Certificate IV in Fitness – CPT

3.4 Appraisals of functional

movement

Copyright © 2012 Australian Institute of Personal Trainers.

All rights reserved.

1300 13 84 34
www.aipt.com.au
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Table of Contents

Posture ................................................................................................................................. 2
Posture variables ............................................................................................................... 2
Postural appraisal .............................................................................................................. 5
Anatomical plane of movement ......................................................................................... 6
Muscles, joints, and movements ........................................................................................ 7
Joint range of motion and movements ........................................................................... 8
Agonist, Antagonist, and Synergist............................................................................... 10
Postural appraisal ............................................................................................................ 13
Conducting a basic test ................................................................................................ 13
Strengthen or stretch?.................................................................................................. 15
Allied Health Professionals .......................................................................................... 17

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Posture

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

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

 keeps bones and joints in the correct alignment so that muscles are being used
properly
 helps decrease the abnormal wearing of joint surfaces that could result in arthritis
 decreases the stress on the ligaments holding the joints of the spine together
 prevents the spine from becoming fixed in abnormal positions
 prevents fatigue because muscles are being used more efficiently, allowing the body
to use less energy
 prevents strain or overuse problems
 prevents backache and muscular pain.
Cleveland Clinic (2012) ‘Posture,’
http://my.clevelandclinic.org/healthy_living/back_health/hic_posture_for_a_healthy_back.aspx

Posture variables

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

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

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

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

 http://www.youtube.com/watch?v=IDjAwLyv2uQ
 http://www.youtube.com/watch?v=frqgEsmifbo

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

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

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

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

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

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

 improving functionality
 reducing chance of injury
 reducing muscle soreness and tightness
 relaxation
 improved flexibility and exercise performance.
Range of Motion (2012) ‘Flexibility’ http://www.rangeofmotion.net.au/content/exercise/flexibility

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

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

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

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

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

Postural appraisal

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

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

 muscle imbalance about a joint

 the relationship between muscles acting about that joint (muscle imbalance can be a
major contributor to dysfunctional movement)
 changes in neural action of the muscles responsible for movement about a joint.

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

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

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

More benefits of postural appraisals include enabling trainers to:

 identify areas presenting with a deficit of strength and mobility

 improve postural awareness
 reduce/eliminate the likelihood of injury
 investigate the source of postural deviation
 identify any contraindications to exercise
 provide the client with information upon how their posture may affect their ability to
exercise safely
 provide a basis for referral to another AHP to assist where necessary.
Fitness Trainer Essentials (2008) ‘Postural appraisal for low-risk clients,’ Chapter 4, Pg 173.

Anatomical plane of movement

Sagittal Plane: A vertical plane, passing

from front to rear. This divides the body
into right and left sections. Movements in
this plane are the up and down
movements of flexion and extension.

Coronal/Frontal Plane: A vertical plane

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

Transverse Plane: A horizontal plane

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

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Muscles, joints, and movements

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

If an individual presenting with a specific wrist or elbow issue requested a postural

assessment, then you would be justified in pursuing an appraisal of these areas. As a
general rule of thumb, if the client was apparently healthy and issue-free your appraisal
would be best directed at the major joints and muscles groups of the body.

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

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

Joints Muscles
Hip Gluteal, quadriceps, hamstrings

Knee and ankle Quadriceps, hamstrings, calves, tibialis

Spine Quadratus, lumborum, trapezius, spinal, erectors

Shoulder Pectorals, rotator cuff, latissimus dorsi, trapezius

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

 http://www.teachpe.com/anatomy/movements.php

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Joint range of motion and movements

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

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

The more movement that is possible through a joint, the higher risk of injury. This is due to a
greater range of movement reducing the strength of the joint.
The Better Health Channel (2012) ‘Joints.’ http://www.betterhealth.vic.gov.au/

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

Spinal Flexion / Extension Spinal Lateral Flexion Hip Flexion Hip Adduction
0-90° / 0-25° 0-25° 0-100° 0-20°

Hip Abduction Hip Extension/Hyper Knee Flexion 0- 150 Knee Extension 150- 0°
0-40° Extension
0-30°

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Ankle Dorsi Flexion 0-20° Ankle Plantar Flexion 0-40° Shoulder Abduction 0-150° Shoulder Adduction 0-30°

Shoulder Flexion 0-150° Shoulder Extension/Hyper Elbow Extension 150-0° Elbow Flexion
Extension 0-150°
50-0°

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Agonist, Antagonist, and Synergist

Antagonist: The muscle/s that

directly oppose an agonist,
responsible for returning a limb
to its initial position, e.g. triceps Agonist: The muscle/s primarily
brachii responsible for eliciting
movement about a joint e.g.
biceps brachii

Synergists: Muscles that assist

agonists to produce movement.
May also fixate a joint to
facilitate movement e.g.
brachioradialis

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What causes poor posture?

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

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

Muscle inhibition

Poor muscle strength

Muscle imbalance

Poor joint mobility (ROM)

Damage to connective
tissues

Damage to bony structures

Poor biomechanics

Pregnancy, footwear,
work practices, sports

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The human skeleton has some natural curves that may increase or decrease in size
depending on factors such as genetics and lifestyle. The cervical and lumbar spines both
have a natural curve called “lordosis” while the thoracic spine has a natural, more complex
curve called “kyphosis”.

