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MOVEMENT SCREENING
ordination, predominantly taxing clients’ neurophysiology. In this world muscle recruitment is ‘king’. Harmonised synergist and antagonist recruitment is one sign of good motor control ‘health’. Low ‘quality or poor’ movement health systems present themselves through poor movement control, with resultant substitution patterns and timing and sequence imbalances between stabiliser and/or mobiliser synergists, evidence of altered inter-muscular co-ordination.
Motor control movement screens set non-fatiguing co-ordination and alignment challenges that, if failed, identify faulty movement. Movement that should appear smooth and effort free proves shaky and challenging as inefficient muscle recruitment strategies, correlated to injury, are employed. Performance of two tests of motor control in injury free dancers predicted subsequent injury occurrence over a six month period .Those with poor motor control movement qualities were more likely to be injured irrespective of force or range capabilities which, within these subjects, would be expected to be excellent.
Two Ways Of Looking For The Same Thing On face value biomechanical and motor control protocols (such as the Neuro- Physiological Model) may seem poles apart. Fortunately, although distinctly different physiologically they are united by what they find, namely deficits in movement control. Uncontrolled movement can be classified as physiological or accessory joint actions that cannot be consciously controlled or limited from occurring once the client has been made aware of them and has had several attempts at their correction. The dilemma trainers’ face is which school of thought to join, the subtleties of motor control (see Fig. 3) or the world of strength and range? Ticking the range and strength box allows them to keep these familiar injury related factors in check. However, if the injury risk is motor control specific, trainers may well be delivering less sessions as their clients become somebody else’s patient. Choosing one to the exclusion of the other allows the spectre of injury to remain.
A screening tool capable of a unified approach has, until recently, remained elusive. Finally, the combination of motor control and strength expertise has led to
specificity. Every movement of every exercise has clear purpose, addressing movement faults with either strength, range or recruitment based strategies. The most important person in the process is of course the client. The hope is fewer will need referral outside of your profession into therapy based training, allowing goal achievement in the gym and pain free movement everywhere else.
Fig 3. ‘Subtle’ motor control exercise
current state of the art hybrids. The ‘4x4 Express Screen’, developed by established clinical rehab authors Mark Comerford and Sarah Mottram, is a model of this dual thinking. Its series of multi-joint tests reveals uncontrolled movement evident during alignment and co-ordination, non fatiguing activity in addition to identifying strength and or speed related problems in both the upper and lower body. 4x4 reveals to the client they have a movement control issue. To the trainer it demonstrates the need for a screening tool that is respectful of the varied components of movement, above and below a fatiguing and non- fatiguing threshold.
Once identified, the problem needs fixing and although 4x4 reveals ‘threshold’, it cannot make clear the specific site (i.e. lower back) and direction (flexion) of the movement fault. For such clarity the movement screen has required one more evolutionary step.
The Performance Matrix Movement and Performance Screen (MPS) is currently used globally in elite sport (Premier League, NBA, rugby, dance companies). Its 10 tests pinpoint what the 4x4 cannot. It reports the threshold in addition to the site and direction of the uncontrolled movement risks, rating these risks and allowing for a prioritising of exercise strategies. Armed with such a sharply defined movement control profile of the client, exercise prescription can achieve a unique
Further Reading Hodges, P. W. (2003). Core stability exercise in chronic low back pain. Orthop Clin North Am Apr, 34: 245-54.
References 1. Parkkari, J., Kujala, U. M., & Kannus, P. (2001). Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work. Sports Med, 31: 985–995. Locke, S, (2003). Case control analysis of low back pain at the Queensland academy of Sport: are historical variables useful? J Sci Med Sport 6; Supplement:60 (Proceedings of Australian Conference of Science and Medicine in Sport: tackling the barriers to performance and participation Canberra Australia). Reed, F. E. (2004). The preparticipation athletic exam process. South Med J, 97:871-872. Schwellnus, M. P. (2004). A clinical approach to the diagnosis and management of acute muscle injuries in sport. Int Sport Med Journal 5: 188-199. Fuller, C., & Drawer, S. (2004). The application of risk management in sport. Sports Med, 34: 349-356.
2. Mcneill, W. (2011) Release or recruit. Journal of Bodywork & Movement Therapies (2012) 16, 101-108. 3. Comerford, M. J., & Mottram, S. L. (2012). Kinetic Control: The Management of Uncontrolled Movement. Churchill Livingstone. Australia. 4. Roussel, N. A., Nijs, J., Mottram, S., van Moorsel, A., Truijen, S., & Stassijns, G. (2009). Altered lumbopelvic movement control but not generalised joint hypermobility is associated with increased injury in dancers. A prospective study. Manual Therapy; 14: 630-635. Comerford, M. J., & Mottram, S. L. (2012). Kinetic Control: The Management of Uncontrolled Movement. Churchill Livingstone. Australia. Brooks, C. M. (2012). On rethinking core stability exercise programs. Australasian Musculoskeletal Medicine.
THE AUTHORS Lincoln is a member of the world renowned Performance Matrix team, developing and delivering movement screening & retraining courses for personal trainers & Pilates instructors. He maintains a select PT client base in gyms and homes in addition to his tutoring role for training provider YMCAfit. Mark is a Director of Movement Performance Solutions and world renowned performance and clinical rehab expert, educator and author. His various collaborations have included work for the Chicago Bulls (NBA), Washington Wizards (NBA), and West Side Dance & Physical Therapy (New York City Ballet).
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