Death of Vertical Tibia, Usain Bolt, Complex Patients, and More – Movement Debrief Episode 13

Movement Debrief Episode 13 yesterday involved quite a few rants. Must’ve been the ketones talking.

Here’s what we talked about:

  • Restoring sensation with my patient with low back pain
  • Why it’s okay to have an angled tibia during squatting
  • Would any intervention help/hurt Usain Bolt?
  • The complexity of Usain Bolt
  • Struggling with a complex patient
  • Dealing with uncertainty
  • Embracing the struggle

If you want to watch these live, add me on Facebook, Instagram, or Twitter. (occasionally) They air every Wednesday at 8:30pm CST.

Enjoy.

Here were some of the links I mentioned in this Debrief.

How to Deadlift – A Movement Deep Dive

Squatting Bar Reach – A Movement Deep Dive

The Sensitive Nervous System – Read my book notes here

Clinical Neurodynamics- Read my book notes here

A Study of Neurodynamics: The Body’s Living Alarm

Mobilisation of the Neuroimmune System – Read the course notes here

Explain Pain– Read the course notes here

Extreme Ownership

The Obstacle is the Way

Ego is the Enemy

The Subtle Art of Not Giving a F*ck

July 2017 in Review

Every week, my newsletter subscribers get links to some of the goodies that I’ve come across on the internets.

Here were the goodies that my peeps got their learn on from this past July.

If you want to get a copy of my weekend learning goodies every Friday, fill out the form below.  That way you can brag to all your friends about the cool things you’ve learned over the weekend.

Biggest Lesson of the Month

Maximize proximal before spending time distal. I’ve just seen too many patients where we applied some type of axial intervention, which led to profound changes distally. Position governs all. Thank you for making me realize this daddy-o.

Quote of the Month

Only those who dare to fail greatly can ever achieve greatly. ~Robert Kennedy

Rehabilitation

Blog: What is the Best Test to Discern an ACL Tear?

My boy Scott Gray put together a rock solid post on diagnosing an ACL tear. I’ve been very big as of late on filling the differential diagnosis hole in my game, and this one was beyond helpful. I wish I had heard of the lever test last year when I had a guy pop his ACL in-game.

Blog: The Quadruped Rockback Test: RIP

My buddy Doug Kechijian ever so succinctly puts this dated test to rest. There is so much more that goes into deciding squat depth than can be accurately accounted for with this test.

never question a guy with a loaded gun.

Performance

Research: The effects of two different recovery postures during high intensity interval training

I’m still making my way through this beast. It’s a thesis, but the references and explanations of the science behind breathing, position, and recovery is outstanding. Not only that, but changing your recovery position has had a profound effect on improving my clients’ conditioning.

Video: Lateral Lunge Quick Hit

This was a promo I put out for my 5th Metatarsal RTP podcast. It’s a nice little cue to drive greater frontal plane activity on the non-working leg.

Research: The athlete monitoring cycle: a practical guide to interpreting and applying training monitoring data

So proud of my guy Eric Oetter, who put this incredibly practical guide to load management together with the brilliant Tim Gabbett. EO is doing phenomenal things with the Grizzlies, and this provides a small insight into his process.

Nutrition

Podcast: Does Meat Consumption Cause Cancer? 

Short answer – It depends. I have a coworker who I discuss with the problems of this argument. I’m an avid meat eater because gainzzz, and it turns out that makes the difference. If you aren’t listening to Ronda Patrick by the way, you’re welcome.

Yeah, I’m a meat eater #dealwithit

Podcast: How to Tell if You Have a Leaky Gut

Chris Kresser is a cat I’ve been really getting into as of late. I think there are a lot of cool things within functional medicine, and this guy is one of the most evidenced-based out there.

I think the gut microbiome is a vastly underappreciated area to intervene on. But how do you know if you have a problem? CK tells you how to find out.

Video/podcast: George Brooks, Ph.D on Lactate

This Rhonda Patrick joint talks about all the wonderful things lactate does for us. This molecule always gets a bad rap, but did you know in brain injuries (concussions, TBIs, etc), it’s one of the few substrates that is capable of providing our brain fuel? This was a very fascinating hour in which I learned a great deal.

Research: Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan

Supplemental Podcast: Satchin Panda Interview

What if I told you that there was a way you could keep eating what you are eating yet still lose fat and gain muscle. Would you do it?

