Goniometric Assessment
Rick Richey, MS, LMT
NASM
Faculty Instructor
PURPOSE
• The purpose of this presentation is to
provide the Health and Fitness
Professional with the knowledge and
skills to effectively conduct goniometric
assessments as apart of an integrated
assessment process.
OBJECTIVES
• Following this presentation the Health
and Fitness Professional will be able to:
– Describe the scientific rationale for
goniometric assessments
– Accurately perform a variety of
goniometric measurements
– Correlate goniometric measurements to
the Overhead Squat assessment
SCIENTIFIC RATIONALE
• Goniometric measurement is a major
component of a comprehensive and
integrated assessment process
• Other assessments include:
– Movement Assessments (Overhead Squat
& Single-leg Squat)
– Manual Muscle Testing
SCIENTIFIC RATIONALE
Human Movement
System
Muscular System
Normal
Length-Tension
Relationships
Nervous System
Normal
Force-Couple
Relationships
(muscle balance & strength)
(recruitment of muscles)
Optimum
Structural Alignment
Optimum
Neuromuscular Control
Optimum
Movement
Articular System
Normal
Arthrokinematics
(functional joint motion)
SCIENTIFIC RATIONALE
• However, for many reasons such as
repetitive stress, impact trauma,
disease and sedentary lifestyle,
dysfunction can occur in one or more of
these systems.
• The result is a Human Movement
System Impairment and, ultimately,
injury.
SCIENTIFIC RATIONALE
Human Movement
System Impairment
Muscular System
Altered
Length-Tension Relationships
(muscle imbalance & strength deficits)
Nervous System
Altered
Force-Couple
Relationships
(altered recruitment of muscles)
Altered
Structural Alignment
Altered
Neuromuscular Control
Altered
Movement
Articular System
Altered
Arthrokinematics
(dysfunctional joint motion)
GONIOMETRIC MEASUREMENT
• Goniometric measurements can be highly
effective to help determine the cause and
extent of restriction in joint ROM.
• Especially true when an active ROM
assessment such as an Overhead Squat
and/or Single-leg Squat is performed prior to
goniometric measurement.
– Movement assessment and goniometric
measurement should precede testing for muscle
strength (manual muscle testing) to determine
available ROM at the joint being tested.
THE GONIOMETER
• The goniometer is
the tool used to
measure joint motion.
THE GONIOMETER
Movement
Arm
Axis
Body
Stabilization
Arm
• The body represents the
arc of measurement.
• The axis (A) is the center
of the goniometer
• The stabilization arm
(SA) is the part that will
be placed on the stable,
non-moving limb/bony
segment
• The movement arm
(MA) is the only moving
component and is placed
on the moving limb
NASM MEASUREMENTS
LOWER EXTREMITY
Foot:
Ankle Dorsiflexion
Hip:
UPPER EXTREMITY
Shoulder:
-- 20
Flexion (Bent Knee)
-- 120
Hamstring (90/90 Test) -- 20-0
Abduction
-- 40-45
Internal Rotation
-- 45
External Rotation
-- 45
Extension
-- 0 to -10
Shoulder Flexion -- 160
Glenohumeral Internal Rotation 45
Glenohumeral External Rotation 90
FOOT: ANKLE DORSIFLEXION
• Joint motion
assessed:
– Ankle dorsiflexion
• Muscles assessed:
– Gastrocnemius and
soleus
• Normal Value: 20
FOOT: ANKLE DORSIFLEXION
• Position:
– subtalar neutral
• Execution:
– guide client as he/she actively
dorsiflexes passively assisting
the path of motion to the point
of first resistance or
compensation
– A: Directly below the lateral
malleolus near the base of the
foot
– SA: Lateral aspect of fibula
– MA: Midline of 5th metatarsal
• Common Errors
FOOT: ANKLE DORSIFLEXION
• Human Movement
System Impairment:
– foot compensations
(turning outward,
flattening, and/or heels
rising)
– and/or an excessive
forward lean during an
Overhead Squat and/or
Single-leg Squat
assessment
HIP: FLEXION (Bent Knee)
• Joint motion
assessed:
– Flexion of iliofemoral
joint
• Muscles assessed:
– Gluteus Maximus,
adductor magnus,
hamstrings, posterior
capsul
• Normal Value: 120
Gluteus Maximus
Adductor Magnus
Hamstrings
HIP: FLEXION (Bent Knee)
• Position:
– supine with the knee fully
flexed and hip in neutral
• Execution:
– passively flex the hip to the
point of first resistance or
compensation
– A: Greater trochanter
– SA: Lateral midline of the
pelvis
– MA: Lateral midline of the
femur
• Common Errors
HIP: FLEXION (Bent Knee)
• Human Movement
System Impairment:
– rounding of the low back
during the Overhead Squat
and/or Single-leg Squat
assessments
• NOTE: If the low back
rounding is preceded by
an excessive arch or
arching of the low back,
the hip flexors (psoas and
rectus femoris) may be
the overactive muscles.
HIP: HAMSTRING (90/90 Test)
• Joint motion
assessed:
– Extension of the
tibiofemoral joint
– Flexion of iliofemoral
joint
• Muscles assessed:
– Hamstrings,
gastrocnemius, neural
tissue (sciatic nerve)
• Normal Value: 20-0
Hamstrings
HIP: HAMSTRING (90/90 Test)
• Position:
– hip and knee flexed at 90
• Execution:
– passively extend the knee
until the first restriction or
compensation
– A: the tibiofemoral joint
– SA: Lateral midline of the
femur
– MA: Lateral midline of the
fibula
• Common Errors
HIP: HAMSTRING (90/90 Test)
• Human Movement
System Impairment:
– feet turned out,
– feet flattening,
– knee moving inward (short
head of biceps femoris),
– knees moving outward
(long head of biceps
femoris),
– and/or low back rounding
during the Overhead Squat
and/or Single-leg Squat
assessments
HIP: ABDUCTION
• Joint motion
assessed:
– Abduction of
iliofemoral joint
• Muscles assessed:
– Adductor complex,
pubofemoral ligament,
iliofemoral ligament,
medial hip capsule
• Normal Value: 40-45
Adductor
complex
HIP: ABDUCTION
• Position:
– hip in neutral and knee
extended
• Execution:
– passively abduct the leg
until the first restriction or
compensation
– A: the ASIS
– SA: one ASIS to the other
ASIS
– MA: midline of the femur
• Common Errors
HIP: ABDUCTION
• Human Movement
System Impairment:
– knees moving
inward
– and/or an
asymmetrical
weight shift during
the Overhead Squat
and/or Single-leg
Squat assessments
HIP: INTERNAL ROTATION
• Joint motion
assessed:
– Internal rotation of
iliofemoral joint
Piriformis
• Muscles assessed:
– Piriformis and hip
external rotators,
adductor magnus
(oblique fibers),
ischiofemoral ligament
• Normal Value: 45
Oblique fibers
HIP: INTERNAL ROTATION
• Position:
– hip in neutral and flexed to
90
• Execution:
– passively rotate the femur
internally until the first
restriction or compensation
– A: the patella
– SA: line down the center of
the body
– MA: tibial tuberosity
• Common Errors
HIP: INTERNAL ROTATION
• Human Movement
System Impairment:
– knee moving inward
– or outward
– and/or asymmetrical
weight shift during the
Overhead Squat and/or
Single-leg Squat
assessments
HIP: EXTERNAL ROTATION
• Joint motion
assessed:
– External rotation of
iliofemoral joint
• Muscles assessed:
– Adductor magnus
(vertical fibers)
iliofemoral ligament,
pubofemoral ligament
• Normal Value: 45
Vertical fibers
HIP: EXTERNAL ROTATION
• Position:
– hip in neutral and flexed to
90
• Execution:
– passively rotate the femur
externally until the first
restriction or compensation
– A: the patella
– SA: line down the center of
the body
– MA: tibial tuberosity
• Common Errors
HIP: EXTERNAL ROTATION
• Human Movement
System Impairment:
– knee moving inward
– and/or asymmetrical
weight shift during the
Overhead Squat and/or
Single-leg Squat
assessments
HIP: EXTENSION
• Joint motion
assessed:
Psoas
Iliacus
– Extension of
iliofemoral joint
• Muscles assessed:
– Psoas, iliacus, rectus
femoris, tensor fascia
latae, sartorius
• Normal Value: 0 --10
TFL
Sartorius
Rectus femoris
