Last week, someone commented to me “I heard you speak in 2009, you are so much better!” I was really grateful for that compliment. I have been working hard on being a better speaker for the past several years. I frequently get asked, “how do you become a better speaker?” So I thought I would write a series on it.

Auditorium

One of the turning points in my speaking career was attending speakers training with Thomas Plummer and Greg Rose. Speakers’ school commences with “Welcome to Hell”, the opening line from Greg Rose. He goes on to say, “After a talk, when you ask your friends and colleagues how you did, they will tell you you that you did great…….we are not your friends.”

And with that warm introduction, speakers’ school begins. First, you are filmed and evaluated on how you walk into a room or on to stage. Key message here – head up, good posture and what you are currently doing is neither (even if you think you are).

Then, your wardrobe is critiqued…..how was I supposed to know that pleats and cuffs were for fat old men? After critiquing what you are currently wearing, they take a picture of you to see which color shirts look best on you with your complexion and hair color. As far as appearance goes, here are a few general guidelines (particularly for men):

      • Bright color, non-patterned shirt
      • Dark colored pants
      • Professionally cut hair
      • Large watch so you can see time
      • Clean, polished shoes
      • Fashionable belt (no, not the one you won at the rodeo)

These seem like small things, but they add up for a lot of unspoken credibility.

You then read a children’s book outloud and your voice, inflection, and speed are critiqued. This is something that you can do on your own. Play it back. Can you understand yourself and do you find yourself interesting — not your topic, but your voice? Could you imagine if people read books to their children in the same manner that they give a talk in front of people – but I guess that monotone, non-dramatic voice would be good for getting the kids to sleep!

Then comes the real test – a 5 minute talk that is filmed in high definition – no notes, no power point. It is then played back while you sit at the front of the class. You get to critique yourself first. Then, the class critiques you. Then, two guys in the back (Greg and Thom) who can only be described as the Simon Cowells of public speaking give you “feedback.” No holds barred!

As if that is not bad enough, you “get” to give your talk again implementing the feedback you received. Each time you make a mistake such as  the common “um” or “ya know”, you have to stop and start over. Evidently the phrase I said over and over again was “you guys”. If it takes multiple attempts for you to get rid of your filler phrase, the class gets to throw things at you every time you say it – most of the objects are Nerf, but let me tell you, a Nerf soccer ball hurled at your face from the side (only seen at the last second before it hits you) can be quite the jolting experience.

If you have survived all of this, and take the time to implement all of the feedback, you will be a better communicator. I promise. If you are not up for speakers’ school quite yet or can’t get to one, there are some simple steps you can take to improve your public speaking. Start by doing an audio recording of yourself reading a children’s book and then video yourself giving a 5 minute talk…..you will be better for it.

I will be doing an entire series on communication as it is so important, not just for public speaking, but for achieving buy in for what you want to accomplish — performing a home exercise program, implementing group injury prevention testing, or for your colleagues to join you on your quest for excellence.

I wrote a post for Medbridge on the Common misconceptions of the Functional Movement Screen. Here are the 3 misconceptions I covered:Trunk Stability Push Up

 

Misconception #1: The Functional Movement Screen isn’t really a screen because it’s not sensitive

Misconception #2: The Functional Movement Screen is designed to be diagnostic

Misconception #3: The Functional Movement Screen results relate to how the person will perform under load or in competition

 

To read the entire post CLICK HERE

Disclosure: I teach an online Return to Sport Testing course for MedBridge. To find out why I recommend MedBridge CLICK HERE

 

 

Using two different statistical techniques, the authors performed a factor analysis to determine if the individual tests of the Functional Movement Screen are independent of each other or sum together into one construct. Basically, they looked at whether the total score of the FMS is useful to reveal the whole picture of an individual’s movement or if the individual score on each test needs to be considered.

The sum of the parts is not necessarily the whole

Here is what they found:

 “Results do not offer support for validity of the FMS sum score as a unidimensional construct.” 

 The individual test results give different information than the total FMS score. In other words, a score of 1 on the push up is not measuring the same movement construct as a score of 1 on the squat.

Another quote from the study:

“When using FMS results to communicate with patients and to direct rehabilitative needs, the sports medicine professional should focus more on the individual movement scores rather than the composite score”

This is definitely the case, as a person can have a composite score of 16 and score a 1,3 on the Active Straight Leg Raise and a zero on the squat. Even though the person has a high composite score, he still has pain and substantial fundamental movement deficits that must be addressed.

