Chapter 7 Functional Assessments Flashcards
Movement Efficiency
- is the ability to generate appropriate levels of
force and movement at desired joints while stabilizing the entire kinetic
chain against reactive and gravity-based forces.
How do we get Movement Efficiency?
- All movement begins and ends from a static base, ideally a position where all body segments are optimally aligned.
- Since movement originates from this base, a postural assessment should be conducted to evaluate body-segment alignment.
- Movement screens that evaluate how posture impacts the ability to move should be incorporated.
Static Posture
- Represents the alignment of the body’s segments
- Holding a proper postural position involves the actions of postural muscles.
- the presence of poor posture is an indicator that movement may be dysfunctional.
Good Posture
- State of musculoskeletal alignment that allows muscles, joints, and nerves to function efficiently.
- If a client exhibits poor static posture, this may reflect muscle-endurance issues in the postural muscles and/or potential imbalances at the joints.
Static postural assessment may offer valuable insight into:
- Muscle imbalance at a joint and the working relationships of muscles around a joint
- Altered neural action of the muscles moving and controlling the joint
- Potentially dysfunctional movement
With tight or shortened muscles that are overactive and dominate
movement at the joint, potentially disrupting healthy joint mechanics.
Personal trainers should consider conducting a static postural
assessment on their clients as an initial assessment.
Muscle imbalance and postural deviations
- can be attributed to many factors that are both correctible and non-correctible.
Correctible factors:
- Repetitive movements
- Awkward positions and movements
- Side dominance
- Lack of joint stability or mobility
- Imbalanced strength-training programs
Non-correctible factors:
- Congenital conditions
- Some pathologies
- Structural deviations
- Certain types of trauma
Movement Efficiency Pattern
- Proper postural alignment promotes optimal neural activity of the muscles controlling a joint.
- When joints are correctly aligned, the length-tension relationships and force-coupling relationships function efficiently.
- Good posture facilitates proper joint mechanics.
Muscle Imbalances Associated with
Kyphosis-lordosis Posture
Hypertonic (shortened)
Hip flexors
Lumbar extensors
Anterior Chest/Shoulders
Latissimus Dorsi
Neck extensors
Inhibited (lengthened)
Hip extensors
External Obliques
Upper back extensors
Scapular stabilizers
Neck flexors
Muscle Imbalances Associated with Flat-
back Posture
Hypertonic (shortened)
Rectus abdominis
Upper-back extensors
Neck extensors
Ankle plantarflexors
Inhibited (lengthened)
Iliacus/psoas major
Internal Oblique
Lumbar Extensors
Neck flexors
Muscle Imbalances Associated with
Sway-back Posture
Hypertonic (shortened)
Hamstrings
Upper fibers of posterior
obliques
Lumbar extensors
Neck extensors
Inhibited (lengthened)
Iliacus/psoas major
Rectus femoris
External oblique
Upper-back extensors
Neck flexors
Right-angle Rule of the Body
An initial training focus should be to restore stability and mobility and attempt to “straighten the body before strengthening it.”
The trainer should start by looking at a client’s static posture
following the right-angle rule of the body.
This model portrays the human body in vertical alignment across the
major joints.
Plumb Line Instructions
The objective of this assessment is to observe the client’s
symmetry against the plumb line.
Using a length of string and an inexpensive weight, trainers can create a plumb line that suspends from the ceiling to a height 0.5 to 1 inch (1.3 to 2.5 cm) above the floor.
A solid, plain backdrop or a grid pattern with vertical and horizontal lines that offer contrast against the client is recommended.
Clients should assume a normal, relaxed position.
Personal trainers should focus on the obvious, gross imbalances and avoid getting caught up in minor postural asymmetries.
Plumb Line Positions: Anterior View
position the client
between the plumb line and a wall.
With good posture, the plumb line will pass
equidistant between the feet and ankles,
and intersect the:
Pubis
Umbilicus
Sternum
Manubrium
Mandible (chin)
Maxilla (face)
Frontal bone (forehead)
Plumb Line Positions: Posterior View
position
the individual between the plumb
line and a wall.
With good posture, the plumb
line should ideally intersect the sacrum and overlap the spinous processes of the spine.
