4 Stuart McGill Assessing Movement Part One Transcript

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

This transcript has been edited for smoother reading. Editorial decisions were made to retain Stuart’s meaning while
converting the live lecture format to text—Stuart has not reviewed this transcript for accuracy.
For more information on this workshop DVD, please visit
movementlectures.com, backfitpro.com or otpbooks.com.
Over the years, I’ve been involved in quite a number of debates. Science, however, always guided the way. It allowed
us to converge on a reasonable, justifiable opinion. In many cases, there was no clear conclusion. I suspect we’re going
to have the same experience today. If I can quote Dr. Steven Rose, “Science needs more clinical perspective and clinical
perspective needs more science.”
Let me give you an example: Thirty-two years ago the new versions of human rights legislation came into Canada.
In order to deny employment to a person, a proven mismatch between the demands of the job and the capabilities of the
person had to exist. It set off an entire scientific effort to start quantifying the demands and abilities of the individual.
When I was finishing my PhD, my boss was an expert witness in these cases. Today’s discussion recalls some of my
testimony preparation—how simple does a screen need to be or how robust does an assessment need to be to satisfy the
legalities of this new human rights test? After working on that for 30 years, here we are talking about exactly the same
thing—the issue being simplicity versus what you get with complexity.
In preparation for today, I re-read, I think, everything Gray Cook has written, as well as that of a lot of others. The
Movement book introduced movement principles to many people. Until the very last little section, I can’t argue with what
I heard this morning in Gray’s brilliant lecture or in his book.
This is all good information: Don’t load dysfunction. Address the cause of dysfunction.
1—Stuart McGill—Assessing Movement: A Contrast in Approaches DVD transcript, Part One of Three
For more information on this workshop DVD, please visit movementlectures.com, backfitpro.com or otpbooks.com.
I’m going to follow a few lines of logic and see
if we can all leave with an extended expertise. What
helps us to be better at what we do? I think, and I
hope to show, we will need both scientific and clini-
cal input. Is there sufficient support?
We are asked to be expert witnesses, and few
are ever coached by a lawyer on how to present what
we know. I see my role today as exactly the same as
an expert witness in court. You’re the jury. My job is
not to tell you what to decide. My job is to provide
the information so you make the right decision.
Movement is complicated. We see the output
when observing movement, but we can’t identify the
input until we analyze it. If we simply observe move-
ment, the infinite combinations of forces produced
by the movement won’t be revealed.
If I perform a squat right now, you can’t tell if my gluteals are driving the squat mechanism or if my gluteals are ex-
tending my knee. Those of you who wouldn’t consider that have been taught anatomy. You’ve studied cadavers. The muscle
doesn’t cross the joint. Therefore, how can it affect the knee? It’s complicated. You have to measure it.
That’s why we measure tissue loads. Describing the motion can’t reveal injury mechanism, stress or joint stability.
I’m not talking about the stability of standing and balancing. I’m talking about actual joint stability where tissues become
overloaded.
Earlier you viewed a YouTube clip of the soccer player Ronaldo. The rules or criteria that govern movement and the
way we move are constantly changing, aren’t they? Ronaldo moved differently than the sprinter, and he moved differently
again when he had to run around the cones as the criterion changed.
Which was better? Fatigue, fear and having a hangover from the night before his training all influenced his expres-
sion of movement. You saw him create strength, buttressing force through his body and creating shock waves through the
linkage. It all changed depending on the criteria.
You viewed the website of Professor Troje, where he showed how he motions body mass index and gender. Each of
us is encoded and revealed in the movement patterns.
With those thoughts, I want cover many years of study and take you through my scientific journey. I’m the first
professor at our university the students see. I’m also the last they see when they exit in the fourth year.
I start by teaching them little nuances of movement. I show them the Functional Movement Screen. My first ques-
tion to them, which emerges when I test them—Can a movement screen predict how a person will move in other tasks
with movement? In other words, should a biomarker for injury risk be sensitive to movements that contain injury mecha-
nisms? In teaching our students, we’d have them do these different movement tests, plus a whole host of others.
