Thanks for coming. So I forced myself to look at movement differently!

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Reconsidering The Way We Look at Movement Gray Cook MSPT, OCS, CSCS Pitt-Marquette Challenge Lecture Virginia Commonwealth University February 1, 2012 Thanks for coming How did I get here?

1 Reconsidering The Way We Look at Movement Gray Cook MSPT, OCS, CSCS Pitt-Marquette Challenge Lecture Virginia Commonwealth University February 1, 2012 Thanks for coming How did I get here? Too many smart people disagreed on movement topics like exercise, rehabilitation and athletic performance. I realized it was a question of perspective. Keys to Considering Movement So I forced myself to look at movement differently! 1. Never forget the developmental foundation 2. Consider patterns and parts equally 3. Screen, Test, Assess Basic Function 1

2 A little history for you 2

3 Keys to Considering Movement 1. Never Forget The Developmental Foundation 1. Never forget the developmental foundation 2. Consider patterns and parts equally 3. Screen, Test, Assess Basic Function Did you catch that?

Is this a bad movement or have we just become bad squatters? Keys to Considering Movement 1.

Screen, Test, Assess Basic Function Argue for a cultural weakness and you will soon own it! 2.

measuring specific points, but not as consistent when measuring whole patterns.

4 Is this a bad movement or have we just become bad squatters? Keys to Considering Movement 1. Never forget the developmental foundation 2. Consider patterns and parts equally 3. Screen, Test, Assess Basic Function Argue for a cultural weakness and you will soon own it! 2. Consider Patterns and Parts Equally Reductionism is necessary but not sufficient We are good at measuring specific points, but not as consistent when measuring whole patterns. The Jump Study We must develop a system for discussing movement patterns that fosters communication and clarity among the many professions that claim movement as their territory. 4

5 Jump Study take away The movement pattern changed but no change in anatomical parts was necessary. Don t ask for a positive adaptation if you cannot get a positive response. Most neurological systems are not operating as efficiently as they potentially can. Movement Patterns Is squatting deep normal or exceptional? 5

6 Movement Patterns Be Practical in Your Practice When a squatting pattern is poor, is the reason always anatomical? Anatomy, Kinesiology, and Biomechanics are not movement they are simply ways to discuss parts and patterns of movement. Always remember the map is not the territory! When you are lost in the wilderness do you want a competent woodsman or a mapmaker? Keys to Considering Movement 3. Screen, Test, Assess Basic Function 1. Never forget the developmental foundation 2. Consider patterns and parts equally 3. Screen, Test, Assess Basic Function Professional Confidence? Thin Slicing The Book Blink Expertise - advanced pattern recognition 6

7 Thin Slicing Experts in any field are able to accurately and quickly identify patterns, while novices stumble through the process and do not recognize the salient features of things. Goldman Algorithm ECG Unstable Angina Fluid in Lungs SBP <100 mmhg a 70% improvement in identifying these patients (95% probability) Please Define Screen Screen Test Assess 1) A system for selecting suitable people 2) To protect somebody from something unpleasant or dangerous. Practical Meaning to check risk Test 1) A series of questions, problems, or practical tasks to gauge somebody s knowledge, experience or ability... 2) Measurement with no interpretation needed Practical Meaning - to measure ability Assess 1) To examine something in order to judge or evaluate it... 2) To calculate a value based on various factors... Practical Meaning to judge inability 7

Working Definition Screen Rate and Rank Function Test Measure Ability Function Assess - Inability / Dysfunction Working Definition Screen Predict Test Predict Assess Diagnose Rate Checklists?

8 Working Definition Screen Rate and Rank Function Test Measure Ability Function Assess - Inability / Dysfunction Working Definition Screen Predict Test Predict Assess Diagnose Rate Checklists? & Rank Problems then measure!!!!! Keys to Considering Movement 1. Never forget the developmental foundation 2. Consider patterns and parts equally 3. Screen, Test, Assess Basic Function We have a problem It all starts with Function! Functional Training Functional Exercise Functional Rehabilitation 8

9 What is Function? Defining Function Can you define function as it pertains to movement? Define dysfunction Function is the absence of dysfunction Dysfunction Dysfunction = limitations with movement competency Deficiency = limitations with physical capacity Dysfunction Movement competency below a standard accepted level The accepted level is based on: risk of injury poor adaptive capability Separate from physical capacity But where should we start looking for dysfunction? What movement parameter should we use? 9

10 1. Never Forget the Developmental Foundation How about movement patterns used in fundamental development? Movement Patterns 2. Consider Patterns and Parts Equally There are numerous ways in which slight subtleties in movement patterns contribute to specific muscle weaknesses... Dr. Shirley Sahrmann Movement Patterns The relationship between altered movement patterns and specific muscle weaknesses requires that re-mediation addresses the changes to the movement pattern; the performance of strengthening exercises alone will not likely affect the timing and manner of recruitment during functional performance. Dr. Shirley Sahrmann What is she talking about? Motor Control It s a much better term then stability 10

11 Considering Patterns of Movement During the 1990 s, the continued evolution of rehab required that movement remain the central focus. The APTA adopted a philosophical statement clearly stating that movement dysfunction is the basic problem addressed by rehab intervention. Ok - we need to look at movement patterns how? We need a SOP! standard operating procedure a consistent reproducible system Stick to a System (standard sequence) Only by sticking to a standard sequence will the physician be sure of leaving nothing out and only by leaving nothing out are true findings feasible. Dr. James Cyriax Consistency The physician arrives at a diagnosis not from the evidence furnished by one painful movement but by careful determination of a consistent pattern. Dr. James Cyriax It seems clear We should look at movement patterns. We need a consistent system to address movement dysfunction. But what else can we do? We can t just talk movement and function; we also need to consider pain! 11

12 Questions Do people move poorly because they are in pain? or Are people in pain because they move poorly? What about pain? Pain, however undesirable, serves an important biological function acting as a warning signal that all is not well in the movement system. - Dr. Vladimir Janda What is the problem? Nothing is ever one thing, but usually a complication of multiple factors with each hiding the others tracks... How will we group in the future? Screen, Test, then Assess Observe the order or lose perspective! Screen Generalized Grouping of Dysfunction Asymptomatic (no report of pain with movement) Test Specific Measurement of Dysfunction Asymptomatic (no report of pain with movement) Assess Judgment of Dysfunction / Diagnosis Symptomatic (pain associated with movement) THE FUNCTIONAL MOVEMENT SCREEN Scoring of the FMS 1. Squatting 2. Stepping 3. Lunging 4. Reaching 5. Leg raising 6. Push-up 7. Rotary Stability Perform Pattern as Directed - Perform Pattern with Compensation/Imperfection - Unable to Perform Pattern - Pain with Pattern Regardless of Quality 12

13 Rate and Rank Movement Competency Then measure the level of severity in the category Grouping is the KEY! Pain with movement regardless of quality Dysfunctional movement quality Imperfect movement quality Near perfect movement quality Pain with movement regardless of quality Dysfunctional movement quality Imperfect movement quality Near perfect movement quality Y Balance Testing Assessment The Big 7 Cervical Patterns Upper Ext. Patterns Multi-Segmental Flexion Multi-Segmental Extension Multi-Segmental Rotation Single Leg Stance Squatting Pattern - The Big 7 - The Big 7 Cervical Patterns Upper Ext. Patterns 13

14 Multi-Segmental Flexion - The Big 7 - The Big 7 Multi-Segmental Extension Multi-Segmental Rotation - The Big 7 Single Leg Stance - The Big 7 - The Big 7 Scoring of the SFMA Squatting Pattern Stop Treatment FN - Functional and Non-Painful Proceed with Caution FP - Functional and Painful DP - Dysfunctional and Painful Continue Treatment DN - Dysfunctional and Non-Painful 14

15 Where Does SFMA Fit In? So What Do We Know? History Ortho-Neuro Exam SFMA Local Biomechanical Testing Altered Motor Control Neurodevelopmental Perspective Regional Interdependence Pain with Movement Altered Motor Control Movement complicated with pain produces inconsistent and unpredictable movement patterns. Movementbook.com - Chapter 2 videos Neuro-Developmental Perspective Neurodevelopmental Perspective The Neuro-Develomental Perspective has taught us that movement was developed in patterns not in individual muscles. 15

16 This concept is more complete than stability training for many reasons! This concept is about control - not activation. Motor control involves coordination and balance of complementary muscular influence. This concept is more complete than stability training for many reasons! Some muscles need to be turned up and some need to be turned down. The responses need to match the changes in the internal and external environment. Neuro-Developmental Perspective We knew any assessment had to be derived from basic patterns that are part of the natural development of human movement. Regional Interdependence Regional Interdependence Refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient s primary complaint. The injury behind the injury Concussion! Neck??? Ankle! Hip??? Shoulder! Wrist, Hand, and Elbow??? -Wainner et al JOSPT

Regional Interdependence Mobility and Motor Control = Movement Pattern A muscle may appear weak when it is not, if there is inadequate stabilization of its attachment points, which itself is

17 Regional Interdependence Mobility and Motor Control = Movement Pattern A muscle may appear weak when it is not, if there is inadequate stabilization of its attachment points, which itself is dependent upon a chain of muscles. - P. Kolar Hips Mobile Stable Core T-Spine Mobile Broken Pattern (first identify then measure) Lets Summarize Hips Stiff Sloppy Core T-Spine Stiff Point One Establish a SOP for identifying dysfunction within fundamental movement patterns Define dysfunction Agree on fundamental movement patterns Point Two Separate painful movement patterns from dysfunctional movement patterns whenever possible. Use a reliable tool to compartmentalize problematic movement patterns 17

Point Three As a general rule do not manage or treat painful movement patterns with exercise.

movement patterns with systematic corrective exercise strategies and use manual efforts and

patterns Limitations in mobility Limitations in motor control Point Five Establish minimum

and retest the dysfunctional movement patterns (Test / Retest Model) If we don t think

18 Point Three As a general rule do not manage or treat painful movement patterns with exercise. Manage painful movement patterns with manual therapies and modalities Manage dysfunctional movement patterns with systematic corrective exercise strategies and use manual efforts and modalities to assist as needed Point Four Identify impairments within dysfunctional movement patterns Limitations in mobility Limitations in motor control Point Five Establish minimum levels of mobility followed by minimum levels of motor control competence whenever possible and retest the dysfunctional movement patterns (Test / Retest Model) If we don t think logically about this stuff - who will? Make things as simple as possible but no simpler. Albert Einstein 18

19 FunctionalMovement.com The End 19

Paradigm Shift. Biomedical Model. Regional Interdependence Model. Evidence to Support R-I Exam

Paradigm Shift. Biomedical Model. Regional Interdependence Model. Evidence to Support R-I Exam A Clinical Approach to Assessing and Addressing Movement Pattern Dysfunction Models of Adverse Health Regional Interdependence Evidence to Support R-I Systematic Assessment Case Studies using System Implementation