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“You Can’t Manage What You Can’t Measure”

At L.A. Sports & Spine we use 0-3 from the FMS for all tests AND exercises. Pr. Janda taught me “every exercise is a test”. 
When we examine static (i.e. posture) or dynamic function (i.e. movement) we want to know if the position 12116008_1525848917706812_3957018206277066479_nor movement is painful (Score = 0). If it’s not painful we want to judge if the movement is poorly compensated(Score = 1), acceptably compensated (Score = 2), or impeccable (Score = 3).  The definitions for scoring are straight from FMS & Gray Cook’s book Movement.
At your own clinic/gym  come up w/ “agreed upon” criteria for the difference between a 1 & 2 amongst your trainers & clinicians. This is an excellent opportunity for team building & “brainstorming”. If you group mutually agrees on what is important for intervention or progression it is more likely to be useful.
It should reflect your philosophy of how much compensation you allow before you feel an exercise would cause more harm than good in a particular patient/client/athlete. Clearly we don’t want to “police perfection” Lewit said, “don’t try to teach perfect movement patterns but correct the key fault that is causing the trouble.”

Where Does “Go Hard or Go Home” Apply?

With that in mind we need to know when is it time to progress someone. This is a key to efficiency. If Screen Shot 2015-05-20 at 6.42.07 AMsomeone is ready for strengthening & we are still perfecting motor control we can slow their progress. Worse, if they engage in ADLs or sports because the VAS has reduced let’s say from 7/10 to 3/10 & we are ONLY doing motor control training for competency of movement patterns (base of pyramid)  they may be “at risk” since they may need some S&C training for capacity (middle of pyramid).
The Training Pyramid is the basis for my new Functional Training Handbook. In any person – not just an athlete – DURABILITY comes from S&C.

The Traditional Model: Is More Always Better

All athletes know they need to train for sport so they are durable or robust. Of course this is not an excuse for “adding strength on top of dysfunction.” Which is why we need criteria for how much motor control is enough (i.e. 1’s vs 2’s). Pr Janda pioneered looking at the quality of movement patterns to identify unacceptable compensations. When present more (i.e. sets, reps, weight) would not be better, but would only re-inforce faulty patterns leading to overuse syndromes.
The exact line is more up to your clinic or center, but should be generally agreeable intra-office. In the end, it is all about results. The FLOW channel must be individualized. It should not be “too little too late” or “too much too soon”. We need stress to make a change. Making change happen & accomplishing goals will bring about extremely high levels of patient/client/athlete satisfaction & fulfillment. Train hard & recover hard should be the motto.

 Why Process is King

Nicole Rodriguez of EXOS says we need, “real time intervention of RX in the training/sporting environment to improve motor control & permanence.” This is a process. No one knows what will when following the CAP improve function & reduce sensitivity, so test we must. However, this does not mean there aren’t ground rules. If poor mobility is suspected by positive passive or non-weight bearing tests then releasing tight structures first is a good “rule of thumb”. Examples include –
  • restricted ankle mobility during a squat
  • tight hip flexors or rectus femurs during bridges
  • stiff upper thoracic kyphosis during arm elevation

Synergists can also substitute causing faulty movement patterns –

  • overactive shoulder shruggers during arm elevation
  • overactive paraspinals during leg extension
  • overactive SCMs when holding the head up

It’s important to take a functional, outcome based approach since every patient is unique. Evidence-based approaches are important but they only apply generally. They tell us more about what not to do than what to do. N=1 in the gym & clinic. For this a functional approach that can be customized to the activity-performance goals & capacity shortfalls or stability deficits of the individual is best.

“Don’t Train the Test” (G Cook)

Since, “every exercise is a test” it is tempting to train the tests. But, as you can see from the above examples such as the squat that improving ankle mobility may be the key rather than trying to cue proper squat mechanics.

If we attempt to train an exercise & it’s a 1 then we look for ecologically valid moves that are nested to it that we think will re-set the weak link.

For example, if we have an –
  • anti rotation problem in 1 leg bridge we might do pallof press.
  • poor single leg Dead Lift we might stretch posterior hip capsule
  • if we have decreased T4 extension mobility we might do squats
  • if we have poor squats we might do Dead lifts
This doesn’t mean we never train a test, but only in a “peel back” which is reactive
  • i.e. poor OH squat we would do Goblet Squat or windowpane squat

Bear in mind these are just guides and results always trump theories. But, many “go to” troubleshooting ideas percolate to the surface when one understands the kinetic chain during various movement patterns & sports.

