FMS Symposium

The Book Movement just came to life.

Here's a recap:

Gray Cook on Profiling Movement

• We sometimes view movement through a filter. A filter which is based on our backgrounds, be it our techniques, professions, or specializations. The goal of the FMS team is to talk about the principles because we all need standardized principles to govern our principles.  The principles of which they speak are based on the neurodevelopmental perspective, a perspective that is based itself on motor learning, and trial and error. Think of babies...in order to improve movement, they must learn it.
• With respect to fundamental movement patterns, it is important to know if the individual is a) competent and b) symmetrical. Delving into competency a little deeper, consider vision. In order to obtain your drivers license, you must first take a vision test. Therefore, first establish competency, then go after performance.
• Dentists are smart. They make you come in twice per year for check ups (screens). This standardization is important. The functional movement system model is all about a "standard operating procedure". Pilots figured it out. Due to the risk of death, they collectively established a standard operating procedure, a checklist, prior to flying. Death is not a risk in movement. This is why we have faulty movement patterns.

"We have risk factors for every organ in the body...except the neuromusculoskeletal system"

"Don't change your system, just throw a movement competency system in front of it"

"Movement pattern atrophy...it's possible"

• Athletic performance is defined by durability. Athletes cannot perform if they're not on the field.
• The NSCA requires CPR for certification. But you don't see heart attacks in the weight room, you see a bunch of people in the squat rack with a bunch of injuries
• Stiffness (i.e. in low back pain) is a strategy. A compensation for poor motor control. To slow you down and prevent you from further injury. This is your parking brake.
• Strength training stabilizers is not stabilization training.
• True stability should really be called motor control. Movement pattern improvement is a product of motor control, which is a product of stiffness (or lack thereof). Therefore, first clear mobility to minimize compensation in order to improve motor control.
• You can treat the pain, just don't exercise the painful pattern.
• Don't bring expert evaluation to the screen. Call it like it is. Then group them based on the screen and move on.
• Motor control isn't just about activating a muscle, it may also be about deactivating another. To move efficiently, the body must be safe. It cannot be threatened. Sometimes we just need to find a way to remove the parking brake. Because typically, we're already strong enough. We simply lack the stability-motor control.
• Clinically, we must first treat the dysfunctional non-painful in order to assess its influence on the painful area. Treating the painful area first may only exacerbate the problem.

"Don't be tied to your methods...be tied to your systems and principles".

Phil Plisky

"It's not about the natural history of pain and injury, it's about the recurrence rate"

Kyle Kiesel on the Functional Movement Screen

• Always think about the bigger picture
• "Whether you are a waiter or a brain scientist, if you want to get the particulars correct, in a hierarchical fashion, don’t start with the details. Start with the key ideas and, in a hierarchical fashion, form the details around these larger notions." - John Medina, Brain Rules
• How to use the FMS. 1) Near discharge to bridge the gap from rehab to fitness. 2) To help with return to sport and sport decision making. 3) To help with injury prediction

Greg Rose & Gray Cook on the Selective Functional Movement Assessment

• It's about the assessment and the logic behind the assessment.
• On proprioception - there's no input into the system if the joint can't move. The true definition of motor control also includes adequate mobility. This is Charlie's core pendulum theory.
• If the body doesn't know what to do, the first thing the body does is create stiffness or achieve control in a different manner.
• Mobility and stability form the foundation of the SFMA

"Our diagnostics (our thought process and clinical decision making) is just logic"

• Breaking the movement down magnifies the problem. First do gross movement, because too often we break it down before looking at the big picture. Think about Usain Bolt. Let's say his multisegmental flexion (toe touch pattern) is good, yet his active straight leg raise is limited...would you go after his ASLR?
• The SFMA is simply a roadmap, it tells you where to go so that you can utilize the most appropriate tool in your toolbox (Graston, ART, Needling, etc).
• The SFMA scoring system i based on 2 questions. 1) Did it hurt? and 2) Was the movement good or bad?
• Most of the time, the region that is hurting is the region that is doing something right.