HIP: EXTENSION
• Position:
– supine with the opposite
hip flexed
• Execution:
– passively allow the hip to
extend until first restriction
or compensation
– A: greater trochanter
– SA: midline line of the trunk
– MA: lateral condyle
• Common Errors
HIP: EXTENSION
• Variations:
– Psoas - thigh will stay in a neutral position
and knee will remain bent
– Rectus femoris - the thigh will remain
neutral and the knee will extend
– TFL - the thigh will abduct and internally
rotate and the knee will extend
– Sartorius - the thigh will abduct and
externally rotate and the knee will remain
flexed
HIP: EXTENSION
• Human Movement
System Impairment:
– arching of the low back
– and/or excessive forward
lean during the Overhead
Squat and/or Single-leg
Squat assessments
SHOULDER: FLEXION
• Joint motion assessed:
Infraspinatus
Teres minor & major
– Flexion of shoulder
complex
Triceps
• Muscles assessed:
– Latissimus dorsi, teres
major, teres minor,
infraspinatus,
subscapularis, pectoralis
major (lower fibers), triceps
(long head)
• Normal Value: 160
Latissimus dorsi
Pectoralis major
SHOULDER: FLEXION
• Position:
– supine with shoulder in
neutral and knees bent
• Execution:
– passively flex the shoulder
until excessive scapular
movement is felt or the first
resistance barrier is noted
– A: lateral shoulder
– SA: Mid-axillary line
– MA: lateral epicondyle
• Common Errors
SHOULDER: FLEXION
• Human Movement
System Impairment:
– arching of the low back
– and/or arms falling
forward during the
Overhead Squat
assessment
SHOULDER: GLENOHUMERAL
JOINT INTERNAL ROTATION
• Joint motion
assessed:
– Internal rotation of
glenohumeral joint
• Muscles assessed:
– Infraspinatus, teres
minor, posterior
glenohumeral joint
capsule
• Normal Value: 45
SHOULDER: GLENOHUMERAL
JOINT INTERNAL ROTATION
• Position:
– supine with the humerus
abducted and elbow flexed
at 90
• Execution:
– passively lower the
humerus until the first
resistance barrier or
compensation is noted
– A: olecranon process
– SA: perpendicular to the
floor
– MA: ulnar styloid process
• Common Errors
SHOULDER: GLENOHUMERAL
JOINT INTERNAL ROTATION
• Human Movement
System Impairment:
– and/or arms falling
forward during the
Overhead Squat
assessment
SHOULDER: GLENOHUMERAL
JOINT EXTERNAL ROTATION
• Joint motion assessed:
– External rotation of
glenohumeral joint
Subscapularis
• Muscles assessed:
– Subscapularis, latissimus
dorsi, teres major,
pectoralis major, anterior
deltoid and anterior
glenohumeral joint capsule
• Normal Value: 90
Teres major
Latissimus dorsi
SHOULDER: GLENOHUMERAL
JOINT EXTERNAL ROTATION
• Position:
– supine with the humerus
abducted and elbow flexed
at 90
• Execution:
– passively lower the
humerus until the first
resistance barrier or
compensation is noted
– A: olecranon process
– SA: perpendicular to the
floor
– MA: ulnar styloid process
• Common Errors
SHOULDER: GLENOHUMERAL
JOINT EXTERNAL ROTATION
• Human Movement
System Impairment:
– and/or arms falling
forward during the
Overhead Squat
assessment
CONCLUSION
• Goniometric assessments provide
information concerning ROM at specific
joints
• Most valuable when used in integrated
assessment process including
movement assessments and manual
muscle testing.
Questions?
Thank you!
Contact Information
• Rick Richey
– Rick.Richey@nasm.org
– Facebook: rfrichey
– Instagram: IndependentTrainingSpot
• NASM
– www.nasm.org
Goniometric Assessment
Rick Richey, MS, LMT
PURPOSE
• The purpose of this presentation is to
provide the Health and Fitness Professional
with the knowledge and skills to effectively
conduct goniometric assessments as apart
of an integrated assessment process.
OBJECTIVES
• Following this presentation the Health and
Fitness Professional will be able to:
– Describe the scientific rationale for
goniometric assessments
– Accurately perform a variety of
goniometric measurements
– Correlate goniometric
measurements to the Overhead
Squat assessment
SCIENTIFIC RATIONALE
• Goniometric measurement is a major
component of a comprehensive and
integrated assessment process
• Other assessments include:
– Movement Assessments (Overhead
Squat & Single-leg Squat)
– Manual Muscle Testing
SCIENTIFIC RATIONALE
• However, for many reasons such as
repetitive stress, impact trauma, disease
and sedentary lifestyle, dysfunction can
occur in one or more of these systems.
• The result is a Human Movement System
Impairment and, ultimately, injury.
GONIOMETRIC MEASUREMENT
• Goniometric measurements can be highly
effective to help determine the cause and
extent of restriction in joint ROM.
• Especially true when an active ROM
assessment such as an Overhead Squat
and/or Single-leg Squat is performed prior
to goniometric measurement.
– Movement assessment and
goniometric measurement should
precede testing for muscle strength
(manual muscle testing) to
determine available ROM at the joint
being tested.
THE GONIOMETER
•
The goniometer is the tool used to
measure joint motion.
THE GONIOMETER
• The body represents the arc of
measurement.
• The axis (A) is the center of the goniometer
• The stabilization arm (SA) is the part that
will be placed on the stable, non-moving
limb/bony segment
• The movement arm (MA) is the only
moving component and is placed on the
moving limb
NASM MEASUREMENTS
FOOT: ANKLE DORSIFLEXION
• Joint motion assessed:
– Ankle dorsiflexion
• Muscles assessed:
– Gastrocnemius and soleus
• Normal Value:
20
FOOT: ANKLE DORSIFLEXION
• Position:
– subtalar neutral
• Execution:
– guide client as he/she actively
dorsiflexes passively assisting the
path of motion to the point of first
resistance or compensation
– A: Directly below the lateral
malleolus near the base of the foot
– SA: Lateral aspect of fibula
– MA: Midline of 5th metatarsal
• Common Errors
FOOT: ANKLE DORSIFLEXION
• Human Movement System Impairment:
– foot compensations (turning
outward, flattening, and/or heels
rising)
– and/or an excessive forward lean
during an Overhead Squat and/or
Single-leg Squat assessment
HIP: FLEXION (Bent Knee)
• Joint motion assessed:
– Flexion of iliofemoral joint
• Muscles assessed:
– Gluteus Maximus, adductor magnus,
hamstrings, posterior capsul
• Normal Value:
120
HIP: FLEXION (Bent Knee)
• Position:
– supine with the knee fully flexed and
hip in neutral
• Execution:
– passively flex the hip to the point of
first resistance or compensation
– A: Greater trochanter
– SA: Lateral midline of the pelvis
– MA: Lateral midline of the femur
• Common Errors
HIP: FLEXION (Bent Knee)
• Human Movement System Impairment:
– rounding of the low back during the
Overhead Squat and/or Single-leg
Squat assessments
• NOTE: If the low back rounding is preceded
by an excessive arch or arching of the low
back, the hip flexors (psoas and rectus
femoris) may be the overactive muscles.
HIP: HAMSTRING (90/90 Test)
• Joint motion assessed:
– Extension of the tibiofemoral joint
– Flexion of iliofemoral joint
• Muscles assessed:
– Hamstrings, gastrocnemius, neural
tissue (sciatic nerve)
• Normal Value:
20-0
HIP: HAMSTRING (90/90 Test)
• Position:
– hip and knee flexed at 90
• Execution:
– passively extend the knee until the
first restriction or compensation
– A: the tibiofemoral joint
– SA: Lateral midline of the femur
– MA: Lateral midline of the fibula
• Common Errors
HIP: HAMSTRING (90/90 Test)
• Human Movement System Impairment:
– feet turned out,
– feet flattening,
– knee moving inward (short head of
biceps femoris),
– knees moving outward (long head of
biceps femoris),
–
and/or low back rounding during the
Overhead Squat and/or Single-leg
Squat assessments
