Dooley Noted: 7/5/2016
In a recent NKT study group, we discussed MSE testing in the vein of the SFMA by Gray Cook.
However, we broke the segments apart to look for ideals in load sharing between extension segments, as we pointed out common compensators in this basic movement pattern.
In a load-shared movement system, the MSE would have a balance of the following:
1. Feet that approach dorsiflexion, with weight shifting anteriorly with a planted heel
2. Equally bent knees and anteriorly translating tibiae
3. Hip extension from 10-30 degrees, depending on patient anatomy and access, with the ASIS extending past the toes
4. Proper and equal load sharing of the spinal segments into extension, with none spinal part exceeding extension of another part
5. Arms reaching overhead at ear level
6. Absence of rib flaring
Some common mistakes visualized on MSE include the following:
1. Inability to dorsiflexion the feet and/or bend the knees equally on each side.
2. Lack of hip extension, so that hips stay locked over the heel or midfoot.
3. Excessive lumbar extension hinging, with minimized thoracic extension
4. Excessive neck extension, especially if the arms cannot reach the ear level without bending the elbows
5. Rib flare, which usually accompanies a T12 extension lock with limited upper thoracic mobility and limited hip extension
In our case study observations, we found these common patterns for compensation and subsequent down-regulation:
1. Lack of thoracic extension T6-11, with T13 extension hinge, right great toe flexion gripping, lack of hip extension
Suspected compensators: right flexor hallucis longus, erectors, iliacus
Suspected down-regulated structures: gluteus maximus
2. Lack of shoulder placement over ears in overhead reach (lack of T1-T4 extension); scapula moves past heels more than hips move past toes
Suspected compensators: thoracolumbar erector spinae, iliacus, hip flexors
Suspected down-regulated structures: multifidii, longus colli
3. Excessive cervical extension, decreased upper thoracic extension
Suspected compensators: cervical extensors (semispinalis, upper trapezius, splenius capitis)
Suspected down-regulated structures: TVA eccentrically, t spine erectors, longus colli
4. Toe gripping with lack of hip extension
Suspected compensators: flexor digitorum longus
Suspected down-regulated structures: gluteus maximus, multifidus, psoas eccentrically
Consider dialing down the over-eagerness of the compensators to improve overall load sharing and injury prevention on the MSE.
As always, it’s your call.
– Dr. Kathy Dooley