It has been quite some time since I sat down and wrote. Although it is no excuse, it was an insane last few months. Flu bug hit the house, then a trip for a family wedding and a subsequent week on my own at the shop. Therefore I was running the show, and I have to say things went rather smoothly. That lack of time has made me more intent on writing, more so, now than ever. I feel as if I have done a disservice to the blog and those who take the time to read it. Mom, thanks for logging in do much to boost the numbers. Over this time I have been emailing back and forth with a good friend, Graeme, whom you all remember is the guy who called me out a month back.
We have been discussing the assessment of movement and “dysfunction”. There is great debate on this on the internet with many of the top guys in the game of strength coaching taking sides and in some cases splitting hairs over the nuances of assessing movement. As I have talked about in previous blogs, I utilize a screening process to aid in the development of programs for all the athletes that I work with. Graeme had read a post from Vern Gambetta who had his take on assessment of movement. Knowing that I have used some type of screen in my coaching Graeme asked my opinion. The subsequent response was that Graeme and I have a similar view in the use of assessment of movement and recognizing dysfunction. The following is Graeme’s take on movement assessment.
Assessing movement requires there to be levels of quality to movement (obvious). Of interest then is what constitutes movement quality. It’s probable that not everyone will agree on the constituents as quality is subjective and it’s definition is difficult to pinpoint, but I think that key criteria to movement quality are:
- 1. Whole-body Coordination / Rhythm. The relation of body and limbs to each other across time and space.
- 2. Active Mobility. The capacity to move joints through a wide range/amplitude via contraction/relaxation of appropriate muscles
- 3. Speed of Movement.
- 4. General Technical Competency.
Obviously there are other factors at play (proprioception, motor control, muscle balance, posture, stability, balance, etc) but I consider some of them further down the ‘ladder’ and some of them as categories distinct from movement (though interacting with it, since movement is an integrated expression of all body systems). I tend to think of 3 broad categories here.
- 1. Musculoskeletal Balance. Comparison of function (strength/mobility) between muscle groups and movements (right/left, agonist/antagonist, push/pull/squat/lift/rotate) and the impact of this on posture (spinal & skeletal alignment).
- 2. Proprioception. Ability to sense ones position and movement in space.
- 3. Motor Control. Ability to contract/relax muscles to produce precise and accurate movement.
For me, confusion stemmed from the fact that tests have been developed that seem to address these other factors via specific movements, and are thus called ‘movement assessments’; the term has become umbrella-like. Personally, I think a lot of these ‘movement assessments’ are addressing Musculoskeletal Balance, Proprioception and/or Motor Control…they are just doing it through movement. So I now see our earlier conversation as having 2 aspects: 1) What is important in assessing movement quality and 2) the relevance/use of so-called ‘movement assessments’ .
So in that regard, I agree with Gambetta in that assessment of movement must focus on movement quality, with the emphasis on sport-related movements reflecting ones progress into specialization. In practice, this lies more in the domain of the head coach, not the S&C coach (they have more sport-specific expertise and far more observation time). However, it is our job to help address mobility/strength/awareness/etc issues that the coach picks up on. Still, as S&C coaches, we must be concerned with and regularly address lifting patterns. In doing so, I think it is flawed to try and mold athletes into an ‘optimal’ pattern, as each body type & physiological profile will result in a different ‘optimal’. Better to work within a general framework and make adjustments tailored to the individual. As Gambetta said, this can be done through daily observation & correction in training and does not necessitate a specific test.
In terms of ‘other movement assessments’ like the single leg squat, reach tests, etc, I agree with Gambetta in that they are of limited use in evaluating movement; their procedure involves movement, but the variable of interest is something else (stability/mobility, strength, balance, etc). He didn’t address whether he found them useful for other purposes. I think they are, but it’s the method of quantification and the purpose for which the test is used/interpreted that is crucial. I tend to lean towards screens for Musculoskeletal Balance. Partly because proprioception and motor control work very closely with one another and, when combined, result in coordination (which can be assessed visually on a daily basis). More so because, although Musculoskeletal Balance can impact movement quality, I consider it to be a separate entity that has its own health / performance ramifications.
The typical approach for tests of Musculoskeletal Balance seems to be to look for imbalance and then correct the ‘problem’. I think this is a flawed concept; as said earlier, we will always find something wrong if we look for it. Particularly in an athletic population where the sport itself will create (and perhaps necessitate) imbalance…hunched shoulders in boxers, R-L shoulder imbalances in tennis players, spiral line imbalance in strikers/throwers, hyperkyphosis in cyclists, perhaps slight scoliosis in skaters, etc. As you mentioned, the level of athlete will alter our approach and I agree with you that, in the developing athlete, there is more merit to spending time working towards the ‘optimal’ value; this contributes to the base that we specialize off of. However, there is the risk of spending too much time on correcting an endless list of ‘faults’, with no good evidence (that I’m aware of) that it translates to improved performance. In fact, I remember Matt Jordan commenting once that according to some of these tests, the best athletes in the world are sometimes ‘unbalanced’ and full of ‘dysfunction’. Just like we accept compromises in certain biomotor abilities to specialize in others, it is also likely that we have to accept compromises in Musculoskeletal Balance to specialize in a movement demanded by a sport. If the imbalance is not affecting health, risk of injury, or the ability to train/compete, then I’m not convinced dedicating time to correct it is worthwhile. Though Poliquins ‘Structural Balance’ work indicates lifts can be improved by addressing imbalance between various exercises, this is only of interest to me if the exercise that will be improved 1) has relevance (i.e. transfers) to sport performance, which is dependent on the lift, and 2) the current maximal strength level of the athlete in that lift. I would be interested in learning if his process impacts risk of injury or posture (I have a hunch it would…I just haven’t found anything on it yet).
Instead, I think screens should be used to create an individual baseline and then monitor to prevent extreme imbalance that has known health implications. They may also provide information as to why certain movements are difficult, or provide a goal if returning from injury. I’m unsure of the value of correlating results to performance given all the other contributing factors…but maybe. Of importance is to favor screens that score quantitatively over qualitatively and objectively over subjectively. I like the idea of using/comparing maxes of typical exercises (i.e. front/back squat, snatch etc) as they are more applicable movements without familiarization issues, scoring is not subjective, results can be obtained from recent training sessions (or tests added with minimal training interruption). They also allow for comparison to performance standards (if available). I see tests requiring subjective interpretation like the overhead squat or Klatt Test more as an indicative/confirmation tool if a technical issue is unable to be corrected by movement/load adjustment or raising awareness; again, probably of more use in developing athletes. Of course, true diagnostics of muscle dysfunction should be left to the PTs/ATs!
To try and tie this rambling string of thought together….I consider ‘movement assessment’ to be a specific term relating to overall movement quality (coordination/rhythm, active mobility, technique and speed). This can be looked at on a daily basis within training w/o specific tests. Probably prudent to note that this is different from technical analysis (which would be more concerned with a reductionist view of body position as oppose to a global view of body movement). Other ‘movement assessments’ are poorly termed as they actually assess characteristics other than movement. In terms of those looking at Musculoskeletal Balance, I think there is value in periodic comparison of specific maximal lifts and posture assessment, with the interpretation from a health perspective rather a performance one (working to prevent extremes rather than trying to achieve a desired ‘optimal’).
In my own practice, I utilize the Functional Movement Screen (FMS), but only in combination with other test, such as spinal alignment and strength testing. Although the tests do address dysfunction, it answers many questions on limitations to movement. Those may be hip or ankle immobility but that aids me in understanding the movements exhibited by my clients. As I have also maintained, although I look at posture and dysfunction, I understand that there will be certain “dysfunctions” specific sports will foster. Many of my swimmers exhibited rounded shoulder for example. It was a product of their sport. Did I try and change it? Yes, to some degree, but it was in the aim of not exacerbating the issue further and realizing that I would consider “normal” for a general population, would not be valid for an athlete. The biggest issue I see with movement assessments, and much of the testing in general is many coaches test for the sake of testing and do not address the issues, or utilize a consistent follow up program to monitor change. Therefore what was the purpose? As well, there is some degree of understanding what to do with the results of testing. I think the issue is with the so-called certification of testing, where as you attend level one, and can now administer the FMS for example. However, to understand the correcting phase programming you must attend level two… at another monetary cost. Many coaches think they will “figure” out the rest after level one, as they are reluctant to spend more on their education, only to not fully understand the results of the test. They lack the dedication to follow through fully with the understanding or the accreditation. For these reasons, movement assessment tends to get a poor reputation. I think there is merit to testing, whether it physiological, strength or biomechanical, however the utilization of the testing results must be incorporated with training so that improved results are see.
As this is getting rather long, I will leave it there for many of you to ponder on your own. I think this leaves a lot to consider and I would once again like to thank my good friend Graeme (one of the smartest guys I know) for allowing me to share his thoughts with you.
Yours in Health and Performance,
Jeff Osadec, MKin, CEP, CSCS
A good synopsis of movement screening, Jeff (and Graeme). The concept of ‘optimal’ when it comes to movement across different sports has always been tough to reconcile, and I think you touched on that nicely. Other than collecting massive amounts of longitudinal data, can you think of any way to provide a range of subjective scores (e.g. for any of the FMS tests) that might be acceptable in a given sport? Is the FMS even that precise with only one of 3 choices for any given test? I also particularly liked Graeme’s distinction of the unique dimensions of testing movement. Very thought-provoking.
The FMS is a great base test, but it is only scratching the surface. I have seen and heard of many people who are performing the FMS and using it as a stand alone test. That is why we have paired it with a number of other test, that give is a greater picture of what is happening from a movement perspective and then how to address it from a programming point of view. The more I work with the FMS, and create data sheets so that my clients can see what their results were, I have aimed to automate as much of the programming as I could. But, I have found myself going back to simple interpretation of the scores for each client on an individual basis. Here is the thing, for FMS, the three scores aim to make the interpretation of the results pretty easy, however there is the misconception. Each individual brings with them their own series of issues and “dysfunctions”. I do not think you can look at a sport and group everyone together and see a set of subjective scores. At this point I think there are too many external factors that each athlete has that impact the results. I think each athlete needs to be assessed and interpreted on a case by case basis. And maybe in a few years when we compile the data we may see trends, but at this time, I have not seen enough results to set a series of subjective scores.