In out first article on Assessments, What they are and why you need one, we discussed the postural assessment and the functional movement screen and what we are looking for in them. Then we discussed the Functional Movement Screen in the 2nd installment. In this article we’ll talk about the Full Assessment and how it can help us figure out the root cause of an issue that the FMS may uncover.
The Full Assessment protocol covers about 70 different “tests”. Some are similar to the FMS; the Overhead squat and lunge (which is more like a standard lunge than the FMS screen), pushups and active straight leg raise. Other tests get into the realm of Physical Therapy and we look at both passive movement (I move your arm or leg) and active (you move it yourself). Still others test your strength and where you get it. For example the shoulder/scapula strength test looks to see if a downward force on your arms, held at shoulder height & 10 & 2 positions, is strongly resisted or shows weakness, whether you are you are using the correct muscles to resist and whether there is any pain.
The Full Assessment looks at the entire body from your head and neck down to your toes. Yes we literally test your big toe to see how well it moves. If your big toe is restricted or there is pain you are going to have problems on any movement that requires you to flex it, like walking. A toe that hurts when you walk means you’ll start to move differently to stay away from the pain. Over time that new way of walking becomes permanent. The longer the toe hurts the more permanent your new walking pattern becomes. The change in the way your foot moves because of the toe starts to make the knee get off track, then the hip starts to compensate. This goes on up the chain to the shoulders and neck. Even if the big toe is no longer in pain, if you haven’t corrected all the compensations you’ll continue to walk poorly. This eventually leads to more dysfunction and pain in other areas. Just like the kids song – the foot bone is connected to the ankle bone, the ankle bone is connected to the shin bone, the shin bone is connected to the knee etc.
So your big toe was banged up, you walk funny and you get weird pain in the hip or knee on that side & your doc says there’s nothing wrong with you. MRI is clean, pain relievers work a little. Sometimes there is no pain other times it’s bad. So you train through it, whether it’s running or squatting you back off a little if it hurts, otherwise full bore. Then one day something goes pop…..
At the point where the doc told you he can’t find anything and the MRI s clean is where you need to stop and think about things. If you’re a runner is your running form good; are your shoes good but you still get pain in the knee or hip. Your deadlift feels great but your back squats hurt your knee or causes pain in the hip. Why? Off to the Physical Therapist or Chiropractor.
The Chiro pops you and you feel much better for a few days but the pain returns, you go back, you get popped it feels better, etc…. Now I have nothing against Chiros but I feel the work they do needs to be done in conjunction with massage, corrective exercise and strength training. The Chiro aligns you, the massage therapist loosens the tissue (you could see the MT first), the correctives help reinforce the Chiro & MT work, the strength training locks everything in place. That is a plan that will get you fixed quickly and keep you that way. Over time you may cut out the chiro, but the massage should be at least once per month especially if you train hard. The correctives may eventually come out but the strength work should always be included at least once a week in addition to training for whatever your goals are.
From another perspecitve if you see an MT but not the chiro and you have a disc out of alignment and you do the correctives and strength work you’ll never fix the problem, because nothing else will get the disc back in place. Or it could make the recovery process a lot longer. Likewise, leaving out the strength training means that the changes brought on by the Chiro & MT won’t stick more than a week or so. Strength training alone, especially the wrong strength training will probably make things worse!
Going the PT route: PTs typically only look at a narrow area around the problem spot and may give you exercises to strengthen the quads in the case of knee pain or the glutes for hip pain, but have they found the source of the problem??? PTs like docs are trained to get rid of the immediate problem – pain, rather than the root of the problem.Not all PTs are like this but if your’s isn’t checking out your entire body when doing an assessment they are going to miss things.
You might have a shoulder pain in certain movements and the doc can’t find anything and the MRI is clear but the pain is there when you press overhead or do pushups. Do you keep training and hope it goes away? Do you pop some pain relievers? I hope not, masking the pain then training is a sure way to wreck yourself. Do you stop training the exercise(s) that cause the pain or just stop training to see if it gets better? What if I could tell you in an hour what may be causing the problem and how to resolve it?
The Full Assessment really gets into the nitty gritty. Depending on which way your leg moves on a certain test, couple with the results of another test can tell whether your IT band is tight your your quads are tight! Other tests will bring out scapular weakness or instability, problems which will lead to shoulder dysfunction and injury at some point. We may find some things the FMS doesn’t find.
One test in the Full Assessment is the toe touch. Sounds simple but many people can’t touch their toes, others can but are cheating, a slight bend of the knee or rounding the upper back too much. In many people, the lower back (lumbar spine) is locked up and when the bend over the lumbar area is flat as a board instead of being rounded. So we’ll have the do a toe touch on the ground to see if there are any changes. If there are differences we could have a weak core or balance problems. Do the toe touch on the ground eliminates gravity and the need for core stability and balance.
In our next installment we’ll talk about how the postural assessment, FMS and Full Assessment all tie together and what to do with all the info.