Plumb Line Positions:
Sagittal/Transverse Views
Position the individual between the plumb line
and the wall, with the plumb line aligned
immediately anterior to the lateral malleolus.
With good posture, the plumb line should
ideally pass through:
The anterior third of the knee
The greater trochanter of the femur
The acromioclavicular (A-C) joint
Slightly anterior to the mastoid process of
the temporal bone of the skull
Deviation 1: Ankle Pronation/Supination
Both feet should face forward in parallel
or with slight (8 to 10 degrees) external
rotation.
Toes pointing outward from the
midline, as the ankle joint lies in an
oblique plane with the medial
malleolus slightly anterior to the lateral
malleolus
The toes should be aligned in the same
direction as the feet.
Ankle Pronation/Supination: Lower Extremity
Effects
Ankle pronation forces rotation at the knee and places additional
stresses on the knee.
As pronation moves the calcaneus into eversion, this may actually lift the outside of the heel slightly off the ground.
In turn, this may tighten the calf muscles and potentially limit ankle dorsiflexion.
A tight gastrocnemius and soleus complex (triceps surae) may force calcaneal eversion in an otherwise neutral subtalar joint position.
Deviation 2: Hip Adduction
Hip adduction is a lateral tilt of the pelvis that elevates one hip higher than the other.
If a person raises the right hip, the line of gravity following the spine tilts toward the left following the spine.
This position progressively lengthens and weakens the right hip abductors, which are unable to hold the hip level.
Sleeping on one’s side can produce a similar effect, as the hip abductors of the upper hip fail to hold the hip level.
Deviation 3: Hip Tilting (Anterior or Posterior)
Anterior tilting of the pelvis frequently occurs in individuals with tight hip flexors.
With standing, a shortened hip flexor pulls the pelvis into an anterior tilt.
An anterior pelvic tilt rotates the superior, anterior portion of the pelvis forward and downward.
A posterior tilt rotates the superior, posterior portion of the pelvis backward and
downward.
Pelvic Rotation
An anterior pelvic tilt will increase lordosis in the lumbar spine, whereas a posterior pelvic tilt will reduce the amount of lordosis in the lumbar spine.
Tight hip flexors are generally coupled with tight erector spinae muscles, producing an anterior pelvic tilt.
Tight rectus abdominis muscles are generally coupled with tight hamstrings, producing a posterior pelvic tilt.
This coupling relationship between tight hip flexors and erector spinae is defined as the lower-cross syndrome.
With ankle pronation and accompanying internal femoral rotation, the pelvis may tilt anteriorly to better accommodate the head of the femur.
Pelvic Tilt Screen: ASIS and PSIS
To evaluate the presence of a pelvic tilt, a trainer can use a consensus of four techniques:
The relationship of the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS) (two bony landmarks on the pelvis)
The appearance of lordosis in the lumbar spine
The alignment of the pubic bone to the ASIS
The degree of flexion or hyperextension in the knees
Shoulders: Torso/Shoulders
Relative to Line of Gravity
Determine whether the torso and shoulders are symmetrical relative to the line of gravity.
A torso lean would shift the alignment of the sternum and spine away from the plumb line and create tightness on the flexed side of the trunk.
However, if the hips are level with the floor and the spine is aligned with the plumb line, but the shoulders are not level with the floor, this may represent muscle imbalance within the shoulder complex itself.
An elevated shoulder may present with an overdeveloped or tight upper trapezius muscle.
A depressed shoulder may present with more forward rounding of the scapula.
The shoulder on a person’s dominant side may hang lower than the non-dominant side.
Shoulders: Rotation of the
Scapulae and/or Arms
Determine whether the scapulae and/or arms are internally rotated.
Anterior view
– If the knuckles or the backs of the client’s hands are visible when the hands are positioned at the sides, this generally indicates internal rotation of the humerus or scapular protraction.
Posterior view
– If the vertebral/inferior angles of the scapulae protrude
outward, it indicates an inability of the scapulae
stabilizers to hold the scapulae in place.
Shoulders: Normal Kyphosis
Determine whether the spine exhibits normal kyphosis.
With the client’s consent, the trainer can run one hand gently up the thoracic spine between the scapulae.
