Assessment is the key to most personal training programs. After all, if we don’t know key details about the person with whom we initiating a training program, how can we expect to design an effective and safe plan? Traditionally, personal trainers have learned about 4 components of fitness: muscular strength, muscular endurance, cardiovascular endurance, and flexibility. Along with these components of fitness, we have learned protocols to assess our potential and current clients and design effective programs.
Before assessing someone’s range of motion and flexibility, we must be certain this person has successfully completed the health history, and has any relevant medical clearance.
As trainers, we have traditionally been taught to think in terms of muscles, and not joints. Both strength and flexibility are traditionally aligned with the performances of specific muscles or muscle groups. Strength, how much a muscle can lift or resist, and flexibility the degree in which a muscle will stretch or lengthen. However, as we begin to look at the entire joint, two key terms come into play – mobility and stability. Mobility refers to movement around the entire joint, and stability refers to the integrity of the entire joint – for example in holding a certain posture.
With this thought process, the goal of a flexibility assessment is not merely to determine whether the client needs stretching. A basic assessment of flexibility includes active range of motion assessment to determine:
- whether the client can move in a pain free range of motion without pain in the joints. If someone experiences pain in the joints, we should refer them out to a qualified medical professional for examination.
- to observe the way the person moves, and to examine differences between the right and left side.
- to assess whether individual muscles or groups may need some flexibility training.
There are many options for the trainer when assessing flexibility and range of motion. The following is one option for assessment of lower body flexibility.
We must acknowledge that an assessment is ongoing, and does not merely begin when we sit down with a client to answer certain questions on a form. Observing the way in which a person carries themselves and moves is crucial to the assessment process. How does this person sit, stand, and walk across the room?
Before we even begin the official assessment, we can observe the client below on the stretch table in a relaxed position. If the feet are pointed to the outside (for example), barring any foot, ankle, or knee problems, we might assume that this posture is a position of external rotation at the hips. The important thing to remember is that we are not diagnosing anything; we are merely trying to be better at observing what we see in our clients. Our job as personal trainers is to observe, and then attempt to piece together various components of the puzzle that make up each individual client.
The position of external rotation at the hips can be caused by the external hip rotator muscles being excessively overdeveloped and/or tight; or repetitive movement patterns of sport or life, therefore causing the femur to be drawn into that position.
This position, however, can also be caused by other muscles being relatively weak (which keep the femur in a more neutral position) e.g. the adductor muscles. This is an example of looking at mobility and stability, as opposed to examining isolated features of flexibility and strength.
We can ask the client to hold both legs in a neutral position. This particular client reported feeling his inner thighs “working” to maintain this position. This could lead one to believe that the relatively weak adductor muscles are the contributing factor to the observed posture, as opposed to tight external hip rotators. To test our assumptions, we can perform a simple strength test to assess the strength of the adductors (which should be stronger than the abductors but many times are not). We can also assess the flexibility of the external hip rotators.
A simple adductor test is to have the client lie on one side; and perform a few repetitions of adduction. Ask for the client’s feedback concerning their perception of the movement, e.g. “…does it feel difficult to do this?” You can also have the client hold the leg in the adducted position against your isometric resistance. Determine the difficulty with which the client either can or cannot maintain this position. This particular client reported and demonstrated difficulty in maintaining the adducted position.
We can then ask the client to lie prone, bend both knees and let the legs fall to the outside. “Normal” range of motion for hip internal rotation with the knee bent is approximately 45 degrees. (This is sometimes confusing to the eye, e.g. the hip is rotating internally, which means that the external rotators are lengthening or stretching). In this example, the client’s range of motion is within this normal range, but there is a slight difference between the right and left side. We can determine if the imbalance is due to that side being tighter (by stretching; or asking the client if he feels more of a stretch on one side); or if that side is weaker in the adductors.
The above is simply one example of how our observational skills –before even stretching the client – can help us in looking at the big picture of the person in front of us.
The assessment should be done actively, i.e. the client should move their own limbs without assistance by their hands. This is an important point. For example, if you ask your client to pull their knee to their chest and they do this with their hands, you will perhaps miss the opportunity to observe that on one side it is more difficult than the other. The client may have poor core stability or weaker hip flexors on one side, which you would not see unless they are actively moving the limbs. Once the client performs the movements actively, it is then another option to have them move passively, in order to determine an individual muscle’s flexibility, or lack thereof.
I suggest you ask the client to perform these movements with minimal cueing, e.g. without asking the client to keep their abs tight. The goal is to observe the client moving the way they normally move. If you then observe, for example, that they have less core stability with one leg moving compared to the other, you can then ask them to repeat the movement keeping the abs tight to determine their level of core control.
General Flexibility Assessment for the Lower Body
Hip Flexion/Bent Knee
Client may feel a stretch in the gluteus max. on left side. If the right thigh “pops” up off the table the hip flexors on the right side may be tight. Other observations: does the client’s hip externally rotate as it flexes? Does one hip flexor appear weaker than the other?
Hip Flexion/Straight Leg
If client cannot lift left leg up to approximately 80-90 degrees, it may be due to hamstring stiffness. If the right hip flexors are tight, you may see that thigh pop up off the table again. The client may also feel cramping the left hip flexors if they are tight and/or weak especially in this end range of motion. Other observations: What does the core stability look like when one leg is lifting, compared to the other?
Hip Abduction/Straight Leg
Ask the client to externally rotate, then abduct the leg at the hip. Look for a lack of core stability. If the client feels a stretch in the adductors before reaching 45 degrees of abduction, adductors may need stretching.
This is a difficult assessment since the client is using a lot of muscle to bring the leg across the midline of the body. Again, the point is to look at movement of the entire joint, i.e. do they maintain core stability? Does the whole body roll over to attempt the movement? Do they feel a stretch on the lateral side of the left leg? Active range of motion should be approximately 30 degrees past the midline of the body. They may feel stretching in the gluteus medius/minimus; or they may feel a stretch in the IT Band. Other observations: they may feel “pinching” in the inner thigh, as the adductor muscles are contracting in the end range of motion, which is a range where many people don’t get to!
Hip External Rotation
This movement assesses basic hip mobility; the client may feel stretching in the short adductors, or the gluteus medius/minimus. These muscles are probably tight if the client’s knee does not fall to approximately 45 degrees (halfway to the table). Additional Observations: If the client is restricted in these muscles, you may notice awkwardness in even being able to get the leg into this position.
Hip Internal Rotation (as previously discussed)
Client lies prone; flexes both knees; lets feet fall apart. If the feet do not fall to approximately 45 degrees (halfway to the table), the client may need stretching in the external hip rotators.
If the client cannot bend the knee past approximately 110 degrees, it is a good indication that the quads are tight. It is important to make sure the client feels no knee, or back pain in this position. If the left hip flexors are tight, you may see the pelvis come up off the table, in essence arching the low back.
After doing this assessment, you will get an idea of which muscles are tight, and in need of stretching. You will also have a greater understanding of the entire body, e.g. strength imbalances, core stability issues, and basically more information with which to begin a stretching program, or to make stretching a part of your personal training program.
For more information on Flexibility Training Programs offered by Annette Lang, please go to the USA home page, and click onto the Reebok University logo.