Chapter 7: Functional Assessments Flashcards
Structural Integrity
The alignment and balance of the musculoskeletal system. Allows for joints, muscles, and nerves to function efficiently together.
Kyphosis & Lordosis
Kyphosis: Increased posterior thoracic curve
(rounded shoulders)
Lordosis: Increased anterior lumbar curve (Jen selter)
ASSOCIATED MUSCLE IMBALANCES
Tight/Hypertonic:
- Hip Flexors
- Lumbar Extensors
- Anterior Chest/Shoulders
- Lats
- Neck Extensors
Inhibited/Weak Muscles:
- Hip Extensors
- External Obliques
- Upper back extensors
- Scapular Stabilizers
- Neck Flexors
Flat Back
Flatback: Decreased anterior lumbar curve (posterior pelvic tilt)
ASSOCIATED MUSCLE IMBALANCES
Tight/Shortened:
- Rectus Abdominis (6-pack muscle)
- Upper back extensors
- Neck extensors
- Ankle plantar flexors
Weak/lengthened muscles:
- Iliacus/psoas major
- internal oblique
- lumbar extensors
- neck flexors
Sway Back
Sway back: Decreased anterior lumbar curve + increased posterior thoracic curve (full hunchback)
ASSOCIATED MUSCLE IMBALANCES
Tight/Shortened Muscles:
- Hamstrings
- Upper fibers of posterior obliques
- Lumbar Extensors
- Neck Extensors
Weak/Lengthened muscles:
- Iliacus/psoas major
- External Obliques
- Rectus Femoris (Quad muscle)
- Upper back Extensors
- Neck Flexors
Scoliosis:
Lateral spine curve, often combined with vertebral rotation
Muscular imbalances
Correctable/ Uncorrectable conditions
Correctible:
- Poor posture from habit, repetitive movements, bad joint mobility/stability, side dominance and strength programs that are not balanced.
Non-correctable:
- Certain pathologies (rheumatoid arthritis), congenital conditions (such as scoliosis), structural deviations and traumas (amputation and surgeries etc.)
Static Postural Assessment
- Give insight into muscle imbalances; which often lead to dysfunctional movement.
- When performing plumb line static posture assessment it is KEY to focus on MAJOR imbalances, as bodies are rarely ever symmetrical.
Deviation 1: Ankle pronation
Supination – high arches
- Inversion foot movement
- knee (tibial) movement – external rotation
- Viewpoint: from the front
- Femoral movement – external rotation
Pronation – Arch flattening
- Eversion foot movement
- Knee (tibial) movement – Internal rotation
- Viewpoint: from the front
- Femoral movement – Internal rotation
Deviation 2: Hip adduction/hiking
One hip is elevated above the other due to lateral tilt of pelvis (me)
Deviation 3: Pelvic Tilting
Anterior pelvic tilt: The anterior and superior portion of the pelvis rotates forward and downward from the sagittal view
- Pouring water out of the front of a bucket
- Tight hip flexors. Associated with a sedentary lifestyle and spending lots of time sitting.
Posterior Pelvic Tilt: The superior and posterior portion of the pelvis rotates backward and downward.
- Pouring water out of the back of a bucket
- Dominant/tight rectus abdominis and tight hamstrings
Deviation 4: Shoulder Position & Thoracic Spine
Depression, elevation, abduction, adduction, downward rotation, and upward rotation
SUSPECTED OVERLY TIGHT/SHORTENED MUSCLES
Shoulders that are not level – Tight/overactive Upper trapezius, rhomboids, and levator scapula
Asymmetry to midline – flexed side/lateral trunk flexors
Forward rounded shoulders (protracted) – Upper trapezius, Serratus anterior and anterior scapulohumeral muscles
Depressed chest/kyphosis – Pectoralis minor, internal obliques, rectus abdominis, and shoulder adductors
Medially rotated humorous – latissimus dorsi and pectoralis major, subscapularis
Deviation 5: Forward Head
The forward head position – Overactive/tight upper trapezius, cervical spine extensors, and levator scapulae.
