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

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Static postural assessments

Structural integrity: The alignment and balance of the musculoskeletal system. Allows for joints, muscles, and nerves to function efficiently together.

Kyphosis lordosis muscular imbalances

Shortened muscles (hypertonic/facilitated)

• Lumbar extensors, hip flexors, anterior shoulders/chest, neck extensors, and latissimus dorsi

Lengthened muscles (inhibited)

• External obliques, scapular stabilizers, hip extensors, neck flexors, and upper back extensor

Flatback muscle imbalances

Shortened muscles (hypertonic/facilitated)

• The rectus abdominis, neck extensors, upper back extensors, and ankle plantar flexors

Lengthened muscles (inhibited)

• Psoas major/iliacus, lumbar extensors, internal obliques, and neck flexors

Swayback imbalances

Shortened muscles (hypertonic/facilitated)

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• Lumbar extensors, hamstrings, upper fibers of posterior obliques, neck extensors

Lengthened muscles (inhibited)

• Psoas major/iliacus, external obliques, neck flexors, rectus for Morris, and upper back extensors

Muscular imbalances

Correctable conditions

• Poor posture from habit, repetitive movements, bad joint mobility/stability, side dominance, and strength programs that are not balanced.

Non-correctable conditions

• Certain pathologies (rheumatoid arthritis), congenital conditions (such as scoliosis), structural deviations, and traumas (amputation and surgeries, etc.)

Deviation #1: Ankle supination/pronation

Supination – high arches

• Inversion foot movement
• knee (tibial) movement – external rotation
• Viewpoint: from the front
• Femoral movement – external rotation

Pronation – Arch flattening

• Eversion foot movement
• Knee (tibial) movement – Internal rotation
• Viewpoint: from the front
• Femoral movement – Internal rotation

Deviation #2: Hip adduction/hiking

One hip is elevated due to a lateral tilt of the pelvis

Deviation #3: Pelvic tilting (posterior or anterior)

Posterior pelvic tilt – The superior and posterior portion of the pelvis (ASIS) rotates backward and downward.

• A good way to remember this is like dumping water out of the back of a bucket
• Dominant/tight rectus abdominis and tight hamstrings

Anterior pelvic tilt – The anterior and superior portion of the pelvis (ASIS) rotates forward and downward from the sagittal view

• A good way to remember this is by pouring water out of the front of a bucket
• Tight hip flexors. Associated with a sedentary lifestyle and the majority of the time sitting down.

Deviation #4: The positions of the shoulder/thoracic spine

Depression, elevation, abduction, adduction, downward rotation, and upward rotation

Suspected overactive/tight muscles and observations

• Shoulders that are not level – Tight/overactive upper trapezius, rhomboids, and levator scapula
• Asymmetry to midline – flexed side/lateral trunk flexors
• Forward rounded shoulders (protracted) – Upper trapezius, Serratus anterior, and anterior scapulohumeral muscles
• Depressed chest/kyphosis – Pectoralis minor, internal obliques, rectus abdominis, and shoulder adductors
• Medially rotated humorous – latissimus dorsi and pectoralis major, subscapularis

Deviation #5: Head positioning in the sagittal view

The forward head position – Overactive/tight upper trapezius, cervical spine extensors, and levator scapulae.

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Movement screening

The five primary movements :

• Raising/bending and lowering/lifting movements such as squatting
• Single/one-leg movements
• Pushing movements(in the horizontal/vertical planes) and resultant movements
• Pulling movements (in horizontal/vertical planes) and resultant movements
• All of the rotation movements

Lift and bend (Refer to Table 7-9)

Compensations

Knees move inward in the anterior view

• Tight/overactive hip adductors and TFL
• Lengthened/underactive gluteus Maximus and medius

When the movement initiates at the knees sagittal view

• Not enough glute activation
• Indicates hip flexor and quadriceps dominance

Back arches extensively in sagittal view

• Tight/overactive latissimus dorsi, back extensors, and hip flexors
• Loose/underactive rectus abdominis, core, hamstrings, and gluteal group

Back rounds forward in the sagittal view (Has the same focus as number three)

• Underactive/loose upper back extensors
• Overactive/tight Teres major, Peck minor and major, and latissimus dorsi

The hurdle step (Refer to Table 7-10)

Compensations

Inward leg hip rotation in the anterior view

• Raised leg internal rotators or a tight stance leg
• Raised leg external rotators or an underactive stance leg

The hiking of the raised hip from the anterior view

• A tight stance leg hip flexors (Will limit the posterior hip rotation during the raise)

Shoulder push stabilization (Referred to Table 7-11)

Compensations

Noticeable “winging” during the push-up movements at the scapulothoracic joint (sagittal view)

• The trapezius, levator scapula, serratus anterior, and rhomboids (periscapular muscles) cannot stabilize the scapulae on the rib cage. A flat thoracic spine can also cause this.

Thoracic spine mobility (Refer to Table 7-12)

Compensations

A bilateral discrepancy in the transverse view (assuming they had no other previous issues)

• Side dominance possibility
• Possible paraspinal development differences
• Possible torso rotation (Maybe connected to hip rotation)

Flexibility assessments and muscle length

The Thomas test (Quadriceps/hip flexion length)

PSL (Passive straight leg) raise

To test hamstring length

A normal hamstring length: moving at least 80° of flexion before posterior pelvic rotation

Shoulder mobility

Extension and flexion

• Good shoulder mobility: The client can flex shoulders to 170 to 180 degrees

External and internal rotation of the humerus at the shoulder test

Apley’s scratch test (shoulder mobility)

• If your client can touch certain spots, this shows good shoulder mobility

Core and balance

Sharpened Romberg test

• This will assist your client’s static balance by having them close their eyes in standing with a lower support base.

Stork stands the balance test.

• You can assess your client’s balance by having them stand on 1 foot in a stork stand position.

Mcgill’s torso muscular endurance test

• Endurance test for the trunk flexor
• Contraindications – Not good for people with lower back pain, recent surgery, or a flare-up of lower back problems.

Trunk collateral endurance test

• Contraindications
• Not good for clients that have shoulder pain or weakness in the shoulders
• Not good for people that have lower back pain, recent surgery, or a flare-up of lower back problems.

The trunk extensor endurance test

• Contraindications
• Not the best for clients that have deficiencies in strength
• Example: a client that cannot lift their torso to a neutral position from a forward flexed position

Clients that have a very high body mass

Not good for people that have lower back pain, recent surgery, or a flare-up of lower back problems.

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