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10/30/2013

Section7:
MuscularStrength,
EnduranceandFlexibility
ACSMGuidelines:Chapter4(pp.94107)
ACSMManual:Chapter5,6

HPHE4450
Dr. Cheatham

Outline

Importanceofmuscularstrengthandendurance
Typesofmuscularcontractions
GeneralTestingGuidelines
Musclestrength
HandGripDynamometry,1RM

MuscularEndurance
PushUpTest,CurlUpTest,YMCABenchPressTest

Importanceofflexibility
SitandReachTests
LumbarFlexionandExtension
SpecificROMTests

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ImportanceofMuscularSandE
Healthrelatedfitness
componentthatmay
maintainorimprovethe
following:
Bonemass(relatedto
osteoporosis)
Glucosetolerance(relatedto
Type2diabetes)
Musculotendinous integrity
(relatedtolowerriskofinjury,
lowbackpain)
CarryoutADLs
FatfreemassandRMR
(relatedtoweight
management)

Performanceapplications

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

Dynamic
Musclegeneratesforcewhilelengtheningor
shortening
Concentric:Muscleshortens
Eccentric:Musclelengthens

Isotonic:Fixedresistance
Isokinetic:Fixedmovementspeed

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GeneralTestingGuidelines
Useafamiliarization/practicesession
Adheretospecificprotocol
Predeterminedrepetitiondurationandrangeof
motion

Thestandardizedprotocolshouldinclude:
Strictposture
Consistentmovementspeed
FullROM
Useofspotters(ifnecessary)
Equipmentfamiliarization
Properwarmup

MuscularStrength
Definition:Maximalforcethatcanbegenerated
byaspecificmuscleormusclegroup
Specificto:
Musclegroup
Typeofcontraction
Speedofcontraction
Jointangletested
Resultsfromatestarespecifictotheprocedures
used
Nosingletestexistsforevaluatingtotalbody
muscularenduranceormuscularstrength

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MuscularStrength
Purposeofmeasurement:
Assessmuscularfitness
Identifyweaknesses
Monitorprogressinrehabilitation
Measuretheeffectivenessoftraining

AssessingMuscularStrength
Commonassessments
Handgriptest
1repetitionmaximum(RM)benchpress
Isokinetic testing

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AssessingMS HandGrip

AssessingMS HandGrip

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AssessingMS HandGrip

Numbersareinpounds(lbs).

AssessingMS 1RM
OneRepetitionMaximum(1RM)
Maximalforcethatcanbegeneratedbyaspecific
muscleormusclegroup
Theheaviestweightthatcanbeliftedonlyonce
usinggoodform
DynamicStrength
GoldStandard

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AssessingMS 1RM

AssessingMS 1RM
6or10RMTest
Canbeusefulespeciallyfordeterminingweightsfor
exerciseprescription
Adapt1RMprocedurestodetermine6or10RM
value.
Optional:
Convert10RMvaluetoa1RMestimationbydividing
10RMweightby0.75

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AssessingMS 1RM
InterpretationofData:
ACSMprovidesnormchartsforUpperBody
Strength(BenchPress)andLowerBodyStrength
(LegPress)
ValuesareoftenexpressedasStrengthtoweight
ratio
StrengthtoWeightRatio=WeightLifted/BodyWeight
Bothweightsmustbeinthesameunits

AssessingMS 1RM

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AssessingMS 1RM

AssessingMS 1RM

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AssessingMS 1RM

MuscularEndurance
Definition:Theabilityofamusclegroupto
executerepeatedcontractionsoveratime
periodsufficienttocausemuscularfatigueorto
maintainaspecificpercentageofmaximum
voluntarycontractionforaprolongedtime
Sameideawithrespecttospecificityandmuscle
strength

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AssessingMuscularEndurance
Commonassessments
Pushuptest
Partialcurluptest
YMCAbenchpresstest

AssessingME PushUpTest

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AssessingME PushUpTest

AssessingME PushUpTest

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AssessingME CurlUpTest

AssessingME CurlUpTest

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AssessingME CurlUpTest

AssessingME YMCABenchPressTest

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AssessingME YMCABenchPressTest

Flexibility
Definition:Functionalcapacityofthejointsto
movethroughthefullrangeofmotion(ROM)
Jointspecific
Dependson:
Jointcapsuledistensibility
Adequatewarmup
Muscleviscosity
Complianceoftheligamentsandtendons

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Flexibility
Whyisflexibilityimportant?
PerformanceofADLs
Relationshiptolowerbackpain
Athleticperformance

AssessingFlexibility
Commonassessments:
SitandReachBoxTest(trunkflexion)
YMCASitandReachTest
LumbarFlexionandExtension
SpecificRangeofMotionTests

GeneralTestingGuidelines
Stretching,lightaerobicexercise(510min)
Practicesessiontoassesspain,discomfort

