PT on the Net Research

Reebok Movement Screens - Case Study 2


This is the second article exploring how to use the Reebok Movement Screens to decide program priorities for a potential or current client. The following introductory paragraphs are the same as in Case Study 1, as they provide some important information before you get started.

Getting Started

First, you should complete the traditional health and fitness assessments you and/or your facility prefer to use. From there, go to the “Training Tools” section in the main menu of PTontheNET.com, where you can use the Health & Lifestyle Questionnaire to get extensive information about your client. With this and other information you receive, you can "create a client profile" of which several are listed. For the purposes of this article, I will use the Reebok Movement Screens in order to get a well rounded insight into what the client needs in the program.

Reebok Movement Screens

There are five movement screens on the website: Deep Squat, Hurdle Step, In Line Lunge, Active Straight Leg Raise and Seated Rotation.

These screens are great tools for determining:

  1. Asymmetries between the left and the right sides.
  2. Gross instabilities in the kinetic chain and/or the core.
  3. The relationship between mobility and stability throughout the entire body.
Deep Squat
Hurdle Step
In Line Lunge
Active Straight Leg Raise
Seated Rotation

General Thoughts Concerning the Movement Screens

These Screens are NOT designed to diagnose any medical conditions. They are simple assessments to help personal trainers get a better perspective of your clients' movements. Traditional assessments look at quantity of movement, but not always quality of movement. These screens are wonderful for giving you an insight into where your client has developed imbalances in movements. All of these screens are based on fundamental patterns that we have learned very long ago. When you think of kids playing, or sports in general, these movements are foundational patterns. It is not necessary for your client to warm up before doing these screens, as they are designed to look at the ‘weakest link’. Also, during the screens, we don't ask the client to lift any additional weight besides their own body weight. In short, we want to see how your client moves when he/she doesn't know what we are looking for!

All of the movement screens and guidelines are explained and described in Gray Cook’s Reebok Movement Screen Audio Clinic series.

Client Assessment

The client’s name is Terri and I will show how – with what I see in the screens and learn from her health and fitness assessment – I can set up a beneficial, corrective training program.

Responses from the Health History/Lifestyle Questionnaire

Terri's Deep Squat

Following the directions for the Deep Squat, my observations include:

I scored a 1 for the Deep Squat since Terri did not get down to where her thighs are parallel to the floor. Also, her arms did not maintain the flexed position at the shoulder as she did the squat.

The first suggestion if the client's squat does not look really good is to elevate the heels, putting the ankle in a plantar flexed position before the movement starts. By doing this, the ankle no longer needs to dorsiflex as much as before, essentially making it easier for those clients who have difficulty in getting enough dorsiflexion for a proper squat. I ask Terri to do another set of squats with her heels up on a board, and it does not change the quality of the movement. This leads me to believe that her limitation is not related to the foot or ankle.

I then ask Terri to do the squat again with her hands out in front, not fully flexed at the shoulder. This position does not require the lats to stretch as much as when being fully flexed. Terri's squat does look a little better. Also, she no longer feels the tension in her upper middle back when she squats with her arms in front instead of overhead.

My thoughts as of now include:

The most important thing is to not jump to automatic conclusions at this point. The only thing I know now is what I observed during the squat. I will have a clearer picture of what is happening after I see the other 4 screens, as well as any other assessments I might ask her to do later.

Terri's Hurdle Step

Following the directions for the Hurdle Step, my observations include:

Based on these observations, I score each side a 1, and the entire screen a 1. I record the observation that Terri compensates more on the left side (when the left leg is moving) than the right.

My thoughts as of now include:

Terri's In Line Lunge

Following the directions for the In Line Lunge, my observations include:

Based on these observations, I score the left side a 1, and the right side a 2, with the total score for the screen being a 1 (because you always score the lower side as the total score).

My thoughts as of now include:

Terri's Active Straight Leg Raise

Following the directions for the Active Straight Leg Raise, my observations include:

Based on these observations, I score the left side a 1, and the right side a 2, with the total score for the screen being a 1 (because you always score the lower side as the total score).

My thoughts as of now include:

Terri's Seated Rotation

Based on these observations, I score the screen a 2, since there were no compensations. I make note of the tension in her upper middle back.

