Task Category: Competency

Muscled Arm, Shoulder and Torso Models – Bringing it all Together (Pull)

Torso Model

Muscled Arm, Shoulder and Hand/Wrist Models

Review Lab Exam Comptencies

The following exercise pairings will be possibilities for your lab exam.

Goblet Squat & Bird Dog
  1. Instruct client to stand with feet approximately shoulder width apart, toes pointed slightly out. | 1
  2. Discuss the importance of maintaining as erect a torso as possible (neutral spine) throughout the movement. | 1
  3. Instruct client to keep knees aligned with toes (knees don't collapse in) | 1
  4. Discuss target ROM (squat until knees are bent below 90 degrees) | 1
  5. Cue client to keep weight back (e.g.: weight over ankles or more towards heels than toes) | 1
  6. Client completes at least 10 reps. | 1
  7. Screen pain/discomfort during squat. | 1
  8. Offer client the option to use a mat | 1
  9. Explain and cue engaging the core, keeping pelvis stable | 1
  10. Instruct and verify client can fully extend a single leg (while maintaining neutral spine) | 1
  11. Instruct and verify client can fully extend a single arm (while maintaining neutral spine) | 1
  12. Instruct and verify client can fully extend the opposing arm-leg, hold for ~2 seconds | 1
  13. Perform 6-8 reps per side | 1
  14. Screen pain/discomfort during bird-dog | 1
  15. Explain a stretch appropriate for a novice client that targets the muscles trained in the squat. | 1
Split Squat & Push Up
  1. Determine a stance length/width that should allow the client to be balanced. | 1
  2. Mention the importance of maintaining as erect a torso as possible (neutral spine) throughout the movement. | 1
  3. Explain target range-of-motion (i.e. knees form a 90˚angle at the bottom of the movement.) | 1
  4. Cue client to push off through the heel of the lead leg | 1
  5. Complete 8-10 reps per leg | 1
  6. Screen pain/discomfort during split squat | 1
  7. Offer client the option to use a mat | 1
  8. Have client assume a prone position (lying face down) on the floor with the legs fully extended and the toes pointed down to the floor. | 1
  9. Cue your client to keep the core engaged (torso should remain in a straight line; neutral spine) | 1
  10. Have client place their hands on the floor, palms down, ~ 1 to 3 inches wider than shoulder-width apart with the elbows pointed outward. | 1
  11. Explain the impact of moving hands closer in/further away from shoulder-width | 1
  12. Have client push (i.e. fully extend the elbows), then lower the body by allowing the elbows to flex to a 90° angle (or a position where the chest is hovering 1-2″ above the ground) | 1
  13. Complete at least 10 reps | 1
  14. Screen pain/discomfort during push-up | 1
  15. Explain a stretch appropriate for a novice client that targets the muscles trained in the split squat. | 1
Hip Bridge & Plank
  1. Offer client option to use a mat | 1
  2. Have client lie on their back, feet planted on the floor. Arms at sides for balance | 1
  3. Explain that movement involves client thrusting hips forward to full extension by pushing off heels and contracting glutes | 1
  4. Watch client demonstrate movement, helping client achieve full extension, if necessary | 1
  5. Complete at least 10 reps | 1
  6. Screen pain/discomfort during bridge | 1
  7. Demonstrate/teach progression to 1-leg bridge | 1
  8. Again, offer client the option to use a mat | 1
  9. Mention the importance of maintaining as erect a torso as possible (neutral spine) throughout the movement | 1
  10. In a prone position, have client brace against forearms, with elbows positioned under the shoulders, legs fully extended and the toes pointed down to the floor | 1
  11. Explain and cue engaging the core | 1
  12. Instruct the client to raise body upward until body is help in a straight line | 1
  13. Have client attempt to hold position for at least 30 seconds | 1
  14. Screening of pain/discomfort during plank | 1
  15. Explain a stretch appropriate for a novice client that targets the muscles used in the hip bridge | 1
Inverted Row & McGill Crunch
  1. Position a bar in a rack to a height that will allow client to extend arms without lying on the floor | 1
  2. Using a slightly wider than shoulder width grip (hands pronated), have client hang underneath the bar | 1
  3. Client’s body should be straight (neutral spine) with heels on the ground with their arms fully extended | 1
  4. Instruct the client to initiate movement by flexing the elbow, pulling their chest towards the bar. Pause then return to starting position | 1
  5. Complete at least 10 reps | 1
  6. Screening pain/discomfort during row | 1
  7. Offer your client a mat | 1
  8. Have client lie on their back on the floor with one leg extended straight and flat on the floor, the knee of the opposite leg should be bent and the foot flat | 1
  9. Explain to client the desired range-of-motion and target muscle activation | 1
  10. Have client place their hands hands palms down on the floor underneath the natural arch in their lower back | 1
  11. Have client slowly raise their head and shoulders off the floor without bending the lower back or spine | 1
  12. Hold this position for 7 to 10 seconds, then lower torso back to mat | 1
  13. Complete 3-5 repetitions | 1
  14. Screening pain/discomfort during crunch | 1
  15. Explain a stretch appropriate for a novice client that targets the muscles used in the row | 1

