Will the FMS Cure Most Communicable Diseases?
Gray Cook
Posted February 15, 2011
Hey Mike
Many of the over simplifications have been addressed in the book. Unfortunately people talk more than they read and I can tell it is beginning to irritate you.
OK, so the title is a bit tongue-in-cheek. However, if you are a regular Strengthcoach.com reader you might be tempted to answer yes. It seems every thread now begins with the statement “have you done the FMS on them”. Every answer parrots the same mantra. If you attack the weak pattern, the athlete or client will be miraculously cured.
The weak pattern will drive performance problems, but performance problems can also be due to poor performance. That’s why I suggest that both be tested.
To be honest, I think doing the FMS should be step one for every client that complains of pain. In fact, if you have the time it should be step one for every client, period.
I actually think the SFMA will get the painful problem managed more efficiently and effectively than the FMS. I advise the people with pain to skip the FMS.
I am a huge fan of the FMS, of Gray Cook and of Lee Burton (the co-creator). However as Alwyn Cosgrove likes to say first we underreact, then we overreact. As one member said yesterday “has the pendulum possibly swung too far?”. The FMS is a screen. It is a way to begin to gather information about an athlete or a client relative to the way they move. For me it is step one when an athlete or client complains of pain. What it is not is a heat-seeking missile that will expose a weak pattern and present a miracle cure.
I just read a thread that intimated that FMS correctives will cure shin splints. That is what prompted me to write this article. Yes, the shin splints could be the result of a biomechanical fault that originates in the hips or the core but it is overuse that causes shin splints. In past years when I ran too much my shins hurt. If I followed a more progressive program they did not. Every overuse injury is not a movement fault.
Totally agreed — every overuse injury is not a movement fault — but don’t stop there — prove it! If the FMS shows serious dysfunction then you cannot rule out a movement problem. On the other hand if the FMS is clear or at least 2s on everything with no asymmetries then you have identified a performance problem, programming overload, or inappropriate activity choice.
Some people just aren’t the right body type for distance running. No amount of corrective work is going to make an offensive lineman into a distance runner. If you fix his Active Straight Leg Raise and then send him out for a 5 miler he will probably still have shin or low back issues.
This may be the way some misguided people use our model — but I’ve never implied anything like this — ever!
It is the old hammer analogy. My hand hurts when I hit it with the hammer. The Dr’s advice, hit the nail.
I love the fact that everyone has embraced the FMS and is beginning to see the value of screening, evaluating or assessing but please let’s not overstate it’s value so that people begin to discount it. The Functional Movement Screen is step one in the process. Step two is up to you. Step two does not have to be “refer them to an SFMA therapist”.
I’ve never said to send the FMS client or athlete with pain to a medical professional trained in the SFMA. It’s just nice when someone speaks the same language. All I’ve ever said is — don’t go it alone — get some help and limit your liability and protect your client / athlete in the most responsible way possible.
There are thousands and thousands of excellent therapists who have no idea how to perform the FMS who will do an excellent job of getting someone better.
Agreed! No argument from me!
There are numerous models for therapy and rehab. Gray’s model best fits the Sahrmann model of rehab through movement. As strength coaches, athletic trainers and physical therapists, this model fits extremely well for us as it works within the confines of our abilities. However, I have seen the best results when the skills of manual therapy are combined with the model of rehab through movement. In my experience the “weak pattern” is very often a result of a soft tissue or joint dysfunction that simply will not get better by attacking the weak pattern. Often a qualified physical therapist must aggressively attack joint function or tissue quality.
Our fascination with the FMS reminds me of the old internet fascination with ART. Every internet thread started with “have you found an ART provider yet”. We need to remember that all methods are tools in a toolbox. Sometimes the best tool is the computer or the phone. Much like the TV show Who Wants to be a Millionaire, the best thing you can do is phone a friend to get the right answer.
Please be careful not to oversimplify complex processes. There are no right answers and as the old saying goes, there are many ways to skin a cat. If someone asks you “how do I skin a cat”. You are not required to answer “have you performed the FMS on the cat yet”.
