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Reconsidering The Way We Look at Movement

Gray Cook MSPT, OCS, CSCS Pitt-Marquette Challenge Lecture

Virginia Commonwealth University

February 1, 2012

Thanks for coming

How did I get here?

Too many smart people disagreed on movement topics like exercise,

rehabilitation and athletic performance. I realized it was a

question of perspective.

So I forced myself to look at movement differently!

Keys to Considering Movement

1. Never forget the developmental foundation

2. Consider patterns and parts equally

3. Screen, Test, Assess Basic Function

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A little history for you

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Keys to Considering Movement

1. Never forget the developmental foundation

2. Consider patterns and parts equally

3. Screen, Test, Assess Basic Function

1. Never Forget The Developmental Foundation

Did you catch that?

1954

1965

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Is this a bad movement or have we just become bad squatters?

Argue for a cultural weakness and you will soon own it!

Keys to Considering Movement

1. Never forget the developmental foundation

2. Consider patterns and parts equally

3. Screen, Test, Assess Basic Function

2. Consider Patterns and Parts Equally

Reductionism is necessary but not sufficient We are good at measuring specific points, but not as

consistent when measuring whole patterns.

We must develop a system for discussing movement patterns that fosters

communication and clarity among the many professions

that claim movement as their territory.

The Jump Study

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Jump Study take away

The movement pattern changed but no change in anatomical parts was necessary.

Dont ask for a positive adaptation if you cannot get a positive response.

Most neurological systems are not operating as efficiently as they potentially can.

Movement Patterns

Is squatting deep normal or exceptional?

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Movement Patterns

When a squatting pattern is poor, is the reason always anatomical?

Be Practical in Your Practice

Anatomy, Kinesiology, and Biomechanics are not

movement they are simply ways to discuss parts and patterns of movement.

Always remember the map is not the territory!

When you are lost in the wilderness do you want a competent woodsman or a mapmaker?

Keys to Considering Movement

1. Never forget the developmental foundation

2. Consider patterns and parts equally

3. Screen, Test, Assess Basic Function

3. Screen, Test, Assess Basic Function

Professional Confidence? Thin Slicing

The Book Blink Expertise - advanced

pattern recognition

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Thin Slicing

Experts in any field are able to accurately and quickly identify patterns, while novices stumble through the process and do not recognize the salient features of things.

Goldman Algorithm

ECG

Unstable Angina

Fluid in Lungs

SBP

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Working Definition

Screen Rate and Rank Function

Test Measure Ability Function

Assess - Inability / Dysfunction

Working Definition

Screen Predict

Test Predict

Assess Diagnose

Rate & Rank Problems then measure!!!!!

Checklists?

Keys to Considering Movement

1. Never forget the developmental foundation

2. Consider patterns and parts equally

3. Screen, Test, Assess Basic Function

We have a problem It all starts with Function!

Functional Training

Functional Exercise

Functional Rehabilitation

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What is Function?

Can you define function as it pertains to movement?

Defining Function

Define dysfunction

Function is the absence of dysfunction

Dysfunction

Dysfunction =

limitations with movement competency

Deficiency =

limitations with physical capacity

Dysfunction

Movement competency below a standard accepted level

The accepted level is based on:

risk of injury

poor adaptive capability

Separate from physical capacity

But where should we start looking for dysfunction?

What movement parameter should we use?

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1. Never Forget the Developmental Foundation

How about movement patterns used in

fundamental development?

2. Consider Patterns and Parts Equally

Movement Patterns

There are numerous ways in which slight subtleties in movement patterns contribute to specific muscle weaknesses...

Dr. Shirley Sahrmann

Movement Patterns

The relationship between altered movement patterns and specific muscle weaknesses requires that re-mediation addresses the changes to the movement pattern; the performance of strengthening exercises alone will not likely affect the timing and manner of recruitment during functional performance.

Dr. Shirley Sahrmann

What is she talking about?

Motor Control

Its a much better term then stability

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Considering Patterns of Movement

During the 1990s, the continued evolution of rehab required that movement remain the central focus.

The APTA adopted a philosophical statement clearly stating that movement dysfunction is the basic problem addressed by rehab intervention.

Ok - we need to look at movement patterns how?

We need a SOP! standard operating procedure

a consistent reproducible system

Stick to a System (standard sequence)

Only by sticking to a standard sequence will the physician be sure of leaving nothing out and only by leaving nothing out are true findings feasible.

Dr. James Cyriax

Consistency

The physician arrives at a diagnosis not from the evidence furnished by one painful movement but by careful determination of a consistent pattern.

Dr. James Cyriax

It seems clear

We should look at movement patterns.

We need a consistent system to address movement dysfunction.

But what else can we do?

We cant just talk movement and function; we also need

to consider pain!