A young lady performs an overhead squat. You
can screen her on the FMS criteria, and it’s probably
a ‘1’ or ’2.’ I hope most of you would agree due to the
shoulder carriage and the depth of the squat. In the
next task, I dropped a coin on the floor. Being a nice,
polite Canadian student, she bends down and picks up
the coin.
My point now is that performance of a con-
strained task doesn’t predict how a person will perform
in an unconstrained task.
I began to wonder about movement behav-
iors that change loading and injury risk, so I bor-
rowed this from Professor Kiesel’s study in 2007 of
what a FMS ‘3’ deep squat looks like.
In my opinion, there is an injury mechanism
occurring there. I can’t load that spine—not at this
instance in any case. I would score that on my cri-
teria as a ‘1’ and not a ‘3,’ because if you add load
to that back, the risk is greatly elevated. On the
right, however, she scored much more poorly, but
I would put load on that back in that posture. It’s
not perfect either, so the notion that a high score
indicates the absence of a flaw, injury mechanism
or pain assumes these are captured in the tests.
We tested this idea of predicting movement patterns of a biomarker and we found that a free, unconstrained task
was better at predicting squat competency free of injury mechanisms than a constrained task. This has implications on
injury prediction, exercise programming and training capacity. Let’s extend the logic that unconstrained movement allows
variability and is linked to overuse injury, which implies repetition.
Movement variability, however, is like every other variable. Too much and too little are associated with injury. Go
back to Bernstein’s classic work of 1930 where he observed professional blacksmiths and the consistency of their perfect
hammer blows. He also noted the high variability of how they accomplished the movement to create the same end point.
He coined the phrase ‘repetition without repetition.’
The logical question becomes—how long must we observe a movement to obtain a baseline of that person’s move-
ment signature? Would it be an hour, a day, a week or perhaps a lifetime? But the rule changed. The criterion has now
shifted because in the weight room, we’re going to stress the linkage to higher levels and that will determine if that person
survives or not.
We have to reduce the variability to optimality so the pained person feels the immediate benefit of moving well. Pain
is the guide. However, if they’re uninjured, this relationship is no longer clear because what strengthens one person may
break down another.
Now, the question becomes—what information did you need to guide your program design to determine the dosage
and the nature of the correction? The story evolves. Can movement in one task, say a general task and not a constrained
task, predict movement in an occupational task—a complex goal-driven task?
This is a logical question since any simple screening task is a small sample of the movement repertoire. Is a screen a
valid proxy for the movement of daily life—the movement habits and movement engrams? An engram is the encoded tape
that resides in the cortex of the spinal cord. What is most relevant to the movements performed in real life?
From this logic, we screened a group of firefighters
in Pensacola, Florida, on only five patterns—a squat, a
lunge, a lift, a push and a pull. These patterns turned
out to better predict their competency in actual fire-
fighting tasks. Now we’re moving up the continuum
from simple assessments to more complex assessments,
and we’re obtaining more information along the way.
This screening is much more expensive in terms of time,
man-hours, skill investment and money.
Predicting movement is important. In another
study, we used the FMS and found it wasn’t sensitive
to certain variables of movement or competency and
injury mechanisms.
Look at this firefighter who scored a ‘20,’ this means
by definition there was no pain. But when we asked him to
do actual firefighting tasks we started to see extreme aberrant
frontal knee movement.
This is quite a potent injury mechanism. Would a con-
strained screen predict how a parent picks up a baby? The
way they choose to move determines the risk of injury.
Now, we’re really honing in on some seminal ques-
tions. What’s the ideal posture or movement?
Survey the posture of the mixed martial artists and
you’ll find many of them have a flat back—not much lor-
dosis. Work with world-class sprinters and you’re going to
notice the opposite—a lot of lordosis in the low back. The
reason? To win, a fighter has to kick his opponent in the head. They turn the pelvis so the power of the hip is expressed
through the flexion range.
To do Jiu-jitsu, they require athleticism, but by default, it’s robbing Peter to pay Paul. They don’t have power out
of the extensor end, which is critical for sprinting. So, if a MMA fighter is coming after you, run. My point is that power
production out of those two people is entirely different.
