No matter what your movement practice is (pumping iron, CrossFit, calisthenics, yoga, etc.), every movement practice should have a means of assessing where you at currently, and have ways of tracking improvements over time. If you don’t include this component in your training or movement practice, how do you know if you are improving the way you want? How do you choose which exercises to use? How do you know how to design or structure a program that is conducive to hitting your goals? If you are a professional working with clients, how do you know which therapeutic intervention or training modality is most appropriate to address a client’s symptoms or goals?
Assessments are meant to give us an idea of what is not functioning optimally, what is comprising said function, and how we can get a big-picture idea of how those pieces fit together in order to create a corrective and preventative strategy to restore function and optimize movement.
One key element of how I like to assess clients is to use a global-local-global approach in our movement assessment. This is one of the key tenets of a technique I utilize regularly in my practice, Dynamic Neuromuscular Assessment (DNA).
Straight from the DNA manual,
“When we notice an imbalance in the integration of the movement, we can then start looking at the components of that movement. Local assessment is looking at the individual pieces that would combine into the greater movement. When the dysfunctional component is corrected, then the global movement is reevaluated.”
We’ve all heard the expression, “a chain is only as strong as its weakest link,” and that idea certainly applies to human movement. Whatever global movement we do, we need to understand what components make up those global movements, what is the function of each of those components, and what is impairing that function, ultimately creating a weak link in the chain.
Here’s a simple example:
A client comes in getting elbow pain throwing a baseball. The global movement is throwing a baseball. Some necessary pieces involved in throwing a baseball might be:
rotational mobility of the thoracic spine
eccentric lengthening of the lats to decelerate the arm
and/or coordinated timing of pronation/supination in the forearm
Muscles/soft tissues of the thorax, shoulder, arm, & hand
If any of these “local” components are not functioning properly, the global movement will be compromised. Let’s say there is limited mobility in the thoracic spine, which is causing the scapula and rotator cuff muscles to compensate, and through biomechanical inefficiency, the pain shows up at the elbow. If we correct the client’s inability to rotate through the thoracic spine, the weak link in the global movement has been fixed, and chances are good that the elbow pain will resolve as a result.
No matter what techniques or strategies you use to assess movement, utilizing a global-local-global approach, is the best possible approach for restoring movement to the fullest capacity, and getting the best outcomes for relieving pain and restoring functional movement.
What is Missing from Most Assessment Strategies?
Many of you out there, particularly fitness professionals, might be familiar with the Functional Movement Screen (FMS), created and popularized by Gray Cook. FMS has become one of the gold standards for screening movement within the training space, but even Gray himself would be the first to tell you that there are absolutely shortcomings with it. The FMS is a great example of how we would assess movement at the “global” level. Unfortunately, an assessment like this does not necessarily give us enough information as far as what is causing those global movements to not function properly. We need to dig deeper.
One of the common shortcomings I’ve seen and experienced firsthand throughout the years with different movement assessment techniques is that they more or less end up just boiling down to, “Can you do this?” To which the proposed solution is often, “If not, practice it until you can.” This is a tedious and unpredictable solution. Unfortunately, most fitness professionals simply don’t have the knowledge or skills to assess movement much deeper than their own subjective idea of what a movement should “look like.”
Another pitfall with most movement assessment strategies is that they often lack the tools to assess movements at a local level. This is where something like manual muscle testing can really become a powerful tool in your arsenal as a movement professional. We can specifically assess the function of individual muscles, joints, connective tissues, reflexes, etc.
In the example I previously mentioned (baseball pitcher), I could have my client throw a baseball, and I could then utilize muscle testing to assess whether or not that movement is functional for them. If not, the nervous system will compensate and this will show up in a muscle test, either creating a hypertonic (locking up) response, or an inhibitory (shutting muscles off) response. I could then assess where the aberrant nervous system response is coming from, whether it is structural (lats, shoulder ligaments), physiological (pancreas and spleen are related to lats), or an emotional memory/experience (remembering the pain and associated psychological stress from an old wrist injury). Once I fix the dysfunctional component, the global action of throwing a baseball should greatly improve because we normalized the weak links the body was compensating around. We would then want to test the limits to which his nervous system and structure can tolerate load, volume, etc.
