, lunge, and single leg squats. During high load conditions it is the individuals’ ability to absorb forces through the muscular system and to develop power (rate of force development)

Spine Buckling

This finding represents the spines inability to handle load.  What this means is that the spine is unable to support itself due to poor core musculature support.  Much like a mast on a ship, the spine requires guide wires to tightly hold the mast upright otherwise it will crack and the ship will lose its sails.  Similarly, without appropriate conditioning of the core muscles around the spine and pelvis, the body’s mast (your spine) will buckle causing you to lose the wind in your sails and the spring in your step.  Simple movement such as bending forward becomes painful.  This finding tends to become apparent while perform any bending movement.

Sandwich Movement

This finding represents when a person has does not display a hip hinge, has poor mobility through their hips, and favours using their back while perform a specific movement.  Essentially, what is seen is the torso and legs form the “bread” of the sandwich while the space in between becomes the filling.  A well conditioned pattern finds that the torso is in a neutral position with the chest up; while a “sandwich pattern” finds the chest bent into the legs and facing down – they look like a sandwich. In this position the low back is doing the lifting not the legs. Adopting this pattern negates the most powerful muscles in your body in favour of the back which predisposed the individual to developing chronic low back pain. Correcting this movement pattern and developing a proper hip hinge would be tremendously beneficial. In fact, most people with low back pain display this dysfunction that once corrected no longer have back pain.

Pelvic Control

Much like the above three findings, pelvic control reflects the patient’s ability to dynamically (through movement) maintain a stable pelvis (foundation) while performing various movements.  Dysfunctions are seen as aberrant movements of the pelvis; shifting, tilting, hiking and rotating. These dysfunctions occur largely because of an inability to maintain neutral spine control and are linked to the findings throughout the other anatomical sites, such as your ankle and foot. The impact of poor pelvic control relates to its’ central position in the body. Your pelvis is the transfer point for forces generated in your hips (the main power centre in the body) combined with force contributions from other areas of the body. Pelvic control is like the drive train of a car which functions to transfer power developed from the engine to the wheels. Many problems throughout the body will occur with poor pelvic control such as low back pain, hip problems, knee problems, and even shoulder problems.

Something to Think About:

Regardless of whether you are an athlete or not, pelvic control is essential. If you are an athlete the demands for pelvic control are much higher and are reflective of the demands of your sport. For example it well known that hip and leg contribution to pitching velocity and tennis serve velocity is over 50 percent. This is only possible through pelvic control, or “THE CORE”. Many athletes that fail to develop the core suffer injuries by trying to make up the power elsewhere, such as the elbow and shoulder for both pitchers and tennis players.

SCAPULO-THORACIC HUMERAL

Where your arms attach to your spine

Thoracic Collapse

This is a secondary finding often times associated with sandwich movement.  This finding indicates that the patient is not hinging from the hips resulting in a back dominant initiation of movement resulting in thoracic or mid back collapse.  Essentially, the mid-back often times follows the lead of the low back; if the low back is poorly supported, then the same will be seen in the mid-back.

Thoracic Rigidity/Hyperkyphosis

This finding is the opposite of the thoracic collapse.  It represents the inability of the patient to maintain a “chest up” position while under load and undergoing specific movements, irrespective of the stability of the low back.  In chronic situations, this finding can contribute to thoracic outlet syndrome, neck pain, and headaches.

Scapular Winging

This finding represents poor posture of your should blades (aka scapulae).  This finding indicates that you are chest dominant in your posture with likely tight, forward rolled shoulders and weak mid-back muscles.  This can predispose patients to developing chronic rotator cuff tendons, mid-back, shoulder, and neck pain.

Internal GH Rotation

Internal glenohumeral rotation represents a finding that is often associated with hyperkyphosis and scapular winging.  This can also predispose the patient to chronic rotator cuff injuries leading to pain and poor function while attempting to participate in their chosen activity or job.

CRANIO-CERVICAL JUNCTION

Where your neck meets your head

Anterior Head Carriage

This represents the general finding found in almost all people to some degree or another.  It’s what I call the modern cave man position in which our head juts forward in front of our bodies when we primarily sit in a poor position in front of the computer, read or slouch. This finding can represent poor muscular control of the deep muscles of your neck and may lead to chronic neck and jaw pain as well as headaches due to hyperactive posterior neck musculature.

