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Section7:MuscularStrength,

EnduranceandFlexibility

Section7:MuscularStrength,

EnduranceandFlexibilityACSMGuidelines:Chapter4(pp.94107)

ACSMManual:Chapter5,6ACSMGuidelines:Chapter4(pp.94107)

ACSMManual:Chapter5,6

HPHE4450Dr. CheathamHPHE4450Dr. Cheatham

OutlineOutline

Importanceofmuscularstrengthandendurance Typesofmuscularcontractions GeneralTestingGuidelines Musclestrength

HandGripDynamometry,1RM MuscularEndurance

PushUpTest,CurlUpTest,YMCABenchPressTest Importanceofflexibility

SitandReachTests LumbarFlexionandExtension SpecificROMTests

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ImportanceofMuscularSandEImportanceofMuscularSandE

Healthrelatedfitnesscomponentthatmaymaintainorimprovethefollowing: Bonemass(relatedto

osteoporosis) Glucosetolerance(relatedto

Type2diabetes) Musculotendinous integrity

(relatedtolowerriskofinjury,lowbackpain)

CarryoutADLs FatfreemassandRMR

(relatedtoweightmanagement)

Performanceapplications

TypesofContractionsTypesofContractions

Static(Isometric) Musclegeneratesforcewithoutmovement(i.e.muscledoesnotchangelength)

Dynamic Musclegeneratesforcewhilelengtheningorshortening

Concentric:Muscleshortens Eccentric:Musclelengthens

Isotonic:Fixedresistance Isokinetic:Fixedmovementspeed

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GeneralTestingGuidelinesGeneralTestingGuidelines

Useafamiliarization/practicesession Adheretospecificprotocol

Predeterminedrepetitiondurationandrangeofmotion

Thestandardizedprotocolshouldinclude: Strictposture Consistentmovementspeed FullROM Useofspotters(ifnecessary) Equipmentfamiliarization Properwarmup

MuscularStrengthMuscularStrength

Definition:Maximalforcethatcanbegeneratedbyaspecificmuscleormusclegroup

Specificto: Musclegroup Typeofcontraction Speedofcontraction Jointangletested Resultsfromatestarespecifictotheproceduresused

Nosingletestexistsforevaluatingtotalbodymuscularenduranceormuscularstrength

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MuscularStrengthMuscularStrength

Purposeofmeasurement: Assessmuscularfitness Identifyweaknesses Monitorprogressinrehabilitation Measuretheeffectivenessoftraining

AssessingMuscularStrengthAssessingMuscularStrength

CommonassessmentsHandgriptest1repetitionmaximum(RM)benchpressIsokinetic testing

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AssessingMS HandGripAssessingMS HandGrip

AssessingMS HandGripAssessingMS HandGrip

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AssessingMS HandGripAssessingMS HandGrip

Numbersareinpounds(lbs).

AssessingMS 1RMAssessingMS 1RM

OneRepetitionMaximum(1RM) Maximalforcethatcanbegeneratedbyaspecificmuscleormusclegroup

Theheaviestweightthatcanbeliftedonlyonceusinggoodform

DynamicStrength GoldStandard

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AssessingMS 1RMAssessingMS 1RM

AssessingMS 1RMAssessingMS 1RM

6or10RMTest Canbeusefulespeciallyfordeterminingweightsforexerciseprescription

Adapt1RMprocedurestodetermine6or10RMvalue.

Optional: Convert10RMvaluetoa1RMestimationbydividing10RMweightby0.75

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AssessingMS 1RMAssessingMS 1RM

InterpretationofData: ACSMprovidesnormchartsforUpperBodyStrength(BenchPress)andLowerBodyStrength(LegPress)

ValuesareoftenexpressedasStrengthtoweightratio

StrengthtoWeightRatio=WeightLifted/BodyWeight Bothweightsmustbeinthesameunits

AssessingMS 1RMAssessingMS 1RM

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AssessingMS 1RMAssessingMS 1RM

AssessingMS 1RMAssessingMS 1RM

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AssessingMS 1RMAssessingMS 1RM