HIP: ABDUCTION
• Joint motion assessed:
– Abduction of iliofemoral joint
• Muscles assessed:
– Adductor complex, pubofemoral
ligament, iliofemoral ligament,
medial hip capsule
• Normal Value:
40-45
HIP: ABDUCTION
• Position:
– hip in neutral and knee extended
• Execution:
– passively abduct the leg until the first
restriction or compensation
– A: the ASIS
– SA: one ASIS to the other ASIS
– MA: midline of the femur
• Common Errors
HIP: ABDUCTION
• Human Movement System Impairment:
– knees moving inward
– and/or an asymmetrical weight shift
during the Overhead Squat and/or
Single-leg Squat assessments
HIP: INTERNAL ROTATION
• Joint motion assessed:
– Internal rotation of iliofemoral joint
• Muscles assessed:
– Piriformis and hip external rotators,
adductor magnus (oblique fibers),
ischiofemoral ligament
• Normal Value:
45
HIP: INTERNAL ROTATION
• Position:
– hip in neutral and flexed to 90
• Execution:
– passively rotate the femur internally
until the first restriction or
compensation
– A: the patella
– SA: line down the center of the body
– MA: tibial tuberosity
• Common Errors
HIP: INTERNAL ROTATION
• Human Movement System Impairment:
– knee moving inward
–
–
or outward
and/or asymmetrical weight shift
during the Overhead Squat and/or
Single-leg Squat assessments
HIP: EXTERNAL ROTATION
• Joint motion assessed:
– External rotation of iliofemoral joint
• Muscles assessed:
– Adductor magnus (vertical fibers)
iliofemoral ligament, pubofemoral
ligament
• Normal Value:
45
HIP: EXTERNAL ROTATION
• Position:
– hip in neutral and flexed to 90
• Execution:
– passively rotate the femur externally
until the first restriction or
compensation
– A: the patella
– SA: line down the center of the body
– MA: tibial tuberosity
• Common Errors
HIP: EXTERNAL ROTATION
• Human Movement System Impairment:
– knee moving inward
– and/or asymmetrical weight shift
during the Overhead Squat and/or
Single-leg Squat assessments
HIP: EXTENSION
• Joint motion assessed:
– Extension of iliofemoral joint
• Muscles assessed:
– Psoas, iliacus, rectus femoris, tensor
fascia latae, sartorius
• Normal Value:
0 --10
HIP: EXTENSION
• Position:
– supine with the opposite hip flexed
• Execution:
– passively allow the hip to extend
until first restriction or compensation
– A: greater trochanter
– SA: midline line of the trunk
– MA: lateral condyle
• Common Errors
HIP: EXTENSION
• Variations:
–
Psoas - thigh will stay in a neutral
position and knee will remain bent
– Rectus femoris - the thigh will
remain neutral and the knee will
extend
– TFL - the thigh will abduct and
internally rotate and the knee will
extend
– Sartorius - the thigh will abduct and
externally rotate and the knee will
remain flexed
HIP: EXTENSION
• Human Movement System Impairment:
– arching of the low back
– and/or excessive forward lean during
the Overhead Squat and/or Singleleg Squat assessments
SHOULDER: FLEXION
• Joint motion assessed:
– Flexion of shoulder complex
• Muscles assessed:
– Latissimus dorsi, teres major, teres
minor, infraspinatus, subscapularis,
pectoralis major (lower fibers),
triceps (long head)
• Normal Value: 160
SHOULDER: FLEXION
• Position:
– supine with shoulder in neutral and
knees bent
• Execution:
– passively flex the shoulder until
excessive scapular movement is felt
or the first resistance barrier is noted
– A: lateral shoulder
– SA: Mid-axillary line
– MA: lateral epicondyle
• Common Errors
SHOULDER: FLEXION
• Human Movement System Impairment:
– arching of the low back
– and/or arms falling forward during
the Overhead Squat assessment
SHOULDER: GLENOHUMERAL JOINT INTERNAL
ROTATION
• Joint motion assessed:
– Internal rotation of glenohumeral
joint
• Muscles assessed:
–
Infraspinatus, teres minor, posterior
glenohumeral joint capsule
• Normal Value:
45
SHOULDER: GLENOHUMERAL JOINT INTERNAL
ROTATION
• Position:
– supine with the humerus abducted
and elbow flexed at 90
• Execution:
– passively lower the humerus until
the first resistance barrier or
compensation is noted
– A: olecranon process
– SA: perpendicular to the floor
– MA: ulnar styloid process
• Common Errors
SHOULDER: GLENOHUMERAL JOINT INTERNAL
ROTATION
• Human Movement System Impairment:
– and/or arms falling forward during
the Overhead Squat assessment
SHOULDER: GLENOHUMERAL JOINT
EXTERNAL ROTATION
• Joint motion assessed:
– External rotation of glenohumeral
joint
• Muscles assessed:
– Subscapularis, latissimus dorsi,
teres major, pectoralis major,
anterior deltoid and anterior
glenohumeral joint capsule
• Normal Value: 90
SHOULDER: GLENOHUMERAL JOINT
EXTERNAL ROTATION
• Position:
– supine with the humerus abducted
and elbow flexed at 90
• Execution:
– passively lower the humerus until
the first resistance barrier or
compensation is noted
– A: olecranon process
– SA: perpendicular to the floor
– MA: ulnar styloid process
• Common Errors
SHOULDER: GLENOHUMERAL JOINT
EXTERNAL ROTATION
• Human Movement System Impairment:
–
and/or arms falling forward during
the Overhead Squat assessment
CONCLUSION
• Goniometric assessments provide
information concerning ROM at specific
joints
• Most valuable when used in integrated
assessment process including movement
assessments and manual muscle testing.
CONTACT INFORMATION
• Rick Richey
– Rick.Richey@nasm.org
– Facebook: rfrichey
– Instagram: IndependentTrainingSpot
Concussions & Our Clients
Presented By:
Theresa Miyashita, PhD, ATC, PES, CES
April 18, 2015
Objectives
•
•
•
•
•
Define concussion
MOIs
Signs/Symptoms
Sequale
Returning
Concussion Fact Sheet
•
•
•
•
•
•
•
1.6-3.8 m
$56.3 b
Most expensive pediatric pathology
#1 sport:
Most common causes:
3x more likely
4-6x more likely
How many concussions have
you sustained in your life?
• A=0
• B=1
• C=2
• D=3
• E = 4+
How many times have you had
your “bell rung” / “dinger”?
• A=0
• B=1
• C=2
• D=3
• E = 4+
What is a concussion?
• Type of TBI
• Complex
How many concussions have
you sustained in your life?
• A=0
• B=1
• C=2
• D=3
• E = 4+
MOIs
Are concussions graded based
upon severity?
• A =Yes
• B = No
Do you have to lose consciousness
to have a concussion?
• A = Yes
• B = No
What is the most common
symptom?
• A = Dizzy
• B = Loss of consciousness
• C = Headache
• D = Blurry vision
Red Flags
• Decreased level of
consciousness
• Increasing
confusion
• Slurred speech
• Inability to
recognize
people/places
• Increasing irritability
• Numbness in
arms/legs
• Unequal pupils
• Repeated vomiting
• Seizures
• Worsening
headache
Most concussions resolve in ___
days.
• A=1
• B=5
• C = 10
• D = 30
Concussion Management
Your client sustained a concussion. Now
what?
Can one resume activity the same
day one sustains a concussion?
• A = Yes
• B = No
Is it safe to take medication(s) to
treat an acute concussion?
• A = Yes
• B = No
Are there any standard imaging
techniques which can detect a
concussion?
• A = Yes
• B = No
Diffusion Tensor Imaging
Progression
How long do we wait between
each step?
• A = 1 hour
• B = 12 hours
• C = 24 hours
• D = 48 hours
Should a pediatric and adult
progress at the same rate?
• A = Yes
• B = No
Progression
Sequale
• Are there potential, permanent,
complications associated with
concussions?
– A = Yes
– B = No
Potential Complications
• Depression
• Parkinson
• ADD/ADHD
• Alzheimer’s
• Anxiety
• ALS
• SIS
• CTE
Post Concussion Syndrome
Return
How can we ensure a safe return to
activity?
Questions?
Thank you!
Contact Information
• Theresa Miyashita
– Theresa.miyashita@nasm.org
• NASM
– www.nasm.org
Concussions & Our Clients
Theresa Miyashita, PhD, ATC, PES, CES
Objectives
Define concussion




