This is a chapter 8 summary of the book “Movement” by Gray Cook. What to Look For The SFMA breakouts are utilized to determine if one’s movement deficiencies have a mobility or stability origin. There are further possibilities in each of these categories. It Could Be a Mobility Problem There are two subsets of mobility problems that include tissue extensibility dysfunction (TED) and joint mobility dysfunction (JMD). From here, we can break it down even further in each subset. Here are some potential TEDs Active/passive muscle insufficiency Limited neurodynamics (they said neural tension; come on Gray!) Fascial tension Muscle shortening Hypertrophy Trigger points Scarring/fibrosis And here are some potential JMDs Osteoarthritis/arthrosis Single-joint muscle spasm/guarding Fusion Subluxation Adhesive capsulitis Dislocation It could be a Stability Problem 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. There are several examples of SMCD problems. Motor control dysfunction. High threshold strategy. Local muscle dysfunction/asymmetry. Mechanical breathing dysfunction. 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. Relatedness Mobility and stability can influence one another. If I were to lose mobility at one segment, motor control can be distorted at nearby segments.
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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. 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. 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)
Read MoreMovement 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. 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: Muscular imbalance. Habitual asymmetrical movements. Improper training methods. Incomplete recovery from injury. 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. 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.
Read MoreMovement 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. 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. 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
Read MoreMovement 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. 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
Read MoreThe Sensitive Nervous System Chapter VII: Assessment with a Place for the Nervous System
This is a summary of Chapter VII of “The Sensitive Nervous System” by David Butler. Education When it comes to patient education, there are four things that every patient wants to know: 1) What is wrong with me? 2) How long will it take to get better? 3) What can I do for it? 4) What can you (the clinician) do for it? When we do educate, we must not forget that pain is a biopsychosocial phenomenon and multifactorial. The onion skin model below provides a good relationship analogy for this. The first goal addressed in education is making the patient understand pain. Patients must realize that pain is the defender, not the offender. It is our body’s way to perceive a threat. Therefore, we must quell this fear before focusing on function. Here are some suggested ways to describe pain in non-threatening ways. Back trouble. Neck discomfort. Twinges. Feelings. When obtaining pain information from our patients, this is something that we do not have to measure. Instead, it is important to look at variables associated with pain, namely. 1) Geography & nature, aggravating/relieving factors, links. 2) Mechanism of injury. 3) Explore how patient’s classify their symptoms (e.g. my joints are worn out), and ask why they think the symptoms still persist. 4) Consequences of the pain. 5) Coping types. 6) How the patient relates to pain (do they get angry or play the blame game). When determining treatment course, instead of focusing on the structure at fault, look at
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