aCe group fitness instruCtor fitness assessment protoCols

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

THE FITNESS ASSESSMENTS PRESENTED HERE ARE NOT INTENDED TO SERVE AS

comprehensive coverage of the topic, but rather as an introduction to various assessments

that fall within the scope of practice of an ACE Certified Group Fitness Instructor (GFI).

For full coverage of the appropriate use of fitness assessment protocols and sequencing

guidelines, refer to the ACE Personal Trainer Manual.

CARDIORESPIRATORY-FITNESS TESTING

Maximal and submaximal exercise tests using the treadmill or bicycle ergometer are not

well-suited for measuring the cardiorespiratory fitness of groups. In the group fitness setting,

field tests for measuring cardiorespiratory endurance, such as the YMCA submaximal step

test, are more appropriate because they are easy to administer, practical, inexpensive,

and less time-consuming than the treadmill and bicycle ergometer tests. One important

consideration for administering a cardiorespiratory field test with a group of individuals is

that participants must be taught how to accurately measure their heart rates.

YMCA Submaximal Step Test

The YMCA submaximal step test is one of the most popular step tests used to measure

cardiorespiratory endurance and is considered suitable for low-risk, apparently healthy,

nonathletic individuals between the ages of 20 and 59. This particular test uses any 12-inch

(30.5 cm) step, with the Reebok

step being utilized most frequently in fitness settings (four

risers plus the platform).

CONTRAINDICATIONS

Due to the nature of step testing, this assessment may not be appropriate for:

•Individuals who are extremely overweight

•Individuals with balance concerns

•Individuals with orthopedic problems (e.g., knee or low-back)

•Individuals who are extremely deconditioned, as the intensity of the test may

require near-maximal effort

•Individuals who are short in stature, as they may have trouble with the step

height

ACE GROUP FITNESS INSTRUCTOR

FITNESS ASSESSMENT PROTOCOLS

CONTENTS

Cardiorespiratory-fitness

Testing

YMCA Submaximal Step Test

Muscular Strength and

Endurance Testing

Push-up Test

Curl-up Test

Static Postural Assessment

Plumb Line Instructions

Plumb Line Positions

Deviation 1: Ankle Pronation/

Supination and the Effect on

Tibial and Femoral Rotation

Deviation 2: Hip Adduction

Deviation 3: Pelvic Tilting

(Anterior or Posterior)

Deviation 4: Shoulder Position

and the Thoracic Spine

Deviation 5: Head Position

Postural Assessment

Checklist and Worksheets

Movement Screens

Bend and Lift Screen

Hurdle Step Screen

Shoulder Push Stabilization

Screen

Thoracic Spine Mobility Screen

Balance and the Core

Sharpened Romberg Test

Stork-stand Balance Test

Flexibility and Muscle-length

Testing

Sit-and-Reach Test

Thomas Test for Hip Flexion/

Quadriceps Length

Passive Straight-leg (PSL)

Raise

Shoulder Mobility

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Equipment:

•12-inch (30.5 cm) step

•Stopwatch

•Metronome

•Stethoscope (optional)

Pre-test procedure:

•After explaining the purpose of the YMCA submaximal step test, set the

metronome to a cadence of 96 “clicks” per minute, which represents 24 steps

cycles/minute (or 96 foot placements).

üDescribe and demonstrate the four-part stepping motion (“up,” “up,”

“down,” “down”).

üEither foot can lead the step sequence.

üPermit a short practice to allow participants to familiarize themselves with

the cadence.

• The goal of the test is to step up and down on a 12-inch riser for three minutes

(Figure 1).

• Explain to the participant that heart rate will be measured through

palpation (or auscultation) for one full minute upon completion of

the test, counting the number of beats during that first minute of

recovery. It is important for the participant to sit down immediately

following the test and remain quiet to allow the instructor to

accurately assess heart rate.

Test protocol and administration:

• On the instructor’s cue, the participant begins stepping and the

stopwatch is started.

• The instructor can coach the initial steps to make sure the

participant is keeping pace with the metronome. Cue the time

remaining to allow the participant to stay on task.

• Atthethree-minutemark,thetestisstoppedandtheparticipant

immediately sits down. Count the participant’s heart rate (HR) for

one entire minute.

ü The test score is based on the fact that the immediate post-

exercise HR will decrease throughout the minute cycle.

ü It is important that the HR check begin within five

seconds of test completion. (Placing a stethoscope to the

participant’s chest enhances the tester’s ability to count the

actual heartbeats. In some cases, the participant may be

uncomfortable with this procedure, in which case a radial pulse

check will also suffice.)

•The participant’s one-minute post-exercise HR is recorded.

•Encourage a three- to five-minute cool-down followed by stretching of the

lower extremities. The participant may experience post-exercise dizziness or

other signs of distress if no cool-down is performed (i.e., blood pooling in the

extremities and accelerated HR).

•Classify the participant’s score using Table 1 or 2 and record the values.

•Continue to observe the participant, as negative symptoms can arise

post-exercise.

For those who score “below average” to “very poor,” it will be necessary to be

conservative in the initial exercise program. Keeping exercise duration and intensity

to a minimum will be important. For those who score “above average” to “excellent,”

it would be appropriate to focus on exercise duration as well as intensity.

Figure 1

Three-minute step test—stepping cycle

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Table 2

Post-exercise Heart Rate Norms for YMCA Submaximal Step Test (Women)

Age (years)

Rating % Rating 18–25 26–35 36–45 46–55 56–65 66+

Excellent 100 52 58 51 63 60 70

95 75 74 77 85 83 85

90 81 80 84 91 92 92

Good 85 85 85 89 95 97 96

80 89 89 92 98 100 98

75 93 92 96 101 103 101

Above average 70 96 95 100 104 106 104

65 98 98 102 107 109 108

60 102 101 104 110 111 111

Average 55 104 104 107 113 113 116

50 108 107 109 115 116 120

45 110 110 112 118 118 121

Below average 40 113 113 115 120 119 123

35 116 116 118 121 123 125

30 120 119 120 124 127 126

Poor 25 122 122 124 126 129 128

20 126 126 128 128 131 129

15 131 129 132 132 135 133

Very poor 10 135 134 137 137 141 135

5 143 141 142 143 147 145

0 169 171 169 171 174 155

Table 1

Post-exercise Heart Rate Norms for YMCA Submaximal Step Test (Men)

Age

Rating % Rating 18–25 26–35 36–45 46–55 56–65 66+

Excellent 100 50 51 49 56 60 59

95 71 70 70 77 71 74

90 76 76 76 82 77 81

Good 85 79 79 80 87 86 87

80 82 83 84 89 91 91

75 84 85 88 93 94 92

Above average 70 88 88 92 95 97 94

65 90 91 95 99 99 97

60 93 94 98 101 100 102

Average 55 95 96 100 103 103 104

50 97 100 101 107 105 106

45 100 102 105 111 109 110

Below average 40 102 104 108 113 111 114

35 105 108 111 117 115 116

30 107 110 113 119 117 118

Poor 25 111 114 116 121 119 121

20 114 118 119 124 123 123

15 119 121 124 126 128 126

Very poor 10 124 126 130 131 131 130

5 132 134 138 139 136 136

0 157 161 163 159 154 151

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

MUSCULAR STRENGTH AND ENDURANCE TESTING

GFIs can measure participants’ dynamic muscular fitness using calisthenic-type strength and

endurance tests. These tests are based on specific exercises, such as the push-up and curl-

up, and require the participant to perform a maximum number of repetitions for each exercise

during the assessment.

Push-up Test

The push-up test measures upper-body endurance, specifically of the pectoralis muscles,

triceps, and anterior deltoids. Due to common variations in upper-body strength between men

and women, women should be assessed while performing a modified push-up. The push-up is

not only useful as an evaluation tool for measuring upper-body strength and endurance, but is

also a prime activity for developing and maintaining upper-body muscular fitness.

CONTRAINDICATIONS AND CONSIDERATIONS

This test may not be appropriate for participants with shoulder, elbow, or wrist

problems. Alternate muscular-endurance tests or the Cooper 90-degree push-up test

(where the elbows do not exceed a 90-degree angle) may be more appropriate. A major

problem associated with tests that require performance to fatigue is that the point

of “exhaustion” or fatigue is highly influenced by an individual’s level of motivation.

Novice exercisers may not push themselves to the maximal point of exertion.

Equipment:

•Mat (optional)

•Towel or foam block

Pre-test procedure:

•After explaining the purpose of the push-up test, explain and demonstrate the correct

push-up version (standard or modified) (Figure 2).

•The hands should point forward and be positioned shoulder-width apart, directly under

the shoulders. The hips and shoulders should be aligned (i.e., rigid trunk) and the

head should remain in a neutral to slightly extended position.

•The goal of the test is to perform as many consecutive and complete push-ups as

possible before reaching a point of fatigue. The push-ups must be steady, without any

rest between repetitions. Explain that only correctly performed push-ups are counted.

•Encourage the participant to perform a few practice trials before the test begins.

Modified bent-knee position Standard push-up position

Figure 2

Push-up test

Test protocol and administration:

•The test starts in the “down” position and the participant can begin the test whenever

he or she is ready.

•Count each complete push-up until the participant reaches fatigue. A complete

push-up requires:

üFull elbow extension with a straight back and rigid torso in the “up” position

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

üThe chest touching the instructor’s fist, a rolled towel, or a foam block, without resting

the stomach or body on the mat in the “down” position

•The test is terminated when the participant is unable to complete a repetition or fails

to maintain proper technique for two consecutive repetitions.

•Record the score.

•Classify the participant’s score using Table 3. For example, if a 46-year-old female

participant completed a total of 23 modified push-ups, she would be classified as

“very good,” which signifies that her upper-body muscular endurance scored very well.

