1 Gray Cook Assessing Movement Part One Transcript

GRAY COOK
Assessing Movement: A Contrast in Approaches, Part One 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.
This was not something I ever conceived doing, but I arrived here yesterday and it just feels right.
It feels right to stand up here and tell you what we think we know, and what we’re pretty sure we don’t
know but what we’re going to keep pressing on.
In 1990, I became a physical therapist. The same year, I became a strength coach. I got a license
to do two completely different things the same year—to disturb the comfortable and comfort the dis-
turbed. Those are the two professions I stepped into, and the line between performance and rehabilita-
tion has never been clear for me.
When I watched my first daughter walk, roll and crawl, I said, “With all of my background and
all of my training and everything I’ve been taught, I can’t improve this. I can’t do anything except to
provide a safe environment and let our Creator do the work.” The human system wants to move and
wants to explore. If it hits an obstacle, it automatically programs an alternative. Watching her learn to
move the very first time thumped me right at the heard. If I can’t improve this, then what am I doing
at 8:30 on Monday morning?
1—Gray Cook—Assessing Movement: A Contrast in Approaches DVD transcript, Part One of Three
For more information on this workshop DVD, please visit movementlectures.com, functionalmovement.com or otpbooks.com.
What do I think I’m doing by regurgitat-
ing somebody’s anatomical parts and treating
things? If I’m not aware of what’s going on here,
I can’t contribute to that. I’m getting paid for it
either way, but something happened over about
a five-year journey in my career. I realized that
unless I raise the bar on myself, I’m going to
get rewarded my entire life for not improving a
model that definitely needs improvement.
In every aspect of human biology, we have
a screen and an assessment to talk to you about
the parts in your body. We don’t assess your
eyes. We screen them first. If you fall below the
cut, we assess your eyes. We do the same thing
with your hearing, nose, throat and prostate.
The reason we’ve gotten better at treating certain things is that ability to first screen and then assess
those who fall below the cut. But when it comes to movement, either we overlook it and go straight to
performance or we obsess on details that don’t make a difference. That’s not the bottleneck. We’ve got
to find that bottleneck.
If we approach this with two themes—first, the natural process of movement as the original oper-
ating system, so stick as close to that as you can, and second, let’s not treat movement any differently
than any other ailment in the human body. Screens come before assessments. If you do assessments
first, you’re going to find false positives.
I was reading a book a couple of years
ago called, Start with Why. The book re-
minds me I owe you a statement of why
I’m saying the things I’m saying, and why
we did the things we’re doing. But, once I
do ‘why,’ I owe you ’what‘ and ’how.’
Let’s get back to why for a minute.
When people show up at work, most
of them can say what they do, but they
can’t tell you why they’re doing it. It’s very
important you, your peers and your col-
leagues embrace a ‘why statement.’ I don’t
care what that is. If it’s not good, you’ll
change it, and if it’s good, it’ll drive every-
thing you do.
In the Movement book we published a few years ago, I made a statement: First move well, then move
often. This makes me a bit of an ass because if I don’t define well, I just made a little statement that actu-
ally creates controversy. So, I’ve got to define well. If I do it wrong, at least I tried. We’ve got a piece of
metal to hammer on and it’ll be better.
First move well, then move often.
The Functional Movement Screen is no different than blood pressure. If your blood pressure is not
right, we’re not doing cardio today and if it is, get the hell on with it. That’s it. It’s that simple.
All too often, we scrutinize functional
methods without functional metrics. I re-
alized this very early in my career. I had a
natural affinity watching people move and
knowing the next thing that would prob-
ably help their movement. There’s no genius
there. There’s no gift there. I’m dyslexic. I
don’t read a lot, but I watch a lot of stuff
and I learn a little bit differently. My brain
attaches to patterns pretty quickly. I was see-
ing and doing some things, and was getting
invited to lecture on functional exercise, but
I realized from the faces in the audience ev-
erybody had a different definition of func-
tion.
Everybody had a different affinity for certain movement patterns, so I wondered why are we even
talking about changing something none of us agree on or have defined? Function is a big word, but if
we don’t strive to define it, everything we do in the name of function doesn’t count. We’re making up
the rules for a game we think we’re good at. As long as you’re making up the rules, you’re always going
to be good.
Here’s where I want to start today: We’ve got parts, patterns and performance.
We’re pretty good at parts. We’ve got great metrics to look at your anatomy—your body parts.
For those of us who work in performance, we’ve got some unbelievable metrics with which to
evaluate performance. If you have poor performance, what’s the solution? If I have a 14-year-old child
with a slow 40-yard dash, what’s the solution for that child? You’ve got to go to speed camp. Right? We
have an opportunity for you.
What would you think if the coach
at the speed camp didn’t even own a stop-
watch?
“Well, I made your kid faster and you
owe me a thousand bucks.”
“How do I know he’s faster?”
“Take my word for it.”
“You don’t even own a stopwatch.”
“Yeah, he’s faster.”
How is that different than what we do
with function? You don’t have a stopwatch.
I didn’t have a stopwatch.
We all think we’re doing a great job, but we’ve got to set a bar over there. We’ve got to inform our
colleagues of that bar. If we don’t hit that bar, we’d better own the mistake. We’re not going to get a bit
better unless we do, so set a bar and try to hit it. If I don’t make you faster, I’ve got to own that.
If I don’t make you more functional,
I’ve got to own that, but in the process of
that humility, I become better. Every day,
set that bar. Don’t believe your own BS
because it’s not good. Don’t believe that.
If your parts are the problem, we already
know that. We already know how to in-
vestigate that and we can think about how
much potential you have.