Is their injury potential the same? Why should the screen be the same? I don’t know what’s ideal until I can do an or-
thopedic exam. If knee load is influenced by hip anatomy, how do you score ideal? I need more information to determine
what is ideal. We all realize that posture change simply migrates loads and injury risks from one region of the body to an-
other. All movement is a trade-off, but if avoiding injury is the goal, avoiding the injury mechanism is logically justifiable.
What happens if we add speed and load to some
of these movements? Let’s go back to our firefighters in
Pensacola. We measured movement competency in real
firefighter tasks. This isn’t trivial science. It’s difficult to
measure a firefighter breaching the hole in a roof. We
measured joint stability and joint loads, and scored their
movement competency in patterns of movement being
a lift, squat, lunge, push, and pull. The scores were based
on well-documented injury mechanisms like spine, pos-
ture and frontal knee plane motion, to name a few.
When we added the load, 64% of them scored
more poorly than without load. In other words, injury
mechanisms started to appear. With the other 36%,
adding load was the corrective. This split isn’t uncom-
mon to see in highly accomplished athletes. When we
added speed, exactly the same thing happened. Some
improved and others got worse. From a clinical perspec-
tive, we needed to measure this.
Dynamic balance and direction of force through a
linkage is a very different skill than static movement. It’s
fun to watch some of the deadlifting coaching videos on
YouTube. You will see the form break long before they
reach maximum. The simple screen at that point doesn’t
matter because the injury mechanism was revealed as
load was increased.
The logical question at this point is—can you
change faulty movement?
In Kyle Kiesel’s 2011 work, he performed
an off-season training program for seven weeks.
They were able to increase the FMS score by three
points. I like the study, but the exercises were de-
signed to change the FMS score. Whether move-
ment actually changed or not, I don’t know. It
wasn’t reported. It’s always a valid criticism that if
there’s no control group, maybe they just got better
at repeated testing.
With that, we went back to our firefighters—
this time Waterloo firefighters. We said, “We’re not
going to coach you, but we’re going to tell you the
criterion on which you’re being scored.”
Their movement dysfunction disappeared in
10 minutes. We got the same three-point increase in movement score. Now, this was a surprising observation, but it has
implications on the use of a technique to measure movement that’s also used to establish a baseline and as a metric to
evaluate the effectiveness of the training study.
What does this suggest? It’s possible some people have movement competency, but they may not know how to ex-
press it. It’s also possible that the FMS actually captures movement dysfunction. Or does it reflect the understanding of
the task? It appears we might be seeing a bit of both. It’s just a cascading logic.
The next cascade in logic is that once you change movement in real life, can an exercise or training approach change
patterns in other tasks?
Back to Florida where we had 75 firefighters—25
were in a control group and 25 were in what we called
the fitness-training group. We don’t really care if fitness
group sacrifices form because we’re measuring them on
the number of repetitions. The third group of 25 was
what we called the movement-matters group. They were
coached on every repetition and we insisted on good
form. The coaches were from Athletes Performance of
Phoenix, Arizona.
We measured movement in the transferred tasks
of real firefighting. Did we change their movement?
Joint loads and some criterion variables were measured
during activities like breaching a door or advancing a
fire hose.
The fitness-training group and the movement-
matters group increased their fitness, and the controlled
group did not. Then, we re-measured movement com-
petency—coaching matters for transference. Adding
fitness by itself created poor movement quality. In the
example of the squat, the fitness-training group got
more fit, but their scores on the FMS worsened.
My interpretation was that placing an emphasis
on how each exercise was performed—in other words,
a movement-orientated fitness approach—altered the
firefighters’ habitual movement patterns in the real
tasks of firefighting-grade transference. Emphasizing
fitness alone for repetitions decreased movement com-
petency, but just gave them more strength and power to
create some tissue load.
Incidentally, I believe this is the first study that has shown movement can change with no real change over time in
the FMS score. I don’t know of another study that has had such breadth in the transfer to tasks in real life.
Here’s another consideration for corrective exercise. Do stretching, strengthening and endurance change movement
patterns? This time we had four groups in a short six-week trial.
The first group was stretched with very scientific three-dimensional stretching of the joint capsule and fascia. Dr.
Janice Moreside is an expert on stretching and quite a lot of effort went into this study. Group #2 did stretching and stabi-
lizing. Group #3 just did stabilizing. Group #4 was a control. I was astounded at the very successful increase in hip range
of motion in both stretching groups. I didn’t think it was possible, but it happened.
