Chapter 7 - Functional Assessments Flashcards
The alignment and balance of the musculoskeletal system. Allows for joints, muscles, and nerves to function efficiently together.
Functional Integrity
What are the 4 Postural Deviations
Kyphosis
Lordosis
Flat Back
Sway Back
What is Kyphosis?
Increased posterior thoracic curve from neutral.
Excessive posterior curvature of the spine typically in the thoracic region.
What is Lordosis?
Increased anterior lumbar curve from neutral.
Excessive anterior curvature of the spine that typically occurs at the low back.
What is Flat Back Posture?
decreased anterior lumbar curve
What is Sway Back ?
decreased anterior lumbar curve and increased posterior thoracic curve from neutral.
Tightened/Shortened muscles in Kyphosis/Lordosis?
Hip Flexors Lumbar Extensors Anterior Ches/Shoulders Latissimus Dorsi Neck Entenstors
Weak/Lengthened muscles in Kyphosis/Lordosis?
Hip Extensors External Obliques Upper Back extensors Scapular Stabilizers Neck Flexors
Tightened/Shortened muscles in Flat Back Posture?
Rectus abdominus
Upper Back Extensors
Neck Extensors
Ankle Plantar Flexors
Tightened/Shortened muscles in Sway Back Posture?
Hamstrings
Upper Fibers of Posterior Obliques
Lumbar Extensors
Neck Extensors
Weak/Lengthened muscles in Flat Back Posture?
Iliacus/psoas major
Internal Oblique
Lumbar Exensors
Neck Flexors
Weak/Lengthened muscles in Sway Back Posture?
Illiacus/Psoas major Rectus Femoris External Oblique Uppber Back extensors Neck flexors
Correctable Muscle Imbalances?
Repetitive Movements habitually poor posture side dominance lack of joint stability/mobility imbalanced strength programs
Non-Correctable Muscle Imbalance?
Scoliosis
Rheumatoid Arthritis
Structural Deviations
Surgeries/Amputations
What are the 5 deviations?
Ankle Pronation/Supination Hip Adduction Pelvic Tilting Shoulder Position/Thoracic Spine Head Position
What is ankle pronation?
Arch Flattening Foot - Eversion Tibia(Knee) - Internal Rotation Femoral - Internal Plane of View - Front
What is ankle supination?
High Arches Foot - Inversion Tibia(Knee) - External Rotation Femoral - External Rotation Plane of View - Front
What is Hip Adduction deviation?
Lateral tilt of pelvis that elevates one hip
Lengthened(Weakened) Leg Hip Abductors
View from back
Deviation: Anterior Pelvic Tilt?
Pelvis Tilted down and forward
Associated with Tight Hip flexors, sedentary lifestyle and lots of time sitting
Plane of View - Saggital
Deviation: Posterior Pelvic Tilt?
Pelvis tilted down and backwards
Associated with Tight rectus abdominus and hamstrings
Plane of View Saggital View
Shoulder Deviation: Shoulders not level
Upper trapezius
levator scapula
rhomboids
Plane of View: Frontal
Shoulder Deviation: Asymmetry to midline
Lateral trunk flexors
Plane of View: Frontal
Shoulder Deviation: Protracted (forward, rounded)
Serratus anterior
anterior scapulo-humeral muscles
upper trapezius
Plane of View: Sagittal
Shoulder Deviation: Medially Rotated humerus
Pectoralis major and latissimus dorsi (Shoulder adductors)
internal obliques
Plane of View: Frontal
Shoulder Deviation: Kyphosis and depressed chest
Shoulder Adductors Pectoralis minor rectus abdominus internal oblique Plane of View: Sagittal
bend and lift screen: lack of foot stability: ankles collapse inward/feet turn outward: tight muscles
soleus
lateral gastrocemius
peroneals
bend and lift screen: knees move inward: tight & underactive
tight:
hip adductors
tensor fascia latae
underactive:
gluteus medius and maximus
bend and lift screen: unable to keep heels in contact with floor: tight
plantarflexors
bend and lift screen: hip and knee initiation of movement:
movement initiated at knees may indicate quadriceps and hip flexor dominance, as well as insufficient activation in glutes
bend and lift screen: unable to achieve parallel between tibia and torso
poor mechanics; lack of dorsiflexion due to tight plantarflexors (which normally allow the tibia to move forward)
bend and lift screen: hamstrings contact back of calves
muscle weakness and poor mechanics; inability to stabilize and control the lowering phase
bend and lift screen: back excessively arches: tight & undercactive
tight:
hip flexors
back extensors
latissimus dorsi
underactive: core rectus abdominus glutes hamstrings
bend and lift screen: back rounds forward: tight & underactive
tight:
lat dorsi
teres major
pec major and minor
underactive:
upper back extensors
Bend and lift screen: Head Upward
compression and tightness in the cervical extensor region
bend and lift screen: head downward
increased hip and trunk flexion
hurdle step screen: lateral tilt, forward lean, rotation:
lack of core stability
hurdle step screen: anterior tilt with forward torso lean: tight & overactive
tight: stance leg hip flexors
overactive: rectus abdominis and hip extensors
Shoulder Push Stabilization Screen: “Winging” during push-up movement
Inability of parascapular muscles to stabilize the scapulae against the rib cage
Can also be due to a flat thoracic spine.
