TABLE OF CONTENTS 1 The main principles of testing ..............................................................................................4

1.1 Movement must be evaluated ......................................................................................4

2 Identifying Qualities to Test .................................................................................................7

2.1 Time Motion Analysis ....................................................................................................9

2.2 Biomechanical Analysis – Assessment of the forces and loads placed on the body ........9

2.2.1 Biomechanical Analysis and Electromyography ....................................................11

2.3 Establish a list of Key Quality .......................................................................................11

2.4 Choosing Appropriate Tests ........................................................................................12

2.5 Establish normative data, considering age, gender, competition level, and position. ..13

2.5.1 Pass / fail Qualities ...............................................................................................13

2.5.2 Qualities that are directly related to performance ...............................................13

2.5.3 Standards Change ................................................................................................14

3 Limitations of Testing ........................................................................................................15

4 The Categories of Testing ..................................................................................................16

4.1 Anthropometric Qualities ............................................................................................18

4.1.1 Relative vs. Absolute ............................................................................................18

4.2 Movement Qualities ...................................................................................................19

4.3 Physiological Qualities .................................................................................................20

5 HOW WE EVALUATE MOVEMENT - 5-SITE INTEGRITY ........................................................22

5.1 Movement Evaluation Process ....................................................................................23

5.2 Principles of 5-SITE Integrity ........................................................................................24

5.3 Factors that Effect Movement Quality: posture, mobility, output, control and capacity 25

5.4 Part One: Basic Movement Testing .............................................................................27

5.5 Part Two: Power Movement Testing ...........................................................................27

5.5.1 Methods to evaluate expression ..........................................................................28

6 Analysis: Putting it all together ..........................................................................................28

6.1 5 Site Integrity Movement Analysis .............................................................................28

6.2 Performance Profile and Comparison Spectrum ..........................................................28

7 FIELD TESTS .......................................................................................................................30

References ................................................................................................................................32

8 Appendix B: Common Movement Dysfunctions .................................................................33

8.1 Foot and Ankle ............................................................................................................33

8.1.1 Pes Planus ............................................................................................................33

8.1.2 Limited Dorsiflexion .............................................................................................33

8.1.3 External Foot Flare ...............................................................................................34

8.2 Knee............................................................................................................................34

8.2.1 Dynamic Valgus ....................................................................................................34

8.2.2 Sagittal Control ....................................................................................................34

8.3 Lumbopelvis and Hip ...................................................................................................34

8.3.1 Hip Hinge .............................................................................................................34

8.3.2 Hip Mobility .........................................................................................................34

8.3.3 Hip Strength Quality .............................................................................................35

8.3.4 Spine Buckling ......................................................................................................35

8.3.5 Sandwich Movement ...........................................................................................36

8.3.6 Pelvic Control .......................................................................................................36

8.4 Scapulo-thoracic Humeral ...........................................................................................36

8.4.1 Thoracic Collapse .................................................................................................36

8.4.2 Thoracic Rigidity/Hyperkyphosis ..........................................................................37

8.4.3 Scapular Winging .................................................................................................37

8.4.4 Internal GH Rotation ............................................................................................37

8.5 Cranio-Cervical Junction ..............................................................................................37

8.5.1 Anterior Head Carriage ........................................................................................37

8.5.2 Lateral Shift ..........................................................................................................37

8.5.3 Rotation ...............................................................................................................37

1 THE MAIN PRINCIPLES OF TESTING Testing is purposeful evaluation of key qualities to reduce injury and to evaluate athletic factors that contribute to sport performance. The main principles of testing are summarized in the list below.

1) Establish baseline and to evaluate progress. Gather data consistently over time to evaluate athletic strategies (rest and recovery, training, nutrition, etc.) to improve performance and reduce injuries.

2) To compare and identify relative strengths and weaknesses. Compare results between athletes at similar and different ages, and competition levels to give them an indication of their strength, weaknesses, and relative athleticism or fitness.

3) Talent Identification 4) Education. Help the athlete to understand more completely his / her body and the

demands of the sport

1.1 Movement must be evaluated

Most testing is performed to measure an outcome - either the distance reached, the time taken to perform a task, or the amount lifted. In more sophisticated testing force produced, power, and other physiological parameters are measured. But there is a huge problem - a huge black box surrounds the athlete.

Figure 1: The Black Box Effect. Assessing movement only for the outcome as opposed to the quality of the movement.