I was further stunned when we re-measured move-
ment patterns during functional tasks. Even though
they developed all of this newfound movement in the
hips, they never used it in the functional patterns. They
defaulted back to the encoded engrams . Incidentally,
Group #2—told to stretch and stabilize, which I hope
you realize is a Gray Cook philosophy—had the greatest
gains.
Corrective exercise can really change stress pro-
files in joints, but the controversy of the mechanism of
stretching is still very much open for debate. Are tissues
actually being stretched? Are we conditioning neural
pathways?
One of my PhD students at the time was a McKenzie-trained therapist, Joan Scannell. She said to me, “Stu, there’s
a hyperlordotic spine. We should change that. That person is going to get hurt. He’s not moving well.” Then, a flat back
might come into the clinic or the lab the next time and she’d say, “I don’t like that. That’s not healthy.”
I didn’t believe her because I thought that
was the body confirmation the person found elas-
tic equilibrium in. I believed people found elastic
equilibrium when they stood. Again, I was wrong.
We measured elastic equilibrium in each one
of those people. What we found was the hyperlor-
dotics—the ones with their butts stuck out—stood
in elastic stress, but when they sat down, they had
less stress than the flat backs. When the flat backs
sat down, they became stressed.
Could we change elastic equilibrium? There
was the gold standard. We’re really changing the
stress on the tissues. She trained the groups differ-
ently—a very Janda-like approach of lengthening
that which is deemed tight and strengthening that
which is deemed weak or loose.
I was surprised again. The hyperlordotics started standing in elastic stress and then by the end of the training cycle,
they now stood with the elastic equilibrium. She took their stress away, but here’s what you’re going to see over and over
again.
In corrective exercise, you rob Peter to pay Paul. Now, that person is sitting in more flexor stress. The lesson? Cor-
rective exercise is not straightforward and this notion of robbing Peter to pay Paul is going to keep coming up over and
over again.
I had a paper published in Spine concerning four people in pain, including an Olympic volleyball player and an elite
powerlifter. It received quite a bit of attention.
We were immediately able to take their pain away through movement change, but the tool we used was different for
each person. It wasn’t a matter of adding mobility to one or adding stability to another. We needed more information and,
based on that, we gave them a corrective program. Three out of the four improved.
With these preliminary thoughts under our belts, let’s get to the real seminal question: Can movement quality predict
future injuries?
I want to show you some of our work with police, firefighters and athlete groups. The work of Tim Hewett and
Greg Myer from Cincinnati is a successful study of specific injury—ACL injuries of female basketball players. The injury
cases clustered on the injury mechanism variables. Their success proves screening for injury mechanisms with appropriate
intervention is possible and it works to reduce specific injuries.
In a small study, we followed an NCAA basket-
ball team. The power of this study was in the extent
of the number of variables we looked at. We measured
their endurance, their bodyweight strength, their ab-
solute strength and their hip mobility. We did move-
ment assessments on them. Interestingly enough, the
ones who got hurt had a higher FMS. Hold that fact
for a moment and follow my next thoughts.
This is a soon-to-be-published study on sprint-
ers and cross-country runners. It found that every
increase in the FMS score increased injury risk one-
and-a-half times. Many people are now finding some
relationship like this—we’re not the only ones. Are we
missing something? Could it be exposure?
Going back to our basketball study, I think the
answer is yes. The better players are better athletes.
They have a better FMS. They have more than double
the playing time of many of their teammates. Now,
this is starting to disguise the true relationships of
measuring movement quality with screens.
I’ve been in the occupational world for 30 years
and that’s exactly what they have found. You must
control exposure if you’re going to compare scientific
studies and glean out what those scientific studies
actually contain. Don’t fall for reading only the ab-
stracts.
By the way, the NBA does a much better job in
their Combine regarding the ability to predict perfor-
mance in the game than the NFL does. That’s what
we learned from studying both basketball players and
football players.
This takes us on now to a very important study
published this past year by Listman . They had a huge
number of subjects, 874 military recruits entering
boot camp for either six or 10 weeks. To better enable
study comparisons when you have large numbers of
people with a lot of variables, reduce the variability
for the weighing machine of statistics.
