Lesson 10: Functional Assessments Flashcards
1
Q
What is autogenic inhibition?
A
An automatic reflex relaxation caused by stimulation of the Golgi-tendon organ (GTO.)
2
Q
What is reciprocal inhibition?
A
The reflex inhibition of motor neurons of antagonists when the agonists are contracted.
3
Q
What does autogenic inhibition state that the activation of the GTO does to muscle spindle response?
A
It inhibits muscle spindle response.
4
Q
Explain the process of a static stretch (5)
A
- The low force/long duration stretch causes a small change in muscle length which stimulates low grade muscle spindle activation and temporarily increases muscle tension.
- As duration prolongs, the muscle spindles desensitize which causes a progressive decrease in low grade muscle tension - muscle relaxation.
- After 7-10 seconds, the Golgi-tendon Organ activates which means any muscle tension is inhibited to allow for further stretching.
- Holding the stretch for over 10 seconds past this past will put stress on the collagen fibers causing them to deform as they pull apart and lengthen the tissue - creep.
- After completing the stretch, the muscle spindle quickly re-establishes its stretch threshold.
5
Q
What two components could be related to the increased ROM observed after acute static stretching?
A
Reduced tension and creep in muscles.
6
Q
What does reciprocal inhibition state in terms of muscle activation on one side of the joint and its result for the antagonist muscle?
A
Reciprocal inhibition states that activation of a muscle on one side of a joint coincides with neural inhibition of the opposing muscle on the other side of the joint to facilitate movement.
7
Q
What is the stretch reflex?
A
A reflexive muscle contraction that occurs in response to rapid stretching of the muscle.
8
Q
When is the stretch reflex not present?
A
During static stretches.
9
Q
What is the difference between active and passive static stretches?
A
Passive stretches involve someone else providing the force whereas Active stretching is when you provide the force yourself to increase intensity.
10
Q
What is Proprioceptive Neuromuscular Faciliation?
A
PNF is a method of promoting the neuromuscular mechanisms through the stimulation of proprioceptors in an attempt to gain more stretch in a muscle.
It uses both autogenic and reciprocal inhibition and a contract/relax method.
11
Q
What are the 3 types of a PNF Stretch?
A
- Hold-Relax
- Contract-Relax
- Hold-Relax with Agonist Contraction
12
Q
What do all 3 of the PNF stretches start with?
A
A 10 second passive pre-stretch.
13
Q
How is the Hold-Relax PNF Stretch technique performed?
A
After the pre-stretch, the client holds and resists the provided forced so that an isometric muscle contraction holds for 6 seconds in the targeted muscle group. The client then relaxes and allows a 30 second passive stretch to increase ROM.
14
Q
How is the Contract-Relax PNF Stretch technique performed?
A
After the pre-stretch, the client pushes against the external force to cause a concentric muscle contraction throughout the full ROM of the targeted muscle group. The client then relaxes and allows a 30 second passive stretch to increase ROM.
The external force should not be so hard that there is no room for movement, it should allow the client enough room to resist and push against.
15
Q
How is the Hold-Relax with Agonist Contraction PNF Stretch technique performed?
A
After the pre-stretch, the client holds and resists the provided forced so that an isometric muscle contraction holds for 6 seconds in the targeted muscle group. Before the client fully relaxes, they perform a concentric action of the opposing muscle group.
16
Q
What is dynamic stretching?
A
Dynamic stretching mimics a movement pattern that is to be used in the upcoming workout/sport. It prepares the client’s muscles and warms them up for what is coming.
17
Q
What is ballistic stretching?
A
Ballistic stretching incorporates bounce-like movements to triggers the stretch reflex.
It has greater risk of injury.
18
Q
What do Zachaweski and Reischl believe a ballistic stretch should be like?
A
Confined to small ROM, after a static stretch and no more than 10% past the static ROM.
19
Q
What is Zachaweski’s athlete programme for ballistic stretching to reduce injury risk?
A
His programme believes that an athlete should progress from slow-velocity and control to high-velocity activity after static stretching:
- begin with slow, short-end range ballistic movements.
- progress to slow, full-range movements.
- progress to fast, short-end range movements.
- progress to fast, full-range movements.
The use of control and range are by the client themselves as there is no external force.
