Musculoskeletal screening

Comprehensive Screening Process

We take a detailed history to identify the cause (mechanism of injury) and any other pre-disposing factors. Thereafter, we use a wide range of assessments to identify musculoskeletal problems.

What is the purpose of musculoskeletal screening?

Effective screening, carried out by qualified clinicians with sports specific knowledge can identify potential biomechanical and/or anatomical problems (deficits) that are likely to disrupt normal efficient movement - especially suitable for runners, cyclists and triathletes. Although often neglected or mis-understood, musculoskeletal assessment represents a critical component within the world of sports medicine / sports science......as minor disruptions to normal movement patterns are likely to lead to:-

• Reduced performance

• Overuse injury

Measuring knee ROM

We offer musculoskeletal screening which takes approximately 60-75 minutes and prices start at £60 including rehabilitation strategies - when necessary. Our screening process incorporates key elements of biomechanical assessment, for both gait (running) activities and cycling activities. Crucially, unlike many sports injury clinics, we differentiate between the two sports specific activities for optimum performance.

Assessment and any subsequent treatment strategy often require different approaches to address the underlying deficits / dysfunction. This approach applies to both recreational and competitive athletes. Therefore, triathletes and duathletes can be assessed for both activities on the same visit. 

Marginal gains

We seek to provide athletes with the all important, but often elusive, 'marginal-gains'. As such, we work in collaboration with Mercury Performance Coaching to help their athletes achieve their goals. This involves an integrated approach, where athletes undergo a comprehensive musculoskeletal screening before embarking on their customised coaching plan. The aim is to identify and resolve potential musculoskeletal deficits likely to disrupt compliance and athletic performance.

Rationale

Pre-Bikefit Screening (bike screening) is designed to complement and enhance the Bike fitting process. Screening of the cyclist helps to establish the correct bike setup (bike positioning). Arguably, the first to introduce the concept of Pre-Bikefit Screening, we are now recognised as one of the UK's leaders. Ideally, the Bike fitting process should constitute a comprehensive package, which should incorporate cycling specific musculoskeletal screening, and when required, personalised rehabilitation strategies. Thereafter, the clinical findings are incorporated into the Bikefit to provide optimum bike positioning - hence cycling performance.

Foot/Pedal interface - key to efficiency and comfort

The foot/pedal interface is considered the 'cornerstone' to effective bike fitting, and thus requires special attention throughout all stages of the process. The foot/pedal interface dictates how effectively pedal forces are transmitted downwards via the cranks, and potentially, how harmful forces are transmitted up the kinetic-chain – impacting on the knee, hip, pelvis, back and neck.

The foot/pedal interface consists of the foot type and respective anatomic or biomechanical malalignment (tilt), cycling shoe design, shoe insert, pedal and cleat system and any necessary cleat wedges / internal Specilized BG shims necessary to correct foot and limb malalignment.

Cycling is very repetitive; during 1 hour of cycling, a rider may average up to 5,000 pedal revolutions. The slightest amount of anatomic malignment at the foot/pedal interface creates abnormal knee movement (Figure 1), which can lead to reduced performance and overuse injury.

Our own unique research carried out at Manchester Metropolitan University (2010) demonstrated that increasing levels of power loss strongly correlated with increasing levels of foot dysfunction. Conversely, increasing levels of Specialized BG varus wedges, used to correct foot dysfunction (Figure 2), strongly correlated (P<0.05) with increasing levels of power output.

Forces applied to the pedal during the downstroke reach their maximum at approx 90° of crank angle. Studies show that as forces increase so does the amount of misalignment (tilt) in the direction that allows the forefoot to become parallel with the pedal (Fig 1). Inward tilting of the forefoot causes the knee to move inwards towards the top-tube – depicted by red arrows in (Fig 1). The dotted-oval trace represents knee motion during a pedal revolution. Varus wedges support the forefoot in cyclists with forefoot tilt (Fig 2), which results in increased levels of power output.

        Figure 1                  Figure 2

Club level cyclists and older cyclists - likely beneficiaries

Club level cyclists and older cyclists are likely to benefit the most from pre-screening and subsequent adjustments at the foot/pedal interface. They are more likely to have lower-limb and foot malalignment problems, and especially older cyclists, while having similar limb and foot malalignment problems, are more likely to have degenerative changes in lower-limb joints, which can disrupt normal pedalling. Previous fractures of the leg and even factors such as hip replacements in older cyclists commonly alter leg-lengths, which in turn, disrupt normal pedalling biomechanics. Chronic pelvic and low back problems are often associated with poor foot mechanics. Competitive cyclists and triathletes come from Lancashire, Cumbria, Manchester and Merseyside.