Parts don’t predict performance. Some
of you have a pristine anatomy and you’re
never going to do anything great in physi-
cal performance. Some of you have an
unbelievingly compromised anatomy and
you’re probably at the top of your class in what you’re doing in a movement endeavor. Your parts don’t
predict performance and if your performance is poor, all I have to offer is performance training.
What if that’s not the bottleneck? What if your child doesn’t need speed camp? What if your child
has a locked-up ankle and a scoliosis that doesn’t allow reciprocal patterns in running? Is speed camp
going to help that or is it just going to expose greater humility in the endeavor?
Think with me for a minute. If we have an entry point to discuss human movement, don’t go to
parts and don’t go to performance. The entry point is patterns. It’s a behavior. It’s how you’re using your
parts before you get loaded or have to perform. It’s the one opportunity we get to look at your hardware
and your software devoid of skill and showmanship.
Up to about two or three years of age, we don’t worry about your parts or your performance. If you
make your patterns, if you make your developmental milestones, get on with it. Enjoy your life. If you
don’t meet a developmental milestone, we investigate your parts and performance. If a child isn’t crawl-
ing by a certain age, we become alerted, but as long as children make that window of rolling, crawling,
head control, hand-eye coordination and gait— as long as they make those milestones, we don’t worry
and they do just fine.
In physical therapy, if we do one thing
right, it’s probably dealing with zero to three-
year-olds and then all of a sudden, we start
measuring stuff without reason. There’s no
investigative question mark that tells us to
do it. We automatically start looking at per-
formance because of sports, athletics and fit-
ness. We get either hung up in performance
and want to offer people performance-ad-
vantage strategies, or we identify ourselves by
our parts.
Really what I’m here to talk about today is
that the entry point for discussing the muscu-
loskeletal system is patterns. If the patterns fall
below the cut, just like if you’re hypertensive…
let’s figure out why, and if you’re not, let’s stop
talking about it. Get on with it. You need the
next metric, which is performance. What do
you want to do? Go do that. Your movement
patterns aren’t your bottleneck.
We can obsess on movement patterns. We
can try to make you so good you could work
at Cirque du Soleil. There’s no performance ad-
vantage for obsessing on movement perfection
unless that’s your sport. I can show you a Hall
of Fame full of people with movement imper-
fection.
But very rarely did they get there with movement dysfunction.
There’s a huge line between perfect, imperfect and dysfunction. But between perfect and imper-
fect, the line just went away. The only line I’m really worried about is the one between imperfect and
dysfunction.
What happens is we become the police of perfection, and in many cases what we’re trying to do is
keep ourselves on the job. When people move well enough, get on to the next thing and if they don’t
move well enough, figure out why or refer them to somebody who can. It’s as simple as that.
I think patterns could be our entry point because it’s the lowest level of behavior we should be able
to measure that tells us if your parts are working together with your software. It’s your hardware and
your software.
The developmental model tells us those patterns are great biomarkers if we look at them correctly.
I’m not thinking for a minute I’m perfectly correct with the Functional Movement Screen. I just think
somebody had to throw out a tool so we can break it and build a better one. If nobody throws out
a tool, we’re not bettering in the process.
We’ve got to find that weakest link. It’s a
weakest link strategy.
I had an opportunity to speak at Nike
awhile back. I got up on stage and said, “I
get credit for doing stuff in both physical
therapy and performance, but all I’m do-
ing is pulling out red flags. All I’m doing is
pulling out red flags.”
If you’ve got a bunch of questions
about your health or performance and
you’re only sleeping two hours a night,
that’s your bottleneck right there. I’m not
a sleep specialist, but that’s your bottle-
neck. That’s the problem. We know what
the minimum is. It’s slightly more than five
hours. If you’re getting two hours of sleep,
that’s your bottleneck.
We debate the SAID principle—Spe-
cific Adaptation to Imposed Demand. When
does the SAID principle not work? When
does training not work? If you’re dehydrat-
ed, training doesn’t work. Your body learns
nothing. You get smoked so quickly you
don’t learn anything.
When you’re not getting enough
REM cycles, nothing happens. If your nu-
trition is poor, nothing happens. These are
bottlenecks. These are red flags. If you have these things in your life, there’s no amount of exercise or re-
habilitation in the world that’s going to change your life in any meaningful way. These are bottlenecks.
Is movement a bottleneck? It could be. We haven’t looked at it that way. We’ve got minimums
everywhere else—sleep, nutrition, hydration. We’ve got minimums everywhere else. Is movement ever
going to be a minimum? Do you, in some cases, move so poorly that it’s your bottleneck? The reason
you’re in pain, the reason you can’t lose weight and the reason you can’t perform better could be move-
ment.
Instead of moving well, the knee-jerk reaction, especially in this country, is to move more often
and assume it will work itself out. There’s a point at which it won’t work itself out. There’s a point at
which you will reinforce compensation.
I was quoted in Men’s Journal this past
month, where I said, “The minute you
load a pattern, the minute you train a pat-
tern, the minute you drop impact, stress,
volume and intensity on a movement pat-
tern, it’s like hitting ‘save‘ on a Word docu-
ment.” Make sure that Word document is
good before you hit ‘save’ on it.
If your pattern can be improved be-
fore I load and reinforce it, why wouldn’t
we do that? The load actually can, in many
cases, lock in a better pattern and create a
more stable, sustainable and durable pat-
tern.
On the other hand, if you start loading a movement pattern and you set in motion all those bio-
logical adaptation things on a bad pattern, you have reinforced compensation, substitution, poor align-
ment, inappropriate motor control and substandard mobility. You’ve reinforced it.
