Screens have become a popular trend in sports medicine in an attempt to keep players from injury and improve on-field performance. A very recent article in the British Journal of Sports Medicine by Roald Bahr put these screening methods into question, calling to light the complexity of understanding injury risk and possible risk factors in such a dynamic environment. These screens can come in various forms, including as sport specific screens, such as a TPI Golf Screen, or general screening systems like the popular Functional Movement Screen (FMS).

While the FMS has grown in popularity, its validity as a pure injury-risk screen based on composite score has come into question. However, a new approach, which is beginning to be looked at through research and clinically, is to use these “screens” as a baseline for performance. Gray Cook advocates for a clean toe touch and symmetrical 2’s on the Active Straight Leg Raise screen to be able to safely learn a deadlift pattern. A savvy coach or therapist can utilize the rest of the tests to create buckets of exercises which should be avoided or trained based on results of the seven FMS tests.

From a therapy standpoint, the most important findings of the screens and assessments we use are to determine how to treat impairments. Using the Functional Movement Systems way of evaluating movement, there are three categories of issues – Tissue Extensibility Dysfunction, Joint Mobility Dysfunction, or a Stability-Motor Control Dysfunction (SMCD). Each category requires different treatments, which is why a one-size-fits-all therapy approach simply does not work.

There are a million ways under the sun to attack a TED, and no clear-cut winner on which method is the best. The consensus, though, is that if it works for you, that’s the best. Physical therapists often talk about having lots of “tools in their toolbox,” which is why so many seek out continuing education courses to learn about new techniques that might offer relief to a slow-responding patient. A small sampling of these systems includes Self Myofascial Release (SMR), dry needling (DN), instrument assisted soft tissue mobilization (IASTM), Active Release Technique (ART), the EDGE Mobility System or Eclectic Approach, and many others. The most commonly seen is SMR – it is relatively easy to teach and can be done on your own with a few items like a foam roller, a tennis/lacrosse/golf ball, and various other common items. Techniques such as ART, DN and IASTM often require advanced education courses only provided to licensed medical professionals and students, and there are even different schools of thought on how these techniques can be applied. However, none of the research is conclusive as to which technique works best. Systematic reviews and meta-analyses come with lukewarm recommendations at best, but at the same time, there is still a growing body of evidence being formed since many of these specific techniques are relatively new. As will be discussed later, though, most clinicians would agree that simply performing one of these techniques is not nearly enough to fix an issue. Many therapy outlets and practitioners, like Erson Religioso, use a computer analogy to these techniques – they can change the movement document that exists in your brain, but some form of exercise has to be performed afterward to hit “save” on the changed document.

JMD’s are a little more difficult to attack than a TED, and require the guidance of a medical professional to fix. These often include arthritis, a joint subluxation, surgery, etc. Again, various techniques exist, including gentle joint mobilizations, distraction, or manipulations. Both JMD’s and TED’s are body-related issues – bottom-up in neurological terms. For whatever reason is specific to the patient, the body’s joints or tissues have stopped working at their full function and need to be fixed.

These two are in contrast to an SMCD, which is a “brain-down” issue, which can arise for many reasons. Often, these will show up after a TED or JMD is corrected, and your brain hasn’t quite remembered how to use the range that was lost while the tissue or joint was dysfunctional. The goal is to get the brain to “remember” how to use the right muscles to, for example, move the arm further overhead. These corrections often come in the form of drills that use various body positions and forces applied to specific muscles to force the body to move in the right way. There are almost countless ways to accomplish these fixes, whether that be from manual facilitation, the use of bands, or even the colorful tape you might see on professional or Olympic athletes. SMCD’s can also arise naturally due to poor training, either through improper form, too much load on a tissue, or not enough recovery. A frequent debate is whether or not these specific, naturally arising SMCD’s need to be addressed aside from normal training, and, in my personal opinion, that’s the next step in performance.

These screens don’t need to just be performed once and checked back when an issue arises – using them regularly to look for sport-specific preparedness can improve performance and reduce injury risk. Using the earlier idea of the FMS creating buckets of exercises, athletes can and should be quickly screened before movements to make sure there aren’t any day-to-day changes in their movement capacity. Things as wide-ranging as injuries, previous training sessions, how the athlete slept that night, or how much walking they’ve done today can all affect preparedness. Research has shown that FMS scores can change over the course of a season or due to a training program, and while practicing a test can often lead to learning or practice effects, a true screen should be above that level.

Bobby Prengle, SPT, CSCS
Par4Success Intern, Summer 2016
Class of 2017
Duke University School of Medicine
Doctor of Physical Therapy Division
For more on the Physical Therapy services we offer here at Par4Success, please visit our Physical Therapy page.