Friday, November 26, 2010

What's a "Movement Assessment" Why do we need one, and how does it help, RIGHT NOW?

What is a movement assessment? Cut to the chase, a movement assessment looks at how one moves. Why? if one's movement is hinky with anything from a slightly hiked shoulder to an over-prontating foot, to someone saying it hurts when they sit for awhile or their joints hurt, to someone else constantly hitting their golf balls to the left, or they're stuck at a plateau in a lift, there's something going on with one's movement that's not right and that IS having performance consequences, right this second. Right.This.Second.That performance hit may manifest as pain as plateau as poor target acquisition, but it's happening NOW.  It could also change dramatically, just as quickly. Right now.

Why so fast an effect? the nervous system reacts that fast to shut down performance where a threat is perceived. Inflammation in the shoulder: restrict movement; vision problem - yes, threat - slow down movement.

Neurons are very tiny: it doesn't take a huge BOO! of surprise to trigger an inner threat response and appropriate system power withdrawl.  Often that threat is so subtle we don't initially perceive it. But our nervous system does - have you seen this demo of the arthrokinetic reflex to underline this point?

By the time we do see something - pain, performance, plateau, etc - the issue may be bigger, but there will still be an immediate response to threat reduction.

The role of a movement assessment is that by looking at one's movement and one's responses to movement work, we begin to find a path to address what's happening that is having whatever the performance cost is - whether that cost is pain or plateau or whatever - and from there we develop active strategies  to get it sorted.

A movement assessment uses a suite of tools to consider movement, including the visual, vestibular and proprioceptive systems. It starts with the understanding that the nervous system drives everything; connects everything, so working with the nervous system as directly as possible is a fast path to immediately testable results. Right. This. Second. Movement is a Fast Connector to immediate change.

The role of a movement specialist in this process is to look at and listen to what a person's movement may be saying about their performance. It lets the specialist begin a dialogue with one's performance to get that performance back. If a hip is not moving well, for instance, it might be that working with one's ankles and shoulders will help; it may be that checking one's balance or vision will help give back that range of motion to the hip; it may be moving out of a dark gym and into a better lit area that makes the difference. We see the effect immediately in movement.

People who Would Benefit from Movement Assessments: all of us.
I've seen folks who move very well - Dennis Frisch whom i interviewed a little while ago about bodyweight work has beautiful form. But alas none of us are perfect. But hurrah, the more perfect the movement, often the better everything else. Movement is Plastic! we can improve it - constantly. 

Scenarios: as identified above, anyone who says "i get sore when i try this" or "i can't break past this weight for this lift" or "i get headaches sitting at the computer" or "my vision is getting worse" or "i'm having a hard time sleeping" - no exaggeration - a movement assessment can only help.

Everyone is Individual. The intriguing thing is that while we all have a lot in common in terms of our physiology, the combinations of differences in our experience mean that what may be causing me the exact same pain in my shoulder may be utterly different from what's causing yours. A movement assessment is dynamic. By assessing and reassessing throughout the movement assessment, we tune in what's working; we chuck what's not. Immediately. It's also an active process - you are doing the movments, the work - which means the tools you get in an assessment you take home with you for your practice, benefit and continued self-assessment.

Caveat: let's assume that anyone reading this who's thinking of an assessment has seen their medical professional and been cleared to rehab or to train. Going from there, let's look in more detail at the what and why of an assessment.

The next bits here go over some of the things that happen in an assessment and why, then looks a bit at the rationale for the approach. 

Assessment Overview
The name movement assessment - at least how i'm talking about it - is very much short hand for a suite of evaluations that a movement specialist would carry out sitting down with you. And indeed, since there are good folks and better folks in any profession, this check list may help you determine if the person you're thinking of working with you is indeed right for you.

Ok, so what would a movement assessment include?
Client History. First things first is usually doing a written history and an interview about your history. This preliminary work can be super detailed or more concise depending on your goals with that coach/specialist.  For instance, if you're working on nutrition and fitness, and the movement assessment is part of a baseline view of you, that history may include a food log and a lot of info about eating practices; if you're going in because you have this pain in your knee, well the food part may be initially far more brief. In each case, injury history, medical conditions, current supplements etc etc are going to be part of the intake.

Movement. At the heart of something called a movement assessment would be, you would think, an assessment of one's movement. Absolutely. The cool thing is, movement is informed by a lot of stuff, from the stresses we're experiencing  to the cast on the foot that may be currently limiting us.

one of these  placed inside the mouth along the jaw
changes a person's gait
Bite Busting Effect on Movement. Intriguingly, research a colleague pointed out to me shows that something as simple as one of those rolled up cotton sticks dentists use, when put on the side of one's mouth actually changes one's gait. That simple can have that knock on an effect. So as i've echoed here many times, the site of pain is not the source of pain. Nor is the site of a seeming performance break necessarily the source of that performance obstacle.

VPP. Because of this near anything can cause anything issue, a real movement assessment is going to have to be able to consider those factors that impact our movement. Fundamentally, these are the somato-sensory system or the visual vestibular proprioceptive hierarchy (VPP for short). I've written a bit about the VPP over here, by way of overview.

