Movement Chapter 7: SFMA Introduction and Top-Tier Tests

This is a chapter 7 summary of the book “Movement” by Gray Cook.

Intro

The SFMA’s goal is to assess functional capabilities. This system is based on Cyriax differentiation and grading principles. Instead of describing things as strong, weak, painful, or painless; the following descriptors are utilized:

  • Functional nonpainful (FN): Unlimited movement and able to complete a breath cycle at end-range. Called the dead end.
  • Functional painful (FP): Called the marker, reassessed.
  • Dysfunctional nonpainful (DN): Limited, restricted, impaired mobility, stability, or symmetry. Labored breathing with movement also implicates this choice. Called the pathway, where treatment occurs.
  • Dysfunctional painful (DP): Called the logical beehive because we do not know if pain is causing poor movement or vice versa. It is an unreliable place to work unless acute situations.
Cee Lo is still pushing for the FU to get recognized in the SFMA.

SFMA corrective and manual therapy lie in treating the FP’s and DN’s. The order at which things are treated also matters, so the order listed below for the top tier tests is also typically where treatments should hierarchically begin.

  • Cervical spine patterns (CSP)
  • Upper extremity patterns (UEP)
  • Multi-segmental flexion (MSF)
  • Multi-segmental extension (MSE)
  • Multi-segmental rotation (MSR)
  • Single leg stance (SLS)
  • Overhead deep squat (ODS)

We then operate the SFMA in the following fashion:

Movement Chapter 6: Functional Movement Screen Descriptions

This is a chapter 6 summary of the book “Movement” by Gray Cook.

Screening Keys

The FMS is not considered a training or competition tool; it simply ranks movements.  Here are the keys to a successful screen.

First off, know the following bony landmarks

  • Tibial tuberosity
  • ASIS
  • Lateral and medial malleoli
  • Most distal wrist crease
  • Knee joint line

3 repetitions are performed for each movement, and it is important to stand far away so the whole movement can be seen. When testing both sides, take the lowest score if an asymmetry is present.

Here are the movements (videos courtesy of Smart Group Training).

The Deep Squat

Purpose: Full-body coordinated mobility and stability; linking the hips and the shoulders.

Here is how it is done.

Hurdle Step

Purpose: Evaluate stepping and stride mechanics.

Here is how it is done.

Inline Lunge

Purpose: Test deceleration and left/right function utilizing contralateral upper extremity patterns and ipsilateral lower extremity patterns.

Here is how it is done.

Shoulder Mobility

Purpose: Evaluate scapulothoracic rhythm, thoracic spine and rib mobility.

Here is how it is done.

ASLR

Purpose: Tests hip flexion, hip extension, and core function.

Here is how it is done.

Trunk Stability Pushup

Purpose: Tests reflexive core stability.

Here is how it is done.

Rotary Stability

Purpose: Check multi-planar pelvic, core, and shoulder girdle stability. Also looks at reflexive stability and transverse plane weight shifting.

Here is how it is done.

FMS Conclusions

The FMS is designed to give a corrective pathway that may involve temporarily ceasing potential risk activities. Many things can perpetuate faulty movement, so it is best to control as many variables as possible. Here are some possible activities that may be compromised if one scores lower than a 2 on the screen.

  • ASLR:  Heavy closed-chain loading activities, running, plyometrics.
  • Shoulder mobility: Heavy or overhead pushing/pulling movements.
  • Rotary stability: Conventional core training, high threshold training that requires core control.
  • Trunk stability pushup: Heavy upper/lower extremity loads; vigorous plyos.
  • In-line lunge: Exercises and loads involving the lunge pattern
  • Hurdle step: Exercises and loads involving the single leg stance pattern
  • Deep Squat: Exercises and loads involving the squat pattern.
Loads? The way you’re moving you don’t need loads.

