FUNCTIONAL MOVEMENT ASSESSMENT

FMA Lecture 1 v4.0 13/07/2020

Copyright FIT College 2020 1

FUNCTIONAL MOVEMENT ASSESSMENT

FMA Lecture 1

What you will learn

This session will teach you about:• Factors affecting movement• Movement screens• Conducting movement screens • 7 Moves

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Factors Affecting Movement

Movement disruption

• A movement can become disrupted when connective structures and tissues are not supple and coordinated

• In a perfect human structure, every joint would be fully open, every inch of soft tissue would be supple, every ligament would be intact, every bone would be healthy, every nerve would be free to fire, every blood vessel would be open, and every bony landmark would be in alignment

• This is likely to result from: • Altered length-tension of muscles – are they short or long?• Poor control – are they weak or injured?• Altered joint motion – is there restricted range of motion (ROM) or is it

hypermobile?

• If there is one area or segment of the body that is affected, other areas will have to compensate to complete the task or activity

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Altered length-tension

• Length-tension is a relationship between the length of a muscle and its ability to apply force

• Shortened muscles tend to be stronger and contract earlier or are more dominant in movements

• Lengthened muscles tend to be weaker and contract later or not all in some movements

• A change in resting length of a muscle, whether it has come from postural variation or injury, will affect its ability to apply force during movement

• A change in resting length will result in a muscle behaving differently during movement which forces the body to alter its normal movement patterns and variations can be observed

Movement control

• The sequence of recruitment, the speed and the strength of contraction performed by muscles are all important in generating coordinated movement

• A larger part of controlling this comes from the nervous system, in its ability to respond to a stimulus and recruit muscles

• When a person is unable to implement good muscle control, a loss of balance and decreased ability to react to a stimulus occurs during movement

• Weak or injured muscles may have less influence on control and stability and deviations to movement can be observed

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Joint movement

• The health of a joint and the structures surrounding it (cartilage, ligaments and tendons) influence the normal movement of the joint

• A change in these structures can result from:• Inherited levels of joint flexibility – loose or tight • Injuries that result in limiting or increasing joint ROM• Types of training that promote increased ROM like stretching and

gymnastics

Assessment of movement

• Can you remember the reasons why you assess a client's physical fitness?

• Identify strengths and weaknesses• To show a starting level of fitness

• This also applies for assessment of movement and posture • Identify uncoordinated or restricted movements • A baseline level of posture

• Also, there are numerous other reasons why it is important to assess a person’s movement and posture:

• Vary an existing training program• Monitor improvement• Compare results• Re-evaluate program

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Movement Screens

What is a movement assessment?

• Movement assessment is the practice of analysing movement during functional activities

• Exercises can be used to assess the movement of individual joints and the performance of movements both compound and isolated

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Why assess movement?

• While people often have various training goals, i.e. losing weight, increasing muscle mass, or improving fitness levels, the primary objective of all training programs should be to improve movement function

• This means a training program should also help people enhance their ability to perform activities used in daily life and sport and create an opportunity for the normal healthy function of joints and muscles to create movement

Why assess movement?

• Understanding the way a person moves allows for the opportunity to make better choices for exercise selection in regards to:

• The type of postural control needed during movement• Differences from right and left sides during movement, e.g.

asymmetries• The ability to move fluently and efficiently

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What to look for in movements?

• When assessing movement, look for the following:• Does the movement occur through a full range or partial range?• Do all joints move together, or are some moving at different times?• Is the normal alignment of spine maintained throughout the

movement, or does it change?• Is the movement smooth and continuous or disjointed and jerky?• Is the movement performed at a constant pace, tempo or different

speeds?• Is the same pattern of movement repeated for the whole set or is

each rep different?• Is there any pain associated with any movement?• Does the client voice concern over a movement or part of a

movement?

How to observe movements

• Where to stand?• Decide where you need to stand – each test will generally give you instructions on

what view to take, but be prepared to look at things from all sides

• How many repetitions to watch?• Generally, you need to see the client perform 3 repetitions, from 2 different angles

(front/back and side) to get a feel for what happens. If you’re still unsure, have the client do more reps till you see some consistent behaviour in the movement

• Reasons to stop the exercise?• If a person feels faint, pain, discomfort or just can’t do the exercise, ask them to

stop immediately

• What order movements should you follow?• Be sure to do the movements in the order shown on the forms

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Conducting Movement Screens

Foundation movements

• Foundation movements form the basic building blocks of other movements

• Most movement patterns draw on these in one way or another, for example

• Holding a brace position of the trunk is an important part of a push-up, squat, deadlift etc.

