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More and more individuals are working proactively to improve their flexibility, strength, power, endurance by performing high level activities despite being inefficient in their fundamental movement patterns

Move well, then move more oftenOtherwise we pattern dysfunctionFind the weak link (physical/functional limitation)If weak link not found, body will compensate causing inefficiencies = decreased performance and increase injuries

Reductionist approach vs. global movement patterns

Purpose of Movement ScreeningIdentify individuals at risk who are looking to maintain or increase activity levelAssist in creation of specific corrective exercisesProvide a systematic objective tool to monitor progress throughoutCreate a functional movement baseline which allows for rating and ranking and return to work / play criteria

% of population that can pass the entrance Military Test

WWI – 70%WWII – 50%Today -- > 30%

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What is the Core????

What is its purpose???Stability / Postural controlStability / Postural controlEnergy TransferBreathingContinence

Only takes 20% of mm strength to stabilize a jointRTC will never catch up to Pecs / LatsStabilizers fire first / prime movers fire second

Core works as a reactive unit, so it is important to Core works as a reactive unit, so it is important to train it that way

Crossing streetDon’t blame the musculature, blame the pattern of activation

During injury, body shuts down stabilizers and fires primary mm to splint the area

Rolling, POE, Crawling, Half-Kneeling, kneeling, squating, standing, stepping

Rolling at 6-8 months – or DD80% of my full grown patients can’t segmental roll

These activities create the motor programs that they need further along the development.

Creates kinetic chain and kinetic linking

Children squat to investigate, and deadlift to inspect

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Mobility = ability of the neuromuscular system to allow for efficient movement of a joint or series of joints through a full, non restricted, pain free ROM

Stability = Active neuromuscular control exerted on a joint to redirect force and control movement in the presence of normal muscle flexibility and joint mobility.

Cant have stability without mobility

Athletes / Individuals that score < 15 = 11x (p<0.05) more likely to become injured

Athletes / Individuals with Asymmetries = 3x (p<0.05) more likely to become injuredj

Study based on 2 NFL teams with an n = 124Below cut score = 3.1x more likely to be injuredAsymmetry = 2.3x more likely to be injured

Kiesel and Plisky ACSM 2008

Purpose = FMS as a tool for predicting serious injury risk in NFL

n = 46Pre participation FMS scoresSignificant injuries (3 or more weeks on injured reserve) recorded and analyzed at end of seasonFMS 15 P i i di f i ifi i jFMS < 15 = Positive predictor of significant injury

Injury rates climbed from 15% to 51%Specificity (0.91)Sensitivity (0.54)Odds ration = 11.67Positive likelihood ration5.92

IMPORTANT TO NOTE THAT ASYMMETRY IS JUST AS BIG A PREDICTOR OF INJURY AS A LOW FMS SCORE

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64 Healthy NFL players at the start of the season.Pre and Post FMS scores obtained for each subject

Intervention7 week corrective exercise programp gIndividualized to each subject based on their FMS scoresSupervised 4/week and an optional 2/week

ResultsPost test = significant # of subjects improved to above the injury threshold (P<0.01)Significant number of subjects without asymmetries (P = 0.01)

Functional / Fundamental Movement Testing

Pre Employment or Participation Physicals

Performance Testing

469 firefighters Pre test / Post Test Design

6 month intervention30 min dedicated to exercise per shift (12 flexibility exercises)Flexibility tests usedy• Sit and reach• Twist and touch (for torso rotation)• Flexion and extension limits of the R shoulder• Flexion and extension limits of the R knee

Significant increase in flexibility at post testNo change in injury rates between groupsSignificant decrease in lost time from workCost savings!!!

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433 firefighters on full duty status• average age 21 to 60 years •408 male (94.2 percent)•25 female (5.8 percent).

Each participant perfromed an introductory FMS screen and was then enrolled in a multi disciplinary screen and was then enrolled in a multi disciplinary training protocol based on FMS scores

Reduction in lost time = 62%Reduction in number of injuries = 42%

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# of Participants433

# of Injuries in Historical Group

# of Injuries in intervention Group

% Reduction (P-Value)

Back Injuries 39 22 44% (0.024)Upper Extremity

Injuries29 15 48% (0.03)

Lower Extremity 10 7 30% (0 46)Lower Extremity Injuries

10 7 30% (0.46)

Lost Time BackInjuries

29 11 62% (0.0036)

Lost Time Upper Extremity Injuries

21 8 62% (0.01)

Lost Time Lower Extremity Injuries

8 3 62% (0.13)

FMS: Deep Overhead SquatFMS: Deep Overhead SquatAssess Bilateral symmetrical mobility of the hip,

knees, and ankles

Dowel assesses symmetrical mobility of the shoulders and T-spine

Inability to perform can be:• DF restriction• Hip flexion restriction• Knee flexion restriction• Shoulder flexion restriction• T spine extension restriction• S&MCD

Hurdle StepHurdle StepAssesses bilateral mobility and stability of hips,

knees, and ankles

Demonstrates• Stance leg ankle, knee, and hip stability

St l t i l hi t i• Stance leg terminal hip extension• Step leg OKC ankle DF, knee flexion, hip

flexion• Good proprioception

Inability to perform• Instability of stance leg• Poor mobility of step leg• Also looks at asymmetrical hip motion

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In Line LungeIn Line LungeBilateral mobility and stability of hips, knees, and ankles

Requires stance leg stability of the ankle, knee, and hip as well as stance leg CKC hip abduction

G t b l t tGreat balance test

Failure can be due toInadequate mobility of either stance or step legInadequate stability of the stance ankle and kneeTightness of the rectus of the stance legImbalance between weakness of the adductors and tightness of the abductors about one or both hips

Shoulder Mobility TestShoulder Mobility TestBilateral shoulder mobility

• EADIR• FABER

ER is often gained at expense of IR in h d thl toverhead athletes

Posture with forward head and rounded shoulders (UCS)

Scapulothoracic dysfunction that can lead to gh ROM limitation

ASLRASLRAssess active gastroc/soleus and hamstring

ROM while maintaining a stable / neutral pelvis

Lower abdominal stability with active ROM of HS of HS

Inability to perform may be due to:• Poor dynamic HS ROM• Inadequate passive mobility of

opposite hip as a result of iliopsoastightness

Trunk Stability Push UpTrunk Stability Push Up

Trunk stability in a sagital plane while upper extremity movement is performed in a CKC.

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Rotational StabilityRotational StabilityMultiplanar stability while

creating upper and lower extremity mobility

The ability to perform the Rotational Stability test requires asymmetric trunk stability in both sagittal and transverse planes d i t i d during asymmetric upper and lower extremity movement.

Many functional activities in sport require the trunk stabilizers to transfer force asymmetrically from the lower extremities to the upper extremities and vice versa.

It is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known musculo-skeletal pain.

When the clinical assessment is initiated from the perspective of the movement pattern, the clinician has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main musculo-skeletal complaint, but contribute to the associated disability.

Does not replace IE testing … it is a complementGuide to the most dysfunctional NON PAINFUL movement patternModeled after Cyriax's selective tissue testing, Modeled after Cyriax s selective tissue testing, each test of the SFMA is scored as functional/non-painful, dysfunctional/non-painful, functional/painful or dysfunctional/painful.