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AssessingFlexibility SitandReachTests

AssessingFlexibility SitandReachTests

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AssessingFlexibility SitandReachTests

AssessingFlexibility SitandReachTests

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AssessingFlexibility SitandReachTests

MakingaSitandReachBox

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AssessingFlexibility LumbarFlexion
Seatedwithpelvisstabilized
Tapeispositionedwithzero
atthespinous processC7
Measuredownthesuperior
iliac
Lumbarflexionperformed
untilfirstsignofresistance
Averagehealthyrange:4
inchincrease

AssessingFlexibility LumbarFlexion

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AssessingFlexibility LumbarExtension
Samebodyandtapepositionasforflexion
assessment
Lumbarextensionisperformeduntilfirst
signofresistance
Averagehealthyrange:2inchincrease

AssessingFlexibility LumbarExtension

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AssessingFlexibility ROMTests
UseofGoniometers:
Fulcrumcenteredto
identifiedanatomic
landmark
Stabilizationarm
remainsfixed
(establishesthestart
position)
Movementarmmoves
inrelationtoclients
movement(establishes
theendingposition)

AssessingFlexibility ROMTests
GeneralProcedures:
Beforebeginning:
Providetheclientwithademonstrationofan
ROMtest
Positionthegoniometer
Locatethefulcrumatthejointaxisorhingepoint
Wheretheaxisofrotationoccursforthetwobody
segments

Placethestabilizationandmovementarms
Centeredalongeachbodysegment

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AssessingFlexibility ROMTests
Goniometryisanaccuratemeasureif:
Allanatomiclandmarksareidentified
Jointaxispointhasbeenclearlydefined
Bodyisstabilizedinproperalignment
Clientisinstructedtomoveslowlythroughthe
properROMandthegoniometer isproperlyaligned
TestadministratorisfamiliarwithnormalROMfor
eachjoint
ObservationofwhetherROMassessmentispain
freeoccurs

AssessingFlexibility ROMTests
Foreachassessment,locationsofthegoniometer
forthefollowingthreepointsarespecified:
1. Fulcrum
2. Stabilizationarm
3. Movementarm

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AssessingFlexibility ROMTests Shoulder


Movement:Flexion
Goniometer position
1. Fulcrum:Lateralaspectofgreatertubercle
2. Stabilizationarm:Perpendiculartothefloor
3. Movementarm:Alignwiththemidlineofhumerus
andreferencethelateralepicondyle

Stabilization
Clientisingoodposturewithastabilizedscapula
(retracted),thoracic,andlumbar
Stabilizescapulatopreventtilting,rotation,or
elevation

AssessingFlexibility ROMTests Shoulder


Movement:Flexion
Starting/endingbodyposition
Seatedwithglenohumeral
in0degreesofflexion,
extension,abduction,or
adduction
Headisinneutralposition
Palmofhandfacingbody
Elbowcompletely
extended
Clientperforms
glenohumeral flexionuntil
thefirstsignofresistance

AverageROM:0180

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AssessingFlexibility ROMTests Shoulder


Movement:Extension
Goniometer position
1. Fulcrum:Lateralaspectofgreatertubercle
2. Stabilizationarm:Perpendiculartothefloor
3. Movementarm:Alignwiththemidlineofhumerus and
referencethelateralepicondyle

Stabilization
Clientisingoodposturewithastabilizedscapula
(retracted),thoracic,andlumbar
Stabilizescapulatopreventtilting,rotation,orelevation
Placetowelunderhumerus tostabilizeandalignwith
acromion process

AssessingFlexibility ROMTests Shoulder


Movement:Extension
Starting/endingbodyposition
Clientisproneontablewith
glenohumeral in0degreesof
flexion,extension,abduction,
oradduction
Headisinneutralposition
Palmofhandfacingthebody
Elbowisextendedcompletely
Performglenohumeral
extensionuntilthefirstsign
ofresistance
AverageROM:060

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AssessingFlexibility ROMTests Shoulder


Movement:InternalRotation
Goniometer position
1. Fulcrum:Olecranon processoftheelbow
2. Stabilizationarm:Perpendiculartothefloor
3. Movementarm:Alignwithlateralmidlineofulnaand
referencetheulnar styloid

Stabilization
Clientisingoodposturewithastabilizedscapula(retracted),
thoracic,andlumbar
Stabilizescapulatopreventtilting,rotation,orelevation
Placetowelunderhumerus tostabilizeandalignwith
acromion process

AssessingFlexibility ROMTests Shoulder


Movement:InternalRotation
Starting/endingbodyposition
Clientissupineontablewith
humerus abductedat90
degreesandelbowisflexed
at90degrees.
Elbowisat0degreesof
supination andpronation
Clientperforms
glenohumeral internal
rotationuntilthefirstsignof
resistance