That black box represents the movement that produces the outcome. Failure to assess the movement neglects the cause, where the effect is the outcome. For example, a basketball player jumps 34 inches, which is great considering an average NBA basketball player jumps 28 inches. Everyone is happy. The athlete is happy as well as those evaluating the athlete because this score places him in the 95th percentile. Great??? I work with this athlete and he has patella femoral pain and patellar tendinosis of the knee. When he jumps his knee collapses inwards. This movement dysfunction (in ward movement of the knee, called dynamic valgus) is present during all his movements - when he accelerates and quickly changes direction, when jumps off one foot and during most single leg movements. In fact, a recent MRI, revealed moderate degeneration of the patella femoral joint. This athlete is in pain. You can image how this impacts his performance. He is unable to perform to his potential. He walks around in constant discomfort. NOT GREAT!

This could have been prevented. This athlete has been tested many times at college, and as a professional. Interestingly his movement dysfunctions were never revealed, allowing the problem to magnify over time. The source of his problem is a very common movement dysfunction is dynamic knee valgus. I must remind you to read the report on AOA Fall Fitness testing, where over 90 percent of the athletes tested display this problem. We must stop this from happening. The impact on their athletic development, and more importantly the impact on their quality of life are too large to ignore. Without question movement is the main quality to access. Interestingly, movement is poorly evaluated if at all during most testing. Common evaluation processes in the NFL, NBA, and NHL fail to evaluate movement. We must incorporate movement into our testing protocols. How we evaluate movement will be discussed in section 5 HOW WE EVALUATE MOVEMENT - 5-SITE INTEGRITY, pg. 22.

2 IDENTIFYING QUALITIES TO TEST To determine what to test, requires an understanding of the demands of the sport. This concept is called specificity, which is comprised of: a) mechanics; b) motor-coordination; and c) energetics. The demands of the sport are very different based on age, gender and competition level. Therefore testing protocols must be progressive to reflect physiological development and the demands of the sport based on competition. For example the testing protocols for a recreational 8 year-old basketball player should be different that a professional basketball player. Likewise the testing protocols for the professional basketball player should be different than an Alpine Ski racer. The tests always reflect the principles of testing that are sport, age, gender, and competition appropriate. Overtime tests will change. Factors that necessitate the change in testing are based on:

a) Evolving demands of the sport. Athletes are becoming faster, more specialized, and more powerful.

b) Improved diagnostics. As technology and our understanding of factors that effect performance and injury risk develop, our tests will evolve. The shift to movement is one example of how testing is changing. Some other key factors that need to be tested include, references included for further information:

a. Power output, agility, and reactive abilities in response to a sport specific decision challenge

b. Mental strength and resilience c. Psychological status d. Biochemical and Nutritional status e. Hydration levels f. Genetics g. Injuries

To adhere to the principles of testing the following steps are performed:

1) Time motion analysis 2) Biomechanical Analysis – Assessment of the forces and loads placed on the body during

sport competition 3) Establish a list of key qualities. Notes these key qualities are organized into the

categories of testing which are explained in section 4. 4) Choose appropriate tests based on points 1 - 2

5) Establish normative data to evaluate if tests to evaluate key qualities can predict sport performance and injury risk - considering age, gender, competition level, and position.

2.1 Time Motion Analysis

Identifying key qualities begins with time motion analysis of the sport that is specific for age, gender and competition level. The purpose of the time-motion analysis is to understand the physiological demands of the sport and dominant movement patterns of the sport. For a review on how to perform time motion analysis I would refer you to the listed resources below. Time motion analysis examines the movements occur during the sport, classified into high powered or high intensity, moderate intensity, or low intensity or recovery. Based on the amount of time within each intensity zone, gives us the energy profile for the specific group that was tested. For example the energy profile of a recreational boy’s basketball team will be much different than the intensity profile of an NBA Basketball team during the playoffs.

Resources:

1. Zatsiorsky VM. Kinematics of Human Motion Human Kinetics; 1997. 2. Hall S. Basic Biomechanics. Toronto: Mosby; 1995. 3. Baechle T, Earle R. Essentials of Strength and Conditioning Toronto: Human Kinetics;

2000. 4. Bartlett R. Introduction to Sport Biomechanics: Analysing Humnan Movement Patterns.

2nd Edition ed: Routeledge; 2007. 5. Griffths IW. Principles Biomechanics & Motion Analysis; 2005. 6. Schmidt R. Motor Control and Learning Toronto: Human Kinetics; 2005 7. Stone MH, Stone M, Sands WA. Principles and Practice of Resistance Training. Toronto:

Human Kinetics; 2007.

2.2 Biomechanical Analysis – Assessment of the forces and loads placed on the

body

Delving deeper into sport analysis requires an understanding of the kinetics being applied to the body during sport and the forces and motions (kinematics) that are developed by the athlete during the sport – see Table 1: Kinetic and Kinematic factors that are evaluated during sport Biomechanical Analysis.

Kinetics – the study of the relationships between forces and their effects on bodies at rest (statics) and bodies in motion (dynamics).

