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

Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.

 

1. Static postural assessment
   1. Structural integrity – that state of musculoskeletal alignment and balance that allows muscles, joints, and nerves to function efficiently
   2. Kyphosis-lordosis muscle imbalances
      1. Shortened (facilitated/hypertonic)
         1. Hip flexors, lumbar extensors, anterior chest/shoulders, latissimus dorsi, neck extensors
      2. Lengthened (inhibited)
         1. Hip extensors, external obliques, upper-back extensor, scapular stabilizers, neck flexors
   3. Flat-back muscle imbalances
      1. Shortened (facilitated/hypertonic)
         1. Rectus abdominis, upper back extensors, neck extensors, ankle plantar flexors
      2. Lengthened (inhibited)
         1. Iliacus/psoas major, internal oblique, lumbar extensors, neck flexors
   4. Sway-back muscle imbalances
      1. Shortened (facilitated/hypertonic)
         1. Hamstrings, upper fibers of posterior obliques, lumbar extensors, neck extensors
      2. Lengthened (inhibited)
         1. Iliacus/psoas major, rectus femoris, external oblique, upper-back extensors, neck flexors
   5. Muscle imbalances
      1. Correctable
         1. Repetitive movements, habitually poor posture, side dominance, lack of joint stability/mobility, imbalanced strength programs
      2. Non-correctible
         1. Congenital conditions (scoliosis), some pathologies (rheumatoid arthritis), structural deviations, certain traumas (surgery, amputation, etc…)
   6. Deviation 1: ankle pronation/supination
      1. Pronation: arch flattening
         1. Foot movement: eversion
         2. Tibial (knee) movement: internal rotation
         3. Femoral movement: internal rotation
         4. plane of view: from front
      2. Supination: high arches
         1. Foot movement: inversion
         2. Tibial (knee) movement: external rotation
         3. Femoral movement: external rotation
         4. View: from front
   7. Deviation 2: Hip adduction (hip hiking)
      1. Lateral tilt of pelvis, elevates one hip
   8. Deviation 3: pelvic tilting (anterior or posterior)
      1. Anterior pelvic tilt: superior, anterior portion of pelvis (ASIS) rotates downward and forward. Saggital view
         1. Dumps water out of the front of the bucket
         2. Associated with: tight hip flexors, sedentary lifestyle, lots of time spent sitting (shortened hip flexor position0
      2. Posterior pelvic tilt: superior, posterior portion of pelvis (ASIS) rotates downward and backward
         1. Dumps water out of the back of the bucket
         2. Associated with: Tight/over dominant rectus abdominis coupled with tight hamstrings
   9. Deviation 4: shoulder position/thoracic spine
      1. Elevation, depression, adduction, abduction, upward rotation, downward rotation
      2. Observations and suspected tight muscles
         1. Shoulders not level: tight upper trapezius, levator scapula, rhomboids
         2. Asymmetry to midline: laterl trunk flexors (flexed side)
         3. Protracted (forward, rounded): serratus anterior, anterior scapulohumeral muscles, upper trapezius
         4. Medially rotated humerus: pectoralis major and latissimus dorsi (shoulder adductors), subscapularis
         5. Kyphosis and depressed chest: shoulder adductors, pectoralis minor, rectus abdominus, internal oblique
   10. Deviation 5: head position (saggital view)
       1. Forward head position = tight cervical spine extensors, upper trapezius, levator scapulae (saggital view)
2. Movement Screening
   1. 5 primary movements
      1. Bending/raising and lifting/lowering movements (squatting)
      2. Single-leg movements
      3. Pushing movements (in vertical/horizontal planes) and resultant movements
      4. Pulling movements (in vertical/horizontal planes) and resultant
      5. Rotational movements
   2. Bend and lift (table 7-9)
      1. Compensations
         1. Anterior view, Knees move inward
            1. Overactive (tight) hip adductors, TFL
            2. Underactive (lengthened) gluteus medius and maximus
         2. Sagittal view, movement initiated at knees
            1. Indicates quadricep and hip flexor dominance
            2. Insufficient activation of glutes group
         3. Sagittal view, back excessively arches (lumbar and thoracic spine view)
            1. Tight hip flexors, back extensor, latissimus dorsi
            2. Underactive core, rectus abdominis, gluteal group, hamstrings
         4. Sagittal view, back rounds forward (same view focus as 3)
            1. tight latissimus dorsi, teres major, pectoralis major and minor
            2. underactive upper back extensors
   3. Hurdle step (table 7-10)
      1. Compensations
         1. Anterior view, stance-leg hip rotation (inward)
            1. Tight stance-leg or raised-leg internal rotators
            2. Underactive stance-leg or raised-leg external rotators
         2. Anterior view, hiking of raised hip (looking at raised-leg)
            1. Tight stance-leg hip flexors (limits posterior hip rotation during raise)
   4. Shoulder push stabilization (table 7-11)
      1. Compensations
         1. Sagittal view, “winging” during the push-up movement at scapulothoracic joint
            1. Parascapular muscles (serratus anterior, trapezius, levator scapula, rhomboids) are unable to stabilize the scapulae against the rib cage. Can also be due to flat thoracic spine
   5. Thoracic spine mobility (table 7-12)
      1. Compensations
         1. Transverse view, bilateral discrepancy (assuming no previous issues)
            1. Possible side-dominance
            2. Possible differences in paraspinal developments
            3. Possible torso rotation, possible associated with some hip rotation
3. Assessing flexibility and muscle-length
   1. Thomas test (hip flexion/quadriceps length)
   2. Passive straight-leg (PSL) raise
      1. Assess length of hamstrings
      2. At least 80 degrees of flexion before pelvis rotates posteriorly = normal hamstring length
   3. Shoulder mobility
      1. Flexion and extension
         1. Ability to flex shoulders to 170-180 degrees = good shoulder mobility
      2. Internal and external rotation of humerus at shoulder test
      3. Apley’s scratch test for shoulder mobility
         1. Ability to touch specific landmarks indicates good shoulder mobility
4. Balance and core
   1. Sharpened Romberg test
      1. Assess static balance by standing with reduced base of support and eyes closed
   2. Stork-stand balance test
      1. Assess static balance by standing on one foot in a modified stork-stand position
   3. Mcgill’s torso muscular endurance test
      1. Trunk flexor endurance test
         1. Contraindications: Test may not be suitable for those with low-back pain, had recent back surger, and/or are in the midst of acute low-back flare up
      2. Trunk lateral endurance test
         1. Contraindications:
            1. May not be suitable for those with shoulder pain or weakness
            2. May not be suitable for those suffering from low-back pain, had recent back surgery, and/or are in midst of low-back flare-up
      3. Trunk extensor endurance test
         1. Contraindications:
            1. May not be suitable for those with major strength deficiencies
               1. Individual cannot even lift the torso from a forward flexed position to neutral position
            2. Client with high body mass
            3. Low-back pain, recent back surgery, acute low-back flare-up

 

Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.