Assessments and Postural Deviations Flashcards
Postural Deviation 2: Hip Adduction
Lateral tilt of pelvis that elevates one hip higher than the other
Weakens and lengthens hip abductors (glute muscles and TFL) of raised hip, which are unable to hold hip level
Flat-Back Posture: Tight (facilitated/hypertonic/shortened) Muscles
Rectus abdominis, upper-back extensors, neck extensors, ankle plantar flexors
Sway-Back Posture: Tight (facilitated/hypertonic/shortened) Muscles
Hamstrings, upper fibers of posterior obliques, lumbar extensors, neck extensors
Lordosis/Kyphosis: Weak (inhibited/lengthened) Muscles
Hip extensors, external obliques, upper-back extensors, scapular extensors, neck flexors
Five Common Postural Deviations
Ankle pronation (arch flattening) or supination (high arches), hip adduction, anterior/posterior pelvic tilt, shoulder position, head position
Postural Deviation 3: Anterior/Posterior Pelvic Tilt
Anterior tilting generally occurs in individuals with tight hip flexors (iliopsoas, rectus femoris, sartorius, and TFL) and erector spinae; rectus abdominis and hamstrings are lengthened
With posterior tilt, rectus abdominis and hamstrings are tight, with lengthened/weak hip flexors and erector spinae
Lordosis/Kyphosis: Tight (facilitated/hypertonic/shortened) Muscles
Hip flexors, lumbar extensors, anterior chest/shoulders, lats, neck extensors
Sway-Back Posture: Weak (inhibited/lengthened) Muscles
Iliopsoas, rectus femoris, external oblique, upper-back extensors, neck flexors
Flat-Back Posture: Weak (inhibited/lengthened) Muscles
lliopsoas, internal obliques, lumbar extensors, neck flexors
Five Primary Movements (ADL)
Bending/raises and lifting/lowering (aka bend-and-lift), single-leg movements, pushing, pulling, rotation
Scapular Protraction and Scapular Winging
Inability of scapular stabilizers, primary rhomboids and serratus anterior, to hold scapulae in place
Scapular Protraction: Noticeable protrusion of the medial border of scapulae outward
Scapular Winging: Protrusion of the medial border AND the inferior angle of scapulae outward
Postural Deviation 4: Shoulder Position
Shoulders not level: tight upper traps, levator scapulae, rhomboids
Asymmetry to midline: tight lateral trunk flexors (flexed side)
Protracted (forward/rounded): tight serratus anterior, anterior scapulo-humeral muscles, upper traps
Medially rotated humerus: tight pecs major and lats (sh adductors), subscapularis
Kyphosis and depressed chest: tight pecs major/minor and lats, rectus abdominis, internal oblique
Postural Deviation 5: Head Position
Earlobe should align over acromioclavicular joint
If forward, tight upper traps, levator scapulae, cervical spine extensors
Postural Deviation 1: Ankle Pronation and Supination
Pronated subtalar joint forces internal rotation of tibia, slightly less internal rotation of femur —>knees turn inward, calcaneus everts = stress on knees
Supinated subtalar joint creates external rotation of tibia and femur, knees turn outward
Lumbar Dominance during Squat
Lack of core and gluteus muscles to counteract hip flexors (iliopsoas, rectus femoris, sartorius, and TFL) and erector spinae as they pull the pelvis forward during a squat.