Lateral Shift

Lateral shift of your head on your shoulders may represent a muscle imbalance present at your shoulder, neck, or upper back.  It may also represent a favoured motor pattern that if not corrected can lead to over stressing specific structures and tissue, resulting in breakdown and injury.

Rotation

Rotation is very similar to the finding of lateral shift and is often found in conjunction with it. Rotation may also represent a favoured motor pattern that can indicate the presence of weak and tight neck muscles.

Courtesy of Dr. Thomas Lam

Related posts:

1. Optimum Body Mechanics A brief summary of maximizing Optimum Body Mechanics in activity...
2. Flexion Endurance Testing: V-Sit vs Plank Comparing the V-sit flexion endurance test vs the front plank...
3. Dr. Stuart McGill in Toronto A recent publication by Dr. McGill and an upcoming course...

Related posts brought to you by Yet Another Related Posts Plugin.

What we need:

• Dorsiflexion mobility

Why we need it:

• Minimize stress on knee

How we can get it:

KNEE:
What we need:

• We need to realize that the knee is often an innocent bystander

Why we need it:

• We need to realize this because the research says so

How we can get it

• We can achieve optimal knee mechanics by looking both above (the hip) and below (the ankle) this joint.

HIP:

What we need:

• Saggittal plane mobility
• Extension strength

Why we need it:

• Minimize stress on lumbar spine

How we can get it:

• Glute Bridge
• Glute Bridge – Marching
• Glute Bridge – 1 Leg

What we need:

• Frontal & Transverse plane dynamic stability

Why we need it:

• Minimize dynamic valgus at knee and dynamic internal rotation at knee

How we can get it

• Side Lying Abduction
• Clam Shells (Hip – External Rotation)
• Mini Band – External Rotation
• Airplane (I’ll get a video of this up soon)

LOW BACK / CORE:

What we need:

• Antirotation, Antiextension, Antilateral flexion STABILITY

Why we need it:

• To be able to transfer forces THROUGH not TO the “joint” (aka Core”)

How we can get it:

• Antirotation: “Pig on a Spit” Roll
• Antiextension: Front Plank series including the Body Saw
• Antilateral flexion: Farmer walk / Suitcase carry

What we need:

• Lumbar intersegmental stability

Why we need it:

• To be able to transfer forces THROUGH not TO the “joint” (aka Core”)

How we can get it:

• Effective “core activation” methods

THORACIC SPINE:

What we need:

• Rotation & Extension mobility

Why we need it:

• Lumbar relief & Shoulder mobility

How we can get it:

SHOULDER:

What we need:

• Scapular stability

Why we need it:

• Shoulder mobility

How we can get it:

For those of you who are unfamiliar with this approach of looking at the body, please have a look at Coach Boyle’s The Joint by Joint approach and FITS Toronto’s 5-site Integrity

Anatomical photos courtesy of Primal Pictures

Related posts:

1. Common Movement Dysfunctions What to look for when screening and assessing the moving...
2. Minimizing Hip & Groin Injuries Considerations for minimizing hip and groin injuries in activity and...
3. Jumping Rope: A triathlete’s off season secret weapon? As I was jumping rope in between workouts yesterday (thats...

Related posts brought to you by Yet Another Related Posts Plugin.

• An inability to stabilize the pelvis while performing dynamic lower body movements (i.e. performing lunges in the weight room or skating in hockey) may result in shear forces sustained by the spine, creating a compensatory pattern of inefficient/lack of gluteal activation, muscle spasm, and undue stress on the hip joints and muscles.

Therefore, to minimize the risks to specific muscles that cross this joint, we must maximize the integrity of the slings that cross it. Four myofascial slings are involved here, and they include:

• Posterior oblique sling – located across the back from gluteus maximus, through the thoracodorsal fascia, and up to the latissimus dorsi.
• Anterior oblique sling – in the front of the body from the external oblique, through the anterior abdominal fascia, to the contralateral internal oblique and the adductor musculature
• Longitudinal sling – from the peroneii/fibularis group in the lateral lower leg, up the biceps femoris, the sacroiliac ligaments, through the deep thoracodorsal fascia, and up the erector musculature
• Lateral sling – containing the PRIMARY frontal plane stabilizers for the hip joint – the gluteus medius, tensor fascia lata, and the lateral stabilizers of thoracopelvic region (i.e. quadratus lumborum)

Therefore, to assess and correct one’s risk for hip and groin injuries, it would be prudent to test the integrity of these slings and their myofascial components through such testing procedures as the BUNKIE TEST.