Sorry the FMS — misunderstandings take time out of the other stuff you would like to do. Unfortunately we are both in education and it is our responsibility to answer the stuff directed at us. I hope that the people who have read my new book are not the ones misapplying the model. As a matter of fact every response I’ve provided is in the book.
I’ve also attached all the principles from chapter 15 in the book. All I really care about is the principles — the FMS and SFMA are just the methods I use to stay as close as possible to the principles. I also provided extra commentary in blue. Enjoy
Thanks for the heads-up!
One last thing brother — I think a quick way to clarify whether an FMS question is worth answering is to ask the individual who posted it if they have read the Movement Book. If they have not there is a good chance the answer is readily available. If someone posted about Shirley’s work you might first question if they had studied her work as much as you have.
PS- If you have the time the FMS should still be step one for every client, period. But remember it is a way to begin to gather information about an athlete or a client relative to the way they move. “
Principle # 1
We should separate painful movement patterns from dysfunctional movement patterns whenever possible to create clarity and perspective.
*What I want you to know — I feel the starting point is to separate pain and dysfunction and I have opinions about what to do next. I guess I’m not satisfied with the current systems I see in place. I’m not offended when people criticize the screen — I’m just disappointed when they don’t have a viable solution to put in it’s place.
Principle # 2
The starting point for movement learning is a reproducible movement baseline.
*What I want you to know — We set far more performance baselines than movement baselines. When we do set movement baselines they are often not standardized. Without standardization it is nearly impossible to develop a statistical injury prediction model.
Principle # 3
Biomechanical and physiological evaluation does not provide a complete risk screening or diagnostic assessment tool for comprehensive understanding of movement-pattern behaviors.
*What I want you to know — This does not imply that we stop looking at biomechanics and physiological factors. It just means that we need to add a whole movement profile into the equation. The # 1 risk factor for a future injury is a previous injury… Even if you have a good PT, even if you have a good trainer, even if you have a good coach… We don’t have bad pros we suffer from the lack of a manageable system.
Principle # 4
Movement learning and relearning has hierarchies’ fundamental to the development of perception and behavior.
*What I want you to know — A clear understanding of movement pattern capability reduces the trial and error we often experience when trying to gauge a client or athletes movement learning capabilities. It also offers a level of risk management that is supported by research.
Principle # 5
Corrective exercise should not be a rehearsal of outputs. Instead, it should represent challenging opportunities to manage mistakes on a functional level near the edge of ability.
*What I want you to know — There is more to corrective exercise than just doing exercises correctly.
Principle # 6
Perception drives movement behavior and movement behavior modulates perception.
*What I want you to know — When movement pattern dysfunction is identified the client or athlete is often unable to correct the problem with verbal instruction or isolation exercise.
Principle # 7
We should not put fitness on movement dysfunction.
*What I want you to know — Everyone seems to agree with this but no one seems to have a systematic solution. Basically every trainer I know says they have enough experience not to do this but no one has a reproducible system. Everyone just vouches for himself or herself. My question is — If everyone is doing so well why do we still have low back pain, non-contact athletic injuries and training related injuries.
Principle # 8
We must develop performance and skill considering each tier in the natural progression of movement development and specialization.
*What I want you to know — The FMS is not the only thing — but I feel it is the first thing. Frequency, intensity, volume, performance level, and all the other factors regarding appropriate activity and conditioning must still be considered. It is entirely possible to have a good FMS and still get shin splints from running. This scenario suggests that movement capability is present but performance considerations were not managed.
Principle # 9
Our corrective exercise dosage recipe suggests we work close to the baseline, at the edge of ability, with a clear goal. This should produce a rich sensory experience filled with manageable mistakes.
*What I want you to know — It is refreshing to explore exercises that require increased sensory awareness. I used to think 3 sets of 10 reps would fix stuff and then I started to measure things to see exactly what I had changed — not much.
Principle # 10
The routine practice of self-limiting exercises can maintain the quality of our movement perceptions and behaviors, and preserve our unique adaptability that modern conveniences erode.
