Kinetic Chain Assessments Streamlined

Corrective exercise - as an exercise discipline - uses a systematic process that involves identifying neuromusculoskeletal dysfunction, developing a plan of action and integrating a corrective strategy. This process requires knowledge and application of an integrated assessment process in order to determine the appropriate program design and exercise techniques.

Here we’ll look at the why and how we assess as movement specialists.

*Movement assessments are typically much more in-depth than initial fitness consulations (where general medical history and baseline assessments are made).

8 Reasons to do Movement Assessments Before Corrective Exercise

As fitness professionals who specialize in corrective exercise, it's absolutely important that we start off the right way: with movement assessments!

• Establish a baseline/starting point
• Create realistic expectations
• Discover the specific GOALS and NEEDS of each client
• Create individualized exercise programs that are systematic and progressive
• Create value in the services we offer
• Establish ourselves as knowledgeable
• Help ensure client accountability
• Consistency = CREDIBILITY

After all, if you are not assessing, you are just guessing!

How to use the SOAP acronym for Fitness

Using the SOAP acronym can be helpful for analyzing clients and determining the appropriate program design. SOAP stands for:

• Subjective
• Objective
• Assessment
• Plan

Subjective information can be gathered using a pre-participation screening tool such as a general health history and a health-risk appraisal such as the PAR-Q (Physical Activity Readiness Questionnaire). These tools can help to identify pertinent information such as:

• Occupation
• Lifestyle
• Medical history
• Past injuries
• Surgeries
• Medications
• Dietary habits
• Exercise history

As with any exercise program design, one should start with a Needs Analysis in order to gain an understanding of what is required for the activity or sport. This should include:

1. What is the basic energy system involved?
2. What are the movements that must be trained?
3. What are the most common injury sites?
4. A biomechanical assessment

(Kraemer, 1984)

Objective information typically involves data that we can quantify and use to evaluate progress. This can include:

• Weight/Height
• Vital signs (blood pressure and pulse)
• Body composition
• Circumference measurements
• Static posture analysis
• Movement screen
• Range of motion
• Muscle testing
• Upper body strength endurance (e.g., push-up test)
• Lower body strength endurance  (e.g., wall squat test)
• Sub Max VO2 (e.g., 3 minute step test)

Your Assessment will be based on the data collected from the Subjective and Objective information, which will ultimately be used to design a Plan (program design).

Kinetic Chain Assessments

A kinetic chain assessment is designed to identify dysfunction within the human movement system (HMS):

• Altered length-tension relationships of soft tissues (muscles, ligaments, tendons and fascia)
• Altered force-couple relationships (compensatory movement)
• Altered arthrokinematics (joint dysfunction)

Dysfunction in the HMS will lead to:

• Altered sensorimotor integration
• Altered neuromuscular efficiency
• Tissue fatigue and breakdown (cumulative injury cycle)

A streamlined assessment of the Kinetic Chain should include:

1. Static postural assessment
2. Dynamic movement screen (e.g., overhead squat assessment)
3. Range of motion testing*
4. Manual muscle testing*

the 5 kinetic chain checkpoints

Janda, a Czech neurologist, identified predictable patterns of muscle imbalance where some muscles become shortened/overactive and others become lengthened/underactive. He labeled these as:

• Upper Crossed Syndrome
• Lower Crossed Syndrome
• Pronation Distortion Syndrome.

These can be identified through a static postural assessment, by viewing the client from the anterior, lateral and posterior positions and systematically at each of the five kinetic chain checkpoints:

1. Feet and ankles
2. Knees
3. Lumbo-pelvic-hip (LPHC) complex
4. Shoulders
5. Head/cervical spine

Upper Crossed Syndrome

• Characterized by: Rounded shoulders and a forward head posture. This pattern is common in individuals who sit a lot or who develop pattern overload from uni-dimensional exercise
• Shortened Muscles: Pectoralis major and minor, latissimus dorsi, teres major, upper trapezius, levator scapulae, sternocleidomastoid, scalenes
• Lengthened Muscles: Lower and middle trapezius, serratus anterior, rhomboids, teres minor, infraspinatus, posterior deltoid, and deep cervical flexors
• Common injuries: Rotator cuff impingement, shoulder instability, biceps tendonitis, thoracic outlet syndrome, headaches

Lower Crossed Syndrome

• Characterized by: Increased lumbar lordosis and an anterior pelvic tilt
• Shortened Muscles: Iliopsoas, rectus femoris, tensor fascia latae, piriformis, adductors, hamstrings, erector spinae, gastocnemius, soleus
• Lengthened Muscles: Gluteus maximus, gluteus medius, VMO, transversus abdominus, multifidus, internal oblique, anterior and posterior tibialis
• Common injuries: Hamstring strains, anterior knee pain, low back pain

Pronation Distortion Syndrome

• Characterized by: Excessive foot pronation, genu valgus and poor ankle flexibility
• Shortened Muscles: Peroneals, gastrocnemius, soleus, iliotibial band, hamstrings, adductors, iliopsoas
• Lengthened Muscles: Posterior tibialis, flexor digitorum longus, flexor hallicus longus, anterior, tibialis, posterior tibialis, vastus medialis, gluteus medius, gluteus maximus
• Common Injury Patterns: Plantar fasciitis, posterior tibialis tendonitis (shin splints), anterior, knee pain, low back pain

(Page, 2010)

What is a Movement Screen?

