GRAY COOK

Assessing Movement: A Contrast in Approaches, Part Three of Three

This transcript has been edited for smoother reading. Editorial decisions were made to retain Gray’s meaning while
converting the live lecture format to text—Gray has not reviewed this transcript for accuracy.
For more information on this workshop DVD, please visit
movementlectures.com, functionalmovement.com or otpbooks.com.

My earlier discussions this morning focused on the movement screen as the entry point for a movement model. With
the assistance of Kyle Kiesel and Mark Cheng, we’re going to run through a quick screen.
This isn’t really an appropriate venue to try to scrutinize the movements. If you want to invest yourself and give the
movement screen a deeper look, this is all in the Movement book. We also have plenty of material and videos online at
functionalmovement.com.
As they go along, we’re going to transfer the movement information to this white board. With that information, I’ll
discuss what to do and not do with the information. Stuart McGill had some great points earlier regarding being specific in
specific situations. However, I want to pose one question for you to ponder during the movement screen demonstration.
Is there such a thing as a movement vital sign?
We’re all familiar with vital signs. Regardless of your specialization, there should be a comprehensive vital sign that
makes a statement about a person’s health or state of readiness.
That was my intention with the Functional Movement Screen (FMS)—to develop a movement-pattern metric.
Should we assess a movement vital sign before we introduce a change in movement? That question is where this all began.
Most people are getting ready to enter some type of movement situation, be it tactical, athletic, fitness or weight

1—Gray Cook—Assessing Movement: A Contrast in Approaches DVD transcript, Part Three of Three
For more information on this workshop DVD, please visit movementlectures.com, functionalmovement.com or otpbooks.com.
loss. Can we begin with a common denominator on
a general screen? Can we then get more specific as we
need to?
I want to stress that the movement screen is not
a point to assess anything the patient or athlete is cur-
rently doing. So, back to our vital signs: Initially, it’s
not important to know why a person is hypertensive.
First, determine if there’s hypertension.
You shouldn’t load a screen too heavy—it will be
too restrictive and/or not productive enough. All we’re
trying to do is categorize movement patterns.
There’s been some confusion about the order of
the tests. These tests can be performed in any order.
We perform the movement screen in a certain order
for convenience and flow. It can be intimidating for
new patients if we begin by lying on the floor with us standing over them. That’s one reason to progress from upright tests,
then going to the floor.
With the deep squat being first, it would seem to be the most important test in the movement screen, but it’s actually
the last pattern we take action on. If you had a poor score on every one of these tests, we make you first try to improve
every other test. Then we tackle the squat, because it’s an accumulation of almost every one of those other patterns.
Movement screens have been around for a while. When Dr. Cheng edited a project Brett Jones and I did, he helped
us better understand our dissection the Turkish getup, an exercise that’s probably familiar to you. A lot of information has
come from Pavel Tsatsouline of StrongFirst and others, but we could look back in history and see that the Turkish getup
was used to evaluate triplanar mobility, stability and symmetry.
There’s something absolutely brilliant about the seven patterns in the Turkish getup. If we use the Turkish getup as
a screen, one of the first things we do is locate where restrictions are. The goal is not to stand up with the weight, it’s to
look at the integrity of each position change. If you have integrity on one side, wouldn’t it be nice to have integrity on the
other side?
The Turkish getup is non-specific. I like to see a little bit of symmetry in the body, but we’re not going to obsess on
that. There are a couple of different ways you can get asymmetry in the movement screen. You can have a ‘3’ and a ‘2.’ You
can have a ‘3’ and a ‘1.’ You can have a ‘2’ and a ‘1.’ The ‘1’ is basically what we’re calling dysfunction.
Always look for the ‘1s,’ and if they’re associated with an asymmetry, see if the movement can be improved. I’m not
telling you it has to be improved, but it’s a movement parameter. It’s probably affecting proprioception and the input of
the system.
These are the movement issues to clear before
we start exercising. I’m constantly surprised by the
diversity of the intake criteria exercise profession-
als use when preparing to stress people. The tests
of the movement screen can definitely help with
program design, but they can also tell us what not
to do.
Remember, we talked about removing a neg-
ative. If we’ve got a dysfunction somewhere, there’s
a limitation as well. Seek to explain it first and ask
yourself, “Do I want to load this at its current level
of quality or should I try to improve quality before
I impose a load?”
We use terms like movement competency
versus physical capacity. Does this mean we don’t