20
Q
What is Active-Isolated Stretching?
A
Usually used for rehabilitation, AI Stretching is hold for on 2 seconds at a time but has a higher repetition rate with a further degree of stretch after each repetition.
21
Q
Why is Active-Isolated stretching good for the muscles?
A
The repetitions and more gradual increase of motion/stretch allows the muscle to gradually progress and adjust to the stretch.
22
Q
Why is Active-Isolated stretching better for the joints than static stretching?
A
AI Stretching prepares the body for exercise and protects the joints attachments that static stretching can weaken.
23
Q
What is fascia?
A
Fascia is a densely-woven, specialised system of connective tissue that covers and unites all of the body’s compartments.
24
Q
What is the purpose of fascia?
A
To surround and support body structures which supports stability and cohesive direction for the line of pull of muscle groups.
25
How does the fascia system protect and surround the quadriceps?
The fascia that surrounds the quadriceps keeps the muscle group contained to the anterior part of the thigh whilst running vertically as to make the line of pull more effective at extending the knee.
26
When in a normal state, how does fascia appear?
Has a relaxed and wavy configuration.
27
How does fascia have the ability to move?
It can move and stretch without restrictions.
28
Why might fascia not be able to move and stretch without resitrictions?
When there has been an acute injury, repeated stress, bad posture which may cause damage to the fascia and further result in shortened fascia/muscle tissue which would lead to excessive pressure and therefore a weakened ROM and point of pain.
29
What is myofascial release?
A technique that applies pressure to the tight, restricted areas of fascia and underlying muscle in an attempt to relieve the tension and improve flexibility.
30
How does myofascial release work?
By applying pressure to the tight area, you are inhibiting the tension by stimulation the Golgi-tendon Organ to bring about autogenic inhibition.
31
How can tender areas of soft tissue be diminished?
These trigger points can be diminished by myofascial release and followed by static stretching.
32
What is the practical application of myofascial release?
Commonly done via a foam roller, the client can roll themselves back and forth of an area of 2-6 inches that covers the tender area for 30-60 seconds. Alternatively, they may choose to just hold a static position near to or on the tender point for the duration.
33
What component will determine the duration of myofascial release?
The duration is often determined by the tenderness of the area and pain tolerance of the client.
34
What does myofascial release do for the muscles/connective tissue?
Ultimately, myofascial release realigns the elastic muscle and connective tissue fibers from a bundled knot position to a straighter arrangement. It resets the proprioceptive mechanisms of the soft tissue which reduces hypertonicity within the underlying muscles.
35
What happens when is a tissue is subjected to force?
It deforms in shape.
36
What does the deformation of a tissue (when subjected to force) depend on? (3)
1. Type of tissue
2. Amount of force
3. Tissue's temperature
37
What is a tensile deformation?
When a tensile/horizontal force is applied to a tissue and causes it to lengthen.
38
What is the difference between stretching and stretch?
```
Stretching = the process of elongation
Stretch = the elongation itself
```
39
What are structures containing large amounts of collagenous fibers limited to?
Limited to stretch due to the collagen fibers tensile strength and inextensibility.
40
What happens when a collagen fiber is pulled?
The crimp of a collagen fiber will straighten and increase in length, as it does so, it releases energy which allows it to return back to its resting state once the stretch force is removed.
41
What does a collagen fiber act as?
A spring.
42
What does crimp refer to?
The wavelike folds of collagen fibers found in connective tissue.
43
What is collagen made of?
Fasciles which are further made of fibrils, subfibrils and collagen filaments.
44
At what % of stretch will the crimp of a collagen fiber be taken up?
3%.
45
What is a sarcomere?
A basic functional unit of a myofibril that contains contractile proteins that generate skeletal muscle movement.
46
What are elastic fibers responsible for? (2)
1. Determining the extensibility of muscle cells.
| 2. Reverse elasticity.
47
What is reverse elasticity?
The amount to which stretched material can return to its normal resting state.
48
What is the rupture point for an elastic fiber?
150% beyond its normal resting state.
49
What do collagen and elastic fibers work together for?
To support and facilitate joint movement.
50
How should someone try to obtain plastic/permanent tissue lengthening via stretching?
With static low force, long duration stretches and elevated tissue temperature.