What they chose to do in this case was to make every variable binary. They had them run and recorded time, then
categorized them by the median of their run time. You were either faster than the median or slower than the median. They
took out all the variability of run time to allow the statistics to be conducted.
With the univariate analysis, which picks out single variables that have protective power—a slow run time, a FMS
under ‘14’ for traumatic injury, not for overuse injury—training for six weeks was better than training for 10. Exposure
was the difference. The multivariate analysis—having a previous injury history, training not as long, a poor FMS score and
a longer run time because you were slower—helped predict your risk of injury.
There’s a new study coming out. I’ve only read the
abstract and don’t know any more than that. What they’re
showing is a lower FMS score has a prediction of twice in
terms of injury risk than not. We’re going to have to wait
on that to see.
Our next study followed every member of the City
of Toronto SWAT team for three years. We had 100%
participation. Remember the Listman study where they
had to reduce variability by taking every variable and
making it binary—either above or below a score? We
didn’t do that with this one. Instead, we categorized vari-
ables and let the full variability stay in the data.
An example is weight—we tracked the smaller
members all the way through. Lighter weight was inter-
estingly more predictive of injury. Let me follow that through, because once again injury risk was greater in those who
were more fit, except they didn’t have as much back endurance. In hip range of motion using the full Thomas Test— full
flexion on one and full extension on the other—had some predictive ability.
When we looked at non-FMS movement com-
petency, again there were a few predictive tests. Shirley
Sahrmann’s test—the pelvic rock—was one of the most
powerful predictors. But when we went to the indi-
vidual FMS tests, no model emerged. It wasn’t predic-
tive. Yet, the logic that’s contained in the FMS tests,
like asymmetry, came out in other tests, but we had to
make it more severe in order for it to show.
Contingency table sensitivity is the ability to cor-
rectly predict your chance of getting an injury, or speci-
ficity to correctly predict your chance or probability of
not becoming injured. It’s how we judge the metrics of
a particular intervention. For a screen, sensitivity and
specificity are very important for proper categorization,
but I don’t think those numbers are being used quite properly.
The studies I’m discussing give specificity and sensitivity numbers. Someone might say it has a sensitivity of 0.36, so
you’re correctly predicting 36% of injury. But now you have a person in front of you. Generally in medicine, we’d like to
see a specificity of about nine. Nine times out of 10, you’re able to tell that person, “You are going to get cancer,” or not.
Do you see what I mean? What you get out of the study doesn’t pertain now you’re in front of that client and you’ve
got to say if he or she is at risk or not. Anything less than 0.5 is a coin flip. If I have a person in front of me and I don’t
get a specificity of 0.5, I might as well just flip a coin and say ‘you’re going to get cancer or you’re not,’ or ‘you’re going to
get a back injury or you’re not.’
Now, we go back to our police study and see a sensitivity of 0.28. I should have just flipped a coin if I’m going to use
it to apply to the person in front of me. That’s a different usage for telling me how well the tests give us information and
insight into the injury mechanism. That number is just for a back injury, and then we go to all injuries. It’s below 0.5, but
I will tell you the policemen who are getting hurt are spending much more time in the weight room.
Do you know what they’re training? The internet ‘fitness daily challenges.’ Again, it’s disguising the relationships of
moving well—fitness and all the rest of it, including injury.
Another metric used for judging the worth of these various interventions is the odds ratio. To have an odds ratio, you
need an established injury rate. Then, you intervene and say if the rate changed. If you smoke, you have doubled the risk
of getting cancer. Your odds ratio would be a ‘2.’ In epidemiology, having an odds ratio of ‘2’ is quite spectacular. That’s
very powerful evidence if you can show you’ve changed the risk by doubling it.
For three years we’ve been following 1,300 fire-
fighters in the province of Alberta. We’ve got complete
fitness data on only 280 of them—all kinds of health
and lifestyle information. We have them perform ex-
actly the same exercise and look, to give one example,
to see who got a back injury.
