Chapter 6 Movement Assessments

Question 1

Learning Objectives

Answer 1

Upon completion of this chapter, you will be able to:

• Explain the rationale for performing movement assessments.
• Understand the difference between transitional and dynamic movement assessments.
• Determine potential muscle imbalances based on certain movement compensations.
• Design a corrective exercise strategy to improve movement impairments.

Question 2

The Scientific Rationale for
Movement Assessments

Answer 2

Movement assessments, based on sound human movement science, are the cornerstone of a comprehensive and integrated assessment process.

Question 3

Muscle balance

Answer 3

Establishing normal length-tension relationships, which ensures the proper length and strength of each muscle around a joint.

Question 4

Kinetic chain

Answer 4

“Kinetic” denotes the force transference from the nervous system to the muscular and skeletal systems as well as from joint to joint, and “chain” refers to the interconnected linkage of all joints in the body.

Question 5

Overactive/ underactive muscles

Answer 5

The terms “overactive” and “underactive” are used in this text to refer to the activity level of a muscle relative to another muscle or muscle group, not necessarily to its own normal functional capacity. Any muscle, whether in a shortened or lengthened state, can be underactive or weak because of altered length-tension relationships or altered reciprocal inhibition (chapter three)

Alterations in muscle activity will change the biomechanical motion of the joint and lead to increased stress on the tissues of the joint, and eventual injury

Question 6

Types of Movement Assessments

Answer 6

Transitional movement assessments

Dynamic movement assessments.

Question 7

Transitional movement
assessments

Answer 7

Assessments that involve movement without a change in one’s base of support.

Question 8

Dynamic Movement
Assessments

Answer 8

Assessments that involve movement with a change in one’s base of support.

Question 9

Transitional Movement Assessments

Answer 9

1. Overhead squat
2. Single-leg squat
3. Push-up
4. Standing cable row
5. Standing overhead dumbbell press
6. Star balance excursion
7. Upper extremity assessments

Question 10

OVERHEAD SQUAT ASSESSMENT

Answer 10

This is designed to assess dynamic flexibility, core strength, balance, and overall
neuromuscular control.

These results suggest that the movement impairments observed during this transitional movement assessment may be the result of alterations in available joint motion, muscle activation, and overall neuromuscular control that can point toward people with elevated injury risk.

Question 11

Compensations: Anterior View

Answer 11

1. Feet.
   a. Do the feet flatten and/or turn out?
2. Knees:
   a. Do the knees move inward (adduct and internally rotate)?
   b. Do the knees move outward (abduct and externally rotate)?

Question 12

OSA

Compensations:
Lateral View

Answer 12

1. LPHC:
   a. Does the low back arch (excessive spinal extension)?
   b. Does the low back round (excessive spinal flexion)?
   c. Does the torso lean forward excessively?
2. Shoulder:
   a. Do the arms fall forward?

Question 13

OSA

Compensations:
Posterior View

(see chart for review)

Answer 13

1. Feet:
   a. Do the feet flatten (excessive pronation)?
   b. Do the heels rise off the floor?
2. LPHC:
   a. Is there an asymmetric weight shift?

Question 14

MODIFICATIONS TO THE OVERHEAD SQUAT ASSESSMENT

Answer 14

There are a couple of modifications to the overhead squat assessment that the health and fitness professional can make to gain a clearer picture of the possible overactive and underactive muscles. These include elevating the individual’s heels or performing the overhead squat assessment with the hands on the hips.

Question 15

MODIFICATIONS TO THE OVERHEAD SQUAT ASSESSMENT

1. Elevating Heels

Answer 15

Elevating the heels does two primary things. First, it places the foot and ankle
complex in plantarflexion, which decreases the stretch (or extensibility) required
from the plantar flexor muscles (gastrocnemius and soleus). This is important
because deviation through the foot and ankle complex can cause many of the
deviations to the kinetic chain, especially the feet, knees, and LPHC.

Question 16

MODIFICATIONS TO THE OVERHEAD SQUAT ASSESSMENT

Elevating Heels E

cont.

Answer 16

Second, it alters the client’s center of gravity (CoG) by decreasing the base of support (less or shorter contact surface of the foot on the ground) and shifting the CoG forward. When the CoG is moved forward, it allows the individual to sit more upright or lean back more. This is also important because with less forward lean there will be less hip flexion needed and less emphasis placed on the LPHC. In all, this modification allows the health and fitness professional to see the influence the foot and ankle have on the individual’s deviations.

Question 17

MODIFICATIONS TO THE OVERHEAD SQUAT ASSESSMENT

2. Hands on Hips

Answer 17

Placing the hands on the hips directly removes the stretch placed on the latissimus dorsi, pectoralis major and minor, and coracobrachialis and requires less demand from the intrinsic core stabilizers. This allows the health and fitness professional to see the influence the upper body has on the individual’s compensations.

Question 18

SINGLE-LEG SQUAT ASSESSMENT

PURPOSE

Answer 18

This transitional movement assessment also assesses dynamic flexibility, core strength, balance, and overall neuromuscular control. There is evidence to support the use of the single-leg squat as a transitional movement assessment ( 13 ). This assessment also appears to be a reliable and valid measure of lower extremity movement patterns when standard application protocols are applied.