MuscularEnduranceMuscularEndurance

Definition:Theabilityofamusclegrouptoexecuterepeatedcontractionsoveratimeperiodsufficienttocausemuscularfatigueortomaintainaspecificpercentageofmaximumvoluntarycontractionforaprolongedtime Sameideawithrespecttospecificityandmusclestrength

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AssessingMuscularEnduranceAssessingMuscularEndurance

Commonassessments Pushuptest Partialcurluptest YMCAbenchpresstest

AssessingME PushUpTestAssessingME PushUpTest

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AssessingME PushUpTestAssessingME PushUpTest

AssessingME PushUpTestAssessingME PushUpTest

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AssessingME CurlUpTestAssessingME CurlUpTest

AssessingME CurlUpTestAssessingME CurlUpTest

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AssessingME CurlUpTestAssessingME CurlUpTest

AssessingME YMCABenchPressTestAssessingME YMCABenchPressTest

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AssessingME YMCABenchPressTestAssessingME YMCABenchPressTest

FlexibilityFlexibility

Definition:Functionalcapacityofthejointstomovethroughthefullrangeofmotion(ROM)

Jointspecific Dependson:

Jointcapsuledistensibility Adequatewarmup Muscleviscosity Complianceoftheligamentsandtendons

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FlexibilityFlexibility

Whyisflexibilityimportant?PerformanceofADLsRelationshiptolowerbackpainAthleticperformance

AssessingFlexibilityAssessingFlexibility

Commonassessments: SitandReachBoxTest(trunkflexion) YMCASitandReachTest LumbarFlexionandExtension SpecificRangeofMotionTests

GeneralTestingGuidelines Stretching,lightaerobicexercise(510min) Practicesessiontoassesspain,discomfort

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AssessingFlexibility SitandReachTestsAssessingFlexibility SitandReachTests

AssessingFlexibility SitandReachTestsAssessingFlexibility SitandReachTests

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AssessingFlexibility SitandReachTestsAssessingFlexibility SitandReachTests

AssessingFlexibility SitandReachTestsAssessingFlexibility SitandReachTests

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AssessingFlexibility SitandReachTestsAssessingFlexibility SitandReachTests

MakingaSitandReachBoxMakingaSitandReachBox

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AssessingFlexibility LumbarFlexionAssessingFlexibility LumbarFlexion

Seatedwithpelvisstabilized Tapeispositionedwithzeroatthespinous processC7

Measuredownthesuperioriliac

Lumbarflexionperformeduntilfirstsignofresistance

Averagehealthyrange:4inchincrease

AssessingFlexibility LumbarFlexionAssessingFlexibility LumbarFlexion

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AssessingFlexibility LumbarExtensionAssessingFlexibility LumbarExtension

Samebodyandtapepositionasforflexionassessment

Lumbarextensionisperformeduntilfirstsignofresistance

Averagehealthyrange:2inchincrease

AssessingFlexibility LumbarExtensionAssessingFlexibility LumbarExtension

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AssessingFlexibility ROMTestsAssessingFlexibility ROMTests

UseofGoniometers: Fulcrumcenteredtoidentifiedanatomiclandmark

Stabilizationarmremainsfixed(establishesthestartposition)

Movementarmmovesinrelationtoclientsmovement(establishestheendingposition)

AssessingFlexibility ROMTestsAssessingFlexibility ROMTests

GeneralProcedures:Beforebeginning:

ProvidetheclientwithademonstrationofanROMtest

Positionthegoniometer Locatethefulcrumatthejointaxisorhingepoint

Wheretheaxisofrotationoccursforthetwobodysegments

Placethestabilizationandmovementarms Centeredalongeachbodysegment

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AssessingFlexibility ROMTestsAssessingFlexibility ROMTests

Goniometryisanaccuratemeasureif: Allanatomiclandmarksareidentified Jointaxispointhasbeenclearlydefined Bodyisstabilizedinproperalignment ClientisinstructedtomoveslowlythroughtheproperROMandthegoniometer isproperlyaligned

TestadministratorisfamiliarwithnormalROMforeachjoint

ObservationofwhetherROMassessmentispainfreeoccurs

AssessingFlexibility ROMTestsAssessingFlexibility ROMTests

Foreachassessment,locationsofthegoniometerforthefollowingthreepointsarespecified:

