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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)

    • 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.

    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)

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    • 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.

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