About the Manual Assessment Test-7

About the Manual Assessment Test-7

By Matt Pedone

I was fortunate enough to participate in a workshop given by Dr. Michael Geraci on the Manual Assessment Test-7 (MAT-7). In this article, I will explain the purpose of the MAT-7, the methodology used in the assessment, what clients can expect to see in the assessment, and what practitioners can gain from using it in their setting. The MAT-7 is a comprehensive movement assessment that evaluates joint mobility, muscle strength and flexibility, and overall quality of movement. The assessment is designed to be a diagnostic tool for personal trainers, physical therapists, etc. used to identify areas of dysfunction and develop targeted interventions. I was able to physically undergo the MAT-7 assessment because I was having lower back pain and wanted to know the course of treatment I should do. 

Created in 2004 by Dr. Michael Geraci, the MAT-7 is a critical tool in evaluating movement patterns and musculoskeletal function. Movement patterns are the specific ways in which a person moves their body in response to physical demands like walking, reaching, or squatting.  Functional, healthy movement patterns give the ability to move freely and efficiently which allows individuals to perform daily activities and job-related tasks. On the other hand, dysfunction in movement patterns, like low back pain or tight hips, can lead to pain, injury, and decreased quality of life. For this reason, physicians, physical therapists, and other medical personnel must correctly evaluate movement patterns to identify areas of dysfunction and develop targeted interventions to prevent such consequences. The MAT-7 follows a specific protocol consisting of seven different tests, hence the name MAT-7. The test includes the squat and single leg squat progression, balance and reach and step-down progression, core range of motion, eccentric core control, scapular reaction, unloaded foot ankle, and a core endurance test. The tests evaluate different aspects of movement, including core stability, hip mobility, and shoulder mobility.

Clients undergoing the MAT-7 can expect a thorough assessment of their movement patterns and musculoskeletal functions. As I mentioned earlier, I underwent the assessment so I can speak about certain tests. It should be noted that, as with any fitness assessment there are a multitude of variables such as age, gender, and level of physical fitness that could affect the results of the assessment. For both males and females, muscle mass decreases by 1% each year, according to a study based on how gender affects physical activity levels, “Women had a sharper decline in frequencies of self-reported physical activity.”  

The first test is a bodyweight squat.  This is an everyday movement pattern for example getting up off a chair. The practitioner should give little to no cues at all. One thing to look for is if the knees should not go past a person’s toes. In a squat position the body’s weight is supported by the feet, the knees and hips bend. When I performed this test, my movement pattern was not ideal, my knees were going past my toes. To correct the pattern, I went to and faced a wall and was trying to grab a tissue box, the tissue box is used as an external cue. This would help me hinge my hips first and ensure my knees didn’t go forward. When I performed the squat test with this correction and was trying to grab the tissue box, I felt a difference: my glutes were more activated and my knees did not go forward at all. After that, Dr. Geraci explained to me that if you were a practitioner and had a client perform this test you would be wasting your time if you had someone who just failed a bilateral squat try to do a unilateral squat. Because I had correctly performed the bilateral squat with his correction, he then had me attempt the single-leg squat. This progression was much harder for me and I was unable to perform the movement correctly because my knee would wobble back and forth. This is an indication of weak glutes and with this, the practitioner should continue to test and see which joint is playing a role in the instability. Based on the joint-by-joint approach by Gray Cook if the knee is unstable the hips or ankles could be the explanation for it.  

The second test was the step-down test. It should be clear that if a client fails the squat test, you skip it. However, for the presentation and my own personal edification, we continued to perform all of the tests.  This test is a two-part balance test that involves reaching and stepping down from a block. This test is going to identify asymmetries in the body as it is performed with a unilateral base of support. In other words, from a static view just standing on one foot or dynamically walking or running. Balance is used to maintain posture by shifting the center of gravity in the body. This one was very challenging for me; Dr. Geraci noted that my knee was coming down even further when I attempted to balance myself on the block which indicated that I was lacking the necessary quad activation. If I felt pain on my symptomatic side, it would have indicated that my hamstrings were tight. Dr. Geraci had me hold a medicine ball and try a twist with the step down which helped me gain more control because my glutes were activated by this adjustment. 

