Chapter 7: Functional Assessments Flashcards
Define “posture”
A static base or alignment of the body segments
Lordosis
Increased anterior lumbar curve
Kyphosis
Increased posterior thoracic curve
So like, hump back and forward neck
Flat Back
Decreased anterior lumbar curve
So like they’re too flat and not standing with the natural curves of the spine. Kind of slouched forward
Sway back
Decreased anterior lumbar curve and increased posterior thoracic curve (hips pushed forward) and neck is usually pulled forward
Scoliosis
Lateral spinal curvature often accompanied by vertebral rotation
What are some muscle imbalances associated with Kyphosis-lordosis Posture?
Facilitated/Hypertonic (Shortened):
- Hip flexors (iliacus, psoas major, rectus femoris and sartorius)
- Lumbar Extensors (erector spinae)
- Anterior chest/shoulders
- Latissimus Dorsi
- Neck Extensors
Inhibited (Lengthened) -Hip Extensors (gluteus maximus, posterior head of the adductor magnus, and the hamstrings) -External Obliques -Upper-back Extensors Levator Scapulae) -Scapular Stabilizers: (Serratus Anterior Trapezius muscles: Upper/Middle/Lower Levator Scapula Rhomboid)
What are some EXERCISES to help correct muscle imbalances associated with Kyphosis-lordosis Posture?
The key muscles to work here are:
The glutes, hamstrings, abs, and back muscles
- Plank
- Side Plank
- Superman
- Crunches
- Bird Dog
- Dead Bug
- Hip Bridge
- Pull Aparts
What are some muscle imbalances associated with Flat Back Posture?
Facilitated/Hypertonic (shortened):
- Rectus abdominis
- Upper Back Extensors
- Neck Extensors
- Ankle Plantarflexors
Inhibited/Lengthened Muscles:
- Iliacus/psoas major
- Internal Oblique
- Lumbar Extensors
- Neck Flexors
What are some corrective exercises for flat back syndrome?
The focus is to strengthen the core and hip muscles, as well as stretching the hamstrings
- Cobra Pose
- Bird Dog
- Standing Forward Fold
- Locust/Superman Pose
- Plank
- Leg Lifts/Sit and March in place (psoas)
What are the muscle imbalances associated with sway back posture?
Facilitated/Hypertonic(shortened):
- Hamstrings
- Upper fibers of posterior obliques
- Lumbar Extensors
- Neck Extensors
Inhibited(Lengthened):
- Iliacus/psoas major
- Rectus Femoris
- External Obliques
- Upper-back extensors
- Neck Flexors
What are some exercises to help improve sway back posture?
Often caused by tight hamstrings, weak abdominal muscles, and lax ligaments in the back and spines. Sitting for too long can cause this
Exercises:
- Plank
- Glute Bridge
- Band Pull Aparts
What are some good exercises to help with scoliosis?
- Pelvic Tilts
- Cat-Camel
- Double-Leg Abdominal Press
- Bird Dog
What are the 5 key Postural Deviations?
- Ankle Pronation/Supination
- Hip Adduction (hip hiking)
- Anterior/Posterior Pelvic Tilting
- Shoulder Position and the Thoracic Spine
- Head Position
What are some benefits associated with improving posture, movement, core, balance, and flexibility?
The result of improving in these foundational areas is an improved quality of life and the ability to perform activities of daily living with more ease
What can a static posture assessment offer valuable insight into?
- Muscle Imbalances at the joint and the working relationship of the muscles around the joint
- Altered neural action of the muscles moving and controlling the joint
What are some types of muscle imbalances or postural deviations which are correctable?
- Repetitive Movements (neural)
- Awkward positions and movements
- Side Dominance
- Lack of Joint Stability
- Lack of Joint Mobility
- Imbalanced Strength Training Program
What are some types of muscle imbalances or postural deviations which are NOT correctable?
- Congenital conditions (scoliosis)
- Some Pathologies (rheumatoid arthritis)
- Structural Deviations (tibial or femoral torsion, femoral anteversion)
- Certain Types of Trauma (surgery, injury, amputation)
How to set up a Plumb Line for a Posture Assessment
Use a string and a washer, suspend from ceiling or other fixed height so that the washer is 0.5-1 inches above the floor.
Select a location with a solid plain backdrop
Client should wear form fitting athletic wear, remove shoes and socks, then they can stand in front, behind, and next to the plumb line for visual assessment
The clients symmetry is determined by observing the right angles between the weight bearing joints and the plumb line
What are the muscles primarily responsible for plantarflexion of the ankle?
“Triceps Surae”:
- Gastronemius
- Soleus
What are the prime movers for hip flexion and knee extension?