MOIs
Signs/Symptoms
Sequale
Returning
Concussion Fact Sheet







1.6-3.8 m
$56.3 b
Most expensive pediatric pathology
#1 sport:
Most common causes:
3x more likely
4-6x more likely
Red Flags










Decreased level of consciousness
Increasing confusion
Slurred speech
Inability to recognize people/places
Increasing irritability
Numbness in arms/legs
Unequal pupils
Repeated vomiting
Seizures
Worsening headache
Most concussions resolve in ___ days.
Concussion Management
Your client sustained a concussion. Now
what?
How many concussions have you sustained in your
life?
How many times have you had your “bell rung” /
“dinger”?
Can one resume activity the same day one sustains
a concussion?
Is it safe to take medication(s) to treat an acute
concussion?
What is a concussion?


Type of TBI
Complex
Are there any standard imaging techniques which
can detect a concussion?
Diffusion Tensor Imaging
How many concussions have you sustained in your
life?
Progression
MOIs
Are concussions graded based upon severity?
Do you have to lose consciousness to have a
concussion?
What is the most common symptom?
How long do we wait between each step?
Should a pediatric and adult progress at the same
rate?
Progression
Post Concussion Syndrome
Sequale

Are there potential, permanent, complications
associated with concussions?
Potential Complications








Depression
ADD/ADHD
Anxiety
SIS
Parkinson
Alzheimer’s
ALS
CTE
Return
How can we ensure a safe return to activity?
Advancements in Activation Techniques
By
Dr. Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
NASM Master Instructor, President, Brookbush Institute
B2’s Rules of
Human Movement Science
•
HMS Rule #2:
– Every structure (muscle) that crosses a joint will affect joint motion.
• Corollary to Rule #2:
– Every structure that crosses a joint will be affected
by movement impairment of that joint.”
•
HMS Rule #5:
– Every inhibited prime mover will result in synergistic dominance of
the ancillary movers for that joint action.
Defining “Activation”
• “Isolated” Activation Techniques are
generally single-joint movement
patterns designed to load a specific
under-active muscle(s), while
minimizing contribution of over-active
synergists.
Goal of Activation Exercise
• Increase neural
drive,
synchronization, and
firing rate of
underactive muscles
(2, 4, 6).
Multi-joint movement patterns are not
activation techniques!
• Why Not?
– Relative Flexibility
– Synergistic Dominance
– Compensation pattern
• Example: Deadlifts are
not a corrective exercise!
Acute Variables
• Repetitions: 12 – 20
• Sets: 1 – 2 Sets
• Tempo:
– 4:2:2 (promote eccentric control)
– 2:4:2 (promote strength at end range)
• Load:
– Generally lighter loads - Form First!
Cuing
• Reciprocal Inhibition of Over-active
Synergists
– We will use activation of functional antagonists to
reduce activity of over-active synergists.
• For example: Flexing the toes to reciprocally inhibit the
EHL & EDL during Tibialis Anterior Isolated Activation
What should we activate?
• Exercise Selection is based
on:
– Human Movement Science
– Research
– Assessment (Overhead
Squat)
– Practice
– Outcomes
• Search for Congruence
Common Underactive Muscle
Dysfunction
Tibialis Anterior
LLD
Tibialis Posterior
LLD
Tibial Internal Rotator
LLD, LPHCD
VMO Activation
LLD, LPHCD
Gluteus Medius
LLD, LPHCD
Gluteus Maximus
LLD, LPHCD
TVA Activation
LPHCD
Shoulder External Rotators
LPHCD, UBD
Serratus Anterior
UBD
Trapezius
UBD
Deep Cervical Flexors
UBD
Deep Cervical Flexor Activation
• Longus Colli
• Longus Capitis
• Over-active Synergists
– Levator Scapulae
– Sternocliedomastoid
– Scalenes
Shoulder External Rotator Activation
• Infraspinatus
• Teres Minor
• Over-active
Synergists
– Posterior Deltoid
– Supraspinatus
Serratus Anterior Activation
• Serratus Anterior
• Over-active Synergists
– Pectoralis Minor
– Subscapularis
Trapezius Activation
• Lower Trapezius
• Middle Trapezius
• Over-active
Synergists
– Levator Scapulae
– Rhomboids
TVA Activation
• Intrinsic Stabilization
Subsystem
–
–
–
–
Transverse Abdominis
Multifidus
Diaphragm
Pelvic Floor
• Overactive Synergists:
– Psoas
– Latissimus Dorsi
Gluteus Medius Activation
• Gluteus Medius
• Overactive Synergists
– Tensor Fascia Latae
(TFL)
– Gluteus Minimus
– Quadratus Lumborum
Gluteus Maximus Activation
• Gluteus Maximus
• Over-active
Synergists
– Biceps Femoris
– Erector Spinae
– Adductor Magnus
Tibial Internal Rotator Activation
•
•
•
•
Popliteus
Semitendinosus
Semimembranosus
Gracilis
• Over-active Synergists
– Anterior Adductors
– TFL
– Biceps Femoris
VMO Activation
• Vastus Medialis
Obliques
• Over-active
Synergists
– Vastus Lateralis
– Biceps Femoris
Tibialis Anterior Activation
• Tibialis Anterior
• Over-active
Synergists
– Extensor Hallucis
Longus
– Extensor Digitorum
Longus
Tibialis Posterior
• Tibialis Posterior
• Over-active
Synergists
– Flexor Hallucis Longus
– Flexor Digitorum
Longus
– Fibularis Muscles
(Peroneals)
More to Learn!
• Progressions and
Regressions
• Reactive Activation
• Activation Circuits
NASM CES Model
*Brookbush Institute (built on NASM
CES)
• Mobility
1. Release
2. Mobilize
3. Lengthen
• Activity (Activation
Circuits)
1.
2.
3.
4.
5.
Isolated Activation
Core Integration
Stability Integration
Reactive Activation
Subsystem
Integration
*Example: Lumbo Pelvic Hip
Complex Dysfunction (LPHCD)
Mobility
1. Release
2. Mobilization
3. Lengthen
Activation Circuit
1.
2.
3.
4.
5.
6.
Clams (IA)
Side-lying leg raise (IA)
Glute max activation (IA)
Quadruped (CI)
Bridges with band (CI)
Single leg balance and
reach (SI)
7. Side-stepping (RA)
8. Squat to row (SubI)
Bibliography
1.
2.
3.
4.
Leon Chaitow, Muscle Energy Techniques:
Third Edition, © Pearson Professional Limited
2007
Dr. Mike Clark & Scott Lucette, “NASM
Essentials of Corrective Exercise Training” ©
2011 Lippincott Williams & Wilkins
Phillip Page, Clare Frank, Robert Lardner,
Assessment and Treatment of Muscle
Imbalance: The Janda Approach © 2010
Benchmark Physical Therapy, Inc., Clare C.
Frank, and Robert Lardner
Carolyn Richardson, Paul Hodges, Julie
Hides. Therapeutic Exercise for Lumbo Pelvic
Stabilization – A Motor Control Approach for the
Treatment and Prevention of Low Back Pain:
2nd Edition (c) Elsevier Limited, 2004
5.
6.
7.
8.
Shirley A Sahrmann, Diagnoses and Treatment
of Movement Impairment Syndromes, © 2002
Mosby Inc.
Michael A. Clark & Scott Lucett, NASM
Essentials of Sports Performance Training ©
2010 Lippincott Williams & Wilkins
Kan, S., Jeon, H., Kwon, O., Cynn, H., Choi, B.
(2013). Activation of the gluteus maximus and
hamstring muscles during prone hip extension
with knee flexion in three hip abduction
positions. Manual Therapy18, 303-307
Selkowitz, D. M., Beneck, G. J., & Powers, C.
M. (2013). Which exercises target the gluteal
muscles while minimizing activation of the
tensor fascia lata? electromyographic
assessment using fine-wire electrodes. journal
of orthopaedic & sports physical therapy, 43(2),
54-64.
Contact Information
• Brent Brookbush
– Brentbrookbush.com
– brent@brookbushinstitute.com
• Follow Me: Facebook, Linkedin, Twitter and Youtube
Dr. Brent Brookbush
DPT, PT, MS, PES, CES, CSCS, ACSM H/FS & Certified RockTape Doc
NASM Master Instructor & President, Brookbush Institute of Human Movement Science
Activation Techniques:
What do we activate?
 Under-active muscles (based on HMS, Research, Assessment, Practice & Outcomes)
Goal of activation techniques:
 Increase neural drive, synchronization, and firing rate of underactive muscles.
What are activation techniques?
 “Isolated” Activation Techniques are generally single-joint movement patterns
designed to load a specific under-active muscle(s), while minimizing contribution of
over-active synergists.
o Multi-joint movement patterns cannot be activation techniques!
Acute Variables:
 Reps: 12 – 20
 Sets: 1 – 2 Sets
 Tempo: 4:2:2 (promote eccentric control) or 2:4:2 (promote strength at end range)
 Load: Generally lighter loads - Form First!
Cuing:
 Reciprocal inhibition of over-active synergists
Techniques:

Tibialis Anterior Activation

Tibialis Posterior Activation

Tibial Internal Rotator Activation

VMO Activation

Gluteus Medius Activation

Gluteus Maximus Activation

Intrinsic Stabilization Subsystem
Activation (TVA)

