Reverse Lunge Dysfunction – Knee Crosses Over Big Toe (Left and/or Right)

Reverse Lunge


Reverse Lunge Dysfunction

Knee Crosses Over Big Toe (Left and/or Right)

Primary Plane – Sagittal
The KAMS system analyzes if the knee migrates anteriorly over the big toe. When the knee of the stationary (non-sliding) leg comes forward over the toe in the overhead position, this is considered as a dysfunction.

Significance


The knee anteriorly crossing over the toe often signifies that the neuromuscular system is recruiting the lower anterior chain muscles, such as the quadriceps, to stabilize the femur and the pelvis. Anterior chain dominance with associated posterior chain weakness will often present in movements such as the reverse lunge and the vertical leap.
Additional stress is placed on the knee joint capsule, patella, ligaments and myotendinous structures. The repetitive stress can lead to strain and possible chronic and/or acute knee injury.

Corrective Strategies

  1. Activate the glutes eccentrically and concentrically in the sagittal plane.
  2. Activate the hamstring complex concentrically and eccentrically in the sagittal plane.
  3. Mobilize the sacroiliac joints.
  4. Mobilize the thoracic spine in the sagittal plane.

Reverse Lunge Dysfunction – Knee Valgus Collapse (L and/or R)

Reverse Lunge


Reverse Lunge Dysfunction

Knee Valgus Collapse (L and/or R)

Primary Plane – Transverse, Coronal (Frontal)
During the reverse lunge, if the patient/client’s knee collapses medially, then this is scored as a dysfunction.

Significance


Valgus knee collapse is often caused by a lack of stability in the ankle and foot arch, as well as a lack of stability in the pelvis. Collapsing of the foot arch often creates an internal rotation of the tibia and the ankle, causing a medial rotation and subsequent Valgus collapse of the knee.
A lack of pelvic stability from muscles such as the gluteus medius, gluteus maximus, and Tensor Fascia Latae can cause a medial rotation of the femur and a subsequent Valgus knee collapse.

Corrective Strategies

  1. Strengthen the glute complex on the side of the stationary foot (non-sliding foot).
  2. Strengthen the muscles surrounding the knees in the frontal and sagittal planes.
  3. Stabilize and strengthen the ankle in the frontal and sagittal plane for the stationary foot.
  4. Mobilize the sacroiliac joints.

Reverse Lunge Dysfunction – Unable to Reach Kneeling Position

Reverse Lunge


Reverse Lunge Dysfunction

Unable to Reach Kneeling Position

Primary Plane- Sagittal
If the patient/client is unable to properly reach kneeling position with good control, then this is scored as a dysfunction by the KAMS system.

Significance


Coordination and motor control is required to slide back to kneeling position. Stability of the lateral and frontal planes is required to maintain balance and coordination while performing this sagittal plane movement.
Pelvic and upper torso control, while performing the reverse lunge, is key in order to maintain a symmetric and stabilized COM during the sagittal plane slide.  M-L center of mass deviation in the upper torso or the hips can reduce the ability to reach a kneeling positioning.
Tension in the anterior hip capsule, hip flexors (psoas, illiacus etc.) and the anterior superficial and deep fascial lines, can limit the ability to slide the posterior leg and attain a kneeling position.

Corrective Strategies

  1. Eccentrically Strengthen the glute complex on the side of the non-sliding foot.
  2. Mobilize knee flexion of the “sliding” leg in the sagittal plane (knee flexion).
  3. Stabilize the core in the coronal plane.
  4. Mobilize extension of the iliofemoral joint of the sliding leg.
  5. Mobilize flexion of the iliofemoral joint of the stationary leg.

Reverse Lunge Dysfunction – Shoulder Axis Tilt (L or R)

Reverse Lunge


Reverse Lunge Dysfunction

Shoulder Axis Tilt (L or R)

Primary Plane – Coronal (Frontal)
If the patient/client shows a transverse shoulder axis tilt greater, then this is scored as a dysfunction.

