Tag: assessment

Within the fitness, strength and conditioning industry, and physical therapy realm, there has been a recent surge towards identifying what assessments are, how they can be utilized, and how they can be implemented in a practical manner in order to derive best practice for athletes, clients, and patients.

From a logical standpoint, it merely makes sense – understand the standards to “test” for, test your individuals, and ideally have whatever your input – whether it is an exercise, treatment, or other modality – affect that individual in a (hopefully) positive manner (or at the very least maintain that movement quality).

However, there are a few items to cover that I want to define. Namely:

1. What makes an exercise “corrective” in nature?
2. What is dysfunctional?
3. What is an “input”?
4. Should fitness and S&C professionals have the ability to affect clients and athletes movement patterns?
5. What are we really “testing” when we perform movement assessments?

Prior to answering these questions, it is imperative to have these pieces of knowledge under your belts:

Joint Position

From the Functional Movement Screen (FMS), it is understood that it can be wisely utilized as a tool to “bucket” movements within a framework intended on screening individuals to exercise in a safe and efficient manner. One question that I associate with utilizing the FMS (I use this test often when screening athletes) comes from Charlie Weingroff, and it is, “Can your joints load and adapt to stress?”

The idea here is if you have an active straight leg raise (ASLR) score of a 1, you are achieving a specific range of motion through your hips, and it varies from person to person. Also, that individual is not imposing enough of a stimuli when asked in a specific manner to bring his or her leg up and back (not the actual words of the screen), that his or her score is now a “1”, instead of a “3”.

This discrepancy can be realized in the form of an asymmetry from limb to limb, from a lack of joint integrity (the head of the femur lacking posterior movement within the acetabulum), or from a lack of inhibition/activation of the posterior and/or anterior chain of the lower quarter.

Long story short, you should be able to bring your leg up to a reasonable degree without any discomfort before you can be lunging, squatting, deadlifting at full ranges of motion.

And the movement screens do not have to be reflective of only one methodology (FMS). I’m not married to one thought process – it merely happens to be well represented and explained by Charlie Weingroff, Dr. Greg Rose, and Gray Cook, so it is a system that I choose to utilize on a day to day basis.

Feel free to utilize Postural Restoration Institute assessments, and other physical therapy minded items in order to represent your thought processes and beliefs.

Inputs & Outputs

The next item involves understanding that the world we all live in provide various stimuli into our system (brain, our body, etc). On an unconscious and/or subconscious level, we all understand that our bodies are, for the most part, attached to the ground by two feet, or that we are laying in bed as we read this, or that the seat we are sitting in is plastic in nature (if you are sitting in a plastic chair of course).

In a more sensical manner, we don’t need to be consciously aware of how many breaths we are taking every minute – it just occurs. More realistically, on a subconscious level our brains interpret that we are often not in danger, and not in threat, so our breathing rates will reflect a more calm and relaxing manner.

There is an input that we are not in danger, so the output is a relaxing heart and breathing rate.

If this is not the case, we may begin hyperventilating in order to bring more oxygen stores to the related fight or flight organs that assist in treating this new danger, this new threat.

There is now a new input – that we are in danger, and our brain recognizes this – so the output is now no longer a relaxing heart rate, but rather an increased heart and breathing rate to reflect the new input.

So you see, there is a cause and effect that occurs from input to output – our body, our organs, our muscles and nerves, among many other items – are simply structures through which the brain imposes a demand upon.

Lifting a heavy weight? Cool. Your brain interprets something heavy in your hands, so you need to activate motor units in order to fire up the muscles used in order to lift said weight – all on an unconscious level.

The Salient Stimulus

I admittedly came across this information by reading and talking with a physical therapist named Zac Cupples (who has a fantastic website in its own regard). What is a salient stimuli? Essentially it is…

“A salient stimulus is something that stands out relative to the background. The intensity is irrelevant; the key is how different the input is. These inputs can occur within the body or the environment.”

Quoted from “It’s the Salient Detection System, Stupid.” from Zac Cupples website.