–> Excessive load in lumbar spine
Quadriceps Dominance during Squat
Loading onto quads during squat shears the knee because the tibia drives forward
–> More pressure onto knees, overloading them
Glute Dominance during Squat
Eccentrically loading glutes during squat by driving hips backwards (hinging)
- –>Spares lumbar spine, relieving knee stress
- –>Activates hamstrings
Movement Screens
Bend and lift screen, hurdle step screen, shoulder push stabilization screen, thoracic spine mobility screen
Thomas Test Movement Screen
Lying on table, bringing one knee into chest, other knee hangs off table
Balance and Core Screens
Sharpened Romberg test, stork stand balance test, McGill’s torso muscular endurance test
Shoulder Mobility Screen Parts
Flexion: lying on back, extending arms overhead
Extension: lying on stomach, extending arms behind
Internal rotation: lying on back, triceps against ground, hands move towards ground
External rotation: lying on back, triceps against ground, back of hands move towards ground
Apley’s Scratch Test
Multiple movements of shoulder girdle at once
Arm overhead, elbow bent, reaching palm down back (shoulder flexion, external rotation, and scapular abduction)
Arm reaching around, back of palm against middle back (shoulder extension, internal rotation, and scapular adduction)
Sharpened Romberg Test
Standing balance, one foot in front of the other, arms crossed with hands against pecs, eyes closed
Need to maintain balance for 30+ seconds
Stork-Stand Balance Test
Essentially tree pose with foot to calf and heel lifted off ground, hands to hips
Men: 50s+ excellent, 41-50 good, 31-40 average, 20-30 fair, less than 20 poor
Women: 30s+ excellent, 25–30 good, 16-24 average, 10-15 fair, less than 10 poor
McGill’s Torso Muscular Endurance Test Battery
Trunk flexor test: seated on mat, hands to chest, feet to floor, at angle (trainer removes board form behind, must hold form
trunk lateral endurance test: forearm side plank
trunk extensor endurance test: trainer holds client’s legs on table, torso off the end, maintaining parallel form
Lordosis
Increased anterior lumbar curve from neutral
How to correct lordosis
Strengthen: abdominals and hamstrings
Stretch: Hip flexors (iliopsoas) and erector spinae
Kyphosis
Excessive posterior curvature of the thoracic spine
= tight shoulder adductors (pectoralis major) and weak scapular abductors (serratus anterior) which pull scapulae into protraction
How to correct kyphosis
Strengthen: Rhomboids and traps
Stretch: Chest muscles
Flat-Back Posture
Decreased anterior lumbar curve (e.g., posterior pelvic tilt)
Sway-Back Posture
Decreased anterior lumbar curve and increased posterior thoracic curve from neutral (e.g., posterior pelvic tilt)
Inversion and Eversion (Ankle)
Inversion: rolling to outside of foot
Eversion: rolling to inside of foot
Supination and Pronation (Foot)
Pronation: collapsing into arches of foot
Supination: arches of foot lift up, rolling foot outwards
Primary Role of Anterior Cruciate Ligament (ACL)
To prevent anterior glide of the tibia away from the femur
You notice a client has lordosis. Which muscles should they stretch?
Hip flexors (iliopsoas) and erector spinae
You notice a client has lordosis. Which muscles should they strengthen?
Abdominals and hamstrings
You notice a client has kyphosis. Which muscles should they stretch?
Pectorialis major, anterior deltoid, latissimus dorsi, neck extensors
You notice a client has kyphosis. Which muscles should they strengthen?
Upper trapezius and rhomboids, neck flexors
Subtalar Joint Pronation: Foot Movement and Tibial/Femoral Movement
Foot: eversion
Tibia/femur: internal rotation
Subtalar Joint Supination: Foot Movement and Tibial/Femoral Movement
Foot: inversion
Tibia/femur: external rotation
Which muscles plantar flex the ankle?
Gastrocnemius and soleus
Anterior Pelvic Tilt - Tight Muscles
Tight or overdominant hip flexors are generally coupled with tight erector spinae muscles, producing an anterior tilt
Posterior Pelvic Tilt - Tight Muscles
Tight or overdominant rectus abdominis is generally coupled with tight hamstrings, producing an a posterior tilt
Anterior Pelvic Tilt - Lengthened/Weak Muscles
Hamstrings, rectus abdominis
Posterior Pelvic Tilt - Lengthened/Weak Muscles
Hip flexors (iliacus, psoas major/minor), erector spinae
If client’s palms face backwards in standing position, what is indicated?