Shoulder External Rotator
Activation

Serratus Anterior Activation

Trapezius Activation

Deep Cervical Flexor Activation
Videos of all techniques and much more at: BrentBrookbush.com
Coupon Codes for NASM Certified Professionals:
NASMDISCOUNTMONTHLY
NASMDISCOUNTYEARLY
Focus on Function
Current Concepts in Functional Anatomy
Rick Richey, MS, LMT
Faculty Instructor, NASM
Certified Tool Users
• There are many fitness tools out there
that provide certifications for:
– Suspension
– Ropes
– Bags
– Balls
– Bells
– Bars
They are still subject to the same rules of
functional anatomy!
Muscle Function
• The muscles of the kinetic chain
function synergistically to eccentrically
decelerate, isometrically stabilize, and
concentrically accelerate movement in
all three planes of motion
Muscle Classification System
•
•
•
•
•
Agonist
Antagonist
Synergists
Stabilizers
Neutralizers
Agonist
• Muscles that act as the prime mover
• Example: Gluteus Maximus (Hip
Extension)
Antagonist
• Muscles that act in direct opposition to
the prime movers
• Example: Psoas (Gluteus Maximus)
Synergist
• Muscles that assists the prime mover
• Example: Hamstring (Gluteus
Maximus)
Stabilizer
• Muscles that support or stabilize the
body while prime movers and
synergists perform the movement
• Example: Inner Unit
Muscle Function
• Key muscles have the ability to
dominate in one plane of motion
– However, all muscles work in all planes of
motion to allow optimal neuromuscular
efficiency
Muscle Function
• The CNS is designed to optimize the
selection of muscle synergies and not
individual muscle contractions
Muscle Function
• Isolated training increases
intramuscular coordination, crosssectional area, and force production of
individual muscles
– However, there is little carry over to
dynamic functional movements that
require optimal levels of Inter-Muscular
Coordination and NME
Muscle Function
• What do muscles do during dynamic
functional movements????
– Focus on Function
– If we know what muscles do during
functional movements, it becomes much
easier to design functional exercises and
create rehabilitation programs regardless
of the tools implemented.
Muscle Function
• Synergistic Dominance
– The neuromuscular phenomenon where
synergists, stabilizers, and neutralizers
take over function for a prime mover
– This creates faulty movement patterns
• Gluteus Medius Example
• Gluteus Maximus Example
• Inner Unit Example
Anterior Tibialis
• Function
• Synergists
• Chain Reactions
Posterior Tibialis
• Function
• Synergists
• Chain Reactions
Soleus
• Function
• Synergists
• Chain Reactions
Gastrocnemius
• Function
• Synergists
• Chain Reaction
Quadriceps
• Function
• Synergists
• Chain Reaction
Hamstrings
• Function
• Synergists
• Chain Reaction
Adductor Complex
• Function
• Synergists
• Chain Reactions
Gluteus Maximus
• Function
• Synergists
• Chain Reaction
Gluteus Medius
• Function
• Synergists
• Chain Reaction
TFL/ITB
• Function
• Synergists
• Chain Reaction
Iliopsoas
• Function
• Synergists
• Chain Reactions
Inner Unit
• Muscles
– Transversus
Abdominus
– Multifidus
– Internal Oblique
– Transversospinalis
– Deep Erector Spinae
• Function
Erector Spinae
• Function
• Synergists
• Chain Reactions
Latissimus Dorsi
• Function
• Synergists
• Chain Reactions
Pectoralis Major
• Function
• Synergists
• Chain Reaction
Scapular Upward Rotators
• Serratus Anterior
• Upper Traps
• Lower Traps
Scapular Downward Rotators
•
•
•
•
Pec Minor
Levator Scapulae
Rhomboids
Lats
Deep Longitudinal System
• Muscles
–
–
–
–
–
ES
TLF
SCTL
BF
(psoas/inner unit?)
• Function
– Reciprocal force
transmission from
the trunk to ground
Posterior Oblique System
• Muscles
– Gluteus Maximus
– LD
– TLF
• Function
– Force Closure for the
SIJ
– Rotational Activities
Anterior Oblique System
• Muscles
–
–
–
–
IO
EO
Adductor Complex
Hip ER
• Function
– Transverse plane
force production and
reduction
Lateral Sub-System
• Muscles
–
–
–
–
GM
TFL
ADD
QL
• Function
– Frontal plane and
pelvofemoral stability
– Dysfunction in LS w/ subtalar pronation, tibial and
femoral Add./I.R.
Functional Biomechanics
• Pronation
• Supination
Pronation
• Multi-Planar
synchronized joint
motion that occurs
with eccentric
muscle function
Pronation
Foot
Ankle
Knee
Hip
DF
DF
Flexion
Flexion
EV
EV
ADD
ADD
ABD
ABD
IR
IR
Supination
• Multi-Planar joint
motion that occurs
with concentric
muscle contractions
Supination
Foot
Ankle
Knee
Hip
PF
PF
Extension
Extension
INV
INV
ABD
ABD
ADD
ADD
ER
ER
Questions?
Thank you!
Contact Information
• Rick Richey
– Rick.richey@nasm.org
• NASM
– www.nasm.org
Focus on Function
Current Concepts in Functional Anatomy
Rick Richey, MS, LMT
Certified Tool Users
 There are many fitness tools out there that
provide certifications for:
- Suspension
- Ropes
- Bags
- Balls
- Bells
- Bars
They are still subject to the same rules of
functional anatomy!
Muscle Function
 The muscles of the kinetic chain function
synergistically to eccentrically decelerate,
isometrically stabilize, and concentrically
accelerate movement in all three planes of
motion
Muscle Classification System
 Agonist
 Antagonist
 Synergists
 Stabilizers
 Neutralizers
Agonist
 Muscles that act as the prime mover
 Example: Gluteus Maximus (Hip
Extension)
Antagonist
 Muscles that act in direct opposition to the
prime movers
 Example: Psoas (Gluteus Maximus)
Synergist
 Muscles that assists the prime mover
 Example: Hamstring (Gluteus Maximus)
Stabilizer
 Muscles that support or stabilize the body
while prime movers and synergists perform
the movement
 Example: Inner Unit
Muscle Function
 Key muscles have the ability to dominate in
one plane of motion
- However, all muscles work in all
planes of motion to allow optimal
neuromuscular efficiency
Muscle Function