51
What does the bend + lift screen do?
Helps to determine the client's symmetrical lower body extremities mobility and stability and upper body stability.
52
What does good form look like in the bend + lift screening?
Heels remain planted, ankles/knees do not fall inwards, shins stay parallel, there is no lateral shift at the torso and the neck is neutrally aligned.
53
What would knees moving inwards indicate in the bend and lift movement?
That the client's hip adductors and TFL are tight and their glute medius and maximus are inactive.
54
What would the trunk arching indicate in the bend and lift screening?
The thoracic and lumbar spine are tight/inactive.
55
What would the heels lifting and knees leading indicate in the bend and lift screening?
That the quadriceps are dominant over the glutes.
56
What are the 5 primary movement screens?
1. Bend + Lift
2. Hurdle-Step
3. Shoulder-Push Stabilization
4. Shoulder-Pull Stabilization
5. Thoracic Spine Mobility
57
What is the purpose of completing movement screens?
To allow the trainer to determine if their client shows altered neural control and to identify the origins of any movement limitations (such as muscle tightness) - these further determine the impact on the entire kinetic chain.
58
What planes must you view a client during movement screens? (2)
Frontal and sagittal.
59
How does a client complete the bend and lift movement screen?
Client holds X2 rods/poles and stands feet hip width apart. The client squats for numerous reps with no vocal ques as to allow for full conclusion.
60
What does the hurdle-step screen examine?
The simultaneous mobility of one limb and the stability of the contra-lateral limb whilst maintaining hip + torso stability all whilst balancing on one leg.
61
How does a client complete the hurdle-step screen?
A string is tied horizontally in front of the client at tibia height (shin bone.) Holding a barbell/dowl on their shoulders, the client lifts one foot over the string and taps the floor before bringing it back over and down. They should do so without shifting their weight.
62
What observations should be made during the hurdle-step screen?
How is the client stabilizing on both legs? Do they lean forward (tight hamstrings)? How do they shift weight between the left and right? How are their ankles/knees/hips?
63
What does the shoulder-push stabilization examine?
The stabilization of the scapula-thoracic joint during closed-kinetic-chain push movements.
64
How does a client complete the shoulder-push stabilization screen?
Lying prone on the floor in either full or bent-knee push up position, the client performs a series of push-ups slowly and controlled.
65
What observations should be made during the shoulder-push stabilization screening?
Any changes in the scapula position relative to the rib cage in both full and lowered position (winging scapula = unstable parascapular muscles, lumbar hyperextension = lack of core and lower back strength) and any scapular instability.
66
What is the purpose of the thoracic spine mobility screening?
To assess trunk rotation.
67
Who would the thoracic spine mobility screening be particularly helpful for?
Anyone that performs rotational activities such as golf/baseball.
68
How does a client complete the thoracic spine mobility screening?
Sitting on the edge of a bench with a block firmly in between the knees and feet planted as to not engage the hips. The client holds a dowl at the front of their shoulders and slowly rotates to the left/right, keeping their back straight and shoulders relaxed.
69
What observations should be made during the thoracic spine mobility screening?
Does the client have a 45 degree rotation on either side? Is one side lacking? Is the body compensating anywhere?
70
How much rotation does the lumbar spine allow for?
15% rotation.
71
What is good posture defined as?
The state of musculoskeletal alignment and balance that allows muscles, joints and nerves to function effectively.
72
What are 5 postural deviations? What is each one?
1. Lordosis - Increased anterior lumbar curve
2. Kyphosis - Increased posterior lumbar curve
3. Flat Back - Decreased anterior lumbar curve
4. Sway Back - Decreased anterior lumbar curve and increased posterior thoracic curve
5. Scoliosis - Lateral spine curvature often accompanied by vertebral rotation.
73
What muscles are hypertonic (shortened) and inhibited (lengthened) in the Kyhposis-Lordosis muscle imbalance?
Hypertonic: Hip flexors, lumbar extensors, anterior chest/shoulders, latissimus dorsi, neck extensors.
Inhibited: Hip extensors, external obliques, upper back extensors, scapula stabilizers, neck flexors.
74
What muscles are hypertonic and inhibited in the Flat-Back muscle imbalance?
