CATA Movement Screening Finalctathletictrainers.org/resources/Documents/CATA Movement...
Transcript of CATA Movement Screening Finalctathletictrainers.org/resources/Documents/CATA Movement...
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Eric Scibek, MS, ATC, LAT, CSCS, PES
Sacred Heart University
• Discuss reliability of FMS and selected
movement screens• Discuss the meaning of FMS composite
score results
• Discuss Deep Squat dysfunction
• Discuss screening in a case
Patient
Evidence
Expertise
A battery of 7 “fundamental” movement patterns (tests) designed to evaluate movement dysfunction and asymmetries.
-Deep squat
-Hurdle Step
-Inline Lunge
-Shoulder Mobility
-Active Straight Leg Raise
-Trunk Stability Pushup
-Rotary Stability
In general:
3 = Able to perform the test correctly2 = Able to perform the test correctly in a
modified position or able to partially
complete the test1 = Unable to successfully complete the
test
0 = Pain during the test or clearing test
• Take highest score from three trials• Ex. Trial 1 = 2, Trial 2 = 1, Trial 3 = 3
• Score the test a 3
• When testing bilaterally, take the LOWEST score between sides
• Ex. Right = 3, Left = 2• Score the test a 2
• When in doubt, score low
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Reliability
• Mixed results
• Strong between novice and expert raters (Minick et al.,
2010)
• Mixed between disciplines (AT, EX, PT) (Scibek et al., 2013)
• Professional education may influence reliability of FMS tests (Scibek et al., 2013)
• Composite score reliability ranges from poor to excellent
• 46 NFL players• No demographic data• FMS done during preseason
• ROC curve analyzed and cut point set at 14• Score ≤14 results in 11.67x greater chance of injury
• 238 NFL players• Players with CS ≤ 14 = 1.87 relative risk related to
injury• Players with at least one asymmetry = 1.80 relative
risk related to injury
• Specificity for low composite and asymmetry= 0.87
• 100 physically active students
• 35 sustained lower extremity injury • ROC curve sets cutoff at 17
• Score ≤17 results in 4.7x greater chance of
injury
• 20 Major junior hockey players• Average FMS score = 14.7 ± 2.57• Score ≤ 14 no more likely to sustain an injury• Injured athletes mean CS = 15• Non-injured mean CS = 14.4• Inconsistent in methods…
• Firefighters with CS ≤ 14 at increased risk of injury (Butler et al., 2012)
• Firefighters with history of injury have 1.68x greater risk of sustaining injury
• Following intervention, lost time injuries reduced by 62%
• Cut point set at 16 (Peate, 2007)
• Military recruits with slow run times and low CS at increased risk of injury (Lisman et al., 2013)
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“The strength of association between FMS composite scores and subsequent injury does
not support its use as an injury prediction tool”
• Does not predict performance among healthy individuals and golfers (Okada, Parchman)
• FMS scores may predict future improvement in performance in track athletes from one season to the next (Chapman 2014)
• Scores can improve with training (Kiesel 2011)
• Training to correct FMS deficits have shown improvement in strength and flexibility in elite HS baseball players (Song 2014)
PROS
• Potential to identify individuals at risk
• It is the best of what we have?…right now
• Time
CONS
• Time • The evidence is not
overwhelming• Is not a predictor of
athletic performance• Do we need all tests for all
populations?• Some tests are difficult to
assess
• “An athlete’s ability to follow directions is as
important as their physical ability to successfully complete the FMS tests.”
• After testing, dig deeper
• ROM, strength, use other screens/tests
• Keep asking questions and contribute to the
body of evidence
The short answer…
YES!!!
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• Torso/Tibia Parallel
• Femur parallel or below• Knees over the toes
• Dowel move beyond toes
• Asymmetry
• Feet ER 1 – Knee displacement, 2 –Torso and tibia do not
remain parallel, 3 – Femur does not reach horizontal, 4 –
Bar extends beyond toes.
Bar beyond toes – 92.3%
Torso parallel with tibia – 76.9%Femur parallel – 50%
Medial Knee Displacement (MKD) – 26.9%
• Very mixed
• Ranges from Poor to Good/Excellent (H. Gulgin &
Hoogenboom, 2014; Minick et al., 2010; Onate et al., 2012; Scibek, Edmond, & Moran, 2013; Smith, Chimera, Wright, & Warren, 2013; Teyhen et al., 2012)
• Variability between Novice and Expert (Minick, et
al., 2012, Onate et al., 2012, Smith et al., 2013)
• Variability across the movement sciences (Scibek et al., 2013)
• Kinematic differences between 1, 2, 3
• Peak DF excursion is greater in those that score 3 (Butler et al., 2010)
• Those that score 3 have significantly greater
peak knee flexion and knee flexion excursion than those that score 2
• Those that score 3 or 2 have greater peak hip
flexion
• Dill et al., 2014
• No difference when classified by normal or
limited ankle ROM
• Sig. difference when reclassified by weight
bearing lunge performance
• Greater knee flexion displacement
• Greater ankle DF
• Mauntel et al., 2015
• Differences between males and females
• Males = greater knee valgus!!!
