Functional assessments are one of the best ways to gain an understanding of what to address with a client’s resistance and flexibility-training program. Performing various assessments can help you identify any compensation that causes the client to deviate from proper postural or movement mechanics. If a client presents a deviation, there are likely muscular imbalances (tight or weak muscle or muscle group) present and you can use that information to select exercises that will address them. While some deviations stem from factors that cannot be corrected through training, it is still helpful to be aware of these deviations.
In this third installment of a four-part series examining the four main types of functional assessments, we take a closer look at the purpose and application of flexibility assessments and how you can use that information to design safe and effective programs for your clients.
With each assessment, the first thing to understand is the objective (purpose) of the assessment—what information can you gather from this assessment? Here are some general notes about the most common flexibility assessments:
Thomas Test for Hip Flexion/Quadriceps Length
This assessment is used to determine if the hip flexors are overactive or shortened and if that tightness might be coming from the iliopsoas or the quadriceps. The iliopsoas attach at the spine and the femur so when it’s shortened, it prevents the femur from moving into an extended position (it wants to hold that flexed position), which will prevent us from lowering the back of the thigh to the table. The rectus femoris, on the other hand, acts at both the hip and the knee. If the hip is in an extended position and the client is unable to bend the knee to 80 degrees, this is an indication that the rectus femoris is tight. If the client can’t do either of these things, both the iliopsoas and the quadriceps are probably tight and the client should focus on stretching both areas.
Passive Straight-leg (PSL) Raise
This assessment focuses on the length of the hamstrings. The goal should be to raise the leg to about 80 degrees, which is just a little bit closer to the body than perpendicular. Be sure that the client’s elevated leg stays straight and that the client’s back maintain contact with the table (no excessive arching) and that the other leg remains straight and in contact with the table.
There are five parts to this assessment and the purpose of each is to assess the range of motion in a particular direction:
When lying on supine, the client should be able to touch the floor with both thumbs. You also want to note if there are any side discrepancies.
When lying prone, client should be able to lift the arms about 50 to 60 degrees with the pinky fingers facing the ceiling. Again, make note of any side discrepancies.
When lying supine with bent knees and arms in a “goal-post” shape out to the sides and fingertips pointing toward the ceiling, the client should be able to rotate the shoulders until the fingertips are pointing toward the toes and the palms of the hands hover about 20 degrees above the mat.
When lying supine with bent knees and arms in a “goal-post” shape out to the sides and fingertips pointing toward the ceiling, the client should be able to rotate the shoulders until the fingertips are pointing toward the head and the backs of the hands make contact with the mat.
Apley’s Scratch Test
This assessment examines the ability to combine motions of the shoulder (glenohumeral joint) and shoulder girdle (scapulothoracic) joint. The hand that is reaching up and over the head to touch the top of the back with the palm should ideally touch the medial or vertebral border of the opposite shoulder blade or even farther down the spine. The hand reaching up the back with the back the hand reaching up mid back should ideally touch the inferior angle of the opposite shoulder blade.
Not every assessment is necessary or advisable for use with every client. It is up to you to determine which ones are needed and which ones can be skipped. If you did some of the movement assessments with a client and saw she had compensations in the hips, you may elect to skip the hip flexibility assessments. If you did not put the client through the movement assessments, you may elect to do all or most of the flexibility assessments as these are generally safe for even deconditioned individuals. If the client has a goal related to a specific activity that requires hip or shoulder mobility (improve a golf swing, for example), you might elect to do all of the assessments.
When you get to the case studies in Chapter 12 of the ACE Personal Training Manual or Chapter 19 of the ACE Health Coach Manual, you will see which assessments are selected for each specific case study based on the individual’s goals.
Assessments are important tools to determine the best programs for your clients. If you need further assistance in understanding how to use movement assessments—or on any other topic that comes up as you prepare for your exam—contact out study coaches at 800-825-3636, Ext. 796, or firstname.lastname@example.org.