Lower Limb Assessment Framework
Over the course of my career, through research, trial and error and from working with some incredibly switched on colleagues, I have developed a framework/guide to simplify lower limb assessments.
The purpose of the framework is to provide the patient with a clear insight into the varied contributing sources of their presentation, while also giving us information as to what we might need to improve, in order to maintain or increase performance markers. This list is not exhaustive or in any particular order.
Flexibility
Reduced flexibility may contribute to sub optimal movement patterns. Gaining flexibility in planes relevant to your sport, can improve skill acquisition and force production capabilities. For most athletes, having adequate flexibility at end range positions can allow us to produce more force in those positions, potentially lowering our risk of injury.
Regarding lower limb flexibility, keys areas of interest include range of motion across the hip, knee, foot and ankle.
Strength
There are many subcategories of strength that we assess, these can be summarised below,
Peak Force
This is the maximum amount of force a tissue can produce over a 3-5 second period. Having a strength base means performing sub maximal tasks will potentially be less fatiguing.
Examples include, Mid-thigh pull, Max squat isometrics, Good old Rep Max testing, Knee, Ankle and Hip pushing isometrics and Knee Bent Calf testing
Strength / Endurance
This can be described as the endurance component of a particular muscle group. How does your muscle tissue tolerate continual loading, and how quickly does it fatigue?
Body weight calf raises, bridges and single leg squats can be useful in gaining an understanding of whether poor muscular endurance is a driver of symptoms.
Reactive Strength
This is an often overlooked, but crucial capacity you need for athletic endeavours. Put simply, how quickly can you react off the ground? How much time do you spend on the ground vs how high can you jump? Generally, the more reactive you are, the more efficient you are. Reactive strength is very important to assess when a lower limb tendon issue could be present
This quality is assessed using Drop jumps and a 10/5 repeated hop test
Power
This is your body’s ability to produce a high amount of force in a small amount of time. Power is a function of Force (load - eg KG) x Velocity (Speed). This is important for acceleration, change of direction and jump height.
Examples include Countermovement jumps, squat jumps and Broad Jumps
Biomechanics
If you are a runner, or involved in a field sport, we will assess your running mechanics as a priority
Core health has access to a curved treadmill which provides a more reliable and accurate assessment of running technique as it replicates running outside of the gym.
Some of the first things I look for are Front side mechanics (What shapes are created IN FRONT of your body) Stiffness at mid stance (what happens at you ankle / knee during loading) and Back side mechanics (What shapes are created BEHIND your body)
In addition to this, we can assess Acceleration, Change of direction and Jump/Land mechanics if relevant
Key Considerations
Key considerations during the assessment includes side to side difference and normative data. Normative data involves comparing your results with up-to-date research in your chosen sport- giving us insight as to how far (or close) you are to normal values.
As previously mentioned, this list is not exhaustive, and often times our assessment will branch out and do more specific testing based on symptoms.
Hopefully this has given you a better understanding of how we go about assessing the full system, not just the injured area. There will be follow up blogs on each of the selected assessments over the course of the coming weeks – stay tuned.
