Weak Links

Properly screening an athlete's movement patterns can reveal weak links that hinder optimum performance.

By Gray Cook

Gray Cook, MSPT, OCS, CSCS, is Clinic Director at Orthopedic & Sports Physical Therapy in Danville, Va.

Training & Conditioning, 12.3, April 2002, http://www.momentummedia.com/articles/tc/tc1203/weaklinks.htm

Athletes who perform at similar levels require similar training programs. Right?

Wrong. The training needs of athletes who turn out the same performance statistics are not necessarily equal, because some of them may be performing below their full potential.

For example, say that you observe two young athletes running a 40-yard dash. They have the same times on the stopwatch, but one athlete has near perfect mechanics and smooth fluid movements, while the second athlete has excessive head movement, poor arm action, and an irregular stride.

If you use the stopwatch times alone, you would be obliged to give both athletes the same training program. But in reality they have distinctly different needs. The second athlete either has significant fundamental movement problems, such as poor flexibility or poor core stabilization, or has not been appropriately trained in fundamental running technique. Therefore, the second athlete would benefit from a functional movement program or a running technique program whereas the other should focus on performance training (speed work and plyometrics).

One useful way to find if an athlete is performing up to his or her potential is to search for and identify a flaw, or a "weak link" in that person's movement patterns. A weak link can be the result of a strength problem, a flexibility problem, a coordination or agility problem, a nagging injury, a skill- or technique-related flaw, or any combination of the lot.

We use a technique called a "functional movement screen" to assess an athlete's movement patterns and uncover weak links. This functional movement screen actually is a series of seven movement tests described below. The tests include the following movements: squatting, stepping, lunging, shoulder mobility, straight-leg raising, a pushup for stability, and a rotary stability test.

These seven tests were picked for the purpose of scoring, and because they are easy to reproduce with minimal time, space, and equipment. Each of the seven tests can receive a score between zero and three:

Award a score of three when the athlete can perform the functional movement pattern.

Award a score of two if the athlete performs the functional movement pattern with a compensation.

Award a score of one when the athlete is unable to perform the movement pattern.

Award a score of zero if the athlete encounters pain while trying to perform the movement pattern.

A total score of 21 is optimal. However, most athletes score below that mark. Athletes who score a total of 14 or better on these functional movement screen tests are in the "safe" zone, which means they do not have any serious movement flaws (weak links). Those who score below 14 have a motion problem and, from our experience, are more susceptible to injuries.

When an athlete scores below 14 points, look at which of the seven tests scores were below two. Tests with scores below two are sources of your athlete's weak links and that is where you must focus your training. For example, a batter who scores below two on the shoulder mobility test has some movement restriction and is not performing to full potential.

Here are detailed descriptions of the seven tests:

Test One: Deep squat. The deep squat is used to assess bilateral, symmetrical, and functional mobility of the hips, knees, and ankles. The dowel held overhead assesses bilateral and symmetrical mobility of the shoulders and the thoracic spine.

Have the athlete begin by assuming the starting position and placing his or her feet approximately shoulder-width apart with the feet aligned in the sagittal plane. The athlete then adjusts his or her hands on the dowel to assume a 90-degree angle of the elbows with the dowel overhead. Next, the dowel is pressed overhead with the shoulders flexed and abducted, and the elbows extended. Then, the athlete is instructed to descend slowly into a squat position. The squat position should be assumed with the heels on the floor, head and chest facing forward, and the dowel maximally pressed overhead. Up to three repetitions may be performed. If the criteria for a score of three is not achieved, the athlete is then asked to perform the test with a 2x6 board under his or her heels. Athletes who are not able to meet this criteria receive a score of two. Athletes who cannot complete the deep squat as described, with or without compensation, receive a score of one.

Test Two: Hurdle step. The hurdle step assesses bilateral functional mobility and stability of the hips, knees and ankles by challenging the body's proper and symmetrical stride mechanics during a stepping motion. It requires proper coordination and stability between the hips and torso during the stepping motion plus stability in the single leg stance.