The Overhead Squat Assessment is designed to assess dynamic flexibility, core strength, balance and overall neuromuscular efficiency. As with the static postural assessment, this should be a systematic process observed from the anterior, lateral and posterior positions, noting compensations at each of the five major Kinetic Chain Checkpoints. These compensations can signify over and under active muscles, abnormal force-couple relationships and joint dysfunction.

Overhead Squat Assessment Protocol

• Barefoot
• Feet shoulder width apart and pointed straight ahead in a neutral position
• Raise arms overhead, with elbows fully extended
• Squat to chair height and then return to start position
• 5 repetitions in anterior, lateral and posterior positions

NASM CES Solutions Table   (Please refer to NASM CES Overhead Squat Solutions Table)

As you can see from the Solutions Table, there are a number of compensations characterized by potentially over and underactive muscles. By integrating range of motion and manual muscle testing, the precise muscles and joints can be isolated, streamlining the process and helping to make the program design more accurate and effective.

Range of Motion Testing

Range of motion assessment looks at the amount of motion available at a specific joint. Active range of motion occurs through voluntary contraction by the client and can be observed through the overhead squat. Passive range of motion is performed without the assistance the client and provides information about joint play and end feel.

Range of motion testing in a clinical setting often involves using a device such as a goniometer or inclinometer in order to quantify joint motion by measuring degrees.

As a trainer, an alternative would be to evaluate motion at the major joints as follows:

• Functional Non-Painful (FN)- Normal pain free motion
• Functional Painful (FP)- Normal motion that is painful
• Dysfunctional Painful (DP)- Abnormal motion that is painful
• Dysfunctional Non-painful (DN)- Abnormal motion that is not painful

If a movement causes pain, refer to the appropriate specialist. As a trainer, you should be looking for Dysfunctional Non-Painful (DN) movements.

The NASM Essentials of Corrective Exercise Training is a useful resource for the normal range of values for each muscle. Doing a visual comparison between sides is also helpful.

Regional Interdependence Model

Regional interdependence is the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with an area of pain. For example, clients who complain of low back pain or discomfort may actually be suffering from dysfunction at the ankle, hip or knee joints.

By focusing corrective exercise strategies at the most Dysfunctional Non-Painful movement impairments (using the NASM CEx model- Inhibit, Lengthen, Activate, Integrate), many common problems affecting the foot and ankle, low back, knees, shoulders and neck can be addressed in a fitness setting.

For more on the RI model, follow the link!

(Wainner, 2007)

Remember, when in doubt, refer out!

Manual Muscle Testing

Muscle testing is an art and a science. There are a number of factors that can cause a muscle to test weak. Essentially, muscles must be properly activated by the nervous system in order to produce internal tension to overcome an external force.

NASM has developed a 3-point grading system and manual muscle testing process:

Testing Muscles in 2 Steps (The NASM way)

*There can be a number of reasons for a weak muscle. As a trainer, you can try reactivation and reintegration techniques. If these fail to work, refer out.

Key Take-Home Points

Optimum program design and a streamlined assessment involves:

1. Subjective information (e.g., PAR-Q, Health History)
2. A Needs Analysis
3. Objective data

• Static posture
• Dynamic Movement Screen
• Range of Motion Testing
• Manual Muscle Testing

4. An Assessment (e.g., per the NASM- CES Solutions Table)
5. Exercise selection based on the above per the NASM- CEx Model:

• Inhibit
• Lengthen
• Activate
• Integrate

* Disclaimer: Check with your state laws regarding the scope of practice for fitness trainers to perform passive range of motion and manual muscle testing techniques on clients.

And if you are not a specialist in corrective exercise yet - but you are interested - follow this link: https://www.nasm.org/continuing-education/fitness-specializations/corrective-exercise-specialist

References

Clark,M.A., & Lucett, S.C. (Eds.). (2010). NASM Essentials of Corrective Exercise Training. Baltimore, MD: Lippincott Williams & Wilkins.

Clark, M.A., Sutton, B.G., Lucett, S.C. (2014). NASM Essentials of Personal Fitness Training. 4^th Edition, Revised. Burlington, MA: Jones and Bartlett Learning.

Kraemer, W.J. (1984). Exercise prescription: Needs analysis. Strength & Conditioning Journal, 6(5), 47-47.

Page, P., Frank, C., & Lardner, R. (2010). Assessment and Treatment of Muscle Imbalance: The Janda Approach. Champaign, IL: Human Kinetics.

Wainner, R. S., Whitman, J. M., Cleland, J. A., & Flynn, T. W. (2007). Regional interdependence: a musculoskeletal examination model whose time has come Journal of Orthopaedic & Sports Physical Therapy, 37(11), 658-660.