Next, was testing my core range of motion. This test is looking at all the planes for directional preference. While looking at my waist, in the sagittal plane, I had to extend (lean backward) and flex (lean forward, trying to bring my chest to my thighs), in the frontal plane I had to glide left and right, and in the transverse plane, I had to rotate from side to side. My head was down when I reached forward, which pulled the spine upwards 4 mm, and I reached for my knee with my head tucked. I felt some tightness in my hamstring. Dr. Geraci said that hamstring tightness is generally upper to mid-thigh, but I had indicated tightness closer to my knee, which is a neural tension point. Nerves are meant to move freely and glide. When there is neural tension, it is referring to the nerves being able to mobile through muscle tissues and bones without being impeded.  To address this, he then had me lift my head up to see if the pain would increase or subside. I felt no change. So, we had to test further. Dr. Geraci explained that if I reached just past my knee, it would’ve indicated about 50% loss of motion; between my knee and ankle would’ve indicated 25% loss of motion, touching toes is 0% loss of motion. I was able to reach about halfway between my knee and ankle and when I picked my head up, I had less pain. An effective treatment to alleviate neural tension is by centralizing the discomfort. To centralize the pain, I did backbends while standing up. By doing this I was taking the pain that was radiating down my leg to my spine. While it may sound like a bad idea to this, I was actually decompressing the nerve. These helped a lot during my recovery process. 

The next test was about eccentric control, this is also a test that should not be performed if the single-leg squat could not be performed correctly. This test is assessing control of my core while on a unilateral base of support. Once again analyzing from the planes, sagittal, frontal, and transverse. I had a hard time controlling my extension when I tried to tap the back wall. This indicates that my mobility in the sagittal plane was asymmetrical.  Dr. Geraci had me move closer to the wall to touch the wall. When I crossed my arms and had to rotate to tap the wall, I fell into it and wasn’t able to control it as well. Next, we checked the frontal plane. I was able to tap my shoulder but not my hip, which could also be a result of weak glutes.  He also was able to conclude that I had tight psoas muscles on my right side because I was able to control my backward descent to tap the wall on my left side whereas I would crash when testing my right side, which was also consistent with the pain on my symptomatic side. Dr. Geraci later explained how he would make this test sport specific. For example, in baseball, the pitcher has to throw the ball a certain way, so if a pitcher has weak internal rotators of the hip, he or she may be at risk of tearing their rotator cuff because they cannot decelerate properly. The fifth test was about scapula reaction. Once again to get a holistic understanding of this assessment I completed this test. This test looks to analyze the interconnectedness of hips and shoulders or as Gary Gray would say “how the hips talk to the scapula”. It is also not always performed if a patient has no upper torso/ extremity pain. Dr. Geraci stated that “the hip is connected to the shoulder” so in theory, the hip’s movement capabilities that allow for a posterior tilt of the scapula. I would say I am a very active gym-goer and after many years, my scapula is rotated anteriorly. Like most of the test, we saw that my right side was inhibited and I was able to get as much range of motion as the left. 

The next test was the unloaded ankle test. The test uncovers the causation of reduced foot mobility. Possible reasons could be because of muscular stiffness and joint instability. In the joint-by-joint approach, practitioners know that the ankle is a mobile joint because it has multiple ranges of motions in different planes. After years of playing soccer, my right ankle has lost its posterior glide due to the number of times I have sprained it. One thing I was not aware of is that most walking and running require 60 degrees of big toe extension. Children have 90 degrees whereas most adults have 60 degrees. The final test is testing core endurance. This as Dr. Geraci says is based on Dr. Stuart McGill’s work and his big 3 exercises: the side plank, McGill curl-up, and bird dog. Practitioners want to start with what clients are most successful at, and when we develop as children, we start out on our stomachs then we progress to roll side to side. A general goal is to hold a core endurance exercise to 60 seconds; however, if a client cannot execute this properly, they should instead perform 6 sets of 10-second holds. Afterward, Dr. Geraci gave me an exercise to do at home, which was the press-up. A press-up starts in a prone position with hands placed under the shoulders and lifts the upper part of the body by extending the arms locking out the elbows, and maintaining hip contact on the floor. Dr. Geraci prescribed this because it also centralizes the pain and with the back bends, after a few days, my pain was gone. Before we had started doing the full assessment Dr. Geraci gathered some information on the injury. He hypothesized that due to my age, my distribution of pain worsened when I was sitting. After the assessment, Dr. Geraci came to the conclusion I had a disc herniation in my lumbar spine. Not only did I learn about the diagnosis of my injury, but I also became aware of the other dysfunctions in my body like my right side being more limited in range of motion.  Since the assessment, I have been constantly working on fixing my disc by incorporating the corrective exercises into my workout routines and as a result, my pain levels have decreased.

The MAT-7 is made to be both objective and subjective because it allows for qualitative and observational measurements. Without a doubt it is a useful tool for physical therapists, however, the MAT-7 requires it to be done by a skilled practitioner who is trained in the technique and understands the results. The practitioner gets to see how the client moves on the x, y, and z-axis. Many people tend to forget that as humans we are 3-D entities that move in these planes: frontal, sagittal, and transverse planes. This assessment is helpful for clients and physical therapists alike. Clients can see their baseline and how far they have progressed, and physical therapists can make interventions accordingly.  

