Chapter 7 – Functional Assessments: Posture, Movement, Core, Balance, and Flexibility

Expand your Knowledge

 

1. Why Should postural assessments be conducted in addition to movement screens?

 

Movement operates from a static base of alignment of the body segments, which is commonly referred to as posture. Since movement originates from this base, a postural assessment should be conducted to evaluate body-segment alignment in addition to movement screens that evaluate how posture, both good and bad, impacts the ability to move.

 

2. Define “good posture”

 

That state of musculoskeletal alignment and balance that allows muscles, joints, and nerves to function efficiently.

 

3. List the correctible and non correctible factors that may contribute to muscle imbalances and postural deviations.

 

a. Correctible: Repetitive movements; awkward positions and movements; side dominance; lack of joint stability; lack of joint mobility; imbalanced strength-training programs

 

b. Non-correctible: Congenital conditions; some pathologies; structural deviations; certain types of trauma

 

4. How might a casual conversation with a client help a personal trainer more effectively identify postural deviations during a static postural assessment?

 

Since individuals may consciously or subconsciously attempt to correct posture when they are aware they are being observed, distractions such as casual conversation may relax the client and lead to a more normal, relaxed position.

 

5. You are conducting a screen to identify ankle pronation/supination. Explain what each of the following results would indicate.

 

a. The foot collapses inward: This client may stand in a more pronated position.

b. The foot rolls outward: This client may stand in a more supinated position.

 

6. Explain the effects of pronated ankles on the body’s kinetic chain.

 

A pronated ankle position typically forces internal rotation of the tibia and slightly less internal rotation of the femur. Ankle pronation also forces rotation at the knee and places additional stresses on some knee ligaments and the integrity of the joint itself. Additionally, as pronation tends to move the calcaneus into eversion, this may actually lift the outside of the heel slightly off the ground (moving the ankle into plantarflexion). In turn, this may tighten the calf muscles and limit dorsiflexion. Ankle pronation may also lead to an anterior pelvic tilt, and therefore lumbar lordosis.

 

7. A sedentary lifestyle where the individual spends long hours in a seated position may lead to which of the five common postural deviations covered in this chapter?

 

Hip tilting (anterior)

 

8. What muscles should be suspected to be tight in each of the following scenarios?

 

a. Anterior tilt of the pelvis: Hip flexors, erector spinae

b. Posterior tilt of the pelvis: Rectus abdominis, hamstrings

c. Forward-head position: Cervical spinae extensors, upper trapezius, levator scapulae

 

9. List the five primary movements that people perform during many daily activities.

 

a. Bending/raising and lifting/lowering movements (e.g. squatting)

b. Single-leg movements

c. Pushing movements (in vertical/horizontal planes) and resultant movement

d. Pulling movements (in vertical/horizontal planes) and resultant movement

e. Rotational movements

 

10. What should a personal trainer do if a client experiences pain during a clearing test?

 

Refer the client to their physician and do not have the client perform additional assessments for that part of the body.

 

11. A client is performing the bend and lift screen. Which muscles should be strengthened during the exercise program in response to each of the following observed compensations?

 

a. The knees move inward: Gluteus medius and maximus

b. The back excessively arches: Core, rectus abdominis, gluteal group, hamstrings

c. The ankles collapse inward: Medial gastrocnemius, gracilis, sartorius, tibialis group

 

12. What is the objective of the hurdle step screen?

 

To observe simultaneous mobility of one limb and stability of the contralateral limb while maintaining both hip and torso stabilization under a balance challenge of standing on one leg.

 

13. Which of the following is NOT accurate regarding the shoulder push stabilization screen? Why?

 

a. Subjects should perform full pushups, only using modified push ups if necessary YES

b. Clients should NOT be cued to use good technique through the screen  It is important to observe the client’s natural movement.

c. Repetitions should be performed slowly YES

 

14. During the shoulder pull stabilization screen, you note that your client’s trunk rotates during the pull. What does this indicate?

 

A lack of core stability.

 

15. When performing the Thomas test for hip flexion/quadriceps length, a client is able to keep the back and sacrum flat, but the back of the lowered thigh does touch the table and the knee does not flex to 80 degrees. What muscle should the trainer suspect is tight?

 

Rectus femoris.

 

16. What movements are performed as part of Apley’s scratch test for shoulder mobility?

 

a. Shoulder extension and flexion

b. Internal and external rotation of the humerus at the shoulder

c. Scapular abduction and adduction

 

17. List the five observations that would mark the termination of the Sharpened Romberg Test

 

a. The client loses postural control and balance

b. The client’s feet move on the floor

c. The client’s eyes open

d. The client’s arms move from the folded position

e. The client exceeds 60 seconds with good postural control

 

18. What aspect of core function is assessed by the blood pressure cuff test?

 

The ability to draw the abdominal wall inward via coordinated action of the transverse abdominis and related core muscles without activation of the rectus abdominis

 

QUIZ

 

1 C; 2 A; 3 C; 4 D; 5 B; 6 D;7 C; 8 B; 9 A; 10 B

 

1. Which of the following observations would be noted as a postural deviation?

 

The cheek bone is forward of the collar bone

 

2. Which of the following postural deviations indicates that a client has medially (internally) rotated shoulders?

 

Front view: backs of hands are visible
 

3. A client should be referred to his or her physician if which of the following is found during assessments?

 

Pain during the shoulder impingement clearing test

 

4. During the bend and lift screen, which observation would indicate that the client has  tight plantarflexors?

 

Heels raise off the floor

 

5. During the hurdle step screen, you observe a client exhibiting an anterior pelvic tilt and a forward torso lean as he steps forward. What is this compensation MOST indicative of?

 

Tight-stance leg hip flexors

 

6. During the Thomas test, you observe that your client can easily lower her right thigh to about 10 degrees above the table with the knee flexed at about 90 degrees. Based on these observations, which of the following notes would you make?

 

Tightness in the right iliopsoas

 

7. Which of the following observations during the passive straight-leg raise represents normal length of the hamstrings?

 

Raised leg stops just short of 90 degrees of movement

 

8. While having a client perform the external and internal rotation test, you observe that he can rotate the forearms internally and externally to about 70 degrees, or about 20 degrees off the mat. Based on these observations, which of the following notes would you make?

 

Tight internal rotators; good mobility for external rotators

 

9. What is the purpose of stability and mobility training?

 

Restorative exercise to improve posture and movement compensations

 

10. Scapular winging during the shoulder push stabilization screen would MOST likely be due to:

 

Scapulothoracic joint instability

 

Show What You Know

 

1. One of your clients, Eileen, complains of muscle tightness along the left side of her torso. Which common postural deviation might you screen for in an attempt to identify the cause of her discomfort?

 

You should test Eileen’s shoulder position relative to her thoracic spine. One likely cause of her pain is a torso lean that shifts the alignment of the sternum (anterior) and spine (posterior), thereby creating tightness in the flexed side of the trunk. This tightness would explain why the shoulders are not level and may create uneven spacing between the arms and the torso.

 

 

 

 

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