Movement screening: what it is & how it helps athletes

The main outcome of movement screening is insight; insight to you as an athlete and the ways in which you can look after yourself, become more efficient and to what level of training is best suited for you.

What is a physiotherapist and what do they do?

What is movement screening?

Movement screening is the process of analysing movement tasks for the purpose of understanding how an individual uses their body. The movement strategies they adopt, are or will, contribute to their physical performance or mechanisms of injury. The body was designed to move a certain way based on how the bones, ligaments, tendons and muscles are arranged. How an individual moves this complex system can be influenced by a lot of things, namely age, activity level, type of activity, sustained postures, limb length, previous injury, weight, etc.

When someone is interested in training, increasing training, or loading movement (i.e. to get in shape, improve sport performance, make activities of daily living easier), it has become more common for sports and health professionals to try to understand how an athlete may handle this load, hence screening movement first.

A variety of movement tasks can be put into a battery of assessments and called a movement screen, however, movement screens are typically made up of fundamental or primal movements that are found in sport, sport specific training and activities of daily living.

Above: ‘The overhead squat as part of the Functional Movement Screen. I question what ‘function’ this movement has in triathlon, as you can see from the position we, as triathletes, are predominantly in on the bike. However, this movement does highlight many ‘weak links’ and ‘compensations’ in my movement, of which require further screening tests to isolate and address. Word of warning! Please do not overhead squat like this…this is a great example of poor movement competency'

The reason is that fundamental patterns which are, squatting, lunging, single leg squatting, upper body pushing and pulling, and trunk bending and rotating are the foundation of all movement. Take a moment to visualise how these fundamental movement patterns exist in your everyday activity; for example, when you bend down to pick up something (Bend pattern) or squat down to get ready to lift something heavy (Squat pattern) or swing something (Rotation pattern) you are performing those fundamental patterns to some degree.

The more physical you are the more often you will perform these patterns and, therefore, how you perform these patterns becomes even more critical. By having you perform movement tasks that represent each of the fundamental movement patterns, the sports performance or sports medicine professional can better understand your movement skill, restriction, or compensation. These terms can be wrapped up into one, known as Movement Competency (Kritz et al. 2009). Simply put, it looks at how you load your joints and control the complex interaction and activation of your muscles to enable locomotion and movement through a variety of static and dynamic postures.

What is the purpose of a movement screen?

As a physiotherapist, much of my caseload is filled with patients who have already sustained an injury and require help to alleviate their symptoms and return to sport. The injury has already occurred, the demand placed on that soft-tissue/joint/bone has exceeded the tissues’ capacity. Demand can be acute in the form of a crash, or chronic in the form of subtle deviations in technique that puts stress on the soft tissue, and over time translates to injury. Predominantly, of the people I’ve asked ‘why have you been to physio?’ the top answer I hear is ‘I hurt my…’ or ‘they treated my…’. There appears to be a misconception that physiotherapy solely rehabilitates injuries and has no role in helping prevent them.

I am a strong believer in ‘if it isn’t broke, why fix it’. Based on human anatomy, strength and conditioning principles, human biomechanics, simple physics and research, sports performance and sports medicine professionals are able to detect areas which may predispose you to injury (Hewett et al. 2015., Myer et al. 2010). With movement screen information you can explore the potential reasons behind any apparent movement incompetency and get an understanding about how your movement competency may respond to exercise (increased volume, intensity or load). This can also be used as a performance enhancing tool, identifying which patterns can be more aggressively loaded and which require more development.

The purpose of a movement screen is NOT to diagnose, because a screen is not comprehensive enough to tell you WHY you are moving the way you are. Nor is it to make you fearful of injury or to ‘make you move normally/properly’. Assessing an injury and assessing ‘human movement’ are not the same thing. Assessing an injury is reactive; the injury has occurred so the sports medicine professional needs to try and understand why, and what is required to optimise healing. Assessing how a person moves is proactive; it provides valuable insight into your movement strategies which may predispose you to injury if the intensity and magnitude of loading you are currently experiencing continues.

In elite sports, movement screening is often performed pre-season alongside other fitness tests with the aim of preventing injury and ultimately, guiding an athletes’ training program to ensure the right interventions are being prescribed and they are training within their competency and capacity.