If we take the word ’movement’ and play with it a bit, we find we’ve got sub-categories of move-
ment. We’ve got movement health. Let me just make that completely simple: If movement makes you
hurt, you don’t have a fitness problem. You have a health problem.
Don’t ask for a fitness solution to a healthcare problem.
‘I’ve got low back pain. What exercises
do you think I should do?’ Low back pain
is not a diagnosis. It’s a symptom.
I get approached a lot—I’m up here
with the microphone. People rush the stage
at a break and tell me about their ailments.
No matter what they say, I respond with, “I
think you’ve got bone cancer. You should
get that checked out.”
If you’re the one in 1,500 people who
have bone cancer, I just saved your life. If
you don’t have it, I just set you on a path
because you probably ruled out the biggest
obstacle you might have. You didn’t give me
enough information!. You only told me where you hurt. I don’t know anything else about this, and if
where you hurt is all you tell me, then why didn’t you solve the problem?
There needs to be an evaluation process. To me, movement health means, if the fact that you move
provokes pain—a biological signal of disharmony in many cases—you’ve got a health problem. Let’s
get this checked out. The feedback I often get is, “I just got discharged from physical therapy.” “I just
finished up a session with my chiropractor.” “I just had surgically corrected jobbing done.”
Movement health: if you’ve got pain when you move, let’s get a diagnosis on that. Some of you will
be limited by your structure; some won’t be. It is what it is. I wish I could change it, but some things
we can’t change. Movement health means if you move and that provokes pain, you’ve got a medical
problem. It’s not a fitness problem.
Get off the internet… and never, ever give somebody a movement solution to their pain without
doing an evaluation. If you do that as a pro-
fessional, you’re part of the problem. Even
though you may empathetically be trying
to help, you’re not doing a service whatso-
ever.
There are one-in-100 opportunities
where you get lucky and that left leg bridge
takes away the low back pain, but you may
have missed quite a few other things where
the biological system was signaling, “I’m in
pain.” Pain is not a bad thing. Pain tells us
there’s disharmony—investigate that.
Movement competency and movement
performance—what’s the difference here? If
moving hurts, you’ve got a healthcare prob-
lem. You need to go through the healthcare
system. No matter how broken it is, go
through the healthcare system. It’s all we’ve
got right now, and hopefully we can make
that better. Movement competency and
physical capacity(or movement performance
all get lumped together.
That’s the biggest misconception with
the Functional Movement Screen. You think
we’re doing a movement screen to figure out who’s the best athlete in the room. We already know who
the best athlete in the room is. We’re trying to figure out how long he’s going to be an athlete. We’re
trying to figure out, can anything be improved? Can we do our job with a movement metric?
Movement competency is the lowest level of movement we’ve got. If we’re going to design a test for
movement competency, we can’t have external loads. We can’t have momentum or impact. We have to
give you the environment a one- or two-year-old has. It’s you and gravity and your own body weight.
If you’re incompetent there, external loads are not a solution for you.
What do I mean by that? If you can’t stand on one leg for 10 seconds, don’t ask me if you need
glute medius training or if you should be doing single-leg deadlifts. You can’t even stand on one leg. You
can’t even handle that load. An external load is going to reinforce that sloppiness. Guess what’s going to
happen? You’ll manage the load. How? Pronation, valgus collapse, dump your pelvis forward and jack
up your low back.
You’ll figure out how to get through it. This system was designed to adapt to anything, so whatever
you use to complete the endeavor, your brain shifts to, ‘Well, it must be important. I guess standing on
one leg, bending over and grabbing a kettlebell is part of life sustainability. Let’s do that, however ugly
it looks.’
Movement competency is a big issue, but let me just give you a quick analogy so it hits home. I
use this one all the time, because it seems to
be the one that works best. I’m going to take
this entire room and march you across cam-
pus. We’ve got a rifle range set up for you.
We’ve got sniper instructors who are
going to put you on equipment and ammu-
nition. You are going to learn how to hit a
bull’s eye at 200 yards—everybody in here
will learn. As long as you can point and lay
on your belly, you’re going to do it. This is
not a movement obstacle here. Everybody’s
going to learn to shoot. We’re going to learn
to control the breath, look through that
scope, find that target and hit it.
Is there anything I need to do before I
march you across campus and let you meet
the people who are going to make you bet-
ter marksmen?
You better believe it. I’m going to
check your eyesight, because the assump-
tion we’re going to make is every one of
those scopes on every one of those rifles is
adjusted for people with 20-20 vision. If
you didn’t bring your glasses today, if you
haven’t been refit for your contacts, that’s
going to be a problem..
The assumption is you have visual
competency. Before I introduce you to a
new skill that requires a low level of visual competency, I should check your eyesight because I’m getting
ready to think you’re a bad marksman and you’re not. You just forgot your glasses. Sometimes the best
marksman in the room is somebody who’s been visually corrected—Lasix surgery, contacts, or glasses.
There’s nothing out in the field that’s going to make your vision better, but if I catch it here, we’re
not going to waste a bunch of training time, instruction and ammunition and give you a negative ex-
perience. I’ve got to establish visual competency before I introduce a visual skill set.
How is that different than teaching a child to run or do a pull-up? It’s not.
There’s got to be a low level or a basic level of movement competency. When I obsess on a
dorsiflexion restriction, it’s not because I’m a biomechanist and know 10 degrees of dorsiflexion will
give you a better push-off. When you have a restricted joint that’s restricted enough to make you flunk
a movement test, your input is compromised.
