We're in the thick of it now!!! You're doing great. Just some helpful tips to keep you on the right track!!!

1. Make sure you read EVERY word of the ACE Booklet. Sometimes ACE will pull questions from the sentences that seem LEAST important. Read every word to make sure you won't get surprised.
2. Know the definitions to all the highlighted words!! They tend to come up a lot throughout the book. You'll see the same words again and again, try and commit them to memory and understand why ACE put them there in the first place.
3. The ACE study guide questions are KEY!! Do these over and over again, in the questions you miss go back to the references and re-read the parts that you didn't understand.
4. Don't worry too much about the Exercise Science booklet. The biggest takeaway will be the anatomy and the nutrition chapter.
5. Make sure to be solid on the math!! Many people report not having a lot of math in their ACE exam, I actually had a good amount! To be safe, study the math problems. Honestly, if you understand them their easy points!!

We're ready for the BIGGEST CHAPTER IN ACE. CHAPTER 7. I read chapter 7 SEVERAL TIMES. ACE loves this chapter and pulls I would say anywhere from 15-25 questions from this chapter alone is on the exam. That's almost 20% of your exam!! Here are some key concepts and a quiz to get you thinking in the right mindset, good luck and keep practicing!!

Here is a note format of key topics to focus on in chapter 7. Questions are sprinkled in through the notes. Try not to memorize but understand. That's why the questions aren't in a quiz or test format.

1. ADL-- Activities of daily living
2. Type 1 and Type 2 muscles
3. Type 1- slow twitch-- lower intensity
4. Type 2- fast-twitch--- fast intensity

This picture is an illustration of muscle fibers that are connected by the number of actin and myosin. Different types of muscle fibers produce different levels of intensity and work in different ways. The two main muscle fibers that you should focus on are Type 1 and Type 2.

1. What are deeper muscles called?
2. Type 1

• Muscle imbalances are highlighted so much in ACE because, in real life, you WILL see this! Most people who work at their jobs sit for most of the day. What does that mean? That means their hip flexors are fairly tight because of the tension and pressure confounded by being in the same position for multiple hours a day and not getting enough movement.

1. Kyphosis-excessive outward curvature of posterior curvature of the spine
2. Lordosis-increased anterior curvature of the spine
3. Scoliosis-lateral curvature of the spine

• Muscle imbalances associated with kyphosis/lordosis posture. In other words, this posture is associated with muscles that are shortened AND TIGHT. Hypertonic muscles-means tight muscles. So with a kyphosis/lordosis posture, what muscles would you expect to be tight?

• Hip flexors, lumbar extensors, anterior chest/shoulders, latissimus dorsi, and neck extensors.
• Think about the sitting in a desk analogy. With a rounded back and hyperextended lumbar spine, when you're sitting at a desk hunched over.... you're definitely going to have some tight hip flexors. This means there is going to be some tension when you move your knees to your chest. Your lumbar extensors are tight due to the hyperextended nature of the lumbar spine. The chest and shoulders are tight due to the rounding of the shoulders from kyphosis. Latissimus dorsi, the muscles on your sides are tight because there isn't much ab engagement going on. In fact, most likely, your abs are weak due to the hyperextended nature of the lumbar spine. Lastly, neck extensors are tight due to the rounding of the shoulder and hunched back, putting pressure on the cervical spine.
• (This is the way to kind of think through the question, imagine you are in a real-life situation. That's the only way to understand this question truly.)

• Now with Kyphosis/lordosis, which muscles would be lengthened?

• Almost the exact opposite. Hip extensors, external obliques, upper back extensors, scapular stabilizers, and neck flexors. What's tight in one part of the body will lengthen in the other side of the body. If you are tight on time, I would recommend memorizing the muscles that will be tight and know that the opposite side of those muscles is lengthened.
• For example, if hip flexors are tight, then hip extensors are lengthened—no need to memorize both shortened and lengthened.

• Muscle imbalances for flat back posture that are shortened/hypertonic/facilitated/tight?

• rectus abdominis, upper-back extensors, neck extensors, ankle plantar flexors

• Muscle imbalances flat back inhibited (lengthened)?

• Iliacus/psoas major, internal oblique, lumbar extensors, neck flexors

• Muscle imbalances with Sway-back posture- facilitated/hypertonic (shortened)?

• Hamstrings, upper fibers of posterior obliques, lumbar extensors, neck extensors

• Muscle imbalances sway back inhibited (lengthened)?

• Iliacus/psoas major, rectus femoris, external oblique, upper-back extensors, neck flexors

• Bend and lift screen (anterior feet compensation and tight and lengthened)

1. Compensation: lack of foot stability
2. Tight: Soleus, lateral, gastrocnemius)
3. Lengthened: Medial gastrocnemius, tibialis, and sartorius)

• Bend and lift screen anterior knees compensation, tight, lengthened

1. Compensation: move inward
2. Tight: hip adductor
3. Lengthened: gluteus medius and maximus

• Bend and lift-anterior-torso- If during a bend and lift screen you notice someone shifting to the side, which muscle would you expect to be tight?-lack of stability

1. Compensation: lateral shift to the side
2. tight/lengthened: side dominance and muscle imbalance due to potential lack of stability

• Sagittal (bend and lift) feet*** popular question. (If during a bend and lift you notice someone compensating with having a hard time keeping their heels to the floor- WHICH MUSCLE IS TIGHT?-plantar flexors

1. Compensation: feet, unable to keep heels to the floor
2. tight: plantar flexors

• You notice someone during a bend and lift struggling to initiate their movement. Which muscle is tight?