Kinematics – describes the motion of objuects without considering the causes / kinetics leading to the motion.

Force, load, power, torque Position

Direction of Force: i.e. Compression, Shear, Torsion

Velocity, Acceleration, Speed

Frictional forces Displacement

Kinematic Chains Path

Joint Stiffness – Motor Control of the Joint

Centre of Mass

Inertia – control of body inertia / postural control

Energy Expenditure for Motion

Table 1: Kinetic and Kinematic factors that are evaluated during sport Biomechanical Analysis

Biomechanical analysis helps us to prevent injuries and improve performance. Let’s give a couple of examples of where understanding biomechanics is important for injury prevention and for sport performance – see below. Note understanding biomechanics is merely descriptive. To develop our athletes we must take this knowledge and devise strategies to produce sound movements – this involves integrating knowledge from many disciplines such as: motor skill acquisition, neuromuscular conditioning, pediatrics, kinesiology, biomechanics, biochemistry, sports medicine, and many more disciplines. Injury Prevention

What are the forces exerted on the body of an Alpine Ski Racer during a downhill event o How does this differ based on the competition level of the skier?

What are the loads necessary to cause and ACL rupture and what is the mechanism that causes ACL ruptures?

o How much force is exerted on the knee during landing with dynamic valgus? o How do we condition our bodies to improve our abilities to control against

dynamic valgus

What are the load characteristics that contribute to low back pain?

Why are the biomechanical factors that contribute to tendinopathies

Sport Performance

How much force is necessary to jump 38”

How do we train our force generating capabilities?

What are the proper mechanics to hit a golf ball 300 yards?

What is the trade-off between developing more force with increased weight. The better we understand the sport, the better we can test our athletes to see if they possess the force generating capabilities to execute the skill while remaining safe. For example, if an athlete is unable to perform a single leg squat; are they capable of performing a proper turn? Regardless the motivation of the athlete, or what equipment the athlete posses, if they can’t

produce adequate force they cannot perform turn properly. If they can’t turn properly, are they at increased risk of injury?

2.2.1 Biomechanical Analysis and Electromyography

Associated with biomechanical analysis is electromyography (EMG). EMG examines the muscle activation involved when a muscle contracts. During movement EMG provides additional information about:

a) Timing of muscle firing b) The percentage of muscle firing compared to maximal voluntary contraction

This information is helpful to understand how muscles are being recruited during an activity. This is especially powerful when this information is combined with manual muscle testing, and movement screening. Aberrant muscle recruitment patterns have been virtually all articulo-myofascial problems, such as:

a) ACL ruptures1-3 b) Patella-femoral pain c) Shoulder impingements d) Low back Problems4, 5

2.3 Establish a list of Key Quality

Once steps 1 - 2 have been performed we are able to develop our key quality lists. This list is prioritized, because not all qualities are equal – see section 2.5.1 - 2.5.3. The evaluation of all key qualities gives us an overall impression of the athlete. Not all athletes will be strong in all qualities, where weaknesses and strengths help us design strategies to aid in the development of the athlete. You can image this key quality list is much like playing a video game where there are various attributes of a character. How you choose to develop the player is based on developing key qualities – not all qualities are equal. For example, you can develop a large, powerful character or a quick, agile character. How you develop each key quality is based many factors such as: existing key qualities, age, sport, competition level, genetics, and adaptability.

2.4 Choosing Appropriate Tests

Now that we’ve determined the key qualities to test we must select appropriates test to evaluate each key quality. Each test needs to fulfill the principles of testing that are age, competition level, and gender appropriate. We want to keep testing to a minimum, where key tests are administered. To accomplish this, each test need to posses:

a) Construct validity – refers to whether a tests measures what is purports to measure. b) High Reliability – refers to the variability of tests results. High reliability occurs if you

perform the test identically you should measure the same result. c) High inter-rater Reliability – different people performing the test should produce the

same results d) Efficiency. How long does the take to explain, perform and analyze. e) Predictive. Is the test correlated with performance or injury prevention.

2.5 Establish normative data, considering age, gender, competition level, and

position.

The importance of testing is to obtain information. This information is then analyzed against a standard(s) to give us an impression of how that athlete performed within that quality compared to others – see section 6: Analysis: Putting it all together. The standards are organized based on:

a) Age b) Competition level c) Gender d) Relative scales (relative to body weight, relative to some other quality)

It is very important to appreciate that in comparison to a standard, certain qualities are:

Pass / fail qualities

Directly related to performance

Standards change based on age, level, position, and sport

Must always be performed with ideal movements

2.5.1 Pass / fail Qualities

Pass / fail qualities are qualities that do not increase performance once a standard is reached. Once the standard has been reached maintenance of the quality is needed. For example, hockey is an explosive sport where shifts last 30 - 45 seconds. During this period the athlete will engage in short high intensity bursts of action, mixed with coasting, hitting, grinding for a puck, and sport specific skills. Most of the energy for this type of exercise comes from the anaerobic alactic system. Recovery between shifts, which is typically 2 minutes, is facilitated by the aerobic system. Studies reveal that once an athlete achieves a VO2 max of 50 ml / kg / min no further improvement in recovery occurs with a higher VO2 max6. In other, words if your VO2 max was 75 ml / kg / min (High VO2 max values range into the low 60s for NHL hockey players with the average ranging from 55 – 58 ml / kg / min.6-9 you will be able to recover between shifts just as well as an athlete with a 50 ml / kg / min. Therefore there appears to be a limit to how much aerobic capacity we require for many explosive sports. However, the impact of having a higher VO2 max may exist outside of just recovery.

2.5.2 Qualities that are directly related to performance

Qualities that are directly related to performance need to be continually developed. For example, an Olympic Weight Lifter must always aim to improve their vertical power quality.

Their sport is based on how much they are able to lift, relative to their body weight. Vertical power is essential, where possessing more vertical power only helps them lift more and directly aids in performance. Sprint Performance10, 11 Hockey12 Rugby Acceleration11 Agility11 Basketball Football Weightlifting13

2.5.3 Standards Change

At times a major contributor to performance at one level may be a pass / fail quality at another level. To continue with our previous hockey example, aerobic capacity is often a performance limiter for hockey players during ages 14 – 16. However, as the athlete matures and rises up competition levels the importance of aerobic capacity becomes less significant – in fact aerobic capacity beyond a VO2 max score of 50ml/kg/min does not seem to improve recovery. This is also true in study by Hoffman et al. (1996) that reported aerobic endurance above a minimal standard does not increase playing time in elite college basketball players14. Therefore training and testing need to reflect and consider the following factors:

reference standard (age, competition level, gender, etc)

Developmental windows of opportunity15

The physiological and neurological development of the athlete

The validity and reliability of the tests

Figure 2: Testing Qualities

3 LIMITATIONS OF TESTING Of course there are limitations with athletic testing. Testing is not fool proof, and just because you test well it does not guarantee that you’ll perform well. The following is a list of common limitations of athletic testing:

Predictive Validity - Factors outside of athleticism are related to performance, which are not tested. These factors contribute to athletic performance and are factors in injury development. For example:

o Failure to measure game decision making qualities. o Procedural knowledge o Cognitive Factors o Psychological factors – anxiety and arousal o Sport skill

State during testing. What was the athlete exposed to prior to testing. For example, did the athlete sleep well? Did they have adequate nutrition? Is the athlete fatigued because of competition? Did the athletes taper or peak for testing? Does the athlete care about how they test?

Testing Anxiety. A phenomenon, usually

4 THE CATEGORIES OF TESTING There are three broad categories to test during our basic testing – anthropometric, movement, and physiological. As indicated in section 2 Identifying Qualities to Test, there are many additional categories of testing. The additional tests are reserved for intermediate and advanced testing protocols. In this guide we will discuss each broad category during our basic testing and a few of the key qualities within each broad category. Note as the athlete progresses through the competition pathway, the same broad categories are used but with more sophisticated testing. Other testing categories will be integrated based on the demands of the sport, age, the appropriateness of the test – see section 2.4. The analysis of each quality against appropriate standards and with the big picture in mind gives us an overall impression of the athlete. The overall impression of the athlete will be discussed in section 6. When there is an injury present, a full orthopedic evaluation will be performed.

Anthropometric Movement Physiological

Table 2: Example of the Testing Protocol across Competitive Pathways

Vertical Lateral Horizontal Agility Acceleration Reactive Abilities Anaerobic Power Anaerobic Capacity Aerobic Capacity