Terri's Screen Scores
The Deep Squat 1
The Hurdle Step 1 (1 on the right side, 1 on the left side)
The In Line Lunge 1 (2 on the right side, 1 on the left side)
The Active Straight Leg Raise 1 (2 on the right side, 1 on the left side)
Seated Rotation 2 (2 on both sides)
Total Score 6

My thoughts as of now include:

At this stage I can continue with some more assessments:

Terri's Basic Needs:

TERRI’S PROGRAM

Reebok Movement Screens Case Study 2: Anterior Pel
Introduction : This case study #2 is for a client with the following conditions: anterior pelvic tilt (lower cross syndrome), tight/short lats and hip flexors – as determined by the following observations:
  • Increase in anterior pelvic tilt during deep squat screen.
  • Inability to keep arms up/tension in upper middle back during deep squat screen.
  • Increase in anterior pelvic tilt during hurdle step screen – more when the left side moves (right side hip flexors don't lengthen enough).
  • Increase in anterior pelvic tilt during in-line lunge screen.
  • Inability to keep right thigh still during active straight leg raise screen.

NOTE: This program is broken up into 3 circuits of 4-5 exercises each – as indicated in the “SETS” column. Each circuit should be done twice.

Warm up : 10 minutes on treadmill or rowing machine.
CARDIO PROGRAM
Activity Intensity Duration Comments
Jogging on her own 65-75%HRR 30-45 min. She does this 2 times per week on other days.
SUMMARY OF PROGRAM
Exercise/Stretch
Reps Dur'n Tempo Sets Intensity Rest
Abdominal - V Sit On Core Board With Rotations 15-20
N/A
Contin. Motion Circuit#1 x 2 2-4lb. ball
Abdominal - Full Sit Up On SB 15-20
N/A
3-1-2 Circuit#1 x 2 B/W
Hip Flexors - Supine Contract Relax Using End Of Table (Assisted) Hold 20-30 sec Cont. hold
N/A
Circuit#1 x 2
N/A
N/A
Bridge - Floor (1 Leg) 5
N/A
3-1-2 Circuit#1 x 2 B/W
Overhead Reach - Sitting Against Wall 10-12 Cont.
N/A
N/A
N/A
N/A
Squat - 1 Leg 10-12
N/A
3-1-2 Circuit#2 x 2 B/W As req'd
Step Up (Frontal) 10
N/A
3-1-2 Circuit#2 x 2 60-75% As req'd
Push Up - On Core Board (With Turn) 10
N/A
3-1-2;hold turn Circuit#2 x 2 B/W As req'd
Rear Delt Fly 10-12
N/A
3-1-2 Circuit#2 x 2 60-75% As req'd
Shoulder Press - Standing With DB 10-12
N/A
3-1-2 Circuit#2 x 2 60-75% As req'd
Step Up (Transverse) 10-12
N/A
3-1-2 Circuit#3 x 2 60-75% As req'd
Pull Up 10
N/A
3-1-2 Circuit#3 x 2 B/W As req'd
Chest Fly (Free Motion) 10-12
N/A
3-1-2 Circuit#3 x 2 60-75% As req'd
Calf Raise - Standing (1 Leg) 10-15
N/A
3-1-2 Circuit#3 x 2 60-75% As req'd
Hip Flexor - Standing Hold 20-30 sec Cont. hold
N/A
N/A
N/A
N/A
Lat - w/ SB, Kneeling Hold 20-30 sec Cont. hold
N/A
N/A
N/A
N/A
Cool Down : Cool down is included as the final 2 flexibility exercises in the program. Client performs these on her own at the end of the session.
Abdominal - V Sit On Core Board With Rotations
Reps : 15-20 Duration : 0 Tempo : Contin. Motion
Sets : Circuit#1 x 2 Intensity : 2-4lb. ball
Preparation :
  • Sit on core board, brace abdominals, raise legs to starting position shown.
Movement :
  • In a controlled manner rotate from side to side, maintaining optimal posture.
Abdominal - Full Sit Up On SB
Reps : 15-20 Duration : 0 Tempo : 3-1-2
Sets : Circuit#1 x 2 Intensity : B/W
Preparation :
  • Sit on the ball.
  • Slowly roll down the ball until the ball is in the small of the back.
  • Be sure you are balanced when back is fully extended.
  • Keep feet in proper alignment facing straight ahead.
  • Align feet directly under the knees.
Movement :
  • Draw the belly button in towards the spine.
  • Place your tongue on the roof of your mouth just behind your top teeth.
  • Squeeze the glutes.
  • Contract the abdominals while curling the upper torso towards your hips.
  • Flex at the hips bringing the upper body to a fully upright position on the ball.
  • Do not push with the legs to perform the hip flexion.
  • Slowly lower the upper body to the starting position.