Hypertonic: Rectus abdominis, upper-back extensors, neck extensors, ankle plantar flexors.
Inhibited: Iliacus/psoas major, internal oblique, lumbar extensor, neck flexors.
75
What muscles are hypertonic and inhibited in the Sway-Back muscle imbalance?
Hypertonic: Hamstrings, upper fibers of posterior obliques, lumbar extensors, neck extensors.
Inhibited: Iliacus/psoas major, rectus femoris, external oblique, upper-back extensors, neck flexors.
76
What classifies as a correctible muscle imbalance factor? (6)
1. Repetitive movements - muscular pattern overload
2. Awkward positions + movements - habitual poor posture
3. Side dominance
4. Lack of joint stability
5. Lack of joint mobility
6. Imbalanced strength training programmes
77
What classifies as a non-correctible muscle imbalance factor? (4)
1. Congenital conditions - scoliosis
2. Some pathologies - rheumatoid arthritis
3. Structural deviations - tibia/femoral torsion
4. Certain types of trauma - surgery, injury
78
What happens when there is proper postural + joint alignment? (5)
1. The length-tensions relationships and force-coupling relationships work effectively.
2. Promotion of joint stability and mobility.
3. Promotion of movement efficiency.
4. Allowance of body to accept and exert force throughout the kinetic chain.
5. Allowance of proper joint mechanics (arthrokinematics)
79
What is the right angle model?
A model that shows the trainer how the client's body sits in vertical alignment across the major joints (ankles, subtalar joints, knees, shoulders, head.)
80
What is the plumb line and how is it done?
The plumb line is used to measure the right angle model, a trainer attaches a string vertically from the floor to the ceiling and the client stands with it medially in front of them.
81
How should the plumb line pass/look from an anterior view?
It should pass equally between the feet and ankles and intersect the pubis, umbilicus, sternum, mandible, maxilla and frontal bone.
82
How should the plumb line pass/look from the posterior view?
It should bisect the sacrum and overlap the spinous processes of the spine.
83
How should the plumb line pass/look from the sagittal view?
It should pass through the anterior third of the knee, greater trochanter of the femur, acromioclavicular joint as well as slightly passing the anterior mastoid of the process of the temporal bone of the skull (in line with ear lobe.)
84
How should feet be planted in good posture?
Both feet should face forwards in parallel (or slight 8-10 degree rotation) and the toes should be aligned in the same direction as the feet.
85
What would a pronated subtalar joint cause?
1. Internal rotation of the tibia and slightly less internal rotation of the femur.
2. Rotation of the knees which will put stress on the ligaments.
3. Calcaneus eversion which may lift the bottom of the heels and move the ankle in to plantar flexion which will tighten the calf muscles.
86
What is the hip adduction?
The lateral tilt of the pelvis that elevates one hip above the other.
87
What happens to the line of gravity is the right hip was raised?
The line of gravity would tilt towards the left and move closer to the right thigh.
88
What is a common reason for an anterior pelvic tilt?
Tight hip flexors.
89
Why is the anterior pelvic tilt common in individuals with a sedentary lifestyle?
As individuals with a sedentary lifestyle are often seated, their hip flexor muscles shorten. When they stand, these shortened muscles pull the pelvis in to an anterior pelvic tilt.
90
What does an anterior pelvic tilt cause?
Rotation of the superior and anterior position of the pelvis downwards and forwards.
91
What does a posterior pelvic tilt cause?
Rotation of the superior and anterior position of the pelvis upwards and downwards.
92
Which of the pelvic tilts (anterior/posterior) is more likely to cause lordosis in the lumbar spine?
Anterior.
93
What are 2 causes of the anterior pelvic tilt?
1. Tight/overdominant hip flexors
| 2. Tight erector spinae muscles
94
What are 2 causes of the posterior pelvic tilt?
1. Tight/overdominant rectus abdominis
| 2. Tight hamstrings
95
What is lower cross syndrome pairing?
1. Tight/overdominant rectus abdominis
| 2. Tight hamstrings
96
What are 2 causes of the anterior pelvic tilt that accomodate the head of the femur?
1. Foot pronation
| 2. Internal femoral rotation
97
Is foot pronation or supination linked to lordosis in the lumbar spine?
Pronation.
98
What is the scapulothoracic region?
