Yesterday I made the 2 hour trip from Portland down to Stanford University for Assessing Movement: A Contrast in Approaches & Future Directions. The course was set up to be a dialogue and debate between Dr. Stuart McGill and Gray Cook. The event was put on by Craig Liebenson with support from the Stanford Sports Medicine Department. Laree Draper of On Target Publications was there to capture the event for a DVD release at a later date.
I have to first thank Dr. Liebenson for putting on the event. It was well run and structured. Also, thanks to Laree Draper for being there to capture it. Laree has done a great job of putting out wonderful educational resources for the profession over the past 4 years or so.
I didn’t know what to expect heading down there. I know these are two passionate individuals, both of whom I have gotten the opportunity to learn a lot from for a number of years, and, based on many of the (foolish) comments on facebook (Ex., “Who won?” or “Did McGill steam roll Gray?” or “Was it a battle?”) I believe this topic is one that people get very emotional about. Truth be told I thought it may turn into a total train wreck with people getting upset, getting loud and uncomfortable, and nothing getting accomplished (IE, no real learning taking place). I was pleasantly surprised. I found both of the presenters to be very complimentary of one another, showing a lot of respect to each other, and maintaining healthy discussion rather than resorting to personal attacks or comments that were not going to lead to further discussion or better learning for the audience.
The morning started out with both speakers giving two lectures in a “you go, I go” type format.
Gray was up first and he presented the basis of the Functional Movement Screen and discussed why we screen, what the FMS is, what it isn’t, and what things the test may be telling you in order to provide you with information to draw up your exercise road map.
Dr. McGill was up next and he presented his review/critique of much of the literature conducted on the FMS. He was very thorough in reading through the literature and I appreciate the time he put into pouring over the research. Throughout this lecture Dr. McGill presented his logic behind what a movement screen looks like to him and some of the issues he takes with the FMS and some of the things he may do differently. This presentation set up Dr. McGill’s next presentation nicely.
Gray followed up with a short discussion about some directions for the future and addressing some of Dr. McGill’s comments. The nice thing about Gray’s talk was that he got up there and acknowledged that the screen may not be perfect but it may be the best thing we have available to a practitioner “at this time”. Gray isn’t so hell bent on his model that he believes it is the only thing you need to do or that it is perfect. He openly said, “As soon as there is something that we believe is better we will embrace it. Whether it comes from our group or another group of professionals.”
Dr. McGill finished the morning with a talk on “Developing the Ideal Screen/Assessment”. As I said above, this talk expanded on Dr. McGill’s first talk and took his logic and applied it to an approach which is based on understanding the needs/demands of the athlete and coming up with tests that evaluate the athlete in those needs/demands. One of Dr. McGill’s favorite quotes regarding movement is, “Just because an athlete can does not mean they will”. In a nutshell, Dr. McGill is saying that just because they can move well on an FMS does not mean they will move well when placed under load or some sort of metabolic demand. Dr. McGill spends a lot of time with his clients (his assessments are 3hrs long) so that he can poke, prod and push the individual to see where/when they “break”.
Following lunch each presenter was then given the opportunity to do a practical session in front of the crowd to further explain their approach. Gray started and he FMS’d a gentleman from the crowd revealing that the guy had adequate movement and met the baseline criteria of the FMS. Dr. McGill followed with a series of tests that would be specific to sport or task. Dr. McGill took the same guy and had him perform an arm over arm rope pull, similar to something a firefighter might do in training, to evaluate the gentleman’s potential for tolerating load in a rather metabolic situation. Dr. McGill also pulled other people out from the crowd and showed some table tests for the hips, squatting and deadlifting patterns, and a series of box jumps looking at how someone performs the movement, creates power, and creates relaxation.
The day ended with a whole bunch of Q&A from the audience and some closing remarks from both parties.
Some Of My Thoughts
Most people end up agreeing on more things than they disagree on and this was the case on Saturday. There was a lot of agreement between the two presenters and during the Q&A, following Gray’s answer, Dr. McGill would often start his answer off by saying, “I can’t disagree with anything the man said.” (that sentence works really well if you read it in a deep Canadian accent). While there are some disagreements that these two guys have they actually agree on a lot of things and I believe that both of their approaches have a place in a comprehensive process (more on that in a bit). The cool thing about the areas that they disagree on is that they are both willing to keep pushing the envelope to try and make it better. Both of them agree that movement screening is essential and they both want to do the best they can for their athletes and the general public.
