Exam 1 Flashcards
Which is most true in regard to proper protocol when measuring circumferences?
Measures should be taken at least twice at each site
Hydrodensitometry is also commonly known as …
Underwater weighing
It well established that excess body fat, particularly when located ___, is associated with hypertension, the metabolic syndrome, type 2 diabetes, stroke, cardiovascular disease, and dyslipidemia
centrally around the abdomen
Android obesity is characterized by …
More fat on the trunk (abdominal fat)
Sarcopenia is best defined as …
The age-related loss of muscle mass and strength
Which of the following best describes the waist-to-hip ratio?
Circumference of waist divided by circumference of hips
Assuming proper technique and equations have been used, the plus/minus error of using skinfold equations to predict percent body fat is …
3.5%
The presence of android obesity when compared to gynecoid obesity increases the risk of which of the following conditions?
All of the above, which is:
-hypertension
-metabolic syndrome
-CVD
The principle behind body composition assessment by using skinfold measurements is that …
The amount of subcutaneous fat is proportional to the total amount of body fat
Which of the following is considered to be an anthropometric method of determining body composition?
Body Mass Index
What is the primary purpose of the swing phase of gait?
Limb advancement
Which phase of gait is eliminated when running?
Double limb support
Which of the answers below is NOT a common gait deviation associated with glute med weakness?
Increased knee flexion during swing to improve ground clearance
What compensatory action would be associated with anterior tibialis weakness during swing phase?
Increased hip flexion
During load response, all the actions occur EXCEPT…
Knee extends
When walking, during which phase of gait does initial contact occur?
Stance
which phase of gait concludes when the foot lifts off the ground?
Pre-Swing
Your client presents with antalgic gait. They have ____ stance time on the ____lower extremity
Decreased; affected
An athlete is having measurements taken to assess her body composition. The coach uses DEXA scan and a new method he is being asked to test. The purpose of using these two measures is to establish what type of validity of the new test?
Concurrent
If an athlete’s test result is high one day and low the next day, which of the following aspects of the quality appears to be compromised?
Reliability
one scorer for a group testing allowed a partial last repetition to count towards an athlete’s total score on the pull-up test, while another scorer did not count that repetition. this difference between scorers is related to which of the following?
interrater reliability
An athlete is able to identify that the back squat 1RM test is being used to test her maximal lower body strength. This is an example of which of the following?
Face validity
What descriptive statistic can be used when quantitative measurements are made on units that are organized into groups ?
Intraclass correlation coefficient
Which factors below can affect reliability between groups?
skill level, age, physical maturity
_____ is a measure of the degree of consistency or repeatability
reliability
what does test-retest reliability assess?
The consistency of results when repeating the test
Emily is conducting a survey to measure stress levels among college students. she develops a set of questions based on her own experiences and opinions. after administering the survey to a small group of students, she analyzes the results and claims that her survey is a valid measure of stress levels among college students. evaluate the validity of Emily’s survey and suggest improvements. What type of validity concern is evident in Emily’s approach?
content validity
which is the most true in regard to proper protocol when measuring circumferences?
measures should be taken at least twice at each site
The flexion clearing test requires the client to
start in quadruped and shift backwards into child’s pose
what does FMS stand for ?
functional movement screen
Score this patient…
patient has heels elevated for deep squat and completes movement correctly without pain
2
Bonazza et al found that clients with a composite score </=___ had an increased likelihood of injury by 2.74 times
14
what is your final score for the patient? he completed the left side without complaint and on the right side noted anterior shoulder pain 2/10 in the left shoulder end of range movement.
0
score this patient…
client id able to complete both sides without pain or loss of balance. (client’s toe is not clearing the rope in oversteps)
1
the total screen score is the sum of the …
final scores
true or false: client should complete a 5-10 minute warm-up with stretching before testing using the FMS
false
What is your client’s left side raw score for this test? Test completed without complaint of pain. (client completes rotary stability test same leg, same arm with no issues)
3
during Trendelenburg gait on the right side, what muscle is likely weak ?
Right gluteus Medius
Anthropometry & Body Composition test preparation…
Ensure all necessary documents are available in the
individual’s file and available for the test’s administration.
Ensure appropriate room temperature.
Calibrate all equipment.
As best as possible, minimize individual anxiety.
Provide a comfortable seat and/or examination table.