Active Start

0 - 6Basic Anthropometry Play Evaluation

FUNdamentals

6 - 8F, 6 - 9MBasic Anthropometry Play Evaluation

Learn to Train

8-11F, 9 - 12MBasic Anthropometry

Basic Movement Screen

Neutral Spine Control Multistage Fitness

Train to Train

11-15F, 12-16M

Basic Anthropometry

Body Composition

Basic Movement Screen

Basic Trunk Evaluation

Jump IndexSingle Leg Hop

Squat Jump

CMJ

DJ

Pent Jump

Single Leg Pent Jump

T-Test 10m Sprint

Multistage Fitness

Train to Compete

15-18F, 16-18M

Basic Anthropometry

Body Composition

Basic Movement Screen

Functional Trunk Evaluation

Jump Index

Concentric Power

Profile

Drop Jump Profile

300m Shuttle Test Multistage Fitness

Learn to Win

18-23F, 18-25M

Basic Anthropometry

Body Composition

Basic Movement Screen

Functional Trunk Evaluation

Train to Win

23+F, 25+M

Basic Anthropometry

Body Composition

Basic Movement Screen

Functional Trunk Evaluation

AnthropometricPhysiological

Test

s ac

cord

ing

to L

TAD

Sta

ges

Basic Movement Screen

MovementPower Movement Screen

4.1 Anthropometric Qualities

Anthropometry refers to the measurement of the human individual for the purposes of understanding human physical variation. Common anthropometric qualities that are measured are height, weight, reach height, leg length, etc. It is important to realize that there is very little we can do to change many of these anthropometric qualities. Muscle cross-sectional area and body composition are the most highly adaptable anthropometric qualities. These qualities can be enhanced with appropriate strength and conditioning and nutrition habits.

4.1.1 Relative vs. Absolute

Anthropometric qualities are important to consider when athleticism. We need to make the expression of the quality relative to each person. For example:

pent jump related to limb length

Vertical power relative to body weight

Aerobic capacity relative to body weight

Wingspan relative to body height.

4.2 Movement Qualities

When we assess movement qualities we look at a) how our bodies produce force, b) respond to forces being applied to the body, and c) how our bodies utilize forces to produce movement or to control against force. Specifically we examine 5-SITE Integrity and the smoothness of the movement. We will be discussing 5-Site Integrity in section 5. In the figure below you will notice how movements are classified into modes and types - Figure 3: Movement Classification System.

Figure 3: Movement Classification System. Modes are classified into basic and power movements. Types are based on anatomical planes – vertical, horizontal, lateral and rotational.

Movement modes classify movements into basic and power movement modes. This is a relative category where low speed body weight movements are considered basic movements, and movements with high speed movements are power movements. You can see in the Figure 3: Movement Classification System. Modes are classified into basic and power movements. Types are based on anatomical planes – vertical, horizontal, lateral and rotational. are examples of basic movements and powered movements organized according to the movement types. Movement types are movements classified according to anatomical planes. In the figure below you can observe the four movement types. Agility and change of directions are combinations of various movement types. It is important to appreciate that each movement type is distinct. Movements in the vertical plane are distinct qualities from horizontal and lateral. For example, high jumpers (vertical type) are not elite sprinters (horizontal type) and just because you are a good sprinter (horizontal type) does mean you can run an effective run a wide receiver route in football (agility / COD). The take home message is each movement type needs to be tested separately.

4.3 Physiological Qualities

Physiological qualities look at how our bodies produce energy to meet the demands of the activities. During sport there are times where we have short explosive activities, followed by periods of coasting. The profile of all the movements, between high intensity or high powered movements with low powered movements (and movements in between) determines the energy or physiological demands of the sport. We call this the energy profile of the sport or activity. As we discussed in section 2.1, we determine this by performing time motion analysis. There are three main energy systems that produce varying amounts of ATP or energy, which are named in the chart below. Note the three energy systems have been described using different names. The rows are all the same energy system.

System

1 Anaerobic Alactic ATP - PC Immediate

2 Anaerobic Lactic Lactic Acid Non-oxidative

3 Aerobic Aerobic System Oxidative

Figure 4: Energy sources for muscle as a function of activity duration. The figure shows how long each of the major energy systems can endure in supporting all-out work.

The energy profile of the activity will determine how much energy is required. Our bodies will utilize the appropriate energy systems to match the activities’ energy demands. Figure 4 shows how long each of the major energy systems can endure in supporting all-out work. Notice how performance drops with sustained all-out work. The reason is based on how much each energy each energy system produces. The highest and most immediate energy system is the ATP-PC system, followed sequentially by the lactic acid, and aerobic system.

5 HOW WE EVALUATE MOVEMENT - 5-SITE INTEGRITY When we are evaluating movement we are examining two components: 1) movement quality and 2) output (expression). Output is expression of the movement, for example the distance travelled, speed, the force or power produced during movement – see Table 1: Kinetic and Kinematic factors that are evaluated during sport Biomechanical Analysis. To efficiently and effectively produce optimal movement output the movement quality must be optimal or ideal. Movement quality is how the movement was performed. To assess movement quality we:

1) Compare the movement to ideal movements – see 2) Assess the range or depth of movement. This gives us an indication of mobility between

and within joint, muscles and fascia. We call this system the articulo-myofascial system, where there are 5 key areas – 5-Site Integrity.

3) Asses the ease or smoothness of the movement.