This leads me to my next point: most movement assessment strategies also lack the tools to assess how physiology and emotions affect motor output, not just structure. In the above example, I just named just a few potential things that most techniques would not even think to look at that might be affecting the motor output of the muscles involved in throwing.
What Should a Good Movement Assessment Include?
I contend that every good assessment should have a few objectives. Primarily, a good assessment is a fantastic opportunity to establish trust and connection between the professional and the client. This includes getting a better understanding of who the person is, what makes them tick, what sort of lifestyle they live, what their goals are, and what those goals mean to them. Essentially, every assessment needs to start with clarifying for both the professional as well as the client WHY they are there in the first place. If you don’t start with why, the goals become blurry, and the pathway to achieving those goals gets even blurrier. We also want to get a thorough injury history and a better understanding of past traumatic experiences (physical and emotional).
On the movement side of the equation, a good assessment should look at:
Soft tissue quality
Fundamental movement patterns
When we look at joint mobility, we want to assess both passive and active and note any discrepancy between the two. All of our joints generally have normal ranges that should be accessible. Often times passive mobility range of motion exceeds active, which is indicative that instability is more likely the cause of limited mobility, rather than structural limitations in the joint itself. Distinguishing between passive and active mobility in a joint’s range of motion is important for deciding whether to aggressively mobilize the joint (structural problem) or creating more stability in a synergistic area, thereby decreasing the protective tension and muscular guarding around the joint.
As far as tissue quality is concerned, we mostly want to make note of tissues and different muscles that are too high tone and too low tone. Based on research done by Dr. Jose Palomar, the creator of a therapeutic technique called Proprioceptive Deep Tendon Reflex (P-DTR), we have an incredibly thorough understanding on how the nervous system creates compensation patterns. Muscles having too high or too low of tone are indicative that the muscles themselves are part of a larger compensation pattern, and many muscles can be involved in any given pattern. Muscle tone is directly related to muscle function. Palpation and tissue quality can be a simple and effective means of following the breadcrumbs to the source of the dysfunction, and can be used as a before and after measurement for changes in nervous system compensation.
In the context of strength training, I there are several foundational movements that I like to help clients improve: breathing, getting up, walking, squatting, hinging, pressing, and pulling. In my practice, I often times also look at sport-specific or activity-specific movements. Whatever I am working with a client to improve, I’m always cognizant of the fundamental kinetic chains that ALL human bodies utilize. Working with athletes, we can get very specific with movements we want to assess. However, before getting too specific, we want ensure all of the basic kinetic chains are functioning independently and that they are functioning relative to each other.
Before we can throw a baseball, we need to have good balance between our anterior and posterior spiral kinetic chains (posterior – wind up; anterior – follow through & release). Before we can have good functional balance of our anterior and posterior spiral kinetic chains, we need to have proper axial stability through our lateral and deep longitudinal kinetic chains. In order to create proper axial stability, our intrinsic core and breathing structures need to be functioning optimally. The layering of these kinetic chains and building functional strength in a way that focuses on integration of these kinetic chains is the best way to restore and maintain function, minimize injury risk, and improve performance-based metrics like strength, speed, power, and endurance.
One other piece probably relatively unique to how I like to assess clients is to also take a look at basic neurological reflexes to make sure the body is integrating multiple systems, not just the musculo-skeletal system. This includes things like visual reflexes, labyrinthine reflex, head-on-neck reflex, joint position, nociceptive withdrawal reflex, and other peripheral receptor-based processing. It’s all important.
There are many ways to assess movement. However, if you are looking for the most optimal way to assess all of the potential factors that affect motor output, muscular function, and ultimately movement and athletic performance and injury risk, you need to have many different tools in your toolbox.
I’m a huge advocate for movement professionals expanding their knowledge and toolbox to enable them to assess with a global-local-global strategy. This requires knowledge in many different areas, and requires techniques and unique skill sets to be able to do. The traditional ways in which we have thought of pain, nervous system influence, and movement are being pushed to new frontiers as integrative techniques like DNA, P-DTR, and others are making new discoveries and new ways to open up healing for clients.
If you’d like to learn more about some the techniques I utilize, please feel free to reach out with questions!