PHRE 1041 Lab Exam Competencies

The following exercise pairings will be possibilities for your lab exam.

Goblet Squat & Bird Dog
  1. Instruct client to stand with feet approximately shoulder width apart, toes pointed slightly out. | 1
  2. Discuss the importance of maintaining as erect a torso as possible (neutral spine) throughout the movement. | 1
  3. Instruct client to keep knees aligned with toes (knees don't collapse in) | 1
  4. Discuss target ROM (squat until knees are bent below 90 degrees) | 1
  5. Cue client to keep weight back (e.g.: weight over ankles or more towards heels than toes) | 1
  6. Client completes at least 10 reps. | 1
  7. Screen pain/discomfort during squat. | 1
  8. Offer client the option to use a mat | 1
  9. Explain and cue engaging the core, keeping pelvis stable | 1
  10. Instruct and verify client can fully extend a single leg (while maintaining neutral spine) | 1
  11. Instruct and verify client can fully extend a single arm (while maintaining neutral spine) | 1
  12. Instruct and verify client can fully extend the opposing arm-leg, hold for ~2 seconds | 1
  13. Perform 6-8 reps per side | 1
  14. Screen pain/discomfort during bird-dog | 1
  15. Explain a stretch appropriate for a novice client that targets the muscles trained in the squat. | 1
Split Squat & Push Up
  1. Determine a stance length/width that should allow the client to be balanced. | 1
  2. Mention the importance of maintaining as erect a torso as possible (neutral spine) throughout the movement. | 1
  3. Explain target range-of-motion (i.e. knees form a 90˚angle at the bottom of the movement.) | 1
  4. Cue client to push off through the heel of the lead leg | 1
  5. Complete 8-10 reps per leg | 1
  6. Screen pain/discomfort during split squat | 1
  7. Offer client the option to use a mat | 1
  8. Have client assume a prone position (lying face down) on the floor with the legs fully extended and the toes pointed down to the floor. | 1
  9. Cue your client to keep the core engaged (torso should remain in a straight line; neutral spine) | 1
  10. Have client place their hands on the floor, palms down, ~ 1 to 3 inches wider than shoulder-width apart with the elbows pointed outward. | 1
  11. Explain the impact of moving hands closer in/further away from shoulder-width | 1
  12. Have client push (i.e. fully extend the elbows), then lower the body by allowing the elbows to flex to a 90° angle (or a position where the chest is hovering 1-2″ above the ground) | 1
  13. Complete at least 10 reps | 1
  14. Screen pain/discomfort during push-up | 1
  15. Explain a stretch appropriate for a novice client that targets the muscles trained in the split squat. | 1
Hip Bridge & Plank
  1. Offer client option to use a mat | 1
  2. Have client lie on their back, feet planted on the floor. Arms at sides for balance | 1
  3. Explain that movement involves client thrusting hips forward to full extension by pushing off heels and contracting glutes | 1
  4. Watch client demonstrate movement, helping client achieve full extension, if necessary | 1
  5. Complete at least 10 reps | 1
  6. Screen pain/discomfort during bridge | 1
  7. Demonstrate/teach progression to 1-leg bridge | 1
  8. Again, offer client the option to use a mat | 1
  9. Mention the importance of maintaining as erect a torso as possible (neutral spine) throughout the movement | 1
  10. In a prone position, have client brace against forearms, with elbows positioned under the shoulders, legs fully extended and the toes pointed down to the floor | 1
  11. Explain and cue engaging the core | 1
  12. Instruct the client to raise body upward until body is help in a straight line | 1
  13. Have client attempt to hold position for at least 30 seconds | 1
  14. Screening of pain/discomfort during plank | 1
  15. Explain a stretch appropriate for a novice client that targets the muscles used in the hip bridge | 1
Inverted Row & McGill Crunch
  1. Position a bar in a rack to a height that will allow client to extend arms without lying on the floor | 1
  2. Using a slightly wider than shoulder width grip (hands pronated), have client hang underneath the bar | 1
  3. Client’s body should be straight (neutral spine) with heels on the ground with their arms fully extended | 1
  4. Instruct the client to initiate movement by flexing the elbow, pulling their chest towards the bar. Pause then return to starting position | 1
  5. Complete at least 10 reps | 1
  6. Screening pain/discomfort during row | 1
  7. Offer your client a mat | 1
  8. Have client lie on their back on the floor with one leg extended straight and flat on the floor, the knee of the opposite leg should be bent and the foot flat | 1
  9. Explain to client the desired range-of-motion and target muscle activation | 1
  10. Have client place their hands hands palms down on the floor underneath the natural arch in their lower back | 1
  11. Have client slowly raise their head and shoulders off the floor without bending the lower back or spine | 1
  12. Hold this position for 7 to 10 seconds, then lower torso back to mat | 1
  13. Complete 3-5 repetitions | 1
  14. Screening pain/discomfort during crunch | 1
  15. Explain a stretch appropriate for a novice client that targets the muscles used in the row | 1

