This simple screening test becomes a form of exercise.

Today we look at a simple CNS screen for your “central pattern generators” or “CPG’s”. If you do not pass, then the exercise becomes the rehab exercise. If you (or your client) does not have good coordination between the upper and lower extremity, then they will not be that efficient, physiologically or metabolically. 

The “cross crawl” or “step test” looks at upper and lower extremity coordination, rather than muscular strength. If performed for a few minutes, it becomes a test that can look at endurance as well. 

It is based on the “crossed extensor” response, we looked at last week. That is, when one lower limb flexes, the other extends; the contralateral upper limb also flexes and the ipsilateral upper limb extends. It mimics the way things should move when walking or running. 
 

• Stand (or have your client stand) in a place where you will not run into anything.
• Begin marching in place.
• Observe for a few seconds. When you (or your client) are flexing the right thigh, the left arm should flex as well; then the left thigh and right arm. Are your (their) arms moving? Are they coordinated with the lower extremity?
• What happens after a few minutes? Is motion good at 1st and then breaks down?
• Now speed up. What happens? Is the movement smooth and coordinated? Choppy? Discoordinated?
• now slow back down and try it with your (their) eyes closed

If  movement is smooth and coordinated, you (they) pass

If movement is choppy or discoordinated, there can be many causes, from simple (muscle not firing, injury) to complex (physical or physiological lesion in the CNS).

• If movement is not smooth and coordinated, try doing the exercise for a few minutes a day. You can even start sitting down, if you (they) cannot perform it standing. If it improves, great; you were able to help “reprogram” the system. If not, then you (they) should seek out a qualified individual for some assistance and to get to the root of the problem.

A bit about the QL...

As we have said in previous posts,  though they can’t act independently we like to think to think of the QL as having two divisions. The lower division arises from the medial portion of the iliac crest and adjacent iliolumbar ligament and inserts onto the transverse processes of the lumbar vertebrae, in the coronal plane from lateral to medial and in the saggital plane from posterior to anterior. The upper division arises from the lumbar transverse processes of the upper 4 lumbar vertebrae and insert into the inferior border of the 12th rib, running in the coronal plane from medial to lateral and in the saggital plane from anterior to posterior; about half of the fascicles of this second division act on the twelfth rib and the rest act on the lumbar spine.

The QL is primarily a coronal plane stabilizer causing lateral bending to the ipsilateral side when the foot is planted as well as posterior rotation of the lumbar spine on the weight bearing side.   When acting unilaterally without the ipsilateral foot fixed on the ground, it can raise the ilia on the side of contraction. It is active during single limb support during stance phase of gait on the contralateral side (along with the external oblique) to elevate the ilium. This is coupled with the ipsilateral anterior fibers of the gluteus medius and minimus pulling the iliac crest toward the stable femur. Sahrmann states “the QL is optimally situated to provide control of lateral flexion to the opposite side via its eccentric contraction to provide control of the return from lateral flexion via its concentric contraction. The muscle is also positioned to play a role in the rotation that occurs between the pelvis and spine during walking”.

Acting bilaterally, it extends the lumbar spine, deepening the lordosis and acting to limit anterior shear of the vertebral bodies.

It is also able to stabilize the 12th rib during forced expiration, thus acting as an accessory muscle of respiration. This fixation is important when we need to superimpose pelvic movements upon it. Furthermore, it increased activation in response to increasing compression in static upright standing postures.

Here is a video of a low back screen we often use

Got Low Back Screen?

What does your low back screen look like? Here is a quick video of some of the screens we use each day.

Ivo and i have a bunch of screens we use to glean information as we move down through the examination tree. Here is one i like to use, it is quick and easy and allows you to check something functionally and quickly while a client turns over. It is a very VERY small piece of a larger puzzle, but it is knowing what to look for and then what to test to verify. You might not have noticed this clients limitations in a passive supine joint assessment, but often when you load them up, mobility and stability challenges start to blossom into something different. If you are thinking, “possible loss of right knee flexion or left hip flexion” you are on the right track, with *caveat. There is more to it, but it is a start.  Hope to see you on www.onlinece.com next week for our new course, “thinking through functional pathologic biomechanics”.  
* Caveat: The lack of joint flexion range doesn’t necessarily mean they need more flexion, it means their flexion mobility is lost and that might mean they need more stability there or elsewhere for the flexion to present. This is the challenge a screen provides, it doesn’t tell you what’s wrong, it tells you if they can or cannot do the screen. If they cannot, it’s your job to find out why, but giving this particular client flexion work (range or strength work) would have led to a quick demise in their status. Quite often a joint displaying less mobility displays such because it has insufficient stability (from lack of skill, endurance, strength, proprioceptive etc) , but this is not a hard and firm rule. It’s your commission to find out the functional limitation(s) that are leading to these deficits and challenges.

