This is a chapter 15 summary of the book “Movement” by Gray Cook.
The goal of movement retraining is to create authentic unconscious movement at acceptable levels. We can develop many methods to achieve our goals, but working under sound principles is paramount. Some of the principles Gray advocates include:
Focusing on how we move.
Look to movement to validate or refute your intervention.
Movement is always honest.
When designing a movement program, we must operate under the following guidelines:
Separate pain from dysfunctional movement patterns.
Starting point for movement learning is a reproducible movement baseline.
Biomechanical and physiological evaluation do not provide a complete risk screening or diagnostic tool for comprehensive movement pattern understanding.
Our biomechanical and physiological knowledge surpass what we know about fundamental movement patterns.
Movement learning and relearning follows a hierarchy fundamental to the development of perception and behavior.
Corrective exercise should not be rehearsed outputs. Instead, it should be challenging opportunities to manage mistakes on a functional level near the edge of ability.
Perception drives movement behavior and movement behavior modulates perception.
We should not put fitness on movement dysfunction.
We must develop performance and skill considering each tier in the natural progression of movement development and specialization.
Corrective exercise dosage works close to baseline at the edge of ability with a clear goal.
The routine practice of self-limiting exercises can maintain the quality of our movement perceptions and behaviors and preserve our unique adaptability that modern conveniences erode.
Some things cannot be fixed, but change what you can.
The brain that learns function can learn dysfunction.
This is a chapter 14 summary of the book “Movement” by Gray Cook.
Corrective exercise is focused on providing input to the nervous system. We are allowing the patients and clients to experience the actual predicament that lies beneath the surface of their movement pattern problem. It is okay for mistakes to be made, for these errors help accelerate motor learning. Minimal cueing should be utilized, as we want to patient to let them feel the enriching sensory experience.
Motor Program Retraining
There are several different methods in which we can achieve a desired motor output.
1) Reverse patterning – Performing a movement from the opposite direction.
2) Reactive neuromuscular training – Exaggerating mistakes so the patient/client overcorrects. Use oscillations first, followed by steady resistance.
3) Conscious Loading – Using load to hit the reset button for sequence and timing.
4) Resisted exercise – Makes patterns more stable and durable.
When you can deadlift that much, most anything is stable and durable.
This is a chapter 13 summary of the book “Movement” by Gray Cook.
Back to the Basics
Mobility deficits ought to be the first impairment corrected. Optimizing mobility creates potential for new sensory input and motor adaptation, but does not guarantee quality movement. This is where stability training comes in. In order for the brain to create stability in a region, the following ought to be present:
Structural stability: Pain-free structures without significant damage, deficiency, or deformity.
Sensory integrity: Uncompromised reception/integration of sensory input.
Motor integrity: Uncompromised activation/reinforcement of motor output.
Freedom of movement: Perform in functional range and achieve end-range.
There are 3 ways to gain mobility:
1) Passively: Self-static stretching with good breathing; manual passive mobilization.
2) Actively: Dynamic stretching, PNF.
3) Assistive: Helping with quality or quantity, aquatics, resistance.
In order to own our new mobility, we use various stability progressions to cement the new patterns. There are three tiers in which stability is trained:
1) Fundamental stability – Basic motor control, often in early postures such as supine, prone, or rolling.
2) Static stability – done when rolling is okay but stability is compromised in more advanced postures.
3) Dynamic stability – Advanced movement.
We progress in these stability frames from easy to further difficult challenges.
Assisted → active → reactive-facilitation/perturbations
Since stability is a subconscious process, we utilize postures that can challenge this ability while achieving desired motor behavior. We can also group the various postural progressions into 3 categories:
1) Fundamental – Supine, prone, rolling (requires unrestricted mobility).
2) Transitional – Postures between supine and standing such as prone on elbows, quadruped, sitting, kneeling, half-kneeling.
3) Functional: Standing variations to include symmetrical and asymmetrical stance, single leg stance.
This is a chapter 12 summary of the book “Movement” by Gray Cook.
A Whole Lotta P
When we build our corrective framework, we must take into account the 6 P’s:
1) Pain – Is there pain with movement? Staying away from pain improves motor control.
2) Purpose – What movement pattern are we targeting with corrective exercise and what problem are we addressing (i.e. mobility, stability, dynamic motor control)?
3) Posture – Which moderately challenging posture is the best starting point for corrective exercise that allows for reflexive activity?
4) Position – Which ones demonstration mobility/stability problems and compensatory behaviors?
5) Pattern – How is the dysfunctional movement pattern affected by corrective exercise?
6) Plan – How can you design a plan based on findings?
The goal when designing the correction is to stay in the middle ground of the autonomic nervous system while providing a rich sensory experience. Movement pattern dysfunction is a behavior that needs to be addressed and changed.
This is a chapter 11 summary of the book “Movement” by Gray Cook.
All exercise affects tone and tension. This influence is the basis for movement. The autonomic nervous system determines movement as threatening or not, which determines requisite tone. It is important to nudge movement towards further nonthreatening yet advanced stimuli.
Proceeding to correct under FMS protocol is determined by screen results and changed via exercise. We first correct mobility, next reinforce stability, then retrain movement patterns. Stability training in particular follows a sequence:
1) Challenge posture and position.
2) Build mid-range strength.
3) Develop end-range stability.
Movement patterns are corrected in the following hierarchy:
The SFMA corrective pathway is nonlinear unlike the FMS. The breakouts will tell you which direction to go to restore optimal movement.
The options are also increased. Often to gain mobility, you would utilize various manual therapies or other modalities. To alter stability, taping, orthotics, braces, or anything else to increase motor control may be utilized.
Movement patterns are corrected in the following hierarchy:
This is a chapter 10 summary of the book “Movement” by Gray Cook.