1. Fulcrum2. Stabilizationarm3. Movementarm

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AssessingFlexibility ROMTests ShoulderAssessingFlexibility ROMTests Shoulder

Goniometer position1. Fulcrum:Lateralaspectofgreatertubercle2. Stabilizationarm:Perpendiculartothefloor3. Movementarm:Alignwiththemidlineofhumerus

andreferencethelateralepicondyle

Stabilization Clientisingoodposturewithastabilizedscapula(retracted),thoracic,andlumbar

Stabilizescapulatopreventtilting,rotation,orelevation

Movement:Flexion

AssessingFlexibility ROMTests ShoulderAssessingFlexibility ROMTests Shoulder

Starting/endingbodyposition Seatedwithglenohumeral

in0degreesofflexion,extension,abduction,oradduction

Headisinneutralposition Palmofhandfacingbody Elbowcompletely

extended Clientperforms

glenohumeral flexionuntilthefirstsignofresistance

Movement:Flexion

AverageROM:0180

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AssessingFlexibility ROMTests ShoulderAssessingFlexibility ROMTests Shoulder

Goniometer position1. Fulcrum:Lateralaspectofgreatertubercle2. Stabilizationarm:Perpendiculartothefloor3. Movementarm:Alignwiththemidlineofhumerus and

referencethelateralepicondyle

Stabilization Clientisingoodposturewithastabilizedscapula(retracted),thoracic,andlumbar

Stabilizescapulatopreventtilting,rotation,orelevation Placetowelunderhumerus tostabilizeandalignwithacromion process

Movement:Extension

AssessingFlexibility ROMTests ShoulderAssessingFlexibility ROMTests Shoulder

Starting/endingbodyposition Clientisproneontablewith

glenohumeral in0degreesofflexion,extension,abduction,oradduction

Headisinneutralposition Palmofhandfacingthebody Elbowisextendedcompletely Performglenohumeral

extensionuntilthefirstsignofresistance

Movement:Extension

AverageROM:060

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AssessingFlexibility ROMTests ShoulderAssessingFlexibility ROMTests Shoulder

Goniometer position1. Fulcrum:Olecranon processoftheelbow2. Stabilizationarm:Perpendiculartothefloor3. Movementarm:Alignwithlateralmidlineofulnaand

referencetheulnar styloid

Stabilization Clientisingoodposturewithastabilizedscapula(retracted),thoracic,andlumbar

Stabilizescapulatopreventtilting,rotation,orelevation Placetowelunderhumerus tostabilizeandalignwithacromion process

Movement:InternalRotation

AssessingFlexibility ROMTests ShoulderAssessingFlexibility ROMTests Shoulder

Starting/endingbodyposition Clientissupineontablewith

humerus abductedat90degreesandelbowisflexedat90degrees.

Elbowisat0degreesofsupination andpronation

Clientperformsglenohumeral internalrotationuntilthefirstsignofresistance

Movement:InternalRotation

AverageROM:070

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AssessingFlexibility ROMTests ShoulderAssessingFlexibility ROMTests Shoulder

Goniometer positionandstabilizationarethesameasininternalrotationoftheshoulder

Startingpositionisthesame,buttheclientperformsexternalratherthaninternalrotationuntilsignsofresistanceoccur

Movement:ExternalRotation

AverageROM:090

AssessingFlexibility ROMTests HipAssessingFlexibility ROMTests Hip

Goniometer position1. Fulcrum:Greatertrochanter ofthelateralthigh2. Stabilizationarm:Lateralmidlineofthepelvis3. Movementarm:Lateralmidlineofthefemur,using

thelateralepicondyle asareferenceStabilization

Clientisingoodposturewithastabilizedscapula,thoracic,lumbarspine,andpelvicarea

Pelvisshouldnotriseofftable Oppositelegnotbeingassessedshouldhavekneeflexedandfootflatontableforaddedstabilityandprotectionfortheback

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AssessingFlexibility ROMTests HipAssessingFlexibility ROMTests Hip