1. Hip flexor dominance, as well as insufficient activation of the gluteus group

• Someone's tibia is moving correctly during the hurdle step. Which muscle could be tight?

1. lack of dorsiflexion

• You notice a lumbar extension during a bend and lift. Which muscles could be tight and lengthened?

1. tight: latissimus dorsi, teres major, pectoralis major and minor
2. lengthened: upper back extensors, rectus abdominis

• What muscles are tight when the head is moving during bending and lifting?

1. Tight: increased hip and trunk flexion, cervical extensor region

• Hurdle step screen foot movement.

1. Tight: soleus
2. Lengthened: medial gastrocnemius, tibialis

• Hurdle steps screen knee movement

1. Tight: hip adductors
2. lengthened: gluteus maximus and medius

• Hurdle step screen hip movement

1. Tight: hip adductors
2. Lengthened: gluteus maximus

• Hurdle step screen torso movement

1. Tight: lack of core
2. Lengthened: lack of core

• Hurdle step screen raised leg movement

1. tight: ankle plantar flexors
2. lengthened: ankle dorsiflexion

• Hurdle step screen: Pelvis movement

1. Tight: stance-leg hip flexors
2. Lengthening: rectus abdominis and hip extensors

Shoulder movement: flexion, extension, abduction, internal/medial rotation, external/lateral rotation, shoulder horizontal adduction, shoulder horizontal abduction

(If you research the shoulder movements of shoulder flexion, extension, abduction..etc. Visually you can understand the concept, and these numbers will make more sense.)

• Flexion: 150-180
• Extension: 50-60
• Abduction: 180
• Internal/medial rotation: 70-80
• External/lateral rotation: 90
• Shoulder horizontal adduction:90
• Shoulder horizontal abduction: 30-40

Elbow flexion and extension

• Flexion: 145
• Extension: 0

Radio-ulnar pronation/supination

• 90/90

Wrist: Flexion, extension, radial deviation, ulnar deviation

• flexion: 80
• extension: 70
• radial deviation: 20
• ulnar deviation: 45

Cervical spine: flexion, extension, lateral flexion, rotation

• Flexion: 45-50
• Extension: 45-75
• Lateral flexion: 45
• Rotation: 65-75

Thoraco-lumbar spine: Lumbar flexion, thoracic flexion, lumbar extension, thoracic extension, lumbar rotation, thoracic rotation, lumbar lateral flexion, thoracic lateral flexion

• Lumbar flexion: 40-45
• Thoracic flexion: 30-40
• Lumbar extension: 30-40
• Thoracic extension: 20-30
• Lumbar rotation: 10-15
• Thoracic rotation: 35
• Lumbar lateral flexion: 20
• Thoracic lateral flexion: 20-25

Hip, flexion, extension, abduction, adduction, internal/medial rotation, external/lateral rotation

• flexion: 100-120
• extension: 10-30
• abduction: 40-45
• adduction: 20-30
• internal/medial rotation: 35-45
• external/lateral rotation: 45-60

Knee, flexion and extension

• flexion: 125-145
• extension: 0-10

Ankle-dorsiflexion, plantar flexion

• dorsiflexion: 20
• plantar flexion: 45-50

Subtalar: Inversion, eversion

• Inversion: 30-35
• Eversion: 15-20

Thomas test: when thigh does not touch table**super important

suspected: hip flexors

Thomas test: when thigh does not touch table, but leg reaches past 80 degrees

suspected: iliopsoas

Thomas test: when thigh DOES touch the table

suspected: rectus femoris

Shoulder flexion mobility:**super important

tightness: latissimus dorsi, abdominals, pectoralis minor

Shoulder extension:

tightness: pectoralis major, abdominalis, biceps brachii

Shoulder external shoulder rotation:

tightness: subscapularis

Shoulder internal mobility:

tightness: infraspinatus, teres minor

** Just a note, tightness means the area to stretch and try and get more flexibility for more comfort.

** If the back is tight, that usually means the chest is weak

** If one area is tight- stretch/ If one area is weak- strengthen it with resistance training

** So if your chest is tight----- then your back will be weak------ so stretch your chest and strengthen your back

Apley's Scratch Test

• scapular abduction and adduction
• internal and external rotation of the humerus

** In this test, look out for the client to touch the medial portion of the scapular. If they can't, that means there is some tightness.

Stork stand balance test

• Males: if more than 50 - excellent/ if less than 20-poor
• Women: More than 30-excellent/ if less than 10 is poor

***IMPORTANT - How to tell the difference between scapular protraction and winged scapular?

• Protraction: palms face backward-medial portion of scapular protrudes
• Winged: looks winged- inferior portion of the scapular