Internal rotation of humerus and/or scapular protraction (abduction)
Shoulders not level: Which muscles could be tight?
Upper trapezius, levator scapulae, rhomboids
Shoulders asymmetric to midline: Which muscles could be tight?
Obliques (flexed side)
Shoulders protracted: Which muscles could be tight?
Serratus anterior, anterior deltoids, pectoralis major/minor
note: serratus anterior tight with scapular protraction and lengthened with scapular winging
Medially rotated humerus: Which muscles could be tight?
Pectoralis major and lats, subscapularis
Kyphosis and depressed chest: Which muscles could be tight?
Pectoralis major and minor, rectus abdominis, internal oblique
Forward head position: Which muscles could be tight?
Cervical spine extensors, upper traps, levator scapulae
Lack of foot stability in bend and lift screen: Overactive/tight muscles
Soleus, lateral gatrocnemius, peroneals (outside of foot)
Lack of foot stability in bend and lift screen: Underactive/lengthened muscles
Medial gastrocnemius, gracilis, sartorius, tibialis anterior
Knees move inward in bend and lift screen: Overactive/tight muscles
Hip adductors, TFL
Knees move inward in bend and lift screen: Underactive/lengthened muscles
Glute maximus and medius
Torso shifts to the side in bend and lift screen: compensations
Side dominance and muscle imbalance
Unable to keep heels in contact with floor during bend and lift screen: Overactive/tight muscles
Gastrocnemius and soleus (plantar flexors)
Unable to achieve parallel between tibia and torso in bend and lift screen: compensations
Poor mechanics, lack of dorsiflexion due to tight plantar flexors
Hamstrings contact back of calves during bend and lift screen: compensations
Muscle weakness and poor mechanics, resulting in an inability to stabilize and control the lowering phase
Back excessively arches during bend and lift screen: Overactive/tight muscles
Hip flexors (iliopsoas), erector spinae, latissimus dorsi
Back excessively arches during bend and lift screen: Underactive/lengthened muscles
Core, rectus abdominis, glutes, hamstrings
Back excessively rounds during bend and lift screen: Underactive/lengthened muscles
Upper back extensors (upper trapezius, levator scapulae)
Back excessively rounds during bend and lift screen: Overactive/tight muscles
Latissimus dorsi, teres major, pectoralis major and minor
Head is downward in bend and lift screen: compensations
Increased hip and trunk flexion
Head is upward in bend and lift screen: compensations
Compression and tightness in the cervical extensor region
Hurdle Step Screen: lack of foot stability, ankles collapse inward or feet turn outward
Suspected tight muscles
Soleus, lateral gastrocnemius, peroneals
Hurdle Step Screen: lack of foot stability, ankles collapse inward or feet turn outward
Suspected lengthened muscles
Medial gastrocnemius, gracilis, sartorius, anterior/posterior tibialis, glute max and minimus
Inability to control internal rotation
Hurdle Step Screen: Knees move inward
Suspected tight muscles
Hip adductors, TFL
Hurdle Step Screen: Knees move inward
Suspected lengthened muscles
Glute medius and maximus
Hurdle Step Screen: Hip adduction
Suspected tight muscles
Hip adductors, TFL
Hurdle Step Screen: Hip adduction
Suspected lengthened muscles
Glute medius and maximus
Hurdle Step Screen: Stance-leg hip rotation
Suspected tight muscles
Stance-leg or raised-leg internal rotators
Hurdle Step Screen: Stance-leg hip rotation
Suspected lengthened muscles
Stance-leg or raised-leg external rotators
Hurdle Step Screen, raised leg: Lack of ankle dorsiflexion
Suspected tight muscles
Ankle plantar flexors
Hurdle Step Screen, raised leg: Lack of ankle dorsiflexion
Suspected lengthened muscles
Ankle dorsiflexors
Hurdle Step Screen, raised leg: Limb deviates from sagittal plane
Suspected tight muscles
Raised-leg hip extensors
Hurdle Step Screen, raised leg: Limb deviates from sagittal plane
