Keynote Lecture from Gray Cook

Where to begin! Today I had the honour of both listening to and meeting Gray Cook. For those that don’t know, I really enjoy his take on movement assessment and have really come around to his way of looking at the body. I don’t agree with everything he says, but I think he is one of the pre-eminent physiotherapists in North America right now. To get more information on Gray Cook and his systems, visit

Gray started off by asking a room full of manual therapists to think outside the box for his presentation. He challenged us to put away our manual therapy minds and look at the body in a different way.  He stated that in order to practice the full scope our profession provides, we must be more then just manual therapists. We must be movement therapists.

Gray went on to talk about developmental movement patterns. He made an amazing point when he stated that with babies, we don’t obsess over goniometer measurements or ROM. We worry about gross movements and developmental milestones. He asserts that as we age, we need to focus less on specific joint ROM and more on total body movement patterns to not only help pain, but prevent it from occurring in the first place.

Gray continues by making the astute point that the medical model does a great job of making objective acceptable levels of basically everything. We know that anything over 120/80 is hypertension, we know what a high blood alcohol level is, we know what number is considered hight cholesterol…but we don’t know what an acceptable level of movement is. Gray explains that the Functional Movement Screen (FMS) is a systematic way of assigning a value to movement patterns that can be tested and re-tested. This provides the therapist with valuable information about both symptomatic and  asymptomatic dysfunction within the body. He believes that all clients should be able to pass an FMS before being discharged from care. Although I agree with him in theory, practically this just won’t happen.

A great example of his movement philosophy is when he talks about watching a child jump off a step and saying that if they go into valgus knee collapse, their glute medius is weak. Yes, that could be the case…but there are many other reasons why a child would go into valgus collapse that we need to be assessed before we could come to any conclusions. This is why the FMS is a great tool within the global physiotherapy toolbox.

Gray incorporates manual therapy by telling us that we should use manual therapy intervention to treat dysfunctional and painful patterns…meaning that if someone gets anterior ankle pain with a deep squat, we should mobilize the talus posteriorly to abolish that pain (if that is in fact the movement restriction at the talocrural joint). Gray then states that as we are treating the painful pattern with manual therapy, we should be using corrective exercise to treat the dysfunctional non-painful patterns…meaning that if someone has very poor weight shifting with single leg standing but no pain, we should treat that problem with corrective exercise because it will lead to painful dysfunction at some point down the road anyway.

7 tests of the FMS

FMS as a way of quantifying movement to create a common language for all practitioners

He went on to discuss what the FMS and SFMA are and how they can be incorporated to the manual therapists everyday practice. He ended by saying “we manage peoples blood pressure before symptoms appear, why not movement?”

I was surprised to learn that many foreign therapists have never heard of Gray Cook or his work. I believe that him being invited as a keynote speaker at an international manual therapy conference is a testament to how much his systems have impacted the orthopaedic community at large. I foresee his textbook, Movement, becoming a standard resource for all physiotherapy students in the future. He lays out the foundations of movement that incorporates assessing and treating dysfunction to help patients get and stay out of pain..and really, isn’t that the goal?

Gray Cook’s career started with an undergraduate degree in sports medicine and exercise science with minors in athletic training and psychology. His interest took him to the University of Miami where he studied physical therapy and furthered his strength and conditioning development and he is a certified strength coach and licensed physical therapist in the same year. His work has targeted fundamental errors in the way that exercise and rehabilitation have been practiced, overlap and even collide. With this work Gray has introduced a systems approach to understanding, training and rehabilitating movement. Fundamental systems minimize logistical errors and will improve communication between the many disciplines that exercise and rehabilitate the masses. Cook suggests that we must map movement patterns and consider movement as a behavior and not simply as clean mechanical data. These basic movement behaviors should be rated and ranked to identify the most fundamental limitation to provide the most logical starting point. He says we must also develop better understanding of how movement patterns are learned, maintained, and restored. Cook’s work cuts to the core of problems like low back pain, obesity, and the general physical decline of a modern culture. By revisiting the natural developmental principals that all infants employ as they learn to walk, run and climb, Gray forces us to rethink motor learning, and modern conditioning practices, corrective exercise, and rehabilitation. In the end Cook contends that we should adhere to natural principles of movement with a systematic approach and let our exercise and rehabilitation methods justify themselves.

Author: Jesse Awenus

My name is Jesse Awenus and I'm a practising physiotherapist in Toronto, Ontario. I work out of Synergy Sports Medicine and rehabilitation, a multi service facility on the west end of Toronto. I graduated from York University in 2007 with a specialized Honors degree in Kinesiology and Exercise Science. I was then accepted at Queen’s University in Kingston, Ontario and graduated with my Masters of Science degree in physiotherapy in 2010. Since that time I have taken post graduate courses in manual therapy with the orthopaedic Division of the CPA. I completed my advanced diploma in manual and manipulative therapy in 2015 and am a Fellow of the Canadian Academy of Manipulative Physiotherapy (FCAMPT). I have also done soft tissue release courses and have completed the Titeliest Performance Institute level one Golf fitness/rehab course along with the Selective Functional Movement Assessment course (SFMA). In 2015 I also completed my certification in Dry Needling, a treatment system that is aimed at reducing pain from myofasical origin (muscle pain), I run a website where I write articles about current evidence in orthopaedic physiotherapy, exercise prescription, and interview some of the great names in the industry. You can learn more at or search JessePhysio on facebook.

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