This idea helped me to detach my previous thoughts of how some modalities that we all know to be archaic in nature (e-stim for example) can still be helpful for our clients/athletes/patients because if it is new to the individual, perhaps there is an input that is being provided to this person on a subconscious level that allows them to relax.

• If those individuals are in pain, maybe they need to listen to a soothing voice to relax their pain receptors in their body.
• If those individuals are unable to move well, maybe they need to breathe more efficiently (via synchronous movement of the ribcage and pelvis) before they can relax those tight hamstrings.
• If those individuals cannot produce force in a productive manner, perhaps they need to stop listening to Katy Perry during their training sessions.

And down the line you go.

Regional Interdependence

From PhysioPedia,

“Simply put, regional interdependence is the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint.”

In a more practical application, this concept can be applied in a common scenario that I see daily:

Someone complains of lower back discomfort (not pain), hip mobility drills are provided, along with stability motor control exercises for the abdominal AND the hips are provided – and you solve their mysterious back issue.

Congratulations, you have witnessed regional interdependence at work. Luckily enough, there is enough evidence out there (even if they don’t call it specifically regional interdependence) to warrant this concept a look-see. (3)

Now, to take this to the next level, I have in my head how some of the inner workings of the body are connected via a concept of homeostasis, or more specifically the swinging pendulum of approaching the midline of all things “health” related.

If you are off on one end of the extreme, your body (in any amount of ways) will attempt to bring you back to baseline.

Here is a picture that helps to demonstrate this idea more effectively:

If the bubble in the middle is in a perfect circle, then all of the other circles surrounding it are in proper order.

Say you perform a set of 10×10 back squats, and this causes your musculoskeletal system to “tug” on the homeostasis circle. Then the body should recognize this, and attempt to force the body to rest – on a localized level because there are less intramuscular glycogen stores than when you first started your back squat session, by causing massive amounts of hormones to start the rest and digest cycle, or by making your central nervous system seem fatigued, so you have to bring it back to homeostasis eventually.

One system is interrelated with another. This will be important to understand as other installments of these assessment experiments come into play.

The More You Know

If you had given me those pieces of information prior to me entering the fitness industry, I would have been much better off and well informed from the get-go.

Take those items separately, and you have some pretty good, foundational information under your belt. You can create exercise programs, a positive training environment for people to thrive under, along with improving your treatment (if you’re a physical therapist) or exercise selection choices (if you’re a fitness or S&C professional).

Now, with those things under your belt, now we can attack the first batch of questions by bucketing them within the above subcategories:

What is corrective exercise?

I’m of the opinion that corrective exercise is at best, merely a novel or salient stimuli introduced into the system, made to help improve a movement quality that may have been lacking before. At the same time, the modality of exercise may be introduced as the correct intervention aimed at helping an individual relax and or restore functionality – massaging a hamstring because it is tight, as opposed to stretching it, for example.

Whether or not it is self-imposed (you performing it by yourself) or having an individual do a specific technique on you (performing massage while you relax on a table), the real terminology should reflect what is believed to be occurring.

Perhaps a better name could be “functional modalities” – exercises, treatments, or other modalities aimed at improving movement (and other  actions) in a functional manner.

But that is neither here nor there.

With corrective exercise, we are aiming to improve joint position, either by changing the position of the joint itself (manipulation techniques found from chiropractors, physical therapists, and/or osteopaths), changing the tonicity of the affected musculature, or even reintroducing a new subconscious learning strategy that you can now utilize instead of the older, possibly incorrect movement pattern.

What is dysfunction?

This is a multi-faceted question (and answer), but at the end of the day, here are my thoughts:

There are only so many humanly degrees of range of motion. Anything outside of those “normative” ranges of value are outliers on a “U-Curve”.

If someone is on the right side of this curve, perhaps they are in need of any treatment modality (mobility drill, joint mobilization, rolling patterns, breathing drills, massage, etc.) to bring them back to the middle.

If someone is on the left side of this curve, we as professionals need to ask,

“Is this shift in range of motion (or movement pattern) an abnormal thing, and if yes, is it helpful to this individual to accomplish their tasks?“

This individual might have 180 degrees of glenohumeral total motion (both internal and external rotation) because they are a pitcher, and it is acquired through years of training.

