Review and practice the Lunge and Squat exercises

Familiarize yourself with various LUNGE and SQUAT  exercises (with and without instability), experience the exercises, and recognize when you would coach these exercises (with whom and when in training).

Lunge Exercises:

The lunge movement pattern provides the foundation for walking, running, and climbing. Being a unilateral movement, it provides an excellent way to recognize imbalances in strength and mobility. Both hips contribute to controlled deceleration (eccentric) and acceleration (concentric) phases.

General form and cue reminders:

  • maintain an active plank
  • maintain a tall torso throughout the movement
  • level pelvis
  • near vertical shin angle
Squat Exercises:

Vertical moving plank – with maximal knee flexion.

General form and cue reminders:

  • maintain core stability
  • maintain neutral posture
  • keep torso tall
  • keep feet rooted into the ground
  • hips will open at the bottom (no valgus collapse)
  • on the return, the hips and shoulders move together.

After reviewing and practising these exercises, mark this task as complete, and move to the final task of completing a full (Hinge or Rotate) Peer Review (full rubric).

Review FMS ‘Big Three’ Movement Patterns

In small groups and using the Functional Movement Screen (FMS) developed by Gray Cook, assess the quality of two classmates’ movement in the ‘Big Three’ functional movement patterns.

FMS Scoring reminders: 0 – pain (referral), 1 – can’t complete either movement pattern correctly, 2- completed a less demanding variation or part of the movement pattern, 3 – perfect completion of movement pattern.

A split pattern is where the movement involves on one side at a time (e.g., 1 leg hurdle step). A straight pattern where the movement involves both sides (e.g., 2 leg squat).  The split pattern will demonstrate asymmetry that may not be noticed during a straight pattern movement.

In split pattern movements, record right and left sides separately.  Look for asymmetry (i.e. differences on right and left side).

Note: The seven FMS movement patterns require familiarity with the following bony structures or superficial landmarks: Tibial tuberosity, ASIS, Lateral and Medial Malleoli, Distal wrist crease, Joint line of knee.

Deep Squat

Set-up Verbal Instructions:

  • Stand tall with your feet shoulder-width apart and toes pointed forward.
  • Grasp the dowel in both hands and place it on top of your head so your shoulders and elbows are at 90 degrees.
  • Press the dowel so that it is directly above your head.
  • While maintaining an upright torso and keeping your heels and the dowel in position, descend into a squat as deeply as possible.
  • Hold the bottom position for a count of one, and then return to the starting position.

Tips for testing:

  1. The client can perform the movement up to three times if necessary.
  2. If a score of three is not achieved, repeat above instructions using the board under the client’s heels.
  3. Observe the client from the front and side.
  4. All positions, including the foot position, should remain unchanged when the heels are elevated with either the FMS kit or a similar size board.

Scoring:

3: 

  • Torso is parallel with tibia or toward vertical
  • Femur is below horizontal
  • Knees do not track inside of feet
  • Dowel aligned over feet

2:

  • Same as above but the heels are elevated

1:

  • Tibia and torso are not parallel
  • Femur is not below horizontal
  • Knees track inside of feet
  • Dowel is not aligned over feet

0:

  • Pain
Hurdle Step

Set-up Verbal Instructions:

  • Stand tall with your feet together and toes touching the test kit.
  • Grasp the dowel in both hands and place it on top of your head so your shoulders and elbows are at 90 degrees. Then while maintaining hand position, lower dowel to the base of the neck and across the shoulders.
  • While keeping an upright torso, raise the right leg and step over the hurdle, making sure to raise the foot towards the shin and maintain foot alignment vertically with the ankle, knee and hip.
  • Touch the floor with your heel and return to the starting position while maintaining the same alignment.

