Prepared by: David Fowler
The ClientThe client is a 30 year old musician that plays club netball. She attends practice once a week and plays a game once a week too. She has no pain but gets a sports massage fortnightly. She notes that the treatment feels good and that they help with muscle recovery. She enjoys the feedback that she receives in regards to the general health of her musculoskeletal system, from her therapist.
The client has decided that she wants to start doing personal training sessions once a week, and weight training in the gym another day, to cross train to improve her performance for her Netball Finals. As she has never done weight training previously, it was decided that Functional Movement Screening (FMS) to assess her movement competency, before applying load to these movements.
This should improve her performance according to the Pyramid of Function (Movement – Performance – Skills).
The AssessmentThe above image reveals that a total score of 13 was achieve by the client. Idealistically, a score of 14 or higher should be obtained. In order to do so, increasing shoulder mobility to 2 and the right active straight-leg raise to 3, would help us achieve this result, and to provide symmetry. Both of these are fundamental aspects that need to be addressed before the client can engage in loaded exercise.
To further evaluate the client’s shoulder mobility restrictions using the regional interdependency principles, her cervical range of motion was evaluated, which showed no restriction. Her thoracic spine rotation revealed restrictions on her left and right. This was followed by crocodile breathing or shallow breathing (chest breathing more than diaphragm breathing).
When the client was asked to touch her toes, to complement the active straight-leg raise screening, a healthy spinal curve and sacral angle was revealed. She also successfully touched her toes.
1. To address low shoulder mobility:Firstly, proper, diaphragmatic breathing was discussed. To do this, crocodile breathing was practiced for 5 minutes. By doing this, the client lay face-first on the floor, breathing normally. This pushed her abdomen into the ground, and her obliques slightly out to the side. The client was asked to practice this for a few minutes every day, especially before training. It is expected that this will help her shoulder and increase her lung capacity, which in turn means better overall body oxygenation during her netball activities.
2. Shoulder Corrective Exercises:
- Thoracic spine rotation with reach: This exercise will get the client to use all the proper muscles to actively improve the rotation of the thoracic spine
- Wall sit with reach: This exercise will improve the actual shoulder girdle mobility
3. To address right active straight-leg raise:The asymmetry that is present in the active straight-leg raise is also an injury predictor if not approached. However, it is secondary to the shoulder dysfunction, as a final score of 1 was obtained for the shoulder, compared to a 2 for the leg raise. Regardless, in order to address the challenge a basic straight-leg raise active stretch, using a towel around the ankle to pull her leg towards her face is performed.
Client EducationIt was explained to the client that due to the low score on her shoulder mobility screen she should avoid heavy arm pushing and pulling, especially overhead.It was asked of her to practice the above exercises for a couple of weeks until she had a shoulder mobility score of at least 2, a score of 3 on the active straight-leg raise; with a total score of at least 14, before she could engage in her new physical activities.
It was explained to her that in order to improve her performance, there needed to be competent movement first. Before one can apply an increased load to a movement, the individual should firstly be able to perform this movement without restriction. If not, the client would be strengthening a dysfunction, and would likely injure herself.
The ResultsThe client successfully completed the prescribed exercises. Unsurprisingly, when the client was screened after 2 weeks, a total score of 15 was achieved. Shoulder mobility increased to 2, and active straight-leg raise to a final score of 3. The client is now moving more competently, and can now go ahead with her Personal Training and weights activities, knowing that she is safe to do so.
DiscussionFunctional Movement Screening (FMS) continuously proves to be a fantastic tool to assess clients, and to help increase their overall performance, by exposing incorrect or restricted movement patterns. Should these dysfunctional movements not be addressed in clients, it is likely that pain and limited performance would result.