Suspected lengthened muscles
Raised-leg hip flexors
Hurdle Step Screen, raised leg: Hiking raised hip
Suspected tight muscles
Stance-leg hip flexors, limiting posterior hip rotation during raise
Hurdle Step Screen: Anterior pelvic tilt with forward torso lean
Suspected tight muscles
Stance-leg hip flexors
Hurdle Step Screen: Anterior pelvic tilt with forward torso lean
Suspected lengthened muscles
Rectus abdominis and hip extensors
Hurdle Step Screen: Posterior pelvic tilt with hunched-over torso
Suspected tight muscles
Rectus abdominis and hip extensors
Hurdle Step Screen: Posterior pelvic tilt with hunched-over torso
Suspected lengthened muscles
Stance-leg hip flexors
Shoulder Push Stabilization Screen: Shoulder “winging” during push-up movement
Instability of parascapular muscles (serratus anterior, trapezius, rhomboids, levator scapulae) to stabilize the scapula against the rib cage
Shoulder Push Stabilization Screen: Hyperextension or “collapsing” of low back
Lack of core, abdominal, and low back strength, resulting in instability
Thoracic Spine Mobility Screen: Bilateral discrepancy
Possible biomechanical problems:
side dominance; difference in paraspinal development; torso association, perhaps associated with some hip rotation
Thomas Test: Correct form
- back of lowered thigh touches table (10° of extension)
- knee of lowered leg achieves 80° of flexion
- knee remains straight and doesn’t fall into internal or external rotation
Thomas Test limitation: Back of lowered thigh does not touch table and knee does not flex to 80°
Primary hip flexors are tight
Thomas Test limitation: Back of lowered thigh does not touch table but knee DOES flex to 80°
Iliopsoas is tight
Thomas Test limitation: Back of lowered thigh DOES touch table but knee does not flex to 80°
Rectus femoris is tight, not allowing knee to bend
Shoulder Flexion and Extension Test: Inability to flex shoulders to 170° or discrepancies between limbs
Potential tightness in pectoralis major and minor, latissimus dorsi, teres major, rhomboids, and subscapularis
- tightness in lats forces lower back to arch
- tightness in pecs minor tils scap forward and prevents arms from touching floor
- tight abdominals may depress rib cage
- kyphosis may round thoracic spine
Shoulder Flexion and Extension Test: Inability to extend shoulders to 50° or discrepancies between limbs
Potential tightness in pecs major, abdominals, subscapularis, anterior deltoid, coracobrachialis, biceps brachii
- tightness in abdominals prevents normal extension of thoracic spine and rib cage
- tightness of biceps prevents shoulder extension with an extended elbow
Shoulder External Rotation Test: Inability to reach floor or discrepancies between limbs
Potential tightness in internal rotators of arm (e.g. subscapularis)
Joint capsules and ligaments could also be tight
Shoulder Internal Rotation Test: Inability to internally rotate the forearm 70° or discrepancies between limbs
Potential tightness in external rotators of arm (e.g. infraspinatus, teres minor, posterior deltoid)
Joint capsules and ligaments could also be tight
Sharpened Romberg Test: Length of test and interpretations
Test ends when client exceeds 60 seconds
Inability to achieve 30 seconds is indicative of inadequate static balance and postural control
Components of Health-Related Assessments
Cardiorespiratory fitness, body composition and anthropometry, muscular endurance, muscular strength, flexibility
Components of Skill-Related Assessments
Anaerobic power, anaerobic capacity, speed, agility, reactivity, coordination
BMI calculation
BMI = Weight (kg)/height² (m)
or
BMI = [Weight (lb)/height²] x 703
BMI Categories
Underweight <18.5
Normal weight 18.5–24.9
Overweight 25–29.9
Obese ≥ 30
Determining waist-to-hip ratio
Waist measurement divided by hip measurement
Waist-to-Hip Ratio Norms: Women
Excellent: <0.75
