As chiropractors, we learn to assess, diagnose and treat conditions of the spine and extremities that cause pain, dysfunction and disease. As sports chiropractors, we take a step further by integrating rehabilitation, physiotherapy, sports-performance training and nutrition to provide a comprehensive approach to our patients. Often our focus is primarily on the location of pain, when it also needs to be seen as a messenger or signal.
The potential exists to become myopic, focusing on one body part as being the problem versus thinking in terms of movement patterns for the entire body and prescribing specific corrective exercises or treatment that addresses a significant dysfunction. Movement, especially moving well and often, is at the heart not only of our early growth and development; it also remains a central issue throughout our lives, especially for aging athletes and patients.
The Functional Movement Screen
In rehabilitation, sports medicine and sports-performance training, much is talked about "functional" and "core" training. Often the "What comes first: the chicken or the egg?" question arises when defining the topic of function and how it relates to determining what is a priority; mobility or stability. One of the most valuable tools in addressing this question and assessing "weak links" in the kinetic chain is the Functional Movement Screen developed by Gray Cook, MSPT, and Lee Burton, PhD. The Functional Movement Screen or FMS grades seven different movement patterns to assess mobility, stability, balance, symmetry and proper movement sequence or patterns.
One way to look at how we function and perform is to visualize a three-layered pyramid that separates first function, then strength/ power performance, and finally sport-specific skills. Think of the rectangular base of a pyramid that defines how well the patient's or athlete's body functions in terms of mobility, stability, balance, symmetry and proper movement patterns. This base is the widest part of the pyramid and upon which all else is built. In the middle is a layer of strength and power performance and on top are specific sports-performance skills.
Often fitness is "piled" onto dysfunction without addressing the functional base of the athlete's "pyramid." This is where potential trouble begins and is a reason patients enter our offices. Many talented athletes can perform at a high level because they are such good compensators. However, they are an injury or accident ready to happen because they are working around a pre-existing problem and simply are not aware or neglect to train their functional weaknesses before beginning their strength and conditioning programs. As Gray Cook says in his book Movement: Functional Movement Systems, "Movement is how we survive, communicate, recreate and thrive." The performance pyramid applies to us all if we are to function well not only in sports, but also our daily activities.
The FMS: Seven Tests
The following tests serve as brief descriptions of the Functional Movement Screen. The screen takes about 10 minutes to perform and is easily integrated into your treatment schedule with your patients. The seven tests of the FMS are each graded 0-3 with a total score of 21 possible. If during any of the movements there is pain, 0 is the score and that particular issue is addressed with appropriate treatment modalities after the entire screen is performed. If one of the tests is performed perfectly, it is graded a 3. A minimum of two points for each of the seven tests (total score of 14) is the minimum to participate in strength training or athletics. A score under 14 increases probability of injury and decreased performance.
The first screen is the Deep Overhead Squat Movement Pattern. It demonstrates fully coordinated ankle, hip and thoracic spine mobility and core stability with the hips and shoulders functioning in symmetrical positions. (By the way, this test is critical especially for your golfers.)
The second screen is the Hurdle Step Movement Pattern Test. It is designed to challenge the body's proper stepping and stride mechanics, as well as stability and control in single-leg stance. This is really helpful in determining symmetry left and right side while assessing hip mobility and balance.
The third screen is the In-Line Lunge Movement Pattern Test. This provides a quick appraisal of left and right function in a basic pattern and is intended to place the body in a position that will focus on the stresses as simulated during rotation, deceleration and lateral-type movements. This test is done with the patient balancing on a 2x6-inch board with their feet in line and while maintaining perfect posture.
The fourth screen is a Shoulder Mobility "Reaching" Movement Pattern Test. This test demonstrates the natural complementary rhythm of the scapular-thoracic region, thoracic spine and rib cage with reciprocal upper-extremity shoulder movements. In other words, you are really testing thoracic spine mobility in addition to glenohumeral movement and scapular stability.
The fifth screen is the Active Straight-Leg-Raise Movement Pattern Test. This is an "apparently" simple test that has the patient supine on the ground and identifies active mobility of the flexed hip and initial and continuous core stability while the opposite hip remains extended and flat on the ground. Don't be fooled by the simplicity of this test, as it also demonstrates the ability to disassociate the lower extremities while maintaining stability in the pelvis and core.
The sixth screen is the Trunk Stability Push-Up Movement Pattern Test. It is used as a basic observation of reflex core stabilization and is not used as a measure of strength, since only one repetition is required. The goal is to initiate movement with the upper extremity without allowing movement of the hips or pelvis.
The seventh and last screen is the Rotary Stability Movement Pattern Test and it is a complex movement, requiring proper neuromuscular coordination and energy transfer from one segment of the body to another through the torso. It has roots in the basic creeping pattern that follows the crawling pattern in the developmental sequence of normal human growth and locomotion. It looks like a bird dog, horse stance or whatever you want to call getting on all fours!
The purpose is to find the weak links in your patients and alleviate them with specific corrective exercise strategies. When this occurs, the individual or athlete will have greater movement efficiency, which will lead to improved performance and a decrease in injury potential.
The Functional Movement Screen is designed for the individual who is not in pain or has an obvious injury. It can be easily integrated for all patients to provide a continuum of care and rational reason to continue with treatment, even when pain or injury has resolved. The Selective Functional Movement Assessment (SFMA) is a different and complimentary screen designed for the patient who has pain and requires a more in-depth treatment protocol. The SFMA will be described in a future article.