Table 3

Fitness Categories for the Push-up by Age and Sex

Age (years)

Category 20–29 30–39 40–49 50–59 60–69

Sex M W M W M W M W M W

Excellent 36 30 30 27 25 24 21 21 18 14

Very good 29–35 21–29 22–29 20–26 17–24 15–23 13–20 11–20 11–17 12–16

Good 22–28 15–20 17–21 13–19 13–16 11–14 10–12 7–10 8–10 5–11

Fair 17–21 10–14 12–16 8–12 10–12 5–10 7–9 2–6 5–7 2–4

Needs improvement 16 9 11 7 9 4 6 1 4 1

Note: M = Men; W = Women

Reprinted with permission from Canadian Society for Exercise Physiology (2003). The Candian Physical Activity, Fitness, & Lifestyle Approach (CPAFLA): CSEP—Health &

Fitness Program’s Health-Related Appraisal and Counseling Strategy (3rd ed.). Ottawa: Canadian Society for Exercise Physiology.

Participants who are sedentary or unaccustomed to working the upper body are likely lacking

in upper-body strength and endurance. If the muscles of the upper body are weak, this can

lead to poor posture and a variety of musculoskeletal problems.

There are a variety of strength-training activities that can be incorporated into group fitness

classes that would help increase muscular fitness in the pectoralis, triceps, and deltoid

muscle groups, individually or collectively. The push-up itself is a great exercise for developing

muscular strength, endurance, and overall tone in the upper body. Push-ups do not require

any equipment and can be performed virtually anywhere.

Curl-up Test

The curl-up test is used to measure abdominal strength and endurance. Like the push-up

test, this test requires the participant to perform to fatigue. The curl-up is preferred over the

full sit-up because it is a more reliable indicator of abdominal strength and endurance and is

much safer for the exerciser. The full sit-up requires additional recruitment of the hip flexors,

which places increased loads across the lumbar spine. Many participants are also inclined to

pull on the neck in an effort to generate momentum during a full sit-up, potentially increasing

the risk for injury in the cervical region. Most participants will be able to perform the curl-up

test unless they suffer from low-back problems. The curl-up test is an easy and inexpensive

method of evaluating abdominal strength and endurance.

CONTRAINDICATIONS

The following issues should be considered prior to the performance of abdominal

strength assessments:

•Participants with low-back concerns should check with their physicians prior to

attempting this test.

•Participants with cervical neck issues may find that this exercise exacerbates their

pain. All participants should be encouraged to relax the neck and rely on their

abdominal muscles to do the work.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Equipment:

•Mat

Pre-test procedure:

• After explaining the purpose of the curl-up test, explain and demonstrate

proper body position and movement technique. The starting position requires

the participant to be supine, with feet flat on the floor, both knees bent to a

90-degree angle, and arms crossed at the chest (Figure 3).

• Cue the participant to perform a controlled curl-up to lift the shoulder blades

off the mat (approximately 30 degrees of trunk flexion), and then to lower

the torso back down to momentarily rest the shoulders completely on the mat

(the head does not need to touch the mat).

• Instruct the participant to exhale on the way up and inhale on the way down.

• Encourage the participant to perform a few practice or warm-up repetitions

prior to the test.

Test protocol and administration:

•The participant starts in the “down” position and begins on the

instructor’s cue.

• Count each complete curl-up until the participant reaches fatigue.

• Make sure the participant is not holding his or her breath during the test.

• The participant must not flex the cervical spine by curling the neck.

• Record the participant score as the maximum number of curl-ups completed.

• Classify the participant’s score using Table 4 or 5. For example, if a 27-year-

old male participant completes a total of 36 curl-ups, he would be classified

in the upper range of “below average,” signifying that his abdominal

endurance needs improvement.

Curl-up test: Up position

Curl-up test: Down position. Head support is

optional.

Figure 3

Curl-up test

Table 4

Norms for Curl-up Test (Men)

Age (years)

Rating % Rating 18 –25 26–35 36 –45 46–55 56–65 66+

Excellent 100 99 80 79 78 77 66

95 83 68 65 68 63 55

90 77 62 60 61 56 50

Good 85 72 58 57 57 53 44

80 66 56 52 53 49 40

75 61 53 48 52 48 38

Above average 70 57 52 45 51 46 35

65 54 46 44 47 43 32

60 52 44 43 44 41 31

Average 55 49 41 39 41 39 30

50 46 38 36 39 36 27

45 43 37 33 36 33 26

Below average 40 41 36 32 33 32 24

35 40 34 31 32 31 23

30 37 33 29 29 28 22

Poor 25 35 32 28 25 25 21

20 33 30 25 24 24 19

15 29 26 24 21 21 15

Very poor 10 27 21 21 16 20 12

5 23 17 13 11 17 10

0 14 7 6 6 5 5

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

STATIC POSTURAL ASSESSMENT

Static posture represents the alignment of the body’s segments, or how the person holds

him- or herself “statically” or “isometrically” in space (Figure 4). Holding a proper postural

position involves the actions of multiple postural muscles, which are generally the deeper

muscles that contain greater concentrations of type I muscle fibers and function to hold

static positions or low-grade isometric contractions for extended periods. Good posture or

structural integrity is defined as that state of musculoskeletal alignment and balance that

allows muscles, joints, and nerves to function efficiently (Kendall et al., 2005). However,

if a participant exhibits deviations in his or her static position from good posture, this may

reflect muscle-endurance issues in the postural muscles and/or potential imbalance at

the joints (Tables 6 through 8 and Figure 5). Movement begins from a position of static

posture. Therefore, the presence of poor posture is a good indicator that movement may be

dysfunctional. Although movement screens offer valuable information related to neuromuscular

efficiency, a static postural assessment is considered very useful and serves as a starting point

from which a GFI can identify muscle imbalances and potential movement compensations

associated with poor posture (Kendall et al., 2005; Sahrmann, 2002). A static posture

assessment may offer valuable insight into:

• Muscle imbalance at a joint and the working relationships of muscles around a joint

üMuscle imbalance often contributes to dysfunctional movement.

• Altered neural action of the muscles moving and controlling the joint

üFor example, tight or shortened muscles are often overactive and dominate movement at

the joint, potentially disrupting healthy joint mechanics.

Table 5

Norms for Curl-up Test (Women)

Age (years)

Rating % Rating 18–25 26–35 36–45 46–55 56 –65 66+

Excellent 100 91 70 74 73 63 54

95 76 60 60 57 55 41

90 68 54 54 48 44 34

Good 85 64 50 48 44 42 33

80 61 46 44 40 38 32

75 58 44 42 37 35 31

Above average 70 57 41 38 36 32 29

65 54 40 36 35 30 28

60 51 37 35 33 27 26

Average 55 48 36 32 32 25 25

50 44 34 31 31 24 22

45 41 33 30 30 23 21

Below average 40 38 32 28 28 22 20

35 37 30 24 27 20 18

30 34 28 23 25 18 16

Poor 25 33 26 22 23 15 13

20 32 24 20 21 12 11

15 28 22 19 19 11 10

Very poor 10 25 20 16 13 8 9

5 24 17 14 9 7 8

0 11 7 4 2 1 0

Figure 4

Neutral spine alignment with

slight anterior (lordotic) curves

at the neck and low back and a

posterior (kyphotic) curve in the

thoracic region

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Table 6

Muscle Imbalances Associated

With Kyphosis-lordosis Posture

Facilitated/Hypertonic

(Shortened)

Inhibited

(Lengthened)

Hip flexors

Lumbar extensors

Anterior chest/shoulders

Latissimus dorsi

Neck extensors

Hip extensors

External obliques

Upper-back extensors

Scapular stabilizers

Neck flexors

Table 7

Muscle Imbalances Associated

With Flat-back Posture

Facilitated/Hypertonic

(Shortened)

Inhibited

(Lengthened)

Rectus abdominis

Upper-back extensors

Neck extensors

Ankle plantarflexors

Iliacus/psoas major

Internal oblique

Lumbar extensors

Neck flexors

Table 8

Muscle Imbalances Associated

With Sway-back Posture

Facilitated/Hypertonic

(Shortened)

Inhibited

(Lengthened)

Hamstrings

Upper fibers of

posterior obliques

Lumbar extensors

Neck extensors

Iliacus/psoas major

Rectus femoris

External oblique

Upper-back extensors

Neck flexors

a. Lordosis: increased

anterior lumbar curve

from neutral

b. Kyphosis: increased

posterior thoracic

curve from neutral

e. Scoliosis: lateral

spinal curvature often

accompanied by verte-

bral rotation

c. Flat back:

decreased anterior

lumbar curve

d. Sway back: decreased

anterior lumbar curve and

increased posterior tho-

racic curve from neutral

Figure 5

Postural deviations

Muscle imbalance and postural deviations can be attributed to many factors that are both

correctible and non-correctible, including the following:

• Correctible factors:

üRepetitive movements (muscular pattern overload)

üAwkward positions and movements (habitually poor posture)

üSide dominance

üLack of joint stability

üLack of joint mobility

üImbalanced strength-training programs

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

• Non-correctible factors:

üCongenital conditions (e.g., scoliosis)

üSome pathologies (e.g., rheumatoid arthritis)

üStructural deviations (e.g., tibial or femoral torsion, or femoral anteversion)

üCertain types of trauma (e.g., surgery, injury, or amputation)

Proper postural alignment promotes optimal neural activity of the muscles controlling and

moving the joint. When joints are correctly aligned, the length-tension relationships and force-

coupling relationships function efficiently. This facilitates proper joint mechanics, allowing the

body to generate and accept forces throughout the kinetic chain, and promotes joint stability and

mobility and movement efficiency. Figure 6 illustrates the importance of muscle balance and its

contribution to movement efficiency. Given how an individual’s static posture reflects potential

muscle imbalance, it stands to reason that instructors should consider conducting a static

postural assessment on their participants as an initial assessment.