Hip Flexors - Supine Contract Relax Using End Of Table (Assisted)
Reps : Hold 20-30 sec Duration : Cont. hold Tempo : 0
Sets : 0 Intensity : 0 Rest : 0
Preparation :
  • Have client lay supine with one leg hanging off table and one knee pulled into chest.
Movement : Note: In video trainer is standing to side for better view of stretch. Description will be of trainer standing at foot of table facing client. This reduces the difficulty for the trainer.
  • Have client pull knee toward chest and you will hold it there.
  • ENSURE LUMBAR SPINE REMAINS FLAT AGAINST TABLE THROUGHOUT STRETCH.
  • Push opposite knee down to focus stretch on illiopsoas, push foot back to focus stretch in rectus femoris.
  • HOLD AT FIRST RESISTANCE BARRIER FOR 20-30 SECONDS, THEN STATICALLY CONTRACT FOR 5-7 SECONDS, RELAX AND MOVE INTO NEWLY ACQUIRED ROM, REPEAT FOR 2-3 REPS.
Bridge - Floor (1 Leg)
Reps : 5 Duration : 0 Tempo : 3-1-2
Sets : Circuit#1 x 2 Intensity : B/W
Preparation :
  • Begin by lying flat on floor in supine position with knees bent, feet flat, toes pointing straight ahead and arms by sides.
  • Activate core by drawing navel towards the spine and squeezing the glutes.
Movement :
  • With core activated and glutes squeezed, lift hips off ground to form a straight line between knees and shoulders.
  • Hold and slowly return back to floor, touching floor momentarily then repeat.
  • If your client feels their hamstring cramping, check their pelvis for correct alignment. Pelvis should be neutral - asis and psis should be even or horizontal. If there is a misalignment correct it. If you aren't sure then gently stretch the quads and try the exercise again.
Progression Considerations
  • Starting in normal position, upon activating the core lift one leg off the floor.
  • Slowly continue the exercise as previously explained.
  • When exercise is completed slowly lower the elevated leg to the floor. Making certain that the client doesn't allow the core to shut down until contact with the floor has been made.
Overhead Reach - Sitting Against Wall
Reps : 10-12 Duration : Cont. Tempo : 0
Sets : 0 Intensity : 0 Rest : 0
Preparation :
  • Sit against a wall with the butt, lumbar spine and shoulder blades in contact with the wall ... the lumbar curve should be VERY slight.
  • Place the bottoms of the feet together (as shown).
  • Ensure a slight drawing in with a pelvic floor contraction to maintain spine angles.
Movement :
  • Start with the arms against the wall so that the shoulders, elbow, and hands are in contact.
  • The elbow joints should be bent at 90 degrees.
  • Trainers: if the client cannot maintain proper spinal alignment when they move their hands into position (i.e.. their back arches) a flexibility program needs to be initiated to increase external rotation at the humerus.
  • Perform an overhead press action, while maintaining shoulder, elbow, and hand contact with the wall.
  • The higher that the client can extend the arm, the more functional flexibility they have in the lats, chest, and anterior shoulder girdle.
  • ENSURE that the client does NOT arch the back as they raise their arms, and that they maintain a drawing in manoeuvre.
Squat - 1 Leg
Reps : 10-12 Duration : 0 Tempo : 3-1-2
Sets : Circuit#2 x 2 Intensity : B/W Rest : As req'd
Preparation :
  • Perform drawing in and pelvis floor contractions.
  • Lift one leg off the floor and dorsiflex elevated ankle. Keep feet parallel in frontal plane.
  • Maintain level hips.
Movement :
  • Grip toes in your shoes or on the floor (IF NO SHOES)
  • Initiate the squat by bending the knee, keep the shoulder blades down and together.
  • As your knees bend, flex forward slightly in the spine but keep chest up.
  • Squat down as deep as you can with good control, maintaining heal contact with floor and watching hip and knee alignment (no pronation).
  • Return back to starting position and repeat.
