For an athlete to
function optimally within his sport, full flexibility, balance, strength,
conditioning and preparation are key to his success. Athletic trainers and
strength and conditioning coaches have the overwhelming responsibility to
assess large groups of athletes and prepare them for each game. This is
very important in the area of college athletics, especially football.
Clinical skills vary
among each healthcare provider. Basic skills need to be incorporated to
determine best utilization of resources and time prior to the athletic
The following will
be a basic assessment tool to give the athletic coach a direction of each
athlete and his specific need.
We will start with
the head and work distally into the feet in our assessment.
The cervical spine
can be assessed by range of motion. The range of motions that are
functional are head forward flexion touching the chin to the sternum.
Extension is such that the chin should be at 45 degrees in relationship to
the shoulders in extension.
Cervical or neck rotation should be
within 10 degrees over the shoulder to each side. Lateral flexion should
at least be obtained half the distance from erect posture to placing the
ear towards the shoulder.
In the event that
the cervical range of motion is less than 50% of the expected, one should refer the
athlete for manual adjustment either through a chiropractor or an
Common problems that
limit range of motion in the cervical spine are subluxations within the
vertebrae or the uncovertebral joints. A quick adjustment by a
chiropractor should correct the subluxation and restore full functional
range. The most common missed vertebral subluxation is the
first thoracic--T-1. These subluxations tighten the upper most fibers of the
upper trapezial muscle limiting extension of the neck by 50%.
can cause nerve like pain syndromes as well as headaches. The most common
headaches are caused by the upper trapezial muscles. These headaches
start at the base of the skull and radiate around the top of the ear
towards the orbits of the eyes.
thoracic area can be accomplished by palpation of the vertebral spinous
processes. There should be uniformity in their heights. Any elevation from
baseline heights would suggest a posterior subluxation that also may need
attention through the chiropractic or osteopathic manipulation
from subluxations of the thoracic spine include difficulty taking a deep
breath, pain with lying on the ribs or pain associated with coughing or
sneezing in the ribcage.
The shoulders are a
very complex structure composing of eleven muscles and multiple ligaments.
The shoulder can be assessed by positioning the shoulder 20 degrees
forward at horizontal and ranging the shoulder with the elbow at 90
degrees through internal and external rotation. 90 degrees in
internal/external rotation is functional.
athletics who have to use high speed throwing mechanisms overhand benefit
from increased external rotation of approximately 120-160 degrees. The
shoulder has two components, one being muscular, the other being
can be done through dynamic stretch techniques whereas ligamentous
releases that are more capsular require manual retraction with assisted
movements of internal and external rotation with the arm in the fully
extended position at 20 degrees forward at the horizontal level of the
A quick assessment
of the latissimus dorsi can be done with the arm extended and thumb down,
ranging it upward through a shoulder arc of 180 degrees such that the arm
is fully abducted at the neck. Limitations or tightness of the latissimus
dorsi will create decreased range of motion of the acromium joint.
To have a successful
overhand throwing mechanism, the acromium must be opened up greater than
30 degrees to allow fluid movement of the rotator cuff muscles in order to
avoid tendinopathy, secondary tightness that would lead to capsulitis as
well as anterior labral tears.
Assessment of the
upper extremities can be done primarily with the arm extended, elbow
extended in a neutral position assessing pronation and supination
movement, pronation of 90 degrees and supination of 90 degrees should be
Failure to get 90
degrees suggests shortening of the flexors or extensors of the forearm,
which create medial and lateral elbow tendonitis. Distally the wrist can
be assessed in flexion/extension movements where flexion is 90 degrees and
extension is 80 degrees.
The lumbar spine
needs to be assessed at the thoracic/lumbar junction as well as the
lumbosacral junction. Palpation of the spine of the 12th
thoracic vertebrae on to the first lumbar spine should be of equal height.
Should there be a stepping down of the spinous processes, this subluxation
may impede optimal respiratory function.
In the lumbosacral
junction, there are many musculoskeletal/ligamentous attachments that
stabilize the spine on to the pelvis. This is one of the most complex
areas of the human body.
Should the initial
inspection of the skin overlying the L5-S1 region show a patch of hair,
this suggests clinically that the patient may have a silent spina bifida
occulta. Spina bifida occulta is the lack of final embryologic maturation
of vertebral fusion. Even minimal spina bifida occulta predisposes
to iliolumbar ligament sprains with rotational movements of the spine
across the stationary pelvis.
The spine can be
palpated in the lumbar area, notably at L4-5 and L5-S1. Should the spinous
process and vertebral bodies shift anteriorly, this would lead the
clinician to suspect spondylolisthesis. Spondylolisthesis is the anterior
shifting of the vertebral bodies upon themselves creating increased
tension in the lower spinal units.
Injuries from age
eight to 15 are the usual causes of spondylolisthesis, as the spine
ligaments have not reached full maturity. Spondylolisthesis will cause
changes in the lumbosacral angles.
Normal angle on
x-ray is 30 degrees, which adequately accommodates spinal weight
distribution. A 10-degree increase in the lumbar/sacral spine angle
increases the force along the spine by 50%. A 20-degree
increase in the lumbar/sacral spine angle increases the weight transmitted
along the normal spinal angle by 75%. Spondylolisthesis for athletes
who partake in weightlifting, especially in the lift and jerk mechanism,
predisposes to significant muscle spasm, and may aggravate the
There are many
structures that attach in the lumbar spine which connect with the lower
thoracic vertebrae such, when these muscles spasm, they may also
precipitate respiratory difficulties and ribcage pain.