The Rules of Screening

• No warm up
• If it looks like a dog and smells like a dog...call it like it is!
• Be picky. The bottom line is, if you think you can make it better, it's dysfunctional
• No shoes
• Monkey see, monkey do. Demonstrate the movement you want to see. Unfortunately, problems arise when you can't perform the movement yourself.

"It's not magic, it was just a stability problem".

• No coaching in the SFMA. Monkey see, monkey do.

"Never bring a mobility problem to a stability correction...DON'T BE A ROOKIE!"

• Don't skip steps. More mistakes are made in the examination because of not looking than for a lack of knowledge.
• Most stability problems aren't strength problems, they're motor control problems.
• Once you find the white elephant (the big Dysfunctional Non-painful pattern), it just becomes logic

Kyle Kiesel on Pain and Motor Control

• Kyle started off this lecture by introducing to us a recently published paper by Hodges and Tucker.
• The new pain theory:

1. Redistribution of firing between and within muscles
2. Involves changes at multiple levels of the motor system
3. Leads to protection from further pain and injury
4. This adaptation has short term benefit and long term consequences
5. It changes mechanical behavior and modifies movement

"We don't need more injury prevention programs, we need a better system" - Phil Plisky

Mike Voight  on Breaking Down Function

“If you train the muscle you may not completely develop the movement, but if you train the movement the muscle will develop appropriately!”

• The importance of mobility and stability for efficient movement. Compensations and incorrect mechanics secondary to deficient mobility and stability may result in inefficiency and increased energy expenditure, possibly leading to poor performance and injury. Thus, mobility and stability testing as the starting point for “functional” rehabilitation.

SFMA Breakouts 101

• Unilateral vs Bilateral
• Loaded vs Unloaded
• Active vs Passive
• Consistent vs Inconsistent

Greg Rose on Functional Training

• Functional training is motor learning
• If you are doing functional training, the above book is the first book you should ever reed.

• We need to be experts in motor control. We need to be neurofunctional trainers
• Cognitive skills are easy to lose. Motor skills are difficult to learn. Focus on feel, not form. Because what matters is the discovery...the learning.
• There are three phases to learning - 1) Discovery 2) Grooving 3) Automatic
• We must do a retention test after practice to gauge learning. This is the clinical audit process. This retention test is the SFMA.
• The more the individual struggles with the exercise (as long as they perform it relatively well) during the visit, the less change of injury tomorrow. If you exercise on a machine that doesn't let you make a mistake, you're not learning
• On feedback - The less the feedback, the more the learning. Intrinsic oriented feedback (what the individual feels) >>> results oriented feedback.

The Functional Continuum

• Subconscious dysfunction (screen here)
• Conscious dysfunction (reset, reinforce here)
• Conscious function (reload here - motor learning)
• Subconscious function (improvement)

The 4x4 Matrix for Reloading a Stability Problem

4 Functional Positions

1. Non weight bearing (supine, prone)
2. Quadruped (I assume also triped)
3. Kneeling
4. Standing

4 Functional Exercise Resistances

1. No external load with pattern assistance (*an example of pattern assistance is RNT - Reactive Neurmuscular Training)
2. No external load
3. External load with pattern assistance
4. External load

1-4 = 1/4 7,8 = 2/4 9 = 3/4 10 = 4/4

"Rookies only do 4x4's"

• The SFMA tells you where to start.
• The 4x4 Matrix gives you exercise progression principles.
• Motor learning principles give you sets and reps.
• On providing us with a list of exercises:

"Isn't it a better idea if I just gave you a philosophy and you make up the exercises?"

Final Objectives

• Logic for screening
• Philosophy for exercise corrections in a logical order
• Mobility fixes for mobility problems
• Stability fixes for stability problems
• DON'T BE A ROOKIE!