physical assessment - OPEX Membership Site

Transcription

Level 1 Assessment
PHYSICAL ASSESSMENT
NOTE:
The handouts provided are for reference only. We invite you to use them AS A REFERENCE, however strongly encourage you
to take your own notes. The notes were developed as a tool - some content may not be covered in the Theory component.
Client cannot move on until previous level is complete; if one area is advanced and another is beginner then prioritize in %’s
how much time is spent on that area for “fitness” balance. NEVER assume one is good at all movements (i.e. performing
back squat before assessing movement of hip/knee bending and air squat)
Double Leg
1.Accordion:
•• Watch for coordination of hip and knee bending at the same time
•• Ability to listen and then move as requested to command “can you squat downward for me, bending your hips and
knees at the same time?”
•• Why is this important before moving on? – Ability to coordinate movement at this level is imperative before moving
on – the action of the brain telling the hips and knees to move at the same time can be “stunted” by some signals
not getting through (i.e. trained to “sit back”, or trained to “bend at knees only” is something you want to look at –
DO NOT assume folks can do this)
2. Air Squat:
•• Watch for maintenance of lumbar curve with squat mechanics (weight on mid foot, knees over 2nd toe, equal
bending of knee and hip, toes slightly out)
•• Why is this important before moving on? – This movement is very functional along with stooping and grasping and
pressing as primal movements we need to be able to do forever and this starts that process
3. Relative Back Squat
•• Client at this level can air squat well
•• Associate client with; mechanics of barbell placement, stance, breath, elbows, torso, depth, speed, control, levers
and limiters, etc..
•• Discuss differences in low bar and high bar back squat (yes we believe both are important to know as coaches as
well as clients)
•• Goal is 1 x BWT high bar back squat @ 30X0 tempo for male and female before discussing %’s of lifts relative to
other lifts and speed strength/strength speed exercises
Copyright OPEX © 2014
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Level 1 Assessment
4. Front Squat : Back Squat:
•• High bar back squat and front squat – same depth
•• How to do 1RM testing
•• FS should be 85% of back squat 1RM – same depth
•• Folks should be squatting BWT x 3 reps before any plyometrics
•• Why is this important before moving on? – Client should be able to move loads correctly as well as under good to
great balance in respect to other movements in order to progress athletically and in competitive situations
•• Discussion around why the %’s work out for the “fitness” enthusiast over time – OPEX data
5. Vertical Jump:
•• Watch for hip “quickness”
•• 3 trials allowed; this is powerful – create setting by cues on explosion
•• Handout on description and norms
•• Equipment required: Measuring tape or marked wall, chalk/ink for marking wall.
•• Procedure: The athlete stands with side to a wall and reaches up with the hand closest to the wall. Keeping the feet
flat on the ground, the point of the fingertips is marked or recorded. This is called the standing reach height. The
athlete then moves away from the wall slightly, and leaps vertically as high as possible using both arms and legs
to assist in projecting the body upwards. The jumping technique can use a countermovement. Attempt to touch the
wall at the highest point of the jump. The difference in distance between the standing reach height and the jump
height is the score. The best of three attempts is recorded.
•• Why is this important? – Moving weight slowly and transferring it into moving weights quickly is what we want all
clients getting to over time – discussion on “athleticism”
Rating
Excellent
Very good
Above average
Average
Below average
Poor
Very poor
Males
(inches)
> 28
24 - 28
20 - 24
16 - 20
12-16
8-12
<8
Vertical Jump Standards
Males
(cm)
> 70
61-70
51-60
41-50
31-40
21-30
< 21
Females
(inches)
> 24
20 - 24
16 - 20
12-16
8-12
4-8
<4
Females
(cm)
> 60
51-60
41-50
31-40
21-30
11-20
< 11
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Level 1 Assessment
Single Leg
1. Trendelenburg/Hip Extension:
•• TR- View from behind the client and have them transfer weight to one leg.
•• TR- A positive Trendelenburg Test is indicated if during unilateral weight bearing the pelvis drops toward the
unsupported side
•• Tell client after test what you are looking for.
•• HE – Lie on back; feet on ground; raise hips to parallel: hips have to be parallel with floor
•• HE – Client places hands on hips on both sides and as they take one leg off to extend it, they feel for a shift in pelvis
downward (this is a positive); coach can visually see drop as well; repeat as necessary without telling what you are
looking for and see if they repeat it over and over or if they make a dormant muscle work a little better
•• Why is this important? – These 2 simple tests can give us an insight into glute med/min function as well as post
chain under low load function for single leg activities; without seeing if there are imbalances here will not allow
proper progression of double leg movements over time or lead to possible injury (overuse usually)
2. Forward Lunges:
•• Step forward and back into place using legs only
•• Tap opposite knee to ground
•• Coach watches from side and front 4 steps each (2 per leg from side, 2/leg from front)
•• Watch for pushing off toes or heels R vs. L, watch for knee tracking on movement vs. standing (caving of foot or
knee on forward step), watch for use of arms to move body, watch for hips going back first as opposed to torso
being straight up and down (usually hips back first is also associated with toe pushers – and quad dominance as
opposed to heel pushers and glute dominance)
•• For over-fat client, a step up to a box may be substituted for a forward lunge.
•• Why this is important? – just like the TR and HE it is a mere look into the single leg movements and the ability of
the person to do this appropriately; BUT with a “noticing” of HOW they do the movement, and furthermore, can
they be taught to do the movement
3. Split Squat A:
•• 3 paces in front of bench
•• Ensure tall torso, back foot flexed appropriately, pad as needed, play with movement to get control
•• Tempo is 3010 (this is strict!)
•• Goal is 8 reps/leg @ 3010 tempo unloaded
•• Tempo can take some time to learn based on balance; goal is improved balance and single leg load for front AND
back leg
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Level 1 Assessment
4. Split Squat B:
•• 3 paces in front of bench
•• Watch for tall torso, build slowly with weights, but not to fatigue
•• Need BWT and db’s available, BB too unsteady
•• Tempo is 3010 (this is strict!) – goal is 1/3 BWT per hand for 8 reps per side
•• Why is this important? – we have found that those who are great squatters relative to their BWT and those who are
not have SIGNIFICANT differences in their ability to do this and the correlation b/t those that cannot do this
5. Single Leg Vertical Jump:
•• Can balance using back foot, back foot can be pumped for propulsion but can’t be used to push off
•• Instruct client to use opposite hand for max reach and touch; show example always before hand
•• Allow trials beforehand then only 2 trials per test
•• No norms/data – just use to compare R to L power and indirect measure of R to L leg speed/power generation
•• Equipment required: measuring tape or marked wall, chalk/ink for marking wall.
•• Procedure (see also variations below): the athlete stands beside wall and reaches up with the hand closest to
the wall. Keeping the feet flat on the ground, the point of the fingertips is marked or recorded. This is called the
standing reach height.
•• Instruct the client to now transfer all weight to the outside leg (the testing leg) and send the inside leg back and
off the ground for support. Explosively jump and touch the wall using only the supported (testing) leg.
•• The best of three attempts is recorded.
•• Why this is important? – implications in bounding activities that require single leg power output can be assessed
before hand by seeing weaknesses in power of one leg over another; if balance is impt in split catches for example,
we want to ensure that both legs can take the toll
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Level 1 Assessment
Upper Body Push
1.Push Up:
•• Watch for low back angle when in plank; which breaks first on push up? (shoulder balance – R to L or overall)
compared to truck angle (i.e. is it the core breaking down 1st before the upper strength/endurance)
•• Watch from front and side; from front to see depth as well as one shoulder working more than another
•• For individuals who can NOT do a push up, use the Front Leaning Rest (FLR) for a time frame as a baseline instead of
a push up.
•• Why this is important? – a push up can tell us a number of things about program designing such a “used”
movement as well as tell us some signs of a possible ability/inability to 1 keep midline stable, 2. co-ordinate
midline and upper pushing (very primal), 3. Assess upper body strength/endurance, 4. Possible consequences of
double arm activities that we do over time that can be seen from the get go on the push up alone
2. Dip:
•• Instruct client to attempt dip (knowing that if they have not developed a significant number of push ups these will
not be tested)
•• Watch for depth and control of eccentric action as well as anterior capsule tightness in shoulder
•• Goal is 3 reps strict before advancement at 3010 tempo
•• Watch for shoulder lowering below elbow
•• Why is this important? – This is one of the best upper body pushing exercises as it involves pure strength relative to
BWT and a flexibility component; as well with the use of rings over time, this will high importance as the strict chin
up is to the kipping chin up
3. Weighted Dip:
•• Same dip depth and instructions per above
•• Watch for changes in mechanics and “feelings” when loaded relative to unloaded
•• Goal is 20% BWT x 1 Dip for females and 33% BWT x1 for males before introducing kipping and progressions for
upper body pushing relative to other movements/exercises
4. Loaded Push:
•• 16” close grip bench press 1RM should be tested.
•• Seated BB overhead press should be 64% of CGBP 1RM (from bar at back of neck to start and concentric start from
behind the neck)
•• Seated DB OH press @ 3010 x 6 reps should be 29%/hand of CGBP 1RM
•• Discussion on “pressing” strength (HSPU, triceps, etc..)
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Level 1 Assessment
4. Loaded Push (cont’d):
•• Why is this important? – Balance in the upper body for high loads is impt to ensure that for the unknown volume
that may occur or if it is planned we are ensuring a healthy and long lasting multi faceted joint(s) – G-H, A-C, S-T
joint
5. Seated Med Ball Toss:
•• Include norms on seated ball toss and data and descriptions on testing
•• Equipment required: 1-2 kg medicine ball, floor mat, wall, tape measure
•• Procedure: The subject sits with their back to a wall, on a mat facing the area to which the ball is to be thrown,
and with the feet extended and slightly apart. The ball is held with the hands on the side and slightly behind the
center. The ball is brought to the chest, and then thrown vigorously out as far as possible. The back should remain
in contact with the wall at all times. Three attempts are allowed.
•• Scoring: The distance from the wall to where the ball lands are recorded. The measurement is recorded to the
nearest 0.5 foot or 10 cm. The best result of three throws is used.
•• Target population: Sports in which upper body strength is important, such as rowing, tennis
•• Advantages: This test is easy and quick to perform for an individual.
•• Disadvantages: several people are needed to conduct this test smoothly: one to mark results, another to check
technique and another to collect and return the balls. If testing a large group, it can be time consuming to put all
the subjects through this test.
•• Comments: The angle the ball is thrown is important. You may want to explain to the subject about the optimal
angle for maximal distance, and to allow some practice attempts. You may aid in the ease of measurement for
this test by extending a tape measure out along the expected path in front of the subject. When recording the
distance, you can either move the tape to where the balls landed or less accurately align where the ball landed to
the approximate distance on the tape.
•• Variations: The seated medicine ball toss can also be done with the subject facing the other way and throwing the
ball over their head for maximum distance. The test can also be performed without a wall, so that the torso can
also be used to help propel the ball. The weight of the medicine ball will obviously affect results, and should be
selected to best test the age group or abilities of your subjects.
•• Why is this important? – Gives us insight to develop some norms and data on its carryover to upper body explosion
type activities; using the hips in all movements fitness enthusiasts do might work well if we can improve non hip
upper body explosion by testing it and seeing how it improves based on the design
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Level 1 Assessment
Upper Body Pulling
1.Scapular strength:
•• Single arm DB tests for ext rot, rhomboid and trap 3 ability
•• Watch for cheating of body parts for this one
•• 30° bench for rhomboid (powell raise)
•• We want to use this as a measure for beginners as to balance in scapula by being able to handle 10#/h for each test
for 8+ reps as well as the advanced person for equal balance between the CG bench press 1RM and 10% of that for a
DB per hand for 8 reps as well
•• Why this is important? – First thought was that multiple joint movements were the only way, and then CP said that
this needs to be taken into consideration. He then went away and did not listen to this and elbow and shoulder
injuries arose; so have gone back to implementing when needed and markedly different in better development
long term for folks moving into chin ups, kipping, etc..
2. Chin Up:
•• Same as dip; goal is 3 reps strict before advancement at 3010 tempo
•• Pronated medium grip (palms away)
•• Instruct client to attempt chin up from hang – even the attempt will tell you a bunch (client willingness, scapular
depression before elbow flexion, etc…)
•• Watch for ability to control negative
•• Why is this important? – Along with the dip, probably the best relative strength to BWT test there is and a mainstay
on all physical and emotional levels (discussion); the balance b/t the chin up and dip should be a focal point in
balance (we ask for equal balance of improvement in strict dips to strict chin ups for optimal shoulder balance over
time)
3. Weighted Chin Up:
•• Same chin up rules as instructions above (discuss difference in dip and concentric first)
•• Client starts from dead hang position and awaits your command
•• Tempo is 30X0 – looking for closed bicep to forearm angle and upper arm by sides with bottom clients ability to
place entire head up and through vertical plane of bar (not “chinning” it through only)
•• Goal is 20% BWT x 1 chin up for females before introducing kipping and progressions for upper body pushing
relative to other movements/exercises
•• Goal is 33% BWT x 1 chin up for males before introducing kipping and progressions for upper body pushing relative
to other movements/exercises
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Level 1 Assessment
4. Loaded Pull:
•• # 1 goal is standing press ratio to chin up to be 65% - male and female
•• # 2 goal is close grip bench press to chin up ratio to be 96% for males (not enough data “yet” on females)
•• Why is this important? – This stage covers the upper pushing/pressing while loaded category and allows
progression once these are achieved into faster movements
5. Kipping:
•• If at this level use technique and ability to determine where they want to go with this (understanding that the
ability to do loaded pulling and scapular balance 1st will allow scapular balance for elbow longevity)
•• Why is this important? – Use for non CrossFitters is just as important as use for CrossFitters for “athleticism” over
time and function of using a full body integration of joints, speeds, angles, timing, co-ordination…etc…
Bending
1.Waiter’s Bow:
•• Bend at waist only, knees remain at 20-30°
•• Look for clients ability to understand what you are asking – there is usually a huge carryover to the lack of
someone being able to understand/comprehend this and their inability to do this and furthermore an increased
chance in low back/pelvic injury
•• Watch valley in low back (some people can still remain tight in erectors and pelvis will not tilt)
•• Ask for tightness on one side more than another
•• Watch for one knee bending more than another
•• Goal is 10-20 sec holds without movement – use 10-20 sec as “moving” assessment if you wish, i.e. 2 sec up, 2 sec
down x 5 reps or 5 sec down, hold for 10 sec and 5 sec up
•• Why is this important? – Seeing that someone can co-ordinate a vital “functional” movement is imperative BEFORE
moving onto loaded stooping – the balance b/t using the TLF, allowing the hamstrings to lengthen and keep low
back in tact is a day to day movement that rivals the squat and grasping/pressing as importance in movement
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Level 1 Assessment
2. Sorensen:
•• Hands crossed at chest, perfect lumbar alignment, ass used, hamstrings tight, chin tucked in
•• Watch for inability to hold head in place – client wants to tilt head back (usually an indicator of lack of postural
control in ass/low back/hamstring)
•• Watch for increased curvature and speed this happens on low back – indicated lack of postural control in ass/hip
extensors – discontinue test
•• Watch for lowering of upper back past your hand position – discontinue test after 1 warning
•• Watch for continual head back – discontinue test after 1 warning
•• Goal is 2 min or more held tight (discussion → endurance athletes, touch and go movements, must be perfected)
•• Why is this important? – This will allow a look into the postural endurance of clients; as if their training calls for a
bunch of stopping activities this will be a good determinant as to how to balance their design of hip flexion to hip
extension and if they can handle postural control exercises
3. Relative Dead Lift:
•• Associate client with barbell movement, create understanding of carryover to other lifts, and discuss foot
placement, shoulder position, breath, hamstrings, lumbar curve, chest broad, lats, levers and limiters, etc…
•• Depending on the training age of client, the Back Squat can be measured as 50% of BWT, 75% of BWT, or 100% of
BWT.
•• Goal is 1.25 x BWT for males and 1 x BWT for females before comparisons or discussions into speed strength
work, strength speed work and structural comparisons to other lifts (scapula strength accounts for the relative
difference between males/females).
4. Loaded Bending:
•• Back Squat 1RM determines where all other movements should be – DL should be 125% of back squat, Power Clean
should be 66% of back squat, Power Snatch should be 51% of back squat
•• Depending on training age of client, the DL can be measured as 50% of BWT, 75% of BWT, 100% of BWT.
•• Why is this important? – When looking to move into speed/skill exercises the ability to balance the right loads
through the hips is important – when people are off on these numbers (god knows we are all different) they will
usually tell you that their weak link lies in the weakness in terms of their overall progression of movements and
true athleticism
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Level 1 Assessment
5. Reverse Med Ball Toss:
•• Standing backwards to line – athlete gets 3 attempts for furthest distance thrown of 8kg (male), 5kg (female)
med ball or shot
•• Athlete is allowed to step over line after full extension – lessons are given before hand about trajectory and height
(handouts and norms given)
•• Power clean and power snatch are also powerful hip extension movements that can be considered and used for
measurement
•• Equipment required: 8kg/5kg shot put, tape measure, clear open area for testing.
•• Procedure: The athlete starts with his back to the throwing area, with their heels at the start line, and the shot
cradled in both hands between the knees. The subject bends forward and downward before throwing the shot
backwards over their head in a two-handed throwing action (optimally at about 45 degrees). Several practices may
be required to get the best trajectory for maximum distance.
•• Scoring: Measurement is made from the starting line to the point of impact of the shot put with the ground. The
measurement is recorded in meters and centimeters. The best result of two trials is recorded.
•• Target population: Sports in which total body power is important.
•• Advantages: This test is easy and quick to perform for each individual, with the equipment readily available in most
sports departments.
•• Disadvantages: Several people are needed to conduct this test smoothly: one to mark results, another to check
technique and another to collect and return the balls. If testing a large group of subjects, it can be time consuming
to put all of them through this test.
•• Comments: The angle the ball is thrown is important. You may want to explain to the subject about the optimal
angle for maximal distance, and to allow some practice attempts.
•• Why is this important? - Gives us insight to develop some norms and data on its carryover to hip explosion type
activities; we use the hips in all types of athletic endeavors, this will be an insight into how explosive this is – and
will by my results carryover to what we see lacking in a person being unable to “open” their hips to move weight
effectively (discussion on development of power and “releasing” objects
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Level 1 Assessment
Core
1.Side Bridge:
•• From knees 1st, then feet; elbow is directly under shoulder; head neutral, cannot tilt to keep in balance with floor
(McGill)
•• Watch for lack of scapular strength with higher trap position and shoulder hike
•• Important that folks develop this 1st – as lack of it has been linked to LB pain (acute and chronic – empirical data
supports this also) – goal is 90 sec per side before you move on
•• Discussion – inner unit/outer unit
•• Why is this important? – Besides McGill’s initial research into the QL as its function in stabilizing the pelvis
(discussion), we have found the side bridge to be a VERY nice way of determining when folks have the appropriate
R to L balance in spinal balance/endurance; allow these movements as well as the “drawing-in” maneuver to lay a
foundation BUT NOT a bias in where you want people starting on the their understanding of spinal alignment
2. Leg Lowering Abs:
•• Have client find neutral spine (approx finger width can fit in under the low back)
•• Legs completely straight, feet neutral; client contracts abs (inner and outer unit if they understand this – “bearing”
down can also be used as an example) and must lower legs until you and client feel a move in the low back
•• An opportunity as well to assess hip flexor tightness
•• Goals are 45° or lower of thigh with ground – an approximation, stand from side if client is willing and wishes to see
direct measures or changes in measurement over time
•• Why is this important? – This one test is an easy measure (based on angle) of an ability or inability of someone to
hold the pelvis in place while the legs move around it – in a no functional sense but none the less a measure with
higher loading…
3. Tabata Sit Up A:
•• An easy measure; feet anchored as we want to see hip flexor and ab muscular endurance
•• Feet anchored; hands remain on temples – elbows can come forward; T/L spine connection must get to
perpendicular with the floor at top of movement, not just upper body (as those with lumbar mobility can do this
without actually tipping pelvis forward and no shortening of hip flexors occur)
•• Hips cannot raise off ground at any time (“Grantin’ it”)
•• Goal is average score of 8 – discussion on variations in scoring
•• Why is this important? – Because it is understandable – it’s a number that folks love for scoring purposes and it
can tell you a lot
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Level 1 Assessment
4. Tabata Sit Up B:
•• Same directions for testing as A
•• Goal is average score of 12
5. Knees to Elbows:
•• I like this one as an advanced “ab” movement because it involves more and more of the overall fascial slings
that are involved in flexion of the hips (grip, scapular depression, arm flexion, ribs meeting pelvis, co-ordination,
endurance, etc.)
•• Of course this one carries over to multiple applications in kipping chin ups
•• Goal is 15 from a hang – swing allowed as by this point the person is capable of using abs and co-coordinating
movements (or maybe this can be a good assessment of co-ordination and timing…)
•• Why is this important? – As mentioned above it is a great lead into the kipping chin up, grip strength and using the
core from an increased challenge of moving the legs around the pelvis as opposed to body around the pelvis as in
the sit up anchored
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Level 1 Assessment
WORK CAPACITY
Pre Screening: Work capacity testing should not be performed if the resting HR is > 95bpm and/or Resting BP
of Systolic > 144mmHg, Diastolic > 94 mmHg
Some people will suffer what is referred to as “white coat syndrome” where the nervousness of having their HR and BP
taken causes an increase in HR and BP. Wait 5 minutes and instruct client to relax and re test.
Level 1 – “Get an idea”
Indirect method based rate of perceived exertion (RPE) and work done:
- Client rows 30 sec on/30 sec off x 3
•• Create workloads after a few minutes of warming up on rower; record and use same workloads over time to get an
indication of RPE relative to work
•• Subjects can be tested on “fitness” if they can produce without remembering a lower RPE per workload over time
-- Example of results: Mary session 1; WL1 – 5, WL2 – 9, WL 3 – DNF
-- Mary session 2; WL1 – 3, WL2 – 5, WL3 – 6
-- This shows indirect improvement – very simple and effective for compliance
•• Use RPE scale as measurement: explain this to client beforehand. RPE Scale:
-- Levels 1-10 where 0 = rest, 1 = really easy, 2 = easy, 3 = moderate, 4 = sort of hard , 5 = hard, 6 = harder than
hard, 7 = really hard, 8 = harder than really hard , 9 = really, really hard, 10 = just like my hardest race (i.e. all
out effort)
Level 2 – “Set some standards”
Anaerobic: (in the definition only in terms of intensity as oxygen will OR can be used and therefore be described as an
anaerobic)
- Ex. 60 sec rowing effort @ 100% (relative to what 100% means to the client); measure avg watts and divide by weight in
lbs (i.e. 200 avg watts for 60 sec divided by 200# male is 1.0 as score for work done in that time) –
•• True anaerobic alactic efforts are most times not applicable to this subject as they cannot “produce” enough
power to elicit a true AnAl response, therefore we use 60 sec because it is not aerobic enough if you are given the
command to go “as hard as you can.”
•• Limitations of the test:
-- Are they skilled in rowing? (take the time to teach it)
-- This is only an indirect definition of anaerobic metabolism
-- The test is row specific; it cannot be carried over to other 60 sec domains – only an assessment
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Level 1 Assessment
Aerobic: (still @ levels where the intensity will not determine the outcome; one in which it does require “sustainable”
activity; as well as one that predisposes people to being on the side of “pushing it” as opposed “pacing it”):
•• Ex. 2K Row for time, 1 mile run for time, Air Dyne 10 min
-- Time or work completed is used as measure for subjects
-- “Fitness” is measured in terms of improvements made over time and compared to norms/standards
-- This motivates clients based on what they might be capable of
Level 3 – “Getting More Specific”
Anaerobic Alactic Test: 10-20 seconds of work at maximal effort using a repeatable and measureable test. While testing
the AnAl energy system we try to establish a test which has the following characteristics: high power, cyclical in nature,
high turnover, high requirement for blood flow, high respiration rate post work, and most times a higher heart rate response.
(ex. 4 reps of a Back squats @ 30X0 versus 16 second sprint
•• Ex. 20 second bike sprint for meters OR 20 second row sprint for meters OR 150 meter sprint for time
Anaerobic Lactic Power Test: 60 sec effort @ 100% (relative to what 100% means to the client)
•• Ex. Rower for 60 seconds for max meters
•• Ex. 300 meter run for time
•• Ex. Airdyne 60 seconds for calories
Anaerobic Lactic Endurance Tests: Testing the ability to hold high power outputs over a varied amount of time periods.
These tests are used to determine how the subjects respond to work over shorter and longer periods of time at high efforts.
1. Short Time Domain: 4-6 min of work at high intensity
-- Ex. 1500 meter row for time, 6 min max calories on the airdyne, 1 mile run for time (if efficient as a runner)
2. Longer Time Domain: 10-12 min of work at high RPE to determine ability to function at high intensities over a longer
time frame.
-- Ex. 3k row for time, 2 mile run, 10 min amrap of appropriate cyclical + self loaded + external loaded
scenarios
Aerobic: Completely “sustainable” activity over a long period of time versus the lactic testing
•• Ex. 60 min Row for meters, 10k run for time, 60 min airdyne, 40k bike time trial,
-- Time or work completed is used as measure for subjects
-- “Fitness” is measured in terms of improvements made over time and compared to norms/standards
-- This motivates clients based on what they might be capable of
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Level 1 Assessment
Level 4 – “Getting Really Specific” (CP-ATP, AnAl, AnLa, Aerobic?)
In Level 4 we are attempting to have a full comprehensive continuum of balanced fitness testing using different energy
systems, different movements, and measurements and responses to CP/ATP as well as different lactic and aerobic tests.
Central Nervous System Testing
1- 1 Rep Max Test
•• Protocol for 1RM building (Being a CNS test, it requires a proper warm up:
-- 50% of possible 1RM; 5 reps @ the right tempo for the 1RM test – 30X0 preferred; rest as needed;
-- 3 reps @ 75% possible 1RM at same tempo; rest as needed;
-- 85% of proposed 1RM load – 1 rep at tempo; rest as needed;
-- 90% of 1RM x 1. From here, build up to a few times based on the CNS ability of the subject (i.e. lower
neuromuscular ability will require less sets to get to 1RM; higher neuromuscular ability will require more
sets – you will see this over time)
2- 85% Test:
•• -85% of 1 Rep Max for max reps performed AT CONSTANT TEMPO (30x0)
•• For 85% test: rest 10 min before placing 85% of 1RM test in place and then test with same tempo
-- Advantages: The required equipment is readily available in most gymnasiums.
-- Disadvantages: Performing a maximum weight lift is only for advanced weight trainers. It is important to
be experienced in the gym and have good technique before attempting this test. The results for muscle
fiber type is specific to the muscle group tested, and may not apply to the other muscles of the body. As
muscle groups are involved in the lifting techniques, the muscle fiber composition of individual muscles is
not able to be determined using this test.
-- Comments: The test results will be specific to the equipment used and the technique allowed, so is best
used for test-retest measures.
Full Capacity Testing
1. Anaerobic Alactic Testing: Determine the differences in subjects to different time domains within that 10-20 second
window.
•• Airdyne 10 seconds vs. 20 seconds
•• 75 meter sprint vs. 150 meter sprint
•• Row 10 seconds vs. 20 seconds
15
Level 1 Assessment
2. Anaerobic Lactic Power Testing: Determine the differences in subject to different high power output efforts over
varied time domains also taking incorporating different modalities.
•• 60 second airdyne for calories
•• 400 meter run for time
•• 1 min row for calories
3. Anaerobic Lactic Endurance Testing: Determine the difference in subject to different high power outputs over longer
periods of time using different tests.
•• “Fran”
•• 800 meter run for time vs. amrap in 3 min of appropriate work for the athlete
•• “Helen”
•• 1 mile vs. 2 mile run for time
•• 1k vs. 2k vs. 3k row for time
-4. Aerobic Testing: Determine the ability of the subject to train through multiple different time domains at a sustainable
effort.
•• 5k run vs. 10k run vs. 60 min run time trial
•• 20 min airdyne vs. 45 min airdyne vs. 60 min airdyne
•• 20 min row vs. 40 min row vs. 60 min row
•• 20 min amrap: 100 meter farmers walk, heavy sandbag walk 200m, 10 burpees
•• 60 min amrap: 1000 meter row, 20 sit ups,
Some Questions to think about when designing level four work capacity tests:
•• Will the test elicit the dose response that we are looking for in the time frame
•• Is the test repeatable, valid, and controlled?
•• How do you determine what is a “good score” for balanced fitness?
•• Are there any limiters within the test will alter the pathway we are looking for (ex aerobic test of 150 hspu)
•• Did the athlete warm up properly to achieve the intensity needed for the desired test
16
Level 1 Assessment
Daniels’ Running formula proposes some insight into what runners “should” have along a graph for performance – we can
transcend and include this for the level 4 work capacity for “balanced” fitness; it will give us a framework from which to
start from on how we can “balance” things out in fitness for people based on scores
Table from: “Healthy Intelligent Training”, Keith Livingston
17
Level 1 Assessment
OPEX CCP Movement Analysis © 2011
Guidelines:
•
Keep all testing environments safe; do not put yourself or your client in danger.
•
All test movements should be incremental: test sub maximal before maximal.
•
End of excursion should be held for 1 second
•
Test should be repeatable
The following tests are adapted with kind permission from Garry Gray and Ed Paget, for more information visit www.
grayinstitute.com and www.theenglishosteopaths.com .
Foot and Ankle
Test: Foot pronation and supination.
•• Find a neutral standing position, observations?
•• Ask client to supinate their feet, repeat as needed to get visual
•• Ask the client to pronate their feet, repeat as needed to get visual
•• Return client to neutral standing position
•• Ask client to rotate arms to the right or left and watch the action of feet.
Look For:
•• Any side of the foot to be off the ground while they stand neutrally
•• From behind to see if the heels are vertical
Implications for training:
•• Locomotion and jumping require a natural pronation and supination of the foot
•• Be careful of overloading double unders, running, jumping, and single leg activity
Ankle
Test: Ankle dorsiflexion
•• Ask client to stand square to wall or other vertical object.
•• Line their right foot up perpendicularly to object and dorsiflex the ankle till the right knee touches the wall.
•• Move foot further away from wall in small increments and repeat until the heal lifts off from floor, measure the
distance from the big toe to the wall.
•• Repeat on the other side.
18
Level 1 Assessment
Look For:
•• Heel coming off the ground to gain distance
•• Foot twisting or subtalar joint movement
Implications for Training:
•• If there is lack of range of motion in both sides, compensation in the squat mechanics
•• If there is inequality of range of motion, there will be rotation up the chain
Hips
Test: Hip movement in all three planes of movement.
1. Flexion:
•• Ask client to stand on one leg with tip toe of other leg touching the floor for balance.
•• Flex forward to target leg, how far down do the fingers go? How far away can the client reach, repeat on other side
Look For:
•• Bending of the knee
•• Heel coming off the ground
•• Client may say “one side feels tighter,” ask where they feel tight
•• With inequality, need to be careful of high rep stooping, sprinting, and volume of running
2. Extension:
•• Ask client to stand on one leg with tip toe of other leg touching the floor for balance.
•• Keep head neutral!
•• Reach overhead to wall with emphasis on thrusting the hips forward.
•• Measure the distance from the foot the client is standing on to wall at the level of the foot.
Look For:
•• The client bend their knee to increase extension
•• Fall back into the wall as opposed to controlling it
•• With inequality, we will be careful of over loading high volume sprinting, knees to elbow, toes to bar, tuck jumps,
box jumps
19
Level 1 Assessment
3. Adduction:
•• Ask client to stand on right leg with tip-toe of left leg touching the floor for balance.
•• Instruct them to move their hips in the frontal plane to the right away from the body until they touch a wall or
target. Move foot away from wall in small increments until it is no longer possible to touch the wall with hip.
Measure the distance and compare sides.
Look For:
•• Bent knee, falling into the wall, torso falling forward
•• Hugely important in balanced fitness through any lower body movement
4. Abduction:
•• Ask client to stand on right leg with tip toe of left leg touching the floor for balance.
•• Instruct them to move hips in the frontal plane to the left towards the body until they touch a wall or target.
•• Move foot away from wall in small increments until it is no longer possible to touch the wall with hip. Measure the
distance and compare sides.
Look For:
•• Bent knee, falling into the wall, torso falling forward
•• Hugely important in balanced fitness through any lower body movement
5. Internal Rotation
•• Ask client to stand on right leg with tiptoe of left leg touching the floor for balance.
•• Have client place a PVC pipe on PSIS a rotate hips to the right in the transverse plane.
•• Take a measurement of the angle of rotation from the starting position for both left and ride sides.
Look For:
•• Front foot coming off the ground or slipping
Implications for Training
•• Look for squat mechanics to be limited if there is a large discrepancy
20
Level 1 Assessment
6. External Rotation:
•• Ask client to stand on right leg with tiptoe of left leg touching the floor for balance.
•• Have client place a PVC pipe on ASIS a rotate hips to the left in the transverse plane.
•• Take a measurement of the angle of rotation from the starting position for both left and ride sides.
Look For:
•• Watch CLOSELY for planted foot to come off the ground
•• Look for squat mechanics to be limited if there is a large discrepancy
Thorax
Test: Thoracic movement in all three planes of movement.
1) Rotation:
•• Stand behind client and ask them to internally rotate both feet.
•• Then ask them to rotate both ways and note any differences between the sides.
Look For:
•• Feet to come off the ground
•• Knees to bend
•• Be careful of high speed sprinting with lack of rotation and high load lunges
2. Flexion/Extension:
•• Ask client to gently roll forward vertebrae by vertebrae noting any flat areas of their spine.
•• For extension do the opposite and ask client to lean backwards notice how much movement comes from the back
in relation to the hips.
Look For:
•• Lack of control
•• Hips shooting forward and/or bending coming from lower back
Implications For Training:
•• Flexion: High repetition movements off the floor
•• Extension: Ability to overhead squat
21
Level 1 Assessment
3. Sidebending:
•• Ask the client to sidebend to the right then to the left noting how far the same side hand travels down the outside
of the leg.
Look For:
•• Forward flexion
•• Single Leg loaded activities, high repetition hip extension activities
Shoulder
1) Scratch Test:
•• To test your left shoulder flexibility, stand and raise your right arm straight up overhead.
•• Bend your right elbow and let your right palm rest on the back of your neck and slide it down your back and
between your shoulder blades.
•• Reach behind you with your left hand so the back of your hand rests on the middle of your back.
•• Now slide your right hand down and your left hand up to try to touch the fingers of both hands. Measure the
minimum distance between the fingertips of the right and left hand. Record any overlap as well.
•• Switch your hands to perform the test on the opposite shoulder.
Look For:
•• Excellent = Fingers Overlap
•• Good = Fingers touch
•• Average = fingers are less than two inches apart
•• Poor = Fingers are more than two inches apart
•• - Single arm vs double arm work to create balance and volume of upper body movements
22
Level 1 Assessment
2. Rope Test: (results for norms in inches)
•• One needs a piece of rope approx. 1-1.5 metres in length and tape measure.
•• The client holds the rope in front of them with both hands shoulder width apart. The athlete extends the arms over
their head and down behind them (allowing the hands to slide along the rope as they do so) until the rope touches
their lower back.
•• The athlete holds this final position whist measurements are recorded. The assistant measures and records the
distance between the tips of the athlete’s thumbs.
•• The assistant measures and records the shoulder width.
•• The assistant subtracts the shoulder measurement from thumb measurement and records the result. The test is
repeated three times and the longest distance, following subtraction, is used to assess the athlete’s performance.
Rating
Excellent
Good
Average
Fair
Poor
Men
<7.00
7.00 - 11.50
11.51 - 14.50
14.51 - 19.75
>19.75
Women
<5.00
5.00 - 9.75
9.76 - 13.00
13.10 - 17.75
>17.75
23
Level 1 Assessment
Summation Scoring System (SSS)
Remember these 10 tips when taking measurements at all sites:
1. Thumbs down at each site approach
2. Calipers in R hand sweep and pinch with L hand
3. Take measures on R side of body entire way down
4. Sit down for cheek score, might have to kneel, squat to get triceps, chin, possibly calf
5. Calipers must be perpendicular to each respective site on the skin
6. Do not “clank” the calipers, treat them with care so as to not de-calibrate them
7. “2 one thousands” hold on each site - take reading at this time
8. 11 total sites, 10 for males, 10 for females, no pec on female taken, no hamstring on
male taken
9. One score taken per site
10. Note facial hair, scarring, changes in sites, etc...on notes for retesting purposes
24
Level 1 Assessment
Chin
Site: Halfway between where neck meets under body of chin to bottom point of chin
Pinch: Just forward of site, vertical fold, calipers downward for reading
Notes: Ask for shaven or note inability to test due to hair; usually no issues with scoring if repeated with same hair
approximately over time. Keep head straight forward and level with horizon.
Norms (chin and cheek): No norms as its on a per person basis from test to retest; does go into overall score but not a
major score to determine “health sum” scores. This site as well as the cheek site requires more data over time with each
client to discover any necessary adjustments; usually changes given in food intolerances will lead to changes in facial
score.
Coach’s Notes (chin and cheek): Most times when folks change their foods alone when they leave before they train and
return for a program this score will change significantly. Combine food changes to allow less “burden” on the system and
some exercise and you got leaner faces – also a very marketable one for beginners as all others can see it.
25
Level 1 Assessment
Cheek
Site: Left cheek; halfway between cheek bone and corner or visible mandible bone
Pinch: Just above site, vertical fold, calipers are parallel to floor
Norms (chin and cheek): No norms as its on a per person basis from test to retest; does go into overall score but not a
major score to determine “health sum” scores. This site as well as the cheek site requires more data over time with each
client to discover any necessary adjustments; usually changes given in food intolerances will lead to changes in facial
score.
Coach’s Notes (chin and cheek): Most times when folks change their foods alone when they leave before they train and
return for a program this score will change significantly. Combine food changes to allow less “burden” on the system and
some exercise and you got leaner faces – also a very marketable one for beginners as all others can see it.
26
Level 1 Assessment
Pec - Males Only
Site: Right side; halfway between under arm crease with arm at side and nipple
Pinch: Above site; slight diagonal fold, calipers follow diagonal, reading facing you
Notes: Get client to flex chest and determine difference in fascia and fat reading (this is VERY important and can be the
determinant between discovering a lack of testosterone or an abundance)
Norms: Ideally, we want the pec and tricep to be equal and between 2-5 mm; the closer and within range they are the
better; there is a direct relationship between the pec and tricep score; when pec is higher and out of range, based upon
testing I have done alone with my clients (hematology + sex hormone balance tests) the male might have adequate
anabolic hormones but is aromatizing it into estrogen usually due to lifestyle factors (i.e. tricep is 5, pec is 23); when
both the pec and tricep are high and out of range, the distance they are from 2-5 indicates the severity of the hormonal
imbalance (i.e. pec 23, tri 28); when both tricep and pec are high, it usually means a lifestyle + physiologic combination
causing the fat storage
Coach’s Notes: High pec sites and higher stress lifestyle usually go together. This site in specific is seen more and more
today, be on the lookout! Ask some questions in lifestyle consult as well about what you are comfortable with in describing
libido, mental acuity, “drive”, etc...
27
Level 1 Assessment
Tricep - Males
Site: Right arm; halfway between elbow and crease of underarm; arm 90 degrees from body with elbow at 90 degrees;
lowest part of tricep on hanging is best site at the halfway point described above
Pinch: To left of site; on straight line between elbow and underarm
Notes: Ask client to voluntarily bend elbow and arm to get each at 90 deg
Norms: We want the pec and tricep to be equal and between 2-5 mm; the closer and lower they are the better; there is a
direct relationship between the pec and tricep score; when the triceps are higher and out of range, the male might have
inadequate anabolic hormone production/metabolism based upon testing I have done alone with my clients (hematology +
sex hormone balance tests) (i.e. tricep is 15, pec is 3); when both the pec and tricep are high and out of range, the distance
they are from 2-5 indicates the severity of the hormonal imbalance as mentioned in pec norms
Coach’s Notes: If interested, ask client for a blood write up just to have “on file” to ensure adequate blood profile (this is
NOT a diagnosis, its for your own learning to see how things are)
28
Level 1 Assessment
Tricep - Females
Site: Right arm; halfway between elbow and crease of underarm; arm 90 degrees from body with elbow at 90 degrees;
lowest part of tricep on hanging is best site at the halfway point described above
Pinch: To left of site; on straight line between elbow and underarm
Notes: Ask client to voluntarily bend elbow and arm to get each at 90 deg
Norms: We want the site of tricep close to 10; between 10-15 is healthy, 15-20 is tinkering on the edge of an imbalance
and 20+ is usually an imbalance in the sex hormone pathway of androgens; females who use the birth control pill, have
not done any true anabolic training and may be prone to having higher estrogen levels due to dysfunction or lifestyle have
higher scores here – side note; the higher this score usually is associated with a higher prevalence of child bearing; strength
bias work and short term work sessions can lower these scores as opposed to hormonal changes only through drugs or
supplementation and/or lifestyle changes
Coach’s Notes: This one and the lower body scores are being implicated more and more over time in associations to
certain dysfunctions – as an example ! (Aberrations In Adipose Tissue Could Increase Risk Of Diabetes In PCOS A study
from the University of Gothenburg, shows that women with polycystic ovary syndrome (PCOS) have aberrations in their
adipose (fat) tissue. This discovery could provide answers as to why these women develop type 2 diabetes more readily,
and shows that it is important for their health that women with PCOS do not put on weight. http://www.medicalnewstoday.
com/articles/213937.php)
29
Level 1 Assessment
Subscap
Site: Right scapula – lower inside border, approx 1 cm from this border down and in
Pinch: To left and slightly above site; diagonal fold downward from left to Right; calipers facing up; ask client to relax
shoulders
Notes: Ask client to relax shoulders completely; describe to females where the site will be prior to assessment by pointing/
touching or showing on a picture (use your discretion); ask females to wear preferably a T back bra for exposure and they
MUST have same bra on next test or note in testing as disturbances in area can change scores dramatically;
Norms: This is an important site mostly related to the management of the interplay b/t insulin and cortisol; we want the
subscap to be between 8-12; this is optimal “function” of how well a person manages the stress/sugar balance; 12-20 is out
of balance and is the same prescription as higher insulin sites with a balance of good lifestyle management strategies on
stress and proper fuel execution daily; scores over 20 are VERY important to see as a possible triad between dyslipidemia,
insulin resistance and/or metabolic disorders and should receive attention.
Coach’s Notes: Refer to a medical professional to ensure all things are “good to go” before training (this is from readings
in syndrome X and chest circumference alone; this high upper back score has been implicated in many of the findings
around the triad)
30
Level 1 Assessment
Midaxilla
Site: R side – halfway down between under arm and iliac crest (usually just below serratus where ribs are)
Pinch: Diagonal fold from left to right downward following fascia of the area described above; pinch above to left of site,
calipers on same diagonal facing you
Notes: Ask client to raise arm to side and approach at 45° angle to client in front; ask females to assist in raising bra or
mention where the site will be done before hand as in subscap site above
Norms: We want the score to be the same as the subscap only in terms of what OPEX has seen in balanced individuals
comparing body fat scores to diagnostics; 6-10 preferred, 10-20 outside of range and 20+ an imbalance of unhealthy
magnitude; we have seen changes in this site based on CP’s original “thyroid” site scoring when there have been thyroid
based drugs or changes in thyroid function (i.e. removal of thyroid cysts or rubs being given have substantially reduced
this site even in relation to all other scores) but not enough changes have been seen when lifestyle/exercise changes have
occurred; these sites change in relation to subscap, iliac and umbilical sites and are ¼ of the mid section scoring for health.
Coach’s Notes: Use this ONLY as another mid section score for a sum of mid section summation for health.
31
Level 1 Assessment
Iliac
Site: Right side; approx 1 cm above iliac most outside portion of iliac crest on side of client
Pinch: Just to left of site; get client to side bend away as you place thumb on iliac crest; as they come back to normal
standing, pinch here; fold is parallel to floor and “slightly” diagonal downward from back to front based on feel of fascia
Notes: Ask client to raise arm to side and approach directly from side bending under raised arm; asking client to place hand
on head is sometimes good; remind clients about where the site is to be taken before hand to ensure if you have to move
any clothing is a good idea
Norms: This is an important site mostly related to the management of the interplay b/t insulin and cortisol; we want this
site to be between 6-9 (yes that is right; most sites you will take are NOT in this area – but this does not mean that this
is not where we need them to be); sites from 10-14 are just out of balance and insulin management does take care of this
easily and fast alone; 14-20 is usually associated with other sites being out of balance (usually a cortisol function over
riding the management of blood sugars) and 20+ again has to be approached as in the high subscap score as above with
close management and maybe more diagnostics outside of our scope; this site can change alone in managing blood sugar
appropriately; it is also ¼ of the mid section health site score that is a good marker of overall health.
Coach’s Notes: Watch this site closely; it has had a very good record in change along with ONLY carb changes alone – both
with changes in the quality and the quantity.
32
Level 1 Assessment
Umbilical
Site: Approximately 2 cm to the left (facing client) of the umbilicus; vertical fold
Pinch: Just above site in a vertical fold pinch, caliper reading is face up
Notes: Ask client to hold shirt if shirt is on; relax belly – 50% of folks will find it hard to relax belly and when touched will
contract abs (site CANNOT be taken unless abs are relaxed); relax arms at sides for those without shirts and approach site
45 deg from the front of client
Norms: An important site that may have larger implications in cortisol management (a very under looked and quite
complex situation – i.e. it is more than “you are stressed, your belly is fat”; some can have a thermometer that has deeper
levels of elevated cortisol for more reasons that just “lifestyle” stress; we want the umbilical site to be at or below 10) Note:
You will have almost 98% of the clients you test scoring higher than 10, much higher. This is a reflection of the norms set by
society on what they think leanness is and should be and what health parameters believe it should be. 10-20 is slightly out
of balance and can be changed easily (although the spread is larger in number; when clients start in this area, they have a
good chance of creating balance; 20+ is unhealthy (if health is defined as sound mind, body and spirit) and requires extra
work as well as a complex interaction of lifestyle, nutrition and exercise balance to change (discussion); this site is also ¼
of the mid section BF sites and overall health scores.
Coach’s Notes: Watch for this site to be implicated more and move over time with “stress” scores.
33
Level 1 Assessment
Thigh
Site: Right leg halfway between crease at hip when flexed forward at 90 degree and top of kneecap
Pinch: Slightly above site; a vertical fold perpendicular to the floor; site leg foot is on floor; weight must be on opposite leg
(i.e. leg of site must be relaxed but foot on floor, slight bend in knee)
Notes: Ask client to hold onto a chair or object to keep their balance while measuring (can be done with tape measure or
hands) the halfway point between hip crease and knee cap; ask client to keep leg up as you find site; pant legs are very
tough to pull up past mid thigh so shorts are recommended for all
Norms: This site along with the quadriceps site is considered a site that may have some correlations with estrogen and its
metabolites. There have been to date no direct changes in lower body fat changes based on a certain prescription except
for multiple cases of the same group that have been noted over and over – for males that have thigh skinfolds over 20 and
start using anabolics their legs DO decrease in the thigh score; and for females that have not unhealthy but higher scores
on the thigh, when they incorporate high lactate sessions on the legs 3-4x/week their seems to be a direct change at site
measures (have seen this with male drug users and female fitness models in particular)
Coach’s Notes: Through CP’s biosig stuff, the thigh measure was not always taken with my scoring as calf was always
a good indicator for LB fat storage. With the SSS, it is important to see changes that occur in the thigh and hamstring
measures – thigh for male only and thigh and hamstring for female for more sites in the LB where females tend to store
more bodyfat relative to males.
34
Level 1 Assessment
Hamstring - Females Only
Site: Right leg; halfway between bottom lip of gluteal fold and under side of knee in middle of hamstring belly
Pinch: There are a few methods of getting this score; it is based on the comfort between client and coach; as long as you
repeat the same method each time with this client, it will be repeatable (fold is always on a straight line between butt and
knee): lying – ask client to lie on belly; approach client from side; find halfway point, pinch just to the L of site and take
measure standing
Notes: Ask client to place weight on non site leg; find halfway point and approach client frombehind; pinch site just above
and record with caliper dial facing up foot on chair – ask client to place foot on chair and from underneath the belly of
hamstring take site as in tricep scoring (with this method the halfway point is usually NOT the lowest point in hamstring
visually so ensure you mark spot first, then take site) pinch just to left of site on vertical fold with calipers straight down
Norms: This site along with the quadriceps site is considered a site that may have some correlations with estrogen and its
metabolites. As with notes in quadriceps site, there is not enough data on this site alone because of the lack of scoring in
the body composition software OPEX had used; but this is an important site for management of estrogen and 2nd site for
females for changes.
Coach’s Notes: As with triceps, this site has some interesting associations with changes in;
1. usage of the pill, association with timing of menses (if client reports water retention around menses) as well as
2. pre/post natal scoring
35
Level 1 Assessment
Calf
Site: Medial aspect of right calf at the level of maximum girth so that the fold taken is vertically along the midline. Visually
determine maximum girth. It is NOT necessarily the ½ way point from knee cap to ankle.
Pinch: A vertical fold so caliper reading is facing up, pinch just above site, a vertical fold perpendicular to the floor
Notes: Ask client to place foot on chair (this is necessary as keeping it on ground keeps tension in the calf); this site has
been called a GH site and to date I have not correlated enough data to say for sure that there is direct links between blood
tests of IGF-1, sleep and recovery (3 of what I think are the main indirect diagnostics for GH levels) and the calf site. It is
an impt site though for overall LB fat scores in correlation with the hamstring and thigh measures as sometimes you’ll see
changes in the LB and not in the upper body scoring, interesting eh?
Coach’s Notes: Use this site ONLY as another lower body accumulation score for body fat.
36

physical assessment - OPEX Membership Site

Transcription

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