Figure 6

Movement efficiency pattern

MUSCLE BALANCE

NORMAL FORCE-COUPLING RELATIONSHIPS

PROPER JOINT MECHANICS

(ARTHROKINEMATICS)

MOVEMENT EFFICIENCY

EFFICIENT FORCE ACCEPTANCE

AND GENERATION

PROMOTES JOINT STABILITY

AND MOBILITY

NORMAL LENGTH-TENSION RELATIONSHIPS

Given the propensity many individuals have toward poor posture, an initial focus of GFIs

should be to restore stability and mobility within the body and attempt to “straighten the

body before strengthening it.” The instructor can therefore start by looking at a participant’s

static posture following the right-angle rule of the body (Kendall et al., 2005). This model

demonstrates how the human body represents itself in vertical alignment across the major

joints—the ankle (and subtalar joint), knee, hip, and shoulder, as well as the head. This

model allows the observer to look at the individual in all three planes to note specific “static”

asymmetries at the joints (e.g., front to back and left to right). As illustrated in Figure 7,

the right-angle model implies a state in the frontal plane wherein the two hemispheres are

equally divided, and in the sagittal plane wherein the anterior and posterior surfaces appear

in balance. The body is in good postural position when the body parts are symmetrically

balanced around the body’s line of gravity, which is the intersection of the mid-frontal and

mid-sagittal planes and is represented by a plumb line hanging from a fixed point overhead.

While this model helps GFIs identify postural compensations and potential muscle

imbalances, it is important to recognize that limitations exist in using this model.

Plumb Line Instructions

Using a length of string and an inexpensive weight (e.g., a washer), GFIs can create a

plumb line that suspends from a ceiling or fixed point to a height 0.5 to 1 inch (1.3 to 2.5

cm) above the floor. It is important to select a location that offers a solid, plain backdrop or

a grid pattern with vertical and horizontal lines that offer contrast against the participant.

When conducting these assessments, the GFI should instruct the participant to wear form-

fitting athletic-style clothing to expose as many joints and bony landmarks as possible,

and have the participant remove his or her shoes and socks. The use of adhesive dots

placed upon the bony landmarks may assist instructors in identifying postural deviations.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

The objective of this assessment is to observe the participant’s symmetry against the plumb

line and the right angles that the weightbearing joints make relative to the line of gravity.

Individuals will consciously or subconsciously attempt to correct posture when they are aware

they are being observed. GFIs should encourage participants to assume a normal, relaxed

posture, and utilize distractions such as casual conversation to encourage this relaxed posture.

It is important to remember that while postural assessments provide valuable information, they

are only one piece to the movement efficiency puzzle, and thus should not be overemphasized.

GFIs should focus on the obvious, gross imbalances and avoid getting caught up in minor

postural asymmetries. Instructors should bear in mind that the body is rarely perfectly

symmetrical and that overanalyzing asymmetries is time-consuming, potentially intimidating

to participants, and may induce muscle fatigue in the participant that can alter his or her

posture even further. Therefore, when looking for gross deviations, the instructor should select

an acceptable margin of asymmetry that he or she will allow and focus on larger, more obvious

discrepancies. For example, start by focusing on gross deviations that differ by a quarter-inch

(0.6 cm) or more between the compartments of the body.

Plumb Line Positions

Anterior and Posterior Views

Source: Kendall et al., 2005

• For the anterior view, position the participant between the plumb line and a wall, facing

the plumb line with the feet equidistant from the suspended line (using the inside of the

heels or medial malleoli as a reference) (see Figure 7a).

• With good posture, the plumb line will pass equidistant between the feet and ankles, and

intersect the pubis, umbilicus, sternum, mandible (chin), maxilla (face), and frontal bone

(forehead).

• For the posterior view, position the individual between the plumb line and a wall, facing

away from the plumb line with the insides of the heels equidistant from the suspended

line (see Figure 7b).

Figure 7

The right-angle rule

(frontal and sagittal

views)

a. Frontal view (anterior) b. Frontal view (posterior) c. Sagittal view

Medial

malleolus

Lateral

malleolus

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

• With good posture, the plumb line should ideally bisect the sacrum and overlap the

spinous processes of the spine.

Sagittal View

Source: Kendall et al., 2005

• Position the individual between the plumb line and the wall, facing sideways with the plumb

line aligned immediately anterior to the lateral malleolus (anklebone) (see Figure 7c).

• With good posture, the plumb line should ideally pass through the anterior third of the

knee, the greater trochanter of the femur, and the acromioclavicular (A-C) joint, and

slightly anterior to the mastoid process of the temporal bone of the skull (in line with, or

just behind, the ear lobe) (see Figure 4).

Transverse View

Source: Kendall et al., 2005

• All transverse views of the limbs and torso are performed from frontal- and sagittal-plane

positions.

GFIs must respect scope of practice when performing a postural assessment on

participants, particularly in the presence of pain or injury. They must understand the need

for referral to more qualified healthcare professionals when pain or underlying pathologies

are present (e.g., scoliosis).

When conducting assessments of posture and movement, the following key components

should be included (Figure 8).

• Participant history—written and verbal

üCollect information on musculoskeletal issues, congenital issues (e.g., scoliosis),

trauma, injuries, pain and discomfort, the site of pain or discomfort, and what

aggravates and relieves pain or discomfort (e.g., with discomfort in the upper back, the

participant may feel temporary relief by hunching forward and rounding the shoulders).

üCollect lifestyle information, including occupation, side-dominance, and habitual

patterns (information regarding these patterns may take time to gather).

• Visual and manual observation

üIdentify observable postural deviations.

üVerify muscle imbalance as determined by muscle-length testing.

üDetermine the impact on movement ability or efficiency by performing movement

screens.

üDistinguish correctible from non-correctible compensations

While postural assessments can be performed in great detail, the following sections

address five key postural deviations that occur frequently in individuals.

Figure 8

A chronological plan

for conducting postural

assessments and

movement screens

*if necessary

HEALTH HISTORY AND

LIFESTYLE INFORMATION

STATIC POSTURAL ANALYSIS

MUSCLE LENGTH TESTING

ACTIVE AND PASSIVE RANGE OF MOTION*

PHASE 1: STABILITY AND MOBILITY

TRAINING (RESTORATIVE EXERCISE)

PHASE 2: MOVEMENT

TRAINING (MOVEMENT PATTERNS)

PHASES 3 & 4: PROGRESSION: LOAD

AND PERFORMANCE TRAINING

Documentation and

determination of

need for referral

to medical

professional

IDENTIFICATION OF CORRECTIBLE

POSTURAL COMPENSATIONS

ADMINISTRATION OF APPROPRIATE

MOVEMENT SCREENS

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Deviation 1: Ankle Pronation/Supination and the Effect on Tibial and Femoral

Rotation

Both feet should face forward in parallel or with slight (8 to 10 degrees) external rotation

(toes pointing outward from the midline, as the ankle joint lies in an oblique plane with the

medial malleolus slightly anterior to the lateral malleolus) (see Figure 7). The toes should

be aligned in the same direction as the feet and any excessive pronation (arch flattening) or

supination (high arches) at the subtalar joint should be noted.

Deviation 2: Hip Adduction

In standing and in gait, hip adduction is a lateral tilt of the pelvic that elevates one

hip higher than the other (also called “hip hiking”), which may be evident in individuals

who have a limb-length discrepancy (Sahrmann, 2002). If a person raises the right hip

as illustrated in Figure 9, the line of gravity following the spine tilts over toward the left,

moving the right thigh closer to this line of gravity. Consequently, the right hip is identified

as moving into adduction. This position progressively lengthens and weakens the right hip

abductors, which are unable to hold the hip level (Table 9). Sleeping on one’s side can

produce a similar effect, as the hip abductors of the upper hip fail to hold the hip level.

Figure 9

Normal hip position

versus right hip

adduction (posterior view)

Source: LifeART image

Kluwer Health, Inc.,

Lippincott Williams

& Wilkins. All rights

reserved.

Table 9

Hip Adduction

Observation Position

Plumb Line

Alignment

Plane of View

Right hip adduction

Elevated

(vs. left side)

Hips usually

shifted right

View from front

Left hip adduction

Elevated

(vs. right side)

Hips usually

shifted left

View from front

Deviation 3: Pelvic Tilting (Anterior or Posterior)

Anterior tilting of the pelvis frequently occurs in

individuals with tight hip flexors, which is generally

associated with sedentary lifestyles where individuals

spend countless hours in seated (i.e., shortened hip

flexor) positions (Kendall et al., 2005) (Figure 10). With

standing, this shortened hip flexor pulls the pelvis into

an anterior tilt (i.e., the superior, anterior portion of the

pelvis rotates downward and forward) (Figure 11). As

illustrated in Figure 12, an anterior pelvic tilt rotates

the superior, anterior portion of the pelvis forward and

downward, spilling water out of the front of the bucket,

whereas a posterior tilt rotates the superior, posterior

portion of the pelvis backward and downward, spilling

water out of the back of the bucket. Figure 13 illustrates

the alignment of the anterior superior iliac spine and

posterior superior iliac spine in neutral alignment, as

well in anterior and posterior pelvic tilts.

Psoas minor

Psoas major

Iliacus

Figure 10

Anterior musculature

of the hip and knee,

prime movers for

hip flexion (iliacus,

psoas major and

minor) and knee

extension

Tensor

fasciae

latae

Rectus

femoris

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Figure 11

Muscular control of the pelvis

by the abdominals and hip

flexors (iliopsoas and rectus

femoris) anteriorly and the spinal

extensors (erector spinae) and

hamstrings posteriorly

Rectus

abdominis

Hip

flexors

Hamstrings

Erector spinae

surface of

the pelvis

Posterior

surface of

the pelvis

Figure 12

Anterior and posterior

tilting of the pelvis—

sagittal (side) view

Back Front Back Front Back Front

Neutral pelvic position

Posterior pelvic tilt

Anterior pelvic tilt

Figure 13

Alignment of the

ASIS and pubic bone

Source: LifeART

image copyright

2008 Wolters

Kluwer Health, Inc.,

Lippincott Williams

& Wilkins. All rights

reserved.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Tight or overdominant hip flexors are generally coupled with tight erector spinae muscles

(Figure 14), producing an anterior pelvic tilt, while tight or overdominant rectus abdominis

muscles are generally coupled with tight hamstrings, producing a posterior pelvic tilt (Table

10). This coupling relationship between tight hip flexors and erector spinae is defined by

Vladimir Janda as lower-cross syndrome (Morris et al., 2006). With foot pronation and

accompanying internal femoral rotation, the pelvis may tilt anteriorly to better accommodate

the head of the femur, demonstrating the point of an integrated kinetic chain whereby foot

pronation can increase lumbar lordosis due to an anterior pelvic tilt (Sahrmann, 2002).

