The simplest way to begin to attack the FMS is to break the test down into the 'Big 3' and 'Little 4'.
Rotary StabilityIt's always tempting to go after the big 3 patterns first since they look more functional, and teaching someone to squat, balance, or lunge is part of what we do in physical therapy and performance training. The problem is that these are very complex patterns requiring great mobility from many joints, and also a great amount of stability around those same joints as the movement is completed.
What Gray and Lee have reported, and many others can vouch for this clinically, is that addressing deficits in the little 4 will often result in improvement in the big 3. One of the great things about the FMS is that you can quickly go back and check your work. Did the corrective technique I employed change the pattern? You should see an immediate change for the better in that pattern. Once the athlete can clear the pattern(s) in the little 4, then go back and check the quality of the big 3. The majority of the time they will be significantly improved, and on occasion the athlete will now pull a 3/3 without directly addressing the pattern.
A perfect example of this is the Active Straight Leg Raise which looks at hip separation on a stable trunk. It looks like a hamstring length test but it's just as common to see increased tone in the hip flexors of the down leg putting the brakes on the leg that is being lifted. If it is determined to be a hip flexor issue then use soft tissue work and corrective exercise to improve the pattern. Now go back and check the big 3.
Each of the big 3 screens has a hip flexor component to them. It's easiest to see in the In-Line Lunge as the back leg must have sufficient hip extension to complete the lunge. In the Hurdle Step, the stance leg must have sufficient hip extension range as the opposite hip flexes to step over the hurdle. Again, limited hip extension on one leg may limit hip flexion on the opposite leg or create instability through the pelvis.
The Deep Overhead Squat is not as obvious but if hip flexor group tone is an issue, then the athlete is already standing with an anterior tilt to the pelvis and is weight shifted anteriorly. This is an easy one to try yourself. Try squatting once as described above and then try with a neutral spine position and an even weight distribution. It's much easier to get depth and maintain stability through the pelvis and core. If you're familiar with Janda's work and lower crossed syndrome this will make a lot of sense.
With all that being said, here is where to start:
1) If the athlete has pain, the screen is scored 0/3. You may complete the screen as a baseline to compare to down the road, but the pain should be addressed first with more formal rehab.
2) An asymmetry in any of the screens should be addressed next. The research has shown a much higher risk of injury in those with right to left asymmetries. If an asymmetry shows in the one of the little 4 and in one of the big 3, then attack the asymmetry in the little four first. Then go back and check the asymmetry in the big 3. You may have just corrected that as well.
3) If no asymmetry is present, or you have cleared those, then address the 1/3 score(s). Once again if multiple 1's are present, address those in the little 4 first. What Gray and Lee are teaching at this point is that the Active Straight Leg Raise and Shoulder Mobility Tests take first priority.
4) If no asymmetries or 1/3 scores are present, then begin to address the 2/3 scores. As I mentioned in #3, correct the Active Straight Leg Raise and Shoulder Mobility first. Move on to the Trunk Stability Push-up and Rotary Stability if needed.
This is just a basic road map based on the latest information from Gray and Lee. The more experience you have, the more comfortable you may be going after 2-3 things simultaneously. For more information on the Functional Movement Screen, check out two FMS corrections from the "Exercise of the Week" segments below. Click HERE to head over to FunctionalMovement.com.
________________________________________________________________________________
Exercise of the Week - FMS Shoulder Mobility Test and T-Spine Rotation Correction
The Shoulder Mobility Test of the FMS looks as much at thoracic spine mobility and scapular stability as it does actual shoulder motion. Stiffness through the t-spine will limit shoulder motion, and very often will show up asymmetrical especially in those that perform more unilateral activities such as throwing, hitting, swinging a club, serving a tennis ball, etc.
Check out the video to see the Shoulder Mobility Test and then the corrective t-spine rotation exercise. You'll see how quickly improvement can be made.
There are multiple ways to perform this exercise. I've shown the easiest one for patient's to do, especially if there is shoulder pain. Most of the time they can pull themselves over with one and reach to the ceiling with the other without difficulty. Be sure the athlete is pressing the knee into the floor, a ball, or foam roller. This engages the core and limits lumbar rotation.
Here are a couple other options
instead of pulling yourself over, reach but think "elongate" through the arm.
A similar method as described by Charlie Weingroff in the discussion forum: "Unload the topside arm, and it is easy to do manually with an arm pull technique. The fancy way is the unload it with a Cook or Jumpstretch band that is anchored to a rack or door. It's got to be tight enough to basically traction the arm as you would with a manual arm pull."
Also goes to show that reefing the shoulder to gain extra motion isn't always necessary. Towel stretches into IR is one of those exercises I used to use, but haven't now in quite some time. Doesn't this video prove that we should milk the t-spine for all its worth first? I'd add t-spine extension work, pec minor release, and some scapular stability first and see what happens.
________________________________________________________________________________
Exercise of the Week - FMS Hurdle Step Corrections
The hurdle step from the Functional Movement Screen has been a difficult test for most athletes to get a '3'. I've been searching for a 'protocol' so to speak to improve this movement pattern in my athletes and patients, and feel like I've come up with a good plan here. I will use this same progression to address single leg stance as part of the SFMA if it is dysfunctional non-painful.
For any of you who may not be familiar with the FMS or SFMA, the hurdle step (FMS) and single leg stance (SFMA) are looking at stance leg stability, stride leg hip mobility, and core stability. If these patterns are out, walking and running mechanics will be adversely affected. Not to mention shoulder stability since we are now connecting the dots so to speak with hip and core instability leading to scapular/shoulder instability in overhead athletes.
Start with psoas activation to improve hip flexion without involving the lumbar spine. Have the athlete sit tall, preferably with his/her back to the wall when first learning the exercise. Flex the hip and perform an isometric hold for 5 seconds with the same side hand giving resistance. Check out the video to see what a difference it can make.
Psoas Activation
I'll start by having the athlete do 4 reps with resistance followed by 4 reps just active motion into the new range. Once they get the hang of it they'll do 2 resisted reps and and 6 more active. This is incorporated into their warm-up.
From there the athlete will work on single leg balance with core engagement. Posture is everything again so they must stay tall and resist lumbar spine flexion during hip flexion. When pulling the band, I cue them to 'squeeze the shoulder blades' vs 'pulling' to engage the core and get thoracic extension. Once set, then they may flex the hip and balance. Some athletes will take a lot of cuing intially to fire to stance leg glute to prevent hip adduction or internal rotation.
Band Stomps are similar as far as posture requirements, but now the band is pulling you into hip flexion and great control is needed is needed through the hips and core to maintain balance and stiffness. I will let them hang on for a few reps to get the feel and then to no hands.
Single Leg Balance with Core Engagement and Band Stomps
As the athlete or patient improves, decrease verbal and tactile cuing and gradually increase the speed of the exercise. I like things to be more automatic as we go versus having to think about it, i.e. it becomes their new movement pattern.
Interested in a membership to SportsRehabExpert.com?
We offer a 14 day trial for only $1. Go to 14 Day Trial for $1 for more information.
About SRE.com
