ASSESSING AND IMPROVING FUNCTIONAL MOVEMENT. Adam D. Richmond, MS, LAT, ATC PES, FMS, SFMA, FR

Transcription

1 ASSESSING AND IMPROVING FUNCTIONAL MOVEMENT Adam D. Richmond, MS, LAT, ATC PES, FMS, SFMA, FR

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3 Objectives 1. Recognize the importance of movement screening and assessment and it s role in injury prediction and prevention. 2. Understand basic movement screening and assessment techniques. 3. Implement strategies to improve mobility. 4. Implement strategies to improve stability.

4 Primary Question? Does movement screening predict injury in the athletic population during sport?

5 Study Population Methods Results Predictive? Rita, S.C. Kiesel, KB Hotta, T Dossa, K Letafatkar, A D2 female athletes 238 American professional football players 84 competitive male runners ages junior hockey players. 100 physically active students ages Preseason screen. Injuries sustained during inseason practices and competitions. Preseason screen. Time-loss musculoskeletal injury during 1 preseason. Preseason screen. Time-loss due to injury was investigated during 6-month season. Preseason screen. Injuries and number of games missed for each injury were documented for 1 season. Preseason screen. Injuries sustained during a regular competitive season. A score of 14/21 or less was significantly associated with injury. Score 14 exhibited a relative risk of Asymmetry exhibited a relative risk of Combined specificity of Composite score had a low predictability for running injuries. DS and ASLR scores of 3 significantly influenced the incidence of running injuries. Those with an FMS score of 14 were not more likely to sustain an injury. Those with an FMS score of less than 17 were at a 4.7 times greater risk of a lower extremity injury. YES YES Composite NO DS/ASLR YES NO YES

6 Study Population Methods Results Predictive? Preseason screen. FMS composite score was Noncontact or overuse 167 injury-free D1 not differnet between Warren, M injuries that required NO athletes. those injured and those intervention from the AT not injured. during sport season. Garrison, M collegiate athletes. Preseason screen. Injury development was tracked throughout the season. Athletes with an FMS score 14 combined with self-reported past history of injury were at 15 times increased risk of injury. YES Bardenett., SM high school athletes. Preseason screen. Injury development was tracked throughout a single season. No statistically significant associations were found between total FMS scores and injury status. NO Schroeder, J Hammes, D male amateur football (soccer) athletes 238 veteran footballers (soccer) aged > 32 years. Preseason screen. Injury defined as noncontact to the lower extremity with minimum 3 days lost. Preseason screen. Player s exposure hours and injuries were recorded for 9 months. There were no significant differences between injured and uninjured players for the composite score. The difference of FMS overall score between injured and uninjured players was not significant. NO NO

7 Study Population Methods Results Predictive? Clay, H D1 female collegiate rowers. Preseason screen. Injury reports / patient complaints of LBP were recorded over a season. Those in the high risk group were significantly more likely to experience LBP during the season and reported a 58% greater mean in years of rowing experience. YES Lehr, ME D3 collegiate athletes. Preseason screen. Test scores and demographic info were entered into an injury prediction algorithm. Non-contact injuries were recorded. Athletes identified as high risk were at a greater risk of noncontact LE injury during the season. **demographics, PMHx, YBT, FMS, presence of pain YES (algorithm) Mokha, M D2 collegiate atheltes. Preseason screen. Musculoskeletal injuries tracked for 1 academic year. Athletes with FMS scores 14 were not more likely to sustain an injury. Athletes with an asymmetry or individual score of 1 were 2.73 times more likely to sustain injury. Composite NO Asymmetry YES Score of 1 YES Garrison, M collegiate athletes. Preseason screen. Injuries tracked throughout the season. Athletes with an FMS score 14 combined with a self-reported past history of injury were at 15 times increased risk of injury. YES Chalmers, S elite junior Australian football players. Preseason screen. Injuries tracked through 1 regular season. Asymmetrical sub-test increased risk of injury. Composite NO Asymmetry - YES

8 Conclusions Clinical Question: Does the Functional Movement Screen predict injury in an athletic population? Answer: It depends. Composite score alone: SOMETIMES Composite score + previous injury: YES Composite score + aerobic fitness: YES (military study) Algorithm including composite score: YES Asymmetry: YES Score of 1: YES

9 Limitations of the Research / FMS Research Population?? Definition of injury Exposure time FMS Hypermobility Sport specific

10 High Blood Pressure = heart attack?? COMPLEX SYSTEM THEORY REDUCTION OF RELATIVE RISK

11 A dynamic, multifactorial model of sports injury etiology adapted from Meeuwisse (1994).43. R Bahr, and I Holme Br J Sports Med 2003;37: Copyright BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

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13 Stress Management STRESS > CAPACITY = INJURY STRESS CAPACITY = TRAINING/REHAB Acute injury = too much stress all at once Chronic injury = too much stress over time STRESS Homework, relationships, practice/games, weight room Biomechanics?

