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I wanted to share something that happened to me while recently evaluating someone for physical therapy. A mother of two elementary school children comes in with complaints of right hip pain and a long history of hammer toes on both feet. Neither of these issues are urgent or in an acute stage. She just wants to prevent them from getting any worse.
I’m not going to bore you with a detailed summary of my evaluation findings. Rather, I’m going to get right to the point where my testing procedures deviated from traditional PT. After doing some selective functional tests in standing (overhead squat, bending forward, trunk twisting, etc.) to help determine where her pain might be coming from, I decided to do a few traditional manual muscle tests to get a better sense of what her hip adductor (inner thigh) strength is like on both sides.
Let me explain why I went right there. You see, the hip adductors play an important role in stabilizing the body through a chain of muscles and connective tissue (fascia) called the deep front myofascial line. This chain runs from the underside of the foot, up the calf and inner thigh, into the front of the hip joint, pelvis, pelvic floor and lumbar spine, and then finally up through the diaphragm, rib cage, thoracic viscera and neck. It’s just one of many myofascial chains that exist throughout the body. However, in my experience, deactivation of the deep front line is a big contributor to hip pain, pelvic floor dysfunction, and restricted joint mobility further up the spine. In fact, it’s common for hip adductor weakness (“the weak link”) to actually limit someone’s neck range of motion. I know this sounds crazy, but that’s just how the body works as a unit.
So let’s get back to how I tested my client’s hip adductor strength. Manual muscle testing is the way I learned to do it in PT school. Most physical therapists still apply these tests to measure strength. I did the testing in two different positions: hook-lying and side-lying. The first one was on her back with her legs in a hook-lying bridge position. I asked the client to keep her knees together and not allow me to pull them apart. She was able to prevent me from “breaking” the position. So I gave her a score of 5/5 on both sides. Essentially this means her adductors are strong. For the second test, I had her turn onto her side and lift her bottom leg off the table. I asked her to not allow me to push it down. She was able to do this without problem on both sides. She felt slightly stronger on the left side compared to the right side, so I gave her a score of 5/5 left and 4+/5 right.
Since these tests are done in isolation, I instinctively knew they gave me limited information about how the entire deep front myofascial line works. Therefore, I decided to test her right adductor on the Redcord suspension system. This type of suspension testing is called NEURAC (NEUromuscular ACtivation). It looks at how the muscles work together as a chain to complete a given movement. There are slings and bungee cords to assist the person as needed.
To my surprise, when I tested her right inner thigh on the Redcord, she couldn’t lift her body off the table, even with significant help from the bungees. She simply couldn’t do it. I asked her to try again and she said “I’m trying but I just can’t get my muscles to do what you are asking.” It’s like her right hip adductors had turned off.
If NEURAC testing wasn’t done, I probably wouldn’t have found this hidden muscle imbalance. The traditional manual muscle tests simply didn’t reveal what was wrong. That’s because they test each muscle in an isolated fashion. But that’s not how the human body moves in real life. For every functional movement, we must engage many muscles along a kinetic chain. Additionally, we must have adequate neuromuscular control to support our joints through these motions. I’m talking about proper activation of our deep core stabilizers (pelvic floor, diaphragm, transverse abdominis, rotator cuff, deep rotators of the hip, etc.). That’s what we target on the Redcord suspension system.
So why are physical therapists still testing muscles in isolation? Does it actually give them any real information about how the person is functioning? If you ask any PT why they are doing manual muscle tests, they will probably say it’s because the insurance companies require this data.
As a cash based PT, I tend to do things differently, especially when I know there’s a better way. Sometimes you have to think outside of the box that the insurance companies have put us in.
To learn more about how we use the Redcord suspension system, click here
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
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