ACE Personal Trainer Manual 5th Edition Chapter 7: Functional Assessments: Posture, Movement, Core, Balance, and Flexibility Lesson 7.3

After completing this session, you will be able to: LEARNING OBJECTIVES After completing this session, you will be able to: Demonstrate proper protocol for key balance and core tests Evaluate and interpret balance and core tests List and explain contraindications for each musculoskeletal movement screen or test Key balance and core tests: Sharpened Romberg test Stork-stand balance test McGill’s torso muscular endurance test battery Trunk flexor endurance test Trunk lateral endurance test Trunk extensor endurance test

BALANCE AND THE CORE Baseline assessments evaluate the need for comprehensive balance training and core conditioning. Dynamic balance tests are generally movement-specific and quite complex. Evaluate the basic level of static balance first by using the sharpened Romberg test and the stork-stand test. Given the importance of balance and the condition of the core musculature to fitness and overall quality of life, these baseline assessments can 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, trainers should aim to first evaluate the basic level of static balance that a client exhibits by using the sharpened Romberg test or the stork-stand test. Figure 7-55 can be used to record the client’s performance on the balance assessments presented in this chapter.

SHARPENED ROMBERG TEST General interpretations The client needs to maintain balance with good postural control (without excessive swaying) and not exhibit any of the test-termination criteria for >30 seconds. The inability to reach 30 seconds indicates inadequate static balance and postural control.

SHARPENED ROMBERG TEST Observations Time the client’s performance until one of the following occurs: The client loses postural control and balance The client’s feet move on the floor The client’s eyes open The client’s arms move from the folded position The client exceeds 60 seconds with good postural control

STORK-STAND BALANCE TEST Objective: To assess static balance by standing on one foot in a modified stork-stand position

STORK-STAND BALANCE TEST Observations Timing stops when any of the following occurs: The hand(s) come off the hips. The stance or supporting foot inverts, everts, or moves in any direction. Any part of the elevated foot loses contact with the stance leg. The heel of the stance leg touches the floor. The client loses balance.

MCGILL’S TORSO MUSCULAR ENDURANCE TEST BATTERY Trunk flexor endurance test Trunk lateral endurance test Trunk extensor endurance test There is more to abdominal tone and core stability than showing off a “six pack.” Possessing a strong core is important when performing simple ADL like lifting a heavy laundry basket or taking part in recreational activities like swinging a golf club. Core stability involves complex movement patterns that continually change as a function of the three-dimensional torque needed to support the various positions of the body. Even back pain and dysfunction can be reversed by having a strong core. Dr. Stuart McGill states that back problems can often be alleviated by improving and then grooving the motor patterns of the abdominal musculature. To evaluate balanced core strength and stability, it is important to assess all sides of the torso. The true benefit of each one of the following tests is in the assessment of the interrelationships among the results of the three torso tests. In other words, the tests are performed individually, but then evaluated collectively. Poor endurance capacity of the torso muscles or an imbalance between these three muscle groups is believed to contribute to low-back dysfunction and core instability.

TRUNK FLEXOR ENDURANCE TEST Objective: Assesses muscular endurance of the anterior deep core muscles Contraindications Low-back pain Recent back surgery Acute low-back flare-up The flexor endurance test is the first in the battery of three tests that assesses muscular endurance of the deep core muscles. It is a timed test involving a static, isometric contraction of the anterior muscles, stabilizing the spine until the individual exhibits fatigue and can no longer hold the assumed position. Terminate the test when there is a noticeable change in the trunk position. Watch for a deviation from the neutral spine (i.e., the shoulders rounding forward) or an increase in the low-back arch. No part of the back should touch the back rest. Record the client’s time on the testing form.

TRUNK LATERAL ENDURANCE TEST Objective: Assesses muscular endurance of the lateral core muscles Contraindications Shoulder pain or weakness Low-back pain Recent back surgery Acute low-back flare-up

TRUNK EXTENSOR ENDURANCE TEST Objective: Assesses muscular endurance of the torso extensor muscles Contraindications A client with major strength deficiencies, where the individual cannot lift the torso from a forward flexed position to a neutral position A client with a high body mass, in which case it would be difficult for the trainer to support the client’s suspended upper-body weight Individuals who suffer from low-back pain, have had recent back surgery, and/or are in an acute low-back flare-up

MCGILL’S TORSO MUSCULAR ENDURANCE TEST BATTERY After completing all elements of McGill’s torso muscular endurance test battery, personal trainers can use Figure 7-62 to record the client’s data. Each individual test in this testing battery is not a primary indicator of current or future back problems. McGill has shown that the relationships among the tests are more important indicators of muscle imbalances that can lead to back pain. In fact, even in a person with little or no back pain, the ratios can still be off, suggesting that low-back pain may eventually occur without diligent attention to a solid core-conditioning program. McGill suggests the following ratios indicate balanced endurance among the muscle groups: Flexion:extension ratio should be less than 1.0. For example, a flexion score of 120 seconds and extension score of 150 seconds generates a ratio score of 0.80. Right-side bridge (RSB):left-side bridge (LSB) scores should be no greater than 0.05 from a balanced score of 1.0 (i.e., 0.95 to 1.05). For example, a RSB score of 88 seconds and an LSB score of 92 seconds generates a ratio score of 0.96, which is within the 0.05 range from 1.0. Side bridge (either side):extension ratio should be less than 0.75. For example, a RSB score of 88 seconds and an extension score of 150 seconds generates a ratio score of 0.59. Demonstrated deficiencies in these core functional assessments should be addressed during exercise programming as part of the foundational exercises for a client. The goal is to create ratios consistent with McGill’s recommendations. Muscular endurance, more so than muscular strength or even ROM, has been shown to be an accurate predictor of back health. Research shows that low-back stabilization exercises have the most benefit when performed daily. When working with clients with low-back dysfunction, it is prudent to include daily stabilization exercises in their home exercise plans.

SUMMARY Baseline assessments evaluate the need for comprehensive balance training and core conditioning. By adhering to the principle of “straightening the body before strengthening it,” aided by the information provided by the assessments for stability and mobility, trainers may witness improved efficacy in their programs and an increased likelihood of success in terms of their clients attaining their goals. Trainers can consider performing the assessments in this chapter and utilizing them as prerequisites to the more traditional assessments of body composition, aerobic fitness, and muscular fitness.