The CNS is designed to optimize the
selection of muscle synergies and not
individual muscle contractions
Muscle Function
 Isolated training increases intramuscular
coordination, cross-sectional area, and
force production of individual muscles
- However, there is little carry over to
dynamic functional movements that
require optimal levels of InterMuscular Coordination and NME
Muscle Function
 What do muscles do during dynamic
functional movements????
- Focus on Function
- If we know what muscles do during
functional movements, it becomes
much easier to design functional
exercises and create rehabilitation
programs regardless of the tools
implemented.
Muscle Function
 Synergistic Dominance
- The neuromuscular phenomenon
where synergists, stabilizers, and
neutralizers take over function for a
prime mover
- This creates faulty movement
patterns
 Gluteus Medius Example
 Gluteus Maximus Example
 Inner Unit Example
Anterior Tibialis/Posterior Tibialis
 Function
 Synergists
 Chain Reactions
Soleus/Gastrocnemius
 Function
 Synergists
 Chain Reactions
Quadriceps
 Function
 Synergists
 Chain Reaction
Hamstrings
 Function
 Synergists
 Chain Reaction
Adductor Complex
 Function
 Synergists
 Chain Reactions
Gluteus Maximus/Gluteus Medius
 Function
 Synergists
 Chain Reaction
TFL/ITB
 Function
 Synergists
 Chain Reaction
Iliopsoas
 Function
 Synergists
 Chain Reactions
Inner Unit
 Muscles
- Transversus Abdominus
- Multifidus
- Internal Oblique
- Transversospinalis
- Deep Erector Spinae
 Function
Erector Spinae
 Function
 Synergists
 Chain Reactions
Latissimus Dorsi
 Function
 Synergists
 Chain Reactions
Pectoralis Major
 Function
 Synergists
 Chain Reaction
Scapular Upward Rotators
 Serratus Anterior
 Upper Traps
 Lower Traps
Scapular Downward Rotators
 Pec Minor
 Levator Scapulae
 Rhomboids
 Lats
Deep Longitudinal System
 Muscles
- ES
- TLF
- SCTL
- BF
- (psoas/inner unit?)
 Function
- Reciprocal force transmission from
the trunk to ground
Posterior Oblique System
 Muscles
- Gluteus Maximus
- LD
- TLF
 Function
- Force Closure for the SIJ
- Rotational Activities
Anterior Oblique System
 Muscles
- IO
- EO
- Adductor Complex
- Hip ER
 Function
- Transverse plane force production
and reduction
Lateral Sub-System
 Muscles
- GM
- TFL
- ADD
- QL
 Function
- Frontal plane and pelvofemoral
stability
- Dysfunction in LS w/ sub-talar
pronation, tibial and femoral
Add./I.R.
Functional Biomechanics
 Pronation
 Supination
Pronation
 Multi-Planar synchronized joint motion that
occurs with eccentric muscle function
Supination
 Multi-Planar joint motion that occurs with
concentric muscle contraction
Corrective Kinesiology Taping
By Dr.
Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS & Certified RockTape Doc
NASM Master Instructor, President, Brookbush Institute
Dr. B2’s “Holy Grail”
“Long-term fix to perfect in one session… every time.”
How does taping help me achieve this goal?
– Enhance Carry-over
1. It’s great to get a result, but what happens when they leave the gym?
2. How do they look during there next session?
3. How many sessions are you going to get?
Reminder: Goal of Activation Exercise
• Increase neural drive, synchronization,
and firing rate of underactive muscles
(2, 4, 6).
Common Underactive Muscle
Dysfunction
Tibialis Anterior
LLD
Tibialis Posterior
LLD
Tibial Internal Rotator
LLD, LPHCD
VMO Activation
LLD, LPHCD
Gluteus Medius
LLD, LPHCD
Gluteus Maximus
LLD, LPHCD
TVA Activation
LPHCD
Shoulder External Rotators
LPHCD, UBD
Serratus Anterior
UBD
Trapezius
UBD
Deep Cervical Flexors
UBD
Goal of Activation Taping
• Maintain the increase in neural drive,
synchronization, and firing rate achieved
during activation exercise (2, 4, 6).
– There is evidence to suggest that taping alone
is effective(???)
How does taping affect motion?
Skin Receptors:
– Pacinian corpuscles (Lamellar) – sudden
changes in pressure, and or vibration.
– Meissner’s corpuscles – light touch; more
abundant in sensitive areas
– Merkel’s Disks – touch discrimination
– Ruffuni’s Endings – Skin stretch and
sustained pressure (mechanical
deformation of joints – angle change).
– Nociceptors - Noxious Stimulus
Taping Basics
1.
2.
3.
4.
5.
6.
7.
8.
9.
Skin Prep (rubbing alcohol)
Length
Round your corners
Tear and fold back paper
Set anchor (no tension)
Tape off tension
No Wrinkles
Set anchor (no tension)
Demonstrate proper removal of tape
Tibialis Anterior Taping
• Tape:
– Starts at the top of tibialis
anterior
– Ends at the dorsum of the
cuboid
• Ankle Position
– Dorsiflexion
– Inversion
• Sign on Overhead Squat?
Popliteus Taping
• Tape:
– Starts at the lateral femoral
condyle
– Ends over the belly of the
medial gastrocnemius
• Ankle Position
– 15⁰ of flexion
– Tibial internal rotation
• Sign on Overhead Squat?
VMO Taping
• Tape:
– Begins at the tibial tuberosity
– Ends mid way up the
anterior/medial thigh, ensuring
the tape stays over the vastus
medialis and not the adductors.
• Ankle Position
– 15-25⁰ of flexion
– Internal Rotation
Sign on Overhead Squat?
Gluteus Medius Taping
• Asterisk covering
gluteus medius
• Position
– Side-lying with bolster
between knees
– Is this appropriate for a
personal trainer?
Lower Trapezius Taping
• Tape:
– Superior to the root (medial) of
the spine of the scapula
– Ends lateral to T12
• Ankle Position
– End Range Shoulder Flexion
– Scapula
Sign on Overhead Squat?
External Rotator Taping
• Tape
– Starts over anterior
deltoid
– Ends under the root of
the spine of the
scapula
• Position
– Chest out/thumbs out.
Lower Cervical Extensor Taping
• Tape
– Starts where the angle of the
upper trap meets the neck. On
the top or anterior side of the
trap.
– Ends just lateral to the 6th
thoracic vertebrae.
• Position
– Ask your client to extent their
thoracic spine and retract their
cervical spine – (“Chest Up,
Chin Tuck”)
NASM CES Model
TAPING?
Example: Lower Leg Dysfunction (LLD)
Excessive Forward Lean:
1. Release calf &fibularis
muscles
2. Mobilize ankles
3. Stretch Calf
4. Activate tibialis anterior
5. Heel walks
6. Single Leg Touchdown to
Scaption
7. Tibialis Anterior Taping
Giving Credit Where it is Due
Thank You NASM
Thank You Rocktape
Thank you Perry Nickelston, Rick Daigle
and Steve Middleton
Bibliography
1.
2.
3.
4.
Leon Chaitow, Muscle Energy Techniques:
Third Edition, © Pearson Professional Limited
2007
Dr. Mike Clark & Scott Lucette, “NASM
Essentials of Corrective Exercise Training” ©
2011 Lippincott Williams & Wilkins
Phillip Page, Clare Frank, Robert Lardner,
Assessment and Treatment of Muscle
Imbalance: The Janda Approach © 2010
Benchmark Physical Therapy, Inc., Clare C.
Frank, and Robert Lardner
Carolyn Richardson, Paul Hodges, Julie
Hides. Therapeutic Exercise for Lumbo Pelvic
Stabilization – A Motor Control Approach for the
Treatment and Prevention of Low Back Pain:
2nd Edition (c) Elsevier Limited, 2004
5.
6.
7.
8.
Shirley A Sahrmann, Diagnoses and Treatment
of Movement Impairment Syndromes, © 2002
Mosby Inc.
Michael A. Clark & Scott Lucett, NASM
Essentials of Sports Performance Training ©
2010 Lippincott Williams & Wilkins
Kan, S., Jeon, H., Kwon, O., Cynn, H., Choi, B.
(2013). Activation of the gluteus maximus and
hamstring muscles during prone hip extension
with knee flexion in three hip abduction
positions. Manual Therapy18, 303-307
Selkowitz, D. M., Beneck, G. J., & Powers, C.
M. (2013). Which exercises target the gluteal
muscles while minimizing activation of the
tensor fascia lata? electromyographic
assessment using fine-wire electrodes. journal
of orthopaedic & sports physical therapy, 43(2),
54-64.
Contact Information
• Brent Brookbush
– Brentbrookbush.com
– brent@brookbushinstitute.com
• Follow Me: Facebook, Linkedin, Twitter and Youtube
Dr. Brent Brookbush
DPT, PT, MS, PES, CES, CSCS, ACSM H/FS & Certified RockTape Doc
NASM Master Instructor & President, Brookbush Institute of Human Movement Science
Activation Taping:
Goal of Activation Techniques:
 Increase neural drive, synchronization, and firing rate of underactive muscles.
Goal of Activation Taping:
 Enhance carry-over: Maintain the increase in neural drive, synchronization, and firing
rate achieved during activation exercise.
How does it work?
 Skin has receptors too: Meisnner’s Corpuscles, Merkel’s Disk, Pacinian corpuscles,
Ruffini endings and Nociceptors
Taping Basics
o Skin Prep (rubbing alcohol)
o Length
o Round your corners
o Tear and fold back paper
o Set anchor (no tension)
o Tape off tension
o No wrinkles
o Set anchor (no tension)
o Demonstrate proper removal of tape
Techniques:

