Why We Assess Movement

Adam1

Let me start this post by saying stating the obvious if you’ve read any of my past writings:  I’m a fan of the Functional Movement Screen or FMS.  All new clients at Paragon Health & Fitness go through the FMS in one form or another before they’re ever asked to go through an entire exercise routine.

That being said, I do not work for Functional Movement Systems.  I do not collect any kind of commissions from them by promoting their materials.  I don’t believe that everything they do is perfect or right.  I do not use the Y-Balance Test or the Functional Capacity Screen.  I do not have any necessary allegiance to FMS, and as soon as I find something better, I have no problem jumping ship.

I am NOT writing this post to defend the FMS or anyone who works for them directly– they certainly don’t need my defending even if I were.  I am not writing this to defend anything that Gray Cook or Lee Burton or any of those guys have said over the last 8+ years since Cook wrote Movement.

I’m writing this because there seems to be a growing “anti-FMS” movement on the internet lately, and I think the majority of those behind this movement either don’t like the fact that Cook and others have found a way to become very commercially successful by branding their methods, or simply do not understand the FMS and how to implement it.

If you have no idea what I’m talking about when I say FMS, I explained the FMS here, and also explained what the FMS is NOT here. In short, the FMS is a relatively simple, 7-movement screen, designed to look at some basic human functions and help us make decisions about the next step in your exercise program.

Recently, I’ve come across several studies like this: https://www.ncbi.nlm.nih.gov/pubmed/26502447

“CONCLUSION:

Based on analysis of the current literature, findings do not support the predictive validity of the FMS. Methodological and statistical limitations identified threaten the ability of the research to determine the predictive validity of FMS.”

To which I say…No shit.

Maybe I missed something along the way, but I’ve never looked at the FMS as a method to predict injury.  So many of these recent studies really seem to be asking the wrong questions when it comes to the FMS.  To think that a movement test, which takes approximately 15 minutes to complete, could accurately predict something with as many variables as athletic injury rate is beyond irresponsible.

So…if we don’t use it to predict injuries, why do we use it?

Let me give you an example of the FMS in use.  We recently had a small group of athletes (6 kids ages 13-15) start their off-season strength and conditioning program at Paragon, all of them working out together.  During their first visit, we had each athlete perform an FMS.

We had 2 kids who’s Active Straight Leg Raise (ASLR) test looked like this:
ASLR 3

Two other’s ASLR looked like this:
ASLR 1

The other two kids were somewhere in between the top image and the bottom image.

Now, did we humiliate and chuckle at the kids who fit into the bottom image category?  No.  Did we get our goniometers out and try to measure their degrees of hip flexion and then foam roll their hamstrings until they got to 90 degrees?  Nope.  Did we even address the “issue” with them or try to “fix” it?  No.  Because our our eyes, as long as it’s not painful, this may not even be something that needs “fixing.”  And if it does need fixing, as trainers/coaches, we very well may not be the appropriate professionals to be doing the work.  How do I know that hip doesn’t have some kind of structural abnormality that no amount of core strength + foam roll + stretch will help?  The answer is we don’t know.

What I do know is I am going to treat the kids who look like the top picture a bit differently than the kids who look like the bottom picture.  On top, I have no reason to believe they can’t learn how to deadlift from the floor, power clean, etc. from day 1.  The kids who look like the bottom picture may not learn how to deadlift from the floor day 1, but maybe a Rack Pull (picture a deadlift, but with the bar elevated from the floor), or a kettlebell deadlift from a step, etc. could be an option.

Since it wasn’t painful, I fully believe that we can work with and help all of the above, and over time, I believe that intelligent training will lead to improved movement, which may open the door for the kids who look like Picture #2 on Day 1 to do all of the things the others are doing.  In the meantime, I’m going to put those kids into a position where they can succeed and let them thrive and get stronger in those positions.