Tips for testing:

  1. Ensure the cord is aligned properly.
  2. Tell the client to stand as tall as possible at the beginning of the test.
  3. Score the moving leg.
  4. Repeat the test on both sides.
  5. The client can perform the movement up to three times on each side if necessary.
  6. Watch for a stable torso.
  7. Observe from the front and side.
  8. Make sure the toes of the stance leg stay in contact with the hurdle during and after each repetition.
  9. If the client physically cannot bring the feet together to touch, ask them to bring their feet together as close as possible with toes touching the test kit, then allow them to perform test from that position.

Scoring:

3:

  • Hips, knees and ankles remain aligned in the sagittal plane
  • Minimal to no movement in lumbar spine
  • Dowel and hurdle remain parallel

2:

  • Alignment is lost between hips, knees and ankles
  • Movement in Lumbar Spine
  • Dowel and hurdle do not remain parallel

1:

  • Inability to clear the cord during the hurdle step
  • Loss of Balance

0:

  • Pain
Inline Lunge

Set-up Verbal Instructions:

  • Step onto the center of the board with the right foot and your toe on the zero mark.
  • The left heel should be placed according to your tibial measurement at “__”.
  • Both toes must be pointing forward with the entire foot in contact with the board.
  • Place the dowel along the spine so it touches the back of your head, your upper back and your tailbone.
  • While grasping the dowel, your right hand should be in the curve of your neck, and the left hand should be in the curve of your lower back.
  • Maintaining an upright posture so the dowel stays vertical and you maintain the three points of contact, descend into a lunge position so your right knee touches the center of the board.
  • Then, return to the starting position.

Tips for testing:

  1. The front leg identifies the side you are scoring.
  2. The dowel remains vertical and in contact with the head, upper back and tail bone during movement.
  3. The front heel remains in contact with the board, and the back heel touches the board when returning to the starting position. Watch for loss of balance. For inline lunge, a loss of balance is stepping off the board.
  4. Remain close to the client to prevent a complete loss of balance.
  5. It’s important to remember that if the person does not at least make contact with the board or ground with the knee somewhere, it is the inability to complete the movement pattern, this is a score of one.
  6. Repeat the test on both sides.
  7. The client can perform the movement up to three times on each side if necessary.

Scoring:

3:

  • Dowel contact maintained
  • Dowel remains vertical
  • Minimal to no torso movement
  • Dowel and feet remain in sagittal plane
  • Knee touches the center of the board
  • Front foot remains in start position

2:

  • Dowel contact not maintained
  • Dowel does not remain vertical
  • Movement in torso
  • Dowel and feet do not remain in sagittal plane
  • Knee does not touch center of the board
  • Flat front foot does not remain in start position

1:

  • Loss of balance by stepping off the board
  • Inability to complete movement pattern
  • Inability to get into set up position

0:

  • Pain

Remember to save, then mark this task complete and move onto the next task.

Case 2 – Wheelchair Spinal Cord Injury

Dave is a 38 year old male.  He was injured in an accident and now has a paraplegic spinal cord injury.  Before his accident he played high level hockey.  He would like to improve his core strength.  His goal is to try out for wheelchair rugby. 

Complete the activities below:

Ideal Exercises

Programming

Practice Rubric

Upper Body Exercises for Wheelchair Users

The following are a list of additional upper body exercises for clients that use wheelchairs and/or may need to remain seated during activity.  

Please practice coaching the exercises below:

1-Seated Side to Side Overhead Reach

2-Seated Lat Stretch

3-Seated Dowel Overhead Chest Stretch

4-Seated Trunk Twist

5-Seated French Press

Case 1 – Wheelchair Lower Body Weakness

Mark is a 14 year old male. Mark has muscular dystrophy (MD). This has resulted in Mark requiring the use of a wheelchair. Even though he finds standing difficult and cannot walk he still has use of his lower body while seated. Mark would like to maintain lower body strength as much as possible.