Figure 14

The erector spinae muscles and

hamstrings (posterior view)

Longissimus

Spinalis

Iliocostalis

Biceps

Femoris

Semitendinosus

Semimembranosus

Table 10

Pelvic Tilt

Observation Rotation Muscles Suspected

to Be Tight

Muscles Suspected

to Be Lengthened

Plane of View

Anterior tilt ASIS tilts

downward and

forward

Hip flexors, erector

spinae

Hamstrings, rectus

abdominis

Sagittal

Posterior tilt ASIS tilts

upward and

backward

Rectus abdominis,

hamstrings

Hip flexors, erector

spinae

Sagittal

Note: ASIS = Anterior superior iliac spine

Deviation 4: Shoulder Position and the Thoracic Spine

Limitations and compensations to movement at the shoulder occur frequently due to the

complex nature of the shoulder girdle design and the varied movements performed at the

shoulder. While the glenohumeral joint is highly mobile and perhaps a less stable joint,

the scapulothoracic joint is designed to offer greater stability with less mobility. However,

it is important to remember that it still contributes approximately 60 degrees of movement

in raising the arms overhead, with the glenohumeral joint contributing the remaining 120

degrees. The scapulothoracic joint also promotes many important movements of the scapulae

(Figure 15). Collectively, however, they allow for a diverse range of movements in the shoulder

complex. Observation of the position of the scapulae in all three planes provides good insight

into a participant’s quality of movement at the shoulders.

Figure 16 illustrates the “resting” position of the scapulae, which can vary considerably from

person to person. The vertebral (medial) border of the scapula is typically positioned between

the second and seventh ribs and vertically about 3 inches (7.6 cm) from the spinous processes

(Houglum, 2010; Kendall et al., 2005). While the glenoid fossa is tilted upward 5 degrees and

anteriorly 30 degrees to optimally articulate with the head of the humerus, the scapulae usually

lie flat against the rib cage (Kendall et al., 2005). While the scapulae should appear flat against

the rib cage, their orientation depends on the size and shape of the person and the rib cage.

Scapular Winging and Scapular Protraction

GFIs can perform a quick observational assessment to identify scapular winging and

scapular protraction. While looking at the participant from the posterior view, if the vertebral

(medial) and/or inferior angle of the scapulae protrude outward, this indicates an inability of

the scapular stabilizers (primarily the rhomboids and serratus anterior) to hold the scapulae

in place. Noticeable protrusion of the vertebral (medial) border outward is termed “scapular

protraction” (Figure 17a), while protrusion of the inferior angle and vertebral (medial) border

outward is termed “winged scapulae” (Figure 17b).

Scapular protraction can also be identified from the anterior view. If the palms face backward

instead of to the sides, this generally indicates internal (medial) rotation of the humerus and/

or scapular protraction (Figure 18). Table 11 lists key deviations of the thoracic spine and

shoulders in various planes of view.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Elevation

Depression

Adduction (retraction)

Downward rotation (return to

anatomical position)

Upward rotationAbduction (protraction)

Figure 15

Scapular

movements

Figure 16

The normal

position of the

scapulae

Medial border of the

scapula

Head of the humerus

Glenoid fossa

Inferior angle of the

scapula

Figure 17

Scapular protraction and winging: Posterior view

Figure 18

Scapular

protraction:

Anterior view

Table 11

Shoulder Position

Observation Muscles Suspected to Be Tight

Plane of

View

Shoulders not level Upper trapezius, levator scapula, rhomboids Frontal

Asymmetry to midline Lateral trunk flexors (flexed side) Frontal

Protracted

(forward, rounded)

Serratus anterior*, anterior scapulo-

humeral muscles, upper trapezius

Sagittal

Medially rotated

humerus

Pectoralis major, latissimus dorsi,

subscapularis

Frontal

Kyphosis and depressed

chest

Shoulder adductors, pectoralis minor,

rectus abdominis, internal oblique

Sagittal

*Serratus anterior is usually tight with scapular protraction and is usually lengthened with scapular winging.

a. Scapular protraction b. Scapular winging

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

DEVIATION 5: HEAD POSITION

With good posture, the earlobe should align approximately over the acromion process,

but given the many awkward postures and repetitive motions of daily life, a forward-head

position is very common (Table 12) (Kendall et al., 2005). This altered position does not

tilt the head downward, but simply shifts it forward so that the earlobe appears significantly

forward of the acromioclavicular (AC) joint. To observe the presence of this

imbalance, use the sagittal view, aligning the plumb line with the AC joint, and

observe its position relative to the ear (Figure 19) (Price, 2010). A forward-head

position represents tightness in the cervical extensors and lengthening of the

cervical flexors. To demonstrate this point, an instructor can place one thumb on

his or her manubrium (top of the sternum) and the index finger of the same hand

on the chin. Slowly slide the head forward and observe how the spacing between

the fingers increases, representing the change in muscle length. An alternative

option for observing forward-head position is via the alignment of the cheek

bone and the collarbone. With good posture, they should almost be in vertical

alignment with each other. To demonstrate this point, have a participant place one finger on

his or her collar bone (aligned under the cheek) and place another finger on the cheek bone

(aligned under the eye) as illustrated in Figure 20 (Price, 2010). From the sagittal plane,

the instructor can observe the vertical alignment of the two fingers.

Table 12

Head Position

Observation

Muscles Suspected

to Be Tight

Plane

of View

Forward-

head position

Cervical spine

extensors, upper

trapezius, levator

scapulae

Sagittal

Figure 19

Alignment of the acromioclavicular joint with the ear

Good posture Forward-head position

Figure 20

Alignment of the collar bone and cheek bone

Good posture Forward-head position

Postural Assessment Checklist and Worksheets

When performing basic postural assessments, GFIs can use the checklist provided in Figure

21 to guide themselves through their observations, and complete the worksheets provided in

Figures 22 and 23 to mark any postural compensations they identify.

MOVEMENT SCREENS

Observing active movement is an effective method to determine the contribution that muscle

imbalances and poor posture have on neural control, and also helps identify movement

compensations (Whiting & Rugg, 2012; Sahrmann, 2002). When compensations occur during

movement, it is usually indicative of some form of altered neural action, commonly referred to

as “faulty neural control,” which normally manifests due to muscle tightness or an imbalance

between muscles acting at the joint.

Movement can essentially be broken down and described by five primary movements that

people perform during many daily activities (Cook, 2010):

• Bending/raising and lifting/lowering movements (e.g., squatting)

• Single-leg movements

• Pushing movements (in vertical/horizontal planes) and resultant movement

• Pulling movements (in vertical/horizontal planes) and resultant movement

• Rotational movements

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Figure 21

Postural assessment checklist

FRONTAL VIEW

Overall body symmetry: symmetrical alignment of the left and right hemispheres

Ankle position: observe for pronation and supination

Foot position: observe for inversion and eversion

Knees: rotation and height discrepancies

Hip adduction and shifting: observe for shifting to a side as witnessed by the position of the pubis in relation to the

plumb line

Alignment of the iliac crests

Alignment of the torso: position of the umbilicus and sternum in relation to the plumb line

Alignment of the shoulders

Arm spacing: observe the space to the sides of the torso

Hand position: observe the position relative to the torso

Head position: alignment of the ears, nose, eyes, and chin

POSTERIOR VIEW

Overall body symmetry: symmetrical alignment of the left and right hemispheres

Alignment of the spine: vertical alignment of the spinous processes (may require forward bending)

Alignment of the scapulae: inferior angle of scapulae and presence of winged scapulae

Alignment of the shoulders

Head: alignment of the ears

SAGITTAL VIEW

Overall body symmetry: symmetrical alignment of load-bearing joint landmarks with the plumb line

Knees: flexion or extension

Pelvic alignment for tilting: relationship of ASIS to PSIS

Spinal curves: observe for thoracic kyphosis, lumbar lordosis, or flat-back position

Shoulder position: forward rounding (protraction) of the scapulae

Head position: neutral cervical curvature (versus forward position) and level (position above the clavicle)

Note: ASIS = Anterior superior iliac spine; PSIS = Posterior superior iliac spine

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Figure 22

Anterior/posterior worksheet

ANTERIOR VIEW: POSTERIOR VIEW:

L R

DEVIATION

L R

DEVIATION

¨ ¨

CIRCLE OR MARK OBSERVED DEVIATIONS CIRCLE OR MARK OBSERVED DEVIATIONS

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Figure 23

Sagittal worksheet

SAGITTAL: LEFT SIDE SAGITTAL: RIGHT SIDE

DEVIATION

CIRCLE OR MARK OBSERVED DEVIATIONS CIRCLE OR MARK OBSERVED DEVIATIONS

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Activities of daily living (ADL) are essentially the integration of one or more of these primary

movements. For example, the action of picking up a child and turning to place the child

in a car seat involves a squatting movement, a rotational movement, a possible single-leg

movement if stepping is involved, a pushing movement, and finally a pulling movement to

resist the effects of gravity as the child is lowered into the seat.

Movement screens help GFIs observe the ability and efficiency with which a participant

performs many ADL. The movement screens, however, must be skill- and conditioning-level

appropriate, and be specific to the participant’s needs. It is important to remember that almost

any screen can evaluate functional capacity, as long as it is relevant to participant needs and

challenges, and provides useful feedback on movement efficiency (Sahrmann, 2002). Screens

generally challenge participants with no recognized pathologies to perform basic movements

and evaluate their ability to demonstrate appropriate levels of stability and mobility throughout

the entire kinetic chain—namely, at the feet, knees, lumbo-pelvic-hip complex, shoulders,

and head. If the participant experiences pain during a movement screen, the test should be

stopped and the participant should be referred to his or her healthcare provider to have the

painful area evaluated before performing that type of movement in a future exercise session.