Mistakes, I’ve Made a Few
When we are talking corrective exercise design, people often make 4 mistakes:
1) Protocol approach: Exercise based on category.
Problem – 1 size fits all.
2) Basic kinesiology: Target prime movers and some stabilizers.
Problem – fails on timing, motor control, stability, and movement.
3) Appearance of functional approach – Use bands and resistance during functional training.
Problem – If the pattern is poor, adding challenges to it can increase compensation. There is also no pre-post testing.
4) Prehabilitation approach – Prepackaged rehab exercises into conditioning programs as preventative measures to reduce injury risk.
Problem – Design is based on injuries common to particular activities as opposed to movement risk factors.
There are also certain mistakes that are often made when utilizing the FMS and SFMA:
1) Converting movement dysfunction into singular anatomical problems.
2) Obsessing over perfection in each test instead of identifying the most significant limitation/asymmetry.
3) Linking corrective solutions to movement problems prematurely.
The overarching rule is to address these movement deficiencies first, as we do not want to put strength or fitness on top of dysfunctional movement.
The Performance Pyramid
When designing an exercise program, we look for three areas to improve performance: Movement, performance, and skill.
It is important that program design is based on the individual’s needs and has these qualities in a hierarchal fashion. For example, if one performs excellent on functional performance capabilities but has poor foundational movement, injury risk may increase.
When implementing corrective exercise, it is important to provide the correct stimulus amount. We want the individual challenged, but not struggling for dear life.
Too easy – >30 reps with good quality.
Challenging, but possible – 8-15 reps with good quality and no stress breathing. There is a decline in quality secondary to fatigue towards the end of rep ranges.
Too difficult – Sloppy from the beginning and only worsens.
Rarely does increasing difficulty equate to increasing resistance. Oftentimes you may advance the exercise position, decrease the base of support, or add more movement complexity.
You may have to remove some activities that feed into dysfunction from one’s current programming, lest you wish to not change the movement pattern. Often how quickly one changes his or her ability to move depends on how diligent one is with corrective exercise.
Realize that corrective exercise should only be supplemental and temporary to what one is doing. It is supposed to be corrective in nature, not preventative. Moreover, movement scores can decrease with hard training, so continual reassessment is important.
The corrective exercise pathway should proceed as follows:
1) Exercise selection is driven by screen and assessment.
2) A thought out framework gives you the best possible choices.
3) Retest, note positive or negative changes, and then use results to modify next session.
4) Reassess once an obvious change is noted to see what the next priority is.
This is a chapter 9 summary of the book “Movement” by Gray Cook.
While I have broken up these sections into patterns, much of what Gray talks about does not involve the patterns themselves, but are still good points to know. Ergo, much like the book itself, this post may seem a little disjointed 🙂
The Deep Squat
One’s inability to squat is not considered a single problem. Instead, a disconnect is present between the body and the brain in the squatting pattern. Our brain sees things in patterns, and the squatting pattern essentially gets smudged. Before performing the squat as an exercise, we must first groove an optimal movement pattern.
One interesting point regarding the squat is that as an exercise it is often a top-down based movement. However, when we learn to squat in development, the movement occurs bottom-up. So one way to train the squat is by starting from the bottom of the squat and working to standing. This method ensures full mobility to perform a full deep squat.
To relate the SFMA to the squat pattern, Gray is very clear about not training the squat if one cannot touch his or her toes.
Hurdle Step and Single Leg Stance
These two movements simultaneously test mobility and stability of both legs. Oftentimes in these patterns you will see a high-threshold strategy (HTS), in which a hyper-protective core response occurs. Research demonstrates that this stabilization strategy can cause poor motor control to occur. These tests also are basic precursors for stepping, running, and climbing.
In this section Gray also mentions that he does not recommend assessing static postures; namely because posture is dynamic and changing.
The inline lunge is more a test of control and efficiency as opposed to strength. Because we talk about control, we must discuss stability. It is important to note that stabilizers do not necessarily need to be strengthened, as these muscles will never be able to overpower prime movers. Instead, these muscles should be trained for endurance, timing, or quicker action.
Shoulder Mobility Reaching Test
These tests assess reciprocal arm patterns and thoracic spine mobility. The movement is challenging because opposing movements end up borrowing mobility and stability from other segments, thus potentially impairing these qualities.
Thoracic extension is necessary to perform this pattern. However, oftentimes people will compensate with thoracic flexion. This compensatory pattern can rob the scapulae of ground to help stabilize the movement.
Active Straight Leg Raise
There are several necessary components to perform this movement optimally:
Adequate mobility and flexibility of the elevated leg.
Pelvic stability prior to and during the movement.
Another interesting tidbit from this section was that research has demonstrated that one’s ability to perform a sit and reach correlated with arterial flexibility.
The pushup, rotary stability, and rolling patterns all assess core functioning. In particular, the pushup looks at reflexive core action, rotary unilateral and diagonal patterns, and rolling the ability to separate upper and lower quadrants.
These issues are also known as stability or motor control dysfunction (SMCD). Most conventional therapies would treat these complaints by strengthening the stabilizers, but this is problematic. When something works reflexively, how can we train something volitionally and expect changes? To train these muscles we must focus on proprioceptive and timing-based training.
Prime mover or global muscle compensation behavior or asymmetry.
Poor static stability, alignment, postural control, asymmetry, and structural integrity.
Poor dynamic stability, alignment, postural control, asymmetry, and structural integrity.
Mobility and stability can influence one another. If I were to lose mobility at one segment, motor control can be distorted at nearby segments. Conversely, if I lack motor control, abnormal mobility may occur to compensate. However, the progression remains the same—restore mobility, then improve stability.
Though the following testing protocols did not make the SFMA, they should still be tested per Gray: