Category — Q&A

My previous article on Movement Reserve stimulated some discussion in the comments section and the following question regarding measuring movement reserve and the FMS was asked by Carl Valle:

Well it’s good to see that some very respected ideas have the same view. What do you do to gage the buffer? How many points away from 21 is the FMS screen?

- Carl

It is a good question and I don’t know that there is a specific answer given the numerous things that affect the athlete’s capacity.  I don’t think that we could say it is just “one thing” or just the “FMS” score.  Like saying, “If you have a 17 out of 21 you are golden”.  There is a ton of complexity as far as the human body is concerned and, as I stated in the article, there are a number of things to look at and I think trying to measure those in some way is the key, as making improvements in all of them will help to improve the physiological buffer zone.

The FMS screen and the scoring numbers have come under fire lately in internet discussions and various blogs.  The developers of the screen suggest a 14 or better out of 21 with no asymmetries or pain on the seven tests as the baseline to begin a more rigorous fitness program.

I don’t know that suggesting a 14 without movement asymmetries as the baseline is such a bad thing.  It would mean that you are right in the middle of all of the tests, suggesting that you have adequate movement ability (per the screen).

I do use the FMS as part of my screening process prior to training.  I’ll briefly cover some of the things that the screen means to me (as it seems to mean different things to different people and often gets wildly misrepresented by some trainers who use it inappropriately), talk about how it would fit into the idea of movement reserve, and give my own answers to some of the common arguments against the screen.  Please keep in mind that I do not work for, am not paid by, and do not represent Functional Movement Systems.  If you would like to hear their ideas on how they implement the screen and what it means to them I suggest taking one of their courses.

The screen itself

Many people have taken issue with the idea that seven tests, conducted in a very controlled manner (verse taking place in a dynamic environment like sport), can predict anything about the athlete.

From my understanding of the system, it was never suggested that the test was to be used as a stand-alone assessment.  I am pretty sure that both Gray Cook and Lee Burton talk about how this only one part of the assessment and does not mean that you do not do other objective testing.  Sports specific tests should still take place.

What the screen does for me is it helps answer the very simple question, “Does this hurt?”

Athletes are often highly motivated people who don’t always disclose when something is painful or hurts (especially when we are talking about dealing with a large team environment).  I know there have been situations in college and professional team settings where you are 6 weeks into the training program and an athlete begins to complain of hip pain (or back pain, or knee pain).  Upon further questioning about when the pain started to come on, the athlete states that, “Well, it has been hurting for the past 3 or 4 months but I thought that it would get better.” 

Using the screen gives the athlete a chance to let you know that something hurts or has been hurting.  Additionally, if something does hurt, we may see them alter the way they perform one of the seven movements, allowing us to ask further questions and dig a little deeper.

The test is there to make sure we don’t miss anything that may be going on that would influence our training program in a certain way.  I don’t understand why people have such a problem gathering as much information as possible about the athlete to ensure that the right program is designed or to help ensure that the athlete gets the appropriate treatment?

Movement Asymmetry

Movement asymmetry and the FMS have been debated by many.  I do agree that the body is asymmetrical in nature.  This is something we know and many individuals argue that these “normal” asymmetries make the FMS a “waste of time” as we may end up wasting training time trying to focus on something that is normal for the individual or a normal adaptation for the given sport.

I think that the scoring for the seven tests does a good job of taking this into consideration.  If you look at how the tests are scored, you will notice that it is really hard to get a “1″ and really hard to get a “3″ but there is a large variation that is acceptable for scoring a “2″.

Given this broad range of scoring for a “2″ it allows us to see the “white elephants”.  What are the big restrictions?  What are the glaring asymmetries that we might need to ask more questions about regarding why this may be happening and what the potential reasons for it are?

I believe this is right in line with the idea of being proactive rather than reactive.  Training people with the blinders on usually ends up biting you in the butt somewhere down the line.  The 8-10min. it takes to administer the test is time well spent if it gives you some valuable information that can help you avoid a train wreck later on.

Movement Reserve and FMS

Taking all of this into account, as well as taking into account the other factors (stress management and developing high levels of fitness) I think that the most important thing to do is to have some sort of screen (FMS or other) that helps you know if what you are doing is moving you in the right direction. 

I don’t know that a specific FMS score would mean that you have a greater amount of buffer zone than someone else given the numerous factors that go into an injury, however, the training that you are doing should be striving to improve the screen that you use (and it should definitely not make it worse!).  Like training for anything else – getting stronger, improving power, improving cardiovascular fitness – you have a way to measure these qualities and it is accepted that improving on your objective tests is a step in the right direction.  The FMS (or whichever screening process you choose to use) should be no different.