2—Gray Cook—Assessing Movement: A Contrast in Approaches DVD transcript, Part Three of Three
For more information on this workshop DVD, please visit movementlectures.com, functionalmovement.com or otpbooks.com.
screen and test physical capacity or don’t consider structure, especially in a medical situation? We absolutely still take these
measures. We’ve got a two-minute top-tier drill in the Selective Functional Movement Assessment (SFMA). Find dysfunc-
tion in a pattern and it sends you down a rabbit hole.
The Movement book includes an exhaustive decision-tree detailing paths to break out these differences. We only end
up at two places on that decision-tree; it’s either a mobility problem or a motor control problem. Both are impairment
measures that demand attention.
There could be an anatomical reason or a contributing component for this problem. Every situation we uncover may
not be structural, so we have a responsibility to follow through. A screen only gives us a movement baseline on the intake
model and then sends us somewhere else.
If one of these patterns hurts, I’ll do a lighter-duty movement assessment and see if I can still provoke that pattern
with something in the SFMA. The SFMA is also going to see how many dysfunctions the patient has that aren’t painful.
Think about that algorithm—we don’t need a scoring system in the SFMA, though it would be nice to see one. Once again
not for the total score, but for communication purposes—we’re setting a baseline.
We don’t use a numeric scale in the SFMA. We use four different options in a movement pattern.
• Functional or normal movement that does not provoke pain
• Functional or normal movement that pro-
vokes pain
• Dysfunctional, limited or compromised
movement that provokes pain
• Dysfunctional, limited or compromised
movement that does not provoke pain
The last one, the dysfunctional, non-painful
pattern, is slipping right under our noses in clinical
practice. I believe it’s what we’re talking about with
regional interdependence. It also could be a contrib-
uting factor to the ‘repeat offenders’ we see in reha-
bilitation—the people constantly returning with an
unresolved problem or with significant limitations
because we’ve aggressively attacked the symptomatic
pattern. We assume the dysfunctional pattern has always been there and isn’t a contributing factor. I’m not saying it is; I’m
saying we only have one opportunity to play this game. Try to do something with the dysfunction that’s not provoking
pain and see if it changes the pain marker.
I’ll present a quality deep squat as an example. Not much movement prep is necessary in that deep squat. Following
the movement, I don’t have a reason to not load or train some of these patterns. But before I loaded or trained some of
these patterns, wouldn’t it be nice to have some type of performance metric? Could I do a better job if I knew his goals?
His sport, career, hobbies or activities? His medical history?
We have no pain on any of the demonstrat-
ed movements. That’s the most important thing.
When we begin training this person, start loading
patterns and modifying the program, we now have a
baseline, a marker in time that helps measure move-
ment as we pursue physical capacity, specialization
or other fitness goals.
How are these changes affecting movement?
We just want to know the changes. We want that
movement vital sign and we want to see if it fluctu-
ates or shifts. People having anatomical reasons for
not moving well, a lot of our ‘2s,’ almost always get
caught by these questions. We could make an argu-

