Integrating Biomechanical Screening into Protocols for Preventive Health Check-up

Sir,

Master health check-ups (MHCs) have become an integral part of preventive healthcare in India, widely promoted as holistic assessments of general health. These packages typically include a battery of blood tests, radiological investigations, and systemic evaluations. While these tests offer essential insights into metabolic and organ health, they represent only a limited portion of an individual’s overall wellbeing. A health check-up that evaluates glucose levels, lipid profiles, renal–hepatic markers, and cardiovascular parameters but does not assess posture, gait, neuromuscular balance, movement efficiency, or functional strength remains incomplete by design.

Globally, healthcare systems are increasingly acknowledging the need to strengthen the functional dimension of health. The World Health Organization’s Rehabilitation 2030 initiative emphasizes that more than one-third of adults worldwide live with some form of musculoskeletal (MSK) impairment or movement-related limitation, most of which goes undetected until symptoms and disability manifest. This gap between “clinical health” (biochemical) and “functional health” (movement) translates into chronic pain, mobility restrictions, productivity loss, and long-term socioeconomic burden.[1,2] Preventive health services therefore require a fundamental paradigm shift: from diagnosing disease after onset to identifying early dysfunction before disease develops.

POST-COVID REALITY: AMPLIFIED FUNCTIONAL HEALTH BURDEN

Even before the COVID-19 pandemic, MSK disorders were the leading cause of disability worldwide.[1] After 2020, the burden has risen sharply. Prolonged work-from-home arrangements, decreased physical activity, altered ergonomics, sedentary routines, and post-viral fatigue have contributed to deconditioning and functional decline in diverse age groups.[3,4,5,6] Numerous studies report increased incidence of neck and back pain, shoulder dysfunctions, impaired proprioception, reduced lower limb strength, and poor postural stability following prolonged lockdown periods.[3,4]

COVID-19 survivors also exhibit persistent functional deficits including fatigue, generalized weakness, joint stiffness, dysautonomia, and exercise intolerance. These long-term sequelae contribute substantially to the MSK rehabilitation caseload.[5,6] Despite these trends, MHC packages have remained largely unchanged, continuing to screen primarily biochemical deviations while failing to address the growing movement-related morbidity that has emerged in the post-pandemic era.

BIOMECHANICAL SCREENING IS ESSENTIAL IN PREVENTIVE HEALTH

Biomechanical screening includes assessment of posture, joint mobility, gait, balance, functional movements, movement symmetry, load distribution, and muscle imbalance profiles. These parameters are critical for identifying early dysfunctions that predict future conditions such as osteoarthritis, spinal degeneration, tendinopathies, or chronic low back pain. Unlike biochemical parameters—which typically indicate disease after it has begun—movement-based assessments identify dysfunction before symptoms arise, embodying the true essence of prevention.

Research demonstrates that many MSK disorders begin as subtle biomechanical abnormalities that progress silently over years. For example, altered scapulohumeral rhythm can precede rotator cuff tendinopathy, abnormal foot pronation can lead to knee pain and plantar fasciitis, and pelvic asymmetry or core instability may contribute to chronic back pain.[7] Without screening, these early deviations remain unnoticed until irreversible degenerative changes occur.

Yet, despite strong clinical rationale, biomechanical screening is absent from most MHCs—not due to lack of value but because traditional healthcare continues to equate “health” with “laboratory results.” This biomedical bias ignores functional health, which is equally essential for healthy aging, productivity, quality of life, and prevention of chronic disability.

EVIDENCE SUPPORTING MOVEMENT-FOCUSED PREVENTIVE SCREENING

Several lines of emerging evidence support integrating movement assessments into routine health check-ups:

• Sedentary behavior studies demonstrate increased MSK pain, reduced mobility, and altered neuromuscular control after prolonged inactivity during COVID-19 restrictions[3,4]

• Long COVID research highlights persistent functional impairments, contributing to high rehabilitation demand and chronic MSK burden[5,6]

• Global rehabilitation guidelines repeatedly recommend incorporating functional assessment into primary and preventive health settings[1,2,8]

• Evidence on practitioner competency shows that many fitness and primary care professionals lack sufficient skill in qualitative biomechanical evaluation, indicating the need for a standardized, physiotherapy-led screening model[9]

• Technological advancements including wearable inertial sensors, digital posture assessment tools, and mobile-based kinematic analysis systems have made biomechanical evaluation feasible even in outpatient settings[10]

• Standardization efforts on biomechanical risk factors are emerging, supporting evidence-based interpretation in clinical screening[11]

• Application of biomechanics in specialized conditions (such as diabetic foot syndrome and cardiovascular risk groups) highlights its clinical relevance in disease prevention[12]

• Pre-COVID MHCs heavily prioritized organ health while ignoring movement health.[13,14] Despite a rising tide of MSK disorders, implementation of biomechanical assessment in preventive check-ups remains scientifically underexplored.

IDENTIFIED RESEARCH GAP

There is insufficient research determining whether early biomechanical deviations—such as joint mobility restrictions, poor balance, kinetic chain dysfunction, or abnormal gait—can predict future pain, disability, or degenerative disorders in general populations.[7] Furthermore, very few studies examine whether integrating gait analysis, simple field tests (e.g., Y-Balance, single-leg squat), wearable sensor data, and therapist-led posture or ergonomic screens into MHCs has long-term preventive value.[15]

Future studies must evaluate whether early detection and timely physiotherapy interventions can reduce MSK burden, healthcare cost, absenteeism, and long-term disability.[16] Strengthening this research evidence will justify widespread policy adoption.

WHY PHYSIOTHERAPISTS SHOULD LEAD BIOMECHANICAL SCREENING

Physiotherapists are the primary professionals trained in human movement science, neuromuscular assessment, ergonomics, and functional rehabilitation. Their expertise positions them optimally to lead biomechanical evaluations in preventive health settings. Physiotherapist-led movement screening is:

• Noninvasive

• Evidence-based

• Cost-effective

• Time-efficient

• Easily integrated into MHC workflow

• Supported by validated clinical tests.

Physiotherapists can generate clinically meaningful reports addressing risk factors, corrective exercises, ergonomic modifications, and early movement interventions tailored to individual needs.

Proposed structure for a movement-inclusive MHC:

1. Static and dynamic posture assessment

2. Gait and functional movement screening

3. Joint mobility and ROM testing

4. Strength and muscle imbalance profiling

5. Balance and core stability measures

6. Workplace and lifestyle risk assessment

7. Individualized risk stratification and corrective plan.

A CALL FOR POLICY REFORM

If India aims to reduce MSK disability burden and promote healthy ageing, functional health must be prioritized alongside biochemical health. Policymakers should:

• Establish national guidelines for biomechanical screening

• Integrate physiotherapist-led assessment modules into all MHC packages

• Support research evaluating long-term benefits

• Encourage digital and sensor-based movement tools.

A preventive health system that screens only internal organ health while ignoring the movement system is fundamentally incomplete. Without biomechanical screening, we are not preventing disease—we are merely documenting it.

Integrating physiotherapist-led biomechanical screening into MHCs will bridge the longstanding gap between clinical and functional health, reduce chronic MSK burden, enhance productivity, and improve population-level quality of life.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.