14 Charlie s Buckets Risk Reduction Movement Output Readiness Sensory Systems FMS, SFMA, TPI, PRI ESD, Strength, Power, Speed Recovery, Sleep, HRV, Questionnaires Vision, Auditory, Sensation, Vestibular

15 Skill Speed/Agility Work Capacity / Strength Sport Movement Capacity Human Movement Capacity

16 Movement Biomechanics Screening and assessment What are we looking for? Pain with movement? Inability to perform simple movement pattern Major asymmetry Fluidity, effort Can your joints get into the correct positions to absorb and adapt to stress? Charlie Weingroff If they can, green light to train, still may FAIL. If not, why? Mobility (passive ROM) Motor skill acquisition (stability / active ROM)

17 Athlete s Name: Sport: Area of Pain/Injury: Date: Movement Assessment C Flexion: C Extension: C Rotation: R: L: LRF: R: L: MRE: R: L: MSF: MSE: MSR: R: L: SLS: R: L: OHDS: Functional Squat: HADL Test: R: L: HABL TEST: R: L: FA Assessment: ADD Drop Test: R: L: Pelvic Ascension Drop: R: L: Passive Abduction Raise: R: L: Straight Leg Raise: R: L: FA IR (ROM): R: L: FA ER (ROM): R: L: Modified Thomas: R: L: Thoracic Assessment: Trunk Rotation: R: L: Horizontal ABD: R: L: Shoulder Flexion: R: L: HG IR: R: L: HG ER: R: L: Breathing Assessment: Apical Expansion: R: L: Posterior Mediastinum: R: L: Post. Rib Hump: R: L: Anterior Rib Flare: R: L:

18 Movement Assessment LAB

19 Accessory Mobility Tests LAB

20 LIVE EXAMPLE LAB

21 Mobility 1. Joint position 2. Tissue Extensibility Dysfunction (TED) 3. Joint Mobility Dysfunction (JMD) 4. Neurolocked

22 Joint Position Postural Restoration Institute (PRI) Theory Human bodies are asymmetrical Neuroligcal, respiratory, circulatory, muscular and vision R liver vs. L heart 3 lobes of lung on right, 2 lobes on left Lateralize to the right Polyarticular muscle chains Muscle energy techniques combine with proper breathing Zone of Apposition Link to autonomic nervous system

23 PRI Position Test Hruska Adduction Drop Test / Modified Ober s

24 Tissue Extensibility Dysfunction Myofascial Release Techniques Dry needling Foam rolling / lacrosse ball Functional Range Release (FR) Active Release Technique (ART) Instrument Assisted Soft Tissue Mobilization (IASTM) Massage Therapy Positional Release Technique Guasha Cupping Long Duration Static Stretching

25 Joint Mobility Dysfunction Maitland/Kaltenborn Mobilizations High Velocity Thrust Manipulation Mulligan Nags, Snags and MWM Long Duration Static Stretching

26 Neurolocked PNF Isometric Contraction PAILS/RAILS Mobility Bands IASTM

27 Joint by Joint Theory

28 Hip Mobility Test OHDS, ILL, HS, ASLR Modified obers (Add. Drop) Passive abduction raise Passive SLR IR/ER = Supine 90/90 passive Extension = modified thomas JMD Flexion = posterior hip capsule IR = posterior/inferior hip capsule ER = anterior/superior hip capsule Abd. = medial hip capsule TED Extension = anterior hip Flexion = posterior hip IR/ER = hip Abd. = medial thigh Add. = lateral hip/thigh

29 Hip Mobility Manual Technique IASTM, MFR MWM PAILS/PNF Self Technique Half kneeling hip flexor Tactical frog and groin rock Pigeon Leg lowering

30 Ankle Mobility Test OHDS, ILL, HS, Half kneeling knee to wall 4-5 inches, closing angle pain? TED Posterior calf/foot Manual Technique IASTM, MFR MWM Self Technique Slant board 2 min gastroc/soleus Wall ankle rock JMD Posterior Joint Capusle Tibiofibular joint/syndesmosis

31 Thoracic Spine / Ribcage Mobility Test OHDS, ILL, SM Lumbar lock extension/rotation PRI test??? TED Thoracolumbar tissue JMD Thoracic spine / Rib cage Manual Technique IASTM, SMR MWV PA mobs Self Technique PRI breathing Foam roll extension Side lying t-spine rotation Rock back extension rotation

32 Motor Skill Acquisition / Stability Control in the presence of change Charlie Weingroff Ability to resist motion and transfer energy Movement pattern specific Proximal to distal Graded exposure Neurodevelopmental Sequence

33 Foot Stability Test OHDS, ILL, HS Local Ankle / Foot Strengthening Global Barefoot training Tripod foot Actively create arch while squatting, deadlifting, etc Mobility Great toe Ankle

34 Knee Stability Test OHDS, ILL, HS Local Quad hamstring ratio Global Lumbopelvic hip complex The knee is dumb does what the hip and ankle tell it to. Mobility Ankle Hip

35 Shoulder Stability Test OHDS, ILL, SM, RS, TSPU Local Rotator cuff Global Scapulothoracic Lumbopelvic hip complex Mobility Glenohumeral Thoracic spine/rib cage

36 Lumbopelvic Hip Complex / Proximal Core Stability Test ALL SEVEN FMS MOVEMENTS Local Inner Core Diaphragm / breathing Position Global Resist motion and transfer energy Movement pattern specific Neurodevelopmental sequence Mobility Hip T-Spine Shoulder

37 Coaching Core Stability Cueing Exhale Belt buckle to mouth Soda Can Lock rib cage to pelvis BREATHING

38 Coaching the Neurodevelopmental Sequence Breathing Dead bug Bird dog Tall/Half kneeling Standing Squat, Lunge, Deadlift, Push, Pull Jumping / throwing MB, plyos

39 Coaching the Squat Mobility Everything!

40 Coaching the Squat Stability Neurodevelopmental Sequence 90/90 wall breathing Quadrupend rock back Tall kneeling MB/hip hinge Goblet RNT Squat

41 Coaching the Toe Touch Mobility TED Hamstrings, medial thigh, posterior hip, lumbar/t-spine erectors JMD Hip capsule Lumbar spine Neuro Hamstrings, medial thigh, posterior hip, lumbar/t-spine erectors

42 Coaching the Toe Touch Stability Neurodevelopmental Breathing standing Where do they live within the spectrum?

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