I look at the body as a sensory system first, and a movement system second. Without the sensory
system, the movement system doesn’t work. If your ankle is locked up, I’m not even worried about
what’s happening on a force plate. I’m worried about the information getting to your brain or your
spinal cord, so you can make a motor program or a reflex stabilization that honors the next move you’re
going to make.
When I’m doing a movement screen,
you might think I’m trying to do biome-
chanics or do a mechanism of injury. I’m
not. You’re asking me to load you. You’re ask-
ing me to train you. You’re asking me to do
something to make you fit. It’s pretty much
like trying to enjoy a concert with your ears
covered, or an art gallery with a blindfold.
The information I’m getting ready to
introduce is sensory—first and foremost. If
your sensory pathways are compromised,
how can your output be better than that?
You’ve got to manage input. That’s very important. The ‘why’ statement here is, let’s not talk about
function and let’s not talk about movement if we don’t have a metric to see if we’re improving it.
Functional Movement Systems was raising the bar for my colleagues and me in our little clinic in
Danville, Virginia in the mid-1990s. We didn’t have a business plan. I didn’t have a publishing deal. I
never thought I’d have a microphone clipped to my chest. All I wanted was to do my job a bit better.
What is the Functional Movement System? We put together a little screen. It’s not sport-specific.
It’s species-specific. We looked at a bunch of patterns. There’s some redundancy built in there. We’re
looking at hip extension three different ways. We’re looking at different patterns. Could the FMS be
improved? Probably. Hopefully, but don’t wait for the GPS if you’ve already got a compass.
Use the compass until the GPS comes out. If there’s a better, quicker, efficient and effective way to
intake movement, I’m going to be the first one championing that cause. But for now, this is a 10-min-
ute investment of your time and it’s the tool I hope you break or don’t break. If you break it, we’ll build
a better one. If you can’t break it, use it as long as you can.
That’s been my thing. We’ve all got a problem with the physical landscape of this country. You
don’t change the physical landscape by injecting a different fitness program. If that were the case, P90X
would’ve fixed it, but it didn’t. We first and
foremost have to set a baseline. If you fall be-
low the cut, you’ve got a problem. If you fall
above the cut, do the next thing.
The scoring system of the FMS has prob-
ably been one of the most effective and least
effective things we do, because the minute
we put a number on something, human be-
ings start measuring themselves. I think there
are people who think there’s going to be an
Olympic event called the Functional Move-
ment Screen where you get a gold medal.
The goal of the movement screen is not
to see how well you can do. It’s to see how bad
you do.
Once you’re above the cut, it’s just like
blood pressure. We don’t worry about it
anymore. We’re looking at it from the bot-
tom—not the top—so a ‘’3’ on a movement
pattern means you’re optimal.
What does that mean? You’re using all
the available range of motion and maintain-
ing fairly good alignment within a pattern.
If you got a ‘3’ on one of those movement
patterns, the first question I’m going to ask
you about your exercise program is, “Why
are you prepping that pattern?”
There’s nothing to be gained there. You can still warm up, but you don’t have to prep that pattern.
If you got a ‘3’ on the deep squat, you
can pretty much enter the squat rack with
a good warm-up. Fifteen minutes of move-
ment prep gets you nothing. It’s wasted
time. You’re doing it because you read it in a
magazine—not because you need it.
Next, a ‘2’ is acceptable. It’s not so
pretty, but we don’t have a lot of evidence to
obsess on that. It’s good enough. The place
where we’ve got to attend is dysfunction.
You can’t complete a bodyweight pattern on
one side, but can on the other, or you can’t
manage that pattern.
What is dysfunction? If you have a bad
pattern, we should be able to turn around and measure something in either your mobility or motor
control that falls way below normal range of motion or normal motor control. The pattern tells us to
measure that or, if the pattern is good enough, don’t measure it. It’s just going to confuse you. It’s going
to give you too many options. Let the movement tell you when you need to measure something.
Pain is a little bit different. If the movement screen provokes pain, that’s a healthcare problem—the
report of pain provoked by a movement pattern. If you walk in the room and you’re already in pain, the
movement screen is not for you. It is not a diagnostic test. If you’re already in pain, I’m not interested
in that because there’s quite a bit of evidence
showing that pain distorts motor control.
Measuring your motor control when I
already know you’re at a disadvantage means
nothing. If you have a healthcare problem,
you deserve an assessment. I’ve got to find
out if this pain is coming from the move-
ment system, or do you have bone cancer?
A differential diagnosis is an extremely im-
portant thing to take off the table before we
start dealing with musculoskeletal pain.
We face a lot of problems. The minute
we inject something into the public domain
like a movement screen or a different lan-
guage when we’re talking about movement, we’re going to butt up against the communication issues.
The entire point of the movement screen is to improve movement communication.
Don’t be confused by a total score. Let’s profile Jack, Mike and John. Who has a better movement
screen? You don’t have enough information to call it.
Here’s how Jack stacks up: Every move-
ment pattern he’s got is acceptable. There’s
no reason to scrutinize his blood pressure.
It’s good enough. He can get on a tread-
mill. If he dies, it’s not because of that.
Mike, on the other hand, is throwing
the javelin. He’s got some asymmetries, but
we pretty much knew that with a person
who throws the javelin. The only thing
my eyes fall upon is that inline lunge. He
can’t even do a lunge on one side—he’s
dysfunctional in the lunge—and he’s ab-
solutely perfect on the other side. Is this a
parts problem or a pattern problem? I don’t
know, but now I have a right to investigate
it.