Why measure body composition ?
Excess body fat is associated with many chronic conditions.
body composition (adults)
~ 70.2% of American adults are classified as either overweight or obese
> 1/3 (37.7%) are classified as obese.
body composition (children)
1/3 (31.8%) of American children and adolescents are overweight or
obese.
body composition (seniors)
Health-related changes in body composition = sarcopenia
Loss of muscle and strength
Fat Mass key terms…
-FM
-Relative percentage of mass that is fat
Fat Free Mass key terms…
-FFM
- percentage of mass that is NOT fat
How to measure body composition
Anthropometry
- Height, Weight, and BMI
- Circumferences
-Skinfold measurements
Densitometry
- Hydrodensitometry
-Plethysmography
Other Techniques
-Dual Energy X-ray Absorptiometry
- Total Body Electrical Conductivity (TOBEC)
-Bioelectrical Impedance Analysis (BIA)
Anthropometric methods
-Height, Weight, and BMI
-Circumferences
-Skinfold measurements
Densitometry methods
includes hydrodensitometry (underwater weighing) and air displacement plethysmography (Bod Pod), are used to estimate body fat percentage by measuring body density or volume.
other techniques for measuring body composition
Dual Energy X-ray Absorptiometry (DEXA) considered the gold standard, while Total Body Electrical Conductivity (TOBEC) and Bioelectrical Impedance Analysis (BIA) use electrical signals to estimate body fat and lean mass.
proper procedures for measuring Height, Weight, &
BMI…
Height
o Shoes Removed
o Make sure measuring device is
parallel to the floor
Weight
o Shoes Removed
o Empty Pockets
BMI
o Calculations
o Body Weight (kg) / Height (m) squared
o (Body Weight (lbs) / Height (in) Squared)
* 703
Circumference measurements
Abdominal circumference measurements, including waist-to-hip ratio, help identify individuals with higher abdominal fat (android obesity), which is associated with increased visceral fat and a higher risk of metabolic syndrome and health problems
skinfold measurements correlation
Skinfold thickness correlates well (r = 0.70–0.90) with Hydrodensitometry values
skinfold measurements principle
The amount of subcutaneous fat proportional to the total amount
of body fat
skinfold measurements reality
The exact proportion of subcutaneous (under the skin) to total fat varies with sex, age, and race
skinfold measurements accuracy
The accuracy of predicting percent body fat from skinfolds is approximately plus/minus 3.5%, assuming appropriate techniques and equations have been used
Skinfold
Procedures
All measurements should be made on the right side of the body with
the individual standing upright.
Caliper should be placed directly on the skin surface, 1 cm away from the thumb and finger, perpendicular to the skinfold, and halfway between the crest and the base of the fold.
Pinch should be maintained while reading the caliper.
Wait 1–2 s (not longer) before reading caliper.
Take duplicate, but not consecutive, measures at each site, and
retest if duplicate measurements are not within 1–2 mm.
skinfold errors
- Poor anatomical landmark identification
- Poor measurement technique
- An inexperienced evaluator
- An extremely obese or extremely lean individual
- An improperly calibrated caliper
conversion
Percent body fat can be estimated once body density has
been determined.
The most commonly used prediction equation to estimate
percent body fat from body density was derived from the two-component model of body composition. [(4.95 / Db) – 4.50] X 100
Age, gender, race, training status, and certain disease states
may affect the density of FFM, with much of this variance
related to the bone mineral density component of FFM.
Densitometry
Estimate of total body fat % from measured whole-body
density (Ratio of Body Mass to Body Volume)
Limiting factor in measuring body density (Accuracy of body volume measurement because body mass is
measured simply as body weight)
Reference/Criterion/Gold Standard for assessing body
composition for many years (DEXA has become Gold Standard in recent years)
Hydrodensitometry (Underwater Weighing)
Ratio of Body Mass to Body Volume
Based on Archimedes Principle:
* When a body is immersed in water, it is buoyed by a
counterforce equal to the weight of the water displaced
2 people with the same mass: the person with > FFM will weigh
more in water (FFM = higher body density and lower body fat percentage)
types of densitometry
hydrodensitometry (underwater weighing) and air displacement plethysmography (bod pod)
Plethysmography (Bod Pod)
Body volume measured based on amount of air displacement
Dual chamber plethysmograph measures body volume by changes in pressure in a closed chamber
Advantage = reduced state of client anxiety compared to hydro
What does BIA stand for ?