Question 19

Single-Leg Squat Assessment

Compensations

see chart

Answer 19

1. Knee:
   a. Does the knee move inward (adduct and internally rotate)?
2. LPHC:
   a. Does the hip hike?
   b. Does the hip drop?
   c. Does the torso rotate inward?
   d. Does the torso rotate outward?

Question 20

PUSHING ASSESSMENT: PUSH-UPS

Answer 20

PURPOSE

The push-up assessment is related to pushing activities and evaluates the function of the LPHC and the scapular and cervical spine stabilizers.

Question 21

Pushing Assessment

Views

Compensation

See chart

Answer 21

1. View the knees, LPHC, shoulders, and cervical spine from the side.

The body should lift as one functional unit.

Compensations 1. LPHC:

a. Does the low back sag?
b. Does the low back round?
2. Shoulders:
a. Do the shoulders elevate?
b. Does the scapulae wing (lift away from the rib cage)?
3. Head/cervical spine:
a. Does the head migrate forward?

PUSHING ASSESSMENT OPTION
Like the pushing assessment, the pulling assessment can also be performed on a machine,
depending on the individual’s physical capabilities.

Question 22

PULLING ASSESSMENT: STANDING ROWS

Answer 22

PURPOSE

The standing row assessment is related to pulling activities and evaluates the
the function of the LPHC and the scapular and cervical spine stabilizers.

Question 23

PULLING ASSESSMENT

Compensations/ Options

Answer 23

1. Low back:
   a. Does the low back arch?
2. Shoulders:
   a. Do the shoulders elevate?
3. Head:
   a. Does the head migrate forward?

PULLING ASSESSMENT OPTION

Like the pushing assessment, the pulling assessment can also be performed on a machine, depending on the individual’s physical capabilities.

Question 24

PRESSING ASSESSMENT: STANDING OVERHEAD DUMBBELL PRESS

Answer 24

PURPOSE

The pressing assessment is related to everyday pressing activities and evaluates the function of the LPHC, scapular stabilizers, and cervical spine stabilizers as well as shoulder range of motion.

Question 25

**Standing Overhead Dumbbell Press Assessment Compensations**

Answer 25

1. Low back: a. Does the low back arch? 2. Shoulders: a. Do the shoulders elevate? b. Do the arms migrate forward? c. Do the elbows flex? 2. Head: a. Does the head migrate forward?

Question 26

**STAR BALANCE EXCURSION TEST** **Balance threshold**

Answer 26

PURPOSE This assessment measures the multiplanar balance and neuromuscular efficiency of the testing leg during closed-chain functional movements ( 18–20 ). The distance one can squat down on one leg while keeping the knee aligned in a neutral position (in line with the second and third toes).

Question 27

**UPPER EXTREMITY TRANSITIONAL ASSESSMENTS**

Answer 27

PURPOSE The upper extremity transitional assessments are used to determine any specific movement deficits in the shoulder complex. These assessments include the: ◆ Horizontal abduction test ◆ Rotation test ◆ Shoulder flexion test

Question 28

**Upper Extremity Transitional Assessments** **Compensations**

Answer 28

1. Horizontal abduction test: a. Do the shoulders elevate? b. Do the shoulders protract? c. Do the elbows flex? 2. Rotation test: a. Do the shoulders elevate (internal rotation)? b. Do the shoulders protract (internal rotation)? c. Are the hands far from the wall (internal and external rotation)? 2. Shoulder flexion test: a. Do the shoulders elevate? b. Does the low back arch? c. Do the elbows flex?

Question 29

**DYNAMIC POSTURAL ASSESSMENTS**

Answer 29

Purpose: To assess one’s dynamic posture during ambulation. * *1. Gait 2. Landing error scoring system (LESS) test 3. Tuck jump test 4. Davies test**

Question 30

**GAIT: TREADMILL WALKING**

Answer 30

PURPOSE To assess one’s dynamic posture during ambulation.

Question 31

**Dynamic Postural Assessments** **Views**

Answer 31

1. From an anterior view, observe the feet and knees. The feet should remain straight with the knees in line with the toes. From a lateral view, observe the low back, shoulders, and head. The low back should maintain a neutral lordotic curve. The shoulders and head should also be in neutral alignment. From a posterior view, observe the feet and LPHC. The feet should remain straight and the LPHC should remain level.

Question 32

**Gait: Treadmill Walking Assessment Compensations** **Anterior View**

Answer 32

1. Feet: a. Do the feet flatten and/or turn out? 2. Knees: a. Do the knees move inward? Anterior View

Question 33

**Gait: Treadmill Walking Assessment Compensations** **Lateral View**

Answer 33

1. LPHC: a. Does the low back arch? 2. Shoulders and head: a. Do the shoulders round? b. Does the head migrate forward?

Question 34

**Gait: Treadmill Walking Assessment Compensations** **Posterior View** **see chart**

Answer 34

1. Feet: a. Do the feet flatten and/or turn out? 2. LPHC: a. Is there excessive pelvic rotation? b. Do the hips hike? Posterior View

Question 35

**LANDING ERROR SCORING SYSTEM (LESS) TEST**

Answer 35

PURPOSE The LESS test is a clinical dynamic movement assessment tool for identifying improper movement patterns during the jump landing tasks ( 21, 22 ). This the test evaluates landing technique based on nine jump landing concepts using 13 different yes or no questions.