If so, then this is your study. By simply restricting the eating window to 9-12 hours in mice, and having them eat earlier in their day, these bad boys lost some major weight. He did a similar study in humans as well. He goes into detail about this and more. Both the paper and the podcast are quite interesting

Sleep

Video/Podcast: Dan Pardi on Sleep

I’ve been on a little Rhonda Patrick (#bae) kick as of late. In this interview, Dan Pardi talks about all things sleep, circadian rhythms, and more. If you can maximize sleep duration, intensity, and timing, you are winning at life. Never thought of sleep described in this manner.

Quick Hit: Tips for a Better Sleep Environment

Here are some of my keys to creating that ideal sleep environment. There might be a few in here that you didn’t think about. What are your keys?

Finance

Book: The Four Hour Work Week 

An oldie, but a goodie. I’m taking my time with this one because it’s a big book and filled with so many practical applications. This book inspired me to check my email, and respond, less frequently. He’s given me so many ideas on streamlining my life. You’ll love the tips he has for elimination and automation. Incredibly practical.

Blog: Student Loans? What Student Loans? 

Given that I’m pretty green at being a PT mercenary, this website has been gold for me. If this doesn’t inspire you to consider travel PT, nothing will. The money is real, and it seriously feels like I’m on vacation all the time.

Me on the left by the time my student loans are paid off

Book: Roger Dawson’s Secrets of Power Negotiating

I recently had to prepare for a salary negotiation, and just reading a few chapters from this book made the process go exceedingly better than I anticipated. Negotiating, like many things, is a skill. This book will teach you the fundamentals to a skill that will benefit so many aspects of your life.

Miscellaneous

Music: “Handshakes with Snakes” by Apathy (NSFW, and likely offensive to most everyone)

As y’all probably know, I am a major hip hop head. Like, pretty much all that I listen to. I found this cat on Spotify while at the gym, and was blown away. Has fire lyrics over insane samples. Listen to the joint called “Moses” which features Twista and Bun B. Un…be…lievable

Current Book: What If

I’ve lately been trying to read something a bit less technical right before bed to help me fall asleep (which has been working well btw). First book I chose was this gem by the creator of XKCD, Randall Munroe. He basically goes through and answers ridiculous questions in the most scientific manner possible. It’s a brilliant combination of interesting and funny.

My favorite so far? “What would happen if you had a mole of moles?” #deep

Photo credits

Air National Guard

Karim benzeoona

DonkeyHotey

 

Master Sagittal Plane, Coaching Progressions, Detaching, & TFL Inhibition – Movement Debrief Episode 5

Did you miss Movement Debrief live yesterday? Though much more fun live, I have a video of what we discussed below.

This debrief was quite fun, as we had an impromptu viewer q&a. Thank you Alan Luzietti for the awesome questions! If you follow along live on Facebook or Youtube, I will do my best to answer any questions you ask.

Yesterday we discussed the following topics:

  1. Why you should emphasize sagittal plane activities longer than you think
  2. How to coach exercises to maximize client learning and compliance
  3. Why detaching from your client encounters makes you a better clinician
  4. Viewer Q&A – “centering from the chaos” & TFL Inhibition

Lastly, if you want the acute:chronic workload calculator I spoke about, click here.

Without further ado:

The Squatting Bar Reach: A Movement Deep Dive

Aka How I Mastered the Sagittal Plane

In our first episode of “Movement Deep Dive,” we go over one of my favorite moves, the squatting bar reach. It’s an excellent technique and I hope this video explanation is helpful.

If videos aren’t your thing, I’ve provided a modified transcript below. I would recommend reading and watching to get the most out of the material.

Learn on!

 

Continue reading “The Squatting Bar Reach: A Movement Deep Dive”

Movement Chapter 9: Analyzing the Movements in Screens and Assessments

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.

Preferably while listening to someone groovy like Marvin Gaye

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.

Inline Lunge

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 down leg extension (otherwise substitution with anterior pelvic tilt and lordosis occurs).
  • 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.

 

Core Stuff

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.

It’s all in the reflexes.

Movement Chapter 8: SFMA Assessment Breakout Descriptions and Flowcharts

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
This is the only TED that I deal with.

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. Conversely, if I lack motor control, abnormal mobility may occur to compensate. However, the progression remains the same—restore mobility, then improve stability.

