ACSM CPT Chapter 17: Functional Movement Assessments and Exercise Programming for Apparently Healthy Participants

ACSM CPT Chapter 17: Functional Movement Assessments and Exercise Programming for Apparently Healthy Participants

Chapter Objectives:

  • Know the integration of the motor system and the sensory system in the motor patterns that are developing.
  • Find the Importance of proprioception, mobility, and stability in the context of progressive exercise programming:
  • Know the Relevance of optimizing posture to improve neuromuscular functions.
  • Find the muscles that are commonly affected by neuromuscular imbalances.
  • Discuss the right assessments and prescriptions for exercise and the self-myofascial release strategies that will improve the potential for movement.

Sensorimotor Control

  • Motor Learning
    • In the early phases of motor learning the performance is largely done by the conscious control, or in other words, a great deal of focus and concentration is needed for people learning the skills and movements patterns to do so successfully. With repeated practices this will become integrated into our movement patterns and eventually require very little thought. So, once these movement patterns have become integrated and stored, they will be essentially automatic and simply fine-tuned by some unconscious memory feedback.
  • Proprioception
    • The sensorimotor system is the sensory system and the motor control system. These work together to control our movements, our posture, and the stability of our joints.
    • Proprioception is defined as the sense of knowing where your own boy is in terms of space, and it is made of static and dynamic. It is an important mediator for mobility and stability of joints and the ultimate calibration of our movements. When we have disturbances in our proprioception, the reactive and preparatory motor control and stability will be changed and thus the risk for injury is increased.
  • Stability and Mobility
    • Stability is the state of being unchanged, even when we have forces acting on us that would normally change some state or condition. Joint stabilization happens from coordinated muscle coactivation and creates a suitable stiffness for the maintaining of the alignment of joints.
    • Being optimally stable involves:
      • Having a stable base to transfer forces.
      • Having the right amount of muscular capacity.
      • Central nervous system motor programming.

Mediators of the Proprioception, Mobility, and Stability

  • Overweight and Obesity and Physical Inactivity
    • This is a worldwide epidemic and with it comes increased risks for many chronic diseases like diabetes, metabolic syndrome, and hypertension. A lot of people with this condition have alterations made to their motor function and their postural control. This is often due to their strength decreases.
  • Propensity for Inhibition of Stabilizing Muscles
    • The tendencies for some muscles to weaken and tighten may also lead to postural problems and alterations that occur in your motor control. These alterations may happen from repetitive actions, overtraining, poor ergonomics, sedentary lifestyle, trauma, or disease.
  • Previous Injury and Limited Variety of Movement
    • Disturbances often follow injury or leave some kind of residual effects. So, some clients may become free of pain from an injury, but still have some form of sensory deficits.
  • Everyday Posture and Limited Variety of Movement
    • Some researchers believe that the impairment of movements come from some biomechanical causes. This essentially means that some direction or long term posture results in the sarcomeres remodeling. So, your muscles would lengthen or shorten to meet the demands you place on your body every day in terms of posture and movements. We would not have a neutral posture over time unless it is enforced. We would just mold to the posture we are constantly in.
  • Joint Structure
    • Mobility and stability are derived from articular geometry. This is the shape and the depth of our joints. 
  • Age
    • Aging has adverse effects on proprioception, stability, and mobility. This is really shown in the fact that the percent of people over 60 years old increases in their risk of falling. This is often due to decreased kinesthesia and postural control, which is worse with age.

What is Neutral Position and Why is it so Important?

  • Neutral position is thought of as the spine’s posture where the total stresses onto the spinal column  and the effort from the muscles put forth to keep the posture is minimal. 
  • Neutral position will optimize the right muscle length tension and force coupling relationships, minimize the compressive forces that are put onto a joint, and optimize the speed and timing of stabilizing muscle contractions.

Assessment and Prescription

  • Establishing a Movement Baseline
    • Assessment of Static Posture
      • Plumb Line Assessment
        • Using either a plumb line or static posture application is useful for finding deviations that may be present. Clients will not have shoes, will have form fitting clothing, and they are encouraged to keep their regular everyday posture during the assessment.
      • Wall Test
        • This is helpful for normal lumbar curve and forward head posture findings. The client will stand with their back against the wall and their feet 6 inches from the wall. The head will be against the wall and the trainers hand will be snuggly between the wall and the client’s lumbar spine. The postural assessments here will show the areas of tightness or weakness.
      • Progressive Approach To Developing Postural Awareness
        • Distinguishing the neutral spine for people can be challenging. The trainer needs to cue the client verbally and manually to arch their lower back and flatten their lower back right after. The client then does this many times and then finds the middle of these two. The client will hold this and then lose neutral by flattening or arching, only to then regain it. The client should then do this with their eyes close and eventually dynamic movements will be added. The three points of contact will be stressed to be maintained.
    • Integrative Assessments and Corrections
      • Wall Plank and Roll
        • This assessment is for lumbar stability and also serves to enhance lumbar torsional control. The client faces a wall with their feet about 2 feet from it. The elbows will be on the wall with the forearms on top of one another.   The client braces their core and shifts to a side plank on one elbow. The body needs to be rolled together as one unit. There shouldn’t be any motion in the pelvis or the lumbar area.
      • Teaching How To Brace
        • The client is instructed to precontract their core before doing isometric exercises. You should essentially pretend that you are about to be hitting the stomach.
      • Diaphragmatic Breathing Assessment and Corrective Methods
        • The diaphragm muscles are the main muscles for respiration, and they are vital for stabilizing the core. If we do not have them, then intra-abdominal pressure is compromised, and that is needed for lifting.
    • Addressing Alignment Issues
      • Appraising the movement quality during the sessions is vital to training. The typical approach for a muscle weakness would be something like this:
        • Tell the client to have a tall neutral posture and hold the position of the movement for 5 – 8 seconds and then relax back. 
        • First progress would be to have the client do multiple sets of the movement and still utilize this 5 – 8 second hold technique.
        • Second progression would be to have the client do the isometric hold with a form of light resistance tubing.
        • Third progression would be to have the client develop endurance and greater muscular recruitment efficiency and the eventually introduce more movements that are dynamic. Rep schemes need to emphasize endurance.
      • Instability Training
        • This is a method of training that will challenge the ability for the client to keep their balance while also challenging their center of gravity. 

Self-Myofascial Release and Stretching

  • This is a form of manual therapy that is used to alleviate some discomfort that is within the tender spots of the fascia and relax the hypertonic soft tissue areas. It involves the compression of the soft tissues with the use of things such as tennis balls, roller massages, and foam rollers.  This is done by the person, instead of by the therapist.

Lifestyle Recommendations

  • Lifestyle habits mediate stability, mobility, and sensory issues that develop over long time periods. While exercise is important, the trainer also needs to make recommendations for lifestyle changes. 
ACSM CPT Chapter 17: Functional Movement Assessments and Exercise Programming for Apparently Healthy Participants 1
ACSM CPT Chapter 17: Functional Movement Assessments and Exercise Programming for Apparently Healthy Participants 2
ACSM CPT Chapter 17: Functional Movement Assessments and Exercise Programming for Apparently Healthy Participants 3

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