A GPS for the Safe Execution of High-Intensity Exercise

[Brett Jones]

A GPS for the Safe Execution of High-Intensity Exercise

Gray Cook MSPT, CSCS, OCS, RKC

High-intensity exercise is a double edge sword. It can cut both ways. It has the ability to both foster and compromise the durability of participating individuals. A systematic approach is the only responsible way to consider High-Intensity Exercise options.

Discussions of exercise always migrate toward techniques and programs, but this is far from the bedrock of the problems they are designed to remedy.

Exercise should simultaneously improve the energy systems and the mechanics of movement. One problem is that modern high-intensity programming seems to focus more on stress, recovery and enhancement of energy systems than fundamental and functional mechanics and fundamental and functional movement patterns.

Repeating movements that appear functional for multiple repetitions WITH ADDED LOAD FOR HIGHER STRESS does not guarantee a durable functional outcome.

Practice often improves the ability to repeat a movement. If the movement is a mistake, the individual is adding muscular strength and endurance to the mistake.

“Practice makes perfect should be corrected to say, PERFECT practice makes perfect.”

If we are to strive to train durability then we should look at the biomarkers of injury risk.

The best available data points to the following:

1. Previous Injury
2. Asymmetry
3. Neuromuscular control and balance
4. BMI
5. Stupidity

Responsible management of the first four can help prevent but not eliminate the fifth.

Insufficient energy systems don’t seem to be a factor in injury risk. However, they may be indicators for better performance. The first responsibility of any exercise professional is management of risk. The second is maintenance and improvement of physical capacity. The order must not be switched.

Therefore, conditioning and training should be a two-step process. First it must remove risk and foster durability by providing a system to reduce asymmetry and neuromuscular control. These factors are more important when previous injury is involved, because asymmetry and neuromuscular control are possibly resulting and contributing factors.

Energy systems can be pushed and stressed with functional applications of exercise once risk is managed and movement patterns reveal mechanical competence against a standardized system.

Since many exercise-programming options exist to condition energy systems, the debate usually revolves around which is the best. The answer is simple and applicable to nearly all-conditioning situations. The most beneficial program will improve conditioning and not compromise durability.

The debate can be put to rest by adopting a functional movement standard that provides information about pre-existing problems involving movement pattern asymmetry, neuromuscular control and balance. Without this system, one or all of these factors will become solidified in the furnace of high intensity training. The clay, like the body, should be unblemished before it can be fired, because the fire should only be used to maintain the form, not create it.

Since 1997, we have had a practical system that addresses these problems. The information has been presented and published internationally with positive feedback. It is reliable and has been discussed and tested in peer-reviewed journals. Its goal is to establish the biomarkers of risk for individuals participating in exercise, high-level activity and athletics.

The official National Institutes of Health definition of a biomarker is:

“A characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes or pharmacologic responses to a therapeutic intervention.”

This biomarker can be demonstrated in about 10 minutes with low cost and equipment.

The continuous debate over “which is the most functional exercise” is laughable, given the amount of standardized information available. We still fight about the exercise programs that give us the best results without discussing risk or durability. But why argue when you can’t even show up for the best workout of your life because you’re hurt!

The path to a GPS for conditioning starts by answering a single question:

What Is Our Baseline for Movement?

The strongest predictor of future injury is previous injury. Since it is known that injury adversely affects movement and that asymmetry and dynamic neuromuscular control are also predictors of injury, a systematic method is needed to screen active individuals for injury risk and identify potential weak links in performance. Additionally, the current best evidence suggests that movement changes after an injury and these changes occur at multiple joints away from the injury site. Pain adversely affects motor control and the results of pain-related motor control changes are unpredictable and highly individualized. Health care professionals need a systematic method to clinically assess and train movement patterns during the rehabilitation process.

The Functional Movement Screen – The predictive system
The Functional Movement Screen (FMS) is a reliable5 screening system created to rank movement patterns that are fundamental to normal function. By screening these patterns, movement limitations and asymmetries are readily identified and measured. Basic movement pattern limitation and asymmetry are thought to reduce the effects of functional training and physical conditioning and recent data suggest these factors may be related to injury in sport.3, 4 One goal of the FMS is to identify those individuals with movement pattern limitations, so individualized correct exercise can be prescribed to normalize movement prior to an increase in physical training or a competitive sports season.2
The FMS is a screen designed for and applied to those individuals without an existing injury or painful complaint.
The Selective Functional Movement Assessment – The diagnostic system

The Selective Functional Movement Assessment (SFMA) is a series of seven full-body movement tests designed to assess fundamental patterns of movement such as bending and squatting in individuals with musculoskeletal pain.1 When the clinical assessment is initiated, from the perspective of the movement pattern, the clinician has the opportunity to identify meaningful impairments that may be unrelated to the main musculoskeletal complaint, but contributing to the associated disability. This concept, known as Regional Interdependence,6 is the hallmark of the SFMA which guides the clinician to the most dysfunctional, non-painful movement pattern which is then assessed in detail. By addressing the most dysfunctional, non-painful pattern, the applications of targeted therapeutic exercise choices are not adversely affected by pain.

The SFMA serves as a clinical model for the musculoskeletal healthcare professional to address Regional Interdependence. This approach is designed to complement existing orthopedic examinations and diagnostic procedures and should serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of movement into musculoskeletal practice.






Selected References


1. Cook E, Kiesel K. Impaired Patterns of Posture and Function In: Prentice B, Voight M, eds. Techniques in Musculoskeletal Rehabilitation. 2nd ed. Chicago: McGraw-Hill; 2006.
2. Kiesel K, P P, R B, Burton L, Cook E. Functional Movement Test Scores Improve following a Standardized Off-season Intervention Program Scand J Med Sci Sports. 2009; In Review.
3. Kiesel K, Plisky P, Kersey P. Functional Movement Test Score as a Predictor of Time-loss during a Professional Football Team’s Pre-season Paper presented at: American College of Sports Medicine Annual Conference, 2008; Indianapolis, IN.
4. Kiesel K, Plisky P, Voight M. Can serious injury in professional football be predicted by a preseason Functional Movement Screen? North American Journal of Sports Physical Therapy. August 2007;2(3):147-158.
5. Minick K, Burton L, Butler R, Kiesel K. A Reliability Study of the Functional Movement Screen. National Journal of Strength and Conditioning Research. 2009;In Press.
6. Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther. Nov 2007;37(11):658-660.
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Strength is a Choice