Functional Movement Screening
I’ve been fielding a handful of questions lately on Functional Movement Screening and Identification. So I thought I’d post my thoughts on the topic here & spur a bit of conversation. The most common question I’ve been asked lately is ‘what do you look for in functional movements when examining a patient?’ The best way to describe what you’re trying to identify faulty movement within specific patterns.
Typically speaking faulty patterns can fall into one of 3 categories: 1) neurological inhibition (muscle just flat isn’t firing for whatever reason) 2) soft tissue inhibition (joint restriction through some sort of soft tissue pathology) or 3) inability to transfer energy (something is wrong with the kinetic chain further away).
If we look closer neurological inhibition can be further broken down into a few subcategories. Inhibition can come from the muscle not receiving proper input (down regulation of the actual muscle – think glutes) or via reciprocal inhibition whereas the antagonistic muscle isn’t down regulating appropriately and allowing the muscle to properly activate (think quad dominant runner/athlete). Both technically are inhibited, the major difference is how you treat. If the glute-hamstring complex isn’t activating due to quad dominance you’d treat the quads to allow appropriate down regulation and consequently appropriate activation of the glute-hamstring complex. If it’s not activating because the glute’s aren’t pulling their weight, you can down regulate the quad all you want and it won’t solve the problem. You’ll have to up regulate the glute to fire appropriately.
Soft tissue inhibition can be caused from a multitude of factors. Scar tissue adhesions, fascial adhesions joint capsule adhesions etc all fall into this category for me. Soft tissue issues are typically all treated the same way. Only way to get rid of adhesions is to remove them. Graston, ART, IASTM etc are all examples of ways to treat the adhesion. We could spend a TON of time on this topic. Honestly, if you want to know more, take a class from Ashli Linkhorn?, Tom Hyde or someone of that caliber. It’s an art form. Just because ‘you’ve seen it done’ doesn’t qualify you to start cranking on people. You do too much & you’re no longer breaking up adhesions… you’re causing soft tissue damage and now YOU’RE the reason the patient isn’t getting better.
Third on the list is one we should all be familiar with. Inability to transfer energy (issues with the kinetic chain). We’re talking joint kinematics & arthrokinematics. How the joint surfaces are moving on each other & therefore transferring energy play a massive role in how the body will respond to functional movement. Take the squat as a prime example. Two bodies can be doing the exact same movement and all other issues are resolved but one athlete can do a deep squat while the other can’t. A lot of times this is caused by the depth of the femoroacetabular joint. If the patient has a deep socket, it doesn’t matter how many times you adjust, or do soft tissue or give exercises, they will NEVER deep squat. However, there are times when appropriate manipulation of the joint surfaces are all the patient needs. How you go about this depends on your level of skill (especially in the extremity) or knowledge of the joint surfaces you’re working on. There are some really good courses on extremity work that go into depth on how to adjust/manipulate based on the style of surface and pathology within the joint.
Now these are my takes on functional movement. Others probably have different ways of breaking it down. Hopefully this helps those of you who are starting to get into functional screening. There are plenty of screenings out there. Please don’t feel pressured into one single method. FMS, SFMA are great tests/protocols put together by Gray Cook. CAFS, 3DMAPS has their own testing & protocols developed by Gary Gray. Craig Leibenson has the DNS protocol and many many others. All are great. All force you to think outside the box & all will help you develop appropriate protocols for your patients.