The pelvis is not one unit, but actually consists of
five bones that are held together with fibrous tissue. In athletics, the
pelvis is subjected to extreme forces, especially when the individual is
thrown to the ground. With enough force to the pelvis, the ileum bone will
shift or sublux against the sacrum, leading to pain and secondary gluteal
muscle tightness. The consequences of a subluxed sacral-iliac may lead to
secondary muscle strains in addition to the gluteals and commonly involve
the erectors of the lumbar spine, multifidus, piriformis and
subluxations of the sacroiliac junctions can be made by having the athlete
lie supine with his legs extended. Visual inspection should assess for
symmetry of the feet as well as functional leg length. If there is
shortening of a leg length, that may indicate that there is pelvic
asymmetry. Most athletes will experience a functional leg length
discrepancy rather than a true leg length discrepancy, which is based on
anatomical length differences.
assessment of the sacroiliac subluxation is done by passively assessing
the patient’s internal/external rotation of the hip in the supine
position. Limitations of 50% of external rotation and 50% of internal
rotation should lead the clinician to assess for subluxations and correct
the subluxations. It appears through clinical experience that internal
rotation is much more limited than external rotation in the subluxations.
Subluxations that occur closer to the sacroiliac joint have a referred
pain pattern from the sacrum into the groin area and occasionally into the
the sacroiliac junctions are best done by chiropractic or osteopathic
manipulation, and once the manipulation is successful, functional range of
motion of the gluteal and lumbar muscles can be restored quickly through
various myofascial release techniques.
In the lower
extremities, assessing quadriceps flexibility can be achieved by having
the athlete in a side lying position where the head, shoulders and knee
are in a straight line. The non-treated quadriceps muscle will be placed
in a position with the knee bent at 90 degrees toward the chest to
stabilize the pelvis.
quadriceps will be placed in a shoulder position in a straight line, and
through active assisted technique of bringing the heel to the buttocks
with the assistance of the clinician, a gentle force is placed at end
range to help promote the functional recovery of putting the heel into the
positions of the quadriceps are then utilized in that the lower extremity.
The next position is to place the proximal leg into a 45-degree abducted
position with the athlete actively trying to bring the heel into the
buttocks, and at end range, the clinician assisting to promote that full
flexibility. The final position is to bring the knee down toward the
table, having it contact the table, while the athlete is again actively
assisting by bringing the heel to the buttocks.
should be approached with an athlete who has had any knee surgery. Should
the patient have had any reconstructive surgery for anterior cruciate
ligament bone grafting or tendon grafting, this technique is to be avoided
Assessment of the
extensors is done by having the patient in the supine position on his back
with the unaffected legs knee up 45 degrees and heel to the ground while
the other hamstring is being assessed through a straight leg raise
Functional is 90
degrees of range; however, anything greater than 70 degrees may be
adequate for the athlete unless it is specifically needed for highly
competitive activities such as gymnastics or track and field events.
In the lower
extremities, the gastrocnemius/soleus complex can be assessed with the
knee extended and the knee bent. Bending the knee inactivates the
gastrocnemius and allows for assessment of soleus function. Soleus
function should allow for dorsi and plantar flexion as well as the
It is important to
initiate with the soleus muscle first as it is the deeper muscle and then
progress to the gastrocnemius muscle as it is the more dominating muscle.
Dorsi flexion should be 30 degrees. Plantar flexion should be 45 degrees
or more. Athletes who have worn shoes or boots such as in figure
skating or skiing will show significantly limited range of motions and
just obtaining neutral dorsi flexion may be functional for those
having restricted range of motion in the ankles is that, should the
support within the boot not be present, they are more susceptible to ankle
fractures when their ankle becomes twisted.
Next is an
important stretch as most athletes are noted to have tight internal hip
flexors iliopsoas. The iliopsoas muscles are deep hip flexors
attaching from T12-L3 transversing through the pelvis, attaching to the
anterior femur. These muscles cannot be stretched effectively by the
athlete alone and requires the assistance from a clinician who is trained
in stretching this muscle dynamically. This stretch of the iliopsoas
improves the spring, takeoff and increases stride length.
assessment of the wrist carpal bones needs to be done. Any carpal
bone shift or subluxation disrupts the proper muscle tendon movement, and
affects the athletes finger and wrist flexibility, strength and dexterity.
This assessment and release technique can be reviewed in another article
of wrist assessments and my Web page.
The wrist and
fingers are very important for golfers, baseball pitchers, football
quarterbacks, wide receivers, gymnasts, basketball players, boxers and
hockey players. The wrist carpal bone release needs to be instructed
by a person who has knowledge and experience in these techniques.
Attempting to do them through reading only may cause more harm than
benefit to the athlete.
Should you have any further questions
regarding this article, please direct your questions or comments to "Ask
the Doctor" section.
Copyright © 2004 - 2012Taras V.
Kochno, M.D. All Rights Reserved
Board Certified in
Physical Medicine and Rehabilitation