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.
