Two of the presenters that had a profound influence on me at the training summit were Gray Cook and Greg Rose. Gray Cook is a physical therapist who helped create the Functional Movement Screen, an assessment tool used by athletic trainers and coaches prior to training to screen for irregular movement patterns that could potentially cause injury.
The full assessment includes the deep squat, hurdle step, in-line lunge, shoulder mobility, straight leg raise, trunk stability push-up, and rotational stability. Each exercise is scored from 0-3, and considered dysfunctional (or irregular) if receiving a score less than 3. If the athlete receives a score of 0, this indicates that movement is not only incorrect, but causes pain. In these cases the athlete is often referred out to a sports medicine clinician who will then assess the athlete with a Selective Functional Movement Assessment to pinpoint the cause of pain.
This is where Greg Rose, a chiropractor and director of the Titleist Performance Institute, offers simple easy to follow guidelines to diagnose and treat altered movement patterns that cause pain.
1.) Distinguish between the source of pain and the cause of pain. Our skeletal system is an alternating pattern of mobile joints and stable joints, and often when the mobile joints do not move properly our stable joints will become unstable to over compensate. This results in painful movement. The knee is a prime example…it is a stable joint with two very mobile joints (the ankle and hip) at either end of it. Something as simple as an ankle sprain can cause altered body mechanics that cause pain in the knee, even though the ankle is the source of the problem.
2.) Once you have diagnosed the source of the problem, go back to the basics to fix it. No one ever taught a baby how to sit up, roll over, crawl, or stand up…they started by laying on their backs and moving their limbs and eventually movement progressed as they got stronger. This is exactly what you should be doing to correct an altered movement pattern. Greg Rose created a simple tool called the 4 x 4 Matrix that includes the 4 basic body positions:
1) Non-weight bearing (laying on your back or stomach)
2.) Quadruped (face down on hands and knees)
3.) Kneeling (full kneeling on both knees, or half kneeling on one leg)
These body positions are then utilized with the 4 different types of resistance:
1.) Pattern assisted without resistance
2.) No resistance
3.) Pattern assisted with resistance
4.) Full resistance
Starting with the easiest combination (1 x 1), the athlete learns the correct movement patterns and can build up from there. Greg suggests performing exercises in progressing body positions (1-4) with pattern assistance and no resistance (1-2) prior to moving onto progressing body positions (1-4) with pattern assisted resistance and full resistance (3-4). Greg has a full catalog of exercises on his TPI website:http://www.mytpi.com/exercises
Once movement patterns that cause pain are addressed and corrected, the athlete can be re-assessed with the Functional Movement Screen and begin their training. Keep in mind that mobility issues always have to be addressed first before any stability issues can be fixed… we have to learn to crawl before we can walk, right?!?!
For you athletes experiencing difficulty or pain, go back to the basics and work your way up. For you trainers and coaches, think outside the box and consider that your athlete’s knee pain might be caused by something other than their knee!! Put them through a movement screen as see where the problem is initiated from. I strongly recommend you check out Gray Cook’s websites: http://graycook.com/ andhttp://www.functionalmovement.com/ , as well as the Selective Functional Movement Assessment site: http://www.sfma.com/site/
“First move well, then move often”
~ Gray Cook