The Basic FMS

Now I know what you are thinking. “Zac, there is no way that some of my clients can perform all these tasks.” Well, Gray has an answer for you.  The FMS does not have to be performed in its entirety, and can be progressed in the following fashion:

BASIC FMS: ASLR, shoulder mobility, and pain-clearing tests.

and then

Rotary stability along with flexion and extension clearing tests

and then

Pushup test if appropriate.

and then

Hurdle step

and then

Inline lunge & deep squat.

Movement Chapter 5: Functional Movement Systems and Movement Patterns

This is a chapter 5 summary of the book “Movement” by Gray Cook.

In this chapter, Gray outlines the interconnectedness of the tests and outlines all of the different breakouts. The movements will be demonstrated in later chapters.

FMS

There are seven movements with different clearing examinations.

1)      Deep squat

2)      Hurdle step

3)      Inline lunge

4)      Shoulder mobility

5)      Active straight leg raise (ASLR)

6)      Trunk stability pushup

7)      Rotary stability.

FMS…Deal with it.

The first three movements are often called the big 3, as they are functional movements that check core stability in three essential foot positions. The remaining four are considered fundamental movement patterns.  Often these patterns are attacked before the first three.

These screens can also be broken up into those that check symmetry and asymmetry:

Symmetrical patterns

  • Deep Squat
  • Trunk stability pushup.

Asymmetrical patterns

  • Hurdle step
  • Inline lunge
  • Shoulder mobility
  • ASLR
  • Rotary stability.

The way we work the FMS is by first attacking asymmetrical patterns before straight patterns, and primitive patterns before functional patterns.

Take that you 1 on the inline lunge.

The FMS is scored on a four point ordinal scale with the following scoring criteria:

3 – Complete pattern

2 – Complete pattern with compensations/deviations

1 – Incomplete pattern

0 – Painful pattern.

There are also three clearing tests that are either positive or negative for pain.

1)      Impingement clearing test (shoulder mobility)

2)      Prone pressup (trunk mobility)

3)      Posterior rocking (rotary stability)

The FMS works by creating several filters to catch for compensations and problems.

1)      Pain – Signal to a problem.

2)      Decreased movements – Even though these movements go less than full ROM, compensations can be caught with multi-joint movements.

3)      Asymmetry

4)      Intentional redundancy to reduce error; consistent findings implicate mobility issues, inconsistent finding implicate stability issues.

Will soon be for sale on zaccupples.com...until Gray sues me.
Will soon be for sale on zaccupples.com…until Gray sues me.

SFMA

The SFMA is not talked about in much detail in this chapter, but here are the top tier assessments:

1)      Cervical spine patterns.

2)      Upper extremity movement patterns

3)      Multi-segmental flexion (MSF)

4)      Multi-segmental extension (MSE)

5)      Multi-segmental rotation (MSR)

6)      Single leg stance (SLS)

7)      Overhead deep squat

From here each component has different breakouts. I have updated these as much as possible based on the recent SFMA course that I have attended.

Cervical breakouts

Active/passive supine flexion → active OA flexion→ active/passive cervical rotation → C1-C2 rotation → extension

Upper extremity breakouts

Active/passive prone patterns → Supine reciprocal patterns → Active/passive 90/90 internal/external rotation → Active/passive shoulder extension and abduction→ Active/passive elbow extension→ Active lumbar-locked extension

MSF breakouts

1 leg forward bend→ Long sit toe touch → ASLR→ PSLR → Rolling → Prone rocking → Supine knee to chest (KTC)

MSE breakouts

SPINAL: backward bend → single-leg backward bend→ prone pressup→ active/passive lumbar-locked (Internal rotation [IR]) → prone on elbows unilateral extension-rotation

LOWER EXTREMITY: FABER → Modified Thomas test → Prone active/passive hip extension → rolling

UPPER EXTREMITY: Unilateral shoulder backward bend → Supine lat stretch with hip flexed/extended → lumbar-locked (external rotation [ER]) extension-rotation unilateral → active/passive Lumbar-locked (IR) extension-rotation unilateral

MSR breakouts

SPINAL: Seated rotation → lumbar-locked (ER/IR) active/passive rotation-extension → prone on elbows unilateral rotation-extension