Good: 0.75–0.79
Average: 0.80–0.86
At Rist: >0.86
Waist-to-Hip Ratio Norms: Men
Excellent: <0.85
Good: 0.85–.89
Average: 0.90–0.95
At Rist: >0.95
How to calculate Lean Mass Percentage
100% – Body fat percentage
How to calculate Lean Mass
Body weight x Lean mass percentage
How to calculate Desired Lean Mass Percentage
100 – Desired body-fat percentage
How to calculate Desired Body Weight
Lean body mass/desired lean body mass percentage
McGill’s Torso Battery Test Ratios
Criteria for good relationship between muscles:
Flexion:extension–> ratio less than 1.0
Right-side bridge:left-side bridge–> Scores should be no greater than 0.005 from a balanced score of 1.0
Side bridge (each side):extension–> ratio less than 0.75
Anthropometric Measurements (8)
- Bioelectrical Impedance Analysis (BIA) records electrical signals as they pass through fat, lean mass, and water in the body
- Air Displacement Plethysmography (ADP)
- Dual-Energy X-Ray Absorption (DEXA) is an x-ray that reads bone and soft-tissue mass
- Hydrostatic weighing
- MRI
- Near-Infrared Interactance (NIR) uses a fiber optic probe to measure tissue composition
- Skinfold measurements
- Total Body Electrical Conductivity (TOBEC) uses electromagnetic forcefield to asses relative body fat
VT2 Threshold Test
Cardio for 15 to 20 minutes at highest intensity sustained during a steady-state exercise
To predict the HR response at VT2 using a 15- to 20-minute test, estimate that the corrected HR response would be equivalent to 95% of the average of the 15- to 20-minute HR.
Applying Results of Cardiorespiratory Fitness Testing
Goal 1: Gradually increase exercise duration
Goal 2: Increase exercise intensity
Muscular Endurance Testing
Push-Up Test, Curl-Up Test (crunches), Body-Weight Squat Test
Muscular Strength Testing
1-RM Bench-Press Test, 1-RM Leg-Press Test, 1-RM Squat Test
Warm up at ~50% of anticipated 1-RM weight, 5-10 reps
Second set ~70–75% of anticipated 1-RM
Third set ~85–90% of anticipated 1-RM
Sport-Skill Assessments
Standing Long Jump Test, Vertical Jump Test, Pro Agility Test, 40-Yard Dash
Stability and Mobility Training: Order of Body Regions
Lumbar spine, hips and thoracic spine, scapulothoracic region, distal extremities
You are conducting the shoulder flexion assessment on your client. In the supine position, the client is able to flex her shoulders and touch the floor, but only if the lower back is raised. Which muscle is most likely contributing the lower back having to be raised?
Latissimus dorsi.
Origin and Insertion of the latissimus dorsi connect the thoracolumbar fascia to the humerus. This muscle is required to stretch throughout the shoulder flexion assessment and can lead to dysfunction if it becomes tight.
Which of the field tests would you administer to assess anaerobic power?
Standing long jump test and vertical jump test
What is the Karvonen Method?
It calculates target heart rate based on maximal heart rate and resting heart rate
Target HR = (HRR x %intensity) + RHR
HRR = MHR–RHR
MHR = [206.9–(0.67 x age)]
When working with a client with cardiovascular disease, which type of exercises should be avoided?
Isometric exercises should be avoided because they can dramatically raise blood pressure and the associated work of the heart.
Three Cardiorespiratory Zones: RPE 6–20 sale
Zone 1: 12 to 13
Zone 2: 14 to 16
Zone 3: 17 to 20
Three Cardiorespiratory Zones: %HRR and %V0₂R
Zone 1: 40 to 59%
Zone 2: 60 to 84%
Zone 3: 85% +
Three Cardiorespiratory Zones: % MHR
Zone 1: 64 to 76%
Zone 2: 77 to 93%
Zone 3: 94% +
Three Cardiorespiratory Zones: METs
Zone 1: 3 to 6
Zone 2: 6 to 9
Zone 3: 9 +
Anaerobic Power Training (Phase 4 CRT)
Focus is on improving anaerobic power to improve phosphagen energy pathways and buffer large accumulations of blood lactate in order to improve speed for short bursts at near-maximal efforts during endurance or athletic competitions.
