Basic Screening & Assessment

Most trainers, massage therapists, and strength coaches do not possess an adequate skill-set when it comes to screening and assessment. This isn’t necessarily their fault as it is poorly taught in most of these profession’s educational curriculum. In fact, so many people get very nervous and almost paralyzed by the idea of having to do some screening or evaluation that they choose to do nothing instead. Some people get so carried away with ridiculous assessments that are practically meaningless that it’s easy to see how one could get a nasty case of “paralysis by analysis!”

However, having a basic evaluation system for things like full-body mobility and movement capacity (including stability) will really set you apart from other professionals and allow you to be more effective at your job. The key is to stay within your specific scope of practice and realize that as non-medical professionals, we cannot “diagnose” anything and are simply obtaining information on each client to guide their safety and effectiveness in movement/exercise.

In this blog Keats Snideman is going to take Bret Contreras through a basic length-tension (mobility/flexibility appraisal) screening system that he uses to evaluate his clients. This screen is used in addition to more dynamic movement screening that includes the FMS as well as some basic table assessments. This blog will show videos outlining his table assessments.

The Functional Movement Screen (FMS)

Before we move onto the table assessments, it is important to have a basic understanding of the FMS. The FMS is a 7 test screen developed by Gray Cook and Lee Burton used to evaluate fundamental movement patterns. The screen will assess risk and can identify situations where the client experiences pain and should be referred to a specialist, situations where a client needs to work on balancing out asymmetries, situations where a client needs to work on increasing mobility, stability, or motor control to improve a particular pattern prior to engaging in various activities. The 7 tests include the deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability push up, and rotational stability. The FMS is a very valuable assessment tool that every trainer should incorporate into their arsenal.

Basic Table Assessments

The table assessments that Keats uses consists of a breathing pattern assessment, a head & neck mobility assessment, a t-spine mobility assessment, a shoulder mobility assessment, and a hip, foot & ankle, and big toe mobility assessment. These basic tests are assessing what is called ”passive movement testing” (although they can all be done actively as well). Passive movement can be further broken down into what is called “physiologic motion,” which is what we are going to be demonstrating, and “accessory joint motion” (joint play, component movements). Accessory movement testing is beyond the scope of testing for the intended audience of this blog so those tests should be left to licensed professionals trained in orthopedic manual assessment.

Breathing Pattern Assessment

In this video, Keats takes a look at Bret’s breathing patterns. He’s looking for natural diaphragmatic breathing that involves breathing into the belly prior to breathing into the thorax.

Head and Neck Mobility Assessment

In this video, Keats takes a look at Bret’s neck mobility from various directions. Normal ranges include 0-80-90 degrees of cervical flexion, 0-70 degrees of cervical extension, 0-30-45 degrees of cervical lateral flexion, and 0-70-90 degrees of cervical rotation.

Thoracic Spine Mobility Assessment

In this video, Keats takes a look at Bret’s t-spine mobility from various directions. Normal ranges are difficult to isolate since the t-spine is intimately connected with cervical and lumbar spine function. Suffice to say people need to be able to at least reverse the normal thoracic kyphosis to straight and be able to rotate at least 45 degrees in each direction from a tall seated position with the hips/pelvis stabilized. The T-spine is truly a huge player in full body movement capacity, breathing, and posture. Its influence on the c-spine (including the jaw/TMJ) and shoulders is often ignored in painful conditions.

Shoulder Mobility Assessment

In this video, Keats takes a look at Bret’s shoulder and scapular mobility from various directions. Normal ranges include 0-180 degrees of shoulder flexion, 0-60 degrees of shoulder extension, 0-180 degrees for shoulder abduction, 0-90 degrees of external rotation, and 0-70 degrees of shoulder internal rotation. Also included are basic length tests for pectoralis major, pectoralis minor, latissimus dorsi and teres major which to a large part determine the mobility in this region.

Hip, Ankle, and Big Toe Mobility Assessment

In this video, Keats takes a look at Bret’s hip mobility, ankle mobility, and big toe mobility from various directions. Normal ranges include 0-120 degrees of hip flexion (with bent knee), 0-90 with straight/extended knee, 0-30 degrees of hip extension (from prone position (knee extended), 0-45 degrees of hip abduction, 0-30 degrees of hip adduction, 0-45 degrees of hip external rotation, 0-40 degrees of hip internal rotation, 0-20 degrees of ankle dorsiflexion, 0-50 degrees of plantar flexion, 0-35 degrees of inversion, 0-15 degrees of eversion, and 0-65 degrees of big toe extension (although only 45 degrees are needed for gait). Also included is the thomas test for hip-flexor length. Not shown but extremely important is the “obers test” for hip-abduction contracture/tightness.

