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Certificate IV in Fitness – CPT 3.4 Appraisals of functional movement Copyright © 2012 Australian

Certificate IV in Fitness CPT

3.4 Appraisals of functional movement

Copyright © 2012 Australian Institute of Personal Trainers. All rights reserved.

1300 13 84 34 www.aipt.com.au

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Posture
Posture

Posture refers to the biomechanical alignment of the individual body parts and orientation of the body to the environment. The human body is always experiencing changes in movement, varying between static and dynamic postural circumstances.

Good posture involves training your body to stand, walk, sit, and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight- bearing activities. Proper posture:

keeps bones and joints in the correct alignment so that muscles are being used properly

helps decrease the abnormal wearing of joint surfaces that could result in arthritis

decreases the stress on the ligaments holding the joints of the spine together

prevents the spine from becoming fixed in abnormal positions

prevents fatigue because muscles are being used more efficiently, allowing the body to use less energy

prevents strain or overuse problems

prevents backache and muscular pain.

Posture variables
Posture variables

Static Posture

This refers to posture that is characterised by no movement. It is any postural position that is held statically for a period of time. Static posture may involve observation and measurement from a variety of perspectives, including anterior/posterior/lateral views to appraise the presence of postural deviation.

views to appraise the presence of postural deviation. Certificate IV in Fitness – CPT | Section
views to appraise the presence of postural deviation. Certificate IV in Fitness – CPT | Section
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Dynamic Posture

This refers to posture that is characterised by movement. It refers to dynamic movement and reflects the changes in an individual’s posture relative to the activity occurring. Dynamic postural appraisal may involve observation of tasks including walking, running, squatting, throwing, and more. Proper posture ensures that the muscles are optimally aligned in proper length and tension relationships for optimal function. This allows your body to absorb and distribute forces throughout your body evenly.

Proper dynamic posture reduces your risk of injury in sports and exercise. It also allows you to produce the most amount of strength and power and increase your endurance giving you an edge over other athletes who may have less perfect posture.

edge over other athletes who may have less perfect posture. For more information on static and

For more information on static and dynamic posture, follow these links:

Fitness Trainer Essentials (2008) ‘Postural appraisal for low-risk clients,’ Chapter 4, Pg 173.

Active or Passive?

There are a variety of joint types within the body, each with different levels of mobility relative to their form and functional role.

In the case of functional movement, possessing appropriate mobility about the major joints will assist safe, efficient, and effective movement. If an individual presents with poor mobility about the major joints, movement will become flawed and is likely to contribute to postural issues and muscular imbalance.

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Range of motion

Range of motion is defined at the maximum range (measured in degrees) a joint can move through. In many instances (such as the elbow joint) this will be the difference from fully flexed to fully extend. The greater the range of movement at a joint, the greater the flexibility this individual has at this joint.

Muscle has a viscoelastic property. This means that performing exercises and stretches to increase range of motion will lead to muscles stretching as they experience creep; that is, they gradually get longer and increase in flexibility. There are methods to ensure that a person’s range of motion is improved and maximised and that the changes are long term.

The benefits of performing exercises and stretching to improve range of motion include:

improving functionality

reducing chance of injury

reducing muscle soreness and tightness

relaxation

improved flexibility and exercise performance.

Range of Motion (2012) ‘Flexibility’ http://www.rangeofmotion.net.au/content/exercise/flexibility

Active moment

Active movement is where the joint is mobilised as a result of direct muscular force, requiring the individual to actively move the joint themselves. So by definition, active movement involves a person moving with the help of their own muscles.

An appropriate example of active movement would include using the hip flexors to initiate movement at the hip.

using the hip flexors to initiate movement at the hip. Certificate IV in Fitness – CPT
using the hip flexors to initiate movement at the hip. Certificate IV in Fitness – CPT
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Passive movement

Passive movement is the movement of body parts by an outside force without voluntary action or resistance by the individual. This is also referred to as passive exercise.

