Gray Cook's Keynote at IFOMPT 2012

Click to read Gray's Keynote address at IFOMPT 2012!

Reconsidering How We Look At Movement: Screening, Testing, Assessing Movement Patterns

Introduced by Bob Rowe, president of AAOMPT - "very good friend, known each other for 25 minutes"

When we look at birth to age 3, we don't obsess over goniometry and MMT
Is it ever ok that we lose the ability to deep squat?

We just look at the way they move, and fundamental patterns of development
We need biomarkers for risk of injury - movement patterns
Normally we hit patients with a barrage of impairment measures

Does it have direct correlation with your function?

We need to screen people who do not have issues first
Other practitioners like dentists and MDs use biomarkers during routine screens to assess our health
We should be screening our patients twice a year using biomarkers

Biomarkers for injury risk (in order of priority)

previous injury

loaded statistic - probably had movement pattern asymmetry and/or motor control issues

asymmetry

the more distal you are, the more asymmetry we expect
the closer we get to your core, the less asymmetry seem to have less injuries

motor control
BMI
stupidity

can be identified, just not corrected!

After a patient is asymptomatic, we do a different test then when they have Sx.

starting with OMPT is the best neurophysicologic reset first
this invokes change without active participation from the patient
reinforce with

taping
bracing
education

protective
corrective - tape, corrective ex

SLS starts developmentally with rolling

not necessarily gluteus medius deficits
separate the asymmetrical asymptomatic patterns from the symptomatic ones
DNs - the more distal ones we should attack with correctives first

less likely to worsen a patient or cause a new injury if your correctives attack the DNs

Treat the symptomatic ones as a clinician
The patient's homework is on the asymptomatic

When the FMS is applied to children, workers, military, athletes

20% failure due to pain rate
these have passed full medical screening for ready to work or an athletic endeavor

What lead Gray to developing the FMS and SFMA

As a novice PT, he thought measuring impairments would predict injury
As a novice strength coach, he thought measures of performance would discovery dysfunction and predict injury
Measuring physical capacity without first establishing movement compentency
Performance tests do not tell you durability

Your d/c criteria should establish injury risk

If your squat is out, do not load it

ACL video

This young female was discharged for her left knee s/p ACL rehab
Would you have discharged her?
9 months later, her right knee was also repaired for ACL rupture

Gray found out he needed to look at movement patterns without impairments

to establish movement compentency so normative data could be gathered to be used for screening purposes

Motor learning is inefficient at best when in pain

That is why a 0 on the FMS is instructed to refer out to a PT, etc

The FMS across the lifespan

A young female athlete after ACL rehab scores below the FMS screen of a 60 yo female
Should that be the

SFMA

the distinction between the SFMA and the FMS is pain
because of pain, the assessment is now an individual situtation
no ordinal data
it is now a category of their movement
not a score

Treatment Considerations

your hands should deal with the FP and DP, exercise should attack the DNs
The greatest "strength" changes are seen in 4-6 weeks
our typical timeframe of Tx
if you're banking on motor control, you need to follow developmental patterns
if a patient cannot roll, or have stability in half kneeling, how do you expect them to practice single leg stance?

A Cyriax quote, "The physician arrives at a diagnosis not from the evidence furnished by one painful movement, but by careful determination of a consistent pattern."

I enjoyed seeing Gray speak in person as I have only read Movement, and had other instructors for the FMS and the SFMA. If you have not taken either of these courses, do not count them out as just simple gross movements. As PTs, we should be looking at movement patterns and in a systematic method. As in the checklist manifesto, you are are much less likely to miss something if you are following a systematic method of asssessment.

I also happened to meet Gray wandering around an empty hallway of the convention center, he was nice enough to talk shop. When everything settles down for him and he is back regularly at his practice, I got the invite to come down, watch him and Dr. Don Reagan, in action, and also do some video interviews! I am honored by the invitation and excited to see him in action at the clinic.