Measure what is important to you and develop a program to improve it.  The better you get in these qualities the better your buffer zone will be.

Patrick
patrick@optimumsportsperformance.com

Patrick -

Would you care to elaborate on how you enhance neuroplasticity after an increased ranged of motion is gained by someone who just recieved soft tissue work. Mobility drills, end range isometrics with arm drivers, etc.

All the best,
Sam

Hello Sam,

Thank you for your question.  I can’t say that I am a “brain” or neuroscience expert – there is so much too know – but I do enjoy reading and learning about it.  I strongly urge you to check out “The Body Has A Mind of Its Own”by Blakeslee and Blakeslee, “The Brain That Changes Itself” by Norman Doidge, and The Brain Science Podcast by Dr. Ginger Campbell.

Regarding the arm drivers and mobility drills, I talked a bit about this in the Fascia and Exercise post that I did several months ago.

Our body schema has to do with the way in which our brain interprets our body maps based on information coming in from things like skin, joints, muscles, viscera, etc.  When our proprioception is negatively affected – from pain, poor movement, disease, injury, fear, etc – our body maps change.  Movement training is one of the ways we can re-establish the appropriate body maps, thus improving overall movement quality.  In “The Body Has A Mind Of Its Own”, page 37, Blakeslee and Blakeslee note, “When you work with instructors of dance, yoga, tai chi, Pilates, Alexander Technique, Feldenkrais, or dozens of other kinds of movement training, you are basically working on body schema awareness.  These methods teach you to purposefully attend to the many core elements of your schema as a means of self-exploration.”

It is this “self-exploration” that I believe we are trying to enhance when performing the various mobility drills following soft tissue therapy.  Obviously there are many hypotheses as too the way in which massage therapy actually improves an individuals movement - actual changes in tissue, changes in the brain, decreased fear, a placebo effect, expectation that something positive has happened, etc.  Whatever the reason, I am of the opinion that soft tissue massage therapy is  effective in increasing the individuals awareness and proprioception.  However, we can’t just leave it at that.  We need them to own it and develop the movement pattern on their own.  This is where mobility drills and specific exercises come in handy.  I believe in choosing the movements for an individual based on what my findings are with either the FMS or SFMA.  From there, I choose the exercises and drills I want to focus on with the goal being to improve the specific pattern that we have found to be the “weak link”.

In a recent paper published in the journal of Manual Therapy, Bourdreau, Farina, and Falla discuss neuroplasticity and motor learning.  More specifically, they go into the importance of “novel motor-skill training” as a way to enhance neuroplasticity following pain or injury.  They state, “Given the evidence that novel motor-skill training is associated with rapid changes in cortical excitability as well as cortical re-organization, this training is relevant for treating patients with musculoskeletal pain.”  They additionally state, “In novel motor-skill acquisition, cortical neuroplastic changes are often accompanied by behavior deemed to be advantageous, such as increases in motor performance.  Finally, they summarize by saying, “Novel motor-skill training should be advocated upon the first presentation of pain symptoms so as to reduce the risk of further and unfavorable neuroplastic changes that are known to occur in association with pain.” 

A principle of the SFMA is that you don’t train the painful patterns, but rather attempt to improve the dysfunctional non-painful patterns.  Perhaps this is the novel stimuli that the brain needs to begin to establish neuroplastic changes and enhance body schema?  Because the pattern you are trying to improve is dysfunctional, meaning not meeting a minimum standard, any corrective interventions you try and impose on that pattern can be thought of as “novel”.

In a non-painful training environment, we use the FMS.  Again, we have a hierarchy of what we want to correct first, and choosing a set of exercises that address those needs can be thought of also enhancing body schema (like Feldenkrais, Pilates, or The Alexandar Technique, listed above).  Soft tissue therapy is commonly used prior to performing the exercise intervention to help improve the individuals proprioception and free up movement (again, either soft tissue wise or brain wise) which can then be trained.  Similar to the WD-40/Duct Tape model that Gray Cook has talked about, where you use some manual therapy (or foam rolling if manual therapy is not available to you) and mobility work to “WD-40″ the joint and enhance mobility and then tack it down with some stability, the “Duct tape”.

Small changes over several sessions can lead to a large change in a movement pattern and hopefully enhance function of the overall system.  Hope that helps answer your question!

Patrick
patrick@optimumsportsperformance.com

In response to Monday’s blog post, Stress!!, the following question was asked

Getting into some of our conversation from yesterday, is there any way we can quantify this stuff without extreme ends? Have you used anything like the Profile of Mood States?