The spine should exhibit a smooth, small, outward curve.
Deviation 5: Head Position
With good posture, the earlobe should align approximately over the acromion process.
A forward-head position is very common.
This altered position does not tilt the head downward, but simply shifts it forward.
The earlobe appears significantly forward of the acromioclavicular (AC) joint.
Movement Screens
Observing active movement is an effective method to identify
movement compensations.
When compensations occur, it is indicative of altered neural
action.
These compensations normally manifest due to muscle
tightness or an imbalance between muscles acting at the joint.
Five Primary Movements
Movement can essentially be broken down and described by five primary movements that people perform during many daily activities:
Bending/raising and lifting/lowering movements (e.g.,
squatting)
Single-leg movements
Pushing movements
Pulling movements
Rotational movements
ADL are essentially the integration of one or more of
these primary movements.
Movement Screens and the Kinetic
Chain
Movement screens must be skill- and conditioning-level appropriate, and be specific to the client’s needs.
Screens generally challenge clients with no recognized pathologies to perform basic movements.
This can help the personal trainer evaluate a client’s
stability and mobility throughout the entire kinetic chain.
Clearing Tests
Prior to administering any movement screens, trainers should screen for pain by using basic clearing tests.
These tests may uncover issues that the individual did not know existed.
Trainers should select clearing tests according to the movements that require evaluation.
The objective when conducting clearing tests is to ensure that pain is not exacerbated by movement.
Any client who exhibits pain during a clearing test should:
Be referred to his or her physician
Not perform additional assessments for that part of the body
Clearing Test: Cervical Spine
The client performs the following movements in a seated position while the personal trainer monitors for any indication of pain:
Move the chin to touch the chest.
Tilt the head back until the face lies approximately parallel or near parallel to the floor.
Drop the chin left and right to rest on, or within 1 inch (2.5 cm) of, the shoulder or collarbone.
Clearing Test: Shoulder Impingement
The client performs the following movement in a seated
position while the personal trainer monitors for any indication
of pain:
Reach one arm across the chest to rest upon the opposite
shoulder and slowly elevate the elbow as high as possible.
Clearing Test: Low Back
The client performs the following movements from a prone position while the personal trainer monitors for any indication of pain:
Slowly move into a trunk-extension position, producing lumbar extension and compression in the vertebrae and shoulder joint.
Move into a quadruped position and slowly sit back on the heels with outstretched arms, producing lumbar and hip flexion.
Bend and Lift Screen:
Frontal View Observations
First repetition
Observe the stability of the foot.
Second repetition
Observe the alignment of the knees over the second toe.
Third repetition
Observe the overall symmetry of the entire body over the
base of support.
Bend and Lift Screen:
Sagittal View Observations
First repetition
Observe whether the heels remain in contact with
the floor.
Second repetition
Determine whether the client exhibits “glute” or “knee” dominance.
Third repetition
Observe whether the client achieves a parallel position
between the tibia and torso in the lowered position, while
controlling the descent phase.
Fourth repetition
Observe the degree of lordosis in the
lumbar/thoracic spine during lowering and in the lowered position.
Fifth repetition
Observe any changes in head position.
Hurdle Step Screen: Objective
To examine simultaneous mobility of one limb and stability
of the contralateral limb while maintaining both hip and
torso stabilization under a balance challenge of standing on
one leg
Hurdle Step Screen: Frontal View Observations
First repetition
Observe the stability of the foot.
Second repetition
Observe the alignment of the stance-leg knee over the foot.
Third repetition
Watch for excessive hip adduction greater than 2 inches (5.1 cm) as measured by excessive stance-leg adduction or downward hip-tilting toward the opposite side.
Fourth repetition
Observe the stability of the torso.
Fifth repetition
Observe the alignment
of the moving leg.
Hurdle Step Screen:
Sagittal View Observations
First repetition
Observe the stability of the torso and stance leg.
Second repetition
Observe the mobility of the hip.
Shoulder Push Stabilization Screen: Objective
To examine stabilization of the
scapulothoracic joint during
closed-kinetic-chain pushing
movements
Shoulder Push Stabilization Screen:
Observations
Observe any notable changes in the position of the scapulae
relative to the ribcage at both end-ranges of motion.
