Screening & Assessing: A Holistic Approach Role Of The Fitness Professional Fitness professionals must assess clientele, but need to understand the difference between medical diagnosis vs fitness limitations. The assessment role of the trainer is to: Screen for current or potential injuries Evaluate posture Evaluate movement Refer out all medical concerns. Causes of Fitness Related Injuries Previous Injuries Asymmetries Lack of proper joint centration Dysfunctional movement patterns Mobility/Stability issues The Assessments The purpose of the assessments performed is to give you a tool to identify limitations in movement, compensations, and asymmetries. A complete assessment protocol should include: Static Assessments Dynamic Assessments Movement Screening Static Posture Test Tall Standing Relaxed The plumb line should fall as follows: The line begins at the ear. Midway through the shoulder Through the lumbar spine Slightly posterior to hip joint. Slightly anterior to the axis of the knee Slightly anterior to the ankle 1
Foot Supination Shorten Muscles: Tibialis anterior Tibialis posterior Medial gastrocnemius Soleus Hip External Rotators Peroneals Lateral Gastrocnemius Foot Pronation Gastrocnemius Soleus Peroneals Hip Internal Rotators Lengthened Muscles Tinialis anterior Tibialis posterior Intrinsic foot muscles Hip External Rotators Tensor Fascia Latae Adductors Semitendinosis Semimembranosis Abdominals Gluteus Maximus Gluteus Medius Gluteus Minimus Biceps Femoris Knees Valgus Hip External Rotators Biceps Femoris Gluteus Max, med, min Tensor Fascia Latae Lengthened Muscles Adductors Semimebranosis Semitendinosis Knees Varus Lumbar Spine and Pelvic Posture Stand with the head, mid back, and hips against a wall. Slide your hand behind your back by the lumbar curve. Should be able to slide hand to about knuckles Anterior Pelvic Tilt Lumbar Extensors Psoas Rectus Femoris Adductors Tensor Fascia Latae Abdominals Hamstrings Gluteus Max, Med, Min 2
Posterior Pelvic Tilt Hamstrings Gluteus Maximus Abdominals Psoas Iliacus Lumbar Extensors Thoracic Spine Cervical Erectors Pec Minor/Major Upper Trapezius Scalenes Levator Scapulae Lengthened Muscles Deep Cervical Flexors Rhomboids Serratus Anterior Middle/Lower Trapezius Cervical Spine and Head Forward Head Posture Suboccipital muscles Sternocleidomastoid Lengthen Muscles: Deep Cervial Flexors Arms Overhead Side View The shoulder should flex to 180 degrees without increase lumbar curve. The lower ribcage should not stick out more than the relaxed test. The inferior angle of the scapula should reach the midline of the trunk Arms Overhead Rear View Provides information regarding the ability to fully flex or abduct the shoulder and how far scapulae will upwardly rotate. Shoulders Flex 180 degrees Scapulae upwardly rotate 60 degrees No Shrugging Hands on Hips Demonstrates proper scapula stability. Scapulae are equidistant from the spine One is not higher than the other Scapula rest against the ribcage without winging. 3
Arms Behind Head Single Leg Dynamic ROM Tests Provides information about general strength and stability in the trunk as well as hip flexion and extension flexibility Hip flexes >90 degrees Support leg fully extended Neutral Spine Ankle Dorsiflexion Knee Flexion Lie prone with legs straight. Bend on knee as far as possible without allow the spine to extend or rotate Optimal ROM is 120 degrees Straight Leg Hip Flexion Lie supine with your hands behind your lower back Raise one leg as high as possible without bending the kneed or change in lumbar curve. Optimal ROM is 70 degrees Hip and Knee Flexion Line supine with hands behind lower back. Raise the knee to the chest as high as possible without changing the lumbar curve. Optimal ROM is 120 degrees. 4
Seated Hip Rotation Thoracic Rotation To perform this test, from a seated position place a ball or block between your knees. Give yourself a hug and rotate to the left and right as far as possible. Look for approx. 60 degrees of rotation Shoulder Flexion Lie face up and raise both arms fully overhead and attempt to touch the floor above your head. Should be able to reach 180 degrees without internally rotating the shoulder or bending the elbows. Lie face up with your arms abducted 90 degrees and your elbow bent 90 degrees. Bring the back of your hand to the floor for external rotation Bring the palm of your hand to the floor for internal rotation Shoulder Rotation Scratch Tests Cervical Flexion To test, keep the teeth closed and bend the head forward You should be able to touch your chin to your chest. 5
Movement Screening Static Tests and Rom test may show basic mobility and stability Movement screening makes the client show they can perform movement with proper stability and mobility Steps to Movement Screening 1. Perform global movement pattern 2. Remove body parts 3. Unload the movement 4. Passive vs. Active The Toe Touch is a fundamental movement. Start standing tall with feet together. Have client bend forward and touch toes. Can they do it? Does it look functional? Toe Touch Screen Remove Body Parts Have the client perform the test on one leg at a time. Removing one leg may show an asymmetry. If this test improves the toe touch it demonstrates one leg is causing the issue. Unloaded Squat Passive Vs. Active Movement Don t assume tight hamstrings if they can t touch standing. Unload or provide stability If they now can, it shows lack of stability not mobility. 6
Assessing Performance/Skill Once mobility and posture have been assessed. Assess for performance and skills that are relevant to clients goals. Strength Power Agility Tasks Sit To Stand Test European Journal of Cardiovascular Prevention 2012. Participants told to sit up and stand with as little support as possible. Scoring below an 8/10 had mortality rates 2 5X higher. 7