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Athletic development specialists dedicated to the art and science of excellence in movement

Movement Screening: What is it Really?

Movement screening has become a hot topic in the training world.  At best, movement screening can triage a situation upon contact with an athlete/client/patient.  At worst, it’s a boutique service from mediocre trainers and coaches to sell “cool” looking new exercises along with spa treatments and smoothies.  Sometimes people put too much faith in screens; other times not enough.  Although we often dig into screening intricacies, let’s explore the basics of what a screen really is. 

What got me to this topic…Its ironic that many athletes will drop a few grand on new auto parts or a new roof for the house without question, yet when a movement screen by a medical or fitness professional identifies at-risk movement traits, those same athletes will blow off the results and continue to train like an idiot (and possibly hire a coach to train them like an idiot) until they get hurt and then blame it on “bad luck.”  I’m not saying these expenditures are unmeritorious as I’m quick to pull the trigger on a car fix, but if athletes understood the concept of screening, perhaps they would act accordingly.  Maybe that’s a call for professionals to better communicate what a screen is…

A screen identifies conditions before those conditions manifest as symptoms.  Blood pressure, breast cancer, and scoliosis are common screens in the medical world.  The World Health Organization actually has formal criteria for screening.  Movement screening looks for movement characteristics that place someone at risk for injury and poor performance before injury symptoms arise.    

Screens need not be formal.  Observation is a screen.  The question “does the person walk into the gym under their own power without a limp?” is a screen.  That’s not a very sensitive screen because people can walk normally yet have pain, but looking for a limp is a screen for risk.  The problem with relying solely on informal screening is that reliability is less predictable and you may identify many at risk people as being not at risk.   

You might say, “Just make the screen really strict.”  The problem with overly strict is that you create false positives.   Breast cancer screens have been controversial as perhaps being overly sensitive.  I don’t know if that’s true, but some have made that claim.  Too many false positives lead to prescription of treatments and medications that aren’t needed.  Not only does this cost a lot for a population, treatment and medications can have side effects, meaning some people who never would have gotten the disease anyway may have health effects from unneeded treatments.  Good news with movement screening is the worst outcome from a false positive is you get a corrective exercise that you don’t “need” for correction but instead can use for a drill. 

Blood pressure is a classic example of a screen.  If your blood pressure exists outside normal range, the medical literature has identified you at risk for various health complications.  Blood pressure doesn’t identify those conditions, but it puts you into specific categories to get you closer to the most appropriate intervention.  Those mathematically inclined might recognize this thought process as an algorhitm (if A then B, if not A then C…).  A screen tells us where to go next in the algorhitm.  If you don’t like the answer for where to go next, you can take appropriate correction, or you can blow through it and put yourself at risk. 

You might think blood pressure is very simplistic, but do you think we’d be better off with a standard medical exam that DIDN’T check for blood pressure?  Screening into an “at-risk” population doesn’t mean bad things will automatically happen, just as passing a screen doesn’t mean you’re invincible.  You can drive thousands of miles with the Check Engine light on (itself a screen) with no mechanical problems or you can break down in two blocks.  If the check engine isn’t on, the car can still break down, but would you prefer a car that doesn’t have the Check Engine light?

Some want to go right into training and “coach ‘em up” with good form.  I’ll agree that large groups don’t lend themselves to screening on the athletic field, but schools do screenings all the time with a small staff of nurses.  One screen is for lice.  Does the school nurse say “We don’t need to screen for lice because I can just coach ‘em up to use good hygiene?”  I hope not!!

Regardless of how you screen, whether via the FMS or some other method, movement screens should honor the literature on injury prediction factors.  Five of the most robust predictors of injury are 1) previous injury,2)  poor neuromuscular control, 3) asymmetry, 4) Body Mass Index, and 5) …doing dumb stuff.

·         Previous injury…If you have been hurt before, are more likely to get hurt again.  Formal results are mixed on movement screening to predict who has been previously injured (in part because an injury may expose injured athletes to quality coaching in the clinic they might not have otherwise had...yes, ironic), but if someone says “Ouch” during a movement screen, you have identified present injury.  If there’s anything more robust than past injury at predicting future injury, it is PRESENT injury.  Since athletes are notorious for concealing aches and pains if they believe they’ll be forced to sit out, movement screens with minimal load are a safe way to check a few basic movements.

·         Neuromuscular control.  If a basic movement is sloppy, the chances of that movement pattern getting better and safer during complicated movement or during periods of physical duress is slim. 

·         Asymmetry.  We aren’t intended to be perfectly symmetrical (our organs aren’t evenly balanced inside our bodies…) but beyond a certain threshold, asymmetry becomes a risk factor.  One reason is for the strong side to cannibalize the weak side.  Asymmetry might not cause a problem now, but it could later. 

The last two factors aren’t addressed via a movement screen per se, but can be addressed via informal observation, which again, is a form of screening. 

·         BMI…People can certainly get carried away with chasing this factor, but it does matter.  

·         Doing dumb stuff…There’s no formal screen for this, but smart coaches can tell who is pushing the line too hard placing them at greater risk for injury.  

SUMMARY

The movement screen is a simple tool based on a simple concept, but many athletes willfully flaunt the results despite putting enormous trust in screens from other fields such as plumbing, roofing, and auto repair.  $5,000 for a new roof?  No problem.  Check Engine light comes on?  Better get to the shop.  Replace a few exercises contributing to poor movement…prepare for battle!  Maybe its denial, maybe misunderstanding, or maybe professionals need to do a better job of explaining what a screen is. 

As part of a medical triage, screening sets a foundation upon which assessment, diagnosis, and treatment may occur. In a performance setting, screening tells us whether someone is safe to train certain movements, much in the same vain as a pre-participation physical.  Given the low cost of heightened sensitivity, movement screening only makes sense to include as part of the triage process. 

Comments

Love the lice check analogy!

Love the lice check analogy!

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