• Males = Greater hip flexion → protec�ve
mechanism
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• EMG
• Compare those with MKD and those without
• Bell et al., 2012 = Significantly greater hip ADD in MKD group
• Padua et al., 2012 = Significant increase in hip ADD, gastroc., and tib. ant. activation
• Elevate heels → decrease in glut max, hip ADD, tib ant, and
gastroc activation
• Decreased DF with knee extended may
contribute to MKD (Bell et al., 2012)
• Bell et al., 2008 found no difference in squat
when assessing passive DF knee ext
• Approached sig. when DF assessed with knee in
slight flexion
• Maybe “clinical significance”???? → 20% difference in
DF between conditions
• MKD group did have sig. dif. hip ER
• Mauntel et al., 2015
• Females have greater hip IR/ER compared to males
• Hip mobility impairments may influence kinetic chain distally
• Dill et al., 2014
• DF PROM does not influence knee & hip kinematics sig.
• Reclassify subjects by weight-bearing ROM…greater knee flex displacement and peak knee flexion. (Normal = >44.02 degrees)
• Bell et al., 2008
• Greater normalized isometric hip extension and
external rotation strength in MKD group
• What is interesting about these findings?
• Bell et al. 2012
• No difference in concentric and eccentric hip
strength between MKD and control
• Does not have strong predictive value in regard to sport performance (Lockie et al., 2015)
• Some prediction on Vert Jump – Deeper squat = Greater Glut Max activation???
• 54% of golfers with DS fault had loss of posture during swing, 29% demonstrate a “slide” dysfunction during swing (Gulgin et al., 2014)
• These lead to inconsistent performance
• Track athletes that score a “3” on DS have greater longitudinal performance (Chapman et al., 2014)
• DS demonstrates minimal injury predictive
value in firefighters and military recruits (Butler
et al, 2013; Bushman et al., 2015)
• Use caution when using this test alone for
predictive value (Bushman et al., 2015)
• Use of DS and ASLR has predictive value in
runners…better than entire FMS (Hotta et al., 2015)
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• Determine NM vs ROM• Unload the squat• Check PROM & AROM• Check closed chain
dorsiflexion• Assess Strength• Heels elevated or not?• Do they know how to
squat???• Select other tests/screens• Correct identified
dysfunction
You perform a Functional Movement Screen on
a 20 year old female Division I soccer player. She has had ankle sprains in HS, but otherwise
no significant history of injury. Additionally she
has limited resistance training experience. She was a three sport athlete in HS (Soccer,
Basketball, Softball).
• Her scores are as follows• DS – 1 (MKD, forward trunk lean, inability to reach parallel)
• ILL – 2 (Left front heel comes off ground, forward lean. Right side only has a forward lean)
• HS – 1 (Left foot kicks hurdle on the way over, Right = 2)
• ASLR – 2 (both sides)
• SM – 3• Push up – 1
• Rotary stability – 2
• What is the Composite Score & does she have an increased risk of injury???
• Maybe, maybe not…
• What do we do next?
1. Eliminate tests that you do not need
a) Shoulder Mobility
b) Pushup?
2. Identify tests that are a 1 and work to identify dysfunctions
a) DS, HS, Push Up
3. Identify other tests/screens that may help guide corrective exercise plan
• Mobility vs Stability
• Unload the squat
• Do they have ROM in unloaded position?
• Assess squat with arms down
• Assess ROM of ankle, knee, & hip• Assess strength at hip and knee
• Single Leg Squat
• Step up/Step down
Questions?
Coming June, 2017
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Bell, D. R., Padua, D. A., & Clark, M. A. (2008). Muscle Strength and Flexibility Characteristics of People Displaying Excessive Medial Knee Displacement. Archives of Physical Medicine and Rehabilitation, 89(7), 1323–1328. https://doi.org/10.1016/j.apmr.2007.11.048
Bell, D. R., Vesci, B. J., DiStefano, L. J., Guskiewicz, K. M., Hirth, C. J., & Padua, D. A. (2012). Muscle Activity and Flexibility in Individuals With Medial Knee Displacement During the Overhead Squat. Athletic Training and Sports Health Care, 4(3), 117–125. https://doi.org/10.3928/19425864-20110817-03
Bushman, T. T., Grier, T. L., Canham-Chervak, M. C., Anderson, M. K., North, W. J., & Jones, B. H. (2015). Pain on Functional Movement Screen Tests and Injury Risk. Journal of Strength and Conditioning Research, 29 Suppl 11, S65-70. https://doi.org/10.1519/JSC.0000000000001040
Butler, R. J., Contreras, M., Burton, L. C., Plisky, P. J., Goode, A., & Kiesel, K. (2013). Modifiable risk factors predict injuries in firefighters during training academies. Work (Reading, Mass.), 46(1), 11–17. https://doi.org/10.3233/WOR-121545
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