5 Movements of ADL
- Bending & Lifting
- Single- Leg Movements
- Push Movements
- Pull Movements
- Rotational Movements
Lift and bend (Movement Screens)
COMPENSATIONS
- Knees move inward in the anterior view
- Tight/overactive hip adductors and TFL(Tensor Fascia Latae)
- Lengthened/underactive gluteus Maximus and medius
- When the movement initiates at the knees sagittal view
- Not enough glute activation
- Indicates hip flexor and quadriceps dominance
- Back arches extensively in sagittal view
- Tight/overactive latissimus dorsi, back extensors, and hip flexors
- Weak/underactive rectus abdominis, core, hamstrings, and gluteal group
- Back rounds forward in the sagittal view (Has the same focus as number three)
- Underactive/weak upper back extensors
- Overactive/tight Teres major (front shoulder), Pec minor and major and latissimus dorsi
- Heels come off ground
- Overactive plantar flexors (calve muscle)
The hurdle step (Movement Screens)
COMPENSATIONS
- Inward leg hip rotation in the anterior view
- Raised leg internal rotators or a tight stance leg
- Raised leg external rotators or an underactive stance leg
- The hiking of the raised hip from the anterior view
- A tight stance leg hip flexors (Will limit the posterior hip rotation during the raise)
Shoulder push stabilization (Movement Screens)
[Push up Screen]
COMPENSATIONS
- Noticeable “winging” during the push-up movements at the scapulothoracic joint (sagittal view)
- The trapezius, levator scapula, serratus anterior and rhomboids (parascapular muscles) cannot stabilize the scapulae on the rib cage.
- This can also be caused by a flat thoracic spine.
- Hyperextension (lower back collapses)
- Lack of core, abdominal, and lower back strength.
Thoracic spine mobility (Movement Screens)
[Ball b/w legs, sitting rotation of spine holding dowel in front squat position]
- Bilateral discrepancy in the transverse view (assuming they had no other previous issues)
- Side dominance possibility
- Possible paraspinal development differences
- Possible torso rotation (Maybe connected to hip rotation)
- 45 degree rotation on both sides = good
The Thomas test (Quadriceps/hip flexion length)
- Flexibility assessments and muscle length
- Pull one knee toward chest while other leg is down, until lower back touches the bench*
COMPENSATIONS
- Back of lowered leg does not touch bench + knee does not flex to 80 degrees
- Tight hip flexors - Back of lowered leg does not touch the bench + knee flexes to 80 degrees
- iliopsoas tight, preventing hips from posterior rotation -> not allowing thigh to touch - Thigh touches, knee don’t flex to 80
- Tight rectus femoris (quad)
Passive Straight Leg (PSL) Raise
- Flexibility assessments and muscle length
- One hand on raised leg calf, other hand under lumbar spine; client plantar-flexes; pull leg until pressure is felt on your hand under client’s back*
- If leg raises more than or equal to 80 degrees… then hams are normal
- if leg raises less than 80 degrees… then hams are tight
Shoulder Mobility Screen(s)
Flexion, Extension, Rotation
Flexion: Client lies supine, knees bent, and raises arms above head trying to touch the floor.
- If shoulders can flex to 170-180 degrees (touching or nearly touching floor) then mobility is good
- Discrepancies in limbs or inability to reach 170 degrees could indicate tightness in pecs, lats, teres major, rhomboids, and subscapularis
Extension: Client lies prone, legs extended, both arms at sides; and tries to raise arms
- 50-60 degrees = good mobility
Internal/External rotation of Humerus: Have client lie supine with knees bent; arms are abducted to 90 degrees, with a 90 degree bend at elbow, then they must rotate forearm forward and backward trying to touch ground.
- External rotation to 90 (touches ground) = good mobility
- Internal rotation to 20 off ground = good mobility
Sharpened Romberg Test
- Client stands with one foot directly in front of the other, arms crossed at shoulders, eyes closed, and attempts to balance as long as possible*
STOP TEST WHEN:
- client opens eyes, uncrosses arms, loses balance, moves feet, exceeds 60 sec. w/ good posture
Stork Stand Test
- client stands on one leg on tippy toes, hands on hips, with the other leg against the standing leg like a yoga bitch, and then balances*
STOP TEST WHEN:
- Client loses balance, or the stork stand position,
Mcgill’s torso muscular endurance test
Flexor: Hold a crunch @ 60 degrees
Extensor: Hold a low back extension
Lateral: hold a sideplank, both sides.
READINGS:
- Flexion : Extension ratio should be less than 1.0
For example: A flexion of 120 sec. and a extension of 150 sec. = 0.8 ratio which is good
- RSB : LSB score should be no more than 0.05 from a balanced score
Example: rsb =88sec, lsb = 92sec… ratio = 0.96 which is within a 0.05 range of 1.0 - SB : Extension Ratio should be less than 0.75
Example: RSB = 88sec, Extension = 150, generates a ratio of 0.59 = good