Which cardiorespiratory training phase is the standard for regular exercisers in a fitness facility?
Phase 2: Aerobic Efficiency Training
Bob has a sedentary lifestyle and you notice that he has scapula protraction. Which muscles could be tight and causing a dysfunctional protraction?
Being in a sedentary lifestyle allows for a hunched posture that over time can tighten the serratus anterior, anterior scapulohumeral muscles, and upper trapezius which causes rounded or protracted scapulae.
While performing the passive straight-leg raise, what degree of movement before rotation of the pelvis are you looking for?
80 degrees or above with opposite leg flat on the mat or table
How do you determine a person’s waist-to-hip ratio?
Waist measurement divided by hip measurement
Your client tells you that they are taking a calcium channel blocker. How would the calcium channel blocker likely affect your client?
Dilates the arteries which lowers blood pressure
During a dynamic stretch, what is sensitive to stretch and is responsible for protecting the muscle against too much stretch?
The muscle spindle is a sensory organ within a muscle and stretches along with the muscle. The muscle spindle is activated and causes a reflexive contraction in the agonist muscle and relaxation in the antagonist muscle. It’s known as the stretch reflex.
When should the exercise session should be discontinued based on heart rate?
If the systolic blood pressure or diastolic blood pressure rise to 250mmHg or 115mmHg, respectively, or if the systolic blood pressure drops below 20 mmHg.
What type of muscle fibers are typically smaller with more aerobic capacity?
Fast-twitch fibers
The appropriate strength ratio for flexion to extension of the shoulder joint?
2:3
What assessment is most appropriate for gathering baseline data to help improve the CR program design for a client who currently runs recreationally for 20 to 35 minutes, 3 to four days a week?
Submaximal talk test for VT1
How much resistance should be used for a client with osteopenia?
Two sets of each exercise, fatiguing muscles in approximately 8 reps
A higher load is recommended because it will stimulate the greatest response in terms of bone density changes
WTF is Wolff’s Law?
Bones respond to the stresses placed upon them — when skeleton is subjected to stressful forces, it lays down more bone tissue, making bones more dense. When there is a lack of stressful forces, bones lose mineral content and become less dense
Hydrostatic weighting is considered the benchmark for measuring body composition. This concept is based on which of the following equations?
Density = Mass/Volume
What’s the purpose of CPR?
To help the person’s body maintain perfusion, or blood flow and oxygen delivery to tissues.
What is an appropriate MET value for walking slowly?
2.0
What is the difference between VO₂ assessments and ventilatory threshold assessments?
VO₂ assessments measure predicted VO₂ max to give us an idea of a client’s cardiovascular health and fitness.
= measure of cardiovascular health and fitness
Ventilatory threshold assessments determine an individual’s heart rate at his or her first and second ventilatory threshold.
= measures markers of intensity to create the most individualized program
What is the difference between the Talk Test and the Submaximal Talk Test?
The Talk Test method is used to measure exercise intensity, but does not require the measurement of heart rate. While the Submaximal Talk Test for VT1 is a formal assessment where heart rate is measured at VT1 and requires the use of equipment and preparation, to administer the test.
What is the Valsalva Maneuver?
The Valsalva maneuver is a strong exhaling effort against a closed glottis, which builds pressure in the chest cavity that interferes with the return of the blood to the heart: it may deprive the brain of blood and cause lightheadedness or fainting.
What is the Q angle?
The Q-angle is the angle formed by the longitudinal axis of the femur and the line of pulls of the patellar ligament. This angle is larger in women and more critical for preserving the integrity of the knee.