- Iliacus
- Psoas Major
- Psoas Minor
How to identify scapular winging and scapular protraction?
Scapular Protraction:
- Noticeable protrusion of the vertebral (medial) border
- Palms point backwards
Winged Scapulae:
-Protrusion of the inferior angle AND vertebral (medial) angle
If the medial and/or inferior angle of the scapular protrude out of someone’s backside then this is a sign the rhomboids and serratus anterior are unable to hold the scapulae in place
How to identify proper head position?
Ear should be in line with the acromioclavicular joint
What is the glenohumeral joint?
Shoulder Ball and Socket Joint;
Connects the glenoid of the scapula and the humerus (arm bone)
What is the acromioclavicular joint?
Also called the AC Joint;
Connects the clavicle (collarbone) and the acromion of the scapula
What is the protocol for assessing proper head position?
From the Sagittal Plane, align the plumb line with the AC joint and observe it’s position relative to the ear
Forward Head Posture is when the head is shifted forward so the ear is not in line with the AC joint
What are the implications of Forward Head Posture?
Tight cervical extensors, upper traps, levator scapular
Lengthening of the cervicle flexors
How to assess proper Shoulder Position and the thoracic spine?
Frontal Plane (Posterior View) or Sagittal Plane: -the scapulae should appear flat against the rib cage
Frontal Plane (Anterior View): palms should face one’s side. Backwards facing palms and shoulder shrugging can be a sign of scapular protraction
What is Scapular Protraction?
When the medial (vertebral) border of the scapula protrude
Backwards facing palms and shoulder shrugging can be a sign of scapular protraction
What is Winged Scapulae?
The protrusion of the medial border of the scapulae AND the protrusion of the inferior angle of the scapulae
What are the implications of shoulders not being level (from the posterior view in the frontal plane)?
Tight upper traps, levator scapulae, and rhomboids
What are the implications of Asymmetrical shoulders (in reference to the the midline?)
…viewing in the frontal plane
Tight Lateral Trunk Flexors (flexed side)
What are the implications of Medially Rotated Humerus (viewing from the frontal plane)?
Tight Pectoralis Major, Latissimus Dorsi, and Subscapularis
What are the implications of protracted (forward, rounded) shoulders from the Sagittal view?
Tight serratus anterior, upper traps, and anterior scapulohumeral muscles
What are the implications of Kyphosis (depressed chest ) from the Sagittal view?
Tight shoulder adductors, Pec Minor, Rectus abdominus, and internal obliques
How to assess Pelvic Tilting?
View from Sagittal Plane: -increased lumbar curve -Bucket Tilting, spilling water forward =Anterior Pelvic Tilt \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ -flattened lumbar curve -Bucket Tilting, spilling water backwards =Posterior Pelvic Tilt
What are the implications of Anterior Pelvic Tilt?
Tight/over dominant Hip flexors (Iliacus, psoas major, minor and tensor fasciae latae) AND tight erector spinae
Lengthened hamstrings and Rectus abdominus
What are the implications of Posterior Pelvic Tilt?
- Tight/overdominant hamstrings and Rectus abdominus
* Lengthened hip flexors and erector spinae
How to assess Hip Adduction (Hip Hiking) aka Lateral Hip Tilt?
View from the frontal plane (posterior)
The adducted hip will appear elevated and the top will be closer to the plumb line (midline)
Frontal View:
1. Observe for shifting from side to side as witness by the position of the pubis in relation to the plumb line
- Alignment of the iliac crests
What are the implications of Hip Adduction (hip hiking) also called Lateral Pelvic Tilt?
Lengthens and weakens the corresponding hip ABDUCTOR making it difficult to hold the hips level
How to Assess Ankle/Foot Position?
Frontal Plane (Anterior or Posterior View): Align client in the center of the plumb line either facing the line or with their back to the line. Their feet should be equidistant from the plumb line, feet should point straight ahead or be slightly externally rotated. Toes should be pointed in the same direction as the foot.
What are some implications of pronated ankle joint (subtalar joint)?
- the arch appears flattened
- internally rotated the tibia and femur
- internal rotation of the thighs and knees
- places stress on the knee joint
- can cause calcaneus (heel) eversion, thus lifting the heel off the ground. This can lead to tight calf muscles which limits dorsiflexion
- can also cause anterior pelvic tilt (lumbar lordosis) because the head of the femur tries to compensate for the internal rotation of the lower extremities
What are some implications of supinated ankle (subtalar) joints?
- appears as high arches
- causes external rotation of the tibia and femur
- stress on knee
- shin splints
- back and hip pain
What are the hip flexor muscles?