Bioelectrical Impedance Analysis
Bioelectrical Impedance Analysis (BIA)
Runs small electrical currents through the body
The electrical conductivity is different between body tissues due
to varied water content
The speed at which the electrical current travels allow the
device to calculate body fat percentage
BIA accuracy
Limited in individuals who are obese due to differences in body
water distribution compared to those in the average weight
range
Body Composition
Norms
No Universally Accepted Norms for Body Composition
Average Ranges:
-Males: 12 – 23 % body fat
-Females: 17 – 26% body fat
Impacted by :
Age
Sex
Race
reliability
a measure of the degree of consistency or repeatability of a test
WHY CAN THE RELIABILITY DIFFER
BETWEEN GROUPS?
Skill level
Age
Physical Maturity Emotional Maturity
TYPES OF RELIABILITY
Inter-rater:
* Between 2 testers/raters
Intra-rater:
* Within the same tester/rater
Test-retest
* Consistency of results when repeating
the test
What does ICC mean?
Intraclass Correlation Coefficient
Intraclass Correlation Coefficient (ICC)
Descriptive statistic that can be used when quantitative measurements are made on units that are organized into groups
Level of Reliability
< .5 = Poor
.5 - .75 = Moderate
.75 - .9 = Good
> .9 = Excellent
VALIDITY
The degree to which a test or test item measures what is supposed to be measured
Key component of testing
A TEST MUST BE RELIABLE TO BE
VALID
TYPES OF VALIDITY (7)
-Construct Validity
-Face Validity
-Content Validity
-Criterion-referenced Validity
-Concurrent Validity
-Predictive Validity
-Discriminant Validity
Construct Validity
refers to a test’s ability to accurately measure the concept it is intended to represent, based on a theory that organizes and explains relevant knowledge and observations
Face Validity
The appearance to the athlete and other casual
observers that the test measures what it is purported to
measure
Content Validity
the evaluation by experts to ensure that a test fully covers all relevant areas or skills in the right proportions
Criterion-referenced Validity
Measures how well a test predicts an outcome
Concurrent Validity
how well a new assessment agrees with an existing assessment
Predictive Validity
The extent to which the test score corresponds with
future performance or behavior
Discriminant Validity
The ability of a test to distinguish between two different
constructs
Gait Analysis
Study of human locomotion & Walking and running (Walking is a series of gait cycles)
What is a single gait cycle called?
STRIDE
What are the Gait cycle components?
weight acceptance
single limb support
limb advancement
Gait Cycle Component: weight acceptance
most demanding task in the gait cycle
involves the transfer of body weight onto a
limb that has just finished swinging forward and has an unstable alignment.
– Shock absorption and the maintenance of a forward body progression
Gait Cycle Component: single limb support
-One limb must support the entire body weight
– Same limb must provide truncal stability while
bodily progression is continued
Gait Cycle Component: limb advancement
-Requires foot clearance from the floor
– The limb swings through three positions as it travels to its destination in front of the body
What are the 4 major criteria essential to walking
-Equilibrium
-Locomotion
-Musculoskeletal Integrity
-Neurological Control
Equilibrium
ability to assume an upright posture
& maintain balance
Locomotion
ability to initiate and maintain rhythmic
stepping
Musculoskeletal Integrity
normal bone, joint, and muscle function
Neurological Control
must receive and send messages telling
the body how and when to move. (Visual,
vestibular, auditory, sensorimotor input)
Walking Requirements
What is Stance Phase?
Foot in contact with the ground ONLY
what is Swing Phase?
Foot NOT in contact with the ground
Step vs Stride
A single gait cycle or stride is defined:
– Period when 1-foot contacts the ground to when that same foot contacts the ground again
-Each stride has 2 phases: stride phase and swing phase
What is stance phase 5 parts?
-Initial Contact (Heel Strike)
-Loading Response (Foot Flat)
– Midstance
– Terminal Stance
– Toe Off (Pre-Swing)
Stance Phase - Motions
shoulder flexes, the pelvis rotates right (in the transverse plane), the spine rotates left, the hip extends and internally rotates, the knee flexes and extends, the ankle alternates between plantarflexion and dorsiflexion, the foot pronates and supinates, and the toes flex and extend.
stance phase 1: Initial Contact (heel strike)
Initial contact is the moment when the foot first touches the ground, with the heel making contact first, while the opposite leg is finishing the terminal stance phase.