*What I want you to know — Motor learning seems to progress at an accelerated rate with exercises that make us work and also pay attention. Self-limiting exercises require a certain level of technical skill before you could even come close to a volume that would place unnecessary risk. My lists of self-limiting exercises are simply suggestions to force precision with higher levels of sensory input.
Six Things I’ve Learned In Six Years of Practice (by Dr. Reiner)
If there is one thing I have come to accept in six years of practice, it’s the more I learn the less (I feel) I know. I believe this is what drives so many of us in the fitness and rehabilitation profession. We are in constant search of the latest and greatest information to improve upon ourselves and ultimately create better athletes, clients, and patients. Reflecting on 2011 made me realize how much material was absorbed this past year. Had I possessed this information fresh out of chiropractic school, there would have been far less headaches and days of frustration. However, learning the hard way often makes us more appreciative of how far we have come. Without further adieu, my list of the top six things I’ve learned over the last six years.
1. It’s not just about you
Sure it’s always nice to think an athlete is back on the field and feeling better than ever because of what “you” did. The fact of the matter is, it’s a team effort. We can’t be experts in every field and with an overwhelming number of therapies, specialists, and philosophies, it’s imperative to create a “team” of like-minded specialists. Our “team” at Fitness Quest 10 consists of chiropractic, physical therapy, massage therapy, acupuncture, nutrition, strength and conditioning, yoga, and Pilates. More often than not one of our athletes will at some point encounter all of us in their quest for athletic perfection. My previous article, “Who’s on your Team“,discusses the importance of surrounding yourself with a group of specialists that communicate well and provide a comprehensive approach to rehabilitation, injury prevention, and athletic performance.
2. Get it right from the start
Top of the line equipment and trendy treatment techniques can make any clinician/therapist feel invincible to any injury that walks through the door. Without proper assessment and a correct working diagnosis, it’s easy to chase pain and treat the symptoms with those cool toys. While chiropractic school provided the basis for standard examination, it’s through courses, seminars, books, and colleagues outside of the chiropractic profession, that I’ve come to understand biomechanics and motor patterning. Understanding movement and analyzing dysfunctional patterns will direct you to the cause of the injury. Bottom line….don’t chase pain. Some of the most influential to my practice include Gray Cook, Dr. Stewart McGill, Shirley Sarmon, Sue Falsone, Greg Rose, Charlie Weingroff, Craig Liebenson, and Mike Reinold.
3. Don’t get caught up in the “black and white” of biomechanics. The nervous system is a bigger beast and creates many shades of gray when treating patients.
Only considering biomechanics when assessing injuries or faulty movement patterns will often leave you short of solving the problem. The nervous system is a far bigger beast to comprehend when motor control issues and compensatory patterns exist. Is it the pain that drives the faulty pattern or the faulty pattern that drives the pain? Studies have shown pain, regardless of its origin, alters motor control.
This same concept applies to the rehabilitation of our stabilizers. Just six years ago in school we learned to “strengthen” weak stabilizers (ie. core and rotator cuff). Current research, however, points to timing as the key factor. Without the nervous system activating our stabilizers first, it doesn’t matter how “strong” we make these muscles. Put down the tubing for your IR/ER shoulder exercises and focus your attention towards patterns that consider timing. Understanding biomechanics is the first step in looking at function, but improving the pattern only comes with careful consideration of the nervous system.
4. Look beyond static posture and alignment
Chiropractic school emphasized posture and alignment with the majority of the assessment occurring in the standing or lying position. While this continues to be a part of my examination, evaluating movement is just as important. The majority of musculoskeletal injuries occur as a result of poor movement quality. For the general population the overall decline in activity, I believe, translates to poor movement competency. As such, the weekend warriors and/or gym goers often present with mechanical neck and lower back pain. Posture and alignment are a start to understanding the problem, but looking at fundamental movement patterns such as gait, running mechanics, and throwing, are essential when working with any patient or athlete.