During Dr. McGill’s talk I found myself nodding along and agreeing with much of what he was saying. In fact, what he was proposing is something that I feel every great strength coach SHOULD be doing – understand the bioenergetic and biomechanical demands of your athletes and test those demands to look for limiting factors that may be holding the athlete back from higher performance. Of course this makes testing difficult because that means you may have to choose different tests for different athletes (and maybe even different tests for athletes in the same sport who play different positions!). It isn’t as algorithmic as people would like it to be. I know people want the easy answer to things but, as Dr. McGill stated many times in his answers during the Q&A, “It depends”. And it does! It always depends! That being said, I believe there is a difference between general screening for risk and specific screening for sport. Which leads me to my question…
I got up and asked a question during the day (in fact, I was the last question of the day, so thanks for Dr. Liebenson for letting me get it in). My question was directed to Dr. McGill regarding his logic and it went something like this:
“Earlier in the day you provided us with a presentation of your logic around movement screening. I found myself nodding along and agreeing with most of what you said as these are things a great strength coach should be doing anyway – understanding the sport and testing the sport. However, in my logic, I draw a line between testing general movement capacity with a screen of simple body weight movements and testing capacity where we are placing someone under physiological or metabolic load to evaluate when or where they break down. During the practical portion today Gray screened a gentleman that we found to have reasonable movement competency. You then placed this same guy under metabolic load with the arm over arm rope pull and found his form broke down after about 15 seconds, indicating that he either doesn’t understand the technique of the activity or he lacks strength or fitness. In my mind the FMS did what it was supposed to do and your screen did what it was supposed to do. One told us that they guy had adequate movement so we didn’t need to worry about a movement fix and the other told us that he lacked technical ability or strength and fitness. Thus, we could conclude that movement wasn’t a problem but we need to provide this individual with a strength/fitness/technical correction instead. Whether we have 3 hours or 1 hour to assess a client, 10 minutes is a drop in the bucket. Do you ever see these two systems living under the same roof?”
Dr. McGill paused and thought about the question for a second or two and then answered that, “It really just depends. It depends on the situation, the athlete, and the scenario.”
My Own Answer
I believe it doesn’t depend. To me, in my logic, the answer is actually simple. If you have pain doing a basic movement then I don’t need to test you under a metabolic challenge because you need medical intervention and medical screening. If you can’t do the movement with your own body weight then I don’t need to place you under some sort of load or strain to see when you will break down – you already broke down with your own body weight! This is the same discussion I have had with some Crossfit folks in the past:
Them: “The person can do the FMS well but then look like crap when I put a bar in their hand have them overhead squat with 95lbs.”
Me: “The FMS told you that they were allowed to do the overhead squat. It did its job. If they can’t squat with 95lbs overhead then the problem is one of strength or fitness. Train them to perform the lift.”
The application of the FMS is an easy one (in my opinion) and can be represented by this decision tree:
I think a lot of times people make this more complicated than it is or they don’t fully understand the message and they misrepresent FMS, turning it isn’t some sort of soft “pseudo-physical therapy” system where people don’t really train – they just do “corrective exercise”. As I have said before in previous blog posts, the FMS can help you with the exercise road map and, at times, tell you what not to do, but it can also be very powerful at telling you what you can do and what you can really work at. When you find those things that you can attack in the program, ATTACK THEM! Get after it. Train hard. Get stronger. Get more fit. Being strong, being fit, and being in shape are just as much “corrective” as moving well. I think some of the issues that people take with the FMS is that they don’t really have a system of how to use it with the training programs they write and they think of it more as a “limiter” to what they do than a powerful tool to help enhance what they do.
I agree with both Gray and Dr. McGill. Rather than focus on the differences between their two messages I embrace them. I believe that we should screen for general/basic movement competency to ensure the individual doesn’t have pain when performing a body weight task and to ensure they can even perform the task with their own body weight in the first place! I also believe that we should be testing individuals under metabolic challenges and not just be focused on the numbers of their output (how much, how high, how fast) but also watching their movement to understand what their strategy is for dealing with load in a fatigued state. Both of these approaches attack different parts of the paradigm and answer different questions about the athlete. They are both necessary. If they weren’t, then I wouldn’t have both “movement” and “fitness” as two of the three key pieces in my Physiological Buffer Zone training philosophy:
Movement is life! If we stop moving we die. I believe Gray said it best, “Move well, then move often.”
If there is one thing that people take away from Saturday’s event (or the DVD when it comes out) it should be that we need a comprehensive evaluation process that starts general and then digs deeper into the specifics, based on athlete/client’s needs. No one ever said the FMS provided all the answers. In fact, if you go back and read Gray’s first book, Athletic Body in Balance, there are chapters in there on strength and power testing and on training endurance capacity. If you go back and even read the chapter Gray wrote in Bill Foran’s High Performance Sports Conditioning Book, the FMS served as one chapter of many in the assessment of the athlete. In fact, the FMS was the broad/general assessment and then each chapter was written by a different coach who specializes each sports (soccer, baseball, football, endurance running, etc). Each sport had its own unique set of tests used to evaluate different physiological capacities necessary for success in that sport. That isn’t much different from what Dr. McGill is proposing with his movement screen approach, which is asking us to put the person under load and see what happens.
Both approaches are necessary and, in my mind, they both live under the same roof.