The hamstrings are a group of muscles comprising the biceps femoris (long and short heads), semitendinosus, and semimembranosus. Together, these assist in various combinations to extend the hip, and flex and rotate the knee.
They are also especially important in walking, running, and participating in many forms of sport and exercise. Testing the hamstrings group can be achieved via the prone leg curl, whereby the patient lies face down and flexes the knees against a pad, ensuring full range of motion with the movement being taken through full knee extension and flexion.
As the hamstrings cross both the hip and knee joints (except for the short head of biceps femoris), they may be subject to higher rates of injury due to the increased joint interactions such as in athletic events requiring great degrees of acceleration, deceleration and lower limb strength (Wright, Delong, & Gehlsen, 1999).
Hamstring injuries are the most common non-contact injury throughout soccer, Australian...
Assessing the muscular strength of the lower limbs generally involves compound movements which is an excellent method to determine global lower limb strength.
However, it is often important to more finely identify deficits in individual muscle groups for injury risk analysis and the development of appropriate treatment techniques.
The leg extension, involving the subject extending the knee joint in a seated position against a shin pad, preferentially tests the quadriceps and can be conducted in either a bilateral or unilateral manner.
From the research we know that:
Muscle strength is the foundation of human movement and of vital importance regardless of age or activity level. Lower limb strength is especially important in providing a stable base from which to move, with the gluteals, quadriceps, hamstrings, and calves playing pivotal roles. The leg press is a compound exercise designed to target each of these muscle groups and can be used in the assessment of lower limb strength.
The subject is typically seated, either horizontally or at a fixed angle, and is required to push a foot plate loaded with additional weight using their lower limbs for a given number of repetitions. Collecting such data allows clinicians to determine whether an athlete is ready to return to sport, whether an individual has the physical capacity to withstand forces greater than bodyweight such as when running, and in the assessment and efficacy of clinical intervention methods and risk of injury or re-injury.
Following adequate warm-up, leg press strength testing may...
The Upper Quarter Y Balance Test (UQYBT) was developed as a clinical test for upper extremity function. It involves the patient setting themselves in the push-up position and reaching in three different directions - medial, supero-lateral, and infero-lateral.
The subject is required to stabilise through the other upper limb (Amasay, Hall, Shapiro, & Ludwig, 2016) use this stability to allow mobility. It can be used to assess the dynamic stability of the upper extremity and the thoracic spine, including any differences between sides, and can assist in the prediction of shoulder injury risk and whether an athlete is ready to return to play (Amasay et al., 2016).
Additional research has revealed interesting implications when using the UQYBT including:
Limited data exists in the literature to date
Two studies found there was no difference in UQYBT performance between dominant and non-dominant limbs. This indicates that UQYBT performance may serve as a good measure in...
The Closed Kinetic Chain Upper Extremity Test (CKCUET) is a simple, easy-to-implement, and easy method to measures your patient or clients strength, power, endurance and closed chain kinetic chain stability of the upper extremities. It can be used in the assessment of risk of injury to the shoulder and the upper extremity.
It involves the patient adopting a push-up position and alternately tapping a pre-determined distance lateral to the stabilising hand as many times as possible within 15 seconds (Dong-Rour, & Laurentius, 2015).
Research has shown that the CKCUET is particularly useful in the following:
Assessment of baseball players’ readiness for return to play following shoulder injury (Roush, Kitamura, & Waits, 2007)
Examination of the effects of shoulder impingement syndrome in athletes and the general population (Tucci, Martins, Sposito, Camarini, and de Oliveira, 2014)
Prediction of handgrip strength, which is important in the...
The Limb Symmetry Index (LSI) is an excellent guide to objectively determine discrepancies in your patient’s upper and/or lower limb strength, function, and mobility.
The LSI is calculated by taking the average of any test scores for the affected limb, divided by the unaffected limb, multiplied by 100 to obtain a percentage difference between limbs.
Clinically, it is an easy-to-use, quick measure that can provide valuable data for baseline and progression purposes. It has been shown to be of significant importance in deciding when an athlete is ready to return to sport after anterior cruciate ligament (ACL) injury, with percentage values for knee extension and flexion strength equal to or above 90% considered to be satisfactory (Abrams et al., 2014).
Recent studies have also shown that:
Unlock your athlete’s potential by assessing their ankle!
If you are trapped into only assessing that knee or hip that your patient is complaining about then we want to give you 3 reasons why you should be getting those shoes off and perform the weight-bearing lunge test (wblt).
The knee that continues to niggle and aggravate your patient may not be a knee problem at all and may be contributed to by a lack of ankle ROM. Addressing these deficits in ROM may help increase motion in more proximal joints and allow for your athlete to absorb and dissipate those large forces in order to help potentially decrease their risk of injury.
3 FOR 1: What can the WBLT tell me???
1 - Potential for altered knee and ankle kinematics with squatting
They found that the individuals with a greater...
The Weight-Bearing Lunge Test (WBLT) is a quick and convenient test used to “determine dorsiflexion ROM” (Hall. E and Docherty. C, 2017) in a weight-bearing position (closed Kinetic chain). The amount of lower limb dorsiflexion is a common point interest for lower limb pathologies as this is one of the first areas of the body to interact with the ground and ground reaction force during activity.
The WBLT has been used to help potentially identify risk lower extremity injuries, which may include the risk of; ACL rupture, Ankle instability (chronic and acute) as well injuries associated with poor landing mechanics (Hall et al 2017).
- Persons with chronic ankle instability CIA) have demonstrated less dorsiflexion ROM during gait and less knee flexion during landing than persons without CIA. (Hall et al 2017).
- Persons with less dorsiflexion ROM demonstrated a less flexed landing strategy that was less efficient at attenuating GRF. (Hall et al 2017).
- A lower degree of...
The SEBT is a multiplane dynamic test that is designed to assess the ability of the patient or client to control their strength, mobility and balance on a single leg. The SEBT has been used to assess lower limb injury risk factors from chronic ankle instability to ACL injuries. “The SEBT has been shown to be a reliable measure and has validity as a dynamic test to predict the risk of lower extremity injury, to identify dynamic balance deficits in patients with a variety of lower extremity conditions” (Gribble, P, Hertel, J, Plisky, P 2012).
The SEBT is a valuable objective test used in a clinical setting to:
- Set baseline movement data and track progression over time for treatment or training plans.
- May help determine an individuals risk of injury in return to sport, activity or in pre-screening.
The importance of the SEBT in identifying risk factors for individuals has been highlighted by research papers namely Gribble et al (2012). as well as Plisky, Rauh, Kaminski...
The clinical interview is one of the most important processes to get right with your patients. It opens the door for you to build rapport with your patient and the all-important first impression to provide them with confidence that you are the person to help them (and hopefully empower them).
It has been commonly found that the interpersonal aspects of physiotherapy and healthcare are some of the most important determinants of patient outcomes and their evaluation of the QUALITY of care. (Hush, 2011)
Set your self up for success in the clinic and consider these strategies with your patients in your next interview/examination!
It is of course, what are your short-term and long-term goals and why are these important to you now?
It's important to have a collaborative discussion of these goals and formalize realistic...