Scapula and associated muscles attaching them to the thorax.
99
What is the glenohumeral joint?
Shoulder joint.
100
When raising arms above the head, what percentage of movement comes from the scapulothoracic region and glenohumeral joint?
60% scapulothoracic region
| 120% glenohumeral joint
101
What classifies as scapula protraction?
Noticeable protrusion of the vertebral border outwards.
102
What classifies as scapula winging?
Noticeable protrusion of the inferior angle and vertebral border outwards.
103
If the palms naturally face backwards instead of to the side, what could this be a sign of?
This indicates either an internal rotation of the hemus and/or scapula protraction.
104
Where should the ear lobes align in good posture?
Over the acromion process (shoulder blade.)
105
What is a forward-head position?
The head is tilted forwards due to poor posture.
106
What would the forward-head position suggest muscle-wise?
Tight cervical extensors and lengthened cervical flexors.
107
What does faulty neural control mean?
This means there are compensations during movements due to muscle tightness or an imbalance between muscles at a joint.
108
What are the 5 primary movements?
1. Bending
2. Single-leg movements
3. Pushing Movements
4. Pulling Movements
5. Rotational Movements
109
What observations should be made with each repetition of the Bend + Lift screen in frontal view? (3)
1st rep - stability of the foot, is there pronation/supination/inversion/eversion?
2nd rep - are the knees aligned over the second toes?
3rd rep - overall symmetry of entire body, is there a lateral shift/rotation?
110
What observations should be made with each repetition of the Bend + Lift screen in sagittal view? (5)
1st rep - do the heels lift off the floor?
2nd rep - is there glute dominance/quadricep dominance?
3rd rep - does the client achieve a parallel position between the tibia and toso when lowered? Do their hamstrings rest against their calves during lowering?
4th rep - is there any lordosis in lumbar spine during lowering and lowered?
5th rep - are there any had changes during the lowering phase?
111
What observations should be made in genreal with each repetition of the Bend + Lift screen? (2)
1. Limitations and compensations
| 2. What is the impact on the entire kinetic chain?
112
What is classified as lumbar dominance during a squat?
When the pelvis pulls forwards during a squat.
113
What is the cause of lumbar dominance?
A lack of core abdominal and gluteal muscle strength that cannot counteract the force of the hip flexors and erector spinae.
114
What does lumbar dominance cause?
Excessive load on the lumbar spine.
115
What is classified as quadriceps dominance during a squat?
When the first 10-15 degrees of a squat are initiated by driving the tibia forwards so that the femur slides over the tibia. During the upward phase, the gluteus maximus cannot generate much force as it is not eccentrically loaded.
116
What does quadriceps dominance cause?
Places extra load on the anterior cruciate ligament (ACL) and extra pressure on the knees.
117
What is classified as glute dominance during a squat?
When the first 10-15 degrees of a squat include a hip hinge (pushing hips back) to eccentrically load gluteus maximus.
118
What is the preferred muscle dominance for a squat?
Glute Dominance.
119
What does glute dominance allow for?
Relieved stress on the knees and lumbar spine as well as activation of the hamstrings which pulls on the posterior tibia and relieves pressure on the ACL.
120
What is the general rule for lunge and squat movements regarding alignment of your knees and why?
They should be aligned over the second toe so that the ankle joint and knee joints are moving in the same direction.
121
What will longer limbed people find during lunge/squat movements? What should the trainer do in this case?
That their knees will move forwards and beyond their toes.
The trainer should make sure they are completing a hip hinge before movements and allow their knees to move further as this will prevent the client creating bad form, placing pressure on the lower back or falling backwards.
122
What equipment is needed during the hurdle-step screen?
X2 objects to attach string to, 36 inch piece of string and 48 inch wooden or plastic dowel.
123
What observations should be made with each rep of the hurdle-step screening in frontal view? (5)
1st - stability of the foot, is there any pronation, supination, inversion of eversion?
2nd - alignment of the stance, is the knee over the foot?
3rd - excessive hip adduction greater than 2 inches due to excessive leg-adduction/downward hip-tilting towards opposite side.
4th - stability of the torso, does the dowel move?
5th - alignment of moving leg, is there dorsiflexion at the ankle? Do the knees/ankles deviate from the sagittal plane?