Observe for lumbar hyperextension in the press
position.
Shoulder Pull Stabilization Screen: Objective
To examine the client’s ability to stabilize the scapulothoracic joint during closed-kinetic-chain pulling movements
Shoulder Pull Stabilization Screen:
Observations
Observe any bilateral discrepancies between the
pulls on each arm.
Observe the ability to stabilize the trunk during the
pull movement.
That is, the ability of the core to stiffen and lift the
hips with the shoulders and resist trunk rotation
during the lift.
Thoracic Spine Mobility Screen: Objective
To examine bilateral mobility of the thoracic spine
Lumbar spine rotation is considered insignificant, as it only offers approximately 15 degrees of rotation.
T-Spine Mobility Screen: General
Interpretations
Observe any bilateral discrepancies between the rotations in each direction.
Identify the origin(s) of movement limitation or compensation.
This screen evaluates trunk rotation in the transverse plane.
Evaluate the impact on the entire kinetic chain.
The lumbar spine generally exhibits limited rotation of
approximately 15 degrees, with the balance of trunk rotation
occurring through the thoracic spine.
If thoracic spine mobility is limited, the body strives to gain
movement in alternative planes within the lumbar spine.
Flexibility and Muscle-length Testing
A personal trainer may opt to assess the flexibility of
specific muscle groups.
Specific muscle groups that frequently demonstrate
tightness or limitations to movement are discussed in this section.
The table on the following slide provides normal
ranges of motion for healthy adults at each joint.
Thomas Test—Hip Flexion/Quad Length:
Objective
To assess the length of the muscles involved in hip flexion
This test should not be conducted on clients suffering from low- back pain, unless cleared by their physician.
Thomas Test—Hip Flexion/Quad Length:
Observations
Observe whether the back of the lowered thigh
touches the table (hips positioned in 10 degrees of
extension).
Observe whether the knee of the lowered leg
achieves 80 degrees of flexion.
Observe whether the knee remains aligned straight
or falls into internal or external rotation.
Passive Straight-leg (PSL) Raise: Objective
To assess the length of the hamstrings
Passive Straight-leg (PSL) Raise: Observations
Note the degree of movement attained from the
table or mat that is achieved before the spine
compresses the hand under the low back or the
opposite leg begins to show visible signs of lifting off
the table or mat.
The mat or table represents 0 degrees.
The leg perpendicular to the mat or table
represents 90 degrees.
Shoulder Mobility Assessment
Apley’s scratch test involves multiple and simultaneous
movements of the scapulothoracic and glenohumeral
joints in all three planes.
To identify the source of the limitation, trainers can
first perform various isolated movements in single
planes to locate potentially problematic movements.
Consequently, the scratch test is completed in
conjunction with:
The shoulder flexion-extension test
An internal-external rotation test of the humerus
Apley’s Scratch Test—Shoulder Mobility:
Objective
To assess simultaneous movements of the shoulder girdle (primarily the scapulothoracic and glenohumeral joints)
Movements include:
Shoulder extension and flexion
Internal and external rotation of the humerus at the shoulder
Scapular abduction and adduction
Apley’s Scratch Test—Shoulder Mobility:
Observations
Note the client’s ability to touch the medial border of
the contralateral scapula or how far down the spine
he or she can reach with shoulder flexion and external rotation.
Note the client’s ability to touch the opposite inferior
angle of the scapula or how far up the spine he or she can reach with shoulder extension and internal rotation.
Observe any bilateral differences between the left
and right arms in performing both movements.
Shoulder Flexion Test: Objective
To assess the degree of shoulder flexion
This test should be performed in conjunction with Apley’s scratch
test to determine if the limitation occurs with shoulder flexion or
extension.
Shoulder Extension Test:
Objective
To assess the degree of shoulder extension
This test should be performed in conjunction with Apley’s scratch test to determine if the limitation occurs with shoulder flexion or extension.
Shoulder Flexion/Extension Tests:
Observations
Measure the degree of movement in each direction.
Note any bilateral differences between the left and right arms in performing both movements.
External Rotation—Humerus (Shoulder):
Objective
To assess external rotation of the humerus at the shoulder joint to evaluate medial rotators
This test should be performed in conjunction with Apley’s scratch test to determine if the limitation occurs with internal or external rotation of the
humerus.