As in our police studies, the ones who are getting
hurt are men who are smaller and fitter. They had a bet-
ter movement competency score. Then, we went back
and really studied what the injury mechanism was. The
back injuries were associated with lifting. The knee in-
juries were associated with gait patterns and running on
and off the truck. The shoulder injuries were associated
with pushing and pulling patterns.
These findings have huge implications. The evidence has suggested that movement patterns and behaviors can be
changed with exercise. We’ve established that. You’re writing new engrams and coaching good form, but now we have the
evidence for using specific screens for specific injuries.
I read everything I could in preparing for this,
including Lee Burton’s thesis. Again, a small study
(only seven injuries), but to quote Lee, “The results
of this study were unable to determine if a move-
ment-based assessment such as the FMS can be uti-
lized as an injury or performance tool.”
My dissonance and confusion takes me now to
what I’ll call the football experience. The first study
I could find was Michael Krackow’s fascinating
study in early 2000. Let me just read the abstract.
The results of this study contraindicated the lit-
erature and the premise of the FMS. It was shown the
athletes who were deficient in stability and mobility
were less likely to sustain a non-contact injury during
the season. In contrast, the athletes who demonstrated greater stability and mobility suffered more injuries, particularly non-
contact.
I wish I could dissect the study for you, but it was
the smaller players who got better FMS scores. He made
the argument they played less hazardous positions, and
the FMS was possibly a proxy for their size.
Professor Kiesel’s study in 2007 was a highly
quoted study, but observe the odds ratio: It came out at
12. This was the game-changer. Remember I gave you
a context? I already showed you how you compute an
odds ratio. You need a historical history of injury. Then
you intervene and measure the ability of that interven-
tion to change injury rates.
They didn’t have an established injury rate. To quote Professor Kiesel, “Since no injury rate data was available for
professional football, a conservative prevalence of 15% was used based on previous high school and collegiate injury and
expert opinion.”
Now, they did the right thing. Scientists make assumptions all the time and it’s perfectly fine. It’s absolutely the right
way to do it—if you make an assumption, you state it. You say, ‘Those are our results with the limitations of the assump-
tions we made.’
The problem is with my scientific colleagues who never read the paper. They read the abstract and they saw this
fantastic odds ratio. But as Gray mentioned earlier, what’s the injury rate in professional football players? It’s 100%, not
15. Can you see this is what I think led to this fantastic response?
Prior to this paper the FMS was flying under the radar from a scientific point of view. I didn’t really give it much
thought, but that paper in 2007 awoke the scientific community.
People were then asking me, “What do you know about the FMS?” I said, “I don’t know anything about it. I have
no scientific ability to make a statement.” It really created the tectonic rumble. It focused the scientists on this thing called
the FMS.
What can I say at this point? I request that all future studies, particularly in football, start tracking height and weight.
We know these measurements are modulators of the FMS. If we’re ever going to sort out whether it predicts injury or
not, you have to eliminate the co-factors. If the FMS is simply a proxy for how big you are and then if those positions in
football are the ones who are getting hurt, we’ll never know.
It all has to be sorted out with co-factors. The next study can’t just state, “The FMS, above a number and below a
number, has a certain prediction.” A study has to track all of these possible co-factors and then we’ll know the truth.
Gary Wilkerson’s many studies at the University of
Tennessee have probably come closest to this statement. I
often mention his quote, “Scientists find what they look
for.” If you look for transverse abdominis, you will find
something cool about the transverse abdominis.
Don’t look any deeper, and you’ll never have a per-
spective to understand the magnitude of the result. But
if you collect a lot of other information, you can start to
evaluate the weighting of all of these things. He has found
injury risk behavior.
A psychological biomarker is a great injury predic-
tor. Expose your playing position, previous injury of his-
tory and your muscular performance reaction time and
you see factors that have been shown to be independent
predictors of injury. Considering many different perspectives in terms of injury prediction, there are all sorts of screening
approaches. The superior approach, at least to predict injury, hasn’t emerged. We’re not there yet.
This next study by O’Connor is another very
large study out of the military. If the soldiers had
an FMS below ‘4’ and above ‘17,’ they were at an
elevated risk of injury. Dissect what’s going on here,
because it’s interesting.