Figure 5: Components of Movement Evaluation

For example, during a single legged squat we examine how each site moves in comparison to a movement dysfunction looking for:

Output

Quality

a) Presence of a movement dysfunction b) Depth or range of motion

All movements place a unique load to the body. By testing the athlete through a battery of tests we can understand the strengths and weaknesses of the each respective area. These tests are based on the movement modes and types– see section 4.2 for modes, types and common movement examples.

Movement Output α Movement Quality

5.1 Movement Evaluation Process

The evaluation process of movement is two parted – 1) basic movement screen and 2) power movements. As discussed earlier these parts differ based on the speed, load and expression required to perform the movement. What is consistent during both parts is the evaluation of the body – 5-Site Integrity. By analyzing basic movements first, we evaluate how the body response to low loads, which are progressively increased until part two. During part two we want the athlete to produce maximum power, where we examine 5-Site Integrity and expression. Each part will be discussed section 5.4 and section 5.5, respectively.

5.2 Principles of 5-SITE Integrity

5-Site Integrity is based on several key principles - see table below. The ability of the body to maintain 5-Site integrity during any movement is based on these principles. Interestingly when we are evaluating each of the 5 key areas during movement we observe common movement dysfunctions – see Appendix 1 Common Movement Dysfunctions. Note in addition to looking for the presence of common movement dysfunction during power movements we are also looking for proper explosive execution of the movement, which is movement specific. The execution of all movement is based on the principles of 5-Site Integrity which are:

The body is made fascial, osseous (bone) and muscular links / chains where motor control and muscular capacities are necessary to maintain proper area relationships.

There are 5 key areas in the body that are interconnected by the fascial system and controlled through complex motor programs and primal reflexes.

Fascial structures must be able to slide relative to each other during movement otherwise force transmission is disrupted leading to impaired movement dysfunctions

Each area must control against loads being applied to each area, where if any key area is unable to control against those loads the system is disrupted

No movement is identical. Movements create unique loads at each key area.

Posture and what we are exposed to effects the mobility, stability and force output of the system

Movement requires proper mobility of all joints and the fascial system throughout the body, where loss of mobility at one joint or a fascial restriction will effect the entire chain.

Fatigue or poor work capacity will effect 5 site integrity

The degree that the system fails is identified by progressive adding specific loads to the system.

Basic Movements

Power Movements

Figure 6: 5-SITE Integrity:

5.3 Factors that Effect Movement Quality: posture, mobility, output, control

and capacity

There are many factors that affect movement. The main factors are highlighted on the following page, which are posture, mobility, output, control and capacity. Each factor has a large impact on our abilities to properly perform movement. How each factor effects movement independently and via interaction effects with other factors beyond the scope of this guide. A great deal of research on movement development exist and this model attempts to conceptually integrates all. A book highlighting how to identify and correct each movement factor is in development.

5.4 Part One: Basic Movement Testing

Basic movement testing are tests to evaluate qualities within the basic movement mode. For example, the single legged squat is a commonly used basic movement test where we evaluate the presence of common movement dysfunctions and the expression of the movement – learn how we assess the single legged squat.

Figure 7: Basic Movement Tests grouped according to types

5.5 Part Two: Power Movement Testing

During performance testing we are interested in the output qualities of the athlete. But of course, we are equally interested in the movement qualities as they develop their output – avoid the black box effect. The difference between performance testing and basic movement testing is the speed and output of the movement. During performance testing we are asking the athlete to perform movements as fast and as explosively as possible. We want to test their output. In this phase we are evaluating force output capabilities, specifically the athletes' ability to produce power, utilize force (reactive abilities), and to control force. Unlike the previous phase; where the body is exposed to low loads, this phase is max output. But like the previous phase we use planar movements (but at max output) to begin our evaluation followed by more complex movements that occur in multiple planes (agility / change of direction capabilities).

Mode / TYPE Vertical Horizontal Lateral Neutral Spine

Endurance and Control

Hip Hinge Gait Analysis Lateral Lunge Plank

Squat In-Lunge Side Shuffle Side Bridge

Overhead Squat Hurdle Over Cross-Over Back Extension Hold

Step-up / DownPlank with extremity

movements

Single Leg Squat Body Control I

Body Control II

Basic Movements

5.5.1 Methods to evaluate expression

6 ANALYSIS: PUTTING IT ALL TOGETHER During the previous sections we discussed the categories of testing, how we evaluate movement focusing on basic movement screening and power movement testing. Now that we’ve gathered all this information we must analyze the data by comparing the results to known standards that are age, sport, and competition appropriate. Specifically there are three reports that are generated.

1) 5-Site Integrity Movement Analysis 2) Performance Profile 3) Comparison Spectrum

These reports are based on years of data, collected by FITS and by sport centres, researchers, from around the world. Currently there are over 10,000 unique data sets in the database, which is constantly growing.