Competency 10: Band Under Arm Chest Press with Overhead Triceps Stretch

The following exercises will be included within one of your lab exam practical cases.  Please review the exercises below so that you are ready to complete your peer review practical assignment at the end of lab.

Kathy is a 45 year old female.  She is a breast cancer survivor.  As part of her treatment she had a bilateral mastectomy.  This has left her with a lot of chest muscle weakness.  Her goal is to regain strength and mobility within her upper body.  Please show Kathy how to complete competency: Band Under Arms Chest Press + Arm Overhead Triceps Stretch

1-Band Under Arm Chest Press

Once as a client and once as the trainer, complete at least one full set of the following exercise.

Questions to consider:  What other special population group would this exercise be particularly useful for?

Movement Pattern: Press | horizontal Target: Pec Major Synergist(s): Deltoids (Anterior), Triceps
Exercise
Regressions: Progressions: Chest Press | Push Up
Key Teaching Points

Whether seated or standing ensure a stable base and neutral spine. Resist the tendency to lurch the head forward. Remain upright and neutral. Relax the shoulders. Do not round or shrug shoulders. Grip should be neutral and comfortable. Elbow position near the body yet comfortable. Engage through the chest and triceps and push forward in a controlled fashion as described in the chest press exercise. The core must remain engaged to ensure upright posture is maintained.
Common Error(s): Rounded shoulders | Forward Head Posture
Spotting: Band/Tubing Anchoring

2-Overhead Triceps Stretch

Once as a client and once as the trainer, complete at least one full set of the following exercise.

Questions to consider:  Should you do this stretch if the client has shoulder instability issues?  How can you also stretch your shoulder internal rotators?