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Questions

Do people move poorly because they are in pain?

or

Are people in pain because they move poorly?

What about pain?

Pain, however undesirable, serves an important biological function acting as a warning signal that all is not well in the movement system.

- Dr. Vladimir Janda

What is the problem?

Nothing is ever one thing, but usually a complication of multiple factors with each hiding the others tracks...

How will we group in the future? Screen, Test, then Assess

Screen Generalized Grouping of Dysfunction

Asymptomatic (no report of pain with movement)

Test Specific Measurement of Dysfunction

Asymptomatic (no report of pain with movement)

Assess Judgment of Dysfunction / Diagnosis

Symptomatic (pain associated with movement)

Observe the order or lose perspective!

1. Squatting

2. Stepping

3. Lunging

4. Reaching

5. Leg raising

6. Push-up

7. Rotary Stability

THE FUNCTIONAL MOVEMENT SCREEN Scoring of the FMS

- Perform Pattern as Directed 3

2

1

0

- Perform Pattern with Compensation/Imperfection

- Unable to Perform Pattern

- Pain with Pattern Regardless of Quality

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Rate and Rank Movement Competency

Pain with movement regardless of quality

Dysfunctional movement quality

Imperfect movement quality

Near perfect movement quality

Then measure the level of severity in the category

Grouping is the KEY!

Pain with movement regardless of quality

Dysfunctional movement quality

Imperfect movement quality

Near perfect movement quality

Y Balance Testing

Cervical Patterns

Upper Ext. Patterns

Multi-Segmental Flexion

Multi-Segmental Extension

Multi-Segmental Rotation

Single Leg Stance

Squatting Pattern

Assessment The Big 7

- The Big 7

Cervical Patterns

- The Big 7

Upper Ext. Patterns

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- The Big 7

Multi-Segmental Flexion

- The Big 7

Multi-Segmental Extension

- The Big 7

Multi-Segmental Rotation

- The Big 7

Single Leg Stance

- The Big 7

Squatting Pattern FN - Functional and Non-Painful

FP - Functional and Painful

DP - Dysfunctional and Painful

DN - Dysfunctional and Non-Painful

Scoring of the SFMA

Stop Treatment

Proceed with

Caution

Continue Treatment

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Where Does SFMA Fit In?

History

Ortho-Neuro Exam

SFMA

Local Biomechanical Testing

So What Do We Know?

Neurodevelopmental Perspective

Altered Motor Control

Regional Interdependence

Altered Motor Control

Pain with Movement

Movement complicated with pain produces inconsistent and unpredictable movement patterns.

Movementbook.com - Chapter 2 videos

Neurodevelopmental Perspective

Neuro-Developmental Perspective

The Neuro-Develomental Perspective has taught us that movement was developed in patterns not in individual muscles.

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This concept is more complete than stability training for many reasons!

This concept is about control - not activation.

Motor control involves coordination and balance of complementary muscular influence.

This concept is more complete than stability training for many reasons!

Some muscles need to be turned up and some need to be turned down.

The responses need to match the changes in the internal and external environment.

Neuro-Developmental Perspective

We knew any assessment had to be derived from basic patterns that are part of the natural development of human movement.

Regional Interdependence

Regional Interdependence

Refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patients primary complaint.

-Wainner et al JOSPT 2007

The injury behind the injury

Concussion! Neck???

Ankle! Hip???

Shoulder! Wrist, Hand, and Elbow???

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Regional Interdependence

A muscle may appear weak when it is not, if there is inadequate stabilization of its attachment points, which itself is dependent upon a chain of muscles.

- P. Kolar

Mobility and Motor Control = Movement Pattern

Hips

Mobile

Core

Stable T-Spine

Mobile

Broken Pattern (first identify then measure)

Hips

Stiff

Core

Sloppy T-Spine

Stiff

Lets Summarize

Point One

Establish a SOP for identifying dysfunction within fundamental movement patterns

Define dysfunction

Agree on fundamental movement patterns

Point Two

Separate painful movement patterns from dysfunctional movement patterns whenever possible.

Use a reliable tool to compartmentalize problematic movement patterns

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Point Three

As a general rule do not manage or treat painful movement patterns with exercise.

Manage painful movement patterns with manual therapies and modalities

Manage dysfunctional movement patterns with systematic corrective exercise strategies and use manual efforts and modalities to assist as needed

Point Four

Identify impairments within dysfunctional movement patterns

Limitations in mobility

Limitations in motor control

Point Five

Establish minimum levels of mobility followed by minimum levels of motor control competence whenever possible and retest the dysfunctional movement patterns

(Test / Retest Model)

If we dont think logically about this stuff - who will?

Make things as simple as possible but no simpler.

Albert Einstein

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FunctionalMovement.com The End