Without the gym environment with wide scale options of kit, variations in ways to load, and machines to target specific tissues, the training experience has become a whole lot more challenging.
Yet the remote virtual coaching process still holds the same principles in place. One of which is that, in order to choose effective exercises for a client, you need to assess.
If you work in health and fitness your most important first principle should always be to do no harm.
Alongside a thorough subjective intake form, having a movement assessment that works in a remote coaching environment is a crucial component in clarifying whether this individual is right for you (does their expectation of remote coaching match your intended delivery), or whether a referral may be needed to an external source (Physio, GP etc…)
With In-Person sessions, our coaching assessment is a combination of both passive table tests looking at typical range of motion assessments as well as an active movement assessment of bodyweight patterns typically associated with training.
Taking training online naturally limits some of the more special tests we would commonly use to assess certain movement capabilities. But this isn’t to say we can’t get a similar outcome from remote assessments.
Whether it’s in person or remotely, we are trying to establish a baseline of what an individual is capable of from a movement perspective. At IFT, we separate our assessment process into those movements strategies that are more inhalation biased, and those that are more exhalation biased.
Inhalation and exhalation are entire body movements. The process of taking air in and expelling in on exhale has an impact on every joint within the body at a subtle yet profound level.
As we breath in, there are associated movements of OA extension and lower cervical flexion at the cervical spine (neck), the ribcage moves into it’s “pump handle” and “bucket handle” up position with elevation/protraction/external rotation of sternal ribs as well as posterior thoracic expansion.
We see decension of both the thoracic and pelvic diaphragms, movement of the illium into flexion, abduction and external rotation, counter-nutation of the sacrum, a decrease in lumbar flexion, relative adduction and internal rotation of the femurs, external rotation of the tibia and a foot that moves into a more planter flexed, supinated position.
All of this occurs to allow for in the increase in internal volume of air and subsequent displacement of the guts downwards as the lungs expand.
As we exhale we see a reversal in these movements, OA flexion, lower cervical extension, pump handle and bucket handle down, with depression retraction and internal rotation at the sternal and infrasternal ribs. The posterior thoracic spine moves into a more lordotic, compressed position.
Both the thoracic and pelvic diaphragms reascend as the illium moves into extension, adduction and internal rotation with a more nutated sacrum that increases the degree of lumbar flexion. The tibia likewise moves into a more internally rotated position and we see a foot moving into a more dorsiflexed, pronated position.
With every step that we take when walking or running, one side of the body should be moving through a phase of inhalation and the associated movements whilst the opposing side completes the opposite.
* Side-note: One of the fortunate evolutionary advantages of being an upright bipedal humans however, is that we don’t need to sync breathing with our phase of walking unlike our quadruped friends!!
Within our movement assessment we are trying to capture a glimpse of an individuals capacity to move between these full ranges of excursion from inhalation to exhalation. Our goal is to establish whether someone is showing a greater bias towards more inhalation or exhalation. As a result, if our goal is to improve the movement quality of an individual, we can make exercise selections that appropriately drive the training outcome we want to achieve.
The simplest representation is that inhalation is associated with flexion, abduction and external rotation. This is expansion and allows movement to occur. Exhalation is associated with extension, adduction and internal rotation. This is compression and allows for force to be produced and movement to be prevented.
For example, we may choose to select more inhalation-biased exercises for an individual who’s assessment demonstrates a stronger exhalation bias that may be limiting movement capabilities.
So what does our remote coaching assessment process look like?
Beginning with feet shoulder width apart, knees locked out, we asking the individual to reach down to their toes. This is a primarily an assessment of exhalation mechanics as the pelvis requires sacral nutation within a toe touch. Sacral nutation is an exhalation associated movement.
However we say primarily as for the sacral nutation to occur, we do still need a degree of expansion to occur in the lumbo-pelvic region and upper thorax to achieve this motion.
* for those interested, notice the two areas that appear flatter on the toe touch, the first around the lumbar spine, and the second between the the shoulder blades. Whilst I can get a full toe touch, it’s not uniform expansion of the posterior ribcage that allows it to happen…
Toe Touch to Full Squat
Our toe-touch pattern turns into a Toe-Touch to Full Squat which is a more inhalation-based assessment. For us to sit into the bottom of a full squat with heels down and the knees tracking straight forward, not having to turn out, requires the pelvis to move into its inhaled position of flexion, abduction and external rotation with a counter-nutated sacrum.
If we can Toe Touch, but cannot achieve the Full Squat position without some degree of compensation, we likely have an individual with a more exhalation bias that would benefit from an exercise selection that drives greater inhalation mechanics if the goal is to improve movement capabilities.
* I’m still limited in hitting true full depth on this one, this is where those two compressed areas within the toe touch have an effect!
Standing Shoulder Extension
The first two assessments could be consider more full body movements requiring us to move through a greater range of motion more similar to the type of exercises we associate with training.
However to confirm our suspicions, we also use isolated assessments specific to joints to further establish an individuals inhalation vs exhalation strategy.
For both the left and right shoulder and hips, we will assess in relative isolation the ability to externally rotate, abduct and flex, i.e. inhalation/expansion. As well as internal rotation, adduction and extension, i.e. exhalation/compression.
Our first assessment is Standing Shoulder Extension which assesses the ability to achieve “pump handle up” mechanics. If we can remember from our introductory paragraphs, this is an inhalation associated movement of the sternal ribs.