Complete the activities below:

Ideal Exercises

Programming

Rubric Practice

Inclusive Language Interview – Disability

Dave is a 38 year old male.  He was injured in an accident 3 years ago and now has a paraplegic spinal cord injury.  Before his injury he was an intermediate level fitness client and played in a weekly basketball league.  He would like to improve his core strength.  His goal is to try out for wheelchair rugby.   

Complete the activities below:

Taking turns with a partner complete the intro, discovery and purpose sections of the practical exam rubric for the case above.  Ask at least two open ended questions and follow-up.  Use inclusive language.  Determine the purpose of the session.  Demonstrate active listening.

No - DON'T

Yes - DO

  • Ask about what they did before the accident
  • Ask them what they would like to do now
  • Use negative terms like confined to or suffering from
  • Use terms like uses a wheelchair or has a spinal cord injury
  • Focus on disability
  • Focus on ability
  • Treat them as overly special
  • Treat them like any other person
  • Overreact if you accidentally make a comment such as "you could also do this in standing"
  • Apologize and move on
  • Talk to them like they have a cognitive limitation
  • Talk to them like any other person
Rubric - Peer Grading

Student to Verify

Intro

Technical


Missing = did not attempt
Developing = asked question, no follow-up
Competent = asked question, attempted to follow-up
Exemplary = asked question, lead to meaningful discussion

Missing = did not attempt
Developing = mentioned target muscle group
Competent = mentioned target muscle group, related to general function
Exemplary = mentioned target muscle group, related to specific client goal

Closing


Missing = did not attempt
Developing = review related to muscle group
Competent = reviewed key teaching points, related to muscle group and function
Exemplary = reviewed key teaching points, related to overall program plan or progression

Missing = did not attempt OR did not give client time to respond
Developing = asked client if they have any questions
Competent = prompted client for specific questions on elements of the workout

Overall Communication

%

Inclusive Language Interview – Chronic Disease

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.

Complete the activities below:

Taking turns with a partner complete the intro, discovery and purpose sections of the practical exam rubric for the case above.  Ask at least two open ended questions and follow-up.  Use inclusive language.  Determine the purpose of the session.  Demonstrate active listening.

No - DON'T

Yes - DO

  • Stare at them
  • Display normal eye contact
  • Use negative terms like suffering from or dealing with ... cancer
  • Use terms like Kathy had breast cancer
  • Talk like they have a contagious disease
  • Follow their lead and discuss their limitations with a positive yet realistic approach
  • Assume all cancer is hopeless or imminently terminal. Conversely do not provide false hope.
  • Be prepared by understanding the nature of their cancer. Discuss the situation with a positive yet realistic approach.

Rubric - Peer Grading

Student to Verify

Intro

Technical


Missing = did not attempt
Developing = asked question, no follow-up
Competent = asked question, attempted to follow-up
Exemplary = asked question, lead to meaningful discussion

Missing = did not attempt
Developing = mentioned target muscle group
Competent = mentioned target muscle group, related to general function
Exemplary = mentioned target muscle group, related to specific client goal

Closing


Missing = did not attempt
Developing = review related to muscle group
Competent = reviewed key teaching points, related to muscle group and function
Exemplary = reviewed key teaching points, related to overall program plan or progression

Missing = did not attempt OR did not give client time to respond
Developing = asked client if they have any questions
Competent = prompted client for specific questions on elements of the workout

Overall Communication

%

Flexion

McGill Crunch

Stability Ball Crunch

Not Recommended: Hanging Leg Raise

Cobra Stretch

Extension

Alternating Superman

Machine Back Extension

Low Back Stretch

Stabilization

Competency Teaching Points

  1. Mention the importance and demonstrate the concept of neutral spine
  2. Prom the prone position, have client brace against forearms, with elbows positioned under the shoulders, legs fully extended and the toes pointed down to the floor
  3. Explain and cue engaging the core
  4. Have client attempt to hold position for at least 30 seconds, watch for form errors

Abdominal Plank

Bird Dog

Dead Bug

Anti-Rotation: Pallof Press