Have your athlete begin by placing his or her feet together and aligning the toes touching the base of the hurdle in a starting position. The hurdle is then adjusted to the height of the athlete's tibial tuberosity. Position the dowel across the shoulders, just below the neck. Ask the athlete to step over the hurdle and touch his or her heel to the floor while maintaining the stance leg in an extended position. The moving leg is then returned to the starting position. The hurdle step should be performed slowly, up to three times bilaterally if needed. If one repetition is completed bilaterally, a score of three is given. If the athlete compensated in some way by twisting or turning the leg, leaning or moving the spine, he or she receives a score of two. If any loss of balance occurs or contact is made with any part of the hurdle, a score of one is given.

Test Three: In-line lunge. The in-line lunge test assesses hip and trunk mobility and stability, quadriceps flexibility, and ankle and knee stability. It also places the body in a position that focuses on the stresses similar to rotational, decelerating and lateral type movements. In addition, the athlete's lower extremities are placed in a scissor position that challenges the body's trunk and extremities to resist rotation and maintain proper alignment.

Begin by obtaining the athlete's tibia length, by either measuring it from the floor to the tibial tuberosity or acquiring it from the height of the string during the hurdle step test. The athlete then places the end of his or her heel on the end of a 2x6-inch board. Then, the previous tibia measurement is applied from the end of the toes of the foot to the board, and a mark is made on the board. A dowel is placed behind the back, touching the head, thoracic spine, and sacrum. The hand opposite the front foot should be the hand grasping the dowel at the cervical spine, while the other hand grasps the dowel at the lumbar spine. The athlete then steps out on the board, placing the heel of the opposite foot at the indicated mark on the board. Then, the athlete lowers the back knee enough to touch the board behind the heel of the front foot. The lunge is performed up to three times bilaterally in a slow, controlled fashion. If one repetition is completed successfully then a score of three is given. If compensation occurs, a two is given. If the athlete cannot complete the movement pattern or loses balance, a score of one is given.

Test Four: Shoulder mobility. The shoulder mobility screen assesses bilateral shoulder range of motion, combining internal rotation with adduction, and external rotation with abduction. It also requires normal scapular mobility and thoracic spine extension.

Start by having the tester determine athlete's hand length by measuring the distance from the distal wrist crease to the tip of the third digit. Then, instruct the athlete to make a fist with each hand, placing the thumb inside the fist. Next, tell the athlete to assume a maximally adducted, extended and internally rotated position with one shoulder, and a maximally abducted, flexed and externally rotated position with the other. During the test the hands should remain in a fist and they should be placed on the back in one smooth motion. The tester then measures the distance between the two fists at the closest point. Perform the shoulder mobility test as many as three times bilaterally. If fists are within one hand length, a score of three is given. If the fists are within one-and-a-half hand lengths, a score of two is given. If the fists fall outside one-and-a-half hand lengths, a score of one is given.

At the end of the shoulder mobility test, have the athlete perform a clearing exam. The clearing exam is added to the shoulder mobility test since shoulder impingement and shoulder instability can go undetected by a simple mobility test. This is not a diagnostic test. It is done simply to provoke pain. When pain is present, the shoulder should be examined and cleared by a physician prior to competitive athletics or conditioning. This movement is not scored; it is simply performed to observe a pain response. If pain is produced, a score of zero is given to the entire shoulder mobility test. This clearing exam is necessary because shoulder impingement can sometimes go undetected by shoulder mobility testing alone.

Test Five: Active straight-leg raise. The active straight-leg raise tests the athlete's ability to disassociate the lower extremity while maintaining stability in the torso. It assesses active hamstring and gastroc-soleus flexibility while maintaining a stable pelvis and active extension of the opposite leg.

Have the athlete assume the starting position by lying supine with the arms in an anatomical position and head flat on the floor. The board is placed under the knees. The tester then identifies the anterior superior iliac spine and mid-point of the patella. Between these two landmarks, the mid point of the thigh is found. The dowel is then placed at this position perpendicular to the ground. Next, the individual is instructed to lift the test leg with a dorsiflexed ankle and an extended knee. During the test, the opposite knee should remain in contact with the board, the toes should remain pointed upward, and the head must remain flat on the floor. The active straight-leg raise test should be performed as many as three times bilaterally. Athletes who successfully reach the end-range position with the malleolus located past the dowel receive a score of three. If the malleolus does not pass the dowel, then the dowel is aligned along the medial malleolus of the test leg, perpendicular to the floor. If this point is between the thigh mid point and the patella, a score of two is given. If it is below the knee, a score of one is given.