We specifically gave John, the lawyer, pain just because I think anytime we could give an attorney
discomfort, it’s a good thing. John, the hypothetical lawyer, gets to have pain on his active straight-leg
raise. I don’t care whether it’s neural tension, sciatica or a hip impingement. I don’t care. I’m not loading
him today, not in that pattern. We need to find out why he has pain.
Let’s go back and look at these scores
again. John, the lawyer, isn’t even on the table.
The screen did its part and said this isn’t even a
fitness problem. This is a healthcare problem.
His score doesn’t matter.
Mark, the javelin thrower, has some is-
sues, but it’s not detected in the total score.
We didn’t build this as a total score system.
The total score only matters in one direction.
A screen with a ‘0’ is considered a healthcare
problem and must be cleared. If you want to
look at total score and you just need to do that,
just be above a ‘14,’ but that’s not an intelligent
way to look at this because it’s not the way it
was built.
Don’t have any ‘0s’ and don’t have any ‘1s.’ You just heard it from the horse’s mouth. That’s it.
Don’t have ‘0s’ and don’t have ‘1s,’ and if you do, you need to figure out why. If you don’t have ‘0s’ or
‘1s,’ get on with it. Just don’t create ‘0s’ or ‘1s.’ That’s the second thing: Don’t create ‘0s’ or ‘1s’ in your
training.
The reason we’re here is because the practice of strength and conditioning and even rehabilitation
had some very poor side effects. I know how to make every one of you double your bench press, but if
I do it too quickly and not holistically, you’re going to give up shoulder mobility to get there. I created
a side effect in my attainment of a single metric. We do that in fitness every day.
Most people who need to have signifi-
cant weight loss—the morbidly obese—are
going to experience an orthopedic issue be-
fore they get into a metabolism that helps
them lose weight. If you really want them
to challenge obesity, realize maybe one of
the reasons they quit moving in the first
place was because it wasn’t comfortable.
Kicking them in the ass and plug-
ging them into a treadmill is not going to
change their lifestyles. Get their diets right.
Make sure they’re sleeping right and take
care of their health first. Fitness falls right
into place. That’s why we use the words
‘health’ and ‘fitness.’ Do you ever hear it reversed—fitness and health? It doesn’t work that way. You put
fitness on top of health, and if we can’t establish movement health, we really don’t have a good fitness
platform.
Let’s take the movement screen and turn it into a pass-fail test. Take the numbers out of it. I want
you to see what the guys who developed this platform see. All we’re doing is scanning that piece of paper
looking for ‘0s’ and ‘1s.’ That’s all we’re doing. We’re working it from the bottom—not the top.
In this instance, an optimal movement by definition is acceptable and an acceptable movement is
also acceptable. Let’s take away the ‘3s’ completely. You’re either really good, you’re okay or you fail. It
just became a pass-fail test.
Look what just happened to the scores. You’re adding them up wrong. It was never made to be a
total score test—‘0s’ and ‘1s’ on each pod in the movement screen are what provides direction. Our
javelin thrower just dropped, didn’t he? If we go pass-fail, the total score works. We’re still not looking
at the lawyer. He’s got a healthcare problem.
We’re not the police of movement perfection. I’ve seen quite a few ideas come out over the years—
a human body standing against a static grid—different ways to look at movement. What I found out
early in my career was that it’s extremely hard for even really good people to pass those tests. Anytime
somebody designs a test that says ‘90% of
the people need my program,’ the test isn’t
for you. It’s for the developer to create a
business opportunity.
That’s not why we’re here. If move-
ment is good enough, get on with it—
go do something with it. If it’s not good
enough, we stand firm on that line. If we
have to adjust the line, we adjust the line,
but we’ve got to stand firm on the line.
Why do we even have a ‘3’ on the
movement screen in the first place? It’s got
nothing to do with what we’re going to re-
strict.
It’s got more to do with the way we pro-
gram exercise. Once we have no ‘0s’ and ‘1s’
on the movement screen, I look at your ‘2s’
and ‘3s.’ If you’re going to do a warm-up, prep
your ‘2s.’ You don’t need to prep your ‘3s.’
Your movement is good enough. As a matter
of fact, you can probably reinforce that move-
ment by loading it a bit.
The FMS has a mobility bias. Why? It’s
because lifestyle, injuries and habitual patterns
cause us to, at least on the surface, look like we
lose mobility. I’m not saying mobility is more
important than stability. You can’t even prove
somebody is stable until they have mobility
because you could be checking stiffness. Stiff-
ness is the body’s efficient default when stabil-
ity is not accessible.
If somebody’s got tight hamstrings, I know how to deal with that. Why do they have tight ham-
strings? It’s because something else isn’t doing its job. Something else can’t do its job. Something else
doesn’t know its job. If you take away those tight hamstrings, you’ve just created a stability problem
because stiffness is the way the brain decided to stabilize this person in this environment with these
stresses.
If you take away a kid’s training wheels, you better have a plan. You better stand beside the bike.
You better run alongside or you’re going to be having a discussion with your wife you don’t want to
have.
Do any of you have some ideas on how to make the lunge look a little bit better in five minutes? I
do. I made a stretch called the Bretzel. It doesn’t stretch any body part. It stretches a pattern. It looks a
little bit like the lunge pattern lying down. Find the side you can’t do it on and learn to breathe there.
When we find asymmetries, we put people in a situation where they can confront that asymmetry.
The very first order of business is to learn to breathe. Yoga has been telling us that for 4,000 years.
I’m going to put you in a position that’s
a little distressing, and ask you to control
your breath. It’s the only thing you’ve got.
