Consult Your Doctor Before… Moving? Part Two

Part Two
Click here for Part One

Movement Competency: The ability to employ fundamental movement patterns like single-leg balance, squatting, reflex core stabilization and symmetrical limb movement.  This can also include basic coordination with reciprocal movement patterns like crawling and lunging. The central goal is not to assess physical prowess or fitness, but to establish a fundamental blueprint and baseline of quality not quantity.

Physical Capacity: The ability to produce work, propel the body or perform skills that can be quantified to establish an objective level of performance. If movement competency is present at or above a minimum acceptable level of quality, deficits in physical capacity can be addressed with work targeting performance. If movement competency is not adequate, it would be incorrect to assume that a physical capacity deficiency could be addressed by working only on physical capacity.

Growth and development follow the path of competency to capacity, but how many fitness and athletic programs parallel this time-honored gold standard of motor development? If screens and standards for movement competency are not employed, we are programming on a guess. Furthermore, if our testing does not clearly separate movement competency tests and physical capacity tests, we exchange a guess for an assumption.

In the Movement book we emphasize the importance of movement competency through screening and assessment, and we further separate movement categories to help the exercise and rehabilitation professional categorize movement deficiency in clients and patients.

We introduce some basic principles in the first chapter of the book and expand those principles in the last chapter. They are based on growth and development of movement, perception, behavior and learning. This discovery is driven by a new paradigm, a model influenced more by the complex neurological system than by rules built solely on the well-worn mechanical maps of bones, joints and muscles. Our first principle on exercise draws a line in the sand, a line that has helped me function as a successful exercise and rehabilitation professional without conflict and with improved clarity.

That line is pain.

It suggests that if a fundamental movement pattern causes pain, there could be a potential health risk with exercise and activity. Sounds pretty simple, right? Nah, we messed it up. The story goes like this.

Something happened about 15 years ago and I cannot explain what exactly perpetuated the problem. It was probably another attempt to soften our language or become more politically correct to protect our expanding delicate sensibilities. It’s a little semantic problem that fuels the fire of very poor logic and disregard for a systematic approach.

It left us with confusion and breaches of professional misconduct on both sides of the issue. It all started the day a client or athlete referred to a health problem as a fitness or exercise issue. Unfortunately, physicians, physical therapists and chiropractors often use the same verbiage: In the same discussion they refer to a patient’s issue as a problem, and discuss personal health problems as issues.

According to most sources, an issue is simply a point of controversy. Is this to imply that?

  • Multiple experts who unfortunately disagree with each others’ expert assessments have comprehensively evaluated the health problems in question.
  • Or does it imply that you have not yet arrived at the answer that best suits your convenience, budget, motives and schedule?

In my professional opinion, the second definition is the most common example of our justifications.

Guilty as charged. My problems are issues and their issues are problems. I want a fast-track to resolution, whereas I expect my patients and clients to earn their recovery through education, effort, lifestyle management and by giving nature time to work.

When we allow health problems to be referred to as fitness issues, we break a cycle designed to protect the user. This is a cycle the user might wish to actively deny, and a cycle that requires responsibility on one side and investment on the other.

That is probably why the phrase health and fitness is never stated with fitness coming before health—this would imply the impossible. Health is a precursor to compressive fitness. Sure, you can achieve higher levels of fitness on a dysfunctional platform, but the level of fitness is short-lived and not comprehensive by definition. It is usually selective, specialized and fragmented. It also compromises long-term durability.

Our expanding database suggests that around one out of every five functional movement screens reveals pain with at least one movement pattern. Out of the 10 simple movement tests—seven movement patterns and three clearing exams—not one exceeds normal range of movement limits or loads the body with abnormal stress. The tests simply ask that a person move within his or her own dimensions. These movements represent the functional patterns and multiple planes that today’s exercise professionals commonly program into routines, classes, boot camps and athletic conditioning. Without some form of pre-exercise screening, many participants will exercise while experiencing issues or pain, and actually think or hope the exercise will somehow work things out if they can persist long enough. This assumption can be dangerous.

Here is what we know: Pain forces the body to react, respond and move in inconsistent and unpredictable ways.

Pain changes movement perception and can alter movement behavior. When you pursue fitness around painful movement patterns, you are at best guessing what to do next and hoping the outcome will somehow produce less pain, all without actually knowing what is causing the pain. Pain is not an issue—pain is pain—and it is the most common reason for consulting a physician in this country, even if it is presented as an “issue.”

In reality, pain is not even the problem; it is a signal that a problem is present. Unfortunately, pharmaceutical companies capitalize on the distress your issues produce and ask that you cover them up and keep on moving. What do they know about movement? Nothing! They don’t need to know about movement—they just need to know you’re impatient. In many cases, they have bypassed medical screening and assessment and through advertisement asked you to ask your doctor if this cover-up is right for you. To compound the issue, physicians have learned that if they do not give you what you ask for, you will find someone who will.

Four potential causes of how health problems became exercise and fitness issues

  1. Poor teamwork—lack of professional communication and courtesy between the exercise and medical professions
  2. Myopic focus—the lack of comprehensive system for movement problems in rehabilitation and exercise
  3. Greed—money for pain, pharmaceutical companies
  4. WIS—Western Impatience Syndrome

Movement Screening

The movement screen was designed to show the exercise professional the one client in five who might unknowingly expect fitness to solve a health problem. Therefore, we suggest that the exercise professional perform a functional movement screen before developing fitness or conditioning programs. We also encourage rehabilitation professionals to perform the same type of screen upon discharge following rehabilitation. This simple investment of 10 minutes provides perspective and clarity. If the screen produces pain, a health problem is present and could potentially compromise exercises and physical activities. Since standard operating procedure is not currently practiced regarding risk and program design for exercise, we use the movement screen to promote consistency. It does not dictate exercise choices. It simply provides an objective checklist and provides fundamental baselines for movement competency.