3—Gray Cook—Assessing Movement: A Contrast in Approaches DVD transcript, Part Three of Three
For more information on this workshop DVD, please visit movementlectures.com, functionalmovement.com or otpbooks.com.
ment that a certain structural issue is going to kick you right into a ‘1,’ and be quickly determined.
Often those structural issues are complicated by pain. Setting this baseline is a quick way to see whether that struc-
tural issue is going to immediately create a movement
compromise when we start imposing loads. I have a
10-minute screening drill. If there’s nothing there
that needs to be improved, get on with the program.
In the case of this example, if we had performance
issues or we were trying to mine better performance,
there’s no evidence to say that movement needs to be
any better. Get on with it.
Stuart addressed specialization and perfor-
mance under different loads. At this point in the
screening process, I’m confident to start imposing
loads and see how much function and performance
we have in each of those patterns. That’s it. If we
started with loads and worked backward, we could
provoke a symptom with a load and that’s going to
give us unnecessary noise.
We’ve got to sneak up on pain. What happens if we start our examination by poking and prodding with palpation?
We could agitate the issue and then everything else we see is already exacerbated. We want to map as much as we can
about the person and the movement, and then dig deeper and provoke problems.
Begin with a question, “Does standing on your feet or moving your body under your control provoke pain?”
If it does, I’m kicking them to a medical model
to try to discover why. How is the pain behaving?
Is there a structural limitation? Are there measurable
limitations in mobility, stability and strength? I’m
not obsessing on symmetry like some people think I
am. When one side is dysfunctional and one side is
not, asymmetry becomes a focal point. It’s going to
impose its own issues.
There are the numbers behind it: Almost 20%
of the people who say, “I want loads,” “I want a pro-
gram,” or “I want to condition and train” scored a ‘0’
on one of the tests. They had pain. They don’t under-
stand why they got a ‘0’ when they just passed a med-
ical physical. We’re missing a movement component
and I believe a screen like the FMS is a starting point.
People ask which test to do when they don’t have time to do all seven. I tell them to make up their own screen be-
cause I can’t do it in less than seven. We need that intentional redundancy. Count the number of times the FMS looks at
hip extension. In single-leg stance, we’re extending a hip on a straight knee. On the lunge, we’re extending a hip on a bent
knee. The leg raise? That one has to remain in extension.
We’re looking for intentional redundancy—and here’s why. When I see a consistent limitation I’m thinking about a
mobility issue. I don’t immediately plan a stretching program. I go directly to a mobility issue. There could be an underly-
ing stability problem. Under that could be a structural problem—a limitation, a barrier or a foreign body in the joint. We
need to be able to explain the consistent limitation.
What about inconsistency? A guy can extend the hip in one pattern and when we change hip position or knee posi-
tion and he can’t extend it. This steers me in the direction of muscle length because we’re working with multi-joint and
single-joint muscles.

4—Gray Cook—Assessing Movement: A Contrast in Approaches DVD transcript, Part Three of Three
For more information on this workshop DVD, please visit movementlectures.com, functionalmovement.com or otpbooks.com.
 When we observe inconsistencies in a movement screen—the hip
extends in one pattern or the shoulder does something in one pattern
and then acts completely opposite in the other pattern—they begin to
appear more like motor control issues.
One of the biggest ‘eureka’ moments of my career came when we
tried to take a kinesiological approach to movement and made a state-
ment: This person has weak abdominals (or weak shoulder stabilizers or
whatever weakness was witnessed). We followed with a test in a differ-
ent position and the weakness was considerably better.
I began to understand that sometimes motor control is pattern-,
position- and posture-dependent, and sometimes it’s stuck—it’s bad
all the way across. We need to understand why the same people who
seemingly displayed a weak core in the lunge appear to have good core
function in the squat or push-up.
Is the core an anatomical entity or is it pattern-specific? Muscle function can be very pattern-specific where there’s
efficiency. Training and habits often create pattern efficiencies, and our understanding of them should prevent us and our
future counterparts from turning every problem into an isolated anatomical attack.
When poor movement is observed, we first think, ‘I hope there’s a structural reason.’ We’re either going to try to
modify it or not, or we’re going to restrict the person for the rest of her life. Structural is easy. How many times have we
seen people with faulty structure have good function? How many times have we seen people with bad function not have
a structural excuse? If we don’t have a structural reason for poor movement, we have to confront it.
The convenient answer is not always available to us, so this simple little screen starts the journey. If a person has a
‘0,’ we go down the rabbit hole, ending at a diagnosis with knowledge of past medical history, a differential diagnosis and,
hopefully, vital signs—including a movement vital sign.
If the person is good enough, proceed with exercise or
training. Test what the person need tested, so you can
expose loads in different periodization and different
training to help the client achieve the goals.
Trying to get ‘3’ in every one of the FMS tests
was never the intent. It won’t ever be an Olympic
event and you don’t win a free DVD for getting a ‘21.’
And if you get a ‘21,’ don’t tattoo it on your shoulder
because it’s going to change.
Isn’t it?
Your heart rate variability will change. Your re-
spiratory patterns will vary. Sometimes your neck
is stiff and sometimes it’s not. When we’re training
people or coaching their workouts, we need to watch
these fluctuations in movement.
A simple screen and baseline helps us do that.

5—Gray Cook—Assessing Movement: A Contrast in Approaches DVD transcript, Part Three of Three
For more information on this workshop DVD, please visit movementlectures.com, functionalmovement.com or otpbooks.com.