5. Don’t throw the baby out with the bath water
The health and fitness industry often discount various techniques, exercises, and philosophies if evidence is inconclusive or unfavorable. While I’m a firm believer in testing our hypothesis and seeking out the best information, it’s the combination of clinical experience and evidence based research that should be the driving force behind our programs/treatments. The majority of the assessment, treatment, and training techniques I utilize are evidence led. Notice I didn’t say evidence based. Performing and executing flawless clinical studies and trials is virtually impossible. Brett Contreras wrote an article demonstrating that one could find a study to prove or disprove just about anything. Whether a study supports or refutes the testing hypothesis, taking into account your clinical experience is sometimes more important. Many researchers are limited to working in a lab without stepping foot in a clinic/training facility. As a clinician or strength coach working in the trenches, we see first hand what is effective and what is not. Just because the Journal of whatever discounts your school of thought doesn’t mean you toss the technique or philosophy aside. While research fuels the growth and science of the health and fitness community, always consider your experience and results within your setting. Proving efficacy is often evident in your success. Bottom line…do what works.
6. Without written goals, it is difficult to track your progress and map out where you are headed
It’s that time of year again, time for New Years resolutions and planning for the upcoming year. We all talk about it, but it often becomes a distant memory by mid February. This past year I took the time to write out several goals, both the professional and personal. Creating a list and placing it a high traffic area my house, kept me on track for the year. Let this be the driving force for self-improvement in the important areas of your life. For me, I made it a point to spend at least 10% of my income on continuing education (thank you Diane Vives for the recommendation). Looking back at the number of seminars, courses, classes, workshops, and books I have learned from this past year, has kept me motivated and passionate about my work. Most important, the attention to both personal and professional goals will help maintain the balance between the two and your focus on the things that matter most.
Let this be the most enlightening and productive year you’ve had yet.
About Dr. Reiner
Dr. Jennifer Reiner is the chiropractor for Water and Sports Physical Therapy and Fitness Quest 10 in San Diego, California. She obtained a Bachelor’s of Science Degree in Exercise Science from the University of Florida and went on to pursue a Doctor of Chiropractic degree from Palmer College of Chiropractic West. As a member of the Palmer West Sports Council, Dr. Reiner focused her studies on sports injuries and rehabilitation. She is also a Certified Strength and Conditioning Specialist (CSCS) by the National Strength and Conditioning Association.
She spent five years as the official chiropractor for the University of California San Diego, providing care to a variety of sports including swimming, soccer, volleyball, track and field, tennis, and basketball. Dr. Reiner is certified in Graston Technique as well as Active Release Technique (ART). She also holds certifications in FMS (Functional Movement Screen), SFMA (Selective Functional Movement Assessment), TRX suspension training, and K-laser therapy. Follow her on Twitter –@drjreiner.
Great Educator: Gray Cook on Movement Quality
Bruce Kelly
Posted June 10 2011
I try never to miss an opportunity to hear Gray Cook speak as he has a way of making the complex seem simple and I always come away with information that I can apply in my systems immediately.
In going to the Pre-Symposium for the Perform Better Summit on June 2nd, in Providence, Rhode Island it was no different.
The title of his presentation was: “Functional Movement Systems: Applying the Model to Real Life Examples”
So here are 10 more “Ah Hah” moments from Gray at the Symposium.
• Specialization hurts adaptability: not only applies to Youth Sports in this country but also to much of the mainstream population
• Stability=motor control. Too many thing of it as strength.
• Movement competency vs. physical capacity: these two schools of thought still seem to be engaged in some sort of civil war. The physical capacity school of thought are the entrenched status quo and the movement capacity camp are the rebel forces!
• More reps of poor quality gives you more endurance to do bad reps. Always stress quality over quantity…that is what your clients really pay you to do well. This one is a correlate to the previous bullet point.
• Correct exercise form is protective not corrective. It’s role is to protect from unsafe movement.
• “It’s as much about exercises/movements you delete as corrective exercises that will impact the FMS.” Sometimes it’s addition by subtraction.
• With older clientele, frequently improving their Active Straight Leg Raise and Shoulder Range of Motion will improve their overall movement and thus their quality of life.
• Reverse engineer the healthy (pain free) and good movement pattern to find out what lead to the success.
• More compressive spinal loading during the golf swing then in an all out 100 meter sprint. (Interesting factoid!).
• Program patterns to improve movement not specific muscles. Gets back to the old NSCA ( I believe) concept of training movements not muscles. What goes around comes around, I guess.
Every time I see Gray, Lee Burton or Brett Jones I learn something more about movement, how fundamental good movement is to all we do, and reinforces why we do the Functional Movement Screen.
Scott Williams and PerformancEDU team up with Northstar Ski School
Very excited to announce, Scott Williams will be heading and PerformancEDU will be assisting in Northstar Ski Instructor’s (200+) functional movement assessment. Scott and PerformancEDU will be screening each instructor through a functional movement to find and:
- Identify the ability to move more efficiently
- Identify injury risk
- Helps us determine injury prone areas and target them with appropriate solutions
After screening all the athletes, we pick the top 3 priorities for the movement screen and then we are ready to start FMS Solutions. Based upon each instructor’s results, we will be programing corrective solutions for:
- Enhanced Performance
- Injury Prevention
FMS Solutions will be placed into the athlete’s movement preparation, skill, strength and recovery sessions during the dryland and in-season sessions. We will be conduction dryland movement session during specific weekends leading up to the season.
PerformancEDU is very excited to educate, motivate and Create GREATNESS with Northstar Ski School Instructors.
Marc Digesti USAW
Founder of PerformancEDU
PerformancEDU teams up with Reno High Baseball Program
I am happy to announce the collaboration of Reno High Baseball and PerformancEDU. It is great to give back to the program which has given so much to me during my tenure here in high school. Coach Pete Savage (Head Baseball Coach) and I have implemented off-season and in-season programming based off of movement quality. We started the fall off by having each athlete go through a Functional Movement Screen. Here is a little background on the Functional Movement Screen:
Why do we want to screen?
- Identify the ability to move more efficiently
- Identify injury risk
- Helps us determine injury prone areas and target them with apporpriate solutions
What are the goals from the screen?
- Enhance Performance
- Injury Prevention
What does the FMS cover?
- Deep Squat
- Hurdle Step
- In Line Lunge
- Shoulder Mobility
- Active Straight Leg
- Trunk Stability Push Up
- Rotational Stability
What does the FMS tell us?
- If there are any asymmetries during the movement
- If there is any pain throughout the movement
- Breaking down movement quality
How do you score the FMS?
- 0-performs movement with pain
- 1-performs movement with loss of balance during
- 2- performs movement pattern with compensation
- 3-performs movement pattern
How do you implement the FMS scoring into programming?
- 0-Soft tissue work
- 1-Mobility while restoring symmetry
- 2-Stability while implementing movement
- 3-Full movement pattern while implementing elasticity
After screening all the athletes, we pick the top 3 priorities for the movement screen and then we are ready to start FMS Solutions. FMS Solutions will be placed into the athletes movement preparation, skill, strength and recovery sessions during the fall, winter and in-season sessions.
PerformancEDU is very excited to educate, motivate and Create GREATNESS with the Reno Huskies.
Marc Digesti USAW
Founder of PerformancEDU
Common Movement Dysfunctions
Jessi Stensland
Movement compensations can lead to repetitive strain to the musculoskeletal system resulting in chronic injury. Inury potential may be decreased when the training session is based around identifying and correcting common movement dysfunctions. When having movement compensations, they are usually in a result of injury, pain, muscled stiffness and/or muscle weakness.
Here are some terms we see during the Functional Movement Screen:
- Compensation-Movement occurring without regard to normal mechanics due to injury, tightness and poor motor control.
- Symmetry (symmetrical)-Equal in appearance or movement between sides.
- Asymmetry-Unequal in appearance or movement between sides.
The picture of Jessi Stensland is a perfect example of an athlete being posturally sound, totally symentrical and fluid while placing a lot of stress on her body.
Great WORK Jess!
Marc Digesti USAW
Founder of PerformancEDU