A typical response: You don’t understand, I exercise all the time—I’m fit, with a minor issue here or there.

A valid and responsible response: I’m not screening you to find a problem;  I’m screening to clear you for exercise. This is a proactive approach and if I find a problem, it will change the direction of my next step as a professional. Either way, I plan to get you moving, but I will not sugarcoat your health problem by calling it an issue, and I would advise you not to cover it up just to participate in a temporary bout of exercise. Problems just don’t get fixed until you call them out!

The one-out-of-five pain statistics of the Functional Movement Screen (FMS) is made up of fit individuals of all ages, including high school athletes and exercise clients of all ages. The statistics also include military operators, firefighters and NFL players, all of whom have passed a medical physical yet still have pain with a movement pattern.

A look into the future

Until we establish poor movement patterns as undisputed risk factors of injury in active populations, we must wait for the “ouch factor” to be present. This sounds primitive and reactive, but that’s how we do things—we mostly fix broken stuff, not something with an obvious potential to break.

As you wait for the research to feel more comfortable before you take action, remember the purpose of the FMS. It suggests a minimum level of movement quality before pursuing higher levels of movement quantity. If you think this is overkill, consider a study performed in 1954 that forecasted some of the western health and fitness problems that plague us today. It demonstrated a staggering difference in children with common genetic roots from different cultures.

For more information on the study and to hear a president comment on the softening of America, go to this link.

My only critique on the study is that I wish they had attempted to demonstrate that the lowest common denominator was not strength or fitness, but instead it was movement. If movement is the lowest common denominator, we need to start at systems that address movement-pattern fundamentals. Once movement fundamentals are present, performance can be investigated with greater clarity.

Now watch this short film.

YouTube Preview Image

To demonstrate why we need to start with principles, I show this well-produced short film in many of the classes I teach. Although some exercise and rehabilitation professionals are inspired by the vision, an equal number get hung up on exercise equipment or methodology, or notice an example of imperfect technique and they just can’t let it go. They fail to see the principles at work and move directly into a debate on methodology or on their particular interest or specialty.

In the classroom, I let the group decline into a sea of debates about methods and trivial differences until after about 10 minutes I put an end to the madness. I inform them that this is exactly how highly educated health and fitness professionals have produced one of the biggest health and fitness problems of all time while enjoying the most resources of any professional generation. We have defended our delicate opinions while our principles have nearly vanished.

If we as exercise and rehabilitation professionals make a point to check methods against principles periodically, we will be just fine.

For now, it would be wise to consult your physician if you suspect a health risk, but don’t expect your movement vital signs to get checked. Those will only get checked if you are working with an exercise or rehabilitation professional who upholds movement principles and possesses systems that support them.

Consult Your Doctor Before… Moving?

Part One

The statements can be endless. Consult your doctor before starting exercise…. using this program… participating in activity—and on, and on, and on. That suggestion is actually made to protect your health, not to refine or individualize your personal approach to exercise activity and athletic endeavors.

Many in the general public assume they may receive some level of exercise guidance from the inquiry, but physicians are not formally trained in exercise prescription, and unless they have specialized training, their opinions on the subject differ greatly. They are, however, pretty effective at screening for serious health risks that could potentially be worsened without guided forms of exercise and activity.

So what’s the takeaway here?

If you ask a physician about health, you will get an expert professional opinion about your health risks associated with exercising and participating in activity. On the other hand, if you ask a physician about specific exercise or fitness practices and programs, you will get an opinion, but it may not be expert. It cannot, by definition, be expert unless the physician answering the question also holds a secondary credential or certification in some form of exercise or activity instruction. Physicians have little time in their training to understand exercise as it relates to rehabilitation, fitness and performance enhancement. Thus, their directive toward exercise and activity is to protect you, not to specifically correct or enhance you.

I’m not throwing stones here, because even though physical therapists and chiropractors use forms of exercise prescription to enhance the rehabilitation process, their opinions on exercise as it pertains to fitness and performance are largely formed by personal experience and not by professional standards. I’m a physical therapist and my exercise opinions outside of rehabilitation were not formed through my formal training. They are a result of my experience, exposure and opportunities to investigate different forms of exercise. My formal training did not expose me to the most effective methods of weight loss or athletic performance enhancement, but my training helped me appreciate how each of these modes of exercise should follow some principle-based format.

Expect the physician to consider your health and advise you based on the systems he or she evaluates. As you walk out of the office with your clean bill of health, do not assume you got a clean bill of movement. Your other systems have been checked, but who will check your movement competency?

Since it appears that a clear standard on the practice and participation of exercise is uncommon, we as exercise and rehabilitation professionals should return to fundamental points of agreement and try to work forward. I propose a clear set of standard exercise principles, principles that are fundamental and nonspecific. They can be applied to the human condition at any point on the path of movement. In the book, Movement, my contributors and I attempted to draw a line in the sand using principles. Our experiences have shown that medical and exercise professionals will not arrive at clear and consistent communication unless they put aside their preferable methods and opinions and revisit the fundamental principles of movement—the undercurrents upon which all exercise, activity and athletic achievement float. Clarifying the underlying principles of movement is refreshing if you have an open mind because your best and worst experiences can be explained when a fundamental principle is either upheld or overlooked.

I would like to provide an assignment while you await the second part of this article, and it’s this: Define the difference between movement competency and physical capacity. Invite you colleagues and peers to participate in the drill.

And now, click here for Part Two.