Monday, May 18, 2015

Does Movement Assessment Really Tell You Anything?

Whether you are a physical therapist, an athletic trainer or a strength and conditioning coach, movement assessment has application across all the professions and with every athlete you see.  A good movement assessment can tell you where the athletes deficits are, what injuries they are at risk for and how those deficits will impact performance. Yet, there are many in the various fields that really question whether or not this is applicable.  How does this one isolated movement correlate to risk of injury and/or athletic performance?  Some of  these questions are legitimate and well founded.  As some professional organizations have selected various movement assessments professing to assess injury risk, do they "show or identify" the movements indicated in the research to be correlated to injury?  Sadly that answer is no.  Sadly they are now seeing the repercussions of that with increased rates of ACL injuries and health care costs.  Why are they not working?  Simply if you want to reduce ACL injuries, you need an assessment that identifies the movements associated with ACL injuries. 

Often many critics of movement assessments will base their perceptions on the understanding of one of the assessments on the market and question how those movements correlate to injury risk and performance.  Although some of those questions are well founded, they do not apply to all movement assessments.  Although we feel most of the movement assessments commonly used have some application in sports, we feel some may be more suited than others.  That said, a well founded movement assessment should be based on the research and it should, can and will assist in identifying deficits in the system.  Secondly, the movement assessment has to be physically challenging enough that it puts the athlete in fatigue like conditions so you can truly assess how they move when it counts the most.  It can not be a shot gun approach that one assessment fits all athletes no matter what level of athlete you are.  Just like a good mechanic working on a Formula 1 car can identify small imperfections in a car's operation which has a great impact on performance, a good movement assessment can do the same.  Yet, the mechanic also runs the car through race like conditions to see how it functions when performing at or near peak performance.  A good movement assessment can and should do the same and be scalable to test all levels of athletes.

Over the course of the last several months, we have presented papers and research to try to clarify many of the questions related to movement assessments.  Most of them are related to movement assessment and the impact on performance and injury prevention.  As health care providers and scientists, this research is critical.  It is important that whatever we use be based on the most current research in the field.  In the area of biomechanics, the movements associated with increased risk have been well publicized and investigated.  The challenge has always been to bridge the gap between biomechanics, physical therapy and performance enhancement.  Each brings it's own area of expertise but yet few have combined that continuum to develop a comprehensive approach to movement.  For years, we have known what the movements are, but what exactly does it mean and how do you improve.  The first component is knowing how to test.

Throughout our blog we have talked about a Movement Assessment we useIt should be clear, we are the founders of this assessment and therefore realize that there is some bias with that.  That said, the beauty of this  assessment is that it is not rocket science.  Once people see it, it just makes sense.  You don't have to make the jump from how the movement impacts injuries or performance, it is clear.  You can see it.  This test is also based on the most current literature and it does identify the movements we "know" put an athlete at risk for injury and which impact performance.   This movement assessment consists of 6 essential movements to sport and which reveal the movement patterns we know that put athletes at risk.  Once the athlete performs, you can see clearly the deviations and how these would impact performance.  Taking the following D1 soccer player to the right as an example.  We can clearly see, after completing the fatigue component where her system is breaking down and how this will contribute to loss of kinetic energy in the system and abnormal loading of the tissues.

If a movement assessment is designed right, each subsequent test performed should aid the examiner in determining where the system is falling apart which should drive the interventions.  With the advent of technology and our understanding of biomechanics, this is much easier today than it was 10 years ago.  Although there can be many contributing factors to the overall movements themselves, technology provides us the ability to determine where the kinetic chain is falling apart and from that determine the root cause of the problem.  With a well structured assessment, differentially diagnosing this can mean the difference between using an orthotic in an athlete, strengthening their hip or both an orthotic and hip strengthening.   From a performance standpoint, anyone who looks at these pictures can clearly see how this would impact an athletes ability to maximize their sprint speed and improve their vertical jump.  In the example of the young athlete in the single leg squat position, most can see how there is a loss of kinetic energy across the system which will impact her overall performance. 

If on the other hand, we look at this athlete performing a single leg hop, this becomes even more evident the impact this will have on injuries and performance.  In this example, looking at the position of the femur in relation to the tibia, we can see how this may lead to patellofemoral issues, patellar tendonitis or an ACL injury.  At the same time, looking at the entire kinetic chain, we can also see how these mechanics can lead to loss of kinetic energy at the foot/ankle, knee, hip and lumbar spine.  Loss of kinetic energy equates to decreased endurance, decreased power output and decreased strength.  Just from this one test alone, we can clearly see the impact this would or could potentially have on injury rate and performance.

So is this just female athletes and only for the less skilled?  Absolutely not.  There is major application across all sports from recreational to professional.  Perfect example is the athlete seen below.  Although this was captured in his combine tests, his movement assessment score indicated he was at low risk.  However, this may be partially due to the fact that the assessment that was used was not able to identify the movements that placed him at risk nor was it challenging enough to put him in sport like conditions.  So, whether you deal with recreational athletes or pro-athletes, males or females, movement assessment can be a critical component to your injury prevention and sports enhancement routine.

Trent Nessler, PT, MPT, DPT:  Physical Therapist | Author | Educator |Innovator in Movement Science and Technology.  Dr. Nessler is a physical therapist and owner of Athletic Therapy Services.  He serves as a practicing clinician and movement change consultant for practices and organizations looking to develop injury prevention initiatives and strategies.  He has been researching and developing movement assessments and technologies for >10 years is the author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.  You can contact him directly at

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