Tuesday, March 23, 2010

Movement Screens: Is Chasing Symmetry a Good Idea?

So called functional movement screens are getting to be all the rage among trainers now. The premise behind them, simply put, is that there are basic human movement patterns which need to be within a certain range of symmetry and if they are not you can actually be predisposed to injury. Of course, post screen there are a constellation of corrective, remedial exercises to bring your "dsyfunctional" movement patterns back into the functional domain.

The jury is out on just how effective these screens are. Some studies show that screening and correcting detected imbalances or "dysfunction" can lower the incidence of injury in a tested population. Some studies show the opposite. Some studies are just inconclusive.

So what's the deal? I'm not going to pick on any one screen in particular, but personally I haven't been impressed with any of the screens on the market nor have I been persuaded by advocates for them. Indeed, after talking to several people who have been screened and heard from them that they still can't get good scores as much as two years later, I'm not convinced that the screens or the corrective movements are worth much. These people have been avoiding exercising like they want to exercise because the screen hadn't "cleared" them. That's just nonsense.


I had one guy send me a video doing the exercise he was not cleared to do and he looked awesome. Either the screen is hooey, the guy conducting the screen doesn't know what he is doing or this guy has screen performance anxiety and tests poorly. (That's a joke...sort of.) The guy might get injured doing this exercise. But the truth is, the screen doesn't promise he won't get injured doing this exercise even with a perfect score. So what's the point?

The truth is, nobody is symmetrical and nobody gets 100% perfectly symmetrical addressing asymmetries. There is no evidence it improves performance and there is no evidence that getting symmetrical will fix existing problems. According to Dr. Mel Siff, "The body and its muscles, tendons and bones are characteristically asymmetric and any attempts to produce greater anthropomorphic and kinesiological symmetry could exacerbate the existing problem or cause new injuries." (Supertraining, pg 239)

Will you really be any better off after having been screened than if you had simply done general joint mobility, some specific stretching and actually exercised within your current skills and ranges of motion?

Nope.

Siff notes, "...discrepencies as large as 10% do not statistically correlate with a major increase in muscular injuries." 10% is pretty big. Movement screens profess to get your dysfunctions and imbalances relatively even. Is it worth it?

I'm skeptical. Bottom line, a screen is an additional certification a personal trainer can use to sell you more services. Just as fat people don't need a $100 pinch fold test to tell them they are fat and unfit people don't need a $50 fitness test to tell them they aren't fit, if you can't touch your toes or get up out of a chair comfortably you don't need a $150 movement screen to tell you aren't moving well. What you do need is to start moving. With or without a supervised program. Most of what ails you will clear up in just the act of getting more exercise.

Everybody is different and there is no one "correct" exercise technique that fits everyone equally. Movement screens may not be a total waste of time, but to me they fall into the same category of a too restrictive, cookie cutter approach to how people are "supposed" to move. One only has to look at elite athletes in any sport at any time and watch how they walk, run or jump to see that there are many "correct" ways to move.

Optimal is individual.

tonight's training: box squats up to 166kg for a double, 100kg x 10 to finish then pulls from below knee to 150kg. 10 minutes of double long cycle 16kg: 5 cleans + 1 jerk = 80 cleans and 16 jerks for the 10 minutes.

24 comments:

  1. Nice post. I "screen" my clients everyday by paying attention to their movements and posture. A trainer/coach with a good background of knowledge and experience should be able to spot movement problems during exercise and plan ahead to include appropriate strengthening, stretching, and foam rolling exercise. A squat, kettlebell swing, and push up can tell you a lot about a person.

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  2. Brian,
    "A squat, kettlebell swing, and push up can tell you a lot about a person." I agree completely.
    R

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  3. Randy,
    This is why the FMS is:
    1) body relative (your leg length, your hand length etc...) for scoring criteria
    2) there are ranges within scoring each screen - Gray took into account the 10% range you mention
    3) FMS minimum is all 2's no asymmetries - not the mobility of a contortionist - just a good baseline of movement.
    The goal is not to be a 21 and be "perfect".
    FMS does not chase "perfect symmetry".
    Performance does not equate to function - baseline movement in fundamental movement patterns is important.

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  4. Randy,
    BTW - Great find on the Siff quote from Supertraining. I had "loaned" my copy some time ago.

    Brett

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  5. Thanks for your clarifications Brett.

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  6. The alternative to "chasing" symmetry is what......ignoring assymetry?

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  7. Dave,
    I don't view it as "either.. or". It's more along the lines of looking at things from a wholistic contextual model, rather than a "deficit model" of simple diagnosis and remediation.
    Any coach worth his/her salt is going to be able to see "issues" and do what's necessary to improve them. There are a lot of bad coaches out there that can't or won't, and spending time w. screens may be a great place for them to start.

    JMO.