Movement Pattern: Single-joint | isolation Target: Triceps Synergist(s):
Exercise
Regressions: Progressions:
Key Teaching Points

This should NOT be done if there is a history of shoulder pain.  Reach one hand behind your back from high and the other from low.  Using a towel, dowel or strap apply light pressure from the down hand creating a stretch in the back of the upper arm.  Alternatively you can place the lower hand on the elbow of the upper arm to apply pressure.  If you apply pressure from the upper arm you will get a shoulder internal rotation stretch on the lower arm when behind the back.  There should be NO pain with the shoulder joint.  Resist excessive arching of the back and keep the ribs from riding upwards.
Common Error(s): Arching the upper back
Spotting:

Competency 9: Assisted Push-Up with Overhead Chest Stretch

The following exercises will be included within one of your lab exam practical cases.  Please review the exercises below so that you are ready to complete your peer review practical assignment at the end of lab.

Mark is a 59 year old male.  He has struggled with his weight for the majority of his life.  Recently he started taking anti-depressant medication.  One of the side effects is additional weight gain.  His BMI is now 32.  He wants to start exercising and change the current path in his life.  He has difficulty getting up and down from the ground.  You have come up with some adaptive exercise ideas.  Please show Mark how to complete competency: Assisted Push-Up with Overhead Chest Stretch

1-Assisted Push-Up

Once as a client and once as the trainer, complete at least one full set of the following exercise.

Questions to consider:  What other special population group would this exercise be particularly useful for?

Movement Pattern: Press | horizontal Target: Pec Major Synergist(s): Triceps
Exercise
Regressions: Progressions: Push Up | Bench Press
Key Teaching Points

Hands under shoulders width and placed firmly on wall. Body posture is aligned (head, shoulders, spine). Feet are shoulder width apart and firmly planted.  Lead with chest (not chin).  Allow for some scapular retraction at the bottom phase.  Engage chest, triceps and core.

Use either the Wall, BB Rack (various heights) or Bench to adjust the intensity of the push-up without having the client on the floor.
Common Error(s): Sagging lower back | Not engaging core
Spotting:

2-Overhead Chest Stretch

Once as a client and once as the trainer, complete at least one full set of the following exercise.

Questions to consider:  Should you do this stretch if the client has shoulder instability issues?

Movement Pattern: Single-joint | isolation Target: Pec Major Synergist(s): Deltoids (Anterior)
Exercise
Regressions: Progressions:
Key Teaching Points

While standing or seated grip the dowel (or stretching strap) widely.  Slowly extend arms overhead with elbows extended.  Engage your core so that your rib cage does not rise up and maintain a neutral pelvis.  The stretch should be within the anterior chest.  There should be NO pain in the back of the shoulder joint.  Clients with suspected should instability SHOULD NOT partake in this exercise.
Common Error(s): Arching the upper back
Spotting:

Competency 8: Band Modified Row with Rear Delt. Stretch

The following exercises will be included within one of your lab exam practical cases.  Please review the exercises below so that you are ready to complete your peer review practical assignment at the end of lab.

Frank is a 72 year old male.  He has advanced arthritis in both of his hands.  This makes gripping and grasping difficult at times.  He has recently expressed interest in exercise.  As part of a balanced program you would like to show him how to train his back muscles despite his gripping issues.  Please show Frank how to complete competency: Band Modified Grip Row + Rear Deltoid Stretch.

1-Band Modified Row

Once as a client and once as the trainer, complete at least one full set of the following exercise.

Questions to consider:  How did you secure the band?

Movement Pattern: Pull | horizontal Target: Latissimus Dorsi Synergist(s): Biceps, Rhomboids
Exercise
Regressions: Progressions: Seated Row
Key Teaching Points

Using the dog loop band tying technique create two dog loops with theraband sheeting.  Wrap around a secure anchor so two looped (mini handle) ends are available.  Slide hand through the open loop and then wrap the band once more around the wrist so that the band is secure without requiring your client to grip the band.  Proceed with band rowing technique and form.
Common Error(s): Rounded shoulders
Spotting: Band/Tubing Anchoring

2-Rear Delt. Stretch

Once as a client and once as the trainer, complete at least one full set of the following exercise.

Questions to consider:  Do you want to stretch your rhomboids/middle traps (scapular retractors) during a rear deltoid stretch?  How could you prevent this?