124
What observations should be made with each rep of the hurdle-step screening in sagittal view? (2)
1st - stability of torso and stance leg.
| 2nd - hip mobility - do the hips allow 70 degrees of hip flexion with no compensation?
125
What general observations should be made during each rep of the hurdle-step screening?
Any movement limitation or compensations and the impact on the entire kinetic chain.
126
What is the main observation during the thoracic-spine obility screen?
Any bilateral discrepancies between rotations in each direction.
127
What is the normal ankle ROM with the knee flexed? Both dorsiflexion and plantar flexion.
Dorsiflexion - 20 degrees
| Plantar flexion - 50 degrees
128
What is the normal knee ROM with both flexion/hyperextension?
Flexion - 0-135 degrees
| Hyperextension - 10 degrees
129
What is the ROM for rotation at the hip?
Internal rotation - 35 degree
| External rotation - 50 degree
130
What is the normal ROM for hip hyperextension?
Less than 20 degrees.
131
What is the normal ROM for hip abduction?
50 degrees.
132
What is the normal ROM for hip flexion with no pelvic rotation?
120 degrees.
133
What is the normal shoulder rotation ROM in the transverse plane?
Internal - 90 degrees
| External - 90 degrees
134
What is the normal ROM for shoulder rotation in the sagittal plane?
Internal - 70-80 degrees
| External - 90-100 degrees
135
What is the normal shoulder rotation ROM in the transverse plane?
Horizontal adduction (flexion) - 130 degrees
Horizontal abduction - to 0 from 130 degrees
Horizontal Extensions - 45 degrees past neutral position
136
What is the normal shoulder ROM in the frontal plane?
Abduction - 180 degrees
Adduction - to 0 from 180 degrees
Hyperadduction - 75 degrees
137
What is the normal shoulder ROM in sagittal plane?
Flexion - 180 degrees
Extension - to 0 from 180 degrees
Hyperextension - 60 degrees
138
What is the purpose of the Thomas Test?
To assess length of the muscles involved in hip flexion and primary hip flexors.
139
What are the two primary hip flexors?
1. Hip flexors/iliopsoaos
| 2. Rectus Femoris - one of the 4 quadricep muscles.
140
How do you complete the Thomas Test?
Client sits at the end of a table with the edge aligned mid-thigh. Trainer places on hand on their back and the other beneath thigh and supports the client as they flex on thigh towards chest and rolls back on to table allowing their back and sacrum to lie flat.
The test is complete once the client's lower back is completely flat.
141
What observations should be made during the Thomas Test?
1. Does the back of the lowered thigh touch the table throughout?
2. Does the knee on the lowered leg exhibit 80 degrees flexion?
3. Does the knee move into internal or external rotation?
142
How can you tell there are tight hip flexors through the Thomas Test?
When the back/sacrum is flat but the the lowered thigh is not touching the table and the knee does not flex to 80 degrees.
143
How can you tell there are tight iliopsoas through the Thomas Test?
When the back/sacrum are flat and knee is flexed to 80 degrees but the lowered thigh does not touch the table/
144
Why does tight iliopsoas cause movement limitations in the Thomas Test?
Tight iliopsoas prevents the hips from rotating posteriorly which stops the tight from touching the table.
145
How can you tell if there are tight Rectus Femoris muscles through the Thomas Test?
The back and sacrum lie flat as does the lowered thigh but the knee does not flex to 80 degrees.
146
Why do tight Rectus Femoris muscles cause movement limitation in the Thomas Test?
As the Rectus Femoris is one of 4 quadricep muscles, if they are tight then they will not allow the knee to bend properly.
147
How do you perform the Passive Straight Leg Raise test?
Client lies supine with legs extended and lower back/sacrum flat on a stable table/mat. The trainer places one hand underneath one calf and the other under the lumbar spine. The client gently plantar flexes their ankles so that their toes point away from them and they slowly raise on leg until there is firm pressure felt beneath the lower back on the trainers hand.
148
What observations should be made during the Thomas Test?
What is the degree of movement attained before there is pressure felt on the hand or when the opposite leg begins to visibly lift up?
149
What would normal hamstring length look like from the Thomas Test?
When the raised leg achieves more than or equal to 80 degrees of movement before the pelvis rotations posteriorly.