What do I do if Clients Don’t Possess Normal Ranges of Motion in Various Joints?

There are three basic scenarios that can occur with your assessments:

1) The individual will possess adequate ROM that doesn’t require any remedial stretching or mobilizations. For these people, a quality training/conditioning program will serve to maintain the range they already have. Semi-frequent re-testing is needed to make sure this range of motion isn’t lost however.

2) The individual has excessive ROM which may or may not be a problem depending on the strength and motor control capacities of the person. Too much ROM (hypermobility) can be just as bad in some situations as too little ROM! For specifically assessing if someone has too much ligamentous laxity/hypermobility all over their body, the Beighton Score is an easy testing protocol to administer.

3) The individual will possess decreased ROM/hypomobility in a given joint motion which could signify that either a musculo-tendinous/fascial or “extra-articular” (outside the joint) problem exists. Or, there could be a problem within the joint (intra-articular) that would required more attention to the joint capsule and other structures that would be best performed by a licensed professional trained to administer joint mobilization (Osteopath, physical/physio-therapist, chiropractor). This is a good reason for personal trainers and bodyworkers to have a good network of other professionals who can perform any specific joint work that might be needed. The basic goal with these people is to improve the range of motion of the truly short or stiff tissues. Utilizing the corrective strategies concept as promoted by the FMS, once lost ROM is regained, it must be backed up with some stability training (static, then dynamic stability) in order for it to stick. Stretching in and of itself is often not enough to change movement in any meaningful way!

A Hypothetical Scenario – Tight Hamstrings

Corrective exercise for a mobility restriction or stability problem is an art unto itself and would require an entire book (just read Gray Cook’s new book which should be available soon) to list all the various protocols. To give one example of a corrective sequence, let’s say that an individual has poor hamstring flexibility. Perhaps they are overworked from synergistic dominance due to weak glutes and tight hip-flexors on the other side. You would want to incorporate self-myofascial release for the hip flexors and activation work for the glutes in order to “release the brakes” on the hamstrings and decrease hypertonicity.

You would also want to incorporate various types of stretches and mobility drills for the hamstrings. Finally, you may want to start the client off with rack pulls and work on gradually increasing the range of motion until a full range deadlift can be perform while maintaining a neutral spine. Knowing various drills and progressions is critical in improving motor patterns and eliminating dysfunction. Assessments & Screens provide you with great information but you also need to know what to do with that information in terms of exercise selection and program design.

At any rate, we hope you enjoyed the videos. Over time, we will try to post more blogs that provide more information on screening and corrective exercise. Thanks for reading and watching!

-Keats Snideman and Bret Contreras

aslr

21 thoughts on “Basic Screening & Assessment

  1. Carlos

    Bret,

    Nice. Keats shows additional information that really makes a big difference. Kudos to both both coaches.

    CV

    Reply
  2. Mike Arone

    Great job guys. Some overlooked aspects of training that people seriously need to take into consideration. The videos were clear and to the point. Those tests are easy enough to conduct daily and will help tremendously….thanks!

    Mike

    Reply
  3. Danny McLarty

    I’ve been performing these assessments for years now, (most of them anyway). And yes, they’ve been helpful with many of my clients. The problem I have (sometimes, not always, but enough to be a concern IMO) is that when I “dig” deeper to confirm something, there are times when the confirmation I’m looking for actually goes against what the other assessment indicated. Other assessment but looking for the same thing. What I mean…

    Let’s say I do the Thomas Test and it shows that the client’s thigh lies parellel to the ground, indicating the psoas is not tight. Then, when he/she does the active (in supine) leg raise, the down leg comes up. This makes me think that maybe the psoas is tight, and contradicts what the Thomas Test just “told” me. (this seemed to happen a bit with Bret’s leg in the video as well) I’ve also seen this with the Thomas Test and the “Neutal Spine Test” (where you stand with your back to the wall and see how much of your hand your can fit behind the person’s back). I could give a few other examples, but I think you get the point.

    Anyone ever have similar findings… where you get an indication on 1 assessment but then later on, the next assessment seems to contradict it?

    Wouldn’t mind getting some thoughts from people so I can continue to work on my assessment skills.

    Thanks!

    Reply
    1. Keats Snideman RKC, CSCS, LMT

      Danny, you bring up some good points for sure! I think the main thing to keep in mind with any of these types of tests is that no “one” specific test is indicative of anything. Tests like these can only be suggestive of particular trends going on (like tight/short hip-flexors or anterior hip structures, including nerves such as femoral nerve). You have to combine them with other, more active/functional tests to see the big picture.