One of the most important tenets in minimizing these injuries is the ability to CONTROL and STABILIZE this region while power is being generated. We want loads to be generated THROUGH THE JOINT and not to it!

Other considerations include ADDuctor to ABDuctor strength ratio, hip static and dynamic mobility, and joint centration.

Related posts:

1. Flexion Endurance Testing: V-Sit vs Plank Comparing the V-sit flexion endurance test vs the front plank...
2. Common Movement Dysfunctions What to look for when screening and assessing the moving...
3. More on the Deep Front Line From the deep line to breathing, from testing to training....

Related posts brought to you by Yet Another Related Posts Plugin.

CERVICAL ZYGAPOPHYSEAL JOINT PAIN PATTERNS II: A clinical evaluation (Aprill et. al., Spine, 1990)

A study testing the reliability of their pain charts by a clinical trial

Guiding principle: if the pain patterns could correctly identify the source of neck pain, they could then be used as diagnostic aids in the clinical assessment of neck pain.

10 subjects used and were administered diagnostic blocks according to the above pain patterns. A positive response was recorded if within 10 minutes, the blocks provided complete relief of pain lasting for the duration of action of the local anesthetic agent used

The diagnostic blocks used were cervical medial branch blocks performed under image intensifier using a lateral approach

In eight cases, there was complete concordance in the predicted levels between the first and second observers

In nine of ten patients, there was complete concordance between the predicted level and the positive response to blocks

Most patients reported areas that were more extensive than those seen in normal volunteers. Therefore, it appears that with stronger stimuli, the pain can spread beyond the core area, overlapping into adjacent zones

Results demonstrated that the segmental pain charts could be used with good accuracy to predict the segmental location of the symptomatic joint

Click here for Part 1A

Photo source

Related posts:

1. Zygapophyseal Joint Pain Patterns: Part 1A (Cervical Spine) This one's for the manual therapists out there. A brief...
2. Its Not Always Bursitis: Greater Trochanter Pain Syndrome The use of “Trochanteric Bursitis” as a diagnosis for lateral...
3. Hamstring Length and the Patellofemoral Joint A summary of my upcoming review on ResearchReviewService.com...

Related posts brought to you by Yet Another Related Posts Plugin.

This one’s for the manual therapists out there. A brief little review of 2 landmark papers pertaining to fact joint pain and referral patterns.

Part 1A:

CERVICAL ZYGAPOPHYSEAL JOINT PAIN PATTERNS I: A study in normal volunteers (Dwyer et. al., Spine, 1990)

A study determining whether or not pain from a given joint assumed a characteristic distribution…where the pain pattern in a given patient might be used as an accurate indicator for clinically diagnosing the symptomatic joint

4 asymptomatic subjects were used

A contrast medium was injected into the joints, acting in a prevocational matter (experimental stimulus). Subjects were then examined for tenderness in both the cervical and shoulder regions

The distributions of evoked pain were recorded and a visual analog scale was completed

The medial branches of the dorsal primary rami were also blocked

The pain felt was deep and achy in quality

Pain patterns:

• C2-3: into the head
• C3-4: (coinciding with the levator scapula) was more rostral than C4-5 (which concentrated by the angle formed by the shoulder and neck)
• C5-6: covered the top of the scapula and shoulder above the level of the scapular spine laterally
• C6-7: extended caudally to the inferior angle of the scapula

Following the analgesic blocks, the subjects unexpectedly demonstrated a slight hypesthesia over the area coinciding with the previous recorded area of invoked pain and tenderness

Concluded that the cervical z-joints can be sources of pain, including referred pain and that a physiological mechanism must exist whereby pain stemming from a z-joint can be referred into the related limb or limb girdle

Further, cervical z-joint pain is distributed in a pattern characteristic of its segmental origin

Click here for Part 1B

Photo source

Related posts:

1. Zygapophyseal Joint Pain Patterns: Part 1B (Cervical Spine) A study testing the reliability of their pain charts by...
2. Hamstring Length and the Patellofemoral Joint A summary of my upcoming review on ResearchReviewService.com...
3. Its Not Always Bursitis: Greater Trochanter Pain Syndrome The use of “Trochanteric Bursitis” as a diagnosis for lateral...

Related posts brought to you by Yet Another Related Posts Plugin.