ACE CPT Chapter 7 - Functional Assessments: Posture, Movement, Core, Balance, and Flexibility
ACE Study Guide Chapter 7

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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 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 (parascapular muscles) cannot stabilize the scapulae on the rib cage. This can also be caused by a flat thoracic spine.

Thoracic spine mobility (Refer to table 7-12)

Compensations

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: 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 clients static balance by having them close their eyes in standing with a lower base of support.

Stork stand test for balance

  • You can assess the balance of your client 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 that have lower back pain, recent surgery or currently have 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 currently have 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 currently have a flare-up of lower back problems.

If you want additional study materials, check out the team over at Trainer Academy. They have incredible study materials for ACE And I have a special limited-time discount for my readers. I also suggest you check out my review on Trainer Academy here.

ACE CPT Chapter 7 - Functional Assessments: Posture, Movement, Core, Balance, and Flexibility 1
ACE CPT Chapter 7 - Functional Assessments: Posture, Movement, Core, Balance, and Flexibility 2
ACE CPT Chapter 7 - Functional Assessments: Posture, Movement, Core, Balance, and Flexibility 3

Tyler Read

Tyler Read, BSc, CPT. Tyler holds a B.S. in Kinesiology from Sonoma State University and is a certified personal trainer (CPT) with NASM (National Academy of sports medicine), and has over 15 years of experience working as a personal trainer. He is a published author of running start, and a frequent contributing author on Healthline and Eat this, not that.

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