This simple screening test becomes a form of exercise.

Last week we explored the “Lean” test to see how your QL and gluteus medius were paired. Today we look at a simple CNS screen for your “central pattern generators” or “CPG’s”. If you do not pass, then the exercise becomes the rehab exercise. If you (or your client) does not have good coordination between the upper and lower extremity, then they will not be that efficient, physiologically or metabolically.

The “cross crawl” or “step test” looks at upper and lower extremity coordination, rather than muscular strength. If performed for a few minutes, it becomes a test that can look at endurance as well.

It is based on the “crossed extensor” response, we looked at last week. That is, when one lower limb flexes, the other extends; the contralateral upper limb also flexes and the ipsilateral upper limb extends. It mimics the way things should move when walking or running.

• Stand (or have your client stand) in a place where you will not run into anything.
• Begin marching in place.
• Observe for a few seconds. When you (or your client) are flexing the right thigh, the left arm should flex as well; then the left thigh and right arm. Are your (their) arms moving? Are they coordinated with the lower extremity?
• What happens after a few minutes? Is motion good at 1st and then breaks down?
• Now speed up. What happens? Is the movement smooth and coordinated? Choppy? Discoordinated?
• now slow back down and try it with your (their) eyes closed

If  movement is smooth and coordinated, you (they) pass

If movement is choppy or discoordinated, there can be many causes, from simple (muscle not firing, injury) to complex (physical or physiological lesion in the CNS).

• If movement is not smooth and coordinated, try doing the exercise for a few minutes a day. You can even start sitting down, if you (they) cannot perform it standing. If it improves, great; you were able to help “reprogram” the system. If not, then you (they) should seek out a qualified individual for some assistance and to get to the root of the problem.

The Gait Guys. Giving you information you can use and taking you a little deeper down the rabbit hole with each post.

One simple hip screen that gives you lots of information.

This is the one leg standing test. We use it as a hip function (abduction) screen(as well as an exercise), to see if a person’s gluteus medius is working in a functional situation (as opposed to manual muscle testing).

As you may remember (don’t remember? Click here), the gluteus medius fires throughout stance phase (ie; when the foot is on the ground). It keeps the pelvis level while the foot is on the ground and works in conjunction with the opposite quadratus lumborum muscle (if you have not read up on this, please see our groundbreaking work on the problematic cross over gait, found here, here and here).

The test is simple; try it on yourself while watching yourself in a mirror. Stand on one leg on your foot tripod (the heel, base of big toe and base of little toe). Raise the opposite foot off the ground by flexing the thigh. Observe.

You should see the pelvis remaining level with no shift of the torso or hips. 

Watch for:

• ·      Pelvic drift to the side you are standing on
• ·      Pelvis drop on the side opposite you are standing on
• ·      Body lean to the side you are standing on
• ·      Excessive hiking of the opposite, non weight bearing hip
• ·      Any combination of the above

Seeing any (or all) of these means the gluteus medius is probably having some trouble.  The reason we say probably is that a person with a hip problem (like arthritis) or an anatomically short leg may do some of these things in compensation.

The question you are hopefully asking is why do they drift, lean, hike, etc? Not everything you see is muscle weakness per se.

• ·      Maybe they have a balance issue
• ·      Maybe they have a disc injury
• ·      Maybe they have injury to the nerve going to the gluteus medius
• ·      Maybe they have a knee/ankle/foot issue
• ·      And the list goes on…

So, if it were a muscle weakness, how could you fix it? Determine the cause. Begin at the bottom with foot exercises: tripod standing, lift/spead/reach with the toes etc. Then have them repeat the exercise IN A MIRROR, maintaining a level pelvis. Yes, it is that simple. Now see if they can translate that to their gait cycle. If so, great. If not, start again and repeat till they can.

The Gait Guys. Making it real, each and every day.

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