The joint is mobilised and moved without the individual contributing to the movement. For example, a therapist mobilises a joint with no muscular effort from the client or the client uses an aid or their own body weight to mobilise a joint.

uses an aid or their own body weight to mobilise a joint. Australian Government (2012) ‘AIS
uses an aid or their own body weight to mobilise a joint. Australian Government (2012) ‘AIS

Australian Government (2012) ‘AIS Movement Science - Biomechanics, Performance Analysis and Skill Acquisition,’ http://www.ausport.gov.au/ais/sssm/ais_movement_science

Postural appraisal
Postural appraisal

It is mandatory for all trainers to conduct a postural appraisal before writing a program for clients. Fitness professionals use posture analysis as a way to create a baseline of exercise programming for their clients. Without assessing their clients, fitness professionals can easily hurt and injure them by giving them the wrong types of exercises and strategies.

Conducting a postural appraisal is a simple, yet valuable tool for the trainer to gain a basic insight in to such issues as:

muscle imbalance about a joint

the relationship between muscles acting about that joint (muscle imbalance can be a major contributor to dysfunctional movement)

changes in neural action of the muscles responsible for movement about a joint.

Tight and short muscles are often overactive and can inhibit other muscles working in synergy during movement, resulting in poor movement patterns.

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Posture analysis helps the trainer identify weaknesses, strengths, and muscle imbalances. For example, if a client has a postural kyphosis (excessive curvature of the thoracic spine), then the shoulders round forward, causing the chest muscles to be tight and short, which inhibits the client's ability to reach up without arching the back.

Once the nature and cause of the condition is identified, the trainer can develop an exercise plan to help the client improve their posture and performance. Some exercises might include pulling exercises, core and hip strengthening, and stretches to counterbalance the stress.

More benefits of postural appraisals include enabling trainers to:

identify areas presenting with a deficit of strength and mobility

improve postural awareness

reduce/eliminate the likelihood of injury

investigate the source of postural deviation

identify any contraindications to exercise

provide the client with information upon how their posture may affect their ability to exercise safely

provide a basis for referral to another AHP to assist where necessary.

Fitness Trainer Essentials (2008) ‘Postural appraisal for low-risk clients,’ Chapter 4, Pg 173.

Anatomical plane of movement
Anatomical plane of movement
clients,’ Chapter 4, Pg 173. Anatomical plane of movement Sagittal Plane : A vertical plane, passing

Sagittal Plane: A vertical plane, passing from front to rear. This divides the body into right and left sections. Movements in this plane are the up and down movements of flexion and extension.

Coronal/Frontal Plane: A vertical plane which bisects the body left to right, dividing the individual front to back (dorsal/ventral). Movements in this plane are sideways movements, called abduction and adduction.

Transverse Plane: A horizontal plane that divides the body into superior and inferior parts. Movements in this plane are rotational in nature, such as internal and external rotation, pronation, and supination.

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Muscles, joints, and movements
Muscles, joints, and movements

Technically, an appraisal of any joint, any muscle, and the movement it elicits is possible; however, one must identify whether the information the appraisal yields will be of value.

If an individual presenting with a specific wrist or elbow issue requested a postural assessment, then you would be justified in pursuing an appraisal of these areas. As a general rule of thumb, if the client was apparently healthy and issue-free your appraisal would be best directed at the major joints and muscles groups of the body.

This will allow you a much more global perspective of the clients posture, increasing the likelihood of an effective assessment.

The major muscle groups and joints that are evaluated during a postural appraisal are detailed in the following table:

Joints

Muscles

Hip

Gluteal, quadriceps, hamstrings

Knee and ankle

Quadriceps, hamstrings, calves, tibialis

Spine

Quadratus, lumborum, trapezius, spinal, erectors

Shoulder

Pectorals, rotator cuff, latissimus dorsi, trapezius

Pectorals, rotator cuff, latissimus dorsi, trapezius For more information on muscle and joints range of

For more information on muscle and joints range of movements, follow this link:

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Joint range of motion and movements
Joint range of motion and movements

The Better Health Channel (2012) describes joints as the part of the body where two or more bones meet to allow movement. Every bone in the body, except for the hyoid bone in the throat, meets up with at least one other bone at a joint. In order for physical movements to be carried out, the individual bones have to be able to move against each other and connected to each other. This is the function of the joints.