Bend and Lift Screen

Objective: To examine symmetrical lower-extremity mobility and stability, and upper-

extremity stability during a bend-and-lift movement

Equipment:

• Two 2- to 4-foot (0.6- to 1.2-m) dowels or broomsticks

Instructions:

• Briefly discuss the protocol so the participant understands what is required.

• Ask the participant to stand with the feet shoulder-width apart with the arms hanging

freely to the sides.

• Place the two dowels on the floor adjacent to the outside of each foot.

• Ask the participant to perform a series of basic bend-and-lift movements (i.e., a squatting

movement) to grasp the dowels and lift them off the floor, holding the lowered position

for one to two seconds to allow the instructor to make some brief observations before

returning to the starting position. The number of repetitions performed is determined by

the number needed to make the necessary evaluations.

üAsk the participant to pretend the dowels are 25-pound weights.

üIt is important to remember not to cue the participant to use good technique, but

instead observe his or her natural movement.

Observations (Table 13):

• Frontal view (Figure 24):

üFirst repetition: Observe the stability of the foot (i.e., evidence of pronation, supination,

eversion, or inversion).

üSecond repetition: Observe the alignment of the knees over the second toe.

üThird repetition: Observe the overall symmetry of the entire body over the base of

support (i.e., evidence of a lateral shift or rotation).

• Sagittal view (Figure 25):

üFirst repetition: Observe whether the heel remains in contact with the floor throughout

the movement.

üSecond repetition: Determine whether the participant exhibits “glute” or “quadriceps”

dominance (i.e., does he or she initiate the downward phase by driving the knees

forward or pushing the hips backward?).

üThird repetition: Observe whether the participant achieves a parallel position between

the tibia and torso in the lowered position (sometimes referred to as the “figure-4”

position), while also observing whether he or she controls the descent to avoid resting

the hamstrings against the calves.

üFourth repetition: Observe the degree of lordosis in the lumbar/thoracic spine during

the lowering movement and while the participant is in the lowered position (i.e., flat-to-

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

neutral or demonstrated increased lordosis) and watch for excessive thoracic extension

in the lowered position.

üFifth repetition: Observe any changes in head position during the lowering phase.

General interpretations:

• Identify origin(s) of movement limitation or compensation.

• Evaluate the impact on the entire kinetic chain.

Figure 24

Bend and lift screen:

Frontal view

Figure 25

Bend and lift screen:

Sagittal view

Table 13

Bend and Lift Screen

View Joint Location Compensation Key Suspected Compensations:

Overactive (Tight)

Key Suspected Compensations:

Underactive (Weak)

Anterior Feet Lack of foot stability: Ankles

collapse inward/feet turn outward

Soleus, lateral gastrocnemius,

peroneals

Medial gastrocnemius, gracilis,

sartorius, tibialis group

Anterior Knees Move inward Hip adductors, tensor fascia latae Gluteus medius and maximus

Anterior Torso Lateral shift to a side Side dominance and muscle imbalance due to potential lack of

stability in the lower extremity during joint loading

Sagittal Feet Unable to keep heels in contact

with the floor

Plantarflexors None

Sagittal Hip and knee Initiation of movement Movement initiated at knees may indicate quadriceps and hip flexor

dominance, as well as insufficient activation of the gluteus group

Sagittal Tibia and torso

relationship

Contact behind

knee

Unable to achieve parallel between

tibia and torso

Hamstrings contact back of calves

Poor mechanics, lack of dorsiflexion due to tight plantarflexors (which

normally allow the tibia to move forward)

Muscle weakness and poor mechanics, resulting in an inability to

stabilize and control the lowering phase

Sagittal Lumbar and

thoracic spine

Back excessively arches

Back rounds forward

Hip flexors, back extensors,

latissimus dorsi

Latissimus dorsi, teres major,

pectoralis major and minor

Core, rectus abdominis, gluteal

group, hamstrings

Upper back extensors

Sagittal Head Downward

Upward

Increased hip and trunk flexion

Compression and tightness in the cervical extensor region

Data from: Abelbeck, K.G. (2002). Biomechanical model and evaluation of a linear motion squat type exercise. Journal of Strength and Conditioning Research, 16, 516–524; Cook, G.

(2003). Athletic Body in Balance. Champaign, Ill.: Human Kinetics; Donnelly, D.V. et al. (2006). The effect of directional gaze on kinematics during the squat exercise. Journal of Strength

and Conditioning Research, 20, 145–150; Fry, A.C., Smith J.C., & Schilling, B.K. (2003). Effect of knee position on hip and knees torques during the barbell squat. Journal of Strength and

Conditioning Research, 17, 629–633; Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, Md.: Lippincott Williams & Wilkins; Sahrmann, S.A.

(2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Mo.: Mosby.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Hurdle Step Screen

Objective: To examine simultaneous mobility of one limb and stability of the contralateral

limb while maintaining both hip and torso stabilization during a balance challenge of

standing on one leg

Equipment:

•Two uprights to anchor string (chair or table legs)

•36-inch (0.9-m) piece of string

•48-inch (1.2-m) wooden or plastic dowel

Instructions:

•Briefly discuss the protocol so the participant understands what is required.

•Fasten a piece of string spanning two points at a height even with the underside of the

foot positioned parallel with the floor, when it is raised to a height that flexes the hip

to 70 degrees (approximately just above halfway up the tibia).

•Have the participant stand with both feet together and the front edge of the toes

aligned directly beneath the string.

üUltimately, this test should be performed with the feet positioned at gait-width apart

[i.e., 2.8 to 3.5 inches (7 to 9 cm)] to simulate single-leg support during walking.

•Place the dowel across the participant’s shoulders, holding it parallel to the floor

(similar to the placement of the bar during the traditional barbell squat).

•Instruct the participant to load onto one leg and slowly lift the opposite leg over the

string, flexing the hip to clear the string and then gently touching the heel of the

raised leg to the floor in front of the string before returning to the starting position.

üThe foot only needs to clear the string and does not need to be lifted as high as

possible.

üIt is important to remember not to cue the participant to use good technique,

instead observing the natural movement.

üRepetitions need to be performed slowly and with control.

•Have the participant repeat the movement with the opposite leg, completing a series of

repetitions with each leg so that the instructor can make the necessary evaluations.

•Allow sufficient practice trials to accommodate learning before administrating the test

screens.

Observations (Table 14):

•Frontal view (Figure 26):

üFirst repetition: Observe the stability of the foot (i.e., evidence of pronation,

supination, eversion, or inversion).

üSecond repetition: Observe the alignment of the stance-leg knee over the foot (i.e.,

evidence of knee movement in any plane).

üThird repetition: Watch for excessive hip adduction greater than 2 inches (5.1 cm)

as measured by excessive stance-leg adduction or downward hip-tilting toward the

opposite side (Figure 27).

üFourth repetition: Observe the stability of the torso (i.e., evidence of torso movement

in any plane as demonstrated by movement of the dowel) (see Figure 27).

üFifth repetition: Observe the alignment of the moving leg (i.e., lack of dorsiflexion

at the ankle, deviation from the sagittal plane at the knee or ankle, or hiking of the

moving hip) (see Figure 27).

•Sagittal view (Figure 28):

üFirst repetition: Observe the stability of the torso and stance leg.

üSecond repetition: Observe the mobility of the hip (i.e., allowing 70 degrees of hip

flexion without compensation—anterior tilting).

General interpretations:

•Identify the origin(s) of movement limitation or compensation.

•Evaluate the impact on the entire kinetic chain.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Figure 26

Hurdle step screen: Anterior view

Figure 27

Hurdle step screen: Anterior view with

compensations

Figure 28

Hurdle step screen: Sagittal view

Table 14

Hurdle Step Screen

View

Joint

Location

Compensation

Key Suspected Compensations:

Overactive (Tight)

Key Suspected Compensations:

Underactive (Weak)

Anterior Feet Lack of foot stability:

Ankles collapse inward/

feet turn outward

Soleus, lateral gastrocnemius,

peroneals

Medial gastrocnemius, gracilis, sartorius, tibialis

group, gluteus medius and maximus—inability to

control internal rotation

Anterior Knees Move inward Hip adductors, tensor fascia latae Gluteus medius and maximus

Anterior Hips Hip adduction

>2 inches (5.1 cm)

Stance-leg hip rotation

(inward)

Hip adductors, tensor fascia latae

Stance-leg or raised-leg internal

rotators

Gluteus medius and maximus

Stance-leg or raised-leg external rotators

Anterior Torso Lateral tilt, forward

lean, rotation

Lack of core stability

Anterior Raised-leg Lack of ankle

dorsiflexion

Limb deviates from

sagittal plane

Hiking the raised hip

Ankle plantarflexors

Raised-leg hip extensors

Stance-leg hip flexors—limiting

posterior hip rotation during raise

Ankle dorsiflexors

Raised-leg hip flexors

Sagittal Pelvis and

low back

Anterior tilt with

forward torso lean

Posterior tilt with

hunched-over torso

Stance-leg hip flexors

Rectus abdominis and hip

extensors

Rectus abdominis and hip extensors

Stance-leg hip flexors

*Hip adduction involves weight transference over the stance leg while preserving hip, knee, and foot alignment. This weight transference requires a 1- to 2-inch (2.5- to 5-cm) lateral shift

over the stance-leg, with a small hike in the stance-hip of 4 to 5 degrees or less.

Data from: Cook, G. (2003). Athletic Body in Balance. Champaign, Ill.: Human Kinetics; Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore,

Md.: Lippincott Williams & Wilkins; Sahrmann, S.A. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Mo.: Mosby.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Shoulder Push Stabilization Screen

Objective: To examine stabilization of the scapulothoracic joint and core control during

closed-kinetic-chain pushing movements

Instructions:

• Briefly discuss the protocol so the participant understands what is required.

üThe participant presses his or her body off the ground as the instructor evaluates

the ability to stabilize the scapulae against the thorax (rib cage) during pushing-type

movements (Figure 29).