General before Specific So a movement assessment will look at how you move naturally.
It may also look at how you move specifically in whatever movement it is that seems to be causing an issue or is a movement you want to improve. It will look at these gross movements before getting into singular detail. So before looking at your knee, a specialist may look at you walk. Before looking at your grip of your golf club, they may look at your whole swing, from walking up to the tea to following through.

photo: Butch Rovan,
A movement assessment is actually a series of iterations. The specialist will do a baseline assessment, offer usually a movement drill for the person to try, immediately reassess the effect of the drill, and refine/reiterate the process of assessing, trying, reassessing.

Pending the person's response to these drills, the assessor may consider other components of the VPP and do specific visual and vestibular assessments to see how these components may be playing a part in the movement response, and will add these as appropriate into the drill mix.

Two big pluses to this approach:
  • the person knows right away if what's happening is making a performative difference
  • the person has a set of actions they can take with them to keep rep'ing in the improvements 
This last point is a biggie, too: the person has a set of actions/drills they can keep doing for themselves after the session to keep improving.  The session dials in what works for the person so they can keep going with it, actively. They own their improvements.

    It sounds really simple this approach, doesn't it? Look at one's movement; do some drills to clean up that movement, test if what you've just tried has had an effect; keep tuning in what you're doing to get the best possible response. And in truth, it is a very elegant approach. But the thing about elegance is that it makes something amazingly rich and complex accessible, performable, or at least perceivable.

    E=mc2 is elegant. But in that simple expression one heck of a wallop is packed to prove it. That said, you may be interested in a bit of what informs this elegant approach of move, test, try, reassess move again approach to performance optimisation.

    The Difference: Theory And Practice Informing the Approach
    Higher Order Bits A movement performance based approach takes as given that the nervous system is the governing system of the body and therefore working with the nervous system will offer the fastest (proprioception operates at oh about 300mph) and biggest bang for the buck. Focusing on the VPP is one way to work with the nervous system.

    This speed of the nervous system is also why we can see immediate effects of what we're doing. Does this drill test better or not? If not, rethink, retune, redo, reassess.

    If we're not testing, we're guessing.

    Example "I have tight hamstrings"
    Because the assessment approach respects the neural hierarchy it's looking at what are the highest order issues in that system that may be causing this effect. The classic example here is tight hamstrings.

    One can wale away at stretching their hamstrings to "loosen them up" so they can bend deeper for whatever their sport movement is, but a few questions come up. First, is "stretching" if one's goal is to lift a heavy weight - say deadlifting - a great idea? Actually, no. Research again shows that stretching - getting the muscles not to fire up and shorten up as strongly and as quickly as they can - is really detrimental for lifting. So the therapy is not even a good match for the practice.

    Second, the higher order question a movment performance specialist will ask is WHY are these hamstrings so tight in the first place? Is there a higher order issue going on? What if it's the person's vision that's inducing a threat response such that the person's bod doesn't feel safe bending over, and would really rather not, is manifesting as restricted hip extension? Until vision is addressed, it's very likely that that restriction will keep coming back.
    Motor Learning: Active rather than Passive. Another part of the approach that is compelling is again, as part of the respect for the nervous system as governor of the body is that that system is always learning. We know from neurology that our movements induce motor learning (movement learning) patterns. What we rep is what our bodies "know" and we go to what we know.  So when we're trying to adjust a movement so that it feels better, lets us go further, then we want to give our nerves learning that new or newish pattern as much stimulation as we can.

    SAID That's "specific adaptation to imposed demand" - it's apparently how we respond to load. We adapt to exactly what we do. So let's imagine the usual passive manipulation space. We're on a table in a practitioner's office. That means we're horizontal. And now we're being held, told to relax, let the therapist do whatever.  Now keep SAID in mind.

    I've written about active and passive before, and there's a great video with that post over here, but in brief,  as presented in that video's summary of manual/active, in manual therapy - where something is being done to us - two things happen:
    • we're usually lying down on a table so we can be worked upon - which is not the position in which we perform
    • in being manipulated literally tens of thousands fewer nerves are stimulated than when we have to coordinate our movement ourselves
    Thus, our nervous system's limited learning is about how to feel while on a table and while being passively manipulated. That's not how most of us spend our days. Likewise, because the action is passive, also, the motor learning opportunity is substantially decreased. This is why *often* people have about a 40min window of feeling really great getting off a table, and need to be adjusted, massaged, whatevered regularly - and would do so likely daily if they could afford it - to try to keep that sensation of wellness.

    Combination of Benefit Effect Of VPP Approach
    By taking a primarily active approach to assessment with a nervous system lens, we leverage the nervous system's speed for accelerating performance improvement. So, by operating with natural and sports-specific active movements,
    • we respect the SAID principle, repping in better quality movement
    • we leverage motor learning's increased neuron engagement so increase speed of uptake
    • we respect the VPP hieararchy to ensure higher order systems are considered
    • we can do immediate, on the spot evaluations of effectiveness
    Whither Manual? None of the above is meant to say manual therapies do not have a place. Lots of good things happen when we are touched by another person. Stress can be decreased; there's evidence to suggest that healer's hands produce electromagnetic fields that non-healers do not and that these radiations have great effect on cells in the process of healing. Fabulous. And sometimes, it's lovely just to go for a massage - to enjoy the restorative pleasure of that moment and feel zen for the rest of the evening. Super.