Tibialis Anterior Taping

Tibial Internal Rotator Taping

Gluteus Medius Taping

Lower Trap Taping

External Rotator Taping

Lower Cervical Extensor Taping
Videos of all techniques and much more at: BrentBrookbush.com
Coupon Codes for NASM Certified Professionals:
NASMDISCOUNTMONTHLY
NASMDISCOUNTYEARLY
Program Design with
“The Big Picture”
How to use another set of eyes in your intake interview
Kenneth Miller, MS NASM-CPT, CES, PES
April 2015
Intake Information
• PAR-Q
• Goals Assessment
• Movement
Assessments
• Performance
Assessments
Assessment Form
Data Results Sheet
NAME_____________________________________ DATE______________________
1. Heart Rate
Resting Heart Rate (HRrest): ________
8. Movement Assessments
Overhead Squat
View
Kinetic Chain
Checkpoint
Anterior
Feet
Estimated Heart Rate Max (HRmax): ________
Movement
Observation
Turn out
Knees
Move inward
Lumbo-pelvichip complex
Lumbo-pelvichip complex
Shoulder
complex
Excessive
forward lean
Low back arches
Kinetic Chain
Checkpoint
Knee
Movement
Observation
Moves Inward
Left
Right
[220-age]
2. Estimated Training Zones
Zone I: ________ to ________
Lateral
[HRmax x 0.65 to 0.75]: If first-time exerciser use; [HRmax x 0.50 to 0.65]
Zone II: ________ to ________
[HRmax x 0.76 to 0.85]
Arms fall
forward
Zone III: ________ to ________ ONLY to be used by high level client or approved by physician
[HRmax x 0.86 to 0.95]
Single-leg Squat
View
3. Blood Pressure
Systolic: ________
Diastolic: ________
Anterior
Left
4. BMI score: ________
weight (kg) / height (m2) or [weight (lbs) / height (inch2)] x 703
5. Body Fat
Biceps: ________ Triceps: ________ Subscap: ________ Iliac: ________ Total BF%: ________
6. Circumference Measurements
Neck: ________ Chest: ________ Waist: ________ Hips: ________ Thigh: ________
Calves: _______ Biceps: ________ Forearm: _________
7. Cardio Assessments
Step Test
VO2 score: ________ Rating: ________ Beginning Zone: ________ Stage: ________
Duration of exercise (sec) x 100 = CV efficiency
Recovery pulse x 5.6
Rockport Walk Test
VO2 score: ________ Rating: ________ Beginning Zone: ________ Stage: ________
132.853 – (0.0769 x weight) – (0.3877 x age)
+ (6.315 x1 for men or + (6.315 x 0) for women
- (3.2649 x time in minutes) – (0.1565 x heart rate) = VO2 score
Pushing/Pulling
Kinetic Chain
Checkpoints
Lumbo-pelvic-hip
complex
Shoulder complex
Head
Movement
Observation
Low back arches
Yes
Shoulders elevate
Head protrudes while
pushing
Overactive (tight) muscles:
1.
2.
3.
4.
5.
6.
Underactive (weak) muscles:
1.
2.
3.
4.
5.
6.
Right
Goal Setting
“Begin with the end in mind”
The 7 Habits of Highly
Effective People
Stephen Covey
What Happened?
• Evaluate Training
Program
• Evaluate Competition
and Practice
Schedule
• Off-, Pre-Season
Preparation
Sports Medicine and Medical
Professional Intervention
• Post-Rehab
Protocols
• Complete
Rehab?
• Compliance
What Else?
• Previous Injuries
– Medical and Rehabilitation
Intervention
• Sports Performance Gaps
– Speak “Coach”
• Physiological Deficits
– Flexibility
– Stability
– Strength
Fill in the “Gaps”
• Understand Goal
• Create and Share
Plan
• Adapt and Modify
• Execute
Calendar
• Competition
Schedule
• School?
• Travel
January February March
Fall
PostOffPower
x
Strength
x
x
Strength Endurance
x
x
x
Stability
x
Corrective Exercise
Winter
Power
Strength
Strength Endurance
Stability
Corrective Exercise
Spring
Power
Strength
Strength Endurance
Stability
Corrective Exercise
Summer
Power
Strength
Strength Endurance
Stability
Corrective Exercise
In-Season
x
x
x
x
x
x
x
x
x
x
x
x
x
Post-
x
x
Pre
April
May
x
x
x
June
x
x
x
Off-
x
x
x
x
In-Season
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Prex
x
August
x
x
x
In-Season
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Post
x
x
September October November December
x
x
Pre-
x
x
Off-
July
Prex
x
x
x
x
x
x
In-Season
x
x
x
x
x
Off-
x
x
In-Season
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Post-
Off-
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
25 1 8 15 22 29 6 13 20 27 3 10 17 24 1 8 15 22 29 5 12 19 26 2 9 16 23 2 9 16 23 30 6 13 20 27 4 11 18 25 1 8 15 22 29 6 13 20 27 3 10 17
Break
2hr/wk
Daily
Integrated
Strength
Stability /
Strength
Stab.
2-3/wk
2-3/wk
Sac. St./ UOP/ PAC-10 Conference Schedule
Hawaii Tourney
Sac. St. Tourney
Worth Tourney
Fresno St. Tourney
Stability / Integrated Strength / Power
Off Season
Summer - Home
Program
Power
1-2/wk
1-2/wk
4-5/wk
2-4/wk
Consecutive
Skill Develop.
Testing
Power
Daily MWF (.5 Hours, T/TH 1 Hour)
Games
Micro-cycles
Strength
3/wk
Conditioning
Open Gym
N. Carolina Tourney
Cathedral City Kick Off
Davis
Santa Clara
Stanislaus
UOP Tourney
St. Mary's
Lifting
Practice
Post Season
Home
Program
Corrective Exercise/
Integrated Stability
Summer 2009
In-Season
Calendar of
Competition
Training Phase
Spring 2009 (Jan 20-May 11)
Pre-Season
NCAA Regional
NCAA Super Regional
Women's College World Series
Fall 2008 (Aug 27- Dec 10)
Period
Santa Clara/ Palm Springs Tourney
Begins
Co
ns
ec
uti
ve
Consecutive
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Conditioning
Kinetic Chain Assessment: injury status/body wt./team condition
Plan
•
•
•
•
Ramp Up Time
Team Practice
Weight Room/Field Conditioning
Home
PROFESSIONAL’S NAME:
CLIENT’S NAME:
DATE:
GOAL:
PHASE:
WARM-UP
Exercise
Sets
Duration
Coaching Tip
CORE/BALANCE/PLYOMETRIC
Exercise
Sets
Reps
Tempo
Rest
Coaching Tip
Sets
Reps
Tempo
Rest
Coaching Tip
Sets
Reps
Tempo
Rest
Coaching Tip
SPEED/AGILITY/QUICKNESS
Exercise
RESISTANCE
Exercise
COOL-DOWN
Exercise
Coaching Tips:
Sets
Duration
Coaching Tip
Contact Information
• Ken Miller
– Ken.miller@nasm.org
• NASM
– www.nasm.org
Program Design with “The Big Picture”
How to use another set of eyes in your intake interview
Kenneth Miller, MS NASM-CPT, CES, PES
Intake Information
•
PAR-Q
•
Goals Assessment
•
Movement Assessments
•
Performance Assessments
Goal Setting
“Begin with the end in mind”
The 7 Habits of Highly Effective People
Stephen Covey
What Happened?
•
Evaluate Training Program
•
Evaluate Competition and Practice Schedule
•
Off-, Pre-Season Preparation
Sports Medicine and Medical Professional Intervention
•
Post-Rehab Protocols
•
Complete Rehab?
•
Compliance
What Else?
•
Previous Injuries
–
•
Sports Performance Gaps
–
•
Medical and Rehabilitation Intervention
Speak “Coach”
Physiological Deficits
–
Flexibility
–
Stability
–
Strength
Fill in the “Gaps”
•
Understand Goal
•
Create and Share Plan
•
Adapt and Modify
•
Execute
Calendar
•
Competition Schedule
•
School?
•
Travel
Plan
•
Ramp Up Time
•
Team Practice
•
Weight Room/Field Conditioning
•
Home
Contact Information
•
Ken Miller
–
Ken.miller@nasm.org
–
NASM
–
www.nasm.org
Behavior Change: Motivating Clients to Achieve Results
•
Have you experiences these frustrations:
•
•
•
•
•
Clients that won’t follow their workout or
nutrition plans
Clients that quit because they don’t really
seem committed to their goals
Clients with the exact same goals and
situations but different results
Some trainers seem to be in high demand for
no real reason
You try to be motivating but it only works with
some clients and not others
•
•
Introduction to the Transtheoretical Model of
Behavior Change
•
•
•
Topics of Discussion
•
•
•
•
Influences on human behavior and motivation
Ways to make clients move toward making
lifelong healthy changes
SWIM to organize the way you use behavior
change strategies
Scope of practice overview
•
•
Created by renown psychologist Arnold
Lazurus
A comprehensive approach to learn about
people and the various dimensions of influence
that make them who they are
BASIC ID
o Behavior
o Affect
o Sensation
o Imagery
o Cognition
o Interpersonal
o Drugs/biology
•
•
•
•
•
•
Behavior – How a person acts
Affect – How a person feels (emotions)
Sensation – What a person feels
(sensory)
Imagery – What a person sees or
visualizes
Precontemplation
o Not intending to change in the next six
months
Contemplation
o Intending to change in the next six
months
Preparation
o Intending to change in the next month
Action
o Just beginning to change
Maintenance
o Working in the process of change for
six or more months
Stages of Change – Coach Focus
•
•
Introduction to BASIC ID
•
•
•
Developed by Prochaska and DiClemente
in the late 1970s.
Focuses on a person’s readiness to
change.
Identifies the stages a person advances
through as they attempt to make change
Stages of Change
Multimodal Screening
•
Cognition – A person’s thoughts or
internal dialogue
Interpersonal – Outside social
influences
Drugs/Biological – Health status
•
•
Precontemplation
o General education about the proposed
change
Contemplation
o Personal impact of the change for the
client
Preparation
o Researching and planning the
necessary preparations to make the
change
Action
SWIMTM - Contingency Contracting for the
Contemplation Stage
• Example Strategy - Create a contract
with the client. The contract should
have a behavioral goal of identifying
several positive effects specific to the
client of getting healthy. Reward the
client with something he or she will
enjoy!
o
•
Implementation of the change in the
client’s life
Maintenance
o Incorporation of the change as a
lifelong habit
Introducing the SWIMTM
What is SWIMTM?
•
•
•
An application and progressive based
model based on scientifically proven
psychological principles human behavior
Use of select BASICID and Goal Setting
principles along the Stages of Change
Model
The specific intersection of the horizontal
and vertical models leads you to the
strategy you should use to initiate change
SWIMTM Matrix
BASIC ID as used in The SWIM
•
•
•
•
•
Behavior - Premacking
•
SWIMTM – Premacking for the
Precontemplation Stage
• Example Strategy – Have the client
set their internet browser home page to
a healthy living website.