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Do I really need a movement screen?

Let’s reframe the question, are you someone who…

Wants to be in good physical condition to cope with variability in training load?

Trains regularly and wants to make sure their training is contributing to performance and not mechanisms of injury?

Has a reoccurring niggle or injury and wants to know whether its related to your movement competency?

Or think of it this way… We as athletes, (especially triathletes) love investing money on the latest pieces of technology to make ourselves become more efficient and ultimately, to race faster. Some, love spending hours cleaning their bikes and racking them in a prize position on the wall. Funny how we ‘have’, or ‘make’ the time to do this, yet struggle to find time to take care of ourselves to enable us to continue to do what we love.

An athlete's body is their engine, chassis, and frame. The most important and potentially efficient ‘piece of kit’ you have. It’s been tested and retested for over 1 million years, and self-identified its flaws, evolving to meet the demands of the world; just as we evolve to meet the demands of training load and exercise. Yet one side effect in human evolution is that as humans, we move toward strength and away from weakness. Therefore, like the bikes you ride, shoes you run in or cars you drive, your bodies need an ‘MOT’ to better understand how you are adapting to the training and physical stimulus you are engaging in to ensure you maintain performance and prevent breakdown (i.e. injury).

Movement screens are not miracle cures, but they are designed to give you an insight into why you move the way you do and what movement compensations are occurring. This information can then be used to better understand if the compensations may potentially lead to injury or sacrifice your sport performance.

As an athlete, I have been fortunate with a sparse injury history and I’m swimming, running and cycling the fastest I’ve ever been, so you may think ‘why bother?’ But, to flip it on its edge, I want to get faster and I want to be able to maintain a higher training intensity. Additionally, I know I have an underlying hip injury which is exacerbated by increased training load and volume.

From screening these basic movements I have now discovered a wider picture of compensations related to stability, mobility and strength deficits around my hip which has helped inform and guide my training. It has enabled me to train with more intensity and progressively increase my running volume. In addition, the screening identified movements that targeted my weaker areas, and by doing them regularly as preventative exercises and using treatments such as massage and joint mobilisation I have been able to train as programmed by my coach. As a physiotherapist and athlete, having learnt the hard way, I now make the time and effort to fully practice what I preach and to be more proactive with injury prevention.

The benefits of a movement screen are intended to prevent you having to take time away from training, and to prevent all the associated stresses and costs.

What screening tools are there?

There are several screening tools out there which are commonly used within sports and rehabilitation settings, alongside a number of assessment methods and testing procedures. Specific screens have been developed to help identify athletes at risk. They allow for replication and re-test reliability. Screening was made popular by Brett Allen and Gray Cook, two accomplished and noteworthy physiotherapists that developed The Functional Movement Screen (Cook et al. 2006) at a time when ‘functional training’ started to become in vogue.

There is also the Movement Competency Screen (Kritz. 2012), designed by Dr. Matt Kritz, a strength and conditioning professional who wanted to better understand the movement competency and movement capacity of the athletes he was coaching, before prescribing exercises and training programmes designed to enhance their performance. After two decades coaching development to elite athletes in professional and Olympic sports, he realised the importance of understanding how an athlete moves, rather than the movement itself. This is of vital importance when considering an athlete’s long term physical development and their ability to sustain, or enhance performance and reduce the incidence of injury.

As a physiotherapist, I am strong believer in having to know the demands of the sport each athlete competes in. Therefore, if I was to screen you as a regular bowls player or triathlete, I would do the background research and ask you, the expert, what you perceive them to be. The demands and the ‘functional’ movements required are sport specific, and what is considered ‘functional’ for one sport may not be for another. The word ‘functional’ is used a lot, especially when describing or qualifying certain ways to train. Siff (2002) simplified the notion of functional training by asking, ‘does the movement pattern or movement you are training, enhance the ‘functional’ competence of your sport?’

How movement screens, which use standardised fundamental movement tasks as we have discussed here, translate to sports specific movement competency is beyond the scope of this article. However, hopefully you are now able to appreciate that within every sport, fundamental movements are the roots of a movement task and there-in lies the reason screening fundamental movements are so effective. They are the stripped down version of a more complex sport specific movement, and how you perform those basic movements can shed significant light on why you may be struggling to perform more sport specific movements or why certain sport specific movements hurt when being performed.