That rotary stability test behaves differently
than the other six in the FMS. When you look at
the skew of the scores, note how few of the soldiers
actually score below ‘14’ and have an elevated risk
of injury. This is very valuable information that you
don’t get from reading the abstract.
I found Schneider’s work to also be very inter-
esting. They just looked at normal everyday people
and found there was no difference in FMS scores be-
tween men and women. There was no difference in
whether they had a previous history or not. They did
find that the men were inherently better at the so-
called stability category of tests. Women scored better
on some of the mobility tests. Once again, look at that
rotary stability test. It’s the one test that doesn’t have
discriminatory power.
I’ve probably dissected this test more than any-
body, and rotary stability test is the odd man out. I try
to ignore the criticism this study has received on the
internet, because it was a really insightful study using a ‘R-squared’ analysis.
Look at the spread of the data. One of the best pattern recognizers is your eye. Of those who scored ‘13’—81% of
them sustained injuries. That’s powerful. It was a lovely way to express this in a ‘R-squared.’
Before I summarize, I want to address one final issue: Rather than simply discussing injury risk, let’s examine what
is being measured in terms of test validity. Cassman’s work with a group in the military finds exactly what we find. They
are experts in designing tests and then assessing the internal consistency of the tests.
Gray mentioned adding the FMS scores, but there’s no support for that because that rotational stability test doesn’t
have discriminatory power. Perform poorly on the other six, the chances are you will do well on that test and vice versa.
We can’t add them because they don’t make the criterion of test consistency to allow you to interpret that sum.
Gray made a case for looking at the weakest link, and that’s the important thing to interpret. He took you through
that exercise of Jack, the lawyer who had the ‘1-0.’ In terms of inter-reliability, until we get past these issues of validity,
reliability doesn’t matter very much to me. We have some guidance on this. How large must the difference in scores be to
be biologically significant?
I want to finish with an example of screening that
can be considered one of the greatest successes in sport:
It’s very powerful evidence that Italy’s AC Milan foot-
ball club (soccer) has reduced injury rate over the last
14 years by 92%.
They assess every player every two weeks. They as-
sess them on mental metrics: Biochemical—that’s their
word for physiological. Structural—their word for bio-
mechanical. They measure movement, power produc-
tion, neural factors and anatomy. They do psychosocial
inventories.
Following every two week assessment, they adjust
the individualized program for that athlete. They tweak
their diet, physical training and mental optimization. They offer psychosocial assistance for those who are under distress.
The bottom line is rigor.
Going back to my experience in occupational injury, no one has been successful with simple tests except those that
incorporate exposure measures and specific injury mechanisms. Those are two references.
I tried to answer as many of the submitted questions as I could in this little scientific review. A few stated, “Well, we
just want to know your opinion.” I don’t really like to do that because now I’m no longer an expert witness.
The job of the witness is to give the information to allow you to make your own decisions. I’m violating that prin-
ciple because you asked for it so I’m now going to give you my opinion.
The practice of screening has not kept pace with scientific development.
In any client-clinician relationship, I can
only justify giving a valid assessment since my aim
is to provide advice that will help screen only for
specific injuries, but you are going to need more
tests going down the rabbit hole, as Gray men-
tioned earlier.
There really isn’t sufficient evidence at this
point in time for general injury. The screens must
incorporate injury mechanisms. The process must
consider the demand on the person, the exposure
and the context. The characteristics of the per-
son loads the gun, but something has to pull the
trigger. The science here is just emerging, but it’s
30 years old in the occupational injury field and
they’re still arguing whether a simple screen is suf-
ficient or more complex.
I want to leave you with something to think
about: The health of every system in the body depends on
good movement.
Could you imagine if every family doctor had
a tool to refer people needing movement restoration?
That could be the most potent intervention of modern
medicine. I think I know of a guy who can lead that
revolution and he’s standing over there: Gray Cook.
The little bit of work we’ve done on this has cost
over half a million dollars. Those are the people who
have funded us for this endeavor.
I’ve done a lot of dissection this morning. My next
talk will build it all back up again.

4 Stuart McGill Assessing Movement Part One Transcript

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

4 Stuart McGill Assessing Movement Part One Transcript

Uploaded by

Copyright:

Available Formats

STUART McGILL

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

You might also like