HIP: Seated active/passive ER & IR → Prone active/passive ER & IR

TIBIA: Seated active/passive ER/IR

SLS breakouts

Vestibular/core: clinical test for sensory interaction balance (CTSIB)→ Vestibular shake test → half-kneeling narrow base → rolling → quadruped diagonals

Ankle: Heel walk/toe walk → Prone passive dorsiflexion/plantarflexion→ Seated active/passive inversion/eversion

Overhead deep squat breakouts

Interlocked finger behind neck squat → Assisted deep squat → half-kneeling dorsiflexion→ Knee to chest holding shins → knee to chest holding thighs

Rolling

Upper & lower prone to supine and supine to prone

Who knew Fred Durst could actually be useful.

Movement Chapter 4: Movement Screening

This is a chapter 4 summary of the book “Movement” by Gray Cook.

What Be the Goal?

Movement screening’s goal is to manage risk by finding limitations and asymmetries via two strategies;

1)      Movement-pattern problems: Decreased mobility and stability in basic movements.

2)      Athletic-performance problems: Decreased fitness.

But movement ain’t one.

The FMS razor, akin to Occam’s razor, is to determine a minimum movement pattern quality before movement quantity and capacity are targeted.

Movement patterns are lost by the following mechanisms:

Ideally, the FMS would be part of the basic tests performed when one is looking to participate in sport. Prior to any athletic engagement, a medical exam is performed to clear someone to participate. This exam is often followed by performance and skills tests. Gray feels that the FMS belongs between these two tests, as there is an obvious gap from basic medical screening to high performance.

Oh gosh that hurdle step is going to be awful after this.

It is not to say that we must only train movement patterns. Rather, all the above qualities can be trained in parallel. The real goal is to manage minimums at each level and make sure improving one does not sacrifice quality at the others.

Movement Chapter 3: Understanding Movement

This is a chapter 3 summary of the book “Movement” by Gray Cook.

You Down with SOP?

Unlike many other areas, movement does not have a standard operating procedure and is thus very subjective. Since movement is the foundation for all activity, it is important that we develop some type of standard for good movement.

Good thing we haven’t heard this point before.

Changing Compensations

Movement compensations are often unconscious, thereby making these patterns difficult to be cued away.  It may be the case that less threatening movements and corrective exercise could be utilized to change undesired patterns.

When designing exercise, it is important to make them challenging as opposed to difficult. Difficulty implies struggling, whereas challenges are what test one’s abilities. Anyone can make something difficult, but not all can challenge.

Function of the FMS and SFMA

The goals of the functional movement systems are as follows:

1)      Demonstrate if movement patterns produce pain within accepted ranges of movement.

2)      Identify those without pain that are at high injury risk.

3)      Identify specific exercises and activities to avoid until achieving the required movement competency.

4)      Identify the best corrective exercise to restore movement competency.

5)      Create a baseline of standardized movement patterns for future reference.

The difference between the FMS and SFMA is that the FMS assesses risk whereas the SFMA diagnoses movement problems.

No treaties for crappy movement. Puns through the roof today.

The FMS operates in the following manner:

1)      Rates and ranks nonpainful movements based on limits and asymmetries.

2)      Identifies pain.

3)      Identifies lowest ranking or most asymmetrical patterns; most primitive pattern if greater than one.

4)      Find activities that may perpetuate the problem and take a temporary break from said activities.

5)      Start a corrective strategy.

6)      Reassess the test.

7)      If improved keep strategy, if not recheck FMS.

8)      Check exercise performance.

9)      Use effective and properly paced progressions.

10)   If changes occurs, retest FMS to establish norms and change corrections.

Whereas the SFMA operates as such:

1)      Find dysfunctional nonpainful (DN) movements (the path) and functional painful movements (FP), which are the markers. Work on DN before FP.

2)      Don’t breakdown functional nonpainful movements (FN).

3)      Only breakout dysfunctional painful movements (DP) if other breakouts can’t be performed.

4)      DN’s should show mobility or stability impairments that need to be addressed.

5)      Check these impairments.

6)      Check FP’s in loaded and unloaded positions; noting the lowest level in which pain is present.

7)      Form working diagnoses based on info from DN’s.

8)      Check for functional activities that could perpetuate the current complaint.

9)      Treat.

10)   Reassess impairments.

11)   Reassess pain breakouts. If changes occur at the lowest level, move up through the breakouts.

12)   Reassess dysfunctional breakouts.

13)   If baseline changes positively, keep chosen strategy.

Once the SFMA is clear, FMS at or near discharge.

Movement Chapter 2: Anatomical Science Versus Functional Science

This is a chapter 2 summary of the book “Movement” by Gray Cook.

Funky Muscles

There are anatomically two basic types of muscles; shunt and spurt. Shunt muscles compress and produce structural integrity because the distal attachment is far from the moving joint. Spurt muscles produce movement because the distal attachment is close to the axis of rotation. While these two muscle types are present, they can vary depending on the function performed. For example, if we perform a movement in the closed chain, the spurt and shunt roles become reversed.

Focusing on a single muscle group causes us to lack understanding of the supporting matrix behind superficial muscle action. Muscle function depends on body position and joint in action.

We can see this point illustrated in Lombard’s paradox, which involves the coactivation of hamstrings and quadriceps when performing a sit to stand. These muscles are antagonistic to one another at their respective joints, yet movement is produced. The resultant effect is the quads and hamstrings becoming global stabilizers.

Muscle activity is task specific, therefore Gray purports four types of muscles:

1)      Global Stabilizers: Multi-joint muscles contracting to produce stability and static proprioceptive feedback.

2)      Global Movers: Multi-joint muscles that produce movement and dynamic proprioceptive feedback.

3)      Local Stabilizers: Deep segmental muscles (1-3 segments) that produce stability and static proprioceptive feedback.

4)      Local Movers: Single joint muscle that produce movement and dynamic proprioception.

These different muscle types require different training modalities.  The example given is stabilizer muscles. These muscles cannot be trained with concentric/eccentric modalities for this will not change the real issue – timing and recruitment. Authentic stability is about effortless timing and the ability to go from soft to hard without a blink.

It is just easier for me to put a cute picture here then pun the previous sentence.
Must…resist…urge…to…pun…the… previous…sentence.

Joints, Ligaments, Fascia, and Breathing

Here Gray discusses how decreased muscle function affects the joints.

Muscles decrease function → joints are stressed→ microtrauma/wear→ Stiff joints give poor feedback→ Muscular demand increases→ Muscle imbalance, inhibition, and guarding occurs.

Both joints and ligaments interact with the nervous system to give us joint position sense, direction, and movement speed. This feedback affects how muscles react.

Fascia also plays a crucial role by redirecting stress and providing dynamic structure. The fascia is what links all the muscles together and facilitates muscle synergy to the nervous system.

Breathing is what connects the entire movement matrix, yet it is often the most neglected area for testing. A good breath can relax the system in the presence of stress and dysfunction. Breathing also has the ability to stimulate the parasympathetic nervous system and increase heart rate variability (HRV). Breathing dysfunction very much parallels movement dysfunction. If one cannot maintain a quality breath at end-range, then the movement is not authentic.

The Neuromuscular Network

One goal of the sensorimotor system is uprightness. This quality depends on three components:

1)      Vestibular – head position

2)      Proprioceptive – Body segments

3)      Visual – Body relative to environment

These three areas account for constantly changing posture, as we must adjust to an ever-changing environment. The hands and feet in particular also play a huge role in how we interact with our environment.

Violence? I say just some environmental interaction.

When we talk about movement and injury, it is important to understand that pain experiences can alter motor control at multiple joints away from the injured sight. This is a highly individual and unpredictable process, and the lack of pain does not equate with normal movement or no risk factors.

While there are many different discussed points in the above section, the reason for this is that everything is very much interconnected. Highlighting one system neglects the others and does not paint an accurate picture.

Movement Dysfunction

There are three types of movement dysfunction:

1)      Developmental – movement opportunities become denied.

2)      Traumatic – Compensations stress other body regions. Baggage follows injuries.

3)      Acquired.

Oftentimes developmental and traumatic dysfunction are very difficult to change. On the other hand, acquired dysfunction can readily be changed. There are two types of acquired dysfunction.

1)      Unnatural activity repeated on natural movement base (throwers, unilateral sports, habitual postures).

2)      Natural activity repeated on an unnatural movement base (fundamental limitations and asymmetries).

Changing acquired dysfunction does not necessarily mean moving more. Moving more does not equal moving well. We need to target particular dysfunction.

Might not move much...but could score a 14 on the FMS.
Might not move much…but could score a 14 on the FMS.

Movement Chapter 1: Introduction to Screening and Assessment

This is a chapter 1 summary of the book “Movement” by Gray Cook.

Intro

This chapter’s central point, and for that matter the whole book, is that movement needs to standardized just like all other therapeutic and performance measures. Movement is fundamental to who we are.

Despite movement being at our center, we continually classify patients and clients by body region. Unfortunately through this reductionism, much is lost. We cannot measure parts and expect that to give us an adequate picture of the whole.

Like Preparation H, Movement feels good on the Whole

Screening

Before we begin training, it is advocated that movement be screened to facilitate an optimal training environment. The screen will determine movement as one of the following three areas:

1)      Acceptable

2)      Unacceptable

3)      Painful

Movement is screened for many reasons. Gray often states that the number one risk factor for injury is previous injury. A movement screen helps find potential risk factors for re-injury. Moreover, if movement is dysfunctional, then all things built on that dysfunction could predispose one to more risk.

The screen also helps separate pain from movement dysfunction. It is widely known that when one undergoes a pain experience, motor control is altered. Because motor control is altered, we may not get the desired training effect secondary to pain. Pain screening gives us an avenue for further assessment a la the Selective Functional Movement Assessment (SFMA).

Movement screening is the first step away from quantitative analysis to movement quality; from reductionism to holism. Once we have a basic movement map we can take a look at quantity. This framework also helps us better understand the person in front of us, as humans tend to operate in patterns and sequences.

Someday I hope this is what things look like when I see a patient or client.

Reductionism creates a paradox between movement and motion. If we assume that a joint has full motion, then by reductionism movements involving the joint will be normal. This thought is often not the case. That is because movement requires motor control, which is the combination of stability, balance, postural control, coordination and perception.

Function vs. Anatomy

It is important to understand the function and anatomy do not always correlate.  Take weakness for example. Weakness can occur for a variety of reasons:

1)      Muscle inhibition.

2)      Dysfunctional stabilizers.

3)      Poor agonistic function.

4)      Increased tone.

The above three examples cannot change weakness based on strengthening alone. If you take tone for example, it is often present to protect the person from accomplishing a task. Muscles do not tighten just because.

Mobility before Stability

When treating movement dysfunction, it is important to first decrease mobility restrictions as able. Once we have established normal mobility, we can cement that new range with stability training. When mobility returns, there is a short window for motor control to be re-established. However, the appropriate stability training dosage must be given. If we go too hard, stiffness will return; but if we do not go hard enough, the pattern will not change. We are essentially hitting the reset button, then reprogramming new software.

Sometimes restarting things just works.

Five Principles of Functional Movement Systems Logistics

Here are the 5 movement tenets per Gray.

1)      Basic bodyweight movements should not provoke pain.

2)      We should not have gross fundamental movement limitations, even if pain-free. For this deficit will lead to substitution and compensation, which will decrease efficiency, which will lead to secondary problems, which will increase injury risk.

3)      Establish movement fundamentals before performance.

4)      Establish fundamental movement before complex movements/skills.

5)      Movement patterns should be mostly symmetrical.