Regards,

Carson Boddicker

Carson, great question.  Quantifying whether or not the athlete is under high amounts of stress and ready for intense/high quality work that day can be done several ways.

First, on my general intake form there is a question regarding the clients own subjective stress levels.  This is something that I further enquire about when talking with the individual, as I want to try and determine where they are at before I start adding more stress.  I’ll ask them about their sleep, their overall daily mood, and times when they feel the most stress.

Having a stress profile as you suggested can be helpful.  Having the individual jot down and/or rate how well they slept the night before, how they feel today, are they sore, how hard would they rate the last workout, etc, can provide you with valuable information to plan training on a specific day.  Additionally, resting heart rate and blood pressure can be taken and compared to previous tests to determine if they are at or around their general norm.

If you don’t want to have the athletes fill out paper work every time, you can also just talk to them and observe them during the warm up.  Being a good observer is an important aspect of being a good coach.  Notice how the athlete(s) look when walking into the gym.  Are they looking sluggish?  Do they look down?  What is their overall posture like (this can tell a lot about a persons general mood)?  From there, during the warm up, you may notice the athlete(s) moving in a slower or uncharacteristic manner.  When I see things like this, I immediately start asking more questions.  If I feel that the athlete is not prepared for intense/high quality training that day, based on what I see and the feedback I am getting, then we go ahead and do a back off day or we just do some soft tissue work and mobility exercises.  I have also sent people home on certain occasions when I felt that taking a full day of rest would be the best thing for them.  Additionally, knowing when stressful periods of the year are coming up can help you plan training.  For example, you work with several collegiate athletes.  Midterms and finals time would be a good time to turn down the training stress as the athletes are usually staying up late to study or write papers, and under high amounts of stress from taking tests all week.

Finally, performance measures can be used if you have a base to measure them against.  A vertical jump or a broad jump (following a good warm up of course) can help to determine if the athlete is ready for strength or power work on a given day.  I believe in Fleck and Kraemer’s Optimizing Strength Training, they recommend taking the average of three jumps.  That number should be roughly 90% or greater than their normal vertical or broad jump if you are going to train power or strength that day.  If it is below 90%, then the athlete is not prepared for high quality work that day and should take a back off day to allow for more recovery to ensure they are ready for the next intense workout.

Those are a few “low-tech” ways of evaluating the athlete, others may have additional ideas, so hopefully they leave the in the comments section.  Of course you can also try and go more “high-tech” with things like the Omega Wave (which I confess I don’t know much about at this time) or even a Polar watch/heart rate monitor that can take your heart rate variability (HRV).

Patrick
patrick@optimumsportsperformance.com

A question that I commonly get asked is, “How do I go about choosing a soft tissue therapist to refer my clients to?”

My last two blog articles were on the topic of going about obtaining a massage licensure.  For some people, this may not be an option as they want to focus on being a great trainer or strength coach rather than “serving to many masters”.  This is something I can certainly appreciate, as picking one thing and really trying to own it will always help you more professionally than trying to do everything.  That being said, if you are not planning on doing the soft tissue work yourself, the next best thing is to partner up with a good therapist!

Having a soft tissue therapist in your network can be an incredibly valuable tool, as they can be instrumental in helping your clients enhance mobility, so that you can then go in and fine tune the movements you are trying to develop.  Additionally, the better you educate the therapist on what you do, your goals and philosophy on training, the more they will be inclined to refer their clients to you for training, as they will realize that you can’t have one (soft tissue work) without the other (training).  You really need both to be effective, in my opinion. 

With so much information out there about different techniques (Active Release, Myofascial Release, Rolfing, Neuromuscular Therapy, “Sports Massage”, etc), knowing who to select can be a daunting task.  So, here is a little cheat-cheat of what to look for in a therapist to ensure that you can find a professional that will prove to be a good referral for your clientele.