6.1 5 Site Integrity Movement Analysis

We evaluate movement to observe the presence of a movement dysfunction across 5 Key areas. Each movement dysfunction is graded on severity and injury likelihood – see Table 3. If there is no movement dysfunction, the movement is considered ideal, with no likelihood of injury. How we arrive at these grades is based on ongoing research on how to evaluate the body utilizing 5-Site Integrity. Note because each area and each dysfunction is unique, each dysfunction has a unique scale.

Movement Screen is clear. No problems.

Attention is necessary. The dysfunction is at the early stages and correction now will help the dysfunction from progressing.

Moderate dysfunction. This dysfunction is concerning because if left unaddressed it will lead to problems. If there are current problems, this dysfunction may be the source of the problem.

Severe attention is needed immediately. Pain that you are experience is the result of this dysfunction.

Table 3: Grading System for Common Movement Dysfunctions

6.2 Performance Profile and Comparison Spectrum

The output of your power movements will be recorded. These results will be compared to an appropriate reference group, based on your age, competition level, sport and goals. This will give you an impression of where your strengths and weaknesses are relative the reference group. From here a program can be developed to improve your overall athleticism, prioritized to the needs of your sport, age, development windows, phase of sport competition, existing injury, the qualities to develop, and other factors. Multiple reference groups can be used during the analysis for the purposes of comparison. Where a deficiency exists, the degree of difference and the requirements to achieve the target can explained.

Figure 8: Example of a Performance Profile and Comparison Spectrum

7 FIELD TESTS

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8 APPENDIX B: COMMON MOVEMENT DYSFUNCTIONS

8.1 Foot and Ankle

8.1.1 Pes Planus

During the movement screen, we examine your foot to determine if the movement in your foot is optimal. Specifically, the most common type of dysfunction in the foot that can lead to energy leaks is a pes planus. Pes planus, or flat feet, is a very common finding among the general population. When dynamically tested, individuals with pes planus will exhibit turning out of their feet and a collapse of the main arch of their feet (longitudinal arch). This finding can also contribute to the other findings within the movement screen.

8.1.2 Limited Dorsiflexion

This finding represents a limitation ankle joint’s range of motion. Specifically, it means that the top of the foot does not get as close to the shin as it should while being loaded such as while

performing a squat. What this means is that those who have limited dorsiflexion in their ankle are likely make up for this lack of range by compensating somewhere else to get to the same depth of a squat. Often times, people will use their backs predisposing them to injury due to overuse/misuse, or they may simply not be able to achieve the same range of movement while performing the specific movement in question.

8.1.3 External Foot Flare

This finding represents turning out of the foot while under dynamic load. This may be a result of poor foot posture stemming from over pronation or pes planus.

8.2 Knee

8.2.1 Dynamic Valgus

This finding represents the knees inability to maintain its dynamic integrity (position during movement) while under load. What we see is a collapsing medially (inward) of the involved knee representing poor control, weakness of the hip musculature, and/or poor foundational support from poorly controlled foot motion.

8.2.2 Sagittal Control

This concept represents the importance of muscular control of one’s knee while under dynamic load. What we see at times is a “shimmy” in the knee while the patient attempts to control knee movements such as a single leg squat. This can represent poor muscular control and coordination of the knee, hip and foot musculature.

8.3 Lumbopelvis and Hip

Where your spine and hip attaches to your pelvis

8.3.1 Hip Hinge

This finding represents the correct way to perform a squat and generally to “bend at the hips”. A good “bend” is initiated at the hip and not the low back where, as the name implies, you literally hinge your movement at your hips. Those who cannot perform this movement and tend to favour bending through their back are predisposed to developing low back pain and poor performance, because instead of using their legs they use their spines to lift. Correcting this movement yields tremendous improvements for patients or athletes in terms of low back pain and performance.

8.3.2 Hip Mobility

This finding represents your hip range of motion in flexion, extension, internal and external rotation, and all combined movements of the aforementioned ranges. As a car needs lubricant to function properly you need hip mobility to keep your hips, low back and knees functioning

properly. Tightness in the hips lead to stress and strain into joints that can create many musculoskeletal conditions that overtime can easily lead to arthritis in the previously mentioned sites. Sitting and our normal activities of daily living reduce our hip mobility. Therefore to be able to achieve your full athletic potential combined with staying injury proof requires you to constantly maintain proper hip mobility.