Bottom Line: While the Functional Movement Screen composite score was initially used in injury prediction research, the score on the individual tests is more important. In my opinion (supported by the research), you should not have any 0’s (pain) or 1’s (can’t perform a simple movement pattern) on any individual test. But guess what, if you have at least 2’s on all 7 tests, you already have a minimum of a 14.

Remember, the Functional Movement Screen is a filter, what are you trying to catch? I am primarily  interested in catching pain with movement as well as  the inability to perform a simple movement.

Ben Kazman J, Galecki J, Lisman P, Deuster PA, Oʼconnor FG. Factor Structure of the Functional Movement Screen in Marine Officer Candidates. J Strength Cond Res. 2014;28(3):672-8.

Recently, I tested a player in professional sports who had the following Y Balance Test and Functional Movement Screen scores.

Move2Perform Report High YBT Low FMS

Test 1 Graph

 Move2Perform Report High YBT low FMS

 

If you will notice, his Y Balance Test Lower Quarter scores were great – symmetrical and above the risk cut point for his gender, sport, and competition level. But his Functional Movement Screen was riddled with fundamental movement pattern deficits and asymmetries. This a classic example of why both tests are necessary for a more complete profile of the athlete’s motor control of body weight.

In an unpublished analysis of 1490 athletes/active individuals, we found 677 (45%) passed the Y Balance Test Lower Quarter and of those 677 that passed, 243 (35%) failed the FMS. So, if you only use the Y Balance Test Lower Quarter, you will miss about 16% of the athletes who are at risk of injury.

However, consider another athlete on the same team:

Move2Perform Report low YBT good FMS

Test 2 Graph

 Move2Perform Report Good FMS poor YBT

As you can see with this player, his FMS score was good (no zero’s or one’s). While he may possess movement competence as demonstrated by the Functional Movement Screen, he has deficits in his motor control capacity as measured by the Y Balance Test Lower Quarter. But with an anterior reach asymmetry and a composite score below his peers (other professional baseball players), he is at risk of injury. His dynamic left/right imbalance and decreased performance at his limit of stability is a substantial risk factor for injury.

If we go back to the analysis of the 1490 athletes/active individuals, we found that 535 (35%) passed FMS and of those 535 that passed, 253 (47%) failed the Y Balance Test Lower Quarter.  If you just use the FMS, you will miss about 17% of the total number of athletes who are at risk injury.

Thus, it is important to use both the Functional Movement Screen and Y Balance Test for a more complete profile of the athlete as well as the most robust injury risk prediction (see Lehr et al 2013). Or at a minimum, establish basic motor control competency with the Functional Movement Screen first, then move on to the Y Balance Test.

What do you think?

In previous posts, I discussed why we would consider testing an athlete in an open-kinetic chain sport with a closed-kinetic chain test. Then, I discussed the hierarchy of testing and began with the Functional Movement Screen Trunk Stability Push Up and the Upper Quarter Y Balance test as basic tests of movement competency, motor control competency, and motor control capacity. Now we will examine another test that looks at capacity – the Closed Kinetic Chain Upper Extremity Stability Test.

 

The Closed Kinetic Chain Upper Extremity Stability Test is reliable and has some discriminant and predictive validity.1-3 The test is performed in a pushup position with the hands placed 36 inches apart on strips of athletic tape. The person reaches with alternating hands across the body to touch the piece of tape under the opposing hand. The number of cross-body touches performed in 15 seconds is recorded. The test can be modified by performing the test in the kneeling position.

It has also been suggested that the number of touches can also be divided by height to normalize the number of touches to each person. While this does give some normalization, the test is still not body relative since everyone has hands placed 36 inches apart (think about how hard that position would be for 5 foot tall gymnast compared to a 7 foot tall basketball player). In addition, a power score can be calculated by “multiplying the average number of touches with 68% of the patient’s body weight in kilograms, which is the weight of the arms, head, and trunk. That score is then divided by 15, which is the duration of the test in seconds. The power score reflects the amount of work performed in a unit of time.”

