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Strength Report: Correcting Movement Dysfunction - Part I: Evaluation

by: Bryan Dermody
Assistant Strength and Conditioning Coach, New York Jets
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The human body is an amazing machine, capable of incredible combinations of strength, speed, agility, mobility and flexibility that produce an impressive array of movement patterns. The problem is that there are many things that can stop functioning correctly within the human body’s very complicated structure. When something stops working properly in a joint or muscle, or a combination of these, the function quickly becomes dysfunction.

  Movement dysfunction is one of the best predictors of injury in athletes. Accordingly, it is imperative that the strength and conditioning coach take steps to turn the athlete with dysfunctional movement patterns into one with fully functional movement, so that the athlete is able to perform injury free and at an optimal level. This is where evaluation becomes so critical. It is a way of determining exactly what is not functioning properly so that the strength and conditioning coach can take a proactive approach to the training process and address dysfunction with an effective plan of correction.

    To evaluate an athlete for specific movement dysfunctions, we first must know what we are looking for in the evaluation process. The simplest and most effective way to describe this is with the stacked joint approach developed by Gray Cook. This approach asserts that the body is simply a stack of joints with the primary need for each joint alternating between mobility and stability. This starts from the ground up: ankle (mobility), knee (stability), hip (mobility), lumbar spine (stability), thoracic spine (mobility), and gleno-humeral joint (stability and mobility). A lack of either mobility or stability in these joints could potentially lead to one or more movement dysfunctions.

    Now that we have a good idea of what dysfunctions we are looking for, we need an effective and efficient evaluation to help us determine what specific dysfunctions each athlete has. The evaluation must meet the following criteria:

1. Contain multiple movements – only after the coach analyzes the aggregate results of several movement patterns can he/she accurately diagnose the athlete’s dysfunction(s) and implement an effective plan of correction.

2. Integrated movement - This consists of movement patterns that require a combination of mobility and stability as described above. Isolated movement is not specific to athletics and thus will not give us a good indicator of functional movement.

3. Quantifiable – must be able to rate level of competence and gauge improvement.

4. Efficient – minimal equipment, space, and time needed to complete.

   The next step in the evaluation process is to select the movement patterns to be evaluated. Pay special attention to the word patterns. The evaluation should not consist of specific movements, but rather contain general movement patterns that meet the above criteria.

*Note: Gray Cook has developed a very systematic and effective approach to evaluating functional movement called the ‘Functional Movement Screen.’ This system meets all of the above criteria for our evaluation and is what I use with athletes whose functional movement I need to evaluate. For those of you who are familiar with the FMS, I would strongly suggest making it an integral part of your strength and conditioning program. For those of you who are not familiar with the FMS, I will take a more simplified approach to the evaluation process for the purposes of this article.

    In general, the following movement patterns are needed to evaluate functional movement via our stacked joint approach discussed earlier: 1. Double-leg squat (i.e., overhead squat with pvc or dowel), 2. Single-leg dynamic support (i.e., reverse lunge with pvc or dowel), 3. Sagittal plane lumbar spine stability or the ability to resist lumbar extension (i.e., push-up or variation) 4. Transverse plane lumbar stability or the ability to resist lumbar rotation (i.e., prone upper and lower extremity limb movement in quadruped or push-up position). You can refer to Table 1 for a description of each test.
    The set-up and execution of each movement are described as follows:

Overhead Squat (See Photos 1-2)

• Athlete starts standing erect with feet shoulder-width apart and pointed straight ahead.

• To determine hand width, the dowel is placed on top of the athlete’s head with the elbows at 90 degrees.

• The dowel is then pressed overhead with the arms locked out.

• Athlete is then instructed to descend into a deep squat position.

Reverse Lunge (See Photos 3-4)

• Athlete starts standing erect with feet shoulder-width apart and pointed straight ahead.

• The dowel is placed behind the athlete’s back touching the head, thoracic spine (upper back) and sacrum (lower back).

• The top hand grasping the dowel is opposite that of the leg that remains forward during the test.

• Athlete is instructed to lunge backward and return to starting position.

Dynamic Push-Up (See Photos 5-6)

• Athlete starts lying face down with feet hip width, knees extended, and toes pulled into the lower leg.

• The hands are then placed at the appropriate place as per the criteria listed above.

• If the athlete cannot perform a push-up in this position, the hands are lowered to the appropriate position.

Iso-Dynamic Push-Up (See Photos 7-8)

• Athlete starts in a push-up position with the hands aligned under the shoulders and the feet hip width apart and pulled into the lower leg.

• Athlete is instructed to lift one leg and opposite arm, hold this position for one second and return to start position.

• If the athlete cannot perform this movement in a push-up position, they are instructed to perform it in a quadruped position.

* The athlete is allowed to perform each test up to three times.
 
      Now that we have a good idea of the movements to be evaluated, scoring each movement becomes the next step in the process. In this simplified approach to athlete evaluation, the entire evaluation is worth a total of 18 points, six points for each movement. Scoring the overhead squat and reverse lunge are relatively simple, with the coach subtracting one point for each Evaluation Criteria that the athlete is unable to perform correctly. The dynamic push-up is scored in a graded fashion as follows: three points are awarded for performing the movement with the thumbs above the head, two points with the thumbs aligned with the chin and one point for the thumbs aligned with the shoulders. The iso-dynamic push-up is also scored in a graded fashion as follows: three points are awarded for performing the movement in a push-up position with a neutral spine and support arm stability, two points for no neutral spine in a push-up position, and one point for neutral spine in a quadruped position.

    On the tests where both sides of the body are evaluated separately, the side receiving the lowest score is the score that is assigned to that movement. In the reverse lunge, the front leg is scored and in the iso-dynamic push-up the right side is scored when the right arm is active and vice versa. Pain on any test is always scored a zero. When in doubt, score low. Interpretation of the scores, as well as analysis of the resulting dysfunctions, will be addressed in Part II of this series.

About the Author: Bryan Dermody is in his first season as Assistant Strength and Conditioning Coach for the Jets. He previously worked as a strength and conditioning coach at both Louisville and Drake. Dermody was also an intern at Iowa for two years and a full time assistant for four years. He graduated from Lakeland College where he was a three-year starter at outside linebacker.






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