Question 36

**Landing Error Scoring System (LESS) Test**

Answer 36

The videos are evaluated as follows: a. Knee flexion angle at initial contact \>30 degrees; 0 = yes, 1 = no b. Knee valgus at initial contact, knees over midfoot; 0 = yes, 1 = no c. Trunk flexion angle at contact; 0 = trunk is flexed, 1 = not flexed d. Lateral trunk flexion at contact; 0 = trunk is vertical, 1 = not vertical e. Ankle plantar flexion at contact; 0 = toe to heel, 1 = no f. Foot position at initial contact, toes \>30 degrees external rotation; 0 = no, 1 = yes g. Foot position at initial contact, toes \>30 degrees internal rotation; 0 = no, 1 = yes h. Stance width at initial contact \< shoulders-width; 0 = no, 1 = yes

Question 37

**Landing Error Scoring System (LESS) Test** **cont**

Answer 37

h. Stance width at initial contact \< shoulders-width; 0 = no, 1 = yes i. Stance width at initial contact \> shoulders-width; 0 = no, 1 = yes j. Initial foot contact symmetric; 0 = yes, 1 = no k. Knee flexion displacement (knee position before jumping), \>45 degrees; 0 = yes, 1 = no l. Knee valgus displacement (knee position before jumping), knee inside great toe; 0 = no, 1 = yes m. Trunk flexion at maximal knee angle, trunk flexed more than at initial contact; 0 = yes, 1 = no n. Hip flexion angle at initial contact, hips flexed; 0 = yes, 1 = no o. Hip flexion at maximal knee angle, hips flexed more than at initial contact; 0 = yes, 1 = no p. Joint displacement, sagittal plane; 0 = soft, 1 = average, 2 = stiff q. Overall impression; 0 = excellent, 1 = average, 2 = poor

Question 38

**Landing Error Scoring System (LESS) Test** **Explanation**

Answer 38

A higher LESS score indicates a greater number of landing errors committed and therefore a higher risk for injury. Although the above process for the LESS test will provide the health and fitness professional with the most comprehensive analysis of one’s functional status, this assessment may be difficult to perform in some settings in which video cameras are not an option. In this case, a modified version of this assessment can be used to assess some of the primary compensations that can be indicators of potential injury. In the modified version, the health and fitness professional would view the individual from an anterior view. The primary compensations to look for would include the:

Question 39

**Landing Error Scoring System (LESS) Test** **cont**

Answer 39

1. Foot position: a. Foot position at initial contact, toes \>30 degrees external rotation; 0 = no, 1 = yes 2. Knee position: a. Knee valgus at initial contact, knees over midfoot; 0 = yes, 1 = no b. Knee valgus displacement, knee inside great toe; 0 = no, 1 = yes If these compensations are present, the professional can use Table 6. 1 to determine potential muscle imbalances that should be addressed through a corrective exercise program.

Question 40

**TUCK JUMP TEST PURPOSE** **see chart**

Answer 40

The tuck jump exercise may be useful to the health and fitness professional for the identification of lower extremity technical flaws during a plyometric activity ( 23, 24 ). The tuck jump requires a high effort level from the individual. Initially, the individual may place most of his or her cognitive efforts solely on the performance of this difficult jump. The health and fitness professional may readily identify potential deficits especially during the first few repetitions ( 23, 24 ).

Question 41

**UPPER EXTREMITY DAVIES TEST**

Answer 41

PURPOSE This assessment measures upper extremity agility and stabilization. This assessment may not be suitable for individuals who lack shoulder stability.

Question 42

**WHEN NOT TO PERFORM THE LESS, TUCK JUMP, AND DAVIES TESTS**

Answer 42

Although very helpful in uncovering movement deficiencies, these dynamic movement assessments may not be appropriate for all populations. This is one reason why subjective assessments, static posture, and transitional movement assessments are important to perform before dynamic assessments as these assessments can be used to qualify one’s ability to perform these assessments. For example, if an individual has difficulty performing the single-leg squat assessment, then the LESS and tuck jump tests may not be appropriate for that individual. Or, if an individual exhibits poor scapular stability during the push-up assessment, then the Davies test should be discouraged. In these examples, the transitional movement assessments should provide all of the answers necessary to begin developing a corrective exercise strategy.

Question 43

**SUMMARY**

Answer 43

Movement assessments are the cornerstone of an integrated assessment process ( 1, 2 ). They allow the health and fitness professional to observe the length-tension relationships, force-couple relationships, and joint motions of the entire kinetic chain. With a thorough understanding of human movement science and the use of the kinetic chain checkpoints to systematically detect compensation in joint motion, inferences as to human movement system impairments can be made ( 1–3, 9, 10 ). This data can then be correlated to other assessments such as goniometric measurements and manual muscle testing so that a comprehensive corrective strategy can be developed.