Significance


Lateral shoulder axis tilt is a compensatory pattern that is often seen when there is restriction or tension in the lateral neuromuscular chains of the body. Restrictions in shoulder extension and external rotation will often be compensated for by dropping the ipsilateral shoulder and rotating the trunk to the ipsilateral shoulder.
During the inline lunge, it is a common finding to see shoulder axis tilt to the ipsilateral side of the sliding leg, due to limited mobility in the lateral chain.
Lateral shoulder plane tilt is often seen as a compensatory movement pattern when there a restriction in thoracic extension and/or reduced scapular stability.

Corrective Strategies

  1. Mobilize core (lateral chain-frontal plane) of ipsilateral side of the tilt.
  2. Mobilize the iliofemoral joint in the sagittal plane on the ipsilateral side of shoulder tilt.
  3. Stabilize core (lateral chain-frontal plane) of contralateral side of tilt.
  4. Mobilize shoulder girdle external rotators/extensors of ipsilateral side of tilt.
  5. Stabilize shoulder retractors of contralateral side of tilt.
  6. Mobilize shoulder elevators such as upper trapezius, levator scapulae, posterior scalene) of contralateral side of tilt.

Reverse Lunge Dysfunction – Reduced Shoulder Extension in the Overhead Position

Reverse Lunge


Reverse Lunge Dysfunction

Reduced Shoulder Extension in OH Position (L and/or R)


If the patient/client is unable to maintain arms/dowel in the overhead vertical position, then this is scored as a dysfunction.

Significance


Core stability in all planes is required to maintain an upright body stance and symmetry in the bilateral scapula. It also allows the GH joint to perform proper shoulder extension and external rotation. When sliding the back leg posteriorly, there must be mobility in the ipsilateral iliopsoas and lateral chain muscles, such as the quadratus lumborum. The lack of mobility in the anterior and lateral chains can cause a compensatory rotation in the upper body and affect one’s ability to maintain the dowel symmetrically overhead.
Thoracic kyphosis and the subsequent inability to create extension in the thoracic spine can limit external rotation and extension at the glenohumeral joint.
The tension in muscles such as the pectoralis major, pectoralis minor, anterior deltoid, latissimus dorsi, can inhibit one’s ability to reach the symmetric vertical position of the arm in this movement.
From a fascial sling perspective, it is common to see reduced shoulder external rotation on the contralateral arm to the sliding leg.  Extension of the sliding leg will often cause tension in the opposite shoulder, due to the spiral fascial line (sling).
Instability of the lower body and core during the slide and return movement can cause the recruitment of upper limb movement, in order to achieve balance during the reverse lunge.
If the patient/client is unable to properly activate the posterior chain (glutes and hamstring) of the planted leg during this movement, and quad dominance occurs, then a common finding is that the upper body will shift forward and limit the ability to get the arms vertically overhead.
 

Corrective Strategies

  1. Mobilize/lengthen the following tissues: anterior GH capsule, pectoralis (major and minor), GH internal rotators, latissimus dorsi
  2. Mobilize the thoracic spine
  3. Mobilize the anterior iliofemoral joint in the sagittal plane.
  4. Strengthen the following tissues: Scapular retractors/stabilizers, lower posterior chain (hamstring, gluteus maximus).

Reverse Lunge Dysfunction – Cannot slide back and return to the starting position (L and/or R)

Reverse Lunge


Reverse Lunge Dysfunction

Cannot slide back and return to the starting position (L and/or R)

Primary Plane- Sagittal

If the patient/client is unable to properly slide into a reverse lunge position and return to standing with proper balance and coordination, then this is scored as a dysfunction.

Significance


The ability to slide back into the lunge and return to the starting position requires eccentric and concentric muscle coordination. Activation of the core stabilizers of the pelvis plays an important role in this movement.
Activation of the pelvic stabilizers must be initiated to provide a stability for the upper body and the lower body during the movement, this includes both eccentric and concentric contraction of the sagittal movers of the lower limb.

Corrective Strategies

  1. Strengthen glute complex in the sagittal plane.
  2. Stabilize/Strengthen core in all planes (coronal, sagittal, transverse)
  3. Train sagittal stride and balance.

Reverse Lunge Dysfunction – PAIN

Reverse Lunge


Pain

Pain (scored as 0)
If the client/patient experiences pain during this assessment that is different from that of a deep stretch, this is scored as a 0.