Brief aside: What if one of those movements (or any other in the FMS) had caused some kind of shooting pain, tingling sensation, or numbness?  I’m going to work with them on the patterns that aren’t painful, and suggest they go see a health care professional (physical therapist, chiropractor, MD, etc.) to address the painful pattern.  This may seem like I’m being overly cautious, and in most cases I will be more cautious than I need to be…However, and I’m only saying this because I honestly have seen it happen in my career…

How do you know that your client’s lower back is a “tight muscle” or “weak spinal erectors,” and not bone cancer?  Seriously trainers, do you think you’re qualified to answer this question?  You’re not.

Back to the athletes mentioned above– In less than 20 minutes total, I was able to put 6 kids through an FMS and found that none of them had any pain, but two of them had significantly different active hip Range of Motion than the rest of the group.  I was then able to quickly create an initial program for the entire group, with some slight modifications for those differing movement patterns.  I’m not sure how anyone could argue the benefit of such an analysis.  I’m confident that by spending 20 minutes up front to evaluate these things, I’m saving a bunch of wasted training time down the road.

So if we return to the question posed above– if it’s not for injury prediction, what is it for?  The answer is pretty simple to me– The FMS provides us with a road map of where we should go next.  It’s then our choice whether or not we follow that road map.  Just because you don’t follow a road map, that doesn’t mean you wont get to where you’re trying to go, I’d just argue that there is some kind of “cost” associated with ignoring the map.

Can your joints actively get into position to absorb and adapt to whatever stress we’re about to put on them?  If yes— get after it!  If no–either change the joints or change the stress.

 

 

 

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What to Expect during your FMS

What should you expect when you receive an FMS Screening?

My previous several posts have talked about movement: Why it’s important to assess movement, where the Functional Movement Screen (FMS) comes in handy, and some common misconceptions of the FMS. Until now, I’ve spoken mostly in generalities about movement and the FMS. Today I want to get a little more in depth about the individual tests of the FMS, so that when you get your first screening you have an idea of what to expect.

To review, each movement on the FMS is scored from 0 to 3. 0 indicates pain and 1 indicates a severe movement dysfunction, while 2’s and 3’s are passing scores. 5 of the 7 movements have left and right components, meaning that each side of your body is tested independently and receive independent scores.

Deep Squat

The first movement on the FMS is known as the Deep Squat. The deep squat tests ankle, hip, upper back, and shoulder mobility while simultaneously challenging stability of the knee, “core,” and shoulder in a symmetrical stance. The client is asked to maintain an upright torso with arms overhead while they descend into as deep of a squat as they can comfortably reach. We use this pattern on a daily basis from tasks such as picking up a basket of laundry to standing up off the toilet.

Hurdle Step

No, you’re not jumping over hurdles…fear not. The Hurdle Step movement is a test of balance in a single-leg stance while also challenging hip mobility and “core” stability. The client is asked to maintain an upright torso while stepping over a hurdle. The hurdle step pattern is used any time we stand on one leg for any period of time.

Inline Lunge

FMS Lunge

The Inline Lunge tests the client’s ability to maintain an upright torso while going through knee, hip and ankle flexion and extension in an asymmetrical stance. In these first three tests, the client is put into what is referred to as the “3 foot positions of function”: Symmetrical, Single-leg, and Asymmetrical. Every standing position that we find ourselves in throughout the day, including athletic events, can be narrowed down into one of these three foot positions and so getting assessed in each of these positions is crucial. We use the inline lunge pattern any time we go up and down stairs.

Shoulder Mobility

The shoulder mobility test is self-explanatory. We challenge the mobility of the client’s glenohumeral (shoulder socket) joint as well as their thoracic spine (upper back) mobility in a bilateral reaching pattern. Limitations or asymmetries on the shoulder mobility test will almost always show up on one or more of the previous 3 tests, showing the importance of shoulder mobility to basic fundamental movements. An asymmetry here can be a red flag for upper body strength training. Think of an overhead pressing movement: If you connect asymmetrical shoulders to a symmetrical load (such as a barbell or even a machine such as the seated shoulder press machine), and you do this consistently, the body will favor the “good” side and it’s only a matter of time before that asymmetry is exacerbated. Eventually a shoulder injury can develop from over-use of the “good” shoulder joint.

Active Straight Leg Raise

The Active Straight Leg Raise test looks like a hamstring flexibility test, and certainly the tension of the hamstrings plays a role in your score, but there is a lot more going on here. The client is asked to raise one leg as high possible while keeping the opposite leg flat on the floor. Sounds like a hamstring test to me, but we are challenging the ability to stabilize the pelvis (“core”) while one leg remains extended on the floor and the other leg goes through an excursion. We see this well…all the time. Any time you take a step whether you’re walking, jogging, sprinting, going up and down stairs, etc., your body has to subconsciously stabilize your pelvis while one leg strides and the other stops you from falling on your face. This happens naturally in the ideal situation, but as we incur injuries and age, we start to lose some of our ability to efficiently complete this basic task. An intervention which improves the Active Straight Leg Raise can have a profound effect on the rest of our basic movements.

Trunk Stability Push-Up

The Push-Up test is another deceptive movement. It looks like a test of upper body strength and certainly if we asked you to do more than 3 of these we would be getting into an area of strength and/or muscular endurance. For the purposes of this test, however, we are again looking at your ability to maintain a rigid torso- a common theme for the FMS- while producing movement in your extremities. This movement pattern shows up at various times throughout the day and is often taken for granted until the ability to perform it is taken away. Ask anyone who has been bed-ridden for a period of time or any senior citizen who has fallen. They’ll tell you how hard it can be to push yourself up out of bed or to get from the floor to a chair or couch. This test is not just for the elderly or sick though. Just about any athletic endeavor requires the individual to reflexively stabilize their spine. Think of the lineman in football who will either reflexively stabilize their spine or crumble to the ground every time they’re hit. It’s another process we don’t think about doing- until we can’t.

Rotary Stability

The final FMS test is called the Rotary Stability test.  The test takes place with the client in a quadruped or “all-fours” position on the floor.  The client is asked to maintain the natural alignment of their spine while flexing and extending their hip and shoulder simultaneously.  This is an assessment of core/spinal stability in the presence of extremity motion.  It does not look all that “functional,” but is a very good window into the function of an individual’s deep core musculature.  Our last 2 tests- Trunk Stability Push-Up and Rotary Stability- also represent important landmarks in our development as humans throughout the life cycle.  Our ability to push ourselves up from a prone position and to crawl are seen very early on in life and are two skills that tend to drastically diminish in adulthood.  Improving these two natural human movements can have a very large carry over to quality of life as we age.

There you have a very basic rundown of the tests found on the FMS.  I highly recommend getting screened before you start an exercise program, and if you’re already participating in an exercise program it’s a great idea to get screened now.  If you’ve hit a plateau in your progress, examining movement can be a complete game-changer.

Thanks for reading, and use the email address below to schedule your first screening!

Adam Reeder
acr30@zips.uakron.edu

Movement Screening Explained (part 2)- what the FMS is not

My last post outlined the basics of the Functional Movement Screen (FMS), why it’s important and what it tells us.  Today, I want to clear up some common misunderstandings that I see around the internet in regards to the FMS and explain what the FMS does not do.

FMS Deep Squat

The FMS is NOT:

-A test of strength, endurance, body composition, cardiovascular fitness, etc. All of these qualities may or may not be important to find out depending on who you are and what your goals are, but they should come after you find out how well you move. Remember, move well first, then move often.

-A predictor of performance. Scoring high on the FMS does not mean you’re a better athlete than somebody with a lower FMS score, nor does it mean you’ll lose weight quicker, or achieve any of your other fitness goals any faster than somebody else.

-A judgement of your character. People with little to no exercise experience tend to develop all kinds of anxiety about the FMS until I explain this point to them. “I’m so out of shape, I’m going to do terribly!” is something that I hear very often prior to a movement screening. The FMS is not meant to award the high achievers and punish those who are out of shape. I explain the FMS as more of a pass-fail test than a graded exam.

  • Did you score a 2 or a 3 on all of the movements in the screen? Great, you passed. Now get to work. There are no bonus points awarded for making a 2 into a 3 and I wont spend a great deal of time trying to do so. If one of your life goals is to get a 3 on the Active Straight Leg Raise and right now all you have is a 2, by all means I’m not going to stop you from trying to improve it, but just know that there’s no reason to think that getting that 3 will make you a stronger deadlifter, make you less prone to athletic injuries, or make you less likely to slip on that patch of ice on your steps.
  • Did you score a 1? You fall under the line of passing the test, and that means that putting you into this pattern is going to exacerbate your dysfunction and perhaps lead to injury. Now let’s make an intervention to clean that movement pattern up. This intervention could come from an endless array of possibilities- mobility, motor control, soft tissue, etc. This is where your coach is invaluable. How do you get from dysfunctional to functional to training as quick as possible? And remember, passing the screen isn’t the end goal, it’s more of a starting point. We just need you to be a 2 or better to be able to safely say “okay- now let’s get to work on your goals.”
  • Did you score a 0? That’s okay. There are still things we can do to help improve your fitness, we just aren’t going to use that particular movement pattern. Let’s get you set up with a really good medical professional and see what exactly is going on. People hate this result, but it’s incredibly necessary and incredibly powerful. Going to see your doctor or physical therapist is not a death sentence to your fitness and in this case it’s actually the fastest and safest way to achieve your goals. Whenever trainers/coaches/instructors act resistant to refer a client with pain to the appropriate medical professional for fear of losing a client, my response is always: “You can’t guarantee that that lower back pain isn’t cancer.” While this may seem like an extreme reach when we’re talking about a very common complaint (back pain), the fact is that pain can often be the only present symptom for a number of very serious diseases, including cancer.

One more thing to add about the FMS: There is a total score which can be generated by adding the scores from each individual test. This total score is where much of the debate exists as to whether the FMS is an accurate predictor of future injury. Several studies have examined the correlation between total score on the FMS and future injury incidence in certain athletic populations, and I’ve cited some such studies at the end of this article. I’ve used the FMS for several years now, and have never paid any particular attention to the total score on the screen. In my opinion, the movements are so different from each other, and athletic injuries vary so widely in nature, that simply combining the scores together and running some statistical analysis of injury incident vs. total score does not seem to make much sense. Due to the way the test is scored, high scores in a few movements can overshadow dysfunctions or asymmetries on other patterns.

For example, a male football player may score as such:

Deep Squat- 2

Hurdle Step- 1 left, 2 right

Inline Lunge- 1 left , 2 right

Shoulder Mobility- 3 left, 3 right

Active Straight Leg Raise- 3 left, 3 right

Trunk Stability Push-Up- 3

Rotary Stability 2 left, 2 right

When totaling score, you take the lowest score per test so, this person with a 1 left, 2 right Hurdle Step would score a 1 for that test. The total score of this screen comes out to 15, a relatively high score and usually the cut-off point for “high” vs. “low” scores in research. This person creates their high score by nailing shoulder mobility, active straight leg raise, and the push up, but I have some serious questions about their hurdle step and inline lunge, two tests which create a functional, on-your-feet demand for both mobility and stability. I would be much more concerned about this individual from an injury standpoint than somebody who had nothing but 2’s across the board with no 3’s.

I believe that an athlete playing with movement pain or severe movement dysfunction probably puts that athlete at a higher risk of athletic injury, I just don’t think a sum total of scores in the FMS is the way we should be looking at injury risk. I focus entirely on individual movement results and look at each movement as it’s own small piece to the injury risk puzzle.

The FMS is a wonderfully simple and valuable tool that can be administered in under 15 minutes and is quite reliable from test to test (see citations 2 and 3 at the end of the article). It can and should be used as a pre-participation screening prior to engaging in sport or exercise and can also be used to monitor movement progress over time, especially if dysfunctions show up at that first visit. If your trainer doesn’t use the FMS, fire him…just kidding. If he or she doesn’t use the FMS just make sure they’re doing SOMETHING to assess your movement quality the first time you meet them. Remember, that doesn’t mean “how many push-ups can you do in a minute?” Quality, not quantity. If you’re not assessing you’re just guessing, and movement is far too important to guess on.

In my next post I’ll go into greater detail on the individual tests and what they mean.

Thanks for reading!

Adam Reeder

Scholarly articles reviewing the FMS:

1) Chorba, R. S., Chorba, D. J., Bouillon, L. E., Overmyer, C. A., & Landis, J. A. (2010). Use of a functional movement screening tool to determine injury risk in female collegiate athletes. North American journal of sports physical therapy: NAJSPT, 5(2), 47.

2) J Orthop Sports Phys Ther. 2012 Jun;42(6):530-40. doi: 10.2519/jospt.2012.3838. Epub 2012 May 14.

3) J Strength Cond Res. 2013 Apr;27(4):982-7. doi: 10.1519/JSC.0b013e3182606df2.

3) Kiesel, K., Plisky, P. J., & Voight, M. L. (2007). Can serious injury in professional football be predicted by a preseason functional movement screen?. North American journal of sports physical therapy: NAJSPT, 2(3), 147.

4) Lisman, P., O’Connor, F. G., Deuster, P. A., & Knapik, J. J. (2013). Functional movement screen and aerobic fitness predict injuries in military training. Med Sci Sports Exerc, 45(4), 636-643.

5) Parchmann, C. J., & McBride, J. M. (2011). Relationship between functional movement screen and athletic performance. The Journal of Strength & Conditioning Research, 25(12), 3378-3384.

Movement Screening Explained (part one)- What is the FMS?

In my last post I explained why movement is such an important entry point for fitness, health and well-being. I gave an example of how a simple movement screen could potentially save valuable training time while making sure that you, the client, are given the most appropriate exercise program.

Today I want to discuss one simple and highly effective way to screen for movement pattern qualities: the Functional Movement Screen or FMS. Keep in mind that this is just one of the many screens available and it’s a great idea to check out as many screening procedures as possible before you decide which is best for you. The FMS is the best one that I’ve ever used, as it gives us a relatively quick, objective analysis of how well you move. I fall into the camp of people who truly believe in the value of this particular screen, and I’m not afraid to admit that. I will save a detailed explanation of each individual movement tested in the screen for a later date and instead I will give a general explanation of the FMS and why it’s an important step to take before you start an exercise program.

What is the FMS?

-A series of 7 individually-scored movement patterns designed to identify movement dysfunction or painful movement.  It was developed by Physical Therapist Gray Cook and his colleagues.  Cook is one of the top minds in rehab and performance today.

FMS-hurdle-step

-A scoring system from 0 to 3.

  • Any movement which produces pain on the FMS results in the score of 0 and is cause for further investigation. This could come from a referral to a licensed medical professional such as a physical therapist. This is the most important finding in a movement screen and makes client-coach communication essential. If a pattern is painful, it should be treated as a medical issue rather than a fitness issue, and as such it shouldn’t be part of your typical exercise program. This does not mean you have to stop working out, and doesn’t even mean that you’ll never train this pattern. It simply means that a fitness solution is not appropriate for what is a medical condition.
  • Any movement that is screened to be dysfunctional but not painful receives a score of 1. This is cause for further investigation but the solution can often be found without referring out to a medical professional. We will still avoid loading this pattern (meaning, adding resistance to it), but we don’t have to avoid it all together. If your trainer/coach is good at what they do, they can often remedy this problem fairly quickly without losing out on valuable training time.
  • Any movement that is not painful and not severely dysfunctional, but not quite perfect receives a score of 2. There may be a flaw in the movement pattern but it isn’t severe enough to raise a red flag and we can safely load this pattern. If this is the person’s lowest score on the entire screen we may spend some time addressing this pattern in warm-up or homework, but we wont spend a ton of training time on it.
  • Any perfectly executed movement receives a score of 3. There is no pain with the pattern and no dysfunction present. This pattern is good to go. Since the FMS is done “cold,” meaning the individual is not permitted to warm-up prior to the screen, we don’t even have to address this pattern in a warm-up. We can, of course, but all of the hardware and all of the software is present for this person to perform this pattern essentially right off the street.

-The FMS also includes a series of “clearance” tests which simply ask the client to report any pain with shoulder impingement, spinal flexion or spinal extension.

There you have it.  That’s the FMS.  An objective, unbiased view of movement quality which can be administered within the first 15 minutes of meeting your trainer.  It gives us valuable information about your mobility, stability and motor control and gives us an accurate baseline of your movement health.  My next post will aim to clear up some common misconceptions of the screen and explain what the screen does NOT do.  If you think you could benefit from a Functional Movement Screen and it’s resulting exercise program, contact me with the information below:

Adam Reeder
acr30@zips.uakron.edu

Why Movement?

movementThe title of this blog is Made for Motion.  I spent much of my last post talking about movement screens and movement quality.  Why?  While popular sites display articles like “6 weeks to 6-pack abs!” or “30 days to Sexy Legs!” why do I start with movement?

It comes down to one sentence: Form Follows Function.

“Functional” has quickly become one of the more over-used buzz words in the fitness industry, but that does not mean it’s not important.  When I say “functional” I’m referring to your ability to move well and with integrity, and if you don’t move well you will never reach many of the goals to which you aspire.  If you have a poor gait pattern, you may never run the marathon you want to run because over the course of training you’re going to be beating your joints up.  If you can’t balance well on both legs, you may never be able to enjoy skiing like you used to, or you may be more prone to falling.  And if you can’t stabilize your spine in certain positions, you may always be predisposed to back pain which is going to stop you from getting in that extra set at the gym, and you’ll never reach your full potential for weight loss, fat loss, muscle gain, or whatever your fitness goals may be.

For these reasons, movement is my entry point.  I assess movement the first time I meet a client, and I’m reassessing movement with every new exercise I give them.  If you’re already a gym-goer you may be reading this thinking “Assessing movement sounds like a chore, just let me do some freaking burpees and get after it.”  But in reality, using movement as an entry point is a short cut to health and fitness success.  Let’s look at two example training approaches:

Scenario 1) Fitness as the entry point- We don’t assess movement, we just put you into a fitness program, wind you up and let you go.  It’s a great program, and many people will do fine on it at least for a while.  But since we didn’t assess movement, it’s essentially a cookie-cutter program.  You do exercises that work for most people, because they work for most people.  You stay on the program for a while, and eventually your shoulder starts bothering you.  So then you skip a few workouts because your shoulder hurts and when you get back into the gym you just go lighter because if it’s lighter it can’t be dangerous right?  Maybe it feels better, or maybe a few weeks later the pain is worse and now you’re having trouble grabbing a dish from a high kitchen cabinet.  Now you have a problem and now we have to circle back and completely rework your fitness program.  In the meantime, you haven’t made progress in weeks.  Your constant state of pain has created something of a hormonal nightmare for your body to deal with and now you’re in a fat-storing state that won’t go away until you’re out of pain.

Scenario 2) We assess movement on your first visit- We find that you have awesome shoulder mobility on one side of your body, but when we test the other side you come up short.  It’s not painful, just “tight” or “stiff.”  Okay, no problem.  We throw some should mobility exercises into your warm-up routine, pick exercises that wont exacerbate your shoulder imbalances, and clean up the shoulder mobility issue over time.  In a more dysfunctional case, maybe we do some further testing and find out why the shoulder is tight in the first place and send you with some homework exercises when you leave.  In most cases, we’re able to take care of the issue within your first several sessions, and you don’t miss out on any fitness opportunities in the meantime because we’re choosing exercises that are specifically appropriate to you.

Those 2 scenarios are obviously an over-simplification and just one example, but things like this happen all of the time.  When you’re starting your exercise program you have a choice- do you want move often and then find out if you move well, or do you want to move well first and then move more often?  My experience says that you should move well first, then move more often.  The improvements are much longer lasting, and often come to the individual quicker, as we eliminate the guesswork involved with cuttie-cutter programs.

Thanks for reading!

Adam Reeder