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  8. I think what is really interesting is that, according to Siff, you can create more problems by trying to fix asymmetries. So why not ignore them?

    If you can't do a specific kettlebell lift, or say a barbell overhead squat is it specific flexibility that is the problem or some dysfunctional, asymmetrical,primitive movement pattern?

    Fussing with the basic movement patterns a screen identifies won't necessarily fix an activity specific issue, while fixing the specific issue at least keeps things moving forward and usually addresses underlying problems: a balanced, deep overhead squat is a balanced, deep overhead squat regardless of whether you get there via "screen corrective exercises" or sports specific flexibility recommendations.

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  9. According to Gray's documented results, assymmetry is a leading predictor of potential future injuries. Seems like a good reason to address rather than ignore them to me.

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  10. David,
    Gray's documented results? Can you cite any of them?
    The FMS theory is that asymmetries cause injuries, at least asymmetries over 10%. Independent studies evaluating the FMS aren't that conclusive. And how many people are over that 10% red line who do athletics? If under 10% isn't an issue, why correct it? (Another Siff take on this is that many of these asymmetries work themselves out in training and some are actually desirable for performance.)

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  11. Randy,
    Getting to a full loaded overhead squat does not mean you got there without asymmetry and issues - load can shove us through restrictions and cause/reinforce compensations.
    There are a significant number of people over that 10% redline - especially those in athletics (injuries and repetitive patterns are great for causing asymmetry and restriction).
    We find very high "performing" individuals (great vertical etc...) who have major restrictions/asymmetries - performance does not equal function.
    5+ years of NFL data and a recently completed military study confirm asymmetry and the predictive nature of the FMS screen - (that last study to be published soon).

    Seeking "perfect" symmetry is WAY different (and is what Siff was referring to) than the FMS.

    You have listened to podcasts and read available information but have you yourself been screened or worked with those that use the screen and corrective strategies?

    The goal of FMS after resolving asymmetries is to get to higher level activities (deadlifting, pressing, pull-ups, etc...) to reinforce the good movement and continue progress. Not continue to "chase symmetry".

    And for once more - you cannot "coach" someone out of dysfunction - if you do not step back to get to the root issues then you will just coach a compensated exercise (although it may look "right" to the coaches eyes).

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  12. Brett,
    "Getting to a full loaded overhead squat does not mean you got there without asymmetry and issues - load can shove us through restrictions and cause/reinforce compensations."
    Where was I talking about fully loaded. What is the difference between the screener's eyes and the coach's eyes on the correctness of an overhead squat?
    Please...if a kid can do an overhead squat with a bar and it looks just like the kid who gets a 3 on an FMS squat with a stick, what is the difference?

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  13. Brett,
    "trigger the right pattern of mobility and stability within itself and by itself to get there and compensations reveal themselves " What makes unloaded patterns correct in the context of loaded patterns?

    If, as your explanation implies, loading changes patterns, then the screen has suspect validity predicting what will happen when moving under load. It can only gauge movement in the context of the unloaded patterns the screen uses.

    Are you saying that if a compensation doesn't reveal itself in the FMS that there won't be compensations revealed when and only when under load? Are you suggesting a passing score on the FMS means that a kid will automatically pull off the floor with a flat back and automatically not round out his lumbars in the bottom of the squat under load?

    What makes "shoving you through restrictions" less of a strengthening exercise than machine kneeling wood chops with an FMS stick attachment? Didn't Pavel have a DVD about "shoving you through restrictions" called Strength Stretching? "Just keep on overhead squatting, Comrade!"

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  14. wow - you don't know what you don't know Randy - if you cannot understand the difference between loaded vs. unloaded patterning and difference between a movement foundation vs. coaching exercises then this goes way beyond you not liking the FMS or any screening for that matter.

    Until you attend an FMS workshop and actually use the screen you will continue to question it and not understand it.

    Pavel actually assumes that you have a movement foundation of joint mobility, flexibility etc... and has himself become a fan of the FMS and its philosophy due to the very poor movement foundation that people bring to exercise.

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  15. Brett,
    Did you actually answer the questions? Or do you just want to take swipes now?
    R

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  16. Not taking swipes just don't feel like educating you when you are intent on changing the subject continually - started out as "thanks for the clarifications" and ends up with the ever moving target from you.

    Did you actually think about what you posted or was it just to spark an argument?

    Olifting certs (from my understanding) start with PVC pipe to pattern the movements unloaded to ensure good form from the start (and catch compensations) so I can't see the gigantic leap from there to screening movement unloaded.

    I am sure you do on some level get the idea of having a movement foundation for exercise so why is movement screening such a sticking point for you - other than it means you having to learn something new?