150
What would tight hamstrings look like via the Thomas Test?
When the raised leg achieves below 80 degrees of movement before the pelvis rotates posteriorly and the opposite leg clearly lifts from the table/mat.
151
How is a Shoulder Flexion test completed?
The client lies supine on a mat, arms by their side, back flat and knees bent. They tense their abdominal muscles as to hold a neutral spine and slowly raise their arms overhead in to shoulder flexion. Keeping them close to their head, they try to touch their forearms and palms to the floor overhead.
152
What should be avoided during a Shoulder Flexion test?
Arching of the lower back or depressing of the rib cage.
| Depression of the rib cage will pull the shoulders up.
153
How is a Shoulder Extension test completed?
The client lies prone on a mat with their arms by their sides, legs extended and forehead on a pillow. They raise both arms in to extension off the mat but keep them close the sides of their head.
154
What should be avoided during a Shoulder Extension test?
Arching of the lower back, rotation of the torso and lifting of the chest/head off the mat.
155
What observations should be made in either the shoulder flexion/extension tests? (3)
The degree of movement in each direction.
Any bilateral differences between left/right arms in both movements.
Any limitations.
156
What would good mobility look like in the Shoulder Flexion test?
The ability to raise arms 170-180 degrees.
157
What could the inability to flex shoulders 170 degrees in the shoulder flexion test indicate?
Tightness in either the pectroalis major/minor, latissimus dorsi, teres major, rhomboids or subscapularis.
158
Why may the lower back arch during the shoulder flexion test?
Due to tight latissimus dorsi.
159
Why may the scapula tilt forward and prevent arms from touching the floor in a shoulder flexion test?
Due to tight pectoralis major or core muscles.
160
Why may the thoracic spine round and prevent arms from touching the floor in a shoulder flexion test?
Due to thoracic kyphosis which is the bending of the spine forwards.
161
What would good mobility look like in the Shoulder Extension test?
The ability to extend the shoulders to 50-60 degrees off the floor.
162
What would the inability to extend the shoulders to 50 degrees indicate in the shoulder extension test?
Tightness in either the pectoralis major, abdominals, subscapularis, certain shoulder flexors, coracobrachialis and biceps brachii.
163
Which muscle group will prevent normal extension of the thoracic spine and rib cage in the shoulder extension test?
Abdominals.
164
What would indicate tight biceps brachii in the shoulder extension test?
Prevention of good extension with an extended elbow but reasonably better extension with a bent elbow.
165
How is the External Rotation of the Humerus (at shoulder) Test completed?
Client lays supine with their back flat and knees bent, the abduct their arms by 90 degrees with their elbows bent and forearms perpendicular to the mat. The back of the forearms must remain on the mat as they slowly rotate the forearms back down towards the mat whilst maintaing the original 90 degree bend until the forearms and backs of hands lie on the mat.
166
Why should a client keep their abdominals tight during the external rotation of the humerus test?
This will avoid any lifting of their lower back and therefore flexing of the spine forwards.
167
How is the Internal Rotations of the Humerus (at shoulder) test completed?
Client lays supine with their back flat and knees bent, the abduct their arms by 90 degrees with their elbows bent and forearms perpendicular to the mat. The back of the forearms must remain on the mat as they slowly rotate their forearms towards the mat, turning their palms to face downwards whilst maintaining the original 90 degree bend.
168
What should the client avoid doing during an Internal Rotation of the Humerus test?
Lifting of the shoulders or flexing of the spine forwards.
169
What observations should be made during either Internal/External Rotation of Humerus tests?
Measurements of degree of movements in each direction and any bilateral differences between left/right.
170
What is the Apley's Scratch test and its purpose?
The combination of shoulder flexion/extension, internal/external rotation of humerus and scapular adduction/abduction to assess many simultaneous movements of the shoulder girdle.
171
How would you perform the shoulder flexion/external rotation/scapular abduction Apley Scratch test and what should be avoided?
From either seated or standing, the client raises on arm overhead and bends the elbow. They rotate their arm outwards whilst reaching behind their head with palm facing inwards to touch the medial border of the contralateral scapula OR as far down spine as possible.
Client should avoid rotation of torso or arching of lower back.
