Primary Movements Two Primary Movement Assessment: NASM-CES - PDF document

1/1/2013 Primary Movements  Two Primary Movement Assessment:  NASM-CES ○ Overhead Squat Practical Application for Athletic Trainers ○ Single-leg Squat  Dynamic Assessment (other)  Single-leg Step Off  Functional Movement M. Susan Guyer, DPE, ATC, CSCS, CES Which one? Rational - OHS  The OHS assesses  total body structural alignment  NASM - CES  dynamic flexibility  FMS  and neuromuscular control from a bilateral standing posture.  Squatting requires optimal motion in the ankles,  SFMA knees, and hips.  Having the arms elevated overhead  stresses the musculature surrounding the shoulder complex  increases the demand placed upon the core stabilizing muscles. Assessment Rational - OHS  The NASM - OHS assessment is the  To perform the OHS correctly without quickest and easiest to perform at the compensation in structural alignment, start of the sport season. one must demonstrate:  optimal and bilaterally symmetrical dynamic  Information obtained can be used to range of motion at each joint (length-tension tailor pre-habilitation programs relationships) specifically to the needs of each  optimal force-couple relationship (proper individual athlete. recruitment strategies).  A word about prevention! 1

1/1/2013 Practicality Overhead Squat Assessment  Once compensations are found we will be able to tell:  Probable overactive muscles  Inhibit/Lengthen  Flexibility Exercises will be used ○ Self-Myofascial Release (SMR) ○ Static Stretching ○ Neuromuscular Stretching  Probable underactive muscles  Activate/Integrate  Strengthening exercise will be used ○ Positional Isometrics ○ Isolated strengthening ○ Integrated Dynamic Movement Anterior Lateral Posterior Set-up  Feet straight ahead Corrective Exercise Continuum  Shoulder width apart  Arms raised above their head as shown Inhibit Lengthen Activate Integrate Kinetic Chain Checkpoints Procedures  Foot/Ankle  Perform a series of squats 5 times per  Knee view  Lumbo-Pelvic-Hip  Squat to the depth of Compels (LPHC) an average chair  Shoulder and Cervical height Spine (Upper Body) 2

1/1/2013 Anterior View Lateral View – Excessive Forward Lean  Kinematic check points  Feet  Knees  Feet  Should be straight ahead, 2 nd metatarsal of each foot should be parallel to one another  Knees  Knees move inward  Knees move outward Anterior View Lateral View View Checkpoint Compensation Probable Over-active Probable Under-active Muscle Muscle View Checkpoint Compensation Probable Overactive Muscle Probable Under-active Muscle Anterior Feet Turn Out Soleus Med. Gastrocnemius Lateral Lat. Gastrocnemius Med. Hamstring Upper Body Arms Fall Forward Latissimus Dorsi Mid/Lower Trapezium Biceps Femoris Gluteus Pectoralis Major/Minor Rhomboids Tensor Fascia Lata (TFL) Medius/Maximus Coracobrachialis Posterior Deltoid Gracilis Rotator Cuff Popliteus LPHC Excessive Forward Soleus Anterior Tibialis Lean Gastrocnemius Gluteus Maximus Knees Move Inward Adductor Complex Med. Hamstring Hip Flexor complex Erector Spinae Bicep Femoris (short Med. Gastrocnemius head) Vastus Medialis (VMO) Low Back Arches Hip Flexor Complex Gluteus Maximus Erector Spinae Intrinsic Core Stabilizers TFL Latissimus Dorsi Lat. Gastrocnemius Vastus Lateralis Low Back Rounds Hamstrings Gluteus Maximus Adducor magnus Erector Spine Move Outward Piriformis Adductor Complex Rectus Abdominis Intrinsic Core Stabilizers Biceps Femoris Med. Hamstring External Obliques TFL Gluteus Maximus Gluteus Medius Gluteus Minimus Lateral View Posterior View  Two main Checkpoints  Check Points  LPHC  Feet ○ Excessive forward Lean ○ Flatten ○ Back Rounds ○ Heels Rise ○ Back Arches  LPHC  Upper body ○ Asymmetrical Weight ○ Arms fall forward Shift 3

1/1/2013 Posterior View Single-Leg Squat Assessment View Checkpoint Compensation Probable Overactive Probable Under Muscle active Muscle Posterior Feet Flatten Peroneal Complex Posterior Tibialis Toe extensor complex Anterior Tibialis  Starting Position Lat. Gastrocnemius Med. Gastrocnemius Biceps Femoris Gluteus Medius  Feet straight ahead TFL  Shoulder width apart Heel Rise Soleus Anterior Tibialis Gastrocnemius  Hands on hip LPHC Asymmetrical Adductor Complex (on Gluteus Medius (on  Shift weight to one leg Weight Shift same side of shift) side of shift)  Procedures TFL Adductor Complex Piriformis (on opposite side  3 squats with hands on Bicep Femoris of shift) Gluteus Medius (on hips opposite side of shift)  Comfortable depth OHS Modifications LPHC – Hip Hike/Hip Drop  Heals raised  Hands on Hips  Pelvis should remain level in the frontal plane  LPHC- Hip Hike or drop  Knee goes valgus Rational - SLS Single-Leg Step Off  Assesses lower body dynamic flexibility and  Added to OHS and SLS as a dynamic neuromuscular control as well as balance form a evaluation of biomechanics and unilateral standing position. function.  Provides a grater challenge to the LPHC as the  Most knee injuries occur in the valgus base of support for the body has been reduced. knee position.  This forces the core and the priprioception mechanism to work harder.  Also assesses functionally applicable movements used in everyday activities. 4

1/1/2013 Right leg step off Test  Standing long jump  Vertical jump Left leg step off Standig LJ Functional Movement Scale Standing LJ  Designed to evaluate athletic movement of agility, power, speed and functional strength  No validity or reliability data as of date 5

1/1/2013 Excessive Forward Lean (Lateral VJ View)  Overactive  Underactive  Gastrocnemius  Anterior Tibialis  Soleus  Gluteus Maximus  Hip Flexor Complex  Erector Spinae  Abdominal Complex  Intrinsic Core Stabilizers ○ Rectus abdominis and External Oblique  VJ Sample Corrective Exercise Program for Excessive Forward Lean Phase Modality Muscles(s) Acute Variables Inhibit SMR Gastrocnemius/soleus Hold on tender Hip flexor Complex area of 30 (TFL/rectus femoris) seconds Lengthen Static Stretching Gastrocnemius/soleus 30-sec hold or 7- or NMS Hip flexor Complex 10 sec. isometric contract, 30 sec. hold Activate Positional Gluteus Maximus 4 reps or Isometrics and/or Core stabilizers increasing Isolated intensity 25, 50, Strengthening 75, 100% OR 10-15 reps with 2 sec. isometric hold and 4 second eccentric Integrate Integrated Ball Wall Squat 10-15 reps Dynamic under control Movement Most Common Findings Knee Valgus  Excessive forward lean (weak intrinsic  Found on Anterior View core)  Knee Valgus with single leg stance (weak gluteal region/poor balance)  Foot Pronation (anterior/posterior tibialis imbalance)  Heel Rises (overactive soleus)  Correction with heal elevation (LPHC)  Erect landing (poor technique) 6

1/1/2013 Foot Pronation References  Found on Posterior View  NASM – CES Movement Assessment  NCAA – ISS data Heel Rises  Found on Posterior View Conclusion  Movement assessments are the cornerstone of an integrated assessment process  Used to observe the length-tension relationship, force-couple relationships, and joint motions of the entire kinetic chain.  This process is only part of the assessment we perform on the athletic prior to competing. 7