    The point may be, howerver, just that: manual therapy has a role but not the sole role or perhaps not even the dominant role.

    Let's break it down: surrendering our own power? When we go to a manual therapist, fundamentally what are we saying? Often it's, i'm broken; i need someone else to fix me. That's understandable. That's what we're taught from an early age. Illness means someone else or something else has to *fix* us. Sometimes, for sure, some external intervention is a good idea. But how much intervention? Remember the old saw about give someone a fish, you feed them for a day, teach them to fish, feed them for a lifetime? With physical problems, it seems we're encouraged to beg fish rather than go fishing.

    You may say - heh! isn't there a contradiction here? you there mc are saying be all proactive and responsible about your health practice and this whole post is about going to get a movement assessment? Ah but i've also said repeatedly "everyone needs a coach." The best athletes may have multiple coaches for different aspects of their game, oui? Likewise grad students have supervisors. Colleagues have mentors. Teams have coaches. Why? does a coach do the work for the athlete?  No. Great coaches guide their charges to help them tune their performance - whatever that may be.

    Likewise many of the movement specialist colleagues i know prefer to see themselves as coaches. Or nudgers. Where we help guide movement to better functioning paths. But the work is still done by the person being coached. And it's that active engagement that fires up SAID, motor learning, and speedy effectiveness.

    The athlete does the work; the coach - by knowing how to test and reassess - helps find the path to tune up the process and make that process happen so much faster and more efficiently.

    A movement assessment is not just a tune up; it's a tune in, a dial in, a performance optimization boost.  The approach i've described focuses on movement performance optimization. Often, what we find is that when we help movement get better pain goes down or disappears too.  So folks with this training actually do see a lot of people who have pain. And we do see a lot of folks who are looking for that nudge to the next level.

    The value add of such coaches/specialists is the speed with which an effect is seen. When folks come in with pain, that's often - here's what's wild - the easiest part of the job. Really. What we'd rather be doing is saying ok, now that you've got that out of the way, can we talk about how to make your workouts, your work, your general well being that much better, too? Why be just "out of pain"? why not be exceptional?

    How can a movement specialist offer this kind of coaching? If you're really interested, take a look at the detailed descriptions of those assessments in each of the certifications offered for instance by Z-Health. We learn literally hundreds of assessments and drills to help tune people's individual performance. Individual. That's another word we'll have to get into another time, but this approach respects that we are complex systems and thus respond in a highly individual way to everything. So those assessments are likewise available to tune what's interesting for you.

    A movement assessment - where this whole post started - is the first step to helping a person optimize their performance no matter what kind of athlete we are from keyboard athletes - as Jen Waak calls some of us in the knowledge working field - to elite sport athletes whom we watch at the olympics. We're moving. Most of us can move better. Guidance to help find that path facilitates and accelerates that performance boost.

    VPP Resources

    Essentials of Elite Performance DVD mini course
    A lot of the drills that might be discovered to be optimal for the person will be in any of the three main z-health dvd's. Detailed descriptions of all of them are over in the Movement listing. These disks include drills for VPP work. So yes, in short, one could skip the whole movement assessment and work their way through these series and performance will improve. You betcha.

    Indeed, the Essentials of Elite Performance mini course on 3 DVDs offers over a dozen self assessments too. And that may be just the ticket for you.

    Why an Assessment then? The difference between a DVD and a live session with a coach is the difference a trained eye can bring to any performance: speed of resolution, refinement of process, acceleration towards the next level of performance.

    Take Aways: Movement Assessment as Tune In
    So what have we got?
    A movement assessment as described here
    • is an iterative assessment that looks holistically at how a person moves before specifically since
    • it recognises that the site of an issue may not be the source of an issue
    • it takes the nervous system as the highest order system, governing the body
    • it respects the somato-sensory hierarchy (VPP)  and can work with each of these systems because
    • it has dozens of assessments and drills within these systems that can be combined and brought to bare
    • because of its focus on the nervous system, it gets immediate feedback on effect
    • it is an iterative process of test, reassess to tune in the best effect
    • it is an active process - the athlete owns their own movement and is improving their own movement
    Getting Going
    IF this approach to movement optimization sounds great to you, and you'd like to investigate it, here's a listing of trainers.

    Working with mc: If there's no one in your neighborhood, some of us, myself included, do assessments via Skype: if you have a web cam and room to take a few paces, you have a set up for an assessment. Contact and related info here.

    If you'd like to learn these coaching approaches yourself, a great way to start is with the Essentials of Elite Performance workshop. Otherwise, i'd recommend just call the office (888-394-4198), let them know mc suggested you call, tell them of your interest and they'll get you going. 

    So there - that's why i suggest a Movement Assessment for whatever ails ya in pain & performance - doctor's approval to train of course understood.

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