172
How would you perform the shoulder extension/internal rotation/scapular adduction Apley Scratch test and what should be avoided?
From either seated or standing, the client reaches on arm behind their back and bends the elbow. They rotate their arm inwards so the palms face outwards to touch the inferior angle of the contralateral scapula OR as far up spine as possible.
Client should avoid excessive arching of lower back or any torso rotation.
173
What observations should be made during the Apley Scratch tests?
The ability to touch medial border of contralateral scapula/inferior angle of contralateral scapula in flexion/external rotation and extension/internal rotation and any bilateral differences between left/right arms in both movements.
174
What is the objective of a Sharpened Romberg Test?
To assess static balance by standing with a reduced base of support and removing visual sensory information.
175
How do you complete the Sharpened Romberg Test?
Client removes their shoes and stands with one foot directly in front of the other. Once they feel stable, client closes their eyes and the timer starts until they either show unstability or reach the 60 seconds mark.
This is repeated twice on each leg.
176
Why would you stop timing during the Sharpened Romberg Test? (5)
1. Client loses postural control/balance
2. Client moves their feet
3. Client opens their eyes
4. Client moves their arms
5. Client exceeds 60 seconds with good postural control
177
What is the objective of the Stork-Stand test?
To assess static balance by standing on one foot in a modified stark-stand position.
178
How do you complete the Stork-Stand test?
Client removes shows and stands with feet together and hands on hips. They lift one foot off the floor and place it gently on the inside of the opposing leg. Timer begins when the client lifts the heel of their stance leg so that they balance on the ball of their foot and until they reach 60 seconds. Repeat 3 times on each leg.
179
Why would you stop timing during the Stork-Stand test? (5)
1. Hands come off hips
2. Foot inverts/everts/moves
3. Elevated leg loses its contact with stance leg
4. Heel lowers to ground
5. Client loses balance
180
What are good/bad results for both Stork-Stand and Sharpened Romberg Tests for female/male?
Male - good >50 seconds, bad <20 seconds
| Female - good >30 seconds, bad <10 seconds
181
What is the McGills Torso Endurance Test Battery?
A combination of 3 tests to assess the endurance capacity of the torso muscles/an imbalance.
182
What does the Trunk Flex Endurance test assess?
The muscular endurance of the deep core muscles.
183
Who is the Trunk Flex/Lateral Endurance test not suited for?
Someone with low back pain, a back injury or recent surgery or acute low back flare up.
184
How do you perform the Trunk Flex Endurance test?
Client starts seated with hips and knees bent at 90 degrees and aligned with second toe. Their arms are folded across their chest with hands touching either shoulder. They lean against a board at 60 degrees and engage abdominal muscles whilst keeping shoulders open and back flat. The trainer moves the board back by 4 inches and times how long the client can hold this position.
185
Why would you stop timing during the Trunk Flex Endurance Test?
Any changes in trunk position:
1. Deviation of neutral spine such as rounding of shoulder and lower back arch
2. Back touches board
186
What does the Trunk Lateral Endurace Test assess?
The muscular endurance of lateral core muscles.
187
How do you perform the Trunk Lateral Endurance Test?
Client is on one side with legs extended and feet stacked atop each other. One arm lies beneath and the other on their opposing side, when ready, the client pushes up into a full side-bridge position. The lower arm is directly beneath the shoulder, elbow bent and forearm facing forward; hips are elevated and body is in a straight line. Timing begins when they push up to a side-bridge.
188
Why would you stop timing during a Trunk Lateral Endurance test?
Deviation from neutral spine or shift of hips either backwards/forwards.
189
What does the Trunk Extensor Endurance test assess?
The muscular endurance of torso extensor muscles.
190
Who might the Trunk Extensor Endurance test not be suitable for?
Someone who has major strength deficiencies, high body mass or suffers from lower-back pain/injury.
191
How would you perform the Trunk Extensor Endurance test?
Client lies prone on a table with their iliac crests at the tables edge and arms supporting the upper extremities by reaching to the floor. Whilst they are supporting themselves, the trainer straps their lower body down as to anchor it. When ready, client lifts themselves until their upper body is parallel to the floor and arms are crossed over their chest. Timing begins when this position is reached and stopped when they can no longer hold themselves up.