Movement Pattern: Single-joint | isolation Target: Deltoid (Posterior) Synergist(s):
Exercise
Regressions: Progressions:
Key Teaching Points

See picture.  Make sure not to shrug the shoulders during the stretch.  Make sure not to allow the scapulae to protract excessively.  Apply the stretch by pushing inwards towards your upper chest.
Common Error(s):
Spotting:

Competency 7: Cable Seated Row from Side Stack with Seated Lat. Stretch

The following exercises will be included within one of your lab exam practical cases.  Please review the exercises below so that you are ready to complete your peer review practical assignment at the end of lab.

Sally is a 42 year old female.  She has been a paraplegic for nearly 20 years.  She has full use of her trunk and upper limbs.  Many years of being in a wheelchair has left her with forward rounded posture.  You want to incorporate more back training.  Please show Sally how to complete competency: Cable Seated Row from Side Stack with Seated Lat Stretch.

1-Cable Seated Row

Once as a client and once as the trainer, complete at least one full set of the following exercise.

Questions to consider:  How might this differ if a wheelchair was involved?  What happens when your client can lift heavy weight?  How do you safely anchor them?

Movement Pattern: Pull | horizontal Target: Latissimus Dorsi Synergist(s): Biceps, Rhomboids, Transverse Abdominus
Exercise
Regressions: Progressions:
Key Teaching Points
  1. Position wheelchair/chair at a distance a little farther away than client’s full elbow extension while holding cable handles/v bar.
  2. Secure the wheelchair by locking brakes.  Have the client sit upright at the front of the wheel chair.  Remove arm rests +/- foot pedals if preferred.  Do not remove arm rests or foot pedals without a spotter if poor trunk or lower limb control.
  3. While engaging the core and maintaining upright spine and head posture/alignment have the client pull the load towards their abdomen.  Shoulder should be back.  Chest up.
  4. Return under control.  This should be done in a slow and controlled fashion.  Their inner core should remain engaged throughout the exercise while still remembering to breath.
Common Error(s): Inappropriate momentum | Rounded shoulders
Spotting: Cables

2-Seated Lat. Stretch

Once as a client and once as the trainer, complete at least one full set of the following exercise.

Questions to consider:  Could you hold onto a secure anchor (e.g. rig) to help increase the stretch?

Movement Pattern: Single-joint | isolation Target: Latissimus Dorsi Synergist(s):
Exercise
Regressions: Progressions:
Key Teaching Points

See picture.  Make sure that you are flexed forward slightly at the trunk.  There should be no discomfort or pain within your lower back.  A dowel can be held and/or you may grasp a fixed cage/rig to help brace yourself and increase the intensity of the stretch.
Common Error(s):
Spotting:

Older Adult Functional Assessment

The TUG (Timed Up and Go) test is indicative of gait speed, balance, and functional level.  See normative data below.  Once as a client and once as the trainer, complete at least one full set of the following exercise.

  Age (yrs)           Time (seconds)

  • 60-69                8.1
  • 70-79                9.2
  • 80-99                11.3
  • >14 seconds is associated with an increased risk of falling

The CS (Chair Stand) test is indicative of leg strength and functional level.  See normative data below.  Once as a client and once as the trainer, complete at least one full set of the following exercise.

  Age (yrs)           Reps (men | women)

  • 60-64               17 | 15
  • 65-69               16 | 15
  • 70-74               15 | 14
  • 75-79               14 | 13
  • 80-84               13 | 12
  • 85-89               11 | 11
  • 90-94                 9 | 9

Please practice coaching the assessments below:

TUG Test

Chair Stand Test

Self-Spotting Strategies

Older adults need to improve and therefore train their balance in order to help maintain functional capacity and diminish the likelihood of injury.  However, unsupervised or poorly explained balance activities can, themselves, put your older adult client at risk.  One way to help minimize risk during exercise is to educate your client about a number of self-spotting strategies.

Please complete the activity below:

Self-Spotting

Complete a practice PHRE-3043 midterm assessment

For your practical assessment (week 7) you must complete one of the 7 competencies posted on the lab website and on FOL. Practice now by working in groups of three students (trainer, client, assessor), each student work through one (different) full rubric.

Read the rubric before you role play, then grade each other using the rubric.