You can’t control your external envi-
ronment sometimes, but you can always
control your internal environment. The
point of yoga is not to become an expert at
any of the patterns. It’s to confront a physi-
cal obstacle and maintain your composure
through your breath.
Do you coach breathing? You should,
because in a dysfunctional pattern, you’re
often going to see dysfunctional breathing.
I don’t know if the breathing is driving the pattern or the pattern is driving the breathing. It doesn’t
matter yet. It’s a coachable thing. That may be improved. Will it ever look perfect? I don’t know, but I’m
fine loading a satisfactory pattern. I’d like to see if that pattern could improve a little bit before a loading
it because, remember, you’re getting ready to hit ‘save’ on a Word document.
The idea of injury risk prediction gets kicked around a lot. I get to do stuff in the NFL. Do you
know what the injury rate in the NFL is? It’s 100 freaking percent. Gray Cook, the Functional Move-
ment Screen and all of our instructors together aren’t going to put a dent in that. There’s eventually a
100% injury rate in that occupation. You’re always going to get hurt.
Is it injury prediction or injury management? We get the unbelievably honorable opportunity to
work with tactical people—people who put their lives on the line not for a scoreboard, but for freedom.
We take that job unbelievably seriously.
They’re going to get hurt, but does that injury have to be complicated with so many things we
could take off the table beforehand? We could introduce better programming and metrics that let you
know if your programming is working or not.
Why does an injury need to be complicated by unnecessary mobility and stability or motor control
problems? It doesn’t. Take it off the table. We have an access point to take all the complicating factors
of an injury off the table in a very proactive manner if we simply screen ‘normals.’
Do you know who does this better than anybody else? Dentists. Do you think you’re getting your
teeth cleaned twice a year by a dental assistant because they don’t think you’re brushing or flossing?
In many cases, your insurance program is paying for another human to brush your teeth. How do we
justify that? Because access to a dentist on a yearly or a bi-yearly basis can prevent more problems than
it costs.
Why do we treat our teeth better than our bodies?
We don’t think about the musculo-
skeletal system until we hurt. This is not
a part of a yearly physical. We’ll stick our
fingers in all kinds of body parts, but we
won’t ever look at your movement until
you say it hurts. Physical assessment does
not involve movement assessment.
Do you know how many kids pass
their pre-participation physicals to com-
pete in high-school athletics, yet still flunk
a movement screen due to pain? There’s
about a 20% fail rate due to pain. This kid
is saying, “Put the pads on me and let me
run into things very hard and fast. By the
way, it hurts when I squat.” I don’t have to predict that injury. The kid’s already got it. That’s the first
thing we take off the table. If an otherwise healthy person has pain with movement, the pre-participa-
tion sports physical is incomplete.
But think of how many people are trying to develop a more fit lifestyle, regardless of age. Consult
your physician before starting an exercise program? What are they going to look at? They’re going to see
if you’ve got fluid in your lungs and if your heart is beating.
I don’t for a minute think the movement screen predicts the mechanism of the injury you’re go-
ing to have. All I know is if you move poorly, don’t load it, and if you have pain when you move, it’s a
medical problem—not a fitness problem.
That’s all I know about the movement screen, but if we combine that information with new and
emerging information we get every day, like previous injury history, the complication of pain, ‘0s’ and
‘1s,’ a Y Balance Test and some psychosocial variables, we might actually put a dent in this problem.
Not for a minute will you ever see me as a professional only do a movement screen. I’ll show you
how I think it’s a great access point so I can make my next best decision, but all the movement screen
sets us up to do is make another professional decision at the end of the movement screen.
Do we seek performance or do we investigate parts? If your parts are dysfunctional—anatomically
compromised—we may have to impose
limitations and give you some good advice,
but if your parts are pretty good and your
patterns suck, you’ve got a software prob-
lem. I think everybody in here is qualified
to confront that if you use a metric to say
whether you changed it.
Give me a population and the very
first thing we’re going to do to manage that
population is to put them in sub-groups.
We’re going to platoon our problems. We
do it in education. We do it in tactical
training. We platoon our problems. People
deserve to be treated as individuals, but here’s
the funny thing. I’ve heard Alwyn Cosgrove
joke about this, “One-on-one fitness is what
we do here. We count those reps for you.”
We’ll teach you to drive in a group. We’ll
teach you to shoot in a group. We’ll do every-
thing in a group except fitness. ‘’No, no, it’s
one-on-one. I need to be here for every rep.’
Really?
We teach kids martial arts in a group.
We teach snipers how to shoot in a group. We
teach people how to drive a car in a group. We
can do fitness way better than we’re doing it.
Don’t let your business model skew the mes-
sage. We can become unbelievably fit again. We can embrace physical culture very easily, and here’s how
you do it. Set a baseline and show how many people are below the cut.
People love to measure themselves. We’ve got an internet full of people blogging about how many
times they did a deadlift or how many times they did a pull-up. If you’re obsessed on numbers, throw
another one in there: How well do you move?
Because all of those other things don’t
mean anything if you’ve got ugly form, if
you were improperly coached or you’re not
posting your minimums.
We fix this entire thing by giving peo-
ple a movement minimum, a cardio mini-
mum, a BMI or a body composition mini-
mum and a strength minimum. Meet your
minimums. Outside of that, I don’t have a
lot of opinions unless you want to special-
ize in something. Meet your minimums.
When we build a screen, it’s intention-
ally not an assessment. It’s not supposed to
be. It’s supposed to tell us if we need an assessment. It’s designed to improve communication. If there’s
confusion about the movement screen, I’m going to own that and I’m trying to fix that right now. It’s
not a total score system.
