The Performance Matrix

Movement assessment, for Movement Health in young athletes and older adults

16th February 2018

Moving well is key:
  • To managing hip pain and improving performance in young athletes

  • To improving walking in older people and managing the problems associated with osteoarthritis of the hip

What we know:

Movement is complex! And everyone moves differently.

It is useful to consider 'The Dynamic Systems Theory' which helps neatly capture the complexity of the factors which can influence any movement pattern.

How we move is influenced by many factors, such as:

  • The activity performed e.g. a side cutting action in a young footballer requires a different pattern from climbing the stairs

  • The person e.g. a history of pain or injury in a young athlete or older person will influence the movement pattern

  • The environment e.g. performing in a match situation may influence the movement pattern, similarly walking on uneven ground can challenge the movement pattern

The output of these interactions is the movement pattern as seen, for example, in how an older adult rises out of a chair or a young athlete performs a cutting manoeuvre. Rather than the assessment merely focussing on the complex factors influencing movement we can  assess the movement patterns that emerge.

We also know that altered movement patterns present in the presence of pain, pathology and compromised function and contribute to:

  • hip and lower limb disorders in young athletes (De Blasier 2017)

  • the development of osteoarthritis (Agricola 2013)

  • and loss of physical function in older adults (Brach 2013)

Evaluating movement if everyone move differently.......

So how can we assess for these altered movement patterns and compromised Movement Health? If we are interested in the health of movement, one particular marker of its current state, is the ability to efficiently co-ordinate movement in multiple degrees of freedom. To test this efficiency we use cognitive movement control tests.


Asks the question: can an individual co-ordinate movement at a specific region (site) e.g. the hip, in a particular plane of movement (direction)  and under low load e.g. rising out of a chair or high threshold e.g. cutting manoeuvre. A positive test illustrates a deficit in co-ordination strategies of movement e.g. hip flexion, low threshold.

see here for more of Cognitive Movement Control Tests

and here for the 'Double Knee Swing

The young athlete with hip pain

Study: Nine footballers aged 12-18 years with unilateral hip or groin pain, diagnosed with FAI on magnetic resonance imaging from an English Premier League football club academy. The footballers performed the Small Knee Bend cognitive movement control test and movement faults (co-ordination impairments) were observed, including hip flexion.

In all nine cases, abnormal movement faults were observed clinically, including uncontrolled hip flexion, demonstrating 'Movement Health' issues in young footballers with  symptomatic FAI. Further studies need to explore the effect on signs and symptoms following retraining. FAI is a strong predictor in the development of hip OA so managing movement may play a key role in preventing the development of OA in later years of the young athlete.

Older and active.....

In older adults, walking is slow, less stable, inefficient and the timing and co-ordination of stepping in gait is poor (Brach 2013). Identifying and retraining 'Movement Health' issue in these individuals may lead to an improvement in walking, physical activity and quality of life.

Acceptable intra-rater reliability has been established for a battery of movement control tests of older adults.


  • Evidence suggests movement impairments are linked with pain, pathology and comprised function across a lifespan - from young footballers to older adults

  • Movement assessment and interventions have a significant role to play in management of pain, improving function and long term Movement Health across a the lifespan

See TPM for the power of movement assessment and retraining for long term movement health


Agricola R, Waarsing JH, Arden NK, Carr AJ, Bierma-Zeinstra SM, Thomas GE, Weinans H, Glyn-Jones S. Cam impingement of the hip: a risk factor for hip osteoarthritis. Nat Rev Rheumatol.  Oct 9(10) 2013

Brach JS,  VanSwearinge JM. Interventions to Improve Walking in Older Adults Curr Transl Geriatr Exp Gerontol Rep. 2(4) 2013 

Botha N, Warner M, Gimpel M, Mottram S, Comerford M,  Stokes M. Movement Patterns during a Small Knee
Bend Test in Academy Footballers with Femoroacetabular Impingement (FAI) Working Papers in the Health Sciences 1:10 Winter 2014

De Blaiser C, Roosen P, Willems T, Danneels L, Vanden Bossche L, De Ridder R. Is core stability a risk factor for lower extremity injuries in an athletic population? A systematic review. Physical Therapy in Sport 2017

Holt KG, Wagenaar RO, Saltzman E. A dynamic systems/constraints approach to rehabilitation. Rev Bras Fisioter. 14(6):446-463 2010

Newell KM. Constraints on the development of coordination. Wade MGWHTA, editor. Dordrecht: Martinus Nijhoff; 1986

Rowsome K,  Comerford M, Mottram S, Samuel D, Stokes M. Movement control impairment screen for older people in community settings: description of a screening tool and intra-rater reliability Working Papers in the Health Sciences 1:15 Spring 2016

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