• A squat pattern is transferred to all forms of triple extension squat movements

• Performance of each foundation movement to set criteria allows you to assess a movement

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The foundation movement screen

• The foundation movement screen consists of 7 different movements:

• Squat • Lunge • Hinge • Push• Pull • Rotate • Brace

• Each exercise has five simple criteria

Movement screen procedure

• The tester shows the client the correct performance, questions them regarding any concerns with the correct performance to ensure understanding of what is being asked

• Three trials are allowed per movement• For bilateral movements, three trials will be performed• For unilateral movements, three trials will be performed in

succession, on both the left and right side, with six trials performed in total

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Movement screen procedure

• Scoring• For each of the 7 movements, you will be asked to assess five

different criteria• You will score each criteria independently of the others• To do this, simply read the criteria and ask yourself if the person

achieved this part of the movement or not• If the person was able to achieve the individual criteria, then place a

‘1’ in the row beside the criteria• If the client failed to achieve this, then place a ‘0’ • Add up the total for each movement - a score out of ‘5’• Add up the total score for the screen - a score out of ‘35’

7 Moves

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Squat

• The squat pattern is a key movement we use in everyday life in actions like sitting and standing

• There has been a lot of debate over the correct technique for squats and much research on these techniques.

• Here are a few common myths we’d like to set right that have now been proven by science, but you may not have heard of them or did not know these were now accepted as fact

Squat movement

• Knees can move over your toes if you have good ankle mobility

• Deep squatting is not bad for your knees if you achieve this by regular and progressive training

• A small butt wink is not bad if you squat deep and have good trunk stability

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Squat movement

• The hips or your knees can move first (although it is more synchronised if knees move first)

• Men generally squat better with wider feet and some load

• Women are more coordinated in squat patterns and width of stance doesn’t change that

Squat procedure

• The person holds arms out front for balance, and then slowly moves into a squat position with the thighs reaching a depth where they are parallel to the floor or below

• Demonstrate to the person the correct procedure of the bodyweight squat, ask them to squat as deep as they can

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Squat scoring

Side on view:• Thighs parallel to the ground

• The client can lower their hips to level with or lower than the height of their knees

• Heels remain on the floor • The client can keep their whole foot flat on the floor for the whole

movement. • Back flat parallel to the shank

• The client can keep their trunk stiff and lumbar spine flat or with normal lordosis. If the client’s back rounds, indicating they cannot keep back flat, or if the client’s trunk is not parallel with the lower leg or shank, this is marked as unsatisfactory

Squat scoring

• Front on view:• Knees aligned feet ~3 cm

• The client can keep their knees aligned with their toes and are allowed to move in or out up to 3 centimetres and remain satisfactory. Sideways movement of more than 3 cm from the width of the big toes is unsatisfactory

• Weight even on both feet• The client’s hips stay in the middle of their feet. If they move to one

side at the bottom of their squat more than 3 cm is unsatisfactory

• NOTE:• If three attempts are not completed, then a score of zero is

recorded indicating unsatisfactory

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Lunge

• The lunge pattern is a key movement also used in everyday life in actions like walking and climbing stairs

• There are many ways to lunge, including forward, back and sideways. With the load carried in the hands, on the bar, by the side or overhead

Lunge movement

• Knees can move over your toes if you have good ankle mobility

• Short step lunges load the rear leg quads, long step lunges load the front leg and glutes more

• Balance is an important skill learnt in lunging

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Lunge movement

• Try and imagine standing on train tracks so when you lunge forward the leg remains on the track rather than crosses to the midline of the body

• It is ok to lean forwards rather than keep your body upright, this also loads the front working leg and not the rear support leg

Lunge procedure

• The person lifts one leg until the front thigh is parallel to the floor, then steps forward and lowers body to the floor

• Lift one leg and balance• Step long and land• Back knee to almost touch the floor• Push back to start position

• Demonstrate to the person the correct procedure of the forward lunge, ask the individual when they are ready, to lunge forward, hold and return

• Three individual repetitions will be performed firstly on the right leg, then three individual repetitions on the left leg

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Lunge scoring

• Side on view:• Weight stays level during the step

• The client is able to balance on 1 leg with knee lifted and keep hips even (or lifted leg side higher than supporting leg side)

• Support knee stays straight• During the balance before the lunge, the clients can keep the support

leg straight without the knee flexing

Lunge scoring

• Front on view:• Shin remains facing the front

• The support leg knee and foot must remain pointing to the front and not rotate in or outwards.

