Home Posts tagged "Functional Movement Screen"

10 More Important Notes on Assessments

About 2.5 years ago, I wrote up an article, 10 Important Notes on Assessments, that was one of my most popular posts of the year. And since I’ve spent a good chunk of the past week going through the L2 Fitness Summit Video Series, Dean Somerset’s presentations on the assessment side of things made me realize that I'm ready for a sequel. Here are a few thoughts that came to mind.

1. Just like training, assessments are getting more specialized.

As the sports performance and even personal training worlds get more specialized, the assessments we need to utilize with our clients must be correctly matched up to the people in front of us. As examples, rotator cuff strength tests are huge for a baseball pitcher, but relatively unimportant for a soccer player. We’d “weight” a single-leg squat test result as less significant for a kayaker than we would for a basketball player. The goals of the client and the functional demands of their sport guide the assessments – both in terms of which ones we perform and how we value the results.

However, the challenge is that you can’t test everything, so it’s important to prioritize. If we used every assessment under the sun, the evaluation would last all day – and we’d spend an entire session pointing out everything that’s wrong with someone. I’d much rather use this time to build rapport.

A VO2max test isn’t high on my list of priorities for baseball players even if it might shed some light on their aerobic base. I can probably get the information I need just as easily – and much more affordably – by taking a quick resting heart rate measurement.

2. Every good test that has an unfavorable outcome immediately sets you up for an even more telling retest.

Assessments give you a glimpse into what could potentially be wrong or right about how someone moves. The more important question is: what interventions make a difference? Their squat pattern improves when you give them an anterior counterbalance? Their hip internal rotation improves when you add some core recruitment? Their shoulder pain goes away when the massage therapist works on their scalenes?

One tenet of the Selective Functional Movement Screen (SFMA) system is to always start with dysfunctional, non-painful patterns. What interventions clean up aberrant movement in non-painful areas to give us "easy" adaptations? This not only expands our movement repertoire, but also facilitates buy-in from the athlete/client.

3. Never go to movement screens without first performing a thorough health history and client “interview.”

I think we can all agree that a pre-participation evaluation can dramatically reduce the likelihood in training. And, I'd argue that the single most important part of this evaluation is the health history and conversation you have with them before they even start the movement screen portion of it.

As an example, imagine you have a hypermobile female client with a history of serious anterior shoulder instability that hasn't been surgically treated. If you do thorough paperwork and a detailed conversation with her, you'll quickly ascertain that you have to be careful with anything that involves shoulder external rotation. If you don't do that preliminary work, though, you might very well pop her shoulder out of the socket doing a basic external rotation range-of-motion test.

Summarily: paperwork first, conversation second, movement third!

4. Have assessment regressions for people who can’t perform certain tests due to pain or poor movement competencies.

I like to use a Titliest Performance Institute screen – lumbar locked rotation – to assess thoracic rotation. It requires an individual to get into a lot of knee flexion, though. So, if you have someone who is extremely short in their quads – or has had a knee replacement and permanently lost that motion, then it’s not a solid test.

You’re better off going to a seated thoracic rotation screen with these folks.

As a good rule of thumb, you’ll need more alternatives to general screens (involving more joints and motor control challenges) than you will for specific assessments (involving fewer). So, as you look through your assessment approach, start to consider how you’ll regress things when things don't go as planned.

5. Don’t overlook evaluating training technique as a means of assessing.

During almost every evaluation of someone who has struggled with pain or performance (which is really everyone), I look at technique exercises they commonly perform. For our pitchers, this might be arm care exercises, or a video of a bullpen. For powerlifters, it might be technique on the squat, bench press, or deadlift. As much as our assessment protocols can be thorough, they’ll never fully offer the specificity that comes from watching people actually train.

6. Don’t use tests to embarrass people.

As an extension of the previous point, if you know someone is going to fail miserably on a screen, don’t test it. If you have a 350-pound woman who wants to lose 200 pounds, she’s not going to do well on a push-up test. You can assume that her upper body strength and core stability aren’t sufficient to handle her body weight.

