Leonardo DaVinci is quoted as saying, "Simplicity is the ultimate sophistication." So very true, and the baby get-up, which is one of the most powerful and simple movement assessments you can perform, proves it.
An individual with a keen eye for assessing movement and why neural sequencing matters in every aspect of daily living will find the BGU an essential tool. It can be a foundation in your examination process to create the most effective recovery strategy for your patient.
Evaluation of movement patterning is essential for determining functional causes of chronic musculoskeletal pain. Traditional anatomical isolation-focused testing helps formulate a diagnosis; however, movement-based assessment correlates pain to real-life activities. Last time I checked, patients have to move in many different vectors when they leave your office to accomplish activities of daily living. It is our responsibility to discover the weak link in their movement system to help prevent recurring injury.
The BGU helps determine if an individual has the proper neuromuscular sequencing pattern to accomplish a fundamental transition pattern of movement. The baby get-up is the great equalizer! It is designed to level the playing field by removing the body's ability to compensate. The beautiful part of the get-up is that the assessment is also the primary corrective. You don't have to pick and choose corrective exercises to fix it. Just do the movement with self-assistance.
This article includes a video demonstration of the baby get-up. Watch the video and then read the how-to's below, watching the video again. Remember, there are no absolutes in any assessment and the history of each individual must be taken into account when introducing this movement.
Movement Setup and Cueing
- Explain and then demonstrate the movement first to the patient, reinforcing the hear – see – do principle.
- Position the patient side lying in a plank-style position, stacked on hips and shoulders.
- Top leg crosses over the bottom and top foot goes flat. (Foot position close to knee or whatever is comfortable, depending on the patient's hip mobility). Ideally, perform the test with no shoes.
- Bottom arm should be perpendicular to the body. Bend elbow at 90 degrees and with hand facing upward.
- Top hand goes to the dorsal surface on the superior medial knee. This prevents the patient from helping with the top hand.
- Cervical spine should not be fatigued. If it is, this is just a cue to you that the patient's neck is probably weak. A person should be able to support their own head weight.
- Initiate movement with the downward arm into internal rotation. When arm reaches normal end range, engage the core to post up on the elbow, reaching the chest toward the sky. It is a diagonal cross-body pattern, highly stressing the oblique system and spiral fascial movement chain of the body.
- Control motion on downward pattern and repeat 3-5 times. On the last repetition, post up into side plank and see how long the patient can hold with proper form (ideally 60 seconds). This step may be eliminated if they have difficulty performing the first phase.
- Repeat on opposite side.
Dysfunctions and Compensations to Look For
- Weakness, fatigue and straining (or pain) in the neck; leading the movement with neck flexion. The neck should be maintained in neutral position throughout the movement.
- Holding breath, which indicates a facilitated diaphragm.
- Sticking points or ratcheting on the movement.
- Swinging momentum from the floor to arm post position, indicating lack of strength.
- Downward straight leg pops up off the ground, indicating possible facilitation of adductors to the opposite-side internal oblique and same-side external oblique.
- Fatigue after 3-5 repetitions. You are looking for neural engagement necessary to engage the movement and repetitions. Look for endurance factors. If they are cheating, they will burn out fast.
Watch for smooth downward motion. The downward leg should always be in line with the upper torso. For the last repetition, the patient should move into the side plank at top of movement. Observe for torso rotation; flexion at waist; losing the plank line; dipping in the center; neck going into flexion (not packed) The head should be in line with the body.
Have the patient hold for as long as they can with good form. When and if they dip in the center three times, the test is over. In a normal side plank, the individual should be able to maintain 60 seconds on each side. If they struggle maintaining the baby get-up plank for 60 seconds, they should not be doing a traditional side plank. Regress to progress!
Corrective Interventions
- Take the top hand and put palm side on the lateral aspect of top leg by the knee; have the patient assist by pulling themselves into the movement only as needed. Do 10 repetitions.
- Take top hand and do isometric tension for 10 seconds on the top leg and inner knee with adduction, to engage the transverse abdominis. Repeat three times and then attempt the movement again.
- Soft-tissue release of the downward leg adductors; then attempt the maneuver again.
- Stop the baby get-up corrective program when the left and right sides are symmetrical.
If someone struggles with the baby get-up, they have difficulty performing rotational patterns, loaded or unloaded. They will power through movements using improper muscle activation to accomplish the task. The body will compensate any way it can to reach the goal you are asking it to hit by taking the path of least resistance.
The movement brain will do it in a functional or dysfunctional way, depending on what it has to work with. It could care less if it gets there the right way or the wrong way. It has one mission: get to point B. Facilitated muscles get overloaded and inhibited muscles get weaker (from a neural activation point first, strength second, and endurance third).
You want precision of movement and quality of execution. The neural groove of sequenced movement must activate first. If a patient can master the baby get-up, you know the body is now prepared to own the pattern. Then you can take the patient to the next progression in active therapy.
Resources
- Chaitow L. Muscle Energy Techniques. Edinburgh: Churchill Livingstone / Elsevier, 2006.
- Cook G. Movement: Functional Movement Systems : Screening, Assessment, and Corrective Strategies. Aptos, CA: On Target Publications, 2010.
- Elphinston J. Stability, Sport, and Performance Movement: Great Technique Without Injury. Chichester, England: Lotus Pub., 2008.
- Liebenson C. Rehabilitation of the Spine: A Practitioner's Manual. Philadelphia: Lippincott Williams & Wilkins, 2007.
- Weinstock D. NeuroKinetic Therapy: An Innovative Approach to Manual Muscle Testing. Berkeley, CA: North Atlantic, 2010.
Click here for more information about Perry Nickelston, DC, FMS, SFMA.