In an editorial for the British Journal of Sports Medicine, Dr. Rod Whitely argues that “screening as we now do it is the same as player evaluation was years ago—it sounds like a good idea, but we are kidding ourselves if we think it is preventing injury.”
If you’ve been around in the sports performance business for the last few years, you have no doubt heard about movement screens. It doesn’t matter what one it is, what it’s called, or whether it requires an expensive workshop to be certified in it. I want to talk about the concept of movement screens.
The rise of movement screens strikes a chord because I think it coincides with the rise of trying to profit off anything. Whether it’s being certified in using scraping tools, movement screening, stretching, kettlebells, or whatever you’d like, the need to patent and profit is alive and well. The good old American way. Dr. Ben Goldacre, refers to this situation as Proprietorialization of common sense, where individuals take something that should be relatively obvious for any trained individual and attempts to make a profit out of it. In the athletic world, we could call it certification syndrome, due to the number of ridiculous certifications one can get.
What’s come along with this attempted patenting of simple ideas and concepts is a shift in mindsets. Dan Pfaff had a great quote the other day on twitter that struck a chord:
“I’m a believer that coaches have been doing movement screens for over 100 years and it’s called watching practice.”
It’s simple, yet true. What else are movement screens except for observing people move? If you’ve coached long enough, you’ve seen the athlete warming up with a hitch in his stride or perhaps spending a little too much time on the ground and looking sluggish. We’ve seen the athlete put on spikes and trip over himself a few times while doing drills signaling that perhaps something’s a bit off for the normally sure-footed runner. And we’ve all made adjustments to workouts based on this.
Taking it a step further, we’ve all watched the athlete run, jump, throw or perform some sort of coordination drill and thought “Hmm, he’s not so good at that, we need to work on that.” Whether that’s watching your athletes perform some crawling exercises in the weight room and noticing people’s movement limitations or seeing some land a plyo hop with a bit of buckling. We are constantly screening during practice. In particular, warm-ups are fantastic screening tools as they go through their accelerations and drills.
But what’s wrong with doing some more screening before hand you say? What’s wrong with grading a series of movements athletes make?
Well, I am probably going on too far of a limb here, but what we’re doing is shifting the process from a subconscious intuitive process to a deliberate/conscious one. We’re taking a process that is natural and dynamic with athletes moving through positions they are adapted to and prepared for, and instead taking them through a series of pre-determined artificial movements. When we do screenings we are looking for issues to fix. When we are watching practice, we’re simply observing.
This subtle mindset flip has profound impacts. The classic study example was actually performed by Dr. James Andrews who sent 31 pro pitchers to get MRI’s on their shoulders- All of them were healthy and had no complaints of arm issues. Of those 31, the MRI showed abnormal rotator cuff damage in 27 of them, and abnormal shoulder cartilage in 28 of them.
As my favorite foot doc, Dr. Don Baxter, liked to tell me, If I got a bone scan on any high level runner, I’d bet my money that a hot spot would show up.
When you look for something wrong, you can find it.
From the Coaches Eye:
The difference is subtle but key. Research shows that experts tend to pick up subtle cues based on experience. They’ve seen this athlete perform A skips thousands of time and if it’s performed with a very subtle hitch, they might get this feeling that something’s not right. Or they’ve seen hundreds of athletes perform an acceleration in a certain way and have experienced what it looks like when someone is about to tweak a muscle. These experiences build up enough of a model in our head so that we can draw upon this experience intuitively.
In a fantastic article by Gary Klein called Insight, Klein outlined the keys to decision making in stressful situations. What he discovered was that under such situations, the decisions were “recognition-primed decisions. The decisions are primed by their ability to recognize situations, and balanced by the monitoring of the mental simulation.”
In other words, we used intuition and pattern recognition to prime the decision and then perform some quick mental simulations of our choices to see if the outcome is satisfactory.
Klein defined intuition as a combination of intuition and tacit knowledge. Tacit knowledge is the opposite of explicit knowledge, which can best be described as knowing facts, and refers to the kind of knowledge that we can’t pass along, such as picking up perceptual cues, our patern recognition ability, and so forth.