Iliacus, psoas major, minor, Rectus femoris, sartorius
Which muscles are responsible for shoulder Adduction?
pectoralis major, latissimus dorsi, teres major, triceps, and coracobrachialis
What is a common cause of “faulty neural control”?
Altered neural action normally manifest due to muscle tightness or an imbalance between muscles acting on a joint
What are the five primary movements that people perform during daily activities?
- Bending/raising & Lifting/Lowering
Example: Squat - Single-Leg Movements
Example: Lunges - Pushing Movements (vert/horiz)
Example: closing car door or getting something off the top shelf - Pulling Movements (vert/horiz)
Example: opening car door, carrying groceries - Rotational Movements
Example: picking up a child and turning to put him in a car seat
What is the objective of the Bend and Lift Screen test?
To examine symmetrical lower-extremity mobility and stability, AND upper extremity stability during a bend and lift movement (squatting)
During the Bend and Lift Movement Screen, what are some implications of ankles collapsing inwards or feet turning outward resulting in lack of foot stability?
Tight: soleus, lateral gastrocnemius, peroneals
Lengthened: Medial gastrocnemius, gracilis, sartorius, tibialis group
During the Bend and Lift Movement screen, what are some implications of knees moving inwards?
Tight: hip adductors, tensor fascia latae
Lengthened: gluteus medius and maximus
During the Bend and Lift Movement screen, what are some implications of the client laterally shifting to one side?
Side dominance and muscle imbalance due to lack of stability in the lower extremity
During the Bend and Lift Movement screen, what are some implications of being unable to keep heels on the floor (Sagittal view)?
Tight Plantarflexors
During the Bend and Lift Movement screen, what are some implications of the client initiating the movement with knees vs. hips?
Knees: Possible Quad & Hip Flexor Dominance
Hips: Possible Glute Dominance
During the Bend and Lift Movement screen, what are some implications of being unable to achieve a parallel figure 4 shape of the torso and tibia (Sagittal view)?
Poor mechanics
Lack of dorsiflexion due to tight Plantarflexors (which normally allow the tibia to move forward)
During the Bend and Lift Movement screen, what are some implications of the hamstrings making contact with the back of the calves (Sagittal view)?
Muscle weaknesses and poor mechanics resulting in an inability to stabilize and control the lowering phase
During the Bend and Lift Movement screen, what are some implications of the back excessively arching vs. back rounding forward (Sagittal view)?
Excessive Back Arch: Tight hip flexors, back extensors, lats.
Lengthened Core, Rectus abdominis, gluteal group, hamstrings
Back Rounds Forward: Tight lats, teres major, pectoralis major and minor.
Lengthened upper back extensors
During the Bend and Lift Movement screen, what are some implications of downward or upward head position?
Increased trunk and hip flexion
Compression and tightness in the cervical extensor region
What are the implications of Lumbar Dominance during a squat?
Implies the lack of core abdominal and glute strength to counteract the force of the hip flexors and erector spinae as they pull the pelvis forward
Causes extra load on the lumbar spine
What are some implications of quadricep dominance during a squat?
This is recognized as the first 10-15 degrees of the movement are initiated by driving the tibia forward thus creating a shearing force on the knee as the femur slides over the tibia.
In this position, the glute max does not eccentrically load and cannot generate as much force during the upward phase of the squat.
This puts more pressure on the knees and the ACL
What are some implications of glute dominance during the squat?
The first 10-15 degrees of the downward movement is initiated by pushing the hips backwards, thus creating a hip hinge. This allows the glutes to be maximally eccentrically loaded and therefore allows the most force to be produced during the upward, concentric phase of the squat. This is the preferred method of squatting as it spares the lumbar spine and knees from excessive stress.
Glute dominance also helps activate the hamstrings, which pull on the posterior surface of the tibia which helps unload the ACL and protect it from potential injury
Define contralateral
The opposite side or limb
How to perform the Hurdle Movement Screen?
- Tie a string so it forms a hurdle. Clients foot must clear the string with approximately a 70 degree angle at the hips
- Have client stand feet gait width apart (about 3 inches) with toes positioned just below the string
- Place a dowel across their shoulders
- Tell that MF to load onto one leg and lift the other leg slowly so it clears the string and place that heel down in front of the string
During the Hurdle Step Movement Screen, what are some implications of the ankle collapsing inwards and/or the feet turning outwards (anterior view)?
Overactive (Tight):
- Soleus
- Lateral Gastrocnemius
- Peroneals
Underactive (Lengthened): -Medial Gastrocnemius -Gracilis -Sartorius -Tibialis Group -Glute Medius and Maximus (Inability to control internal rotation)
During the Hurdle Step Movement Screen, what are some implications of the knees moving inward (anterior view)?