Reverse Lunge – Using the Kinetisense System for the Reverse Lunge Test

Reverse Lunge


Using the Kinetisense System for the Reverse Lunge Test

  1. Instruct the patient/client to stand with the non-sliding foot directly in line with the Kinect camera
  2. Instruct the patient/client to raise both arms overhead, holding the dowel at “snatch” grip, maintain the hands over in line with the shoulder.
  3. Place the “sliding foot” on a slider or slider board.
  4. Instruct the patient/client to slide back into a reverse lunge while maintaining the dowel overhead, until the knee of the sliding foot touches the ground.
  5. Maintaining the dowel overhead, instruct the patient/client to slide back to the starting position. This movement should be slow, controlled and fluid.

Reverse Lunge Overview

Reverse Lunge


Reverse Lunge Overview

The reverse lunge can provide information about a client’s coordination and balance. The purpose of this particular assessment is to challenge the flexibility and stability of individual joints, but also observe for any loss of core stability in the patient/client. This is a more general test as it has implications for all planes of movement, however as a patient/client goes through this movement the faulty movements can provide a significant amount of information regarding their movement abilities.

  1. This test has implications for all of the following:
  2. Posture
  3. Sprinting/running/gait
  4. Jumping
  5. Skating
  6. Gait
  7. Powerlifting
  8. Lateral movement/crossover
  9. Pelvic stability
  10. Hip hinge
  11. Throwing

The Posture of Lifting – CLINICAL SIGNIFICANCE

Posture Angel


Module 6 – The Posture of Lifting

All too often we see people at the gym and training centers lifting heavy weights with improper form. These individuals have the goal of lifting as much as they possibly can at the expense of form, and too often an injury ensues that derails them from their training program. This “mentality” of heavy lifting at the expense of form is detrimental to the neuromusculoskeletal systems in many ways. Not only does this predispose the individual to an increased chance of injury, but it also hinders the overall performance of the athlete, in the long run, oftentimes causing the athlete to plateau.

When assessing lifting it is the same premise as any movement, core stability is required in order to allow for distal mobility. Posture is not only important when someone is sitting at the computer or at their desk, it is a crucial component to lifting as well. The muscular system of the body is made up of different muscles types that differ in myoglobin and mitochondrial capacity. The muscles that are considered to be stabilizers are required to activate first in the preparation of movement, this forms a strong base for the “movers” and allows for mobility and improved performance. The neuromuscular compartmentalization of the movers versus the stabilizers is an integral component to increased performance and the reduction in the risk of injury. If the neuromuscular system is receiving afferent input that there is a lack of stability in the core stabilizers it will then recruit other muscles in compensation. In many cases, these “plan B” and “plan C” strategies in compensation recruit muscles that are of different fibre type and function, and often the “movers” are recruited to become “stabilizers.

The consequences of this compensatory pattern are important in regard to the performance in that muscles and the neuromuscular system, in general, performs at its best when the proper muscles are doing their job and are not overburdened or taking on the responsibility of the other muscles. A great example of this is when there is a lack of scapular stability. It is common to see “winging of the lower border of the scapula during shoulder flexion or abduction. The scapula goes into this “winging” due to the lack of activation of the stabilizers such as the serratus anterior and the lower and mid trap. The result is that there is often over recruitment of the upper trapezius and levator scapula muscles during shoulder movement, and this causes an early elevation and protraction of the scapula. Often the result is fatiguing of the upper trapezius, rolling forward of the shoulder, recruitment of the extrinsic muscles of the neck (SCM, scalene etc.) and tightening of the anterior shoulder and pectoralis muscles. The pattern that just described makes it very difficult for the individual to perform overhead and complex lifts without having to recruit the low back for extension, in order to make up for the restrictions in shoulder extension and external rotation. The sequelae of recruiting the improper muscles and compensation work its way along the myofascial planes from head to toe. These fault patterns become even more ingrained when we “load” weight onto the neuromuscular system.

From a risk of injury perspective, when the demand is greater than the capacity of any tissue (muscular, cartilaginous, bone, neural) there is an increase in the risk of injury. Tissue that is chronically taken past its capacity and that is recruited to perform a function it is not designed to do will fatigue, become fibrous, lose flexibility, lose strength and subsequently, become prone to injury or pain.