What is the likely outcome of a movement screen?

If you were to complete either of the two screens mentioned here, the outcomes maybe different, as they are designed with different core principles. The Functional Movement Screen© provides information about the degree of mobility in your ‘mobility regions’ (Thoracic spine, hips, ankles) and stability in your ‘stability regions’ (Shoulders, lumbar spine, knees and feet). The results can be influenced by soreness, stiffness, or previous injury, which can make prescribing interventions less effective (Frost et al. 2012). The Movement Competency Screen©(MCS) provides information about the quality of the aforementioned fundamental movement patterns, recommending how, and to what degree of load may be used in a training environment to minimize your risk of injury (by otherwise loading a movement pattern performed with faulty technique). Essentially, the MCS score for each pattern is your load level for that particular movement pattern.

The reality is that the information from whatever screening tool, fitness test, musculoskeletal assessment used, will most likely result in a piece of paper with exercises on it, alongside a report and reasons as to why you will benefit from them or other physiotherapy modalities. The main outcome of a screen is insight; insight to you as an athlete and the ways in which you can look after yourself, become more efficient and to what level of training is best suited for you. As well as this, it provides a baseline measure which can be used to monitor your training, and refer to if, in the unfortunate event, an injury occurs.

What did it do for me as a triathlete?

I always thought I had a good insight as to why I moved the way I did, and I used to blame a lot of it on my hip. But in all honesty, I think it was just a good excuse. The human body is interconnected in a complex interaction of the nervous and musculoskeletal system. I was naive to think it was just ‘my hip’, that I was strong enough and good enough not to compensate or that I didn’t have weaknesses in balance and stability. I think had I not done the screens (and had I not become a physio) I would still take the same approach thinking ‘I don’t need to train balance or stability, that doesn’t make me stronger or faster, that won’t help my hip’… well, it does and it can. Think of the wider picture.

Before I did the screens and did my own research I just used to turn my Training Peaks ‘Core and Stability’ sessions green, when instead I’d go to Crossfit (and then wonder why I can’t run the next day). Bad I know, and a lesson learnt the hard way. I now put these sessions at the forefront of my training, not only am I enjoying them, but I’m also really feeling the benefit. It’s good to keep testing and challenging yourself, but this can be done in a way that doesn’t mean overly exerting yourself. Take the time and effort to do them. Go find someone that can do a screen for you… see what they advise, take on-board the advice and see where it takes you. If you never have one, you will never know if you could have been more efficient, train more or avoid time out of training with injury.

Alison Wilson was Great Britain’s fastest female age-group athlete at Kona 2016 and is a physiotherapist working for Body In Motion, High Performance Sport (in New Zealand). She takes a special interest in elite sports and adolescent sports injury management.

Dr. Matt Kritz PhD has spent over two decades working in professional sport, including four Olympic Games with ground and water based athletes who competed in 19 Olympic sports and won over 22 Olympic medals between them. He is now Director of Product Development & Coach Performance at Athlete Nation Limited.

"I believe strongly that movement matters most. How an athlete of any age uses their body is critical when you consider their long-term development or their ability to sustain elite performance over a long career," he says.

References:

Frost, D.M., Beach, T.A., Callaghan, J.P. & McGill, S.M. (2012). Using the Functional Movement Screen™ to evaluate the effectiveness of training. Journal of Strength & Conditioning Research, 26 (6):1620-30.

Hewett, T.E., Myer, G.D., Ford, K.R., Paterno, M.V. & Quatman, C.E. (2016). Mechanisms, Prediction and Prevention of ACL Injuries: Cut Risk With Three Sharpened and Validated Tools. Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/jor.23414

Kritz., M., Cronin, J. & Hume, P. (2009). The Bodyweight Squat: A Movement Screen for the Squat Pattern. Strength & Conditioning Journal, 31 (1): 76-85

Myer, G.D., Ford, K.R., Khoury, J., Succop, P. & Hewett, T.E. (2010). Development and validation of a clinical- based prediction tool to identify female athletes at high risk for anterior cruciate ligament injury. American Journal of Sports Medicine, 38 (10): 2025-2033