Bridge the Gap Between Demands & Capabilities

The assess-correct-reassess process requires humility and dedication to patient/client/athlete goals. We must as de Carmo says learn from a detailed history what the activity demands are. Then, from our examination we have to learn what their capabilities are (competency & capacity). This “aggregation of marginal gains” process is the gold standard in athletic development. Faster, Higher, Stronger
Dave Brailsford who is at the cutting edge of maximizing performance w/ Team Sky (Cycling in England) says, “You can’t run out of marginal gains. The whole thing about them is that it is about continuous improvement. So there is no end point.”

Predicting the Future is a Sucker Bet

 According to Taleb in Antifragile you can’t predict a specific catastrophe, but you can identify fragile entities and make them more robust.
Patients & athletes are only as fragile as they think. Guarding is normal, but often becomes memorized. This leads to fear-avoidance behavior and blocks resolution of activity intolerances related to pain or fear of re-injury.
Once medical “red flags’ are ruled out our goal is to conduct a functional exam to demonstrate that the software-functional problem is the true “silent killer” not a hardware-structural problem or old injury. This should reassure people and help them avoid unnecessary interventions & resultant iatrogenesis.

“The first and fundamental task in classification, and hence also in diagnosis, is whether we have to deal (mainly) with pathology or dysfunction.”– Lewit ‘94

Stanford Assessing Movement Program with Gray Cook, PT, Pr Stuart McGill, PhD.

Grit vs. Aptitude (i.e. Talent)

We are always learning from our mistakes. This is a journey.

“Learn the Craft, so You Can Master the Art”

It is crucial that your “team” all know how to execute the assessments & corrective exercises with high skill. And, that you have agreed upon your scoring criteria for a 1 vs 2 so you are all on the same page. Once we’ve got high quality skills/methods then we can put them in the service of achieving our goals (converting 1’s into 2’s so that as function improves sensitivity (0’s) will diminish)

Once we’ve got high quality skills/methods then we can put them in the service of achieving our goals (converting 1’s into 2’s so that as function improves sensitivity (0’s) will diminish). We are never a “prisoner of protocols” but patient or athlete-centered with individualized programs driven by the assessment process.

The goal is to convert 1’s (painless dysfunctions) into 2’s, then to audit the Screen shot 2015-04-09 at 2.53.48 PMsensitivity of painful  markers (0’s). In this way the patient/client/athlete learns the truth of Dr Lewit’s statement “he who treats the site of symptoms is lost” is true. Even more liberating is the experience that a functional “re-set” proves that the structural or hardware explanation of the source of one’s pain or activity limitation is not the whole story. A multi-planar functional approach allows us to  “hack” into the motor programs & optimize them.
This is not a Corrective Exercise approach so much as prudent training. Cortical plasticity is a gateway to Residual Adaptation. As Guido van Ryssegem, ATC says “Variability is the oil of the CNS”.

Conclusion

At the end of the day our model is very simple and best expressed by Laird Hamilton – “that which enhances performance prevents injury”

For a similar presentation in webinar form click here

 

“Learn the Craft, so You Can Master the Art”

It is crucial that your “team” all know how to execute the assessments & corrective exercises with high skill. And, that you have agreed upon your scoring criteria for a 1 vs 2 so you are all on the same page. Once we’ve got high quality skills/methods then we can put them in the service of achieving our goals (converting 1’s into 2’s so that as function improves sensitivity (0’s) will diminish)

Once we’ve got high quality skills/methods then we can put them in the service of achieving our goals (converting 1’s into 2’s so that as function improves sensitivity (0’s) will diminish). We are never a “prisoner of protocols” but patient or athlete-centered with individualized programs driven by the assessment process.

The goal is to convert 1’s (painless dysfunctions) into 2’s, then to audit the sensitivity of painful  markers (0’s). In this way the patient/client/athlete learns the truth of Dr Lewit’s statement “he who treats the site of symptoms is lost” is true. Even more liberating is the experience that a functional “re-set” proves that the structural or hardware explanation of the source of one’s pain or activity limitation is not the whole story. A multi-planar functional approach allows us to  “hack” into the motor programs & optimize them.
This is not a Corrective Exercise approach so much as prudent training. Cortical plasticity is a gateway to Residual Adaptation. As Guido van Ryssegem, ATC says “Variability is the oil of the CNS”.