For example, the knee joint refers to the point of connection between the femur and the tibia. Joints are held together and supported by tough bands of connective tissue called ligaments and tendons. Smooth cartilage prevents friction as the bones move against one another. In freely moveable joints, the entire joint is enclosed inside a membrane filled with lubricating synovial fluid.

The more movement that is possible through a joint, the higher risk of injury. This is due to a greater range of movement reducing the strength of the joint.

The Better Health Channel (2012) ‘Joints.’ http://www.betterhealth.vic.gov.au/

The table below outlines the range of motion for each joint movement and motion measured in degrees:

Spinal Flexion / Extension 0-90° / 0-25°

Spinal Lateral Flexion

0-25°

Hip Flexion

0-100°

Hip Adduction

0-20°

0-25° Hip Flexion 0-100° Hip Adduction 0-20° Hip Abduction Hip Extension/Hyper Knee Flexion 0- 150
0-25° Hip Flexion 0-100° Hip Adduction 0-20° Hip Abduction Hip Extension/Hyper Knee Flexion 0- 150
0-25° Hip Flexion 0-100° Hip Adduction 0-20° Hip Abduction Hip Extension/Hyper Knee Flexion 0- 150
0-25° Hip Flexion 0-100° Hip Adduction 0-20° Hip Abduction Hip Extension/Hyper Knee Flexion 0- 150

Hip Abduction

Hip Extension/Hyper

Knee Flexion 0- 150

Knee Extension 150- 0°

0-40°

Extension

0-40° Extension
0-40° Extension
0-30°

0-30°

0-20° Hip Abduction Hip Extension/Hyper Knee Flexion 0- 150 Knee Extension 150- 0° 0-40° Extension 0-30°
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Ankle Dorsi Flexion 0-20° Ankle Plantar Flexion 0-40° Shoulder Abduction 0-150° Shoulder Adduction 0-30° Shoulder
Ankle Dorsi Flexion 0-20°
Ankle Plantar Flexion 0-40°
Shoulder Abduction 0-150°
Shoulder Adduction 0-30°
Shoulder Flexion 0-150°
Shoulder Extension/Hyper
Extension
Elbow Extension 150-0°
Elbow Flexion
0-150°
50-0°
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Agonist, Antagonist, and Synergist
Agonist, Antagonist, and Synergist

Antagonist: The muscle/s that directly oppose an agonist, responsible for returning a limb to its initial position, e.g. triceps brachii

a limb to its initial position, e.g. triceps brachii Agonist : The muscle/s primarily responsible for

Agonist: The muscle/s primarily responsible for eliciting movement about a joint e.g. biceps brachii

for eliciting movement about a joint e.g. biceps brachii Synergists : Muscles that assist agonists to

Synergists: Muscles that assist agonists to produce movement. May also fixate a joint to facilitate movement e.g. brachioradialis

fixate a joint to facilitate movement e.g. brachioradialis Certificate IV in Fitness – CPT | Section
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What causes poor posture?

Posture is a dynamic concept, referring to the natural curvature of the spine and vertebrae resulting in the ideal postural position that is known as the neutral spine. In this position, the three natural curvatures of the spine (cervical, thoracic, lumbar) allow loads to be distributed evenly throughout the body, creating the strongest and most balanced position for an individual.