Static Positions - Initial Contact
body is aligned with the shoulder extended, pelvis rotated left, hip flexed and externally rotated, knee fully extended, ankle dorsiflexed, foot supinated, and toes slightly extended.
stance phase 2: loading response (foot flat)
The loading response phase is the period when body weight is transferred onto the stance leg, providing shock absorption, weight-bearing, and forward progression, while the opposite leg is in the pre-swing phase.
Static Positions - Loading Response
shoulder is slightly extended, the pelvis is rotated left, the hip is flexed and slightly externally rotated, the knee is slightly flexed, the ankle is transitioning from plantarflexion to neutral, the foot is neutral, and the toes are also in a neutral position.
the shoulder, pelvis, and hip are in neutral positions, the knee is fully extended, the ankle is relatively neutral, the foot is pronating, and the toes remain neutral: Midstance
phase where the body weight is aligned over the supporting foot, which advances as the opposite foot enters the midswing phase.
Static Positions at Midstance
the shoulder, pelvis, and hip are in neutral positions, the knee is fully extended, the ankle is relatively neutral, the foot is pronating, and the toes remain neutral
stance phase 4: Terminal stance
Terminal stance begins when the heel of the supporting foot lifts and continues until the opposite foot’s heel touches the ground, with body weight shifting beyond the supporting foot
Static Positions - Terminal Stance
the shoulder is slightly flexed, the pelvis is rotated left, the hip is extended and internally rotated, the knee is fully extended, the ankle is dorsiflexed, and the toes are in a neutral position.
stance phase 5: toe-off (pre-swing)
Toe-off is the second double stance phase, beginning with initial contact of the opposite foot and ending with the toe-off of the supporting foot, during which body weight shifts from one limb to the other.
Static Positions - Toe-Off
the shoulder is flexed, the pelvis is rotated right, the hip is fully extended and internally rotated, the knee is fully extended, the ankle is plantarflexed, weight is placed through the great toe, and the toes are fully extended.
Stance Phase Characteristics
During a single stride, there are 2 periods
of double limb support (both feet on
ground):
– Loading response (right) & Toe Off (left)
– Loading response (left) & Toe Off (right)
What are 3 parts of swing phase?
Initial swing
Midswing
Terminal swing
swing phase
The swing phase occurs when the foot is not in contact with the ground and involves the limb advancement, which is divided into three parts: initial swing, midswing, and terminal swing.
stance phase
stance phase occurs when the foot is in contact with the ground and includes the propulsion phase; it consists of five parts: initial contact (heel strike), loading response (foot flat), midstance, terminal stance, and toe-off (pre-swing).
Swing Phase Motions
shoulder extends, the spine rotates right, the pelvis rotates left (passively), the hip flexes and externally rotates, the knee flexes and then extends, the ankle dorsiflexes, the foot supinates (inverts), and the toes extend
swing phase 6: Initial Swing
initial swing starts when the foot is lifted off the ground and ends when it is opposite the stance foot, with footdrop gait often being most noticeable, while the opposite leg is in midstance.
Static Positions - Initial Swing
shoulder is flexed, the spine is rotated left, the pelvis is rotated right, the hip is slightly extended and internally rotated, the knee is slightly flexed, the ankle is fully plantarflexed, the foot is supinated, and the toes are slightly flexed.
swing phase 7: Midswing
Midswing begins at the end of initial swing and continues until the swinging leg is in front of the body, marking the advancement of the leg, while the opposite leg is in late midstance.
Static Positions - Midswing
the shoulder, spine, pelvis, and hip are in neutral positions, the knee is flexed 60-90°, the ankle is plantarflexed to neutral, the foot is neutral, and the toes are slightly extended.
swing phase 8: Terminal swing
Terminal swing begins at the end of midswing and ends when the foot touches the ground, completing the limb advancement.