AverageROM:070

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AssessingFlexibility ROMTests Shoulder


Movement:ExternalRotation
Goniometer positionandstabilizationarethe
sameasininternalrotationoftheshoulder
Startingpositionisthesame,buttheclient
performsexternalratherthaninternalrotation
untilsignsofresistanceoccur
AverageROM:090

AssessingFlexibility ROMTests Hip


Goniometer position
1. Fulcrum:Greatertrochanter ofthelateralthigh
2. Stabilizationarm:Lateralmidlineofthepelvis
3. Movementarm:Lateralmidlineofthefemur,using
thelateralepicondyle asareference

Stabilization
Clientisingoodposturewithastabilizedscapula,
thoracic,lumbarspine,andpelvicarea
Pelvisshouldnotriseofftable
Oppositelegnotbeingassessedshouldhaveknee
flexedandfootflatontableforaddedstabilityand
protectionfortheback

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AssessingFlexibility ROMTests Hip


Movement:Flexion(TestingLegFullyExtended)

Clientissupineontable
withhipin0degreesof
flexion,extension,
abduction,adduction,
androtation
Testingleghasknee
fullyextended
Clientperformship
flexionuntilthefirst
signofresistanceor
untilthepelvisrotates
orkneebreaks
extension

AverageROM:090

AssessingFlexibility ROMTests Hip


Movement:Flexion(TestingKneeandHipFlexedat90Degrees)

Starting/endingbodyposition
Clientissupineontable
withkneeflexedat90
degreesandhipflexedat90
degrees;hipisin0degrees
ofabduction,adduction,
androtation
Kneeisflexedtoreduce
contractionofhamstrings
Clientperformshipflexion
untilthefirstsignof
resistanceoruntilthepelvis
rotates

AverageROM:0120

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AssessingFlexibility ROMTests Hip


Movement:Extension(TestingLegFullyExtended)

Starting/endingbody
position
Clientisproneontable
withhipin0degreesof
flexion,extension,
abduction,adduction,
androtation
Testingleghasknee
fullyextended
Clientperformship
extensionuntilthefirst
signofresistanceor
untilthepelvisrotates

AverageROM:030

AssessingFlexibility ROMTests Hip


Movement:Abduction

Goniometer position
1. Fulcrum:LocateattheASIS(anteriorsuperioriliac
spine)
2. Stabilizationarm:Imaginaryhorizontalline
connectingaxispointASIStotheotherASIS
3. Movementarm:Anteriormidlineofthefemur,
usingthemidlineofthepatellaasareference

Stabilization
Clientisingoodposturewithastabilizedscapula,
thoracic,lumbarspine,andpelvicarea
Stabilizeforlateraltrunkflexiononbothsides

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AssessingFlexibility ROMTests Hip


Movement:Abduction
Starting/endingbody
position
Clientissupineon
tablewithhipin0
degreesofflexion,
extension,androtation
Testingleghasknee
fullyextended
Clientperformship
abductionuntilthefirst
signofresistanceor
lateraltrunkflexion
AverageROM:045
occursoneitherside

AssessingFlexibility ROMTests Hip


Movement:Adduction

Goniometer position
1. Fulcrum:LocateattheASIS(anteriorsuperioriliac
spine)
2. Stabilizationarm:Imaginaryhorizontalline
connectingaxispointASIStotheotherASIS
3. Movementarm:Anteriormidlineofthefemur,
usingthemidlineofthepatellaasareference

Stabilization
Clientisingoodposturewithastabilizedscapula,
thoracic,lumbarspine,andpelvicarea
Oppositelegnotbeingtestedshouldbeabducted
fullytoallowfortestinghiptobeassessed

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AssessingFlexibility ROMTests Hip


Movement:Adduction

Starting/endingbodyposition
Clientissupineontablewithhipin0
degreesofflexion,extension,androtation
Testingleghaskneefullyextended
Clientperformshipadductionuntilthe
firstsignofresistanceorlateraltrunk
flexionorpelvicrotationoccurs
AverageROM:030

AssessingFlexibility ROMTests

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AssessingFlexibility ROMTests
Itisimportanttorecognizethatalearningeffectis
likelywithflexibilitymeasurements.
Thus,thefollowingstatementfromACSM's
ResourceManualforGuidelinesforExercise
TestingandPrescriptionisofimportance:
ArecommendationfromtheAmericanMedical
AssociationsuggeststhatROMshouldbemeasured
usingthreeconsecutivetrialsandaveragedasthetrue
value.IftheaverageROMis50degrees,threeofthe
measurementsmustfallwithin5degreesofthemean.
Iftheaverageisgreaterthan50degrees,three
measurementsmustfallwithin10degreesofaverage.
Suchmeasuresmaybetakenuptosixtimesuntilthey
meetthecriteria;otherwise,theyareconsidered
invalid.

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