Validity

It appears that the CKCUEST does have some discriminant validity. In a recent study, researchers found that those with shoulder impingement performed substantially worse on the test compared to activity level matched controls.3 They also found the MDC to range between 2 and 4. What is interesting is that 15-25% of the “healthy” subjects reported shoulder pain after performing the test. This again speaks to the importance of having a hierarchy of testing (and maybe the number of people that consider having shoulder pain as normal).3 There is one prospective study that examines the predictive validity of the CKCUEST in collegiate football players.4 Researchers did a battery of strength, ROM, shoulder endurance, and CKCUEST at the beginning of the season on 26 players. The authors found that scoring less than 21 touches increased the likelihood of a shoulder injury during the season (5/6 of the injured players scored below 20 touches).4 While this test requires upper quarter stability, it is more of a speed/agility/power test as its measurement is touches per unit of time/height/bodyweight. I think the real value of the test lies in what one of the original authors describes as its ability to identify patients who were

“unwilling or unable to perform or developed pain during the test were not able to participate in their sport pain-free in the glenohumeral complex.”1

Bottom Line: Given the number of healthy people that have pain with the test and its potential predictive validity, it may have a place in the testing continuum to identify those with unreported pain/problems once lower level testing is complete (shoulder mobility, impingement clearing test, trunk stability push up, etc.). In addition, it can be used as one factor to determine that a person has the capacity to accept weight through one limb which is an important demonstration of stability and strength particularly after rehabilitation. Remember, this assumes all lower level testing has been passed.  

CKCUEST Start CKCUEST 2CKCUEST 1

 

 

 

 

 

1.  Goldbeck TG, Davies J. Test-Retest Reliability of the Closed Kinetic Chain Upper Extremity Stability Test: A Clinical Field Test. J of Sport Rehabil. 2000;9(1):35-46.

2.  Roush JR, Kitamura J, Waits MC. Reference Values for the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) for Collegiate Baseball Players. NAJSPT. Aug 2007;2(3):159-163.

3.  Tucci HT, Martins J, Sposito Gde C, Camarini PM, de Oliveira AS. Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in persons with and without shoulder impingement syndrome. BMC musculoskeletal disorders. 2014;15:1.

4.  Pontillo M. Spinelli BA SB. Prediction of In-Season Shoulder Injury From Preseason Testing in Division I Collegiate Football Players. Sports Health. 2014.

Do dancers score differently than other athletes on the Y Balance Test Lower Quarter?

Researchers found that Y Balance Test Lower Quarter performance in collegiate dancers was superior to other athletes, with dancers demonstrating a mean composite reach score of 105%. “This research supports the findings of previous studies by demonstrating dancers’ superior dynamic balance ability compared to other athletes, thus indicating the need for YBT-LQ normative values to be established for dancers.” (Cole et al)

Do modifiable risk factors for injury still remain at return to sport in those with ACL reconstructions?

Another group of researchers (see previous CSM research post for the other research) found that  deficits are present in athletes who return to sport post-ACLR. In particular, the star excursion balance test anterior reach asymmetry and prone heel height difference (a method to identify decreased knee extension ROM) were present at return to sport and clinicians “should consider using the SEBT to identify post-ACLR athletes who may be at increased risk for injury and decreased joint health.” (Stanley et al)

Does pain with clearing or movement tests predict injury in healthy active duty soldiers?

You bet it does!

In a cohort of 1455, “pain was present on 207 (14.2%) FMS movement tests, 176 (13.5%) FMS clearing tests, 56 (3.8%) YBT-LQ, 96 (6.6%) YBT-UQ, 93 (6.4%) 6-m hop tests, 80 (5.5%) triple crossover hop tests, and 13 (0.9%) ankle dorsiflexion. Pain at baseline movement testing was associated (P =.001) with future injury. The odds ratio of being injured in the upcoming year based on pain on movement tests was 2.0 (95% confidence interval: 1.6, 2.5). The odds ratio of being injured in the upcoming year based on prior history of injury was 2.1 (95% confidence interval: 1.7, 2.6).” (Teyhen et al)

 

Teyhen D, Shaffer SW, Butler R, Goffar SL, Kiesel KB, Rhon DJ, Plisky P. Pain and prior injury as risk factors for musculoskeletal injury in Service Members: A prospective cohort study. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A39.

Stanley LE, Shanley E, Thigpen C, Padua D. Star Excursion Balance Test and Heel-Height Difference as Screening Tools in Athletes Who Have Returned to Sport Following Primary Anterior Cruciate Ligament. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A65.

Cole HT, McGivern JM, Morejon A, Sudol-Horowitz T, Pivko S, Brooks G, Lusk MM. The Performance of Dancers on the Lower Quadrant Y-Balance Test (YBT-LQ).Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A67.