Overactive/Tight:
- Hip Adductors
- Tensor Fascia Latae
Underactive/Lengthened:
-Glute Medius and Maximus
During the Hurdle Step Movement Screen, what are some implications of Lateral Hip Adduction (elevated hip) anterior view?
Overactive (Tight):
-Hip adductors, tensor fascia latae (if Adduction is more than 2 inches)
Underactive (Lengthened):
-Glute Medius and Maximus
During the Hurdle Step Movement Screen, what are some implications of the torso tilting forward or rotating (anterior view)?
Lack of core stability
During the Hurdle Step Movement Screen, what are some implications of the client’s raised leg side having lack of ankle dorsiflexion (anterior view)?
Tight Plantarflexors
Lengthened Ankle Dorsiflexors
During the Hurdle Step Movement Screen, what are some implications of the raised limb deviating from the Sagittal plane?
Tight Hip Extensors
Lengthened Hip Flexors
During the Hurdle Step Movement Screen, what are some implications of hiking the raised hip?
Tight stance leg hip flexors (limiting posterior hip rotation during raise)
During the Hurdle Step Movement Screen, what are some implications of anterior tilt with forward torso lean (Sagittal plane)?
Tight stance leg hip flexors
Lengthened Rectus abdominis and hip extensors (glutes and hamstrings)
During the Hurdle Step Movement Screen, what are some implications of the pelvis and low-back having a posterior tilt with a hunched over torso (Sagittal view)?
Tight Rectus abdominis and hip extensors
Lengthened stance leg hip flexors
What is the objective of the Hurdle Step Screen?
To examine simultaneous mobility of one limb and stability of the contralateral limb while maintaining both hip and torso stabilization
What’s the objective of the Shoulder Push Stabilization screen?
To examine stabilization of the scapulothoracic joint and core control during closed-kinetic-chain pushing movements
How to perform the Shoulder Push Stabilization Screen?
Lying on the floor in the prone position, perform a push up or a bent-knee push-up if necessary
What are some observations to watch for during the shoulder push stabilization screen?
-Scapular Winging
=inability of the parascapular muscles (serratus anterior, trapezius, levator scapula, rhomboids) to stabilize the scapulae against the rib cage.
*Can also be due to flat thoracic spine
-Lumbar Hyperextension (collapsing the lower back during push-up)
=Lack of core, abdominal, and low-back strength, resulting in instability
What is the objective of the Thoracic Spine Mobility Screen?
To examine bi-lateral mobility of the thoracic spine
*Lumbar spine rotation is insignificant as it only offers about 15 degrees of rotation
How to perform thoracic spine mobility screen?
- Client sits upright in a chair while squeezing a block/ball between their knees
- Place dowel across the front of their shoulders instructing them to hold it like a front barbell squat grip
- While maintaining a straight, upright posture, the client squeezes the block to immobilize the hips and gently rotates from left to right
What are some observations during the thoracic spine mobility screen?
- The dowel should remain level (no tilting up or down) as this implies lateral flexion of the trunk which isn’t the point of the screening.
- The trunk should achieve 45 degrees of rotation in both directions
- Lack of thoracic mobility will negatively impact glenohumeral mobility
What is a supine position?
Lying on your back
What is a prone position?
Lying on belly
What muscles are responsible for moving the pelvis?
ANTERIOR
- Hip Flexors (Iliopsoas Rectus Femoris)
- Abdominals
POSTERIOR
- Erector Spinae
- Hamstrings
How to position client for Plumb Line tests FRONTAL VIEWS (anterior & posterior)?
ANTERIOR VIEW
-position the client between the plumb line and the wall, facing the plumb line with their feet equidistant from the plumb line
-With good posture, the plumb line will pass equidistant between the feet and ankles, interact the pubis, umbilicus, sternum, mandible (chin), maxilla (face) and frontal bone (4head)
POSTERIOR VIEW
-position the client between the plumb line and wall facing away from the plumb line with the insides of heels equidistant from the plumb line
-With good posture, the plumb line should bisect the sacrum (scrotum) and overlap the spinous processes of the spine
How to position a client for Plumb Line test from the Sagittal View?
- Position the client between the plumb line and the wall, facing sideways, the plumb line aligned immediately anterior to the lateral malleolus (ankle bone)
- With good posture, the plumb line should ideally pass through the anterior third of the knee, the greater trochanter of the femur, the AC Joint, and either in line or slight behind the ear lobe)
What is the objective of the Thomas Test for Hip Flexion/Quadriceps Length?
Objective: to assess the length of the muscles involved in hip flexion