  • Progressions: Inertia progressions - No weight to dumbbells to cables to tubing; Movement progression -S quat with touchdown to squat touchdown to overhead press.
Step Up (Frontal)
Reps : 10 Duration : 0 Tempo : 3-1-2
Sets : Circuit#2 x 2 Intensity : 60-75% Rest : As req'd
Preparation :
  • Maintain good posture throughout the exercise with shoulder blades retracted and depressed, good stability through the abdominal complex, and neutral spine angles.
  • Activate core with proper drawing in and pelvic floor contraction.
Movement :
  • Position feet shoulder width apart, pointing straight ahead.
  • Choose a step or bench that is a comfortable height to step up on.
  • Step forward with one foot onto the bench or step.
  • In a simultaneous motion, step up and “pick up” your hips on the opposite side as your step leg.
  • Step down backwards with the same technique of holding the HIPS LEVEL
  • TRAINERS: watch the hips (to ensure frontal plane stability), and ensure that NO pronation distortion occurs anywhere in the kinetic chain.
  • Progression: When technique is mastered load can be added – dumbbell, then cables, then tubing.
Progression Considerations
  • Step sideways with one foot onto the bench or step, make sure the knee stays in good alignment.
Push Up - On Core Board (With Turn)
Reps : 10 Duration : 0 Tempo : 3-1-2;hold turn
Sets : Circuit#2 x 2 Intensity : B/W Rest : As req'd
Preparation :
  • In optimal posture assume push up position with your hand on the core board.
Movement :
  • Draw your belly button in towards your spine.
  • Maintaining the optimal posture slowly lower your body towards the core board.
  • Hold, return to the starting position and repeat the movement.
  • Avoid letting your lower back to arch and/or round.
  • Keep your chin tucked in and your glutes tight.
  • Do not let your shoulder shrug up.
Progression Considerations
  • Follow all guidelines shown with this exercise before starting movement.
  • During the lowering phase into the push-up slowly rotate the core board in one direction.
  • Reverse the motion and then complete the push phase of the exercise.
  • Watch the core and body for a lot of movement during exercise. If this occurs client may not be ready for exercise.
Rear Delt Fly
Reps : 10-12 Duration : 0 Tempo : 3-1-2
Sets : Circuit#2 x 2 Intensity : 60-75% Rest : As req'd
Preparation :
  • Sit "tall" in neutral spine.
  • Align shoulders with the axis of rotation.
Movement :
  • Perform the motion with emphasis on generating motion from the rear shoulder musculature.
  • Return at desired rep temp.
Shoulder Press - Standing With DB
Reps : 10-12 Duration : 0 Tempo : 3-1-2
Sets : Circuit#2 x 2 Intensity : 60-75% Rest : As req'd
Preparation :
  • Begin with good posture, shoulder blades retracted and depressed.
  • Maintain good posture throughout movement, with stability through the abdominal complex and neutral spine angles.
Movement :
  • Position feet shoulder width apart, pointing straight ahead.
  • Start with the dumbbells at shoulder height, palms facing forward.
  • While maintaining total body alignment, push the dumbbells into full extension overhead.
  • AVOID letting your back arch at ANYTIME (this may indicate tightness in the lats and a stretching program should precede loading of this exercise).
  • TRAINERS: watch the hips (to ensure frontal plane stability) and also watch the scapulae (shoulder blades) to see if there is excessive protraction. (‘winging’) – this may indicate a destabilized gleno-humeral (shoulder) joint
  • Other progressions: Inertia progression – dumbbell, to cables, to tubing.
    Stable to Unstable surfaces - airex pad, ½ foam roller.
Step Up (Transverse)
Reps : 10-12 Duration : 0 Tempo : 3-1-2
Sets : Circuit#3 x 2 Intensity : 60-75% Rest : As req'd
Preparation :
  • Maintain good posture throughout the exercise with shoulder blades retracted and depressed, good stability through the abdominal complex, and neutral spine angles.