Or, on the same note, this individual might have 100 degrees of glenohumeral total motion (both internal and external rotation) for the same reason that they are a pitcher, and it is an accumulation of mis-managed stress that has caused them to lose this range of motion.

As you can see now, there is no true definition of a dysfunction, but it is within the practitioners interpretation of a movement pattern or joint position to determine the next plan of action.

So… What are we really testing when it comes to assessments?

I’m of the belief that within our specific industry the items that we are truly “testing” for involve discovering physiological, neurological, and perhaps even abnormal (but to whose standards) bony structures that may limit movement patterns which may prevent quality of life from being maintained.

Two things in this long winded definition:

• What are these standards?
• Quality of life may be different from individual to individual.

The shoulder range of motion that is necessary for a baseball pitcher will need to exceed 180° of total motion in order to maintain an elite level position on a professional level.

Often times shoulder range of motion is limited in shoulder flexion (reaching up to the ceiling/sky) due to bony and muscular structures limiting this motion.

The shoulder (flexion) range of motion that is necessary for a general population individual is essentially less than 90° from anatomical position – they can use a step stool to get up to the desired location and move their arm out in front of them in order to reach for something.

Two very different qualities of life, and as long as these expectations are understood from both parties, both interpretations of assessments can be very different.

On one end shoulder range of motion is limited due to physiological demands of throwing a baseball at high levels, and on the other end there are degenerative changes to be cognizant of in the second individual.

So the question becomes, if the assessment process is aimed at providing a “roadmap” towards optimal and a more “functional” performance, then the next question must be what paths do you take to get to the desired goals?

This is where multiple inputs can be introduced in order to convey another yet larger message.

Should fitness professionals have the ability to affect movement in a positive manner?

Of course. Otherwise, there would literally not be any jobs for people who are and have been attempting to lose weight, which is a multi-billion dollar industry.

The “ability to affect movement” is worded as such in order to describe the effects of any modality on an individual’s movement. When we as coaches and physical therapists provide cues that the individual must interpret, the words we choose aim to serve a purpose of affecting movement qualities.

If we say move slowly with deliberation, I’m not expecting full on force production similar to a moving train, I’m expecting precision and deliberate movements.

From this vantage point, it should be understood that all systems of the body are interconnected. I had the opportunity to impart some knowledge at Billy Rom’s facility in Long Island, NY (Superior Athletics) this recent May, and I still stand behind this image as being valid.

Long story short, the cardiovascular system can affect the nervous system, which can affect the musculoskeletal system, which can affect the psychosocial system as well.

In the following videos, I’ll be introducing how auditory stimuli can affect the nervous system, which can affect the musculoskeletal system.

If there are indications that an assessment is literally assessing joint position, it should be noted that the nervous system can be manipulated every which way, which can skew the interpretation of the assessment on a very foundational level.

Auditory/Music Experiments

Now, if you’re still with me, great. I’ve got some interesting videos that I hope alters your perception on what you are currently doing, and if anything just shows how altering inputs (auditory stimuli in this case) will affect outputs (movement quality through various movement assessments and screens).

Sometimes, pain is caused by mechanical tension, in which a muscle group is “firing” in an abnormal manner, which may or may not cause specific nerves to fire, signaling your brain to interpret these movements as pain.

One thing auditory music can alter is the sensitivity to which pain is perceived. (1) Imagine someone scratching a chalkboard, or hearing a gun go off nearby. Various wavelengths perceived through the brain interpret these inputs as either signals of danger, or signals of relief.

In an easier to understand context, I cringe whenever I listen to anything by Kesha, Katy Perry, or whoever is the newest pop artist of the month. On the other hand, I get down whenever I hear Michael Jackson or James Brown.

With this in mind, I introduced an element of music and auditory stimuli to see how it affect motoric control during the assessment process. If the concept of test and re-test is new to you, this is it in a nutshell:

1. Test a movement with some sort of standardization in place.
2. Introduce an element of an intervention.
3. Re-test and re-examine the said movement pattern.
4. Did it change? If not, why not?