Static Positions - Terminal Swing
shoulder is extended, the spine is rotated right, the pelvis is rotated left, the hip is flexed and externally rotated, the knee is fully extended, the ankle is fully dorsiflexed, the foot is neutral, and the toes are slightly extended
Gait Pathologies
deviations from a normal gait pattern caused by factors such as pain, injury, surgery, weakness, or balance deficits, and should be analyzed by comparing both sides of the body during the stance and swing phases of the gait cycle
Antalgic Gait
painful walking pattern characterized by reduced stance and increased swing time on the painful leg, along with increased stance and decreased swing time on the non-painful leg
Trendelenburg Gait
caused by gluteus Medius weakness, involves a lateral trunk lean toward the weak side to keep the body’s center of gravity aligned over the weak leg during the stance phase.
Flexed Knee Gait
characterized by a flexed knee, trunk, and lack of arm swing, with no initial contact or toe-off, shortened steps and strides, and a center of gravity staying within the base of support, often seen in elderly individuals with a fear of falling.
What is FMS?
screening tool used to evaluate seven
fundamental movement patterns in individuals with no current pain complaint or
musculoskeletal injury. The FMS is not intended to diagnose orthopedic problems but rather
to demonstrate opportunities for improved movement in individuals
What are the 7 FMS patterns
-deep squat
-hurdle step
-incline lunge
-shoulder mobility
-active straight-leg raise
-Trunk stability push up
-rotary stability
FMS: deep squat
challenges total body mechanics and neuromuscular control. use
it to test bilateral, symmetrical, functional mobility and stability of the hips, knees and ankles. The dowel overhead requires bilateral symmetrical mobility and stability of the shoulders,
scapular region and the thoracic spine. The pelvis and core must establish stability and control
throughout the entire movement to achieve the full pattern.
FMS: Hurdle step
an integral part of locomotion and acceleration. This movement
challenges the body’s step and stride mechanics, while testing stability and control in a single-
leg stance. The hurdle step requires bilateral mobility and stability of the hips, knees and
ankles. The test also challenges stability and control of the pelvis and core as it offers an
opportunity to observe functional symmetry.
FMS: INLINE LUNGE
places the body in a position to simulate stresses during rotation,
deceleration and lateral movements. The inline lunge places the lower extremities in a split- stance while the upper extremities are in an opposite or reciprocal pattern. This replicates the natural counterbalance the upper and lower extremities use to complement each other, as it uniquely demands spine stabilization. This test also challenges hip, knee, ankle and foot mobility and stability.
FMS: SHOULDER MOBILITY
demonstrates the natural complementary rhythm of the
scapular-thoracic region, thoracic spine and rib cage during reciprocal upper-extremity shoulder
movements. This pattern also observes bilateral shoulder range of motion, combining extension,
internal rotation and adduction in one extremity, and flexion, external rotation and abduction of
the other.
FMS: ACTIVE STRAIGHT-LEG RAISE
pattern not only identifies the active mobility of the flexed hip, but looks at the core stability within the pattern, as well as the available hip extension of the
alternate hip. This is not so much a test of hip flexion on one side, as it is an appraisal of the
ability to separate the lower extremities in an unloaded position. This pattern also challenges the
ability to dissociate the lower extremities while maintaining stability in the pelvis and core.
FMS: TRUNK STABILITY PUSH UP
pattern is used as a basic observation of reflex core stabilization and is not a test or measure of upper body strength. The goal is to initiate movement with the
upper extremities in a push up pattern without allowing movement in the spine or hips. The
movement tests the ability to stabilize the spine in the sagittal plane during the closed kinetic
chain, upper body symmetrical movement
FMS: ROTARY STABILITY
pattern is complex, requiring proper neuromuscular coordination and
energy transfer through the torso. This pattern observes multi-plane pelvis, core and shoulder
girdle stability during a combined upper and lower extremity movement. The movement
demonstrates reflex stabilization and weight shifting in the transverse plane, and it represents
the coordinated efforts of mobility and stability observed in fundamental climbing patterns.
Scoring Criteria: 0
Zero is given if the individual has pain during
any part of the movement
Scoring Criteria: 1
if the individual cannot perform the movement pattern even with compensations
Scoring Criteria: 2
if the individual can perform the movement but utilize poor mechanics and compensatory patterns to accomplish the movement
Scoring Criteria: 3
Three is given if the individual can perform the
movement without any compensations according
to the established criteria
When to use the FMS…
FMS is ideally used during pre-participation exams to identify risk factors like muscle imbalances or injury compensation and can be re-screened every 4-6 weeks to assess progress and guide adjustments in training.