  • Activate core with proper drawing in and pelvic floor contraction.
Movement :
  • Position feet shoulder width apart, pointing straight ahead.
  • Choose a step or bench that is a comfortable height to step up on.
  • Step forward with one foot onto the bench or step.
  • In a simultaneous motion, step up and “pick up” your hips on the opposite side as your step leg.
  • Step down backwards with the same technique of holding the HIPS LEVEL
  • TRAINERS: watch the hips (to ensure frontal plane stability), and ensure that NO pronation distortion occurs anywhere in the kinetic chain.
  • Progression: When technique is mastered load can be added – dumbbell, then cables, then tubing.
Progression Considerations
  • Simultaneously flex and abduct leg and place one foot onto the bench or step, make sure the knee stays in good alignment (as shown).
Pull Up
Reps : 10 Duration : 0 Tempo : 3-1-2
Sets : Circuit#3 x 2 Intensity : B/W Rest : As req'd
Preparation :
  • Grasp bar overhead at a width that will allow for the forearms to be perpendicular to the bar when the elbows are flexed at 90 degrees.
  • Maintain a neutral spine from head to toe, AVOID SWINGING LEGS/TORSO!
Movement :
  • Pull body upward as far as neutral in the shoulder girdle (as well as the rest of the spine), can be maintained. ( NOTE : This may mean NOT pulling the chin past the bar!)
  • Lower at desired REP TEMPO.
Chest Fly (Free Motion)
Reps : 10-12 Duration : 0 Tempo : 3-1-2
Sets : Circuit#3 x 2 Intensity : 60-75% Rest : As req'd
Preparation :
  • Grasp a handle.
  • Assume a “sit tall” position with feet flat on floor and free hand placed on same side thigh.
Movement :
  • From the start position, draw your belly button inward toward your spine.
  • Maintaining a “sit tall” position, push the cable handle toward the center.
  • Keeping optimal spinal alignment, return to the start position and repeat movement.
  • Generate movement from the core instead of the arms.
  • If weight becomes too heavy, bend elbow to shorten the lever arm.
Calf Raise - Standing (1 Leg)
Reps : 10-15 Duration : 0 Tempo : 3-1-2
Sets : Circuit#3 x 2 Intensity : 60-75% Rest : As req'd
Preparation :
  • Stand in proper alignment with hands on hips and feet straight ahead.
  • Ensure ideal scapular position by an adequate retraction and depression and chin tuck.
  • Grip toes on the ground.
Movement :
  • While maintaining total body alignment, raise heals off floor and hold.
  • Lower slowly and repeat.
  • Make sure that there is good stability in the frontal plane (no subtalar joint inversion or eversion)
  • Progress to calf raise off a step for more range of motion (dorsiflexion).
Progression Considerations
  • Stand on one leg and keep hips level.
  • While maintaining total body alignment, raise heal off floor and hold.
Hip Flexor - Standing
Reps : Hold 20-30 sec Duration : Cont. hold Tempo : 0
Sets : 0 Intensity : 0 Rest : 0
Preparation :
  • Take staggered stance as pictured.
  • Slightly Abduct and internally rotate the back leg.
Movement :
  • Draw your belly button inward (activating the deep abdominal stabilizing mechanism).
  • Tighten glutes and perform a posterior pelvic tilt.
  • Hold for 20-30 seconds, repeat for 2-3 reps.
  • Avoid arching low back!
  • Do not pull the foot backward. Motion occurs predominately at the pelvis (posterior pelvic tilt), the back leg should not move.
Lat - w/ SB, Kneeling
Reps : Hold 20-30 sec Duration : Cont. hold Tempo : 0
Sets : 0 Intensity : 0 Rest : 0
Preparation :
  • Position client in kneeling position as pictured.
Movement :
  • With one arm at a time on SB, reach out, turn palm up (externally rotate the shoulder), push the low back up (lumbar flexion).
  • When first resistance barrier is felt, hold for 20-30 seconds.
  • Repeat for 2-3 reps.
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