What do I do first?

When we survey the many approaches out there we come to a critical decision the coach or clinician must make, a cross roads so to speak: do we test biomechanics first (table assessments) or neurology first (FMS)?

I understand you might utilize the former before the latter. For myself I’ve always gone with FMS then table assessments. In all this, however, what I find most worth discussing is the school of thought that would say “only breakout whats needs to be broken out with your FMS. Proceed as you fix things.” Conversely, other camps would have us believe “you’re going to get to the same biomechanics eventually so you mind as well throw your entire table assessments at them all together along with the FMS. This way you can fix the specifics and fix things a bit quicker than the longer route.”

Do this if your squat is bad. Don't do it first.

When you look at things the way you are paraphrasing, I can see that there is no right or wrong. I agree that you will typically wind up in the same place. But I don’t think this always works out, and this can be a costly loss of time in some situations.

What is wrong with this approach is that you are assuming/using the FMS as an assessment. In all honesty, you can do this, but it is not what I believe is the intent of the Screen. It’s intent is why I would would suggest doing it before the table assessments or breakouts. If you look at the FMS as just as screen, it is nothing more than a traffic light before passing the intersection into aggressive training. It’s ultimately not primarily supposed to guide or support you past the intersection.  It certainly can do that, but think Screen first.

Now, of course there is evidence to support training the weakest link, but here in lies the rub.

The fact of the matter is that the individual impairments that you would expect to contribute to dysfunctional movement may not always affect movement. Many times can someone do a RFE SS quite well but have a positive Thomas Test. And sometimes functional, non-painful table assessments are associated with horrendous movement patterns. These folks ail from poor motor control.
Taking the FMS out of the equation, and simply using global movements first gives you a reason to search for a cause. When you do the table assessments with what you would consider functional global patterns, you are doing nothing more than gathering trivia.
Does it matter what the impairments or static posture is if the person moves well?  It does work out that way a lot of times.  Just do some random provocative tests on folks you know move well.

Obviously this all also depends on the type of table assessments you’re doing, but the typical gamet of old school Physical Therapy impairment tests are often have poor sensitivity and/or specificity or yield nonmeaningful information to the grand scheme of things.

All in all, you can do them, but I really think they are closer to a waste of time. If you look at full body patterns first, you will know which ones to use and when to call on them to help you figure out something you are seeing that is worthy of intervention.

  • December 22, 2010

Leave a Reply 6 comments

drperry@optonline.net Reply

Well stated Charlie. Step back and observe to get an overall view of how each person is able to move, and control movement. Then start to go deeper in the flowchart of possibilities. Just like an artist starting his masterpiece with a blank canvas; the first strokes of the brushes look like jibberish, yet with time the masterpiece will appear.

bkellylimerick@gmail.com Reply

Charlie,
Good stuff as always. Keep up the good work.

Peter Fabian Reply

Always a pleasure to listen to you all. Also the traditional observing the person moving from the waiting room to the training/treatment space is helpful. It can be full of good insights that when listening to their provocative and easing signs and symptoms gives an indication of “What do I do first”

Mark McGrath Reply

Given that a genius like Janda, described our basic posture as gait mechanism, and that we are one leg 85% of the time in our gait cycle, the most basic evaluation needs to be walking observing the spine, umbilicus, femoral rotation and the organisation of the feet in walking. Followed by evaluation of single leg stance in standing.
Other longitudinal research supportive of this perspective is the work of French researcher Christine Assiante, who describes the movement problem as being able to take a step free of the dependence on lock-down strategies. Lock-down refers to the way we stabilise head on shoulders, and trunk on pelvis in gait mechanism. Locking down would mean that we are using multi-segmental muscles to stabilise because of proprioceptive neglect and therefore poor deep system stabilisation. The unification of these 2 views is a nice marriage of the ‘Prague School’ view with developmental motor control work that the French have done.

MARC ASSARAF Reply

HI, CHARLIE.
1ST I LIKE TO WISH YOU AND YOUR FAMILY A VERY HAPPY HOLIDAY AND A HAPPY NEW YEAR. 2ND I LIKE TO THANK YOU FOR ALL THE GREAT ADVICE YOU HAVE GIVEN ME AND ALL OF US THIS YEAR. I CAN’T WAIT TO GET YOUR CD’S.
KEEP UP THE GOOD WORK.
CIAO
MARC

mboyle1959@aol.com Reply

If you go to the table first, how do you know where to look? The FMS says “look at this”!

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