Behavior – Stimulus Control
•
Behavior
Imagery
Cognition
Interpersonal
Goal Setting
Behavior – How a person acts
•
Behavior therapy - The application of principles
derived from scientific research and theorizing
about learning, classical and operant
conditioning, to everyday problems
Behavior Strategies Used in Coaching
•
•
•
•
Contingency Contracting
Premacking
Stimulus Control
Modeling
Behavior – Contingency Contracting
•
The use of explicit agreements specifying
expectations, and contingencies.
The use of conditions to make it either
impossible or unfavorable for undesirable
behaviors to occur.
SWIMTM – Stimulus Control for the Action
Stage
• Example Strategy – Have clients
remove all unhealthy foods from their
house.
Behavior
•
A type of positive reinforcement where an
unlikely behavior is paired with a likely
(very common) behavior.
Cognition
•
•
Cognition – A person’s thoughts or internal
dialogue.
Cognitive behavior therapy - A group of
psychological treatments that focus on how
people’s thoughts, emotions, and behaviors
affect one another
CBT Strategies used in Coaching
o
o
o
o
Self-monitoring
Problem-Solving
Stress-Management
Cognitive Restructuring
SWIMTM – Stimulus Proposition for the
Action Stage
o Example Strategy - Have clients
imagine the specific setting of a 5K
they are going to run.
Cognition – Self-Monitoring
•
The systematic observation of target
behaviors (e.g., eating and moving for
weight management) and the recording of
those observations
SWIMTM – Self-Monitoring for the Action
Stage
o Example Strategy – Have clients keep
track of physical activity through the
use of an activity journal or smartphone
app.
Imagery – External Imagery
•
SWIMTM – External Imagery for the
Action Stage
• Example Strategy - Have the client
imagine what it would look like to see
his or herself cross the finish line of the
5K from the perspective of a spectator,
family member, and fellow runner.
Cognition – Stress Management
•
A cognitive behavioral technique that
focuses stress through the adjustment of
thought processes.
SWIMTM – Stress Management and the
Action and Maintenance Stages
o Example strategy - Have the client
develop coping statements he or she
can use when the client faces a
challenge during the exercise and/or
nutrition program.
Interpersonal/Social Influences
•
Imagery – What a person sees or visualizes
•
In Imagery, use all of the senses (or at least all
of the senses that are appropriate) to create or
recreate an experience in the mind.
–
–
–
–
Stimulus proposition
Response proposition
Internal Imagery
External Imagery
Statements that describe specific stimulus
features of the scene to be imagined.
Clients tell others about their
backslides or successes.
SWIMTM – Sharing Progress with Others
for the Action Stage
– Example Strategy – Have a client
engage in step competition with one or
more of their friends and have them
sign up so they can view each other’s
weekly progress
Imagery – Stimulus Proposition
•
Foot in the door
Door in the face
Sharing progress with others
Interpersonal/Social – Sharing Progress
with Others
Imagery Strategies in Coaching
•
•
•
•
Social factors that have both positive and
negative impacts on a client’s attitude and
behaviors.
Social Influences used in Coaching
Imagery
•
Imagery performed from the perspective of a
spectator or outside observer.
Goal Setting
•
Something that an individual is trying to
accomplish; the object or aim of an action.
Goal Setting Principles
–
–
–
–
–
–
–
–
Specific and measurable
Realistic but challenging
Short-term and long term
Focus on performance and process
goal
Develop goal commitment
Develop goal achievement strategies
Get goal feedback and evaluation
Set timelines to achieve goals
Professional Practice and Ethics
Benefit to clients
Outcome
Performance
Process
Benefits of Process Goals
•
Provides an opportunity to create many goals
to chip away at, helping build confidence and
motivation while working toward the
performance or outcome goal.
Avoiding Harm by staying within
the scope of practice
•
Making appropriate referrals
when needed
•
Good Record keeping
Benefit to professionals
Types of Goals
o
o
o
•
•
Increased customer satisfaction
•
Lower risk of litigation
•
Quality records that can be
used to retain and gain clients
Scope of Practice – Guided Self-Help vs
Counseling
•
Focus on general wellness
improvements rather than fixing
“problems” (psychopathology)
•
Client collaboration and
guidance not student/teacher
•
Focus on progress and future
not past experiences
•
Goal oriented not
journey/process
Benefits of Short-term Goals
•
•
Like process goals, short-term goals provide
opportunity to create many goals to chip away
at, helping build confidence and motivation
while working toward the performance or
outcome goal.
Also helps make the overall goal seem less
intimidating or far away.
SWIMTM – Goal Setting for the Preparation
Stage
– Example Strategy – Plan two outof-the-gym activities per month to
increase activity.
SWIMTM – Goal Setting for the Action Stage
• Example Strategy – Attend both
planned out-of-the-gym activities
per month.
• Example Strategy – Lose 1.5
pounds of body fat every week for 8
consecutive weeks.
Scope of Practice – General Guidelines
–
Never diagnose
–
Establish network of professionals
(dieticians, physicians, counselors,
etc.)
–
Develop referral process
Transitional Agility Training
How to progress from post-rehab to full conditioning
Kenneth Miller
April 2015
Agility
• Definition:
– : the quality or state of being agile
– : nimbleness, dexterity <played with
increasing agility>
What Happened?
• Evaluate Training
Program
• Evaluate Competition
and Practice
Schedule
• Off-, Pre-Season
Preparation
Sports Medicine and Medical
Professional Intervention
• Post-Rehab
Protocols
• Complete
Rehab?
• Compliance
Demands of Sport
• Metabolic / Energy Systems
• Motions
– Degree
– Plane
• Need for Stability, Strength, Power
Goal Setting
“Begin with the end in mind”
The 7 Habits of Highly
Effective People
Stephen Covey
Communication
• Medical Professional
• Personal Trainer or Strength Coach
• Sports Coach
Fill in the “Gaps”
• Understand Goal
• Create and Share
Plan
• Adapt and Modify
• Execute
Plan
•
•
•
•
Ramp Up Time
Team Practice
Weight Room/Field Conditioning
Home
Weight Room
• Warm up/ Movement Prep
• Modified Lifts
Field Conditioning
• Deceleration Training
• Upper Body Mechanics
• Lower Body Mechanics
Deceleration Training
• Deceleration vs. Acceleration
– Brakes vs. Engine
Upper Body (Running) Mechanics
• Posture
• Shoulder/Thoracic
• Arm
Upper Body Drills
• Preparation
– Forearm Presses
– Reach and Pulls
– Shoulder Circles
• Shoulder Swings
–
–
–
–
Seated
Kneeling
Standing
Single Leg
Lower Body Mechanics
•
•
•
•
Triple Extension
Hip
Knee
Ankle
Lower Body Drills
• Wall Drill
– 1/3/5
• Single Leg Marches
– 1/2/3…
• Plyometrics
– Hops
• Lateral Shuffle
– Balance
Drills
• Speed Ladder and Cones
– Stop
– Balance
– Pause
– Varied Speeds
5/11/2009
SL March (1 count, 2 sec. hold)
2 x 10
Plyometrics
Lateral Hops x 2
10 sec.
Foward Hops x 2
10 sec.
Agility and Quickness
Speed Ladder (w/Stop)
In/In/Out, Lateral In/In/Out, 1 In's,
2 In's
5 yd. Box Drill (w/bal.)
Fwd, Shuffle/Carioca, Back Pedal,
Shuffle/ Carioca
Conditioning
Warm Up
Technical
Lateral Skips
Tic's
Arm Action
Seated Arm Swings (80%)
Posture
Wall March (Alternating 2
count)
Leg
SL March (2 count, 2 sec. hold)
Plyometrics
FWD/ Lateral Hops x 2
Tuck Jumps - Single Response
Agility and Quickness
20 yd (70%)
4
40 yd. (70%)
2
Assess and Challenge Balance,
Transitions, Change of Direction,
Level of Conditioning
Speed Ladder (w/Balance)
10 yd. Box Drill (w/bal.)
Conditioning
20 yd
40 yd.
Goal
Progression
Continue Posture and Balance
Emphasis, increase Intensity of
Plyo's, Agility. Add Technical Drills,
Sprints & Warm up on Ramp,
Challenge Hip Strength
Modified Dynamic Warm Up
Goal
Progression
2 x 20 sec
2x8
2x8
10 sec.
3x5
In/In/Out, Lateral In/In/Out
Fwd/low shuffle&crossover/bkpedal x 2
2
4
Upper body mechanics, posture, deceleration
and change of direction
Continue Posture and Balance Emphasis, increase
Intensity of Plyo's, Agility. Add Technical Drills,
Sprints & Warm up on Ramp, Challenge Hip
Strength
Contact Information
• Ken Miller
– Ken.miller@nasm.org
• NASM
– www.nasm.org
Transitional Agility Training
How to progress from post-rehab to full conditioning
Kenneth Miller
Agility
•
Definition:
Weight Room/Field Conditioning
•
Home
–
: the quality or state of being agile
Weight Room
–
: nimbleness, dexterity <played
with increasing agility>
What Happened?
Evaluate Training Program
•
Evaluate Competition and Practice Schedule
•
Off-, Pre-Season Preparation
Demands of Sport
•
Metabolic / Energy Systems
•
Motions
–
Degree
–
Plane
Need for Stability, Strength, Power
Communication
•
Medical Professional
•
Personal Trainer or Strength Coach
•
Sports Coach
•
Warm up/ Movement Prep
•
Modified Lifts
Field Conditioning
•
•
•
•
Deceleration Training
•
Upper Body Mechanics
•
Lower Body Mechanics
Deceleration Training
•
–
Understand Goal
•
Create and Share Plan
•
Adapt and Modify
•
Execute
Plan
•
Ramp Up Time
•
Team Practice
Brakes vs. Engine
Upper Body (Running) Mechanics
•
Posture
•
Shoulder/Thoracic
•
Arm
Upper Body Drills
•
Fill in the “Gaps”
•
Deceleration vs. Acceleration
•
Preparation
–
Forearm Presses
–
Reach and Pulls
–
Shoulder Circles
Shoulder Swings
–
Seated
–
Kneeling
–
Standing
–
Single Leg
–
Lower Body Mechanics
Balance
•
Triple Extension
•
Hip
•
Knee
–
Stop
•
Ankle
–
Balance
–
Pause
–
Varied Speeds
Drills
•
Lower Body Drills
•
Wall Drill
–
•
1/3/5
•
Contact Information
Single Leg Marches
•
Ken Miller
–
•
1/2/3…
Plyometrics
–
•
Speed Ladder and Cones
Hops
Lateral Shuffle
–
Ken.miller@nasm.org
–
NASM
–
www.nasm.org