That’s right, inhalation in an assessment of exhalation abilities… specifically, for this internally rotated, adducted and extended position of the humerus, we need to be able to exhale/compress the back side of the ribcage to allow for the front side ribcage to expand and allow the pump handle to move into its “up” position.
For this to happen we need to ensure the humerus and elbow remain in an adducted position close to the body and moves straight back without deviating outwards.
* the goal is to reach 60 degrees of extension without the elbow moving away from the body, you can begin to see how mine is beginning to abduct away from midline at the very end. Any further and I’m compensating…
Back-to-Wall Shoulder Flexion
In counter to our assessment of Standing Shoulder Extension, we have Back-to-Wall Shoulder Flexion. Flexion as we have described, involves external rotation and abduct ion, whilst also being inhalation/expansion associated. In contrast for our extension measure, we need expansion of the back-side of the ribcage to allow the shoulder to move into flexion overhead without deviating away from midline.
Begin with back fully against the wall, hips tucked. Fingertips on the wall and your elbow pointing directly forward. Begin to flex the arm overhead without deviating away from the your body or allowing the elbow to turn outward.
Between our two upper body shoulder flexion and extension measures, we gather an understanding of the ability of an individual to move between the excursion of inhalation and exhalation. It is not uncommon to find that an individual may have bias more towards one range than another, greater flexion than extension for example, or even see limitations in both directions in those more compressed individuals who struggle to create any real degree of expansion to allow movement to occur.
* As I continue up the wall I begin to lose contact with my back and the wall. Any further and I begin to “tip” my ribcage back to get overhead…
Shoulder Internal and External Rotation
As we move down to the floor, our first assessments are confirmation of our Back to Wall Shoulder Flexion and Standing Shoulder Extension measures with isolated Shoulder External Rotation and Internal Rotation assessments. This is used to assess the abduction and external rotation portion of our shoulder inhalation assessment (flexion, abduction, external rotation) and the internal rotation element of our exhalation assessment (with the Standing Shoulder Extension having assessed adduction, extension and some degree of internal rotation).
A key component to note here is that these measures should all be confirmed positive for an individual to be deemed to have the full excursion or inhalation to exhalation.
For example if an individual has full shoulder flexion in Back-to-Wall, but doesn’t have isolated shoulder external rotation at 90 degrees of abduction such as in our Shoulder External Rotation assessment, we know that either a compensation has arisen within the test (i.e they’ve deviated away from the required movement and “cheated”) or the don’t have the capacity to get expansion in ALL areas of either the posterior or anterior ribcage associated with each movement.
* we’re aiming for approximately 70-90 degrees of total internal and external range in either direction for around 160-170 degrees of total excursion.
Knee to Chest with Compression
Knee to Chest with Compression is our Shoulder Flexion representation within the pelvis. To achieve the first part of our Knee to Chest with Compression, we need the knee to move directly toward the same side eye, not deviating away from midline, and to comfortably break 90 degrees.
We need the extended leg to remain fixed to the floor without rotating away from mid-line. This moves the hip from a position of inhalation and external rotation in the starting position, moving through exhalation and internal rotation around 90 degrees before we complete the final confirming movement.
The last step is to compress the knee into the abdomen without moving the hip into abduction away from midline or the extended knee flexing and moving away from midline. This final position assesses the ability of the individual to achieve a counter-nutated (inhaled) position of the pelvis and a relative rotation or lumbar spine towards the extended leg.
If an individual can cleanly perform this movement both sides, we know they have the ability to move the pelvis into its full inhaled representation having moved through the exhalation position (90 degrees).
* we should ideally be able to compress the knee fully into the abdomen to achieve the counter-nutated position. You can see how on this right side I can achieve the 90 degree position (exhalation) but cannot move fully into the inhaled, counter-nutated position.
Active Straight Leg Raise
The final assessment within our remote coaching process is an Active Straight Leg Raise. This is our last exhalation-biased measure with our aim being to achieve 90-100 degrees of leg raise with the extended leg remaining in extension without rolling into abduction away from midline.
With the knee extended and toes pointing towards the ceiling, the femur is positioned in a state of internal rotation (Screw-Home Mechanism) which is exhalation associated, as the leg is raised towards 90 degrees of hip flexion, the illium moves into an internally rotated, adducted, extended position, i.e. exhalation.
If we can achieve this 90-100 degree position on both sides of the pelvis with the extended leg remaining in extension, and not rolling into abduction away from midline, we can assume the individual has the capacity to achieve the exhaled position of the pelvis.
* aiming for 90-100 degrees without the extended leg moving into flexion or rolling away from midline.
Our testing protocol is designed to capture the movement capabilities of an individual in relation to their ability to move between the full excursion of inhalation and exhalation. Respiration is a huge driver of movement. We need to take into account the position of joints relative to phases of respiration and how this impacts the movement capabilities of our individual.
An inability to Toe Touch or a limited Active Straight Leg Raise are therefore not hamstring flexibility issues, but represent an inability to achieve the exhaled, nutated position of the sacrum needed to allow this movement to occur.
A limitation in Shoulder Internal Rotation doesn’t require a stretching of the joint to achieve the position. It requires activities that create the “Pump Handle Up” mechanics associated with inhalation of the anterior sternal ribs.
Whilst we may not be able to interact with clients in a face-to-face environment, we still have the capacity to make better exercise decision that increase movement quality and capacity, whilst giving us clear indications that our training is moving an individual in the intended direction.
If you have any questions as a client or coach, or have any virtual tests that you may have been using with good success, it’d be great to hear from you so get in touch!!