Internal Rotation—Humerus (Shoulder):
Objective
To assess internal rotation of the humerus at the shoulder joint to evaluate lateral rotators
This test should be performed in conjunction with Apley’s scratch test to determine if the limitation occurs with internal or external rotation of the
humerus.
Internal/External Rotation—Humerus:
Observations
Measure the degree of movement in each direction.
Note any bilateral differences between the left and right arms in performing both movements.
Balance and the Core
Balance and core baseline assessments evaluate the need for comprehensive balance training and core conditioning.
Dynamic balance tests are generally movement- specific and quite complex.
Trainers should aim to first evaluate the basic level of static balance that a client exhibits by using the sharpened Romberg test or the stork- stand test.
Sharpened Romberg Test: Objective
To assess static balance by standing with a reduced base of support while removing visual sensory information
Sharpened Romberg Test:
Observations
Continue to time the client’s performance until one of the following occurs:
The client loses postural control and balance
The client’s feet move on the floor
The client’s eyes open
The client’s arms move from the folded position
The client exceeds 60 seconds with good
postural control
Sharpened Romberg Test:
General Interpretations
The client needs to maintain his or her balance with good postural control (without excessive swaying) and not exhibit any of the test-termination criteria for 30 or more seconds.
The inability to reach 30 seconds is indicative of
inadequate static balance and postural control.
Stork-stand Balance Test: Objective
To assess static balance by standing on one foot in a
modified stork-stand position
Stork-stand Balance Test: Observations
Timing stops when any of the following occurs:
The hand(s) come off the hips
The stance or supporting foot inverts, everts, or moves in any direction
Any part of the elevated foot loses contact with the stance leg
The heel of the stance leg touches the floor
The client loses balance
McGill’s Torso Muscular Endurance
test
To evaluate balanced core strength and stability it is important to assess all sides of the torso.
Poor endurance capacity of the torso muscles or an imbalance
between these three muscle groups can contribute to low-back
dysfunction and core instability
The McGill’s torso test battery includes:
Trunk flexor endurance
Trunk lateral endurance
Trunk extensor endurance
Trunk Flexor Endurance Test
The flexor endurance test is the first of the three
It assesses muscular endurance of the deep core muscles
It is a times test involving a static, isometric contraction of the anterior muscles, stabilizing the spine until the individual exhibits fatigue and can no longer hold the assumed position.
This test may NOT be suitable for individuals
who:
Suffer from low-back pain
Have had recent back surgery
Are in the midst of an acute low-back flare up
Test protocol and administration
Trunk Flexor Endurance Test
Trainer starts the stopwatch as they move the board about 4 inches back while client maintains 60-degree suspended position
Terminate test when there is a noticeable change in the trunk position.
Terminate also if:
Watch for deviation from the neutral spine or an increase in the low-back arch
No part of the back should touch the back rest
Record time
Trunk Lateral Endurance Test
The trunk lateral endurance test assesses the muscular endurance of the lateral core muscles
This test may not be suitable for individuals:
With shoulder pain or weakness
Who suffer from low-back pain, have had recent back surgery or are in the midst of an acute low-back flare up
Test protocol and administration
Trunk Lateral Endurance Test
Trainer starts stopwatch as the client moves into the side bridge position
Terminate the test when there is a noticeable change in the trunk position
Terminate also if:
A deviation from neutral spine occurs
The hips shift forward or backward in an effort to maintain balance and stability
Record time
Repeat for the opposite side and record the value
Trunk Extensor Endurance Test
Generally used to assess muscular endurance of the torso extensor muscles
This is a timed test involving a static, isometric contraction of the trunk that stabilize the spine
This test may not be suitable for:
A client with major strength deficiencies
A client with high body mass
A client who suffers from low-back pain, have had recent back surgery or are in the midst of an acute low-back flare up
Test protocol and administration
Trunk Extensor Endurance Test
When ready the client lifts/extends the torso until it is parallel to the floor with their arms crossed over the chest
Start the stopwatch as soon as the client assumes this position
Terminate test when client can no longer maintain the position
Record the time