8.3.3 Hip Strength Quality

This finding examines the strength and ease of movement the athlete or patient displays during the various movements assessed. It is seen during low load testing as the depth the individual is able to achieve for example during the squat, lunge, and single leg squats. During high load conditions it is the individuals' ability to absorb forces through the muscular system and to develop power (rate of force development)

8.3.4 Spine Buckling

This finding represents the spines inability to handle load. What this means is that the spine is unable to support itself due to poor core musculature support. Much like a mast on a ship, the spine requires guide wires to tightly hold the mast upright otherwise it will crack and the ship will lose its sails. Similarly, without appropriate conditioning of the core muscles around the spine and pelvis, the body’s mast (your spine) will buckle causing you to lose the wind in your sails and the spring in your step. Simple movement such as bending forward becomes painful. This finding tends to become apparent while perform any bending movement.

8.3.5 Sandwich Movement

This finding represents when a person has does not display a hip hinge, has poor mobility through their hips, and favours using their back while perform a specific movement. Essentially, what is seen is the torso and legs form the “bread” of the sandwich while the space in between becomes the filling. A well conditioned pattern finds that the torso is in a neutral position with the chest up; while a “sandwich pattern” finds the chest bent into the legs and facing down – they look like a sandwich. In this position the low back is doing the lifting not the legs. Adopting this pattern negates the most powerful muscles in your body in favour of the back which predisposed the individual to developing chronic low back pain. Correcting this movement pattern and developing a proper hip hinge would be tremendously beneficial. In fact, most people with low back pain display this dysfunction that once corrected no longer have back pain.

8.3.6 Pelvic Control

Much like the above three findings, pelvic control reflects the patient’s ability to dynamically (through movement) maintain a stable pelvis (foundation) while performing various movements. Dysfunctions are seen as aberrant movements of the pelvis; shifting, tilting, hiking and rotating. These dysfunctions occur largely because of an inability to maintain neutral spine control and are linked to the findings throughout the other anatomical sites, such as your ankle and foot. The impact of poor pelvic control relates to its’ central position in the body. Your pelvis is the transfer point for forces generated in your hips (the main power centre in the body) combined with force contributions from other areas of the body. Pelvic control is like the drive train of a car which functions to transfer power developed from the engine to the wheels. Many problems throughout the body will occur with poor pelvic control such as low back pain, hip problems, knee problems, and even shoulder problems. Something to Think About: Regardless of whether you are an athlete or not, pelvic control is essential. If you are an athlete the demands for pelvic control are much higher and are reflective of the demands of your sport. For example it well known that hip and leg contribution to pitching velocity and tennis serve velocity is over 50 percent. This is only possible through pelvic control, or “THE CORE”. Many athletes that fail to develop the core suffer injuries by trying to make up the power elsewhere, such as the elbow and shoulder for both pitchers and tennis players.

8.4 Scapulo-thoracic Humeral

Where your arms attach to your spine

8.4.1 Thoracic Collapse

This is a secondary finding often times associated with sandwich movement. This finding indicates that the patient is not hinging from the hips resulting in a back dominant initiation of movement resulting in thoracic or mid back collapse. Essentially, the mid-back often times follows the lead of the low back; if the low back is poorly supported, then the same will be seen in the mid-back.

8.4.2 Thoracic Rigidity/Hyperkyphosis

This finding is the opposite of the thoracic collapse. It represents the inability of the patient to maintain a “chest up” position while under load and undergoing specific movements, irrespective of the stability of the low back. In chronic situations, this finding can contribute to thoracic outlet syndrome, neck pain, and headaches.

8.4.3 Scapular Winging

This finding represents poor posture of your should blades (aka scapulae). This finding indicates that you are chest dominant in your posture with likely tight, forward rolled shoulders and weak mid-back muscles. This can predispose patients to developing chronic rotator cuff tendons, mid-back, shoulder, and neck pain.

8.4.4 Internal GH Rotation

Internal glenohumeral rotation represents a finding that is often associated with hyperkyphosis and scapular winging. This can also predispose the patient to chronic rotator cuff injuries leading to pain and poor function while attempting to participate in their chosen activity or job.

8.5 Cranio-Cervical Junction

Where your neck meets your head

8.5.1 Anterior Head Carriage

This represents the general finding found in almost all people to some degree or another. It’s what I call the modern cave man position in which our head juts forward in front of our bodies when we primarily sit in a poor position in front of the computer, read or slouch. This finding can represent poor muscular control of the deep muscles of your neck and may lead to chronic neck and jaw pain as well as headaches due to hyperactive posterior neck musculature.

8.5.2 Lateral Shift

Lateral shift of your head on your shoulders may represent a muscle imbalance present at your shoulder, neck, or upper back. It may also represent a favoured motor pattern that if not corrected can lead to over stressing specific structures and tissue, resulting in breakdown and injury.

8.5.3 Rotation

Rotation is very similar to the finding of lateral shift and is often found in conjunction with it. Rotation may also represent a favoured motor pattern that can indicate the presence of weak and tight neck muscles.