Honorable Mentions

Though the following testing protocols did not make the SFMA, they should still be tested per Gray:

  • Neurological exam.
  • Muscle strength.
  • Joint stability/mobility
  • Tissue tension testing (so…painful…to…write)
  • Identify neuromuscular trigger points
  • Impairment measurements

SFMA Rules

Here are some basic rules to implement when utilizing the SFMA that I picked up from there course.

1)      No warm up.

2)      If it looks like a dog and smells like a dog – it’s a dog.

3)      Be picky. Not bad = not good.

4)      No shoes.

5)      Monkey see, monkey do…perform the movement.

Sometimes it can go too far though...story of my life.
Sometimes it can go too far though…story of my life.

The SFMA generally also follows these basic ideas of testing, which can help assist you through the breakouts

  • Bilateral vs. unilateral
  • Loaded vs. unloaded
  • Active vs. passive

You will notice that the breakouts are a little different than what is presented in the book. These are the official breakouts from the current (6/2013) SFMA course.

Active Cervical Flexion

1. Start with supine cervical flexion (looking for chin to chest)

  •  FN: SMCD
  • DN, DP, FP: Move on

2. Passive supine cervical flexion (chin to chest)

  • FN: SMCD
  • DN, DP, FP: Move on

3. Active supine OA flexion test (20 degrees)

  • FN Bilaterally: If passive cervical flexion was DP/DN – TED/JMD; if FP – potential SMCD.
  • DN: OA flexion JMD/TED &/or possible cervical flexion JMD/TED
  • DP/FP: Stop; treat with modalities over exercise.

Active Cervical Extension

1. Supine cervical extension

  • FN: SMCD
  • DN: JMD/TED
  • FP/DP: Stop; treat with modalities over exercise.

Cevical Rotation-Lateral Bend

1. Active supine cervical rotation test (80 degrees)

  • FN: SMCD
  • DN/DP/FP: Move on

2. Passive supine cervical rotation test (80 degrees)

  • FN: SMCD
  • DN/DP/FP: Move on

3. C1-C2 cervical rotation test

  • FN: If test 2 was DP/DN, treat as lower cervical JMD/TED; if FP, could be an SMCD.
  • DN: C1-C2 JMD/TED &/or possible lower cervical spine JMD/TED.
  • DP/FP: Stop.

Upper Extremity Pattern 1 (MRE)

1. Active prone upper extremity pattern one (touch inferior angle)

  • FN: Move to supine reciprocal upper extremity pattern test shown below.
  • DN/DP/FP: Move on.

If the supine reciprocal upper extremity pattern test is…

  • FN: Mid-range SMCD; check spine extension breakout.
  • DP/FP: Stop the breakout.
  • DN: SMCD end-range SMCD. Check the spinal breakout.

2. Passive prone upper extremity pattern one (touch inferior angle)

  • FN: Move to supine reciprocal upper extremity pattern test shown above.
  • DN/DP/FP: Move on.

3. Active prone shoulder 90/90 IR test (60 degrees &/or total arc of 150 degrees)

  • FN: Move on to shoulder extension (#5).
  • DN/DP/FP: Move on to #4.

4. Passive prone shoulder IR (60 degrees &/or total arc of 150 deg)

  • FN: Shoulder IR SMCD; note this and move on.
  • DN: Shoulder IR JMD/TED; note this and move on.
  • DP/FP: Treat pain and move on.

5. Active prone shoulder extension test (50 degrees)

  • FN: Move on to elbow flexion (#7)
  • DN/DP/FP: Move on.

6. Passive prone shoulder extension (50 degrees)

  • FN: Shoulder extension SMCD; note this and move on.
  • DN: Shoulder extension JMD/TED; note this and move on.
  • DP/FP: Treat pain and move on.

7. Active prone elbow flexion test (thumb to shoulder)

  • FN: Move on to active lumbar locked extension (#9).
  • DN/DP/FP: Move on.

8. Passive prone elbow flexion test (thumb to shoulder)

  • FN: Elbow flexion SMCD; note this and move on.
  • DN: Elbow flexion JMD/TED; note this and move on.
  • DP/FP: Treat pain and move on.

9. Active lumbar locked extension (50 degrees).

  • FN: If no findings so far, combined pattern one JMD/TED.
  • DP/FP: Treat pain.
  • DN: Move on.

10. Passive lumbar locked extension (50 degrees)

  • FN: T-spine SMCD.
  • DN: T-spine JMD/TED.
  • DP/FP: Treat pain.

Upper Extremity Pattern 2 (LRF)

1. Active prone upper extremity pattern two (touch superior medial angle)

  • FN: Move to supine reciprocal upper extremity pattern test shown in the previous section.
  • DN/DP/FP: Move on.

2. Passive prone upper extremity pattern two (touch superior medial angle)

  • FN: Move to supine reciprocal upper extremity pattern test shown in the previous section.
  • DN/DP/FP: Move on.

If the supine reciprocal upper extremity pattern test is…

  • FN: Mid-range SMCD; check spine extension breakout.
  • DP/FP: Stop the breakout.
  • DN: SMCD end-range SMCD. Check the spinal breakout.

3. Active prone shoulder 90/90 ER test (90 degrees &/or total arc of 150 degrees)

  • FN: Move on to shoulder flexion/abduction (#5).
  • DN/DP/FP: Move on to #4.

4. Passive prone shoulder ER (90 degrees &/or total arc of 150 deg)

  • FN: Shoulder ER SMCD; note this and move on.
  • DN: Shoulder ER JMD/TED; note this and move on.
  • DP/FP: Treat pain and move on.

5. Active prone shoulder flexion/abduction test (170 degrees)

  • FN: Move on to elbow flexion (#7)
  • DN/DP/FP: Move on.

6. Passive prone shoulder flexion/abduction test (170 degrees)

  • FN: Flexion/abduction SMCD; note this and move on.
  • DN: Flexion/abduction JMD/TED; note this and move on.
  • DP/FP: Treat pain and move on.

7. Active prone elbow flexion test (thumb to shoulder)

  • FN: Move on to active lumbar locked extension (#9).
  • DN/DP/FP: Move on.

8. Passive prone elbow flexion test (thumb to shoulder)

  • FN: Elbow flexion SMCD; note this and move on.
  • DN: Elbow flexion JMD/TED; note this and move on.
  • DP/FP: Treat pain and move on.

9. Active lumbar locked extension (50 degrees).

  • FN: If no findings so far, combined pattern two JMD/TED.
  • DP/FP: Treat pain.
  • DN: Move on.

10. Passive lumbar locked extension (50 degrees)

  • FN: T-spine SMCD.
  • DN: T-spine JMD/TED.
  • DP/FP: Treat pain.

Multi-Segmental Flexion (MSF)

1. Single leg forward bend (touch toes)

  • FN/DN/DP/FP: Move on.

2. Long sitting (touch toes; 80 degree sacral angle).

  • FN: Move to rolling breakout.
  • DN/DP/FP: Move on.

3. Active SLR (70 degrees)

  • FN: Move on.
  • DN/FP/DP: Move on to passive SLR (#5)

4. Prone rocking (full rock back position)

  • FN: Move on to rolling breakouts.
  • FP/DP: Stop the breakout and treat the pain.
  • DN: Spinal flexion JMD/TED. Treat this first then reassess. Breakout can be stopped for now.

5. Passive SLR (80 degrees)

  • FN: Move on to rolling breakouts.
  • DN/DP/FP: Move on.

7. Supine Knee to chest (knees touch chest)

  • FN: Posterior chain TED &/or active hip flexion SMCD.
  • FP/DP: Stop the breakout and treat the pain.
  • DN: Hip JMD &/or posterior chain TED.

Multi-Segmental Extension (MSE)

SPINE BREAKOUT

1. Backward Bend (ASIS in front of toes, scapula pass heels, uniform curve).

  • FN: Stop the breakout; go to upper body extension flowchart.
  • DN/FP/DP: move on.

2. Single leg backward bend  (ASIS in front of toes, scapula pass heels, uniform curve).

  • FN: SMCD or anterior core TED; go to upper body extension flowchart.
  • DN/FP/DP: Move on.

3. Press up

  • FN: May have SMCD; but check other breakouts. Stop the spinal breakout.
  • DN/FP/DP: Move on.

4. Lumbar locked (IR) active rotation/extension (50 degrees)

  • FN: Move on to Prone on elbow unilateral extension (#6)
  • DN/FP/DP: Move on.

5. Lumbar locked (IR) passive rotation/extension (50 degrees)

  • FN: Thorax extension SMCD; check upper/lower extension breakouts.
  • DN: JMD/TED; check upper/lower extension flowcharts.
  • DP/FP: Stop and treat pain.

6. Prone on elbow unilateral extension (30 degrees)

  • FN: SMCD or anterior torso TED; check upper/lower extension breakouts.
  • DN: Move on.
  • FP/DP: Stop and treat pain.

7.  Prone on elbow unilateral extension (30 degrees)

  • FN: SMCD or anterior torso TED; check upper/lower extension breakouts.
  • DN: TED/JMD.
  • DP/FP: Stop and treat pain.

LOWER BODY BREAKOUT

1. FABER Test (2 fist distance)

  • FN: Move on.
  • DN/DP/FP: Hip/SI JMD/TED or SMCD (only if stabilized FABER changed mobility). Note this and move on.

2. Modified Thomas Test (flat to mat)

  • FN: Move on.
  • FN w/ knee straight: Lower anterior chain TED. Treat.
  • FN w/ hip abducted: Lower lateral chain TED. Treat.
  • FN w/ hip abducted & knee straight: Lower anterolateral chain TED. Treat.
  • DN: Hip extension JMD/TED &/or core SMCD. Treat.
  • DP/FP: Stop and treat pain.

3. Prone active hip extension (10 degrees or >)

  • FN: Move on to rolling breakouts.
  • DN/DP/FP: Move on.

4. Prone passive hip extension (10 degrees or >)

  • FN: Move on to rolling breakouts.
  • DN: Hip extension JMD/TED.
  • DP/FP: Stop and treat pain.

UPPER BODY BREAKOUT

1. Unilateral shoulder backward bend

  • FN: Double check press up on spine extension breakout as well as cervical spine.
  • DN/FP/DP: Move on.

2. Supine lat stretch hips flexed (arms to table)

  • FN: Move on to rolling breakouts.
  • DN/DP/FP: Move on.

3. Supine lat stretch hips extended (arms to table)

  • FN: Lat/posterior chain TED &/or possible hip extension dysfunction; check lower body flowchart.
  • Flexion improves but not full: Same as above. Note these changes and move on.
  • DN/DP/FP: Move on.

4. Lumbar locked (ER) Unilateral extension (50 degrees)

  • FN: Scapular/humero-glenoid SMCD.
  • DN/DP/FP: Move on.

5. Lumbar locked (IR) active rotation/extension (50 degrees)

  • FN: Shoulder girdle JMD/TED.
  • DN/DP/FP: Move on.

6. Lumbar locked (IR) passive rotation/extension

  • FN: Thoracic SMCD.
  • DN: Thoracic JMD/TED.
  • FP/DP: Treat the pain.

Multi-Segmental Rotation (MSR)

SPINE BREAKOUT

1. Seated rotation (50 degrees)

  • FN: Go to hip rotation breakout
  • DN/DP/FP: Move on.

2. Lumbar locked (ER) unilateral extension (50 degrees)

  • FN: Move on to prone on elbows unilateral rotation (#5)
  • DN/DP/FP: Move on.
  • DN/DP/FP switches sides: Move on to to rolling breakouts.

3. Lumbar locked (IR) active rotation (50 degrees)

  • FN: Shoulder girdle TED/JMD.
  • DN/DP/FP: Move on.

4. Lumbar locked (IR) passive rotation (50 degrees)

  • FN: Move on to rolling pattern breakouts.
  • DN: Thoracic JMD/TED.
  • FP/DP: Stop and treat pain.

5. Prone on elbows unilateral rotation (30 degrees)

  • FN: Move on to rolling pattern breakouts.
  • DN: Move on.
  • FP/DP: Stop and treat pain.

6. Passive prone on elbows unilateral rotation (30 degrees)

  • FN: Lumbar SMCD.
  • DN: Lumbar TED/JMD.
  • DP/FP: Stop and treat pain.

HIP ROTATION BREAKOUT

1. Seated active hip ER/IR (>40 degrees/>30 degrees)

  • FN: Move on to prone active hip ER/IR (#3)
  • DN/FP/DP: Move on.

2. Seated passive hip ER/IR (>40 degrees/>30 degrees)

  • FN: Move on.
  • DP/FP: Stop and treat pain.
  • DN: Hip JMD/TED. Make note of this and move on.

3. Prone active hip ER/IR  (>40 degrees/>30 degrees)

  • FN: If seated passive rotation was DN, stop and treat. If not, move on to rolling pattern breakouts.
  • DN/FP/DP: Move on.

4. Prone passive hip ER/IR (>40 degrees/>30 degrees)

  • FN: If seated passive rotation was DN, stop and treat. If not, move on to rolling pattern breakouts.
  • DN: Hip JMD/TED. Go to tibial roation and lower body extension breakouts
  • DP/FP: Stop and treat pain.

TIBIAL ROTATION BREAKOUT

1. Seated active Tibial ER/IR

  • FN: Double check lower body extension flowchart.
  • DN/DP/FP: Move on.

2. Seated Passive Tibial ER/IR

  • FN: Tibial rotation SMCD.
  • DN: Tibial rotation JMD/TED.
  • DP/FP: Stop and treat pain.

Single Leg Stance

VESTIBULAR AND CORE BREAKOUT

1. CTSIB (Static)

  • FN: Move on.
  • DN/DP/FP: Potential static vestibular dysfunction. Refer out/treat. Can move on to Half-kneeling narrow base (#3)

2. CTSIB (Dynamic)

  • FN: Move on.
  • DN/DP/FP: Potential Dynamic vestibular dysfunction. Refer out/treat. Move on in breakout.

3. Half-Kneeling narrow base

  • FN: Go to ankle breakout.
  • DN/DP/FP: Move on.

4. Rolling breakouts

  • FN: Move on.
  • DN: SMCD. Go to ankle flowchart.
  • DP/FP: Treat pain; go to ankle flowchart.

5. Quadruped Diagonals

  • FN: SMCD; go to ankle flowchart.
  • DP/FP: Treat pain; go to ankle flowchart.
  • DN: SMCD or shoulder flexion/hip extension are DN; go to ankle flowchart.

ANKLE BREAKOUTS

1. Heel walks

  • FN: Move on to toe walks (#3)
  • DN/DP/FP: Move on.

2. Prone passive dorsiflexion (20-30 degrees)

  • FN: Dorsiflexion SMCD; note and move on.
  • DN: Dorsiflexion TED/JMD; note and move on.
  • DP/FP: Treat pain and move on.

3. Toe walks

  • FN: Move on to seated ankle inversion/eversion (#5)
  • DN/DP/FP: Move on.

4. Prone passive plantarflexion (30-40 degrees)

  • FN: Plantarflexion SMCD; note and move on.
  • DN: Plantarflexion JMD/TED; note and move on.
  • DP/FP: Treat pain and  move on.

5. Seated active ankle inversion/eversion

  • FN: If no above impairments, then there is a proprioceptive deficits. Otherwise treat above impairments.
  • DN/DP/FP: Move on.

6. Seated passive ankle inversion/eversion

  • FN: SMCD.
  • DN: JMD/TED.

Overhead Deep Squat

1. Interlocked fingers behind neck deep squat

  • FN: Recheck extension breakouts
  • DN/DP/FP: Move on.

2. Assisted squat

  • FN: Core SMCD. Make sure MSE is clear.
  • DN/DP/FP: Move on.

3. Half-kneeling dorsiflexion (20-30 degrees)

  • FN/FP/DP: Move on.
  • DN: TED/JMD; check MSE/SLS breakouts, note and move on.

4. Supine knees to chest holding shins

  • FN: If dorsiflexion normal, then SMCD; If dorsiflexion was DN, then knees/hips/core are normal; if dorsiflexion was DP/FP, then treat dorsiflexion. Chec MSE.
  • DN/DP/FP: Move on.

5. Supine knees to chest holding thighs

  • FN: Knee JMD/TED. Check MSE.
  • FP/DP: Stop and treat pain.
  • DN: Hip JMD/TED. Check MSF for hips an MSE.

Segmental Rolling

1. Prone to supine upper body rolling

  • FN/DN: Move on.
  • DP/FP: Go back to chart that tested rolling.

2. Prone to supine lower body rolling

  • FN/DN: Move on.
  • DP/FP: Go back to chart that tested rolling.

3. Supine to prone rolling with upper body

  • FN/DN: Move on.
  • DP/FP: Go back to chart that tested rolling.

4. Supine to prone rolling with lower body

  • FN: Likely a weight-bearing or higher level SMCD if all patterns were FN; return to the chart that tested rolling.
  • DN: Likely a fundamental SMCD in any of the above patterns.
  • DP/FP: Go back to chart that tested rolling.

Conclusions

Phew, that 2000+ words later and we have a lot of stuff. Digest this information, and give these breakouts a try.

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.