Is Movement Screening Predictive of Performance or Injury Risk?

Is movement screening predictive of performance or injury risk?  

Movement screening is the process of using more global and associative movements to observe how individuals move or use their body.  

There is notable controversy around movement screening, specifically regarding the assumptions we make based on the results of movement screens.

This has been researched extensively enough to establish that the strength of association between movement screens and injury risk does not support the use of screening as a predictive or diagnostic tool (1).  Nor are movement screens a direct indicator of athletic performance (2).

But,

what movement screening does provide us with is powerful insight.

The movement strategies individuals adopt may help us identify areas where movement is restricted, painful or unevenly distributed.  

They may also help us observe an individual’s willingness to move.

I use movement screening as a valuable part of the assessment process to ensure that individuals have all the resources they need for optimal movement capacity.

And that, in turn, does have an impact on athletic performance.

Here is the valuable insight you can gain from using two very useful rotational movement screens: the Multisegmental Rotation Screen and the Cervical Rotation Screen.  While they might not directly correlate to injury risk, you will see how crucial they are to creating optimal athletes. 

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MOVEMENT SCREENING: WHAT TO LOOK FOR

So, if movement screening is not a diagnostic tool, nor predictive of performance, what are we looking for?

First, let me start by reminding you that a thorough assessment involves movement screening, specific testing and functional assessment.  

From both a prehab and a rehab perspective, we use movement screening as well as a battery of many other clinical and functional assessments to determine whether any residual restrictions are likely to impair performance potential.

Movement screening alone is not comprehensive enough to tell you exactly WHY an individual is moving the way they are.  BUT as I mentioned earlier, 

movement screening provides you with powerful insight on HOW an individual moves

Then, you can identify areas where more specific, impairment-based testing is indicated and decide on the appropriate intervention to improve movement capacity.

All that said, you should be looking for something that clearly “looks” suspicious.  Too often, we find ourselves looking for a centimeter here, a degree there. 

Subtle side-to-side imbalances are relatively normal.  When there is a significant difference from one side to the other in regard to symmetry of movement and/or effort, ask yourself:

How does this difference correspond to the context of this individual’s history, complaint, limitation, pain, previous injury, mechanism of injury, etc.?

Let’s make that clearer with some specific movement screening and examples.

MULTISEGMENTAL ROTATION SCREEN

In sports, when individuals take a step, shift weight towards one foot, decelerate or land, impact forces (or load) are absorbed moving into foot pronation, ankle dorsiflexion, tibial internal rotation, and hip internal rotation. 

In more simple terms, we absorb forces in rotation

So, if one joint is compromised, more force will be distributed to other joints.

And one thing we do know is that this can make those joints more susceptible to injury.

By the way, I discuss the concept of load distribution for shock absorption in this ? article, so make sure to give that a read to understand why it is so important for all regions to contribute to rotation.

Perhaps one of the most valuable movement screens you can use to make sure individuals have all the resources they need for this is the MULTISEGMENTAL ROTATION SCREEN.

This screen from the SFMA tests rotational mobility in the trunk, pelvis, hips, knees and feet as a contribution of all of these parts to the total motion.  

Assessing the quality of this total motion is a great place to start given what we know about rotation as an absorption mechanism.

In the MULTISEGMENTAL ROTATION SCREEN, the pelvis should rotate about 50 degrees and the shoulders should line up.  Again, we are looking for symmetry and effort.

WATCH the video below of Virginie, an elite university-level soccer athlete.  Her movement screening clearly shows how different her pelvis rotation to the left is from her rotation to the right:

Guess what?  

Virginie has had two ACL reconstructions on her right knee and one on her left side.  She has also had multiple ankle sprains.

The result of her movement screening show us that something is restricting her rotation to the left.  It could be that she is hesitant to torsion that right knee, which has had 2 ACL reconstructions or that her right knee is restricted in rotation.  Or a little of both.

She might also be limited on the left side.  For example, her left hip internal rotation might be limited, not allowing her to fully rotate her torso to that side.

We don’t know yet because we need to dig deeper, but the MULTISEGMENTAL ROTATION SCREEN has given us literally a TON of information.

Information that tells us that she does not have all the movement capacity she needs to optimally handle and distribute the stresses inherent to her sport: turning, kicking, changing direction, evading opponents, etc.

While there may be no direct correlation between movement screening and injury risk, but the way I see it, it points us to areas where there may be limitations that can predispose Virginie to injury.

CERVICAL ROTATION SCREEN

Another fundamental element of movement screening is the CERVICAL ROTATION SCREEN.

Full cervical range of motion in sports is often under-estimated.  

Whether it’s to track a ball over the shoulder, take a shot, throw, hit or change direction, the cervical spine needs to rotate

and often in the opposite direction of the torso.

Previous injuries, such as those to the neck, shoulder, or even elbow, can wreak havoc on the complex function of the cervical spine.

There are 2 parts to this screen, first assessing rotation in neutral, and then in a flexed position.

Rotation in neutral

In the seated position, they should be able to rotate to bring the chin in line to the mid clavicle without turning the torso.  

MAKE SURE TO WATCH THE MAIN VIDEO OF THIS ARTICLE TO SEE HOW TO PERFORM THIS SCREEN

While symmetry is one aspect to observe, you also want to look for quality of movement. 

Here’s a specific example just to make things clearer: 

Let’s say the individual rotates smoothly and cleanly to the right side, but when they rotate to the left, they tend to laterally flex to gain range.  

Excessive lateral flexion can upregulate the scalenes, which attach to the first rib.  Poor first rib mobility and positioning is associated with thoracic outlet syndrome.  

Like I said, movement screening is not comprehensive enough to tell you exactly WHY the individual is moving the way they are but shows you HOW they move and then you can dig further using range of motion and functional assessments.

Considering the many muscle attachments between the shoulder complex and the cervical spine, the cervical rotation screen can really highlight some things you might have missed if say you had been focusing in on a shoulder assessment.

Rotation in flexion

The second part of the screen is done in flexion because this isolates C1 and C2 (the upper cervical spine or atlanto-axial joint), which contributes to a large part of total rotation range of motion in the cervical spine.  

If there is restriction in rotation to one side, there may be a restriction in the atlanto-axial joint on the opposite side. 

MAKE SURE TO WATCH THE MAIN VIDEO OF THIS ARTICLE TO SEE HOW TO PERFORM THIS SCREEN

MOVEMENT SCREENING PROVIDES POWERFUL INSIGHT

Just because the “science” says something, doesn’t mean you have to throw the entire thing out the window.  

Think critically about what information movement screening can provide you with and how useful that information can be in the context of the individual you are working with.

The way an individual moves is indeed complex and can be influenced by many factors.  Movement screening allows us to assess HOW an individual is moving.  

And while it is not comprehensive enough to tell us WHY they are moving the way they are, it does provide powerful insight on where more specific assessment might be warranted.  

Because the body absorbs and distributes force via rotation, assessing the contribution of the entire kinetic chain to this motion helps us identify areas where this capacity may be limited.  

The MULTISEGMENTAL ROTATION SCREEN and the CERVICAL ROTATION SCREEN are two helpful movement screening assessments that can highlight these limitations and help you build more efficient prehab and rehab programs.

And that, in turn, is important for athletic performance!

REFERENCES

1. Moran, R. W., Schneiders, A. G., Mason, J., & Sullivan, S. J. (2017). Do Functional Movement Screen (FMS) composite scores predict subsequent injury? A systematic review with meta-analysis. British journal of sports medicine, 51(23), 1661–1669. https://doi.org/10.1136/bjsports-2016-096938
2. Parchmann, C. J., & McBride, J. M. (2011). Relationship between functional movement screen and athletic performance. Journal of strength and conditioning research, 25(12), 3378–3384. https://doi.org/10.1519/JSC.0b013e318238e916

Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U