In recent years there’s been a large rise in the number of personal trainers using assessments with their clients prior to beginning a personal training sessions. One of their biggest areas of confusion is firstly whether to do assessments, if so, what assessments to do and lastly whether those assessments offer any value or not.
One of the main reasons that this confusion exists is that many of the assessments taught to personal trainers are presented as diagnostic assessments, when in fact they are investigative or explorative assessments. This difference means that any findings that are the results of assessments are suggestive or indicative, rather than being definitive proof of a specific condition or outcome.
An excellent example of this is the overhead squat. This is often used as an assessment for both upper and lower body function, as well as muscular and structural balance. The premise of this exercise as an assessment is that it allows the personal trainer to observe the kinesiological relationship between the muscles acting on the ankles, knees, hips, spine and shoulders. One of the suggestions made about this assessment is that the sagittal movement of the knees, In particular any limitation of such, is indicative of a restriction at the ankle. Whilst this may be the case, it is only one possible reason for such a restriction, and as such any hypothesis formed should be checked and verified before any definitive course of action is pursued.
The true purpose of an assessment is to provide a personal trainer with enough information to allow them to form an initial hypothesis as to the best means of proceeding with the clients exercise program. Assessments in the scope of practice of the personal trainer are not intended as a diagnostic tool. This does not mean that assessments are worthless or that the information they provide is not indicative, rather, that the information provided should be substantiated by further investigation and assessment.
With this in mind, the following is an example of one of the most valuable and practical assessments available to personal trainers at the moment. Whilst the information it provides is both basic and simple, it will allow personal trainers to develop much more personalised approaches towards better claims outcomes.
Knee To Wall Ankle Mobility Test
Test Purpose: To determine the range of ankle dorsiflexion available to a client.
Test Rationale: Adequate ankle dorsiflexion is essential in any squatting, lunging, jumping or locomotive movement. Determining a clients range of movement at this joint will allow personal trainers to selectively determine the best exercise to train triple extension for that client.
Test Methodology: Have clients stand with the toes of one foot against the wall, instruct them to push their knee forwards towards the wall whilst keeping the heel pressed firmly down on the floor. Provided the client is able to touch then need to the wall, they should move their foot further back and repeat the assessment until they are no longer able to touch they need to the wall without lifting a heel. At this point the distance between the front toes and the wall should be measured. Ideally, clients should in general (not accounting for any structural abnormalities or pathologies) have a range of movement that results in a distance of at least 10cm/4in.
Test Interpretation: If a client presents with less than optimal range of movement at the ankle, this may compromise their ability to squat and lunge safely. Because of this clients should be progressed in quadriceps dominant movements slightly differently.
Option 1: Mitigate the limitation in range
This is the simplest and requires the least skill. Simply elevate the heel/s using a plank of wood, weights disc or mat , when performing the relevant exercise; i.e squats. This is a perfect example of a band aid approach. It may or may not solve the problem, but it will allow clients to work without the limitations of the symptom.
Option 2: RESET – Release, Strengthen, Evaluate, Train
This option is a little more complex and requires a little more skill.
Release – Many restrictions are the result of tight or over active tissues. To facilitate an increase in range of movement focus on stretching and foam rolling the calves, soleus and peroneals.
Strengthen – Often a particular tissue is tight due to it’s over compensation for a less active or weaker tissue. In this case, focus on strengthening the tibialis anterior.
Evaluate – Once any imbalances are being or have been addressed, Observe the movement of the shin/knee during quadriceps dominant exercises. Does the knee move freely forwards whilst the heel remains planted? Is there still evidence of any limitation? Is range of movement being created/limited anywhere else to compensate?
Train – The following is an example of an exercise progression for a client whose ankle mobility was previously limited. Each exercise has its own intrinsic progression options (load, range of movement, position of load, etc.), so this list represents a sequence that either moves from exercises that require less ankle range of movement to those requiring more, or from exercises that bias better range of movement to more demanding alternatives:
- Step Ups
- Front Foot Elevated Split Squats
- Front Squats (the anterior load allows for a more vertical shin position)
- Back Squats
The most important thing to remember is to constantly monitor the clients’ progress and assess the assessment. Most assessments can only truly be said to test the test and it is therefore essential to maintain an open mind as to your findings and the most appropriate course of action available. Just because an assessment may indicate 'x’, does not necessarily mean that that 'x’ is true, just that it is possible. The large degree of individual variance you’ll see from client to client means the best outcome from an assessment is a hypothesis and subsequent programme design rationale. Only time will allow you to discover if it was correct or whether other options need to be explored.