Reconsidering How We Look At Movement: Screening, Testing, Assessing Movement Patterns
Introduced by Bob Rowe, president of AAOMPT – “very good friend, known each other for 25 minutes”
- When we look at birth to age 3, we don’t obsess over goniometry and MMT
- Is it ever ok that we lose the ability to deep squat?
- We just look at the way they move, and fundamental patterns of development
- We need biomarkers for risk of injury – movement patterns
- Normally we hit patients with a barrage of impairment measures
- Does it have direct correlation with your function?
- We need to screen people who do not have issues first
- Other practitioners like dentists and MDs use biomarkers during routine screens to assess our health
- We should be screening our patients twice a year using biomarkers
Biomarkers for injury risk (in order of priority)
- previous injury
- loaded statistic – probably had movement pattern asymmetry and/or motor control issues
- the more distal you are, the more asymmetry we expect
- the closer we get to your core, the less asymmetry seem to have less injuries
- motor control
- can be identified, just not corrected!
After a patient is asymptomatic, we do a different test then when they have Sx.
- starting with OMPT is the best neurophysicologic reset first
- this invokes change without active participation from the patient
- reinforce with
- corrective – tape, corrective ex
SLS starts developmentally with rolling
- not necessarily gluteus medius deficits
- separate the asymmetrical asymptomatic patterns from the symptomatic ones
- DNs – the more distal ones we should attack with correctives first
- less likely to worsen a patient or cause a new injury if your correctives attack the DNs
- Treat the symptomatic ones as a clinician
- The patient’s homework is on the asymptomatic
When the FMS is applied to children, workers, military, athletes
- 20% failure due to pain rate
- these have passed full medical screening for ready to work or an athletic endeavor
What lead Gray to developing the FMS and SFMA
- As a novice PT, he thought measuring impairments would predict injury
- As a novice strength coach, he thought measures of performance would discovery dysfunction and predict injury
- Measuring physical capacity without first establishing movement compentency
- Performance tests do not tell you durability
- Your d/c criteria should establish injury risk
- If your squat is out, do not load it
This young female was discharged for her left knee s/p ACL rehab
- Would you have discharged her?
- 9 months later, her right knee was also repaired for ACL rupture
Gray found out he needed to look at movement patterns without impairments
- to establish movement compentency so normative data could be gathered to be used for screening purposes
Motor learning is inefficient at best when in pain
That is why a 0 on the FMS is instructed to refer out to a PT, etc
The FMS across the lifespan
- A young female athlete after ACL rehab scores below the FMS screen of a 60 yo female
- Should that be the
- the distinction between the SFMA and the FMS is pain
- because of pain, the assessment is now an individual situtation
- no ordinal data
- it is now a category of their movement
- not a score
- your hands should deal with the FP and DP, exercise should attack the DNs
- The greatest “strength” changes are seen in 4-6 weeks
- our typical timeframe of Tx
- if you’re banking on motor control, you need to follow developmental patterns
- if a patient cannot roll, or have stability in half kneeling, how do you expect them to practice single leg stance?
A Cyriax quote, “The physician arrives at a diagnosis not from the evidence furnished by one painful movement, but by careful determination of a consistent pattern.”
I enjoyed seeing Gray speak in person as I have only read Movement, and had other instructors for the FMS and the SFMA. If you have not taken either of these courses, do not count them out as just simple gross movements. As PTs, we should be looking at movement patterns and in a systematic method. As in the checklist manifesto, you are are much less likely to miss something if you are following a systematic method of asssessment.
I also happened to meet Gray wandering around an empty hallway of the convention center, he was nice enough to talk shop. When everything settles down for him and he is back regularly at his practice, I got the invite to come down, watch him and Dr. Don Reagan, in action, and also do some video interviews! I am honored by the invitation and excited to see him in action at the clinic.
Btw, you can get Movement for $9.99 as an e-book. This is one of the best deals in the industry!
Contributed by Erson Religioso III, DPT, FAAOMPT