The Performance Matrix
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Presentation at WCPT: An Online Movement and Performance Screen to Identify and Classify Uncontrolled Movement

15th June 2011

Comerford M(1), S Mottram(1) & Barr A(2)
Performance Stability & KC International (1) Chichester UK, (2) New York USA

World Congress of Physical Therapy 2011 20 - 23 June Amsterdam

Purpose
An online movement screening tool has been developed to identify uncontrolled movement (UCM) in functionally relevant multijoint movement skills. Many current screening tools identify that there is a problem in movement control, but do not classify the uncontrolled movement. This tool has set out to classify the UCM in terms of 3 criteria: 1) the site of UCM, 2) the direction of UCM, and 3) the threshold of UCM. This identification of UCM enables the development of highly specific retraining strategies to optimise movement control recovery.

Relevance

In sport, a significant predictor of re-injury is having a history of previous injury  (Watson AW 2001 Int J Sports Med 22:222–5, Locke S. 2003 J Sci Med Sport 6; Sup:60). Therefore, athletes who return to sport with  painfree full strength and mobility function are the group with significant risk of re-injury. The question of, “what is undetected in this group that predisposes them to re-injury” – has not been adequately answered.

A link has been established between uncontrolled movement and risk of injury (Roussel et al 2009 Man Ther 14(6):630-5). A battery of movement control tests has been shown to be effective in assessing for aberrant movement patterns (UCM) in people with musculoskeletal pain (Luomajoki et al 2007 BMC Musculoskelet Disord 12;8:90).

Although UCM has been shown to be closely related to the presence of musculoskeletal pain, UCM can be identified in people who have a history of recurrent pain, when they are currently pain free (in between pain episodes). UCM has also been identified in people who are pain free and have never had previous pain. Therefore, uncontrolled movement may be a potential risk factor for the development of musculoskeletal pain or injury.
Description

The Performance Matrix - Movement and Performance Screen (MPS) is an online tool consisting of a battery of movement control tests based on the theory of movement dissociation (Sahrmann 2002 Mosby). The tests identify specific sites of UCM (e.g. low back, scapula, hip). They further sub-classify the direction of the UCM at the problem site (e.g. low back-flexion, scapula-forward tilt). In addition, this classification process evaluates the threshold of control failure as being either low threshold (related to aberrant movement coordination, synergistic patterns of recruitment and alignment) or high threshold (related to strength or speed deficiencies). The MPS identifies multiple movement weak links. Each movement weak link is prioritized as high risk or low risk.

Participant Screening

Ninety  male professional footballers from two UK premier league football clubs and one Dutch football club were screened with  a Performance Matrix - Movement and Performance Screen  during pre-season screening in 2009. A performance profile of movement control risks and assets can be generated for each player.

Movement & Performance Screen Report

Analysis

The two most common sites of injury in football are the low back and hip. The MPS identified uncontrolled low back sidebend (high threshold), and low back rotation and low back extension (both low and high threshold) as high risk UCMs. Screening also identified uncontrolled hip flexion and hip medial rotation (high threshold) as high risk UCMs. (Table 1)

Table 1. Frequency of failed tests of Site, Direction & Threshold for the low back and hip. (* indicates high risk)

Uncontrolled Movement Low Threshold High Threshold
Site Direction (L) (R) (L) (R)
Low Back Flexion 30% 30% 30% 30%
  Extension 70% * 78.9% * 70% * 78.9% *
  Rotation 82.2% * 74.4% * 84.6% * 81.1% *
  Sidebend 54.4% 46.7% 92.2% * 80.0% *
Hip Flexion 35.6% 36.7% 88.9% * 87.8% *
  Rotation 26.7% 28.9% 73.3% * 80.0% *

Conclusions

A battery of movement control tests can identify UCM in people with and without musculoskeletal pain. This uncontrolled movement may be a potential predictor of re-injury risk. The UCM can be classified (site, direction and threshold) and prioritized as high risk or low risk.

Implications

The classification of UCM may predict movement control dysfunctions, which if corrected, may prevent the onset or recurrence of pain and  musculoskeletal injury. The ability to assess for and retrain control of uncontrolled movement is a valuable skill for physical therapists involved in injury prevention.

Keywords
Movement screen,  injury prevention

Funding acknowledgement

We thank Alan Tennant (Workscreen) for data analysis. The development of this tool was partially funded by the Advantage Proof of Concept Fund, funded by Advantage West Midlands and the European Regional Development Fund.

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