I keep coming back to it:


7. Watch for straining.

This is something I’ve watched for a lot more in recent years after spending time around my business partner, Shane Rye, who’s one of the best manual therapists I have ever seen. He’s a master of watching people move and picking up on where they tend to store their tone. Maybe it’s jaw clenching when you test rotator cuff strength, or making an aggressive fist when you check their active straight leg raise. Watching for changes in accessory tone can give you a glimpse into where you might get the best benefit with your manual therapy work – and how you might coach them differently while they’re training.

8. The best outcome of an assessment might actually be a referral for a more thorough assessment.

At least once a year, I have an assessment come in - but without doing any training, I refer them on for further evaluation. Usually, it's because something very "clinical" in nature presents, and I feel that they need to see a medical professional before we start working with them. It doesn't happen often, but I'm never shy about "punting" when I feel that someone else is better equipped than I am to help the person in front of me.

9. Don’t take their word for it on body weight.

I once had a 6-8 pitcher tell me that he weighed 235 pounds. The next day, he walked in and remarked, “Coach, I actually weighed in this morning. I was 253 pounds.” Now, 18 pounds isn’t as huge a percentage of total body mass on a 6-8, 253 guy as it is on a 14-year-old, 110 pound female teenager, but it’s still tell us a lot that he could actually swing 18 pounds without even feeling it. That’s a sign of an athlete with poor body awareness and a lack of nutritional control (they definitely weren’t a good 18 pounds). You're better off measuring than just asking.

A side note: this applies to male athletes only; I never weigh female athletes for obvious reasons.

10. Take meticulous notes.

I often find myself looking back on notes we have on long-term clients to see how their movement (and prescribed training) has evolved over the years. It wouldn't be possible if I wasn't very detailed in my note-taking - and this is something I'm always striving to improve upon, as we want to create sustainable systems in our business.

Employees move on, so a client's programming responsibilities may be shifted to other staff members. Sports medicine professionals may want to work from some of our notes. Teams and agents might want information on what we discovered with a player and how we plan to manage them. The more you document, the more prepared you'll be in these situations when collaboration is necessary.

Most importantly, though, whenever I write a new program for a client, I have their evaluation form and their previous program open on my computer. I want to see what I initially noticed and put it alongside the up-to-date programming to verify where we are in our progressions. It's this kind of documentation that allows me to program for dozens of athletes who are not only in our facility, but across the country and overseas.

Wrap-up

I've been assessing athletes for close to 15 years, and I find that our evaluations evolve every single year. If you're looking to stay on top of some of the latest developments on this front, I'd strongly encourage you check out the L2 Fitness Summit Video Series, the new resource from Dean Somerset and Dr. Mike Israetel. It's available at an introductory discount through Sunday at midnight.  You can learn more HERE.

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10 Important Notes on Assessments

I'm a big believer in the importance of the "Assess, Don't Assume" mentality. However, it's crucial that assessments be approached the right way in order to deliver optimal results in strength and conditioning programs. Here are ten thoughts on the subject:

1. Assessments are an easy way to differentiate yourself.

With this era of semi-private training and bootcamps, there are still a lot of coaches and facilities out there that pay no attention whatsoever to pre-participation screenings. On one hand, it's a sad commentary on our industry, as one could argue that omitting assessments sets clients up for injuries. On the other hand, it creates an excellent opportunity for skilled coaches and trainers to differentiate themselves in a low-barrier-to-entry industry. If you're not assessing, you're just guessing! Make it a priority to start learning more about your clients/athletes.

2. Thorough assessments include both specific and general components.

In my eyes, every assessment can be categorized as either specific or general. Specific assessments may be anything from single-joint range-of-motion (ROM) assessments to the provocative tests physicians and rehabilitation specialists may use. They identify specific things like elbow extension ROM or whether a particular test elicits pain.

Conversely, general assessments look at global movements and evaluate multiple joints at the same time. Examples include overhead squats and push-ups.

The problem is that both kinds of assessments can fall short. As examples, you may see unstable young athletes who pass all ROM assessments (specific) with flying colors, but fold up like lawn chairs when they do an overhead lunge walk (general).

You may also see athletes with perfect overhead squats, but significantly limited knee flexion ROM that would make you concerned that they'd pull a quad (rectus femoris) while sprinting. These are just two examples, though; there are countless more we could cite.

