Primal Pattern and Joint-by-Joint Assessment Logic
Domain 4 - Primal Patterns and Joint-by-Joint Assessment Logic
The top tier looks like a list; it is actually a sample of the primal patterns plus the joint-by-joint map underneath them. The exam tests whether you can connect a named pattern to the primal movement it represents and to the mobility/stability expectations of the joints involved, because that is how you predict where a restriction will show up before you breakout.
The seven primal patterns
Squat, bend (hinge), lunge, push, pull, rotate, gait. Mapping to the top tier: overhead deep squat samples the squat; multi-segmental flexion samples the bend; multi-segmental rotation samples rotate; upper extremity patterns 1 and 2 sample push and pull; single-leg stance samples single-leg and gait demands. A patient's complaint usually lives inside one primal pattern, and the top tier recreates that pattern without load so the movement can be judged on its own.
The joint-by-joint map
- Foot: mobility (pronation/supination).
- Ankle: mobility, especially sagittal dorsiflexion.
- Knee: stability.
- Hip: mobility in all three planes.
- Lumbar spine: stability.
- Thoracic spine: mobility.
- Scapulothoracic region: stability.
- Glenohumeral joint: mobility.
- Cervical spine: mobility with control.
The joints alternate mobility and stability. A mobility deficit forces the neighbouring stability segment to compensate - a stiff ankle pushes pronation, knee valgus or lumbar extension upward; a stiff hip pushes lumbar extension. Conversely, a segment that cannot stabilise will lose mobility somewhere else. That alternation is the reasoning engine: find the restricted mobility joint, then rebuild control at the stability segment that was compensating.
Worked example
A lifter has an overhead squat DN and a history of shoulder impingement. Breakouts show limited ankle dorsiflexion bilaterally and limited thoracic extension, with hips and lumbar spine cleared. Joint-by-joint reasoning: two mobility joints failed, and both feed the overhead component of the squat. Program ankle and thoracic mobility, then retest the squat before loading overhead.
Traps that cost marks
- Stretching a stability segment (the lumbar spine) to buy mobility.
- Chasing hip mobility when the ankle is the actual restriction.
- Ignoring the foot in a squat or single-leg problem.
- Listing primal patterns without linking them to the failed top-tier test.