 

CSM 2014

  • The Selective Functional Movement Assessment top tier testing reliability was examined in two ways:
    Click for larger view

    Click for larger view

    categorizing each of the 7 patterns into pattern into 4 categories (FN, FP, DN, DP) or by the criteria checklist (the criteria by which each movement is determined to be functional or not). Both methods demonstrated good to excellent reliability in raters who have experience with the grading (i.e. greater than 25 hours experience with the SFMA). Raters with only 8 hours experience had poor reliability. This speaks to the importance of training AND practice in clinically assessing movement (Juneau et al and Glaws et al)

 

  • An individualized corrective program based on movement deficits identified by screening improved collegiate softball players Move2Perform injury risk category. In addition, the FMS and YBT scores improved with significant difference from baseline to final testing in both screens. With regard to overall injury-risk category, there was a 31.2% reduction from high-risk to low-risk categories with this individualized injury-prevention program. The researchers suggested further risk reduction may have occurred if all of the players in the highest risk category (substantial risk) received one on one interventions (Erion et al)

 

  • A high percentage of athletes after ACL reconstruction cleared by the surgeon to return to sport did not pass even basic injury prediction tests including the Functional Movement Screen and Y Balance Test Lower Quarter. The authors stated, “progressive standardized tests of neuromuscular function may be beneficial to add to the interdisciplinary decision making process when returning patients safely to their prior level of sports participation” (Butler et al)

 

References

Erion A, Alm A, Hudson C, Matsel K. Athlete-Specific Corrective Exercises Improve Functional Movement Tests and Injury Risk Categories in a Collegiate Softball Team. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A53-4.

Juneau CM ,Hewett T, , Glaws K, Becker L, Di Stasi S. Inter- and Intra-rater Reliability of the Selective Functional Movement Assessment in a Healthy Population. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A53.

Glaws K, Juneau CM, Becker L, Di Stasi S, Hewett T. Intra- and Inter-rater Reliability of the Standard Scoring of the Seven Fundamental Movements of the Selective Functional Movement Assessment (SFMA) in Healthy Adults. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A53.

Butler RJ, Mayer S, MD,  Garrett W, Taylor D, Moorman C, Toth A,  Queen R. Functional testing differences in ACL reconstruction patients cleared vs. not cleared to return to sports using clinical examination. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1) A34

While there has been a lot of great information presented, here are a few pearls from the first day:

2014-02-04 13.03.39

  • Not surprisingly, wrestlers perform better than baseball players on the Upper Quarter Y Balance Test.  Just like the Lower Quarter Y Balance Test, norms and risk cut points need to be gender, age, sport/activity specific. Want more info in need for population specific norms CLICK HERE

 

  • Shoulder flexion ROM limitation may be a risk factor for injury in professional baseball pitchers. This was not presented as formal research, but was briefly mentioned as an upcoming publication during the morning throwing athlete session. I am intrigued.

 

  • Asymmetrical Lower Quarter Y Balance Test at 12 weeks status post ACL reconstruction identifies those who won’t pass hop testing at time of return to sport. This is important as it can identify early those who may need different rehab strategies before higher level (e.g. plyometric) activity can be performed

 

References

Garrison C, Wolf G, Bothwell J, Conway J, Thigpen C.  Single Leg Squat Symmetry at 3 months is related to Single Leg Functional Performance at Time of Return to Sports Following Anterior Cruciate Ligament Reconstruction. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1):A50-51.

 

Myers HS, Poletti M, Butler R. Functional Performance on the Upper-Quarter Y Balance Test Differs Between Throwing Athletes and Wrestlers. Poster presentation. J Orthop Sports Phys Ther. 2014;44(1):170.

In a previous post, I discussed the importance of closed kinetic chain testing in a baseball player. A quote from one of the original reliability studies on the Closed Kinetic Chain Upper Extremity Stability Test (Goldbeck & Davies 2000) provides additional support for the need for closed kinetic chain testing:

“Typically, in clinical practice, a measurement or test is performed to evaluate the status of a particular parameter, and then, based on the test results, appropriate intervention strategies are applied to improve the deficit. Clinicians must ask themselves why closed kinetic chain upper extremity exercises are being integrated into treatment programs when no testing has been performed to demonstrate any deficits in those areas”

So, if you are doing rