MSK Fitness Tests

Grip Strength - Overview

- Measure of isometric strength and is a widely used indicator of total body strength
- Predictive of functional limitations and disability later in life

Grip Strength Protocol

- Adjust the dynamometer to for the 2nd joint of the fingers under the handle

- Hold the dynamometer with the forearm at the level of the thigh away from the body

- Squeeze the handle vigorously while exhaling

- Measure each hand twice, alternating trials with each hand

- Record to the nearest 1kg

Grip Strength - Scoring

Combine maximum scores form each of the left and right hands to the nearest 1kg

Push Up Test - Overview

- Measure of muscular endurance of the chest, shoulders, and arms
- Muscular endurance is important in the performance of everyday tasks, such as carrying groceries, or shoveling snow which require repeated submaximal contractions over a prolonged period of time

Push up Protocol

- Lie on stomach, legs together, not touching

- Hands pointed forward, positioned under the shoulders

- Females use knees as pivot point

- Instruct the client to focus on floor as they complete each push-up

- Keeping body in good alignment, extend the arms pushing the torso up

- Chin touches the mat in the down position (stomach and thighs do not touch mat)

- Repeat as many times as possible with no time limit

- Encourage the client to breathe throughout

- Stop the test when:

- The client strains forcibly

- Unable to maintain the technique over two consecutive repetitions

- Incorrect repetitions will not be counted

Sit and Reach Test - Overview

- Most common way to measure hamstring and lower back flexibility
- Considered valid and reliable measure of general flexibility
- Tightness of hamstrings and lower back is an indicator of current poor back health
- Reduced flexibility has been associated with adverse functional outcomes, which may limit one's ability to perform activities of daily living, leading to loss of independence
- Reduction in stride length, owing to a decreased flexibility of pelvis and hip, combined with reduced leg strength and power, is a major contributor to limited mobility and walking speeds of older adults

Sit and reach Protocol

- Before the test: (warm up)

- Performs modified hurdler’s stretch

- Twice with each leg, holding the stretch for 20 seconds

- Client sits on floor with legs extended, without shoes. Balls of feet against cross board

- Inner edge of the soles 6 inches apart

- Instruct clients to concentrate on pushing the sliding marker and to lower the head and exhale to maximize the distance reached

- Arms fully extended, palms down, index fingers side by side pressing against the sliding block

- Hold flexed position for 2 seconds

If knees flex, trial is not counted

- Do not attempt to hold the knees down and do not allow the client to use a bouncing or jerking motion

Sit and reach Scoring

2 trials recorded to the nearest 0.5 cm

Use highest score to determine rating

Vertical Jump Overview

- Measure of peak leg power or the ability to contract the leg muscles with speed and force in one explosive action
- Muscular power has important implications for functional capacity and independent living, especially as one ages

Vertical Jump Protocol

Client:

- Stands next to wall and reaches as high as possible with palm toward wall and feet flat on the floor

- Record standing reach height to nearest 0.5 cm

Measurement:

- Client moves so elbow width from the wall

- Instruct the client to concentrate on the tape as they jump as high as possible

- Squat down to a balanced semi-squat, arms down and back

- Should pause for 1-2 seconds and then jump as high as possible – arms fully extended

- Record peak jump height to nearest 0.5 cm

- Perform 3 trials with 10–15 seconds recovery between trials

- No run up, step up or pre-jump is permitted (feet flat on the floor to start).

Vertical Jump Scoring

Subtract the stand and reach measurement from the best of the three jump and reach trials to get the maximum difference

Back Extension Overview

- Measure of isometric endurance of primarily the back extensor muscles
- Lower back pain is a significant public health concern
- Evidence suggests that good isometric trunk endurance may help prevent lower back pain

Pre screening requirement - Back extension

- Not suitable for clients with current back discomfort or pain
- All clients who do not knowingly experience back discomfort or pain should lie prone on a mat and perform a single straight-leg extension with each leg, followed by the same straight-leg extensions combined with an extension of the opposite arm
- If there is discomfort or pain the test should not be done

Back Extension Protocol

- Briefly explain the purpose of the test and describe the protocol in full including test termination criteria. - The QEP should demonstrate proper body position before beginning the test with the client.
- Have the client lie face down on the mat with the iliac crest positioned at the edge of the platform and the hips, shoulders, and head aligned. (The client can support their upper body by placing the outstretched hands on the floor or a chair). - Secure the client's lower torso by holding the lower thighs or upper calves. - Alternatively, use two padded support straps to secure the client with one placed at the gluteal crest and the other below the knees. Do not straddle the client or hold the ankles. The protocol should not be conducted if the QEP cannot safely and securely anchor the client to the bench.
- Once the client is secured, have them raise and cross their arms on the chest and concentrate on the floor as they hold the horizontal position (Figure 4.10). This horizontal position must be held with no rotation or lateral shifting as long as possible to a maximum of 3 minutes (180 seconds).
- Test termination criteria is as follows: 1) client experiences pain, discomfort or fatigue; 2) client's torso drops below the horizontal (allow for one warning and adjustment), or 3) reaches the maximum time.
- Record the time the horizontal position is held to the nearest 0.1 second.
- Immediately upon test termination, help the client off the step. Ask the client to lie on their back with both knees bent for one minute (which relaxes the back muscles).

Back Extension - Scoring

Record number of seconds the horizontal position is maintained

Forearm Plank - Overview

Activates anterior core muscles more than posterior core muscles

forearm plank protocol

- Have the client lie prone on a mat with elbows in contact with the ground.
- Upper arms directly beneath the shoulders and forearms should be in a neutral position with hands in front of the elbow.
- Feet should be narrow but not touching.
The timing starts when the client raises the pelvis from the floor assuming a rigid anatomical body position so that only their forearms and toes support the body.
- Have the client concentrate on the floor as they hold the forearm plank position.
- The timing continues until:
1. The client chooses to stop, or
2. Client experiences pain, discomfort or fatigue, or
3. The client cannot maintain the proper position as described above (after two consecutive corrective clues give)

Forearm Plank - Scoring

Record time in the horizontal position is held to the nearest 0.1 second

One leg stance Overview

- Static balance is the ability to maintain the center of gravity within the supporting base while standing or sitting
- It is essential for normal gait and is critical for activities of daily living such as turning, stair climbing, and dressing
- Direct relationship between lower levels of balance and risk of falls and fractures among older adults
- Balancing on one leg requires static balance, leg endurance, and integration of visual and inner ear signals and receptors in muscles and joints

One leg stance Protocol Eye open

- Starting Position (eyes open)

- Client stands barefoot behind or beside a sturdy chair on a flat floor surface

- Hands on opposite shoulders crossed in front of the chest

- Client chooses leg to balance on, lifting the other foot so that it is near but not touching the ankle of the standing leg.

- Ask the client to focus on a marker on the wall at eye level in front of the client for the duration of the eyes-open test.

- Time commences when the client raises the foot. Time ends when: 1) arms are moved (e.g., uncrossed); 2) the raised foot is moved towards or away from the standing limb or touches the floor; 3) the weight-bearing foot is moved to maintain balance (e.g., rotated on floor); 4) a maximum of 45 seconds has elapsed.

Eyes closed - protocol

- Starting Position and Measurement is the same as Eyes Open
- Time ends according to the same criteria as eyes open or when the client opens their eyes
- If the client loses balance during the first 3-s of the eyes-closed test, allow a second try to account for potential set-up error.
- Record the time for all trials.

One leg Stance Scoring

Take the best time for each of the eyes-open and eyes-closed to compare to means by age group and gender