• Instruct the participant to lie prone on the floor with arms abducted in the push-up

position or bent-knee push-up position.

• Ask the participant to perform several push-ups to full arm extension.

üSubjects should perform full push-ups; modify to bent-knee push-ups if necessary.

üIt is important to remember not to cue the participant to use good technique, but

instead observe his or her natural movement.

üRepetitions need to be performed slowly and with control.

Observations (Table 15):

• Observe any notable changes in the position of the scapulae relative to the rib cage at

both end-ranges of motion (i.e., the appearance of scapular “winging”) (Figure 30).

• Observe for lumbar hyperextension in the press position.

General interpretations:

• Identify the origin(s) of movement limitation or compensation.

• Evaluate the impact on the entire kinetic chain.

Figure 29

Shoulder push stabilization screen

Figure 30

Shoulder push stabilization

screen with scapular winging

Table 15

Shoulder Push Stabilization Screen

View Joint Location Compensation Key Suspected Compensations

Sagittal Scapulothoracic Exhibits

“winging”

during the

push-up

movement

Inability of the parascapular muscles (i.e., serratus

anterior, trapezius, levator scapula, rhomboids) to

stabilize the scapulae against the rib cage. Can also

be due to a flat thoracic spine.

Sagittal Trunk Hyperextension

or “collapsing”

of the low back

Lack of core, abdominal, and low-back strength,

resulting in instability

Data from: Sahrmann, S.A. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Mo.: Mosby; Kendall, F.P. et al. (2005).

Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, Md.: Lippincott Williams & Wilkins.

Thoracic Spine Mobility Screen

Objective: To examine bilateral mobility of the thoracic spine. Lumbar spine rotation is

considered insignificant, as it only offers approximately 15 degrees of rotation.

Equipment:

• Chair

• Squeezable ball or block

• 48-inch (1.2-m) dowel

Instructions:

• Briefly discuss the protocol so the participant understands what is required.

•Instruct the participant to sit upright toward the front edge of the seat with the feet

together and firmly placed on the floor. The participant’s back should not touch the

backrest.

•Place a squeezable ball or block between the knees and a dowel across the front

of the shoulders, instructing the participant to hold the bar in the hands (i.e., front

barbell squat grip) (Figure 31).

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

• While maintaining an upright and straight posture, the participant squeezes the block to

immobilize the hips and gently rotates left and right to an end-range of motion without any

bouncing (Figure 32).

üIt is important to remember not to cue the participant to use good technique, but

instead observe his or her natural movement.

üAsk the participant to perform a few repetitions in each direction, slowly and with

control.

Observation (Table 16):

• Observe any bilateral discrepancies between the rotations in each direction.

General interpretations:

• Identify the origin(s) of movement limitation or compensation. As an individual rotates,

the facet joints of each vertebra experience shearing forces against each other. One way

to reduce this force and promote greater movement is to laterally flex the trunk during the

movement or at the end-range of movement. This screen evaluates trunk rotation in the

transverse plane. Therefore, any lateral flexion of the trunk (dowel tilting up or down) must

be avoided.

• Evaluate the impact on the entire kinetic chain. Remember that the lumbar spine

generally exhibits limited rotation of approximately 15 degrees (Sahrmann, 2002), with

the balance of trunk rotation occurring through the thoracic spine. If thoracic spine

mobility is limited, the body strives to gain movement in alternative planes within the

lumbar spine (e.g., increase in lordosis to promote greater rotation).

Figure 32

Thoracic spine mobility screen: End position

Figure 31

Thoracic spine mobility screen: Starting position

Table 16

Thoracic Spine Mobility Screen

View Joint Location Compensation Possible Biomechanical Problems

Transverse Trunk None if trunk rotation achieves

45 degrees in each direction

Transverse Trunk Bilateral discrepancy (Assuming

no existing congenital issues in

the spine)

Side-dominance

Differences in paraspinal development

Torso rotation, perhaps associated with some hip rotation

Note: Lack of thoracic mobility will negatively impact glenohumeral mobility

Data from: Sahrmann, S.A. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Mo.: Mosby.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

BALANCE AND THE CORE

Given the importance of balance and the condition of the core musculature to fitness

and overall quality of life, these baseline assessments should be collected to evaluate the

need for comprehensive balance training and core conditioning during the early stages of

a conditioning program. While dynamic balance correlates more closely with people’s daily

activities, these tests are generally movement-specific and quite complex. Consequently, GFIs

should aim to first evaluate the basic level of static balance that a participant exhibits by

using the sharpened Romberg test or the stork-stand test. Figure 33 can be used to record the

participant’s performance on the balance and core assessments presented here.

Figure 34

Sharpened Romberg test

Balance Worksheet

Balance Right Leg Left Leg Difference

Sharpened Romberg test ______ seconds ______ seconds ______ seconds

Stork-stand balance test

______ seconds ______ seconds ______ seconds

Sharpened Romberg Test

Sources: Black et al., 1982; Newton, 1989

Objective: To assess static balance by standing with a reduced base of support while

removing visual sensory information

Equipment:

• Flat, non-slip surface

• Stopwatch

Instructions:

• Explain the purpose of the test.

• Instruct the participant to remove his or her shoes and stand with one foot directly in front

of the other (tandem or heel-to-toe position), with the eyes open.

• Ask the participant to fold his or her arms across the chest, touching each hand to the

opposite shoulder (Figure 34).

• Allow sufficient practice trials. Once the participant feels stable, instruct him or her to

close his or her eyes. Start the stopwatch to begin the test.

• Always stand in close proximity as a precaution to prevent falling.

• Continue the test for 60 seconds or until the participant exhibits any test-termination cue,

as listed in the Observations section.

• Allow up to two trials per leg position and record the best performance on each side.

Observations:

• Continue to time the participant’s performance until one of the following occurs:

üThe participant loses postural control and balance.

üThe participant’s feet move on the floor.

üThe participant’s eyes open.

üThe participant’s arms move from the folded position.

üThe participant exceeds 60 seconds with good postural control.

General interpretations:

• The participant needs to maintain his or her balance with good postural control (without

excessive swaying) and not exhibit any of the test-termination criteria for 30 or more

seconds.

• The inability to reach 30 seconds is indicative of inadequate static balance and postural

control.

Figure 33

Balance worksheet

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Stork-stand Balance Test

Source: Johnson & Nelson, 1986

Objective: To assess static balance by standing on one foot in a modified stork-stand

position. This is a more challenging variation of the blind stork-stand test, where the stance

foot remains flat on the floor, but the test is conducted with the eyes closed.

Equipment:

• Flat, non-slip surface

• Stopwatch

Instructions:

• Explain the purpose of the test.

•Ask the participant to remove his or her shoes and stand with feet together, hands on

the hips.

• Instruct the participant to raise one foot off the ground and bring that foot to lightly touch

the inside of the stance leg, just below the knee (Figure 35).

üThe participant must raise the heel of the stance foot off the floor and balance on the

ball of the foot (Figure 36).

üStand behind the participant for support if needed.

üAllow 1 minute of practice trials.

üAfter the practice trial, perform the test, starting the stopwatch as the heel lifts off the

floor.

üThe test is performed with the eyes open.

• Repeat with the opposite leg.

• Allow up to three trials per leg position and record the best performance on each side.

Observations:

• Timing stops when any of the following occurs:

üThe hand(s) come off the hips.

üThe stance or supporting foot inverts, everts, or moves in any direction.

üAny part of the elevated foot loses contact with the stance leg.

üThe heel of the stance leg touches the floor.

üThe participant loses balance.

General interpretation:

• Use the information provided in Table 17 to categorize the participant’s performance

Figure 35

Stork-stand

balance test:

Starting position

Figure 36

Stork-stand

balance test:

Test position

Table 17

The Stork-stand Balance Test

Rating Excellent Good Average Fair Poor

Males >50 seconds 41–50 seconds 31–40 seconds 20–30 seconds <20 seconds

Females >30 seconds 25–30 seconds 16–24 seconds 10–15 seconds <10 seconds

Data from: Johnson B.L. & Nelson, J.K. (1986). Practical Measurements for Evaluation in Physical Education (4th ed.). Minneapolis, Minn.:

Burgess.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Figure 37

Worksheet for

conducting

flexibility

assessments

SIT-AND-REACH TEST

Distance reached:___________________________________ Additional notes:__________________________________

THOMAS TEST

Left hip: Normal q Tight q Right hip: Normal q Tight q

Additional notes:___________________________________ Additional notes:__________________________________

PASSIVE STRAIGHT-LEG RAISE

Left Hamstrings: Normal q Tight q Right Hamstrings: Normal q Tight q

Additional notes:___________________________________ Additional notes:__________________________________

SHOULDER FLEXION

Left shoulder: Normal q Tight q Right shoulder: Normal q Tight q

Additional notes:___________________________________ Additional notes:__________________________________

SHOULDER EXTENSION

Left shoulder: Normal q Tight q Right shoulder: Normal q Tight q

Additional notes:___________________________________ Additional notes:__________________________________

INTERNAL ROTATION

Left shoulder: Normal q Tight q Right shoulder: Normal q Tight q

Additional notes:___________________________________ Additional notes:__________________________________

EXTERNAL ROTATION

Left shoulder: Normal q Tight q Right shoulder: Normal q Tight q

Additional notes:___________________________________ Additional notes:__________________________________

APLEY’S SCRATCH TEST

Left reach-under: Normal q Tight q Right reach-under: Normal q Tight q

Additional notes:___________________________________ Additional notes:__________________________________

Left reach-over: Normal q Tight q Right reach-over: Normal q Tight q

Additional notes:___________________________________ Additional notes:__________________________________

FLEXIBILITY AND MUSCLE-LENGTH TESTING

Evaluating participants’ ranges of motion using flexibility tests is a great way to determine

areas of the body that may need an emphasis on stretching. Stiff, inflexible muscles and

joints pose a risk for injury and may adversely affect the performance of the simplest

tasks. During the initial assessments of posture and movement, a GFI may opt to assess

the flexibility of specific muscle groups that he or she suspects demonstrate tightness

or limitations to movement. Figure 37 can be used to keep records when conducting the

flexibility assessments presented in this section.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

MEN

Ages 18–25 26–35 36–45 46–55 56–65 >65

% Rating

90 22 21 21 19 17 17

80 20 19 19 17 15 15

70 19 17 17 15 13 13

60 18 17 16 14 13 12

50 17 15 15 13 11 10

40 15 14 13 11 9 9

30 14 13 13 10 9 8

20 13 11 11 9 7 7

10 11 9 7 6 5 4

Figure 38

Sit-and-reach

flexibility test

WOMEN

Ages 18–25 26–35 36–45 46–55 56–65 >65

% Rating

90 24 23 22 21 20 20

80 22 21 21 20 19 18

70 21 20 19 18 17 17

60 20 20 18 17 16 17

50 19 19 17 16 15 15

40 18 17 16 14 14 14

30 17 16 15 14 13 13

20 16 15 14 12 11 11

10 14 13 12 10 9 9

Table 18

Norms for Trunk-Flexibility Test Fitness Categories (inches)

The following may be used as descriptors for the percentile rankings: Well above average (90), above average (70), average (50), below average (30), and well below average (10).