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  17. Brett,
    Instead of focusing on what you presume I am or not up to you could either:
    a) answer the questions raised (as a result of your subsequent responses)for the benefit of the rest of the class
    or
    b) post a link to any article that answers the questions if you are too busy
    Movement screening per se is not sticking point for me, some of the claims are. I'm sorry you don't feel like educating me, but maybe you can step up for the benefit of anyone else reading.

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  18. You had the experience of assisting an athlete with regaining their toe touch and saw an immediate change in their form on an exercise.
    you could not coach them into the position but after addressing a simple movement pattern like the toe touch you had a direct effect on performance and made your job as a coach easier and more effective.

    You have read the articles and listened to the podcasts etc....
    Do you really have any questions?

    Chops with the Cook bar have nothing to do with "shoving through restrictions" - they are a core stabilization drill (static hip with dynamic upper and a reflexively stabile core) - again you do not know what you do not know.

    Unloaded patterns are the movement foundation for loaded patterns.

    Does that mean there will not be "any" under load? Flip that question
    If there are compensations unloaded how can there NOT be compensations loaded?

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  19. Brett,
    "If there are compensations unloaded how can there NOT be compensations loaded?"
    Henneman, Sheridan: load elicits different recruitment patterns than when unloaded...if unloaded was the same as loaded, then why ever train under load?

    Load can cause compensations that you won't see in an unloaded movement screen. But load can also improve movement patterns. For example the toe touch example you recalled above.

    You won't agree with this technically I'm sure, but the toe touch is an example of "loading a dysfunctional pattern" to elicit a correct pattern. Squeezing a medicine ball between the knees is loading (or, as I also experimented with, spreading the knees against a jump stretch band)

    As I said over on Geoff's blog, your mechanic can clear your car for a long trip, but that doesn't mean you will get good results knowingly or unknowingly exceeding the manufacturer's specs on towing a trailer.

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  20. No it is correcting a dysfunctional pattern to assist in learning the goal skill. If someone cannot hip hinge they will always struggle or compensate in activities that involve hip hinging until you clear that fundamental movement pattern.

    You are correct the screen cannot account for stupid.

    Without the fundamental movement patterns being clear you cannot assume that load is actually causing the compensations loaded or unloaded.

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  21. Thanks Brett,

    If the loaded squat looks different than the screen dowel squat, safe to say the load is causing something, no? (If a kid can't OHS correctly with a 20kg bar but can with a PVC pipe...load maybe is the issue? Probably? Does the screen predict issues under load? Again, I don't think so.)

    Anyway, to answer your question above, yes, I have been screened, although I screened myself (using tests from Gray's Ath Bod in Bal Book) Using the scoring criteria I've seen and heard discussed over and over on FMS videos etc, I scored myself a perfect 0, because all of the movements cause me pain.

    So, following protocol I referred myself out to a Doc and informed him that it hurts when I move like this(and this and this and this and this and this and this) So of course he said if it hurts when you move like that (that, that etc), don't do it.

    So as it stands, I'm not cleared to train myself at all now. But I do anyway. KB swings, snatches, clean and jerks, box squats, some barbell power cleans and snatches. The usual. Just can't do it as hard or as often as I would like to. But at 52 do I have to?

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  22. Self Screening is about as effective as self surgery
    TPI had a self screen up for about 6 months and over 70% of people reported that they cleared the squat (even gave themselves a 3) but according to the 50,000+ screens collected by TPI professions on clients the % of people that actually score a 3 is roughly 28%.

    Get screened by an FMS/SFMA Physical Therapist - you are in pain and continuing to train and continuing to have pain etc... This is not the screens fault - it is your fault for not clearing the movement or injury issues present.

    Loaded vs. unloaded - again - if you have cleared the unloaded patterns and an issue shows up in the loaded pattern (as in the squat example you gave) - now you can assume that the compensation is not from a fundamental movement pattern but is instead a compensation due to but not limited to things like - too much load too fast, simple neurological learning needed on the drill etc...

    I'll see if I can find the name of an SFMA PT for you...

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  23. Brett, If you read my post carefully you would see I didn't give myself passing scores on the screen. According to the screen I should probably be in a wheelchair with an oxygen tank. Is an SFMA PT going to give me a better score if I am in pain on the screen movements? Didn't think so.

    Plus, I never said my pain was the screen's fault. I said I gave myself 0's as per protocol for having pain during the screening movements. That's the way it goes.

    So, yes like everyone else in the world I am training at my own risk whether cleared by a screen or not. I am cleared to exercise by a doctor even though I have some pain.

    You are not suggesting that FMS assumes responsibility for injuries that occur after someone is screened and cleared are you? Whose fault is it if an athlete gets hurt after he is screened and cleared? Not FMS. I'm pretty positive about that.

    Thanks for the offer, that is very generous but not necessary. If I (or anyone else reading) wanted to find an SFMS-PT I would just go here and click on the map:
    http://www.functionalmovement.com/SITE/functionalmovementscreen/locatefmstrainer.php

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