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
    1. Shortened muscles (hypertonic/facilitated)
      • Lumbar extensors, hip flexors, anterior shoulders/chest, neck extensors, and latissimus dorsi
    2. Lengthened muscles (inhibited)
      • External obliques, scapular stabilizers, hip extensors, neck flexors, and upper back extensor
  • Flatback muscle imbalances
    1. Shortened muscles (hypertonic/facilitated)
      • The rectus abdominis, neck extensors, upper back extensors and ankle plantar flexors
    2. Lengthened muscles (inhibited)
      • Psoas major/iliacus, lumbar extensors, internal obliques and neck flexors
  • Swayback imbalances
    1. Shortened muscles (hypertonic/facilitated)
      • Lumbar extensors, hamstrings, upper fibers of posterior obliques, neck extensors
    2. Lengthened muscles (inhibited)
      • Psoas major/iliacus, external obliques, neck flexors, rectus for Morris and upper back extensors
  • Muscular imbalances
    1. Correctable conditions
      • Poor posture from habit, repetitive movements, bad joint mobility/stability, side dominance and strength programs that are not balanced.
    2. 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
    1. Supination – high arches
      • Inversion foot movement
      • knee (tibial) movement – external rotation
      • Viewpoint: from the front
      • Femoral movement – external rotation
    2. Pronation – Arch flattening
      • Eversion foot movement
      • Knee (tibial) movement – Internal rotation
      • Viewpoint: from the front
      • Femoral movement – Internal rotation
  • Deviation #2: Hip adduction/hiking
    1. One hip is elevated due to a lateral tilt of the pelvis
  • Deviation #3: Pelvic tilting (posterior or anterior)
    1. 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
    2. 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
    1. Depression, elevation, abduction, adduction, downward rotation, and upward rotation
    2. 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
    1. The forward head position – Overactive/tight upper trapezius, cervical spine extensors, and levator scapulae.

Movement screening

  • The five primary movements
    1. Raising/bending and lowering/lifting movements such as squatting
    2. Single/one leg movements
    3. Pushing movements(in the horizontal/vertical planes) and resultant movements
    4. Pulling movements (in horizontal/vertical planes) and resultant movements
    5. All of the rotation movements
  • Lift and bend (Refer to table 7-9)
    1. Compensations
      • Knees move inward in the anterior view
        1. Tight/overactive hip adductors and TFL
        2. Lengthened/underactive gluteus Maximus and medius
      • When the movement initiates at the knees sagittal view
        1. Not enough glute activation
        2. Indicates hip flexor and quadriceps dominance
      • Back arches extensively in sagittal view
        1. Tight/overactive latissimus dorsi, back extensors, and hip flexors
        2. Loose/underactive rectus abdominis, core, hamstrings, and gluteal group
      • Back rounds forward in the sagittal view (Has the same focus as number three)
        1. Underactive/loose upper back extensors
        2. Overactive/tight Teres major, Peck minor and major and latissimus dorsi
  • The hurdle step (Refer to table 7-10)
    1. Compensations
      • Inward leg hip rotation in the anterior view
        1. Raised leg internal rotators or a tight stance leg
        2. Raised leg external rotators or an underactive stance leg
      • The hiking of the raised hip from the anterior view
        1. A tight stance leg hip flexors (Will limit the posterior hip rotation during the raise)
  • Shoulder push stabilization (Referred to table 7-11)
    1. Compensations
      • Noticeable “winging” during the push-up movements at the scapulothoracic joint (sagittal view)
        1. 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)
    1. Compensations
      • Bilateral discrepancy in the transverse view (assuming they had no other previous issues)
        1. Side dominance possibility
        2. Possible paraspinal development differences
        3. Possible torso rotation (Maybe connected to hip rotation)

Flexibility assessments and muscle length

  1. The Thomas test (Quadriceps/hip flexion length)
  2. PSL (Passive straight leg) raise
    • To test hamstring length
    • A normal hamstring length: moving at least 80° of flexion before posterior pelvic rotation
  3. Shoulder mobility
    • Extension and flexion
      1. 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)
      1. If your client can touch certain spots, this shows good shoulder mobility

Core and balance

  • Sharpened Romberg test
    1. 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
    1. 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
    1. 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.
    2. Trunk collateral endurance test
      1. 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.
    3. The trunk extensor endurance test
      1. Contraindications
        • Not the best for clients that have deficiencies in strength
          1. Example: a client that cannot lift their torso to a neutral position from a forward flexed position
      2. Clients that have a very high body mass
      3. Not good for people that have lower back pain, recent surgery or currently have a flare-up of lower back problems.

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