The importance of assessment in the field of sports medicine and physical therapy cannot be overstated. One of my biggest mentors throughout my college career has been Mr. Fox. He said when he was learning from the National Academy of Sports Medicine, “Any program design is only as good as your assessment”. This stands as an incredibly powerful statement that emphasizes the critical role that assessment plays in program design. Without a thorough and accurate assessment, any program that is designed will be ineffective and harmful to the client. To design an effective program, it is crucial to understand the individual’s movements and musculoskeletal function, designing a program to address the underlying issues becomes much easier. One example of the importance of assessment in physical therapy is Dr. Stuart McGill’s 3-hour assessment for lower back pain. Dr. McGill is considered to be the greatest mind when it comes to diagnosing back pain and rehabilitating back-pained people. He can treat the underlying reasons that lead to the pain because of a thorough assessment and then designs a program to address these issues. 

At TrainSMART, some of the core values are that they care deeply for the client's success, always go the extra mile, and that they keep clients safe and injury free. After learning from Mr. Fox, Dr. Mancuso, and the team at TrainSMART, I can confirm that they uphold these values when it comes to coaching and it shows in their assessment of their clients. They place a high priority on nailing the assessment to get a baseline of a client’s restrictions before they make the most optimal strategic plan. Dr. Mike Geraci stated that it is better to be “assessment rich and technique poor”. By understanding the importance of spending time on assessment to create an effective program, you get to understand the individual client’s strengths, weaknesses, and limitations through assessment, which allows trainers and practitioners design a program that is tailored to their specific needs. TrainSMART specializes in alleviating lower back pain. They have extensive knowledge and experience in assessing, diagnosing, and treating lower back pain. Assessment is also a critical component of the physical therapy process, with four key components the first being the assessment, history, and diagnosis, the second being functional strength training, the third is corrective exercises and the fourth component is manual therapy. Corrective exercise is the more traditional, stereotypical physical therapy. Mr. Fox, who has been in the sports medicine industry for years, says the most complex and rarest skill that requires extensive education and knowledge of biomechanics and sports medicine is the assessment part. Ultimately, assessment is the foundation for any successful program or treatment plan. Without a good assessment, it is impossible to design an effective program that addresses the individuals’ unique needs and limitations. 

Some other insights I took from Dr. Geraci’s MAT-7 presentation were about workout equipment in commercial gyms and various muscle functions. In the gym, one should highly reconsider doing workouts that involve using a machine like a leg extension. They give the impression of building up muscle but they are not the most optimal in terms of strength training; it also may increase spinal disc pressure. Dr. Geraci and Dr. McGill performed a test where they hooked up electrodes to the quadricep and found that there are fewer motor units recruited in a leg extension than in a squat. A motor unit is the basic muscle contraction unit. This means there is more brain activity doing a basic bodyweight squat than a seated leg extension. I have come to learn that gyms focus more on making everyone look like a bodybuilder rather than a functional, pain-free person. Dr. Geraci made it clear that you need to know that muscles have 6 functions: 3 eccentric and 3 concentric. These functions help improve movement patterns, increase strength and power, and prevent injuries. For example, one of TrainSMART’s favorite prescribed exercises is the squat. This exercise serves as a lower-body pushing movement that can prevent lower back pain from daily activities.  When you squat, the gluteal muscle, specifically the glute maximus, contracts eccentrically to control hip flexion in the descent phase, then concentrically to control the hip by extending it during the ascent. If you take an athlete that plays soccer, for example, the sport requires sprinting and a quick change of direction. The player would perform better if they need to train eccentric functions of their quadriceps and gluteal muscles to better control muscles that decelerate and change direction as well as prevent knee injuries. Concentric contraction refers to the muscle’s ability to generate force and produce movement (initiate, maintain, and accelerate movement). An example of a concentric contraction is when you perform a bicep curl. The bicep muscle contracts concentrically to initiate the movement, maintain the position of the weight, and accelerate the weight towards the shoulder.

In conclusion, the Manual Assessment Test-7 (MAT-7) is a comprehensive movement assessment that evaluates joint mobility, muscle strength and flexibility, and movement quality. It is a critical tool in evaluating movement patterns and musculoskeletal function and is used to identify areas of dysfunction and develop targeted treatment interventions. While the MAT-7 has many advantages, it also has limitations that require a skilled practitioner for accurate interpretation. Clients undergoing the MAT-7 can expect a thorough assessment of their movement patterns and musculoskeletal function, with the potential for improved function and decreased pain through targeted treatment interventions.

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