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 movement 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 to her inner thighs. 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 to contribute to neck pain and tightness. 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. And most physical therapists still apply these tests.
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 her 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 hip adductors are normal and 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 a bit 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. So I decided to test her adductors on the Redcord suspension system.
This type of specialized 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 as needed.
To my surprise, when I tested her right inner thigh on the Redcord, she couldn’t lift her body off the ground. Even with assistance from the bungees, she simply couldn’t do it. I asked her to try again and she exclaimed, “I’m trying but I just can’t get my muscles to do what you are asking!” It’s like her hip adductors had totally turned off. So I gave her additional bungee assistance until she could start lifting herself up. It took a couple of sessions but then she got it!
If NEURAC testing wasn’t done, I probably wouldn’t have found this hidden muscle imbalance. Traditional manual muscle testing simply didn’t reveal what was wrong. That's because it tests each muscle in isolation. But this isn't how the human body actually moves in real life. For every functional movement, we must engage many muscles along a kinetic chain. Futhermore, we must have adequate neuromuscular control to support our joints through these motions. I’m talking about proper activation of the deep core stabilizers (pelvic floor, diaphragm, transverse abdominis, deep hip rotators, rotator cuff, etc.).
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 PTs why they are doing manual muscle tests, they will probably say it’s because the insurance companies require this data.
But I tend to do things differently at Activcore, especially when I know there’s a better way. Sometimes you have to think outside of the box that the insurance companies (and maybe even your PT school) have put you in.
To learn more about how I 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.