When the musculature supporting, bracing, and acting upon the spine during movement does not function optimally, postural issues may arise. These changes may also affect the hips, shoulders, knees, and ankles &andmay include:

Muscle inhibition

knees, and ankles &andmay include: Muscle inhibition Poor muscle strength Muscle imbalance Poor joint mobility
knees, and ankles &andmay include: Muscle inhibition Poor muscle strength Muscle imbalance Poor joint mobility
knees, and ankles &andmay include: Muscle inhibition Poor muscle strength Muscle imbalance Poor joint mobility
knees, and ankles &andmay include: Muscle inhibition Poor muscle strength Muscle imbalance Poor joint mobility
knees, and ankles &andmay include: Muscle inhibition Poor muscle strength Muscle imbalance Poor joint mobility

Poor muscle strength

Muscle imbalance

Muscle inhibition Poor muscle strength Muscle imbalance Poor joint mobility (ROM) Damage to connective tissues
Poor joint mobility (ROM) Damage to connective tissues Damage to bony structures
Poor joint mobility (ROM)
Damage to connective
tissues
Damage to bony structures
Damage to connective tissues Damage to bony structures Poor biomechanics Pregnancy, footwear, work practices,

Poor biomechanics

tissues Damage to bony structures Poor biomechanics Pregnancy, footwear, work practices, sports Certificate IV

Pregnancy, footwear, work practices, sports

biomechanics Pregnancy, footwear, work practices, sports Certificate IV in Fitness – CPT | Section 3.4:
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The human skeleton has some natural curves that may increase or decrease in size depending on factors such as genetics and lifestyle. The cervical and lumbar spines both have a natural curve called lordosiswhile the thoracic spine has a natural, more complex curve called kyphosis.

Muscles acting about the hip, shoulder and spine can have a profound effect upon an individual’s posture. The diagram above displays three changes commonly discovered when posture is appraised. Poor posture can cause problems including back pain, spinal dysfunction, joint degeneration, rounded shoulders, and a potbelly. You can improve your posture and spinal health by making a few lifestyle adjustments.

and spinal health by making a few lifestyle adjustments. Spinal posture Description Scoliosis Refers to

Spinal posture

Description

Scoliosis

Refers to vertebrae with a lateral curve or deviation. The affected section will present with a lateral flexion and rotation of the vertebrae. There are two different types of scoliosis, an S-shaped curvature which results in the spine having 2 curves, and a C-shaped curve which results in the spine having a single curvature.

Kyphosis

Refers to increased posterior curvatures of the spine, usually in the thoracic area. The causes of excessive kyphotic curvature may be structural or functional. Structural change refers to a change in the structure or shape of the spine, whereas functional refers to an individual’s posture.

Lordosis

Refers to an increased curvature of the spine, usually of the lumbar area; though it can also affect the thoracic and cervical areas of the vertebrae. Lumbar lordosis can also result in a significant postural deviation through the pelvic region.

The Better Health Channel (2012) ‘Posture’ http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/posture

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Postural appraisal
Postural appraisal

A formal postural assessment is done with a plumb line. The client is positioned with a plumb

line passing just in front of the lateral malleolus (coronal plane). In an ideal posture, this line should pass just anterior to the mid-line of the knee and then through the greater trochanter,

bodies of the lumbar vertebrae, shoulder joint, bodies of the cervical vertebrae, and the lobe

of the ear.

Postural assessments include an examination of the alignment when a client is standing, tests for flexibility and muscle length, and tests for muscle strength as well as palpitation techniques.

Conducting a basic test
Conducting a basic test
as well as palpitation techniques. Conducting a basic test Conducting a basic postural appraisal test using

Conducting a basic postural appraisal test using a plumb line allows trainers to visually ascertain any deviations or anomalies in an individual’s posture. The use of a plumb line allows trainers to assess the apparent symmetry and balance of the body, comparing left and right sides as well as front to back.

comparing left and right sides as well as front to back. Certificate IV in Fitness –
comparing left and right sides as well as front to back. Certificate IV in Fitness –
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Table of possible anatomical change as a result of muscle tightness or inhibition:

