Gray Cook must be one of the smartest people in the world of movement, rehab, and coaching. It takes a special person to synthesize strength and conditioning, rehabilitation, and human development into one cohesive whole. The systems he developed, in particular the Functional Movement Screen (FMS) and the Selective Functional Movement Assessment (SFMA), provide a systematic way of evaluating and intervening with anyone who wants to move better.
The detractors want you to believe that the system is limited. Or that it’s not specific enough, or that the squat is the most important screen, or that it’s only about regional interdependence. These people are missing the point. When I read critiques of either tool, the FMS or the SFMA, the authors are cherry picking points they disagree with, or misunderstand how the system is to be used.
I’m working my way through Cook’s seminal book, Movement. The lesson he hammers home over, and over, and over again is to use the system exactly as designed. Don’t pick and choose the parts you like, don’t make your own Secret Squirrel version. Just use the system as it’s intended.
You know what? He’s right. I’ve been using the SFMA with every client for 3 years, and the FMS for a couple of weeks, and the closer I adhere to the rules of the system, the better my client’s outcomes are.
For example, one client, let’s call him Ben. He’s not in pain, so he doesn’t need the SFMA to guide treatment. He does have difficulty standing up straight and walking, which is a common compensatory pattern for someone with a spinal fusion.
Let’s run through the FMS scores, then:
Active Straight Leg Raise: 1/1
Shoulder Mobility: 2/2
Rotary Stability: 1
Trunk Stability Push-Up: 1
In-line Lunge: 1/1
Hurdle Step: 1/1
Overhead Deep Squat: 1
What does that mean? These scores are out of 3; 3 is perfect, 2 is acceptable, 1 is dysfunctional, 0 is painful, regardless of movement quality. Remember, this is objective data, there’s no judgement here. He’s not a bad person because he can’t move well.
Yet, he is very limited in his basic movement literacy. What’s movement literacy, you ask? It’s the ability to successfully adapt to movement stress. Or, put it another way: since anything less than a 2 is dysfunctional, a normal exercise program is only going to reinforce the dysfunctions, and leave him at risk for future injury. For Ben, every exercise, except upper body movements, have some kind of compensation pattern.
The good news, is that he’s a quick responder. Soft tissue work on the hip flexors and posterior chain, followed by pattern retraining, gets him to 2/2 on the active straight leg raise. Having coached him on correct technique, hard rolling and baby crawling (yes, I mean crawling like a baby) quickly brings him back to a 2/2 on the rotary stability test.
Most meaningfully to Ben, correcting the rotary stability pattern lets him stand up straight and walk without a cane. It seems like magic, but we’re just dusting off and reloading the right program for “stand up straight.”
Now, those effects are transient, and they need regular practice. The good part is that Ben can quickly get to a point where he can benefit from general exercise, which should reinforce and continue to develop proper breathing, posture, and motor control.
Let’s bring it back to the FMS/SFMA. Without a system to guide my thinking, I’d be relying on trial and error, and my own incomplete knowledge and understanding to drive treatment. The system helps me rank and sequence treatment in the most effective way possible, and use the tools and techniques I like most to do the work.
The screens also give me a way to check my work. If I try a manual therapy technique, and the screen or assessment doesn’t improve, then I didn’t actually make a meaningful change. The same is true for corrective exercise. It can be humbling, but it’s always instructive.