It’s designed to help rehabilitation and exercise professionals collaborate and communicate. It gets
pretty ugly when you try to describe a squat over the phone. It’s pretty cool when you call it a ‘1,’ a ‘2’
or a ‘3.’ It doesn’t mean we’re devaluing all of the nuances of a squat.
The FMS is not how we coach a squat. It’s how we categorize a bodyweight pattern. Your score on
the movement screen has nothing to do with your athletic performance. I don’t know if we’ll ever find
that out, but the first point of performance is participation. If you don’t move well, I just don’t think
you’re going to be here a year from now.
I don’t know why. It could be psychosocial. It could be movement inefficiency. I don’t know why it
is, but people who don’t move well just don’t seem to participate that long. I don’t know if it’s because
of injury or humiliation. I don’t know what it is, but we’ve got to have a baseline for movement. We
currently don’t, so we made a humble attempt to throw out a tool to create a baseline.
The FMS is often viewed as a simplistic
assessment. I own that. It is and so is a blood
pressure cuff, but right after we get those num-
bers, we can take action. Get on with it or let’s
go check it out. That’s all a movement screen
is supposed to do. Many people think the
SFMA, our medical model, involves the move-
ment screen and it does, but not on intake. It’s
on exit.
Think about what we do as clinicians.
There are two things that occur with every
patient going through musculoskeletal reha-
bilitation. They’d like to become asymptom-
atic and they assume if they’re asymptomatic
they’re also functional. But those are two dif-
ferent metrics.
Many times, patients will self-discharge
or we’ll get them taken from us the day they
become asymptomatic. That doesn’t mean
their single-leg stance isn’t dysfunctional. That
doesn’t mean their mobility isn’t compromised.
That doesn’t mean their stability is actionable.
It just means they’re asymptomatic. I can make
you asymptomatic pretty quickly—pharma-
ceuticals, a bottle of whisky or just don’t move.
How many people who exit rehabilitation
compromise their lives and never to do some-
thing again? These people aren’t functional
anymore. The number one risk factor for a future
injury is a previous injury, which means I don’t think we’re clearing up everything we should.
When you discharge somebody from rehabilitation, I’m not saying you’ve got to have them mov-
ing perfectly. I’m saying you owe them the metric they’re not reaching. If your doctor treats you, and
your triglycerides are off the chart, they’re obligated to inform you you’ve got a risk factor.
When you discharge people with poor movement patterns, inform them they’ve got a risk factor,
or at least you think they might have a risk factor. ‘This is something that if I had time I think we should
fix.’ ‘This is something that even though you’re not hurting, it would be the number one movement
thing I’d work on if I were you because it falls below the norm compared to everybody else.’
Each test has its time and place where it’s used, but the whole thing I’m passionate about is stan-
dard operating procedure. If we’re going to deal with musculoskeletal issues, we’ve got to have a stan-
dard operating procedure. We’ve got to.
I often quote from the books Blunder and Why We Make Mistakes. The aviation profession inverted
its incident statistics in a single year, and it didn’t do it through education or equipment upgrades. It
did it through standard operating procedure in the cockpit. It’s not an insult to the intelligence of the
people flying these planes.
It’s saying human error on the little things is something that happens no matter what. Create a
checklist for the little stuff, so you can dedicate your creativity, resourcefulness and brain to the indi-
vidual situations that wash across you every day, but standard operating procedure in the intake should
be consistent. It is with other professions.
The role of sports medicine and reha-
bilitation is to get you strong enough to
train and then what do we watch? Pain.
That’s a great thing to watch. It’s a great
thing to measure. It’s a great thing to see
when it’s related to movement.
The SFMA—our medical movement
screen—is a two-minute drill that says
look at the patterns too. Don’t stop looking
at the parts. Don’t discount performance.
Just add the patterns. Patterns are the ele-
ment that’s not getting caught in current
rehabilitation. If the pattern is limited but
it doesn’t provoke symptoms, we ignore it.
This means we don’t understand the idea of regional interdependence.
What’s the role of strength and conditioning? It’s to get you strong enough to perform. What is the
key marker to watch here? It’s a state of readiness. If you’re not ready to train today, how is that stress
going to make you better?
If you just had an emotional conflict
with your spouse, if you got only two hours
of sleep, if you’re dehydrated and you’ve
had no food in your stomach for three
days, I don’t know if the SAID principle is
going to work for you.
The best strength coaches in the
world—and I think we have some of them
in this room today—are obsessing on a
state of readiness because they realize they
hold stress in their hands. Stress will make
a biological system adapt or fail.
We’re not interested in engineering
failure here. I want to induce just enough
stress to make you grow and to make you
adapt. Your state of readiness determines
how much stress I’m going to put on
you. Understanding the pain component
is how I rehabilitate you. These are the
things we’ve got to watch.
If you’ve got a really good movement
screen on Monday, we train you hard on
Tuesday and your movement screen drops
five points on Wednesday, I don’t know if
I’m going to load you today. Your heart
rate variability may tell me the same thing.
You’re not ready. We have an entry point if you’ve got unhealthy movement and we have an entry point
if you think your movement is healthy.
Many people are surprised when they have pain in a pattern on a movement screen because they
have subconsciously avoided that pattern. We’re getting ready to confront it in exercise, though, and I’d
rather find your pain beforehand on a screen than three sets in with a load. It’s a responsible measure
we need to make.