Sit-and-Reach Test

The sit-and-reach test is used to assess low-back and hip-joint flexibility. Due to the

possibility of injury to the low back and hamstrings, participants should refrain from fast,

jerky movements during this assessment. Instead, they should perform the test trials slowly

and with control. Participants with a history of low-back dysfunction and/or pain should avoid

performing this test.

Equipment:

• Exercise mat

• Tape

• Yardstick

Procedure:

• Participants should perform a light warm-up prior to testing. However, if this test follows

a cardiorespiratory-fitness test, participants may proceed without a warm-up. Additional

light stretching of the low back and hamstrings (e.g., modified hurdler stretch) is

recommended before test administration.

• Place a yardstick on the floor and put a piece of tape at least 12 inches long on the

15-inch mark on the yardstick.

• Review and demonstrate the proper execution of the test. With the shoes off, sit on the

floor with the yardstick parallel between extended legs. The zero mark of the yardstick

should be toward the body.

• The feet should be placed approximately 12 inches apart with the heels aligned with the

tape at the 15-inch mark.

•Extendthearmsinfrontofthechestandplaceonehandontopoftheother,with

fingertips aligned. Inhale in the upright position and exhale while leaning forward,

dropping the head toward or between the arms. The fingers should maintain contact with

the yardstick and knees should remain in full extension (Figure 38).

•Instructparticipantstobeginthetestbyslowlyreaching

forward with both hands as far as possible, holding this

position for approximately two seconds. Remind them to

keep their hands parallel and not to lead with one hand.

The score is the farthest point on the yardstick reached after

three trials (Table 18).

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Group fitness instructors should be aware of the limitations associated with the sit-and-

reach test. First, variations in arm, leg, and trunk length can make comparisons between

individuals—such as when comparing participants’ scores to those listed in the norm tables—

misleading. That is, participants with long arms and/or short legs will get a better result, while

those with short arms and/or long legs will be at a disadvantage. Second, as noted earlier,

individuals with a history of low-back pain should avoid this test due to the end ranges of

motion required in hip and spine flexion to perform it. An option for assessing the length of

the hamstrings while sparing the back is the passive straight-leg (PSL) raise test.

Thomas Test for Hip Flexion/Quadriceps Length

Objective: To assess the length of the muscles involved in hip flexion. This test can actually

assess the length of the primary hip flexors.

• Hip flexors or iliopsoas

• Rectus femoris (one of the four quadriceps muscles)

This test should not be conducted on participants suffering from low-back pain, unless

cleared by their physician.

Equipment:

• Stable table

Instructions:

• Given the nature of the movement associated with this test, the instructor may want to

consider draping a towel over the participant’s groin area.

Figure 40

Thomas test: Test position

Figure 39

Thomas test: Starting position

Table 19

Interpretation of the Thomas Test

Movement/Limitation Suspected Muscle Tightness

With the back and sacrum flat, the back of

the lowered thigh does not touch the table

and the knee does not flex to 80 degrees.

Primary hip flexor muscles

With the back and sacrum flat, the back of

the lowered thigh does not touch the table,

but the knee does flex to 80 degrees.

The iliopsoas, which is preventing the hip

from rotating posteriorly and inhibiting the

thigh from being able to touch the table

With the back and sacrum flat, the back of

the lowered thigh does touch the table, but

the knee does not flex to 80 degrees.

The rectus femoris, which does not allow the

knee to bend

Data from: Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, Md.:

Lippincott Williams & Wilkins.

• Explain the objective of the test and allow a warm-up.

• Instruct the participant to sit at the end of a table with the mid-thigh

aligned with the table edge (Figure 39). Place one hand behind the

participant’s back and the other under his or her thighs.

• While supporting the participant, instruct him or her to gently flex both

thighs toward the chest, and gradually assist as the participant rolls back

onto the table to touch the back and shoulders to the table top.

üInstruct the participant to slowly pull one thigh (hip) toward the

chest, reaching with both hands to grasp the thigh or the area

behind the knee without raising or moving the torso.

üAsk the participant to slowly relax the opposite leg, allowing the knee to

slowly fall toward the table and the lower leg to hang freely off the table

edge [a 1-inch (2.5 cm) spacing between the back of the knee and the

table edge is adequate] (Figure 40).

Observations:

• Observe whether the back of the lowered

thigh touches the table (hips positioned in

10 degrees of extension).

• Observe whether the knee of the lowered

leg achieves 80 degrees of flexion.

• Observe whether the knee remains

aligned straight or falls into internal or

external rotation.

General interpretations:

• Use the information provided in Table 19

to determine the location and identity of

the tight or limiting muscles.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Passive Straight-leg (PSL) Raise

Objective: To assess the length of the hamstrings

Equipment:

• Stable table or exercise mat

Instructions:

• Explain the objective of the test and allow a warm-up.

• Instruct the participant to lie supine on a mat or table with the legs extended and the low

back and sacrum flat against the surface.

• Place one hand under the calf of the leg that will be raised while instructing the

participant to keep the opposite leg extended on the mat or table. Restrain that leg from

moving or rising during the test.

Figure 42

PSL raise: Test position

Figure 41

PSL raise: Trainer’s hand position

Table 20

Interpretation of the Passive Straight-leg Raise

Movement/Limitation Hamstrings Length

The raised leg achieves ≥80 degrees of movement before the

pelvis rotates posteriorly.

Normal hamstrings length

The raised leg achieves <80 degrees of movement before the

pelvis rotates posteriorly or there are any visible signs in the

opposite leg lifting off the mat or table.

Tight hamstrings

Data from: Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, Md.: Lippincott

Williams & Wilkins.

• Slide the other hand under the lumbar spine into the space between the participant’s

back and the mat or table (Figure 41).

• Advise the participant to gently plantarflex his or her ankles to point the toes away

from the body. This position avoids a test limitation due to a tight gastrocnemius

muscle (which would limit knee extension with the ankle in dorsiflexion).

Additionally, a straight-leg raise with dorsiflexion may increase tension within the

sciatic nerve and create some discomfort.

• Slowly raise the one leg, asking the participant to keep that knee loosely extended

throughout the movement.

• Continue to raise the leg until firm pressure can be felt from the low back pressing

down against the hand (Figure 42).

• This indicates an end-range of motion of the hamstrings with

movement now occurring as the pelvis rotates posteriorly.

• Throughout the movement, the participant needs to maintain

extension in the opposite leg and keep the sacrum and low back

flat against the mat or table.

üIf the test is performed with the opposite hip in slight flexion,

this allows the pelvis more freedom to move into a posterior

tilt, allowing a greater range of motion and falsely increasing

the length of the hamstrings.

Observation:

• Note the degree of movement attained from the table or mat

that is achieved before the spine compresses the hand under

the low back or the opposite leg begins to show visible signs of

lifting off the table or mat.

üThe mat or table represents 0 degrees.

üThe leg perpendicular to the mat or table represents

90 degrees.

General interpretation:

• Use the information provided in Table 20 to determine the

limitation(s).

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Shoulder Mobility

Apley’s scratch test involves multiple and simultaneous movements of the scapulothoracic

and glenohumeral joints in all three planes. This represents a challenge in evaluating

shoulder movement and identifying movement limitations. To identify the source of the

limitation, GFIs can first have participants perform various isolated movements in single

planes to locate potentially problematic movements. Consequently, the scratch test is

completed in conjunction with:

• The shoulder flexion-extension test

• An internal-external rotation test of the humerus

Shoulder Flexion and Extension

Objective: To assess the degree of shoulder flexion and extension. This test should be

performed in conjunction with Apley’s scratch test to determine if the limitation occurs with

shoulder flexion or extension.

Equipment:

• Exercise mat

• Pillow (optional)

Instructions:

• Explain the purpose of the test.

• Shoulder flexion:

üInstruct the participant to lie supine on a mat, with the back flat and a bent-knee

position [knees and second toe aligned with the anterior superior iliac spine (ASIS)],

and with the arms at the sides.

üHave the participant engage the abdominal muscles to hold a neutral spine without

raising the hips from the mat.

üInstruct the participant to raise both arms simultaneously into shoulder flexion, moving

them overhead, keeping them close to the sides of the head, and bringing them down to

touch the floor or as close to the floor as possible (Figure 43).

Figure 44

Shoulder extension test

Figure 43

Shoulder flexion test

o The participant must maintain extended elbows and neutral

wrist position (the arms will naturally rotate internally during this

movement).

o Have the participant avoid any arching in the low back during the

movement.

o Have the participant avoid any depression of the rib cage, which

may pull the shoulders off the mat.

• Shoulder extension:

üInstruct the participant to lie prone, extending both legs, with arms at

the sides, and resting the forehead gently on a pillow or the mat.