Test Six: Trunk stability push-up. The trunk stability push-up tests the athlete's ability to stabilize the spine in an anterior and posterior plane during a closed-chain upper body movement. It assesses trunk stability in the sagittal plane while a symmetrical upper-extremity motion is performed. Secondly, the clearing test checks for pain during passive hyperextension of the lumbar spine.

Begin by having the athlete assume a prone position with both feet together. The hands are then placed shoulder-width apart, the knees are fully extended, and the ankles are dorsiflexed. Have the athlete perform one push-up in this position. His or her body should be lifted as a unit; there should be no "lag" in the lumbar spine when performing this push-up. If a push-up is performed successfully, a score of three is given. If this is not possible, the hand position is moved to the lower point and attempted again. If this is successful, a two is given; if not, the athlete receives a one.

At the end of the push-up test is a clearing exam. This clearing exam is necessary because back pain can sometimes go undetected in movement screening. Pain with passive hyper-extension should be evaluated by a physician and diagnosed and cleared prior to competition or conditioning. This movement is not scored; it is simply performed to observe a pain response. If pain is produced a score of zero is given to the entire push-up test. This clearing exam is necessary because back pain can sometimes go undetected by movement screening.

Test Seven: Rotary stability. This test is a complex movement requiring proper neuromuscular coordination and energy transfer from one segment of the body to another through the torso. The rotary-stability test assesses multi-plane trunk stability during a combined upper- and lower-extremity motion.

Start by having the athlete assume the starting position with the shoulders and hips at 90 degrees relative to the torso. The athlete's knees are positioned at 90 degrees and the ankles should remain dorsiflexed. A board is then placed between the knees and hands so they are in contact with the board. Next, have the athlete flex his or her shoulder and extend the same-side hip and knee. The leg and hand should only be raised enough to clear the floor by approximately six inches. The elbow, hand, and knee that are lifted should all remain in line with the board, and the athlete's torso should also remain in the same plane as the board. The same shoulder and knee are then flexed enough for the elbow and knee to touch. This is performed bilaterally for up to three repetitions. If this is performed successfully, a score of three is given. If a three is not attained, then the individual performs a diagonal pattern using the opposite shoulder and hip in the same manner described above. If it is done successfully, a score of two is given. If balance is lost or the athlete cannot perform the movement, a score of one is given.

At the end of the rotary stability test is a clearing exam. This clearing exam is necessary because back pain can sometimes go undetected by movement screening. Pain with maximal flexion of the lumbar spine or hips needs to be evaluated and cleared by a physician prior to competition or conditioning. This movement is not scored it is simply performed to observe a pain response. If pain is produced, a score of zero is given to the entire rotary stability test.

Once you complete a functional movement screen for an athlete, you can apply it as a kind of quality assurance tool. During the preseason, for example, you can use the movement screen score as a functional baseline. If an athlete later becomes injured, you have an extra pre-injury baseline to gauge proper recovery. Even if the injury is no longer painful and the signs and symptoms of the trauma are resolved, the functional movement patterns may still be affected. Therefore, part of rehabilitation should be to restore the movement screen to its original level or even a higher level.

In the off-season during physical development, or during the competitive season, you can continue to use the athlete's movement screen score as a functional baseline for the conditioning program. If the screen score drops below the preseason level, or if it produces a score below 14, the strength coach can focus on first improving mobility and stability to improve functional movement patterns. If the screen score is adequate, the coach can focus on performance or skill training.

The concept of movement screening provides an additional perspective to the planning and implementation of training programs, and it identifies specific areas to focus your rehab or performance-training efforts.

To view detailed illustrations of the seven tests, descriptions of the equipment, and to see a score sheet with scoring rules, visit www.functionalmovement.com