Exercise Is Medicine

by Jade Teta, ND, CSCS, and Keoni Teta, ND, CSCS

Functional Movement Systems

Too often, exercise protocols for musculoskeletal injuries focus on rehabilitation after the fact. Once these treatments are over, patients are often discharged with the same underlying movement disorders that led to injury in the first place. The reason? Up until very recently, there was no standardized understanding of what constitutes normal functional movement and therefore no way to predict and prevent or assess and correct injuries and movement disorders.

This gap has now been filled by the work of physical therapist Gray Cook and his colleagues. Together they have put together a system of screening and analyzing movement so it can be objectively measured, tracked, and corrected. If exercise is to be used as medicine, it is essential to establish a standard of practice in movement medicine. Prevention of musculoskeletal injuries is always the best treatment.

Moving More Is Not Always Moving Better

Exercise prescriptions with a sole focus of greater metabolic stimulus may not always be appropriate when prescribed to individuals with poor movement mechanics. While we are likely safe in our assumptions that overweight and obese individuals will move better with weight loss, this does not mean that they move well in general. Simply doing more activity may not be beneficial if it reinforces poor movement patterns and increases the risk for injury.

Human development from infancy to adulthood requires mastery of movement. The nerves and muscles work as a unit and are inseparable. Movement is usually thought of as animation of isolated anatomy. In reality, it is an integrated system of body patterns. The squat exercise, for example, is not simply a matter of contracting muscles and moving joints. It is a coded and rehearsed pattern of neurological firing translated into physical motion.

Movement Is a Pattern

We regard Cook as the foremost expert on functional movement in the field. He is the author of two foundational pieces of work in movement science. In his books Athletic Body In Balance: Optimal Movement Skills and Conditioning for Performance and Movement: Functional Movement Systems, Cook describes movement as analogous to the relationship between the software and hardware of a computer.^1,2 The muscles and joints act as the hardware, and the neuromuscular firing pattern is the software. In a computer, software is what controls and informs the computer. It works the same in the body, with the nervous system controlling the muscle. Addressing proper movement means attending to movement patterns and not isolating parts.

A Standard for Movement: The FMS and SFMA

The Functional Movement Screen, or FMS as it is popularly known, is “a ranking and grading system that documents movement patterns that are key to normal function.” By acting as a screen for movement, the FMS pinpoints movement dysfunctions that may predispose to injury or dysfunction.

The FMS defines a scoring sequence for ranking of the most limiting movement patterns unique to an individual. This scoring system provides direction to clinicians and helps define beneficial strategies for improvement and when they might be implemented. The FMS can be used to systematically screen underlying dysfunctions and help clinicians restore a foundational movement base from which conditioning programs can be built.

The FMS is complimented by the Structural Functional Movement Assessment, or SFMA. The SFMA is the diagnostic arm of this new functional movement system. The FMS and SFMA are designed to work as partners. The FMS is the precursor to the SFMA as well as a clinical follow-up tool. The FMS looks at seven distinct movement patterns, including a squat, lunge, and hurdle step. Its purpose is to define a baseline of mobility, stability, and pain-free movement.

The SFMA is the clinician’s tool for diagnostic determination. When pain presents during the FMS, the SFMA is used. Together, the FMS and SFMA provide a system that allows the design of tailored movement protocols. In this way, they are able to find, address, and track changes in movement from pain and/or dysfunction to recovery and optimal movement.

It is important to understand that the FMS is a screening tool, and is not meant to be diagnostic, but rather prognostic. The SFMA is the one of the two tests that is diagnostic and helps the clinician pinpoint movement issues more clearly as well as prioritize any necessary treatment. Once a patient has been discharged from any treatment protocol and pain is no longer present, the FMS is used once again to screen movement quality.

Recent Research

Several recent studies have shown the FMS to be a reliable and repeatable screening tool for movement quality. It has also been proved in its ability to predict injury in several high-risk population groups. Minick et al. demonstrated that the FMS has substantial “interrater” reliability when administered by both novice and expert users.³ This is one of the most important qualities of any new clinical tool.

When the FMS is tested in very active populations, its utility becomes much more clear. American football players were analyzed in a April 2011 study out of the Scandinavian Journal of Medicine & Science in Sports. The study showed reliable improvements in FMS scores after a standardized intervention that itself was based off the screening exam. This study also established a FMS cutoff score predictive of increased injuries in athletes.⁵

A 2007 study by Peate et al. showed that firefighters benefited from a FMS guided functional exercise program, with a 42% decreased injury rate. Absenteeism was also significantly reduced. The FMS guided intervention resulted in a 62% reduction in time off work due to injuries over a 12-month period.

Final Thoughts

In the past, no good tools existed to assess and correct movement-related dysfunction. Competence in movement patterns should be of prime importance and a precursor to increased exercise participation. The FMS and SFMA are new and essential tools for the use of exercise as medicine. They provide a much-needed “standard operating procedure” for movement quality. Gray Cook and colleagues have a clinical website, www.movementbook.com, that instructs on these movement systems and provides other resources for clinicians who are interested in learning these valuable screening and diagnostic tools.

Notes

1. Cook G. Athletic Body In Balance: Optimal Movement Skills and Conditioning for Performance. Human Kinetics; 2003

2. Cook G. Movement: Functional Movement Systems. On Target Publications; 2010.

3. Minick et al. Interrater reliability of the Functional Movement Screen. J Strength Cond Res. Feb 2010;24(2):479–486.

4. Kiesel et al. Functional movement test scores improve following a standardized off-season intervention program in professional football players. Scand J Med Sci Sports. April 2011;21(2):287–292.

5. Peate et al. Core strength: A new model of injury prediction and prevention. J Occup Med Toxicol. April 2007;2:3.