üAsk the participant to slowly raise both arms simultaneously into

extension, lifting them off the mat while keeping the arms close to

the sides (Figure 44) (the arms will naturally rotate internally during

this movement).

o A small amount of extension in the thoracic spine is acceptable

during the movement.

o The participant should avoid any arching in the low back or any

rotation of the torso during the movement.

o The participant should avoid any attempts to lift the chest or head

off the mat during the movement.

Observations:

• Measure the degree of movement in each direction.

• Note any bilateral differences between the left and right arms in

performing both movements.

General interpretations:

• Use the information provided in Table 21 to determine the limitation(s)

in these shoulder flexibility tests.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Internal and External Rotation of the Humerus at the Shoulder

Objective: To assess internal (medial) and external (lateral) rotation of the humerus at the

shoulder joint. This test should be performed in conjunction with Apley’s scratch test to

determine if the limitation occurs with internal or external rotation of the humerus.

Equipment:

• Mat

Instructions:

• Explain the purpose of the test.

• Instruct the participant to lie supine, with his or her back flat on a mat in a bent-knee

position (knees and second toe aligned with the ASIS).

• Ask the participant to abduct the arms to 90 degrees, with a 90-degree bend at the

elbows and the forearms perpendicular to the mat (i.e., pointing up toward the ceiling).

üThe upper arms must remain aligned with the shoulders throughout the test.

üThe backs of the upper arms should rest against the mat throughout the test.

• External (lateral) rotation to evaluate medial rotators

üAsk the participant to slowly rotate his or her forearms backward toward the mat, aiming

to rest the forearms and the backs of the hands on the mat adjacent to the head, while

maintaining the 90-degree bend at the elbows (Figure 45).

o The participant should engage the abdominals to avoid arching the low back, and

avoid flexing the spine forward.

o The participant should maintain a neutral wrist position throughout the movement.

• Internal (medial) rotation to evaluate lateral rotators

üHave the participant return to the starting position (forearms perpendicular to the mat).

üAsk the participant to slowly rotate the forearms forward toward the mat, turning the

palms downward while maintaining the 90-degree bend at the elbows (Figure 46).

o The participant should avoid raising the shoulders off the table or flexing the spine

forward.

o The participant must maintain a neutral wrist position throughout the movement.

Table 21

Interpretation of the Shoulder Flexion and Extension Test

Movement/Limitation—Flexion Shoulder Mobility

Ability to flex the shoulders to 170–180 degrees

(hands touching/nearly touching floor)

Good shoulder mobility

Inability to flex the shoulders to 170 degrees or

discrepancies between the limbs

Potential tightness in the pectoralis major and minor, latissimus dorsi, teres major, rhomboids, and

subscapularis

• Tightness in the latissimus dorsi will force the low back to arch.

• Tightness of the pectoralis minor may tilt the scapulae forward (anterior tilt) and prevent the

arms from touching the floor.

• Tight abdominals may depress the rib cage, tilting the scapulae forward (anterior tilt), and

prevent the arms from touching the floor.

• Thoracic kyphosis may round the thoracic spine and prevent the arms from touching the floor.

Ability to extend the shoulders to

50–60 degrees off the floor

Good shoulder mobility

Inability to extend the shoulders to 50 degrees

or discrepancies between the limbs

Potential tightness in pectoralis major, abdominals, subscapularis, certain shoulder flexors (anterior

deltoid), coracobrachialis, and biceps brachii

• Tightness in the abdominals may prevent normal extension of the thoracic spine and rib cage.

• Tightness in the biceps brachii may prevent adequate shoulder extension with an extended elbow (but

may permit extension with a bent elbow).

Data from: Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, Md.: Lippincott Williams & Wilkins; Houglum, P.A. (2010). Therapeutic Exercise

for Musculoskeletal Injuries (3rd ed). Champaign, Ill.: Human Kinetics.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

Observations:

• Measure the degree of movement in each direction.

• Note any bilateral differences between the left and right arms in performing both

movements.

General interpretation:

• Use the information provided in Table 22 to determine the limitation(s) in this flexibility test.

Table 22

Interpretation of the External and Internal Rotation Test

Movement/Limitation—External/Lateral Rotation Shoulder Mobility

Ability to externally rotate the forearms 90 degrees to

touch the mat

Good mobility in the internal (medial) rotators, allowing the joint to move through the

full range

Inability to reach the floor or discrepancies between

the limbs

Potential tightness in the medial rotators of the arm (i.e., subscapularis)

The joint capsule and ligaments may also be tight and limit rotation.

Movement/Limitation—Internal/Medial Rotation Shoulder Mobility

Ability to internally rotate the forearms 70 degrees toward the

mat (i.e., forearms are 20 degrees off the mat)

Good mobility in the external (lateral) rotators, allowing the joint to move through the

full range

Inability to internally rotate the forearm 70 degrees, or

discrepancies between the limbs

Potential tightness in the lateral rotators of the arm (i.e., infraspinatus and teres

minor)

The joint capsule and ligaments may also be tight and limit rotation.

Data from: Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, Md.: Lippincott Williams & Wilkins; Houglum, P.A. (2010). Therapeutic Exercise

for Musculoskeletal Injuries (3rd ed). Champaign, Ill.: Human Kinetics.

Figure 46

Internal (medial) shoulder rotation

Figure 45

External (lateral) shoulder rotation

Apley’s Scratch Test for Shoulder Mobility

Objective: To assess simultaneous movements of the shoulder girdle (primarily the

scapulothoracic and glenohumeral joints)

Movements include:

• Shoulder extension and flexion

• Internal and external rotation of the humerus at the shoulder

• Scapular abduction and adduction

Instructions:

• Explain the purpose of the test and allow a warm-up (e.g., forward and rearward

arm circles).

• Shoulder flexion, external rotation, and scapular abduction

üFrom a sitting or standing position, the participant raises one arm overhead,

bending the elbow and rotating the arm outward while reaching behind the head

with the palm facing inward to touch the medial border of the contralateral scapula

or to reach down the spine (touching vertebrae) as far as possible (Figure 47).

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

üThe participant should avoid any excessive arching in the low back or rotation of the

torso during the movement.

üHave the participant repeat the test with the opposite arm.

• Shoulder extension, internal rotation, and scapular adduction

üFrom a sitting or standing position, the participant reaches one arm behind the back,

bending the elbow and rotating the arm inward with the palm facing outward to touch

the inferior angle of the contralateral scapula or to reach up the spine (touching

vertebrae) as far as possible (Figure 48).

üThe participant should avoid any excessive arching in the low back or rotation of the

torso during the movement.

üHave the participant repeat the test with the opposite arm.

Observations:

• Note the participant’s ability to touch the medial border of the contralateral scapula or

how far down the spine he or she can reach with shoulder flexion and external rotation.

• Note the participant’s ability to touch the opposite inferior angle of the scapula or how far

up the spine he or she can reach with shoulder extension and internal rotation.

• Observe any bilateral differences between the left and right arms in performing both

movements.

General interpretations:

• Use the information provided in Table 23 to determine the limitation(s) in this flexibility test.

Figure 47

Apley’s scratch test: Shoulder flexion,

external rotation, and scapular abduction

Figure 48

Apley’s scratch test: Shoulder extension, internal

rotation, and scapular adduction

Table 23

Interpretation of Apley’s Scratch Test

Movement/Limitation Shoulder Mobility*

Ability to touch specific landmarks Good shoulder mobility

Inability to reach or touch the specific

landmarks or discrepancies

between the limbs

Requires further evaluation to determine the source of the limitation (i.e.,

which of the movements is problematic)

• Shoulder flexion and extension

• Internal and external rotation of the humerus

• Scapular abduction and adduction

*Tightness of the joint capsules and ligaments may also contribute to limitations. It is common to see greater restriction on the

dominant side due to increased muscle mass.

Data from: Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, Md.: Lippincott Williams & Wilkins.

ACE Group FitnEss instruCtor FitnEss AssEssmEnt protoCols

REFERENCES

Abelbeck, K.G. (2002). Biomechanical model and evaluation of a linear motion squat type exercise.

Journal of Strength and Conditioning Research, 16, 516–524.

Black, F.O. et al. (1982). Normal subject postural sway during the Romberg test. American Journal of

Otolaryngology, 3, 309–318

Canadian Society for Exercise Physiology (2003). The Candian Physical Activity, Fitness, & Lifestyle

Approach (CPAFLA): CSEP—Health & Fitness Program’s Health-Related Appraisal and Counseling

Strategy (3rd ed.). Ottawa: Canadian Society for Exercise Physiology.

Cook, G. (2010). Movement. Aptos, Calif.: On Target Publications.

Cook, G. (2003). Athletic Body in Balance. Champaign, Ill.: Human Kinetics.

Donnelly, D.V. et al. (2006). The effect of directional gaze on kinematics during the squat exercise.

Journal of Strength and Conditioning Research, 20, 145–150.

Fry, A.C., Smith J.C., & Schilling, B.K. (2003). Effect of knee position on hip and knees torques during

the barbell squat. Journal of Strength and Conditioning Research, 17, 629–633.

Houglum, P.A. (2010). Therapeutic Exercise for Musculoskeletal Injuries (3rd ed). Champaign, Ill.:

Human Kinetics.

Johnson B.L. & Nelson, J.K. (1986). Practical Measurements for Evaluation in Physical Education (4th

ed.). Minneapolis, Minn.: Burgess.

Kendall, F.P. et al. (2005). Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore,

Md.: Lippincott Williams & Wilkins.

Morris, C.E. et al. (2006). Vladimir Janda: Tribute to a master of rehabilitation. Spine, 31, 9, 1060–1064.

Newton, R. (1989). Review of tests of standing balance abilities. Brain Injury, 3, 4, 335–343.

Price, J. (2010). The fundamentals of structural assessment. In: The BioMechanics Method Corrective

Exercise Program. San Diego, Calif.: The BioMechanics.

Sahrmann, S.A. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Mo.:

Mosby.

Whiting W.C. & Rugg, S. (2012). Dynatomy: Dynamic Human Anatomy. Champaign, Ill.: Human Kinetics.