Clientissupineontablewithhipin0degreesofflexion,extension,abduction,adduction,androtation

Testingleghaskneefullyextended

Clientperformshipflexionuntilthefirstsignofresistanceoruntilthepelvisrotatesorkneebreaksextension

Movement:Flexion(TestingLegFullyExtended)

AverageROM:090

AssessingFlexibility ROMTests HipAssessingFlexibility ROMTests Hip

Starting/endingbodyposition Clientissupineontable

withkneeflexedat90degreesandhipflexedat90degrees;hipisin0degreesofabduction,adduction,androtation

Kneeisflexedtoreducecontractionofhamstrings

Clientperformshipflexionuntilthefirstsignofresistanceoruntilthepelvisrotates

Movement:Flexion(TestingKneeandHipFlexedat90Degrees)

AverageROM:0120

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AssessingFlexibility ROMTests HipAssessingFlexibility ROMTests Hip

Starting/endingbodyposition

Clientisproneontablewithhipin0degreesofflexion,extension,abduction,adduction,androtation

Testingleghaskneefullyextended

Clientperformshipextensionuntilthefirstsignofresistanceoruntilthepelvisrotates

Movement:Extension(TestingLegFullyExtended)

AverageROM:030

AssessingFlexibility ROMTests HipAssessingFlexibility ROMTests Hip

Goniometer position1. Fulcrum:LocateattheASIS(anteriorsuperioriliac

spine)2. Stabilizationarm:Imaginaryhorizontalline

connectingaxispointASIStotheotherASIS3. Movementarm:Anteriormidlineofthefemur,

usingthemidlineofthepatellaasareferenceStabilization

Clientisingoodposturewithastabilizedscapula,thoracic,lumbarspine,andpelvicarea

Stabilizeforlateraltrunkflexiononbothsides

Movement:Abduction

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AssessingFlexibility ROMTests HipAssessingFlexibility ROMTests Hip

Starting/endingbodyposition

Clientissupineontablewithhipin0degreesofflexion,extension,androtation

Testingleghaskneefullyextended

Clientperformshipabductionuntilthefirstsignofresistanceorlateraltrunkflexionoccursoneitherside

Movement:Abduction

AverageROM:045

AssessingFlexibility ROMTests HipAssessingFlexibility ROMTests Hip

Goniometer position1. Fulcrum:LocateattheASIS(anteriorsuperioriliac

spine)2. Stabilizationarm:Imaginaryhorizontalline

connectingaxispointASIStotheotherASIS3. Movementarm:Anteriormidlineofthefemur,

usingthemidlineofthepatellaasareferenceStabilization

Clientisingoodposturewithastabilizedscapula,thoracic,lumbarspine,andpelvicarea

Oppositelegnotbeingtestedshouldbeabductedfullytoallowfortestinghiptobeassessed

Movement:Adduction

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AssessingFlexibility ROMTests HipAssessingFlexibility ROMTests Hip

Starting/endingbodyposition Clientissupineontablewithhipin0degreesofflexion,extension,androtation

Testingleghaskneefullyextended Clientperformshipadductionuntilthefirstsignofresistanceorlateraltrunkflexionorpelvicrotationoccurs

Movement:Adduction

AverageROM:030

AssessingFlexibility ROMTestsAssessingFlexibility ROMTests

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AssessingFlexibility ROMTestsAssessingFlexibility ROMTests

Itisimportanttorecognizethatalearningeffectislikelywithflexibilitymeasurements.

Thus,thefollowingstatementfromACSM'sResourceManualforGuidelinesforExerciseTestingandPrescriptionisofimportance: ArecommendationfromtheAmericanMedicalAssociationsuggeststhatROMshouldbemeasuredusingthreeconsecutivetrialsandaveragedasthetruevalue.IftheaverageROMis50degrees,threeofthemeasurementsmustfallwithin5degreesofthemean.Iftheaverageisgreaterthan50degrees,threemeasurementsmustfallwithin10degreesofaverage.Suchmeasuresmaybetakenuptosixtimesuntiltheymeetthecriteria;otherwise,theyareconsideredinvalid.