• Education -  University education is not everything and many therapist that you will encounter may have nothing more than a diploma from a massage college and a professional licensure (always ensure that they have a professional licensure to protect yourself and your clients!).  By education, I mean, what do they read?  What do they study?  Talk shop with the therapist and get a feel for what they know with regard to anatomy and physiology.  I have found a few massage therapists that are more educated on the body than those who hold degrees in chiropractic or physical therapy because their commitment to continuing education has allowed them to surpass those in other fields who have gotten lazy since obtaining their degrees.
• Do they workout? - While they may not be as educated as you on exercise programming (remember that whole bit about owning your craft?) you do want to know if they exercise and train themselves.  Many masssage therapists that I have run into do very little resistance training and stick with things like yoga or pilates, if they do anything at all.  I am not trying to bash on yoga or pilates, but those that are devout followers of these types of exercise typically don’t believe in strength training (of course there are always exceptions to the rule) and usually will not be open to understanding what it is you try and do for your clients in the weightroom.  Talk to the therapist and get a feel for how much they understand training.  You may additionally want to invite them down for an assessment so that they can get a feel for what you do and how your skills will be a good blend with their skills.
• Get a session - Try out a few therapists and see what their treatment is like.  One thing I always like to find out is what happens during the first session, is there an evaluation that takes place?  What is their intake paper work like?  Do they ask you a lot of questions about any pain you have been feeling, any injuries you have sustained or any surgeries you have gone through?  Do they put you through an assessment to determine a treatment plan?  If so, what does that assessment consist of?  You would be amazed at how many therapists just get you on the table and start working!  That would be like having someone show up for a first training session and you just start working them out.  That doesn’t happen (or at least it shouldn’t)!  You need to ask questions, perform some assessments, and get a general feel for what the individual is capable of so that appropriate training progressions are chosen.  During the session, ask a lot of questions.  What are you doing now?  Why are you doing it?  What is the goal of what you are trying to do?  How does this affect my problem?  Asking questions willl help you get a grasp of whether or not the therapist will be someone you can, or should, refer too.  If I am refering my clients out, I want to be able to communicate to the therapist what I am feeling, what I think is going on, and what my training goals are.  They should be able to be an active participant in the conversation and not just go by what I am saying.  I want them to tell me what they found in their evaluation, what they their course of action is going to be, and any recommendations they have for me regarding exercise progressions based on what they feel or how the client responds to treatment.  Basically, I need the conversation to be a two way street, where we can talk shop and discuss the client to ensure that the best possible outcome is achieved.  Another good option is to ask if you can attend one of your clients sessions so that you can see how they work and what takes place during treatment.
• What is in their tool box and do they know when to use the hammer or the wrench? - I know that things like ART are all the rage right now, but honestly, it doesn’t really matter what letters are after their name.  A good knowledgeable therapist will always be a good knowledgeable therapists, and treatment techniques should be dicated based on what the client needs at the time and not what was learned in this past weekends continuing education course.  Therapists should have a tool box of options and know when to use those tools – when ART would be a better choice over some other technique, and vice versa.  This part comes down to how well the therapists has developed their thought process and application of that which they have learned.  I have seen people get really amazing results with incredibly gentle/superficial techniques and I have seen people get amazing results with really agressive techniques.  Techniques are just that, techniques.  They don’t tell you when to do something, they just tell you how to do it.  The later will get you inconsistent results at best (since not everyone will fit into the mold of any one technique), while the former will allow you to choose wisely based on what you feel, what the client reports, and information gained during the assessment process, ultimately leading to better treatment outcomes.
• Crystals, hot stones, and fancy creams and lotions…………RUN!!!! -  There is nothing wrong with spa services and treatments.  However, this is not something that I would consider to be essential for your training/athletic clientele.  While this stuff may feel good and help you to relax, when you need more clinical based treatments in order to enhance movement, decrease pain, or improve function this is not the way to go.  Aside from the fact that these sessions can be extremely expensive, the overall goal of them is to pamper the client, not deliver a therapy session that is specific to the functional needs of the individual.  So, if you find yourself walking into an establishment that turns out to offer more spa oriented treatments, be polite, say hello, slip them your business card and perhaps pick up a gift certificate for your significant other.

Hopefully these ideas will help you in making a worthwhile selection for yourself and your clients.  If anyone has any other ideas that have helped them select a soft tissue therapist feel free to leave them in the comments section!

Patrick
patrick@optimumsportsperformance.com

Yesterday’s blog about getting a massage license brought on some great comments, concerns, and questions from colleagues in the field.  Rather than answering them in the comments section, I decided to start a new entry pertaining to their thoughts as I think they are important and others may benefit from reading them as they may have some of the same questions.

Patrick
patrick@optimumsportsperformance.com

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Hi Patrick, 

Very interesting blogpost about massage therapy, answered a lot of questions I’ve had.

Regarding “getting the license”, is it really just a case of going to any suitable MT school, making the grade, and then after that is when you can start adding to your skills with things such as Graston techniques, Gua Sha etc.?

Or do you have to pick a direction you want to go with first e.g. NMT, SI etc.?

Thanks
Cedric

Cedric,