Is it Possible to Predict Injury?

           

            Get twenty fitness professionals into a room and ask each of them their definition of functional strength and you’ll likely get twenty different answers. But I’ll wager they’ll all recognize a sloppy squat. We might not know exactly what’s wrong with our wayward squatter, but at least we recognize that if they continue to squat that way, something’s likely to buckle under the strain.

             Fitness, as an industry, has become fragmented. The more specialized it gets, the further it is from establishing an industry standard for movement. If we can all agree that a client’s squat pattern is dysfunctional, then we can collaborate as to how best to fix it. Developing better screening methods might be the answer and there is a tool that helps determine what’s inappropriate for a client: The Functional Movement Screen.

Gray Cook, its inventor, sought to establish an industry standard for movement, a herculean task considering anything he came up with was open to the scrutiny of his peers. He met this challenge by developing seven movement patterns that were indisputable. How? By simply watching his infant daughter learn to walk.

First, she developed the core strength needed to roll onto her stomach. Second, she gained the stability needed to get onto all fours. Third, she crawled. Fourth, she found stable surfaces in which to get into a half kneeling position, stand, and eventually let go. Lastly, she fell in order for the brain to establish a baseline for moving forward. That fall required a posterior weight shift. Her brain knew instinctively that a forward fall would be more devastating than a fall backward. So the brain wrote software that dictated a backward shift of the pelvis, so she would fall safely. No one taught her how to do this; these patterns were in her brain at birth.

The Func­tional Movement Screen (FMS), follows the joint by joint theory which establishes the needs of the different joints and how the function of the joints relate to training. One beauty of the FMS is it allows us to distinguish between issues of stability and those of mobility. Below is a blueprint for how the joints are made to move, or not move.

Ankle	Mobility
Knee	Stability
Hip	Mobility
Lumbar Spine	Stability
Thoracic Spine	Mobility
Scapula	Stability
Gleno-humeral	Mobility

The body is simply a stack of joints. Each joint or series of joints has a specific function and is prone to predictable levels of dysfunction. As a result, each joint has particular training needs.

So how do we take this theory and illustrate how it might help us determine if someone is in danger of becoming injured. The primary illustration is in the lower back. It’s clear we need core stability, and it’s also obvious many people suffer from back pain. The intriguing part lies in the theory behind low back pain—the new theory of the cause: loss of hip mobility.

Loss of function in the joint below seems to affect the joint or joints above. In other words, if the hips can’t move, the lumbar spine will. The problem is the hips are designed for mobility, and the lumbar spine for stability. When the intended mobile joint becomes immobile, the stable joint is forced to move as compensation, becoming less stable and subsequently painful.

The Process is Simple

• _Lose ankle mobility, get knee pain

• _Lose hip mobility, get low back pain

• _Lose thoracic mobility, get neck and shoulder pain, or low back pain

If somebody has a hip mobil­ity issue—if he or she has lost hip mobility—the complaint will generally be one of low back pain. The person won’t complain of a hip problem. This is why Gray suggests looking at the joints above and looking at the joints below, and the fix is usually increasing the mobility of the nearby joint. With the screen, we can tell whether or not dysfunctional movement is a mobility or stability issue. Corrective exercise programming can work to correct the problem, assuring we don’t put fitness on top of dysfunction. 

           

Making it all Relevant

            At first contact, it is imperative for the trainer to gain a thorough understanding of a client’s goals and needs. After screening, we do clients a disservice if we don’t stress the importance of corrective exercise to ensure the physical health of the joints. Improving a golfers swing isn’t merely a matter of improving core strength in rotation, it’s a thorough understanding of which joins are capable of rotation, and ensuring the client can summon that mobility during all phases of the swing. Golfers need as much thoracic and hip mobility to create the fluidity and momentum needed for accuracy and distance. If the thoracic and/or hip are tight, both of these crucial elements of the game suffer, and worse, the potential for injury is increased.

            During this time of year, when skiers are suiting up for the first run, its imperative that we prepare them to deal with the ground forces that both gravity and terrain will place on their joints and soft tissue. Mobility is crucial, but mobility needs the requisite stability to control force production. The screen exposes any weak links in our kinetic chain and can be fixed, thereby decreasing the chances that that unexpected turn or patch of ice will inflict any unnecessary damage. 

In fitness, as in medicine, there are no absolutes, but developing better screening techniques helps us bring issues to light that may not be noticeable at the onset of training. No screen is foolproof. But the likelihood of injury is statistically significant in those who score low in the FMS. If we provide our clients with the means of taking what they achieve in the gym and using it to not only feel better, but to move more functionally, then we’ve achieved something truly unique.