Often, if there is a large discrepancy of a movement pattern, there is no immediate change. This could be indicative of the input not having enough of a signal in order for a change to occur. Think about the decibels needed in order to hear certain noises – if something isn’t loud enough, we as humans won’t be able to react. The same can be applied to inputs – if there isn’t enough of a quality of stimuli, that input aimed at “correcting” said movement pattern won’t be effective, even if it is in the correct realm of being recognized as aberrant or abnormal.

With that said, here is video number one:

 

A couple caveats before your brain asplodes:

1. I chose a neutral choice of music (found here) in order to remove the possibility that I’m listening to something that I like, such as James Brown, or even something I don’t like, such as Kesha.
   
2. I also chose to show the variance of listening to auditory input from one ear to the next.
3. Music can be utilized as a performance enhancing tool for runners. (2)
4. If music can influence perceived exertion, it can similarly enhance or decrease movement qualities, displayed through this simple screen.
5. The movements displayed here are chosen out of ease of filming, and quickness of re-testing.
6. It could be argued that these movements are not a limiting factor towards the whole picture that is the FMS or SFMA, so they are simply noise within the grand scheme of the movement game.
7. Paul didn’t know what his responses would be to these movements, so it is blind in that sense.

On that note, here are my responses to the same music:

 

While this is a lot to interpret, just understand that this now brings up several new questions:

1. What kinds of music can help elicit a better training environment for you and your athletes/clients/patients?
2. What kind of vocal intonation should be utilized in order to elicit a de-threatening of the central nervous system?
3. What words should be utilized in order to elicit a better response of doctor to patient understanding? (3)
   

   Specifically, it seems that motoric control of glenohumeral internal and external rotation is limited, hip flexion is limited, and thoracic rotation is also limited when an unfavorable auditory stimuli is introduced into the system (n=5 since I’ve done this with other individuals also).

4. If joint position is compromised due to an unfavorable auditory stimuli, what occurs to movement quality?
5. Is this something that can be “unlearned” or consciously subdued?

And, for what it is worth, I honestly don’t have answers to these questions. I am simply observing these changes utilizing the above logic and rationale.

Perhaps music selection at commercial gyms can be altered in order to better elicit a training effect for everyone involved. If there is one choice versus another from person to person, perhaps a more neutral music selection can be introduced.

The words we use on a day to day basis can influence how people interpret what and who we are – whether or not we are proving to be useful from an actual physiological point of view is left open to discussion, but maybe someone just really likes listening to you talk, so they are calm and relaxed during your conversations, and they don’t feel their literal and physical pain when talking with you.

All that said, this is “installment one” out of a handful of other installments, because there are tons of variables that can come into play with assessments. With that said, if you’re a strength coach or personal trainer, don’t go blasting awful music into your clients’ ears and expect someone to get strong. Neuromuscular control that can fluctuate at the drop of a hat does not translate to physiological strength that needs to be honed through hundreds if not thousands of repetitions.

Action Plan

Alright, here is where you, the awesome reader can come into play.

If you want, I’d like to see if your movement changes with auditory stimuli (aka music) in place. Do exactly what I did, and you can even play around a little more just to see what changes further. No, this won’t get you to lose 10lbs overnight, but perhaps it will get you to relax your muscles!

Step 1. Test shoulder range of motion similar to how I performed in above videos.
Step 2. Listen to music (found here) and put one ear bud in at a time (right versus left).
Step 3. Identify any changes in movement from one ear to the other.
Step 4. Which one made your shoulder movements easier? Did it make your neck movements easier? Thoracic spine easier?

Let me know in the below comments, because I’m very interested in this process for everyone!

—

As always,

Keep it funky.

References

1 – http://spectrum.library.concordia.ca/974974/1/Cutris_music_pain_relief.pdf

2 – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761862/

3 – http://www.manualtherapist.org/Wainner2008Regional_Interdependence_Musculoskeletal_Exam.pdf