• Leg aligned on landing• When the foot of the lunging leg contacts the ground, the ankle, knee and

hip must be aligned, and all pointing forwards and the shin of the front leg remains vertical and not tilted to one side

• Returns smoothly to the start• The client can return smoothly back to the start and stay in a balanced

position

• NOTE:• If left or right are marked as unsatisfactory, record this meaning a score of

zero• If three attempts are not completed, then a score of zero is recorded

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Hinge

• The hinge pattern is another key movement used in everyday life in actions like bending over, picking up things from the floor, sitting down, washing your hands in a sink etc

• The hinge is also an important movement in exercises like deadlifts and bent over rows

Hinge movement

• Beginners should always perform a hinge unloaded

• Start with a slight knee bend and aim to keep it slightly bent at all times – this unloads the hamstrings and allows the hips to move more easily

• Head and spine alignment are the hardest parts to learn, so spend time getting this right with a low load as it will assist the client in the long term when they add load in deadlifts

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Hinge movement

• Hinging up to ~60 degrees is all the range required – you may move to 90 degrees, but it’s almost certain your lumbar spine will flatten to reach this range

• A slightly wider stance with toes out may help males hinge more smoothly

Hinge procedure

• Lower hands to knees by hinging at hips – butt out

• Demonstrate to the participant the correct procedure of the bent-leg hinge, ask the individual when they are ready, to perform a bent-leg hinge beginning with the downward movement, hold at the bottom point and raise back to the start position

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Hinge scoring

• Side on view:• The trunk remains straight

• Throughout the down and up movement, the client should keep their back in normal or neutral spine alignment with no arching or rounding of the lower back

• Head in a neutral alignment • During the up and down movement, the head remains aligned with

trunk and spine, and the client does not look down or up during the movement

• Knees remain at a fixed angle• Throughout the down and up movement, the client keeps their knees

fixed with no more bending or straightening of the knee

Hinge scoring

• Front on view:• Weight even on both feet

• Throughout the down and up movement, the client is able to keep their body evenly balanced between right and left foot with no movement towards one side

• Shoulders remain square • The client is able to keep their shoulders level with the floor with no

movement towards one side or twisting where one side comes forwards


recorded

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Push

• The push pattern is used in everyday life in actions like getting off the floor and closing doors

• The push pattern is also an important movement in pushing exercises like bench press, DB press, and overhead press

Push-up movement

• Start with hands about shoulder-width apart – this loads the chest and triceps more proportionately and gives you the best chance of doing it well

• Head and spine alignment are important and need to be pointed out the client

• A slightly wider hand position increases chest load and reduces tricep load

• A more narrow hand position increases tricep load and reduces chest load

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Push-up procedure

• Have the client support their weight on hands and knees/toes. Hands placed in a comfortable position shoulder-width apart, fingers forward

• Full body braced, lower the chest to the floor and return

• Demonstrate to the client the correct procedure of the push-up, ask the individual when they are ready to perform a push-up beginning with the upward movement, hold at the top point and lower back down

Push scoring

• Side on view:• The chest is <10 centimetres off the floor

• The client can lower their chest to less than 10 cm from the floor• Trunk remains straight

• Throughout the down and up movement, the client can keep their back in normal or neutral spine alignment with no arching or rounding of the lower back

• Head in neutral alignment• During the up and down movement, the head remains aligned with


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Push scoring

• Front on view:• Weight even on both hands

• Throughout the down and up movement, the client is able to keep their body evenly balanced between right and left hand with no movement towards one side


movement towards one side or twisting where one side drops towards the floor


recorded

Pull

• The pull pattern is also used daily in actions like pulling a door open, opening car doors and pulling yourself up from a seat on the bus

• The pull pattern is also an important movement in pulling exercises like chin-ups, bent over rows and single arm DB rows

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Underbar pull-up movement

• Start with hands about shoulder-width apart on the bar –this loads the back and biceps more proportionately

• Head and spine alignment are important and need to be pointed out the client as they will tend to arch their back to help get up

• A slightly wider hand position increases the load on the back and reduces the load on the biceps

• A more narrow hand position increases the load on the biceps and reduces the load on the back

