Functional Movement Screening: A Guide for Moving Well So That You Can Move Often
I like how Timothy Ferriss, author of The 4 Hour Body, expressed his position on movement preparation:
“Pursuing increases in performance without doing “pre hab” for injury prevention is like getting in an F-1 racecar without checking the tires. The small upfront investment of time will allow for faster progress while avoiding serious setbacks”
Whether it is golfing or CrossFit, exposing and correcting fundamental and functional movement problems before engaging in exercise, increasing workloads, and advancing skill sets can prevent injury and even improve your performance. What Timothy Ferriss is talking about is not performance or skill specific testing, he is advocating movement competency and durability. One way to pursue this is through an unbiased appraisal of movement to address dysfunctional movement patterns that may leave someone vulnerable to injury.
Screening to Correct Functional Movement Patterns
Screening and correcting functional movement pattern is an important idea. We often think our core is doing fine when we are doing crunches and then when we attempt a higher-level activity like a squat or lunge, this is where the rubber meets the road. Once higher level pattern is introduced, that is where we may find out that our core function is compromised. It could be that our core musculature is strong but not able to provide reflexive stability (strong and stable are not the same thing). Inadequate core function could also be the result of a lack of hip mobility. When the hips don’t move well, the low back cannot maintain its position because it must make up for motion that is not coming from the hips.
The outcome for both of these example is often low back pain but how do you know if you have an issue with your core, an issue with your hips, or both? This is why screening is so valuable. Not only are you able to identify deficiencies and work on them, but a Functional Movement Screenwill establish priorities – if there is more than one thing to work on, there will be no question about what should be addressed first.
When we are born, we come into the world with mobility only and it is the foundation for stability and strength, which must be earned. Therefore, if a Functional Movement Screenreveals mobility issues, those quickly move to the top of the list as high priorities. Mike Boyle and Gray Cook explored this idea further when they wrote articles discussing The Joint By Joint Approach.
The Joint By Joint Approach: A Look at Common Tendencies, Patterns, and Problems
Because of the built-in redundancies with the Functional Movement Screen, by the end of the process, mobility and stability issues are accurately identified. What Gray Cook and Mike Boyle did was take this idea of mobility and stability and applied it to our body as a stacked set of joints. We cannot disassociate injury from primary joint function because what we know is dysfunction at one level typically presents itself as pain at the joint above or the joint below.
The example Mike and Gray often use is a good one:
If your hips don’t move, your low back will. I see this everyday with my patients. The problem is now these two areas are doing the opposite of what they are designed to do – the hip is stiff when it is supposed to be mobile and the low back is moving when it should be a source of stability. The outcome is probably going to be back pain.
Here is what the list of primary joint functions looks like:
- Ankle: MOBILITY (in one plane)
- Knee: STABILITY
- Hip: MOBILITY (multi planar)
- Lumbar Spine: STABILITY
- Thoracic Spine: MOBILITY
- Scapula: STABILITY
- Shoulder (Glenohumeral): MOBILITY
There is a pattern to what many clinicians are seeing:
- A lack of ankle mobility often results in knee pain
- A lack of hip mobility often results in low back pain
- A lack of thoracic spine mobility often results in cervical spine pain and shoulder dysfunction
Why We Struggle to Assess Ourselves
Professional experience and research tells us that most people do not have the capability to evaluate their own movement quality. When golfers were asked if they could deep squat, 68 percent reported they could. The reality was 28 percent of them could perform a deep squat pattern. Even professional athletes who are succeeding seem to be doing so it spite of themselves.
According to the research, we know a score 13 or below out of 21 on a Functional Movement Screenis a score that indicates an increased risk of injury. In the past, scores averaged from the NFL Scouting Combine have demonstrated those athletes involved in this process, as a group, did not break 13/21.
Another factor that hinders an accurate self-assessment is a lack of pain. Individuals often equate not having pain with having good function and with being fully restored following an injury. These are not accurate assumptions. There is a change in motor control that often occurs with injury that often does not normalize, even with rehabilitation. A Functional Movement Screen prior to a return to higher level activity can help catch these deficits.
One of the things my patients disclose the most is a fear of loss of function – not being able to carry groceries, manage the dog, climb the stairs, etc. If you had something predisposing you to loss of function and could address it and prevent an injury, wouldn’t you want to? It is no different from the athletes who don’t want to be unable to compete or the fire fighter who does not want to be off his truck due to injury. This is why a Functional Movement Screenis beneficial, regardless of age or ability level, regardless of whether your goal is to continue to reach the dishes in the cabinet or minimize your risk of an ACL tear when you play football.
Functional Movement Screening: A Small Upfront Investment
On an encouraging note, a Functional Movement Screenis probably far less intimidating than what most people imagine. It consists of 7 tests that take 15-20 minutes and this leads the person being screened to what needs attention. It may be that multiple issues need to be addressed. What we know to be true is often correcting lower level pattern will result in improved higher level pattern. It is often appropriate to work on more than one pattern at once but the goal is never to give you 10 mindless things to work on but rather 2-3 effective things. Something else to keep in mind is that perfection is not the goal. Remember the NFL Scouting Combine data? If 13/21 or below is what you want to avoid, 14/21 or higher becomes the goal, not21/21.
It is such a simple idea but one that is overlooked with incredible frequency – “move well, then move often.” If you have pain, see your healthcare provider and get that addressed. If you want to know if you move well and take steps toward preventing injury and improving performance, regardless of the activity, go to the Functional Movement websiteto learn more or to find someone in your area who is qualified to screen and provide correctives. In other words, don’t forget to check the tires.