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

Spinal posture Description

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

Kyphosis Refers to increased posterior curvatures of the spine, usually in the

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

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

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

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Postural appraisal

A formal postural assessment is done with a plumb line. The client is positioned with a plumb
line passing just in front of the lateral malleolus (coronal plane). In an ideal posture, this line
should pass just anterior to the mid-line of the knee and then through the greater trochanter,
bodies of the lumbar vertebrae, shoulder joint, bodies of the cervical vertebrae, and the lobe
of the ear.

Postural assessments include an examination of the alignment when a client is standing,

tests for flexibility and muscle length, and tests for muscle strength as well as palpitation
techniques.

Conducting a basic test

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

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Table of possible anatomical change as a result of muscle tightness or inhibition:

Muscle Possible anatomical changes

Tibialis posterior Pronation and lateral foot rotation

Tibialis anterior Foot eversion

Peroneus longus/brevis Foot inversion

Hamstring group Posterior pelvic tilt with increased lumbar

lordosis
Biceps femoris Medial foot rotation

Semi-tendinosus/Membranosus Lateral foot rotation

Rectus femoris Anterior pelvic tilt, increased lumbar

lordosis
Gluteus maximus Elevation and rotation of pelvis and
increased lumbar lordosis
Psoas Convex curvature of the lumbar spine
(lordosis) and pelvic elevation on
ipsilateral (same) side
Sartorius/gracilis inhibition Posterior rotation of pelvis

Adductor group inhibition Pelvic elevation on contralateral

(opposite) side
Tensor fascia latae inhibition Elevation of pelvis on ipsilateral (same)
side
Abdominals inhibition Increased lumbar lordosis with anterior
pelvic tilt
Latissimus dorsi inhibition Shoulder elevation

Trapezius inhibition Depression of shoulder, depression of

shoulder on ipsilateral side
Rectus femoris inhibition Posterior pelvic tilt, knee hyperextension

Pectoralis major/minor Internal shoulder rotation, shoulder

elevation,‘hunched’ thoracic kyphotic
curvature
Trapezius Shoulder elevation

Latissimus dorsi Shoulder retraction and depression,

external rotation

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

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Strengthen or stretch?

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

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

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

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

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

Improving general posture

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

 Perform stretches every day to improve flexibility

 Exercise regularly to improve muscles strength and tone
 Avoid standing on one foot for long periods of time
 Perform core strengthening exercise so support your back
 Avoid sitting on soft couches and chairs
 Use a pillow to support your neck when sleeping.

Remember – when dealing with basic postural issues

1. Restore appropriate length to muscles that are tight (stretch)
2. Restore isometric strength of weak muscles (strengthen)
3. Establish a base of strength and build upon the dynamic strength of muscles you
have identified as presenting weakness (strengthen).

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

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Facts

One method of increasing ROM and mobility about a joint is to

conducting stretching drills. Static, PNF, dynamic and ballistic
stretching styles will assist in countering the effects of tight
muscles and connective tissue.

Strengthening the musculature and connective tissues around a

joint will assist in increasing structural integrity and providing
muscular balance whilst improving technique and control during
movement.

Examples of common postural issues and basic corrections

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

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

*Lordosis Tight muscles Weak muscles

Hip flexors Abdominals

Erector spinae Hamstrings
Gluteals

Suggested corrective Stretch: hip flexors and spinal extensors

actions Strengthen: abdominal, hamstring, and fluteals

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*Kyphosis/Rounded Tight muscles Weak muscles

Shoulders
Pectoralis majorPectoralis Rhomboids
minor Rear deltoids
Anterior deltoids Middle/Lower trapezius
Latissimus Dorsi

Suggested corrective Stretch: chest stretch, anterior deltoids, lats

actions Strengthen: rhomboids, rear deltoids, trapezius

*Winged Scapula Tight muscles Weak muscles

Pectoralis major Serratus anterior

Pectoralis minor Rhomboids
Subscapularis
Latissimus dorsi

Suggested corrective Stretch: pectorals, lat and shoulder mobility work

actions Strengthen: seated row, scapula fixation work, wall
pushes (scapula pro/retraction)

Allied Health Professionals

Consider the following scenario:

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

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

What should you do in this situation…?

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A Personal Trainer cannot and should not attempt to provide formal diagnosis of a
postural condition.

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

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

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

AHPs you could refer to include:

 Exercise physiologists
 Physiotherapists
 Massage therapist
 Osteopaths
 General practitioners
 Chiropractors
 Podiatrists
 Occupational therapists.

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

If a client presents with good posture and maintains this postural awareness during daily
activities and exercise, the structures comprising their musculoskeletal system are aligned
and balanced, facilitating efficient movement.

If a client presents with poor posture, an individual’s musculoskeletal structures are loaded in
a manner that is inefficient and unbalanced. The body may be exposed to loading that it is
not accustomed to which may increase the likelihood of compensatory change, in turn
increasing the chances of injury or the client developing a chronic postural condition.

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

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

Certificate IV in Fitness – CPT | Section 3.4: Appraisals of functional movement