Movement Screens - why you should get one done.

What are they and why should I be having them done?Movement ScreensWhat are they and why should I be having them done?

Before every pre-season, elite athletes will have a battery of testing done. This includes strength, power, aerobic and anaerobic capacity, and movement screens. During the season, the allied health professionals in the team (generally physios and S&C coaches) will also conduct a combination of formal and informal movement screens – often done in person before training during the week, and through video analysis of training/ game footage.

So what is a movement screen? Why do elite sporting teams put such a high emphasis on them?

As a basic explanation, it is a variety of movements and movement patterns which get put under the microscope to detect potential impairments and restrictions, which may lead to future non-incidental injury (injury caused by means other than physical contact or trauma that is otherwise unavoidable). The selected movements that are being analysed are often your most common movement patterns and tasks that are performed regularly for that chosen sport.

Realistically, the concept of a movement screen is not just limited to sporting athletes or those involved in sports. Literally anyone can have a movement screen done. If you’re the average punter who goes to the gym, or does other forms of exercises regularly like running or yoga, or even if you don’t exercise regularly, then a movement screen may be something to consider doing once or twice a year to get an idea of how your body is moving. The average person doesn’t need to have a movement screen done too often, simply because our movement and load demands during every day activity may not be high enough to cause a potential injury like an elite athlete’s does. But it is still a good idea to get an overall perspective of how your movements and movement quality are trending. You may pick up that your squat has become more restricted since sitting more, or your hinge pattern has become stronger since doing deadlifts at the gym more. The movement screen is less about trying to ‘predict’ who will have an injury based on a set number being reached, but rather a way to identify movement quality (Bennet et al 2020).

For me, some of the most important movement patterns to look at in the lower body include a squat pattern (double and single leg), a hinge pattern (double and single leg), passive ankle range of motion, passive hip range of motion, as well as general mobility through the spine (upper, mid and lumbar). These movements are key for most activities of daily living. Squatting? Important for getting up and down off a chair. Hinge? Important for walking and bending down. Back mobility is also important, as it is central to anything upper body and lower body, and restrictions here can cause compensatory movements both above and below. Passive ankle and hip range of motion are also in, because both of these factors will affect how well we can move in the squat and hinge patterns! Restrictions through the ankles will have compensatory patterns higher up the chain (particularly around the knee, hip and low back), and hip mobility issues will cause compensatory patterns higher up and lower down the chain (lower back, knees and ankles).

How does this link with reducing injury risk?

As mentioned above, restrictions somewhere can lead to compensations somewhere else. Restrictions in ankle dorsi flexion (knee going over the toes) can lead to increasing loads through the patellar-femoral joint, which can then be a contributing factor for patellar tendinopathies and other types of loading issues around the knee (Macrum 2008, DiStefano 2006).

Restrictions in hip control and hip external rotation (often leading to poor knee tracking) can often lead to poor and/or reduced loading through the hip, thereby increasing loading around the knee during squat-type movements, again potentially increasing the chances of someone experiencing patellar-femoral joint pain (Macrum 2008).

What are some key things we look for during a movement screen?

There is a general standardised ‘technique’ for movements like a hip hinge and a squat. However, everyone is different, and things like limb lengths, torso lengths, anatomical hip positions can affect our movement quality. Some of these things we may not be able to control, so does that mean we’re destined for injuries? Probably not. Everyone is different and our body’s learn to load up and move a certain way. So what is more important that form? Symmetry between the left and right limbs. Ideally we want to see between 90% symmetry in most areas of the body.

Some people (particularly females) will have naturally wide hips, so will have weaker glutes compared to someone of the same training age (how long that individual has been training for). First, wider hips immediately promote a coming together at the knees, particularly when going into more hip flexion (deeper into a squat). We must identify whether the knees are actively (the person can use their muscle strength to push the knees out) and/or passively (the practitioner is able to create the movement without the use of the participant’s strength) able to push out away from each other. If they can actively achieve the movement variation we’re after, perfect! Let's look at how we can improve strength and control, now we know this is modifiable! If we can’t seem to get much active correction, but passively we can, then great! We still need to work on improving control to get those knees apart, we just need to modify the loading, ensuring it’s light enough to facilitate active movement into the range we want, and build up the load into a greater range as the participant gets stronger. If we can’t get the correction actively or passively, we don’t need to stress – as this may be very anatomically normal for them, and something their body has become strong at dealing with depending on their time spent training and general activity status (someone who has been training for years is more likely to have less pain with biomechanical abnormalities than someone new to training with biomechanically abnormalities).

But if one side is performing a movement that the other side isn’t’, it may be something we need to investigate further. Is there a biomechanical bias towards this change that may be helpful (i.e. hockey players will have one hip that rotates better, due to the asymmetrical nature of the sport). In the case of hockey, we don’t always need to worry about this asymmetry, as it’s contextual to their demands. We can load up all the corrective exercises in the world, but if they continue to play hockey then it’s unlikely to see any benefit from these exercises. What we’d look at is making sure the athlete has the strength to maintain doing this action repeatedly.

Say we find both hips are significantly restricted both actively and passively, and the participant is new to training and we are concerned about potential future injury risk, then (because we don’t see anatomy changing anytime quickly) what we’d want to do is instigate a training program that focuses on hip control, and work with a light enough load to ensure comfort and confidence within the participant to maintain and slowly build up control and strength over the longer time frames, whilst emphasising more around load management and recovery practices after exercise.

So movement screens seem simple in theory, but go into a lot of detail and can identify potential future injury risk, and give you the opportunity to instigate some control or strength based exercises in order to reduce the future injury risk. They don’t always predict injury due to healthy and normal anatomy variations, but they give us a framework and something to build on to maximise control, mobility and strength around certain body parts.

References:

Bennet H, Arnold J, Norton K, Davison K 2020, ‘Are we really “screening” movement? The role of assessing movement quality in exercise settings’ J Sport Health Sci, Vol 20, pg 30100-9

Macrum, EC 2008 ‘The Relationship Between Dorsiflexion Range of Motion and Lower Extremity Movement Patterns and Muscle Activation’, University of North Carolina at Chapel Hill

DiStefano LJ, P. D., Guskiewicz KM, Hirth CJ, Brown CN, Herman DC, 2006 ‘Ankle Bracing Affects Lower Extremity Kinematics, But Does Not Affect Vertical Ground Reaction Forces During A Jump-Landing’, National Athletic Trainer's Association Annual Conference, Atlanta, Georgia, Journal of Athletic Trainer