Shoulder Push Stabilization Screen: Hyperextension (collapsing) of the low back
Lack of core, abdominal, and low back strength
Thoracic Spine Mobility Screen: how far should the trunk rotate in each direction?
45 degrees
Thoracic Spine Mobility Screen: bilateral discrepancy
Side Dominance
lack of thoracic mobility will negatively impact…
glenohumeral joint mobility
What are the 5 primary movements?
1) Bending/raising and lifting/lowering movements (squatting)
2) Single-Leg Movements
3) Pushing Movements
4) Pulling Movements
5) Rotational Movements
Thomas Test: Objective
To assess the length of the muscles involved in hip flexion. (Do not use on clients with low back pain)
Thomas Test: with the back and sacrum flat, the back of the lowered thigh does not touch the table and the knee does not flex to 80 degrees: muscle tightness?
primary hip flexor muscles
Thomas Test: with the back and sacrum flat, the back of the lowered thigh does not touch the table but the knee does flex to 80 degrees: muscle tightness?
iliopsoas, which is preventing the hip from rotating posteriorly and inhibiting the thigh from being able to touch the table
Thomas Test: with the back and sacrum flat, the back of the lowered thigh does touch the table but the knee does not flex to 80 degrees. muscle tightness?
the rectus femoris, which does not allow the knee to bend
passive straight leg raise (PSL) test: purpose
to assess the length of the hamstrings
passive straight leg raise tes: the raised leg achieves >/ 80 degrees of movement before the pelvis rotates posteriorly
normal hamstring length
passive straight leg raise: the raises leg achives <80 degrees of movement before the pelvis rotates posteriorly or there are any visible signs in the opposite leg lifting off the mat or table
tight hamstrings
Shoulder Flexion: Range of Motion?
170-180 degrees
Shoulder Flexion: How to test?
lay supine on floor with back flat and bent knee position.
hold neutral spine
raise both arms at once, moving them overhead, keeping them close to the head, and bringing them down to touch the floor or as close as possible
shoulder flexion test: inability to flex the shoulders to 170 degrees or discrepancies between the limbs
potential tightness in the pectoralis major/minor, latissimus dorsi, teres major, rhomboids, subscapularis
shoulder flexion test: tightness in the latissimus dorsi will force…
the low back to arch
shoulder flexion test: tightness in the pectoralis minor
may tilt scapulae forward (anterior tilt) and prevent arms from touching floor
shoulder extension test: how to test?
lie prone, extending both legs and arms at sides.
raise both arms simultaneously into extension, lifting them off the mat
shoulder extension: Range Of Motion
50-60 degrees
shoulder extension test: inability to extend the shoulders to 50 degrees or discrepancies between the limbs
potential tightness in pectoralis major, abdominals, subscapularis, biceps brachii
external/lateral rotation test: ability to externally rotate the forearms 90 degrees to touch the mat
good mobility in the internal (medial) rotators, allowing the joint to move through the full range of motion
external/lateral rotation test: inability to reach the floor or discrepancies between the limbs
potential tightness in internal rotators of the arm (subscapularis)
internal/medial rotation test: ability to internally rotate the forearms 70 degrees toward the mat (forearms are 20 degrees of the mat)
good mobility in the external rotators, allowing the joint to move through full range
internal/medial rotation test: inability to rotate the forearms 70 degrees, or discrepancies between the limbs
potential tightness in the external rotators of the arm (infraspinatus and teres minor)
where is the arm/shoulder positioned when it is doing shoulder flexion, external rotation, and scapular abduction
overhead and behind the head reaching for opposite superior scapula
where is the arm/shoulder positioned when it is doing shoulder extension, internal rotation, and scapular adduction
under and behind the back reaching up to touch opposite scapula
trunk flexor endurance test
Assesses muscular endurance of the deep core muscles
trunk lateral endurance test
assesses muscular endurance of the lateral core muscles
side-bridge test
trunk extensor endurance test
assesses muscular endurance of the torso extensor muscles (erector spinae, logissimus, and multifidi)
flexion:extension ratio should be….
less than 1.0
right side bridge:left side bridge scores should be…
no greater than 0.05 from a balanced score of 1.0
side bridge (either side): extension ratio should be…
less than 0.75
Sharpened Romberg Test: continue to time clients performance until one of the following occurs…
Loss of postural control or balance Client's feet move on the floor Client's eyes open Client's arms move from the folded position Client exceeds 60 seconds
Sharpened Romberg Test: The client needs to maintain his or her balance with good postural control for how long?
30 or more seconds
Stork-Stand Balance Test: Males
Excellent: >50 seconds Good: 41-50 seconds Average: 31-40 seconds Fair: 20-30 seconds Poor: <20 seconds
Stork Stand Balance Test: Females
Excellent: >30 seconds Good: 25-30 seconds Average: 16-24 seconds Fair: 10-15 seconds Poor: <10 seconds
