Challenges and Opportunities in Developing a Test Battery for Joint

Mobility using Reach Tasks Starting from Upright Standing Positions

O. Eriksrud, P. Anderson, E. H. Andreassen, S. Litsos, F. O. Sæland, P. Federolf and J. Cabri

Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway

1 BACKGROUND

Joint mobility, the range of motion utilized to

accomplish tasks, is fundamental to activities of

daily living and athletic performance. Conventional

tests of joint mobility are often performed joint-by-

joint in supine or prone positions (Frost et al., 2013);

(McGill et al., 2012). This approach to joint mobility

testing has important conceptual shortcomings. For

example, the kinetic chain is neglected and strength,

balance or coordination issues, which could limit the

effective range of motion in real-life situations, are

not assessed. This might be one reason why many

conventionally determined mobility variables often

fail to predict performance (McGill et al., 2012).

Recently, there has been a development towards

the use of tools and screens based on more global

movement patterns (Cook et al., 2006a; 2006b);

(Kiesel et al., 2007). Therefore, researchers are

calling for a multifactorial approach in the

assessment of human movement (Bahr and

Krosshaug, 2005); (Federolf et al., in press). A

systematic combination of different reach tests in an

upright standing position, such as the Star Excursion

Balance Test (SEBT) (Delahunt et al., 2013); (Plisky

et al., 2006) may represent an approach to test joint

mobility in a way that is more applicable in real-life

situations.

2 OBJECTIVES

The purpose of this study was to determine if a

systematic combination of upright standing reach

tests may be used to develop a test battery for the

assessment of joint mobility, and to identify the

potential challenges that have to be addressed when

applying these tests. In addition, it was assessed if

selected conventional tests of mobility are correlated

with performance in specific reach tests.

3 METHODS

Eight male subjects (23.1 ± 1.5 years; 183 ± 6 cm;

80.2 ± 9.3 kg) performed 20 different bilateral and

unilateral hand reaches, 10 on each foot with toe

touch of the opposite foot (see skeletal posture

representations in Figure 1). The hand reaches were

based on the angulations used in the SEBT. All tests

started from an upright stance position with the

subject then reaching in the following directions:

anterior to the floor (A0); right anterolateral to the

floor (R45); left anterolateral (L45); right lateral

overhead (R90); left lateral overhead (L90);

posterior overhead (P180); right posterolateral

overhead (R135); left posterolateral overhead

(L135); right rotation at shoulder height and (RRot);

and left rotation at shoulder height (LRot).

Reach distances were determined with subjects

standing on a custom testing mat featuring a mesh of

4 crossing lines in anterior-posterior, right-left, and

diagonal directions intercepted by concentric circles

at 10-centimeter intervals (centre graph in Figure 1).

This allowed for an accurate measurement of all

reach distances. Reaches were obtained in

centimetres with the exception of RRot and LRot,

which were measured in degrees. All reaches were

performed with three repetitions and all subjects

executed the reach tests in the same order.

Anthropometric measures of height, leg length, arm

length wingspan and weight were also obtained.

Full body three-dimensional kinematic data were

obtained at 480 Hz using 79 reflective markers

recorded with 14 Oqus cameras (Qualisys AB,

Gothenburg, Sweden). Joint angles of ankles, knees,

hips, trunk, neck, shoulders, elbows and wrists were

calculated at maximum reach distance or angle using

Visual 3D (C-Motion, Germantown, USA).

Subsequent to the reach tasks, a series of

conventional mobility tests were conducted on a

clinical assessment table with the subjects in a prone

or a seated position. These tests included Thomas

test (i.e. supine test of hip extension), ankle

dorsiflexion, and hip internal and external rotation.

Eriksrud O., Anderson P., H. Andreassen E., Litsos S., O. Sæland F., Federolf P. and Cabri J..

Challenges and Opportunities in Developing a Test Battery for Joint Mobility using Reach Tasks Starting from Upright Standing Positions.

 2013 SCITEPRESS (Science and Technology Publications, Lda.)

A goniometer was used to determine joint ranges of

motion.

Pearson product moment correlations between

joints angles and reach performance were calculated.

Correlations were considered significant at p < 0.05

and a statistical trend was assumed for p < 0.1.

4 RESULTS

In all reach tests significant correlations were found

between the reach distance and a specific set of joint

angles. Figures 1 and 2 give a graphical

representation of the results obtained for the tests

carried out when standing on the left leg. Analogue

results were obtained for the right leg. However, not

in all cases a-priory expected correlations between

reach performance and joint angles were confirmed

by the experimental results.

All reach performances were significantly

correlated with all anthropometric measures, height,

leg length, arm length, wingspan, with the exception

of body weight for which no significant correlation

was found with any of the reach tests. Joint range of

motion as determined in the conventional tests

correlated with reach performance only in 7 of 22

analysed comparisons.

5 DISCUSSION

The results of the current study suggest that the

performance in each of the reach tests depends on

the subjects’ ability to engage a specific combination

of joint angles. Therefore a suitable combination of

reach tasks might, in turn, be able to reveal deficits

in an individual’s effective, task- oriented mobility.

Many of the postures observed in the resultant

configurations (Figures 1 and 2) suggest that the

optimal combination of joint angles may not be

limited by mobility in specific joints. Instead, it

appears to depend on the subjects’ ability to stabilize

their posture and to counterbalance their weight.

This consideration may be one of the reasons for the

poor correlation observed between joint range of

motion determined in conventional mobility tests

and performance variables, e.g. upright standing

reach (current study) or game performance variables

Figure 1: Illustration of the tests performed on the left foot. The centre diagram shows the average maximum reach distance

for each subject and the skeletons visualize the subjects’ postures in each reaching task. The joint angles that correlated

significantly with the reach distance or that showed a statistical trend were explicitly pointed out for each test (

=statistical

trend). The following abbreviations were used: L=left, R=right, ER=external rotation, IR=internal rotation, L Lat Flex=left

lateral flexion, R Lat Flex=right lateral flexion, Hor Abd=horizontal abduction, Hor Add=horizontal adduction.

Figure 2: Illustration of the rotational tests performed on the left foot. The centre diagram shows the maximum reach scores

of the eight subjects, the figures to the right and left show the postural setup and point out joint angles that correlated with

the reach performance (

=statistical trend). L=left, R=right, IR=internal rotation, ER=external rotation, Hor Add=horizontal

adduction.

(McGill et al., 2012). Tests for joint mobility based

on “real-life” tasks such as reach tests should

therefore consider balance and joint stability in their

assessment.

Furthermore, reach distance correlated with

anthropometric variables indicating that

normalization or scaling of the anthropometric

properties is important for comparison between

subjects. In addition, joint mobility achieved during

the reach tests has to be analysed relative to

established reference values for joint mobility.

In conclusion, reach tests starting from upright

standing positions challenge joint mobility in a more

natural and specific way compared to conventional

mobility tests and appears to be more relevant to

activities of daily living and athletic performance. It

may be worth to further investigate this approach,

however, several additional issues such as joint

stability, counterbalancing of body weight, and

scaling will also have to be addressed.

ACKNOWLEDGEMENTS

The contribution of Ghelem, A. and Parnevik-Muth,

J. in developing the reach test battery was

instrumental and is thankfully acknowledged.

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