      What you mentioned with the thomas test appearing OK followed by a straight leg raise that seemed to contradict it, is not abnormal. Differences in passive muscle stiffness are going to have more effect during movment of the other limbs and can make you suspect that dynamically, the person may not be able to control the pelvis and lumbar spine dynamically, so I would put more stock in what happens actively than passively.

      In a follow-up blog, I want to film some other type of assessments similar to Janda’s muscle imbalance tests that can shed some more light on things like passive muscles stiffness and muscle firing order. In general though, what happens when people stand up is ulitmately most important, not what they show on a table.

      Keats

      Reply
  4. Dan Hubbard

    Bret,
    Thanks to you and Keats for taking time to make and share these concise and informative videos! I am always trying to improve my assessment skills.

    Reply
  5. Carlos

    Danny,

    I would work with a qualified PT on your testing to see how accurate you are doing things and to see why such “paradoxical” findings are happening with your clients.

    Reply
  6. Danny McLarty

    Carlos,

    I’ve got every assessment (well, not every, but a lot) dvd under the sun. And whenever I watch the author go through the assessment with the viewer (like in the videos Bret provided for this link), I am always like, “yep, that confirms that I am doing it right.” Although, I agree with your thought. If I was to actually get in front of a qualified PT, he/she would probably say that I am just a little off here, or a little off there, causing the “paradoxical” findings.

    I must say again, it doesn’t happen every time, just more than I’d like to see/think I should see.

    Thanks.

    Reply
  7. Carlos

    Anyone wishing to do gait? GRF from sport will not always manifest with table tests but table tests can confirm gait changes. Bret perhaps you could do a video with Carson on a before and after assessment? Many coaches are interested in fixing, not just finding.

    Reply
  8. Dr. Anthony

    Great post!

    I think people need to be careful though about how far they push this. Its a common trap for all health care professionals to try and be the “cream of the crop”. While its excellent to posses this skill set, its also excellent to posses a strong network that is reliable. I learned how to do sutures but do it do it everyday? No. So why wouldn’t I sent a patient to someone who does? The answer is, I will, unless I am so greedy and egotistical that I think I have the unltimate solution.

    Great leaders know when to delegate.

    This stuff is important but if the client is in a state of pain or recurring pain, for the love of God, send them to someone you trust. Build yourself a power network, get respect from multiple disciplines and give your clients the best care possible. Easy as that.

    Thanks for the awesome blog Bret! Its a wonderful breakdown…

    Dr. Anthony

    P.S. My network includes but isn’t limited to the following, the true skill is know when and how to use them!

    Physiotherapist
    Pain Managment Specialist
    Clinical Psychologist
    Massage Therapist
    Pastor (Christian)
    Accountant
    Financial Manager
    General Practictioner
    Orthopedic Surgeon

    Reply
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  11. Pete Ross

    Great stuff Brett: you’re a marvellous source of information. Moreover, my own personal research is being directed by your blog. I’ve also downloaded your e-book. I’ve got so much to learn I’m going to have to be reincarnated to have enough time learn it all!

    Reply
  12. Api

    Hi Bret,

    As an undergraduate at AUT, New Zealand I am doing a research project on using a screening assessment within a commercial gym. I know about the FMS but I have gone with the Movement COmpetency Screening (MCS) by Matthew Kritz, mainly used to assess athletes to improve movement competency and performance. I thought it would be a good idea amongst the public population as most lack basic Movement patterns, have crap mobility,flexibility and stability. Iv am focusing on improving the squat pattern only, so using MCS to determine the correct squat pattern then through a strength programme intervention hopefully progress participants from assisted loads (Strength bands), body weight load and then onto external loads (Free-weight)and re-assess at the end for results. Just wanted to know your thoughts on this project. I know its just brief but any feedback would be much apppreciated. cheers

    Reply
    1. Bret Post author

      Hi Api, I’m familiar with Matt’s screen (have the journal article on it and have spoken to Matt). It’s a great screen. I love your idea – using the squat to improve the squat, and using a systematic progression scheme. I’d just make sure I gave them a lot of frequency. As in 4-7 days per week with lots of sets (but not lots of reps per set). For example, 10 x 3. This way they focus on quality and sinking down into the squat, thereby increasing mobility and stability. When you start adding load, do so by having them hold onto a db or kb in the goblet position. The frequency will dramatically increase the effectiveness of your intervention, so you might have to assign “homework.” Just my two cents! – BC

      Reply
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  14. Conrad

    Great videos! Thanks for the post! And goniometers suck. One thing I particularly picked up was placing something b/w the clients knees when doing the seated t-spine rotation assess. I use the SFMA quite a bit and have previously never really gained good info from that test because people always shift at the hips so this will bring the test back to usefulness for me.

    Reply

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