NASM CES cheat sheet

Corrective Exercise Continuum order is fixed: Inhibit → Lengthen → Activate → Integrate; each step targets the specific tissue or neuromuscular deficit identified in the screen.

Cumulative injury cycle: tissue trauma → inflammation → muscle spasm → adhesions → altered neuromuscular control → muscle imbalance → increased re-injury risk.

Altered reciprocal inhibition: a tight/short agonist reduces neural drive to its functional antagonist (e.g., tight psoas decreases gluteus maximus activation).

Synergistic dominance: a synergist substitutes for a weak or inhibited prime mover, becoming overactive and altering joint motion.

Relative flexibility: the body moves along the path of least resistance, so stiffness at one joint produces compensatory motion at an adjacent joint.

Neuromuscular efficiency requires three normal conditions: length-tension relationships, force-couple relationships, and arthrokinematics.

Davis's law: soft tissue remodels along lines of mechanical stress; Wolff's law: bone remodels along lines of mechanical stress.

Planes of motion: sagittal (flexion/extension), frontal (abduction/adduction, lateral flexion), transverse (rotation); motion is described in all three during screening.

Screening sequence: pre-participation health screen (PAR-Q) → static posture → transitional movement (overhead squat) → dynamic movement (single-leg squat, pushing, pulling) → hands-on tests (ankle dorsiflexion, manual muscle testing).

Overhead squat protocol: 5 repetitions, feet shoulder-width and toes forward, dowel held overhead; observe anterior and lateral views.

Knees move inward (OHSA): overactive adductor complex, TFL, vastus lateralis, short-head biceps femoris; underactive gluteus medius, gluteus maximus, vastus medialis oblique.

Arms fall forward (OHSA): overactive latissimus dorsi, pectoralis major/minor, teres major; underactive lower trapezius, rhomboids, serratus anterior, posterior deltoid.

Excessive forward lean (OHSA): overactive soleus, gastrocnemius, hip flexor complex, abdominal complex; underactive gluteus maximus, erector spinae, anterior tibialis.

Low back arches (OHSA): overactive hip flexor complex, erector spinae, latissimus dorsi; underactive gluteus maximus, hamstrings, intrinsic core stabilizers.

Feet turn out (OHSA): overactive soleus, lateral gastrocnemius, short-head biceps femoris, TFL; underactive medial gastrocnemius, medial hamstrings, gluteus medius/maximus.

Static posture is checked from anterior, lateral, and posterior views in a fixed sequence: foot/ankle → knee → lumbo-pelvic-hip complex → shoulders → head.

Ankle dorsiflexion test: knee drives toward the wall with the heel flat; limited dorsiflexion is linked to feet turning out and excessive forward lean.

Inhibit (self-myofascial release): foam roller or ball on the most tender area, 30–60 seconds per muscle, 1–2 sets; mechanism is autogenic inhibition via the Golgi tendon organ.

Lengthen (static stretching): hold at end range 30–60 seconds, 1–2 repetitions, performed after SMR; neuromuscular/PNF hold-relax uses a 3–10 second isometric contraction then a 20–30 second stretch.

Activate (isolated strengthening): 1–2 sets of 5–10 repetitions with a 1–2 second isometric hold and slow 2–4 second tempo, isolating the underactive muscle.

Integrate (dynamic movement): 1–2 sets of 5–10 repetitions of a whole-body movement at controlled tempo that retrains the activated muscle within the kinetic chain.

Static stretching held longer than 60 seconds immediately before maximal or power activity acutely reduces force and power output.

SMR contraindications: acute inflammation, open wounds or skin infection, varicose veins, bruising, and the abdomen/low back during pregnancy.

Selection rule: the overactive/short muscle is inhibited and lengthened; the underactive/weak muscle is activated and integrated.

Reciprocal inhibition explains why lengthening an overactive muscle can immediately improve activation of its antagonist during the activate step.

Corrective block parameters: 4–6 weeks, 2–4 sessions per week, approximately 10–15 minutes, placed before the resistance-training portion of the session.

Session order is invariant: inhibit → lengthen → activate → integrate → then the remainder of the workout.

Acute variables to set for every corrective exercise: repetitions, sets, tempo, rest interval, load, and exercise selection.

Tempo conventions: stabilization 4/2/1 (4 s eccentric, 2 s isometric, 1 s concentric); strength 2/0/2; power X/X/X.

Progression ladder: increase repetitions first, then sets, then complexity/range of motion, then load or speed.

Reassess with the same screen at approximately 4-week intervals; progress only when the compensation is no longer reproduced.

Program design is assessment-driven: findings dictate which muscles are inhibited/lengthened (overactive) and which are activated/integrated (underactive).

The corrective block can serve as the warm-up (10–15 minutes) or be delivered as a standalone session in Phase 1 stabilization programming.