Rehabilitation Exercise Lecture 2 FDSc FISM year 1 Janis Leach Baseline Measures for fitness testing FLEXIBILITY, STRENGTH, ROM, CARDIOVASCULAR, AGILITY,

Brain warm up/ recap Write down which are physical and which are motor Strength Balance Body Composition Agility Endurance Speed Coordination Power Flexibility Reaction time

Physical fitness Strength Speed Flexibility Endurance Body Composition

Motor fitness Agility Balance Coordination Power Reaction time

Objectives Be aware of common evidence based methods of measurement Understand the importance of using baseline measurements in therapy settings Understand the importance of screening in injury prevention Practical session to be able to instruct a client needing crutches in the NWB phase

Screening and Baseline Measurements Provide measurable values for existing characteristics Can identify intrinsic risk factors in sports Documented baseline and screening measurements are vital for diagnosis and rehabilitation

Anthropometrical Height Weight Body Composition Waist to hip ratio

Body Mass Index Body Mass Index (BMI) is a number calculated from a person’s weight and height. BMI is a reliable indicator of body fatness for some people. BMI does not measure body fat directly, but research has shown that BMI correlates to direct measures of body fat, such as underwater weighing. What are the limitations to BMI?

Body Mass Index Formula: Weight (Kg) ÷ Height (M)2 Example: Height = 173 cm (1.73 m) Weight = 73 kg Calculation: 73÷ (1.73) x 2 = 24.41

Body Mass Index Interpretation of BMI for adults For adults 20 years old and older, BMI Weight Status Below 18.5 Underweight 18.5 - 24.9 Normal 25 – 29.9 Overweight Above 30 Obese

Body Composition Evaluation of amount of fat in relation to lean tissue in the body Norms are 12%-18% for men and 14%-20% for women Obesity at >25% for men and >30% for women Evaluative methods Skin calipers

Skinfold measurements Used to determine the ratio of fat mass to fat-free mass in the body Fat mass: adipose tissue Fat-free mass: bone, muscle, and organs Measurements are performed with a skinfold caliper

Skin-fold measurements The Jackson and Pollock (1985) three-site method has a relatively small margin of error for the general population a. Sites for men: chest, abdomen, and thigh b. Sites for women: triceps, suprailium, and thigh Should be repeated by the same technician during reassessment to decrease error Should be performed prior to physical activity because fluid transfer to the skin could result in overestimations

Skin-fold measurements The Jackson and Pollock (1978) 7 sites are more commonly used with athletes. Chest, Axilla, Abdominal, Suprailium, Subscapular, Triceps ,Mid-Thigh.

Research Friedl et al (2001) Body weight not suitable for assessing results in training programmes for females Why? Study found that there was greater reliability female fat deposit on waist and hips instead of upper arm or thigh.

Waist to hip ratio Waist / hip measurement Found to test the risk of heart disease Research? Task for this week Find a journal article on either WHR or BMI

Somatotype Classification of body type (Physique). There are 3 somatotypes. Endomorph Mesomorph Ectomorph Each of us is likely to be predominant in one of these categories.

Somatotypes Various body measurements are needed in order to work out your somatotype and together with your age and gender, these scores are read from a chart. Height Weight Bone size Muscle girth Fat

Ideal Posture

Lordosis

Kyphosis

Scoliosis

Musculoskeletal Examination Basic exam consists of observation for symmetry, ROM, strength tests for major muscles and specific tests for previously injured areas Questions asked regarding Focus on history of previous injuries, time frame, evaluation, treatment and rehabilitation. Use of protective devices

Musculoskeletal Examination Leg Length (True or Apparent) Foot Shape (Planus, cavus pronation/supination) Muscle Girth (Various sites) Posture Evaluation Laxity ROM Bilateral Comparison

Pronation - Supination Over-pronation Over-supination

Bilateral Comparisons All information obtained from screening can be assessed against population norms. Bilateral comparisons of joint laxity, ROM and tissue abnormalities are vital for accurate diagnosis of subsequent injuries.

Fitness Testing Procedures Muscular function Strength, power and endurance Cardiovascular function Speed and agility Flexibility

Measuring exercise intensity Repetition maximum (RM): "maximal number of times a load can be lifted before fatigue using correct technique (ACSM, 1998). " A "1RM" signifies the maximum resistance a person can move in ONE repetition of an exercise. " A "10RM" signifies the maximum resistance a person can move in TEN repetitions of an exercise.

Cardiovascular function Multistage fitness test (Bleep Test) Some factors to consider Motor skills Turning technique Running surfaces Cooper 12 Minute Run Flat running track Stop watch and recording sheets Suitable for most populations Can be set on treadmill

Hexagonal Obstacle Test 66 cm sided hexagon marked out on the floor. Athlete is always facing A. Athlete jumps in and out of hexagon in alphabetical order. Usually performed 3 times, measured by stopwatch

Flexibility: Sit and Reach

KEY POINT Tests requiring high-skill movements, such as reaction and coordination tests, should be administered before tests that are likely to produce fatigue and confound the results of subsequent tests.

Baseline Testing Vital to have baseline measures during treatment and rehabilitation programs in order to objectively assess outcomes and restore full functional fitness.

Methods Manual Muscle Testing Joint ROM (Goniometer) Girth Measurements (Tape Measure) Pain Scale

Goniometry Measurement of joint mobility/motion Principles Stationary arm aligned with stationary segment proximal to joint evaluated Moveable arm aligned with moveable segment distal to joint evaluated Recording scale 0 – 180º (all joints in 0º position in anatomic position) Generally accepted +/- 5-10º error with goniometric measurements

Goniometry Reliability To increase reliability: Intra-tester: same person getting same results Inter-tester: different people getting same results To increase reliability: All staff use same goniometer

Pain Scales Visual Analogue Scale ASSESSMENT SCALES

Prehab Involves: Full medical history and associated testing. Functional physiological tests. Special tests, ( Core stability, Proprioception).

Prehab Purpose: Injury prevention Detailed evaluation test data may identify weaknesses or markers that indicate predisposition to injury. Once identified, specific interventions can be put in place in order to help prevent injury.

Summary Recognise all available screening and baseline measurement tools Appreciate the need for objective measurement in musculoskeletal screening Recognise the value of Prehab regarding the possible prediction and prevention of injury