Underbar pull-up procedure

• Lying underneath a bar that is higher than arm length• The client grips the bar at shoulder-width (under grip) and makes

the entire body rigid• Heels in contact with ground, knees bent at 90 degrees• The client pulls up so that their chest approaches the bar and

lowers with a controlled movement • There should be no use of momentum by pushing off the ground

or thrusting the pelvis forward

• Demonstrate to the participant the correct procedure of the pull-up, ask the individual when they are ready to perform a pull-up beginning with the concentric movement, hold at the top point and lower eccentrically

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Pull scoring

• Side on view:• The chest is <10 centimetres off the bar

• The client can pull up, so their chest is less than 10 cm from the bar• Trunk remains straight

• Throughout the up and down movement, the client can keep their back in normal or neutral spine alignment with no arching or rounding of the lower back

• Head in neutral alignment• During the up and down movement, the head remains aligned with


Pull scoring


• Throughout the down and up movement, the client is able to keep their body evenly balanced between right and left hand with no movement towards one side




recorded

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Rotate

• Rotation is also another important action used in things like looking over your shoulder, turning to see to your left or right, and throwing skills

• Trunk and especially thoracic mobility are often deficient in people. This can restrict normal back behaviour and lead to back pain and injury

• Trunk rotation is also an important movement in many single arm rowing movements as well as single-arm movements like throwing, swimming and many sports

Trunk rotation movement

• Start beginners in a seated position and teach them to rotate the thoracic spine without moving their hips on the seat

• Head and spine alignment are important, and many people will lose alignment when trying to rotate

• Placing your hands on your head may open up the ribs and allow for smoother rotation

• Work towards a good range of rotation before you load this with exercises like woodchops or single arm DB rows

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Trunk rotation procedure

• Twist your trunk around towards the rear wall, keeping your arms extended and parallel to the floor

• You are allowed to turn your shoulders and waist, but your knees must remain facing the front

• Repeat for the other side with your feet in the same position

Trunk rotation procedure

• Equipment required: wall

• Stand one metre out from a wall with your back to the wall and your feet shoulder-width apart

• Extend your arms out directly in front of you, so they are parallel to the floor, lock your thumbs together

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Rotation scoring

• Front on view:• The trunk remains straight

• Trunk remains straight with no slouching or slumping to the side• The body is aligned vertically

• The client remains vertically aligned with no sideways hip hitching or side bending at the lumbar spine

• Shoulders remain square• The client is able to keep their shoulders level with the floor with no


• Feet and knees face the front• Feet and knees face the front during rotation, while the pelvis rotates

in the same direction to the shoulders • Can rotate 90 degrees each side

• The client can rotate full 90 degrees with arms remaining straight throughout

Brace

• The brace is also another important action used in most day to day activities simply by keeping your body upright and trunk straight

• Trunk and hip control should be cued and reinforced in all movements

• Trunk stiffness and hip stability create a platform from which all arm and leg movements can be based and allow for efficient limb movement

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Brace

• Start beginners in a position with elbows and knees on the floor and teach them to achieve good spine and head alignment first

• Achieving proper spinal curves in this position is important as it transfers to all exercises and activities

• Work towards holding good technique for up to 2 minutes before you change this position and make it more challenging

• Moving to either toes or hands will increase the difficulty significantly and should only be done as long as the person can maintain good spine curves and alignment

Brace procedure

• Procedure:• Support the weight across all four points evenly• Clients are asked to stop if they feel any pain• Time the client in the correct position

• Demonstrate to the participant the correct procedure of the front support, ask the individual when they are ready to perform the front support and hold for 60 seconds in total

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Brace scoring

• Side on view:• Trunk remains straight

• The client can keep their back in normal or neutral spine alignment with no arching or rounding of the lower back

• Head in neutral alignment• The client can keep their head aligned with trunk and spine, and the client does not look

down or up


• The client can keep their body evenly balanced between right and left hand with no movement towards one side

• Shoulders remain square • The client can keep their shoulders level with the floor with no movement towards one

side or twisting where one side drops towards the floor

• Resultant time:• The client was able to hold for 60 seconds

To finish

• Once you have finished each movement screen and recorded a result for each of the 5 criteria, it is now time to add up the score

• Add up the total for each movement - a score out of ‘5’• Put this total in the line under each movement

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To finish

• Add up the total score for the screen - a score out of ‘35• Put this total in the last line of the table

The end

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FUNCTIONAL MOVEMENT ASSESSMENT

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