People who define us by the movement screen alone don’t understand what I realized early in my
career—that a screen simply sends you in one of two directions. It will send you up that pyramid to
skill, or down that rabbit hole if all you do is find a bad pattern and you don’t reduce that pattern into
impairment measures. Let me make that simple for you: a lack of range of motion or a lack of motor
control. Every bad movement pattern can be reduced to those impairments.
People ask how to report this to insurance. Insurance doesn’t get that. Report your impairments. If
a pattern sends you down a rabbit hole and you find poor mobility or poor motor control, report what
they’re used to looking at—less-than-optimal strength or less-than-optimal range of motion. But if you
change those impairments and movement doesn’t get better, you didn’t change anything. You might
have gotten it ready to change, but you didn’t change anything.
We’ve got to manage the impairments,
but if we don’t have a behavioral model—
a movement model—to see if monkeying
with these impairments made you move
better, we just got paid, but you’re getting
ready to limit your lifestyle for the rest of
your life. You’re going to unconsciously
avoid a pattern or you’re going to perhaps
injure yourself because you have incompe-
tent movement ability in that direction.
Let’s not even say you’re going to
injure yourself. Let’s just say you’re inef-
ficient. What is the result of inefficiency?
Fatigue? Poor motor control? If you fatigue
quicker than you’re supposed to, look at all
of the things. You’re either going to limit
your behavior or you’re probably going to
set yourself up for poor alignment, poor
motor control or compensation.
If you have pain, we give you a lower
threshold test and we break down those
patterns, but we responsibly see if impair-
ment measures are on the table. We remove
those impairment measures and try to nor-
malize them, but we don’t assume the job
is done.
We make sure your patterns are at least
competent. We send you back up through
the system, but the FMS may still catch you and suggest that in your exercise program, these are your
bottlenecks. These are your points. The point of the movement screen is that some level of movements
are good enough and some aren’t.
I’ve had the opportunity to deal with
and sit at the feet of some of the best
strength coaches in the world. Here’s what
they do: They create program constriction.
“I want to do power cleans today.” “No,
you’re not. Your deadlift sucks. You can’t
even drive your car in first gear and you’re
asking me fourth gear? No.” The best
strength coaches in the world create con-
striction in their programs. They make you
earn the right to move at a higher level and
if you can’t do that, the program constricts
you.
That’s what the Functional Movement
Screen does. It gives you a measurable reason to constrict somebody. Most of the great strength coaches
I’ve worked with do this through intuition, wisdom, attention to detail and an unbelievable skill set you
have no idea how long it took to develop.
With the FMS, we built this simple little filter that’s going to hopefully catch 80% of the crap the
eye of a great strength coach is going to catch anyway.
A lot of people as our workshops say, “You mean I can’t overhead press?” “You’re absolutely wel-
come to overhead press.” Just don’t teach pressing to somebody with a bad shoulder mobility screen.
If you’re an exercise professional, I’m not telling you what you can or can’t do. I’m telling you, if
you load that pattern and you hurt somebody and I’m on the witness stand, I’m going to ask, “What
was your ethical reason for loading a dysfunctional pattern?” Do you have evidence that says loads
create function? You don’t. You’re using exercise as entertainment. You’re just smoking your clients so
they’ll think they did something today.
We’ve got to make movement better. If we make them move well, they will move more often.
I completely disagree with our current White House administration right now, with the suggestion
to put your kids outside, and tell them to run around 60 minutes a day. Let’s get them to exercise. If
they enjoy moving, they’ll move. If they don’t enjoy moving, they won’t move.
Sure, we’ve got a lot of entertainment value inside doing this, but how many children actually en-
joy moving? Isn’t that the first order of business? Do you even enjoy moving? What is your movement
competency? First move well, then move often. If we manage the first one, in many cases the second
one takes care of itself.
The constriction we impose on movement, the inconvenience we offer in the workout and the
extra attention to detail in a physical examination is a constriction that’s necessary to take action on
something that’s been poorly managed.
We do the FMS because we’re talking too much about functional methods without functional
metrics. Am I saying we won’t have an opportunity to get better at functional metrics one day? Abso-
lutely not, but we’ve got to start somewhere.
I’m going to toss you a screwdriver. See if you can break it. It’s not a wrench, so don’t evaluate it like
a wrench. It’s a screwdriver. It’s called a movement screen. It only does THIS thing. If you try to make
it a performance tool or a diagnostic tool, you’re going to come up disappointed because you’re trying
to drive a nail with a screwdriver.
That’s not what it does. It simply gives you some direction and sets a baseline for movement. If
we must adjust that baseline up or down, I’m perfectly willing to do that, but let’s set a baseline. The
minute we knew what hypertension was, we could do something about it. We’ve got a tool to check it.
We’ve got a lot of programming to modify it or we can just modify it with drugs. It doesn’t really matter.
We’ve got a number, we’ve got a baseline and we can do something with it.
These are not problems for me. These are not problems for people who use the movement screen as
an effective tool. They’re only problems when people use our information as secondhand hearsay. They
don’t read a book, watch videos or study the material. They want one little metric to fix every problem
they’ve got. Don’t do that. Use a metric. Use another one. Set a baseline.
I want to leave you with this: Is it so con-
fusing that the ending point of functional reha-
bilitation is also the starting point of function-
al training? If you’re in the medical profession,
tighten up your discharge criteria. If you’re in
the conditioning or fitness profession, tighten
up your intake criteria.
That’s really my whole point. I’m not here
to defend any of that. We built it and it should
defend itself. Just do me one favor: Use it cor-
rectly. Don’t make assumptions. Don’t think
it’s more or less than it is, and if it doesn’t work
for you, you’ve got no obligation.

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GRAY COOK

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

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