Muscle

Possible anatomical changes

Tibialis posterior

Pronation and lateral foot rotation

 

Tibialis anterior

Foot eversion

 

Peroneus longus/brevis

Foot inversion

 

Hamstring group

Posterior pelvic tilt with increased lumbar lordosis

Biceps femoris

Medial foot rotation

 

Semi-tendinosus/Membranosus

Lateral foot rotation

 

Rectus femoris

Anterior

pelvic

tilt,

increased

lumbar

lordosis

Gluteus maximus

Elevation and rotation of pelvis and increased lumbar lordosis

Psoas

Convex curvature of the lumbar spine (lordosis) and pelvic elevation on ipsilateral (same) side

Sartorius/gracilis inhibition

Posterior rotation of pelvis

 

Adductor group inhibition

Pelvic

elevation

on

contralateral

(opposite) side

 

Tensor fascia latae inhibition

Elevation of pelvis on ipsilateral (same) side

Abdominals inhibition

Increased lumbar lordosis with anterior pelvic tilt

Latissimus dorsi inhibition

Shoulder elevation

 

Trapezius inhibition

Depression of shoulder, depression of shoulder on ipsilateral side

Rectus femoris inhibition

Posterior pelvic tilt, knee hyperextension

Pectoralis major/minor

Internal

shoulder

rotation,

shoulder

elevation,‘hunched’

thoracic

kyphotic

curvature

Trapezius

Shoulder elevation

 

Latissimus dorsi

Shoulder

retraction

and

depression,

external rotation

 

Fitness Trainer Essentials (2008) ‘Postural appraisal for low-risk clients,’ Chapter 4, Pg 173.

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Strengthen or stretch?
Strengthen or stretch?

Over time, poor posture that demands support from phasic fibres causes the deeper supporting muscles to waste away from lack of use. Weak, unused muscles tend to tighten and this shortening of muscle length can compact the bones of the spine (vertebrae) and worsen posture.

When assessing a client’s functional movement capabilities, trainers must assess the following three key factors:

Joint stability

The ability to maintain control or control joint movement and position. To achieve this, muscles, ligaments, tendons, the joint capsule and the neuromuscular factors work synergistically to achieve joint stability without compromising joint mobility.

Joint mobility

The range of uninhibited movement and motion around a joint or body segment. This is achieved through synergistic action of the joint structures and neuromuscular factors without compromising joint stability.

Joint strength

The overall structural integrity of the joint, combines joint stability and mobility to create a healthy, functional and strong joint to facilitate safe and correct movement.

Improving general posture

Below are some tips trainers could offer clients who suffer from poor posture:

Perform stretches every day to improve flexibility

Exercise regularly to improve muscles strength and tone

Avoid standing on one foot for long periods of time

Perform core strengthening exercise so support your back

Avoid sitting on soft couches and chairs

Use a pillow to support your neck when sleeping.

Remember when dealing with basic postural issues

1. Restore appropriate length to muscles that are tight (stretch)

2. Restore isometric strength of weak muscles (strengthen)

3. Establish a base of strength and build upon the dynamic strength of muscles you have identified as presenting weakness (strengthen).

The Better Health Channel (2012) ‘Posture’ http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/posture

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Facts

Facts

One method of increasing ROM and mobility about a joint is to conducting stretching drills. Static, PNF, dynamic and ballistic stretching styles will assist in countering the effects of tight muscles and connective tissue.

Strengthening the musculature and connective tissues around a joint will assist in increasing structural integrity and providing muscular balance whilst improving technique and control during movement.

whilst improving technique and control during movement. Examples of common postural issues and basic corrections

Examples of common postural issues and basic corrections

Poor postural habits, such as sitting slouched at a desk most of the day, can promote muscle imbalances. For example, it is not uncommon for a sedentary person to have relatively tight pectoral and anterior deltoid muscles while the rhomboids and posterior deltoids are weak. This muscle imbalance can contribute to an increase in thoracic curvature causing an increased kyphosis.