3. You must always be willing to refer out.

You're better off being a great trainer/coach than you are trying to be an incredibly subpar physical therapist or physician. Even if you had a tremendous knowledge of provocative tests and rehabilitation techniques, as a trainer/coach, you don't have the same resources (e.g., diagnostic imaging equipment) these professionals have. Furthermore, diagnosing is outside your scope of practice, anyway.

I refer out every single week. It creates great opportunities for collaboration that will benefit our clients/athletes, and for our staff to learn from related professionals. If you see something on an assessment that raises a red flag, it's better to be safe than sorry.

4. Don't assess just for the sake of assessing; make it to the point.

My biggest assessment pet peeve is when the process takes too long. You can do an incredibly thorough evaluation in about 30 minutes, and most shouldn't even take that long. The only ones that would require more time would be those with extensive injury histories or other unique circumstances.

[bctt tweet="The sooner you're done assessing, the sooner you can get to training."]

5. Assess in the context of both injury history and functional demands.

As a follow-up to point #4, you never want to go into a movement assessment "blind" with respect to the person in front of you. Rather, it's best to first review a health history and have a discussion about training history, goals, athletic demands, and expectations. I find that it's best to perform an evaluation with a better knowledge of an individual's history than it is to look at movement and then work backward from it.

For example, if your pre-assessment discussion reveals that an individual was a baseball player growing up, you can expect to see more external rotation on his dominant shoulder. That might lead you to look more closely at whether he has adequate anterior shoulder stability, and whether his scapula upwardly rotates enough. It also might help to explain a low right shoulder.

RightER

Basically, you need to see the big picture; the "answers" are usually a combination of a bunch of tests, questions, and observations.

6. You have to emotionally separate yourself your personal biases when it comes to assessments.

Baseball players are the largest chunk of my clientele. As a result, I evaluate shoulders and elbows in a ton of detail.

Recently, we started training an NFL punter, though.

I did a thorough assessment with him, but let's just say that we didn't spend a ton of time worrying about verifying that he had perfect elbow ROM. Instead, we spent a lot more time looking at his core and lower extremity; otherwise, the assessment would have taken all day, and we'd acquire a lot of information that wouldn't have a significant impact on his programming.

7. Don't let hypermobile clients/athletes "cheat" assessments.

Just like you need to have both specific and general assessments, you also need to make sure to include both mobility and stability assessments. Hypermobile (loose-jointed) individuals are notorious for cheating assessments that are biased toward ROM. Comprehensive assessments need to also evaluate stability.

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In this vein, the Functional Movement Screen does a good job of looking at both sides of the equation. The shoulder mobility, overhead squat, and straight leg raise tests are general assessments largely biased toward mobility, but the trunk stability push-up, hurdle step, rotary stability, and in-line lunge screens are all predominately stability challenges.

To learn more about how hypermobile folks can "cheat" assessments, check out my article, 15 Static Stretching Mistakes.

8. Have some feel; don't make new clients (or any clients) uncomfortable.

If a man is overweight and uncomfortable with his body, it's probably not a great idea to have him take his shirt off for a scapular screen. If a woman is seriously deconditioned, it's probably not a good idea to put her through a lunge assessment that she'll fail miserably. And, it's an even worse idea to do these things in front of a crowded gym.

           Remember that the first day is as much about
           building rapport and starting a friendship as it
            is about evaluating how an individual moves.

As has been said in the past, "They have to know how much you care before they care how much you know."

9. Don't forget to highlight what individuals do well, too.

In How to Win Friends and Influence People, Dale Carnegie wrote, “It is always easier to listen to unpleasant things after we have heard some praise of our good points.” This point applies to fitness and movement assessments, too. Think about it: would you like to be criticized non-stop for 30 minutes? Probably not.

By contrast, if someone highlighted what you did well while also covering some important growth areas for you, wouldn't these suggestions be more well received? Absolutely.

Again, your goal is to establish a great relationship, not just analyze movement.

10. Remember that training is a never-ending assessment.

Every exercise is an assessment. Each time your clients and athletes move, they're providing you with information. The more you pay attention, the better you'll be able to individualize their programs and coaching cues moving forward.

If you're looking for more information on the assessment side of things, I'd encourage you to check out our Functional Stability Training series. These resources go into great detail on evaluating the lower body, upper body, and core.

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