Klein illustrates his point through a sporting example where he discusses the judging of an Olympic diving competition. A judge or TV commentator might note that a splash was slightly too large because the diver separated their ankles. While, us at home, barely notice a difference in the splash and certainly don’t see the slight ankle separation until the TV folks slow down the dive and pin point it. This immediate recognition of what was going on at full speed is what an expert can do. It’s the same across all sports, or even all activities requiring expertise. I was always amazed that when working with coach Tom Tellez that he’d watch someone sprint full out with only his eyes, see some minor detail that wasn’t obvious to anyone else, then you’d go watch the film frame by frame and he’d be spot on. His internal model of what proper running mechanics was so ingrained that he’d pick out subtle hints.
And when you do movement screening by watching practice we are relying on this intuitive tacit knowledge.
When we do a structured deliberate movement screening, we are relying on conscious explicit knowledge. We are going through the motions of checking off if the arm angle is X or if the foot placement is Y and grading it. We need both sides, just as Daniel Kahneman explains in his fantastic Thinking, Fast and Slow, but I can’t help but think that if we become overly reliant on screenings that we’ll lose the ability to rely on our intuition. We’ll override those slight feelings that arise of something being off because the movement screen said X, Y, or Z.
The “grade” becomes the object that matters.
From an Athlete’s perspective:
The same process of ingrained versus deliberately controlled matters in the athlete too.
When we perform artificial movement screens we switch how the athlete engages with movement. If I were to tell a well trained sprinter to do some accelerations with some dynamic warm-up drills of his choice afterwards, these would be performed as skills. His body knows what to do, there’s not a ton of deliberate step by step processing of the movement that’s going on. Instead, it’s largely an ingrained process of motor control.
When we see that an athlete deviates from his “norm” we’re immediately alerted something is wrong or “off” because these movements should be ingrained enough that it’s not simply him making a “mistake.”
When we perform movement tests, depending on whether it’s new or if it’s a simple versus dynamic movement, we’re testing something potentially far away from an athletes movement norms, and whether or not a learning effect is going on.
Instead of a look at how the athlete performs a skill, and using the deviation from that skill to let us know where the weak links are in the system or whether his CNS is fatigued or not, you are relying on assumption. That assumption is that whatever particular movement you are testing, relates in someway to whatever you are doing in the field.
And if you look at the research, the predictive ability of the movement screens for the sports I deal with are pretty dang low. For instance, this study found that runners with better scores on the Functional Movement Screen, were actually more likely to be injured. Well, that didn’t exactly work out like expected….
The reason for that are pretty clear:
The grading is subjective disguised as objective, which I’d argue that if we’re forcing grading, we’re missing the boat. The movements don’t always relate to the athletic environment. The screens look at a few very deliberate “concern areas” which only give a clue if one or two things might be a limiter. Tests are in a controlled environment, not a dynamic one.
Dr. Stu McGill had made the point that “Just because an athlete can does not mean they will” in reference to movement screens. His point was that just because athletes can move in a desired mechanical way in controlled conditions, doesn’t mean that they will move correctly under stressful and uncertain conditions. When you apply stress, whether that’s physiological in terms of fatigue, or emotional/cognitive, the world changes.
In essence, we have the same issues with tests that teachers have with them in the classroom. They provide some pretty little numbers, but do they really assess the issue we’re most concerned with?
I’d argue they don’t.
Now am I saying ditch the movement screens? No. They have many aspects that are appealing and perhaps worthwhile. I’m consistently impressed by the screening Randy Ballard does at Illinois, which consists of various tasks, filmed, to look at how a player actually moves in different tasks. The idea isn’t to throw the baby out with the bath water, but instead to make you question the hype and ask if it’s actually impacted your injury rate.
What I’m suggesting, is perhaps instead of needing to codify every single differences in movement, maybe we’d be better off by engaging in practice, giving attention to how our athletes move and building up a large enough bank of movement watching, that we can let our master pattern recognition software in our brain do it’s job.
The screens should be a part of our program to perhaps identify risks, but not lead to the robotic linear thinking of On test X you scored poorly, So you’ll have this problem, So we need to do Y rehab to correct this. The body doesn’t work like this- it’s a complex self-organizing system that needs challenged in a variety of ways. It needs to be challenged to figure out the best way forward, not trapped.
Attention is the greatest commodity we have to give, and in modern society it’s often the first one to go. Watch your athletes from the beginning to the end of practice. Challenge them and see where the point of breakdown is, mechanically, metabolically, psychologically- and figure out how to address them. Simply being being aware will tell you more than any screen ever could.