The contours of the shoulder region may also change to cause a more rounded shoulderappearance. Similarly, tight lower back and iliposoas muscles may contribute to an increase in the lumbar curvature causing an increased lumbar lordosis.

*Lordosis

Tight muscles

Weak muscles

 

Hip flexors

Abdominals

Erector spinae

Hamstrings

Gluteals

Suggested corrective actions

Stretch: hip flexors and spinal extensors Strengthen: abdominal, hamstring, and fluteals

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*Kyphosis/Rounded

Tight muscles

Weak muscles

Shoulders

 

Pectoralis majorPectoralis minor Anterior deltoids Latissimus Dorsi

Rhomboids Rear deltoids Middle/Lower trapezius

Suggested

corrective

Stretch: chest stretch, anterior deltoids, lats Strengthen: rhomboids, rear deltoids, trapezius

actions

*Winged Scapula

Tight muscles

Weak muscles

Pectoralis major Pectoralis minor Subscapularis Latissimus dorsi Serratus anterior Rhomboids

Pectoralis major Pectoralis minor Subscapularis Latissimus dorsi

Serratus anterior Rhomboids

Suggested

corrective

Stretch: pectorals, lat and shoulder mobility work Strengthen: seated row, scapula fixation work, wall pushes (scapula pro/retraction)

actions

Allied Health Professionals
Allied Health Professionals

Consider the following scenario:

You have recently taken on a new client who, upon completion of a thorough postural appraisal, presents with a number of postural issues that you are concerned may be outside your abilities and scope of practice.

You will confident that you can assist the client; however, you are not sure of where to start, nor are you entirely confident with your conclusions after completing the appraisal. Before preparing a corrective exercise program, you feel as though a second opinion would be worthwhile pursuing.

What should you do in this situation…?

pursuing. What should you do in this situation…? Certificate IV in Fitness – CPT | Section
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A Personal Trainer cannot and should not attempt to provide formal diagnosis of a postural condition.

Your most valuable tool in treating a client is an Allied Health Professional (AHP). These practitioners possess the training and skills to further assess an individual, providing extra information and recommendations on a client’s case.

The Better Health Channel (2012) outlines an Allied Health Professional as a tertiary trained professional (separate from doctors) who works with others in the healthcare team to support a person’s health care. The aim of AHPs is to support diagnosis recovery, and quality of life.

Access to allied health care can increase a person’s mobility and independence. AHPs can also help to reduce the risk of complications in chronic conditions or following illness or injury. Their recommendations can assist you in clarifying and confirming exactly what the client’s condition is, as well as giving you extra assistance in exercise choice, contraindications to exercise, progressions, and much more.

AHPs you could refer to include:

Exercise physiologists

Physiotherapists

Massage therapist

Osteopaths

General practitioners

Chiropractors

Podiatrists

Occupational therapists.

Chiropractors  Podiatrists  Occupational therapists. Good posture is the cornerstone of a sound exercise program

Good posture is the cornerstone of a sound exercise program and good musculoskeletal health. Assessing a client to ascertain good posture allows trainers to effectively and safely prescribe an exercise program that accounts for an individual’s specific needs.

If a client presents with good posture and maintains this postural awareness during daily

activities and exercise, the structures comprising their musculoskeletal system are aligned and balanced, facilitating efficient movement.

If a client presents with poor posture, an individual’s musculoskeletal structures are loaded in

a manner that is inefficient and unbalanced. The body may be exposed to loading that it is not accustomed to which may increase the likelihood of compensatory change, in turn increasing the chances of injury or the client developing a chronic postural condition.

Compensatory change can occur acutely (at the site of the issue) or on a gross level (at another location within the body).

Compensatory change may become the norm for the individual if left untreated. These changes may present themselves subtly and be of no detriment to the client; however, they may become problematic if the client begins an exercise program as an underlying postural issue may be exacerbated by the sudden shift to regular physical activities.