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

2. 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

3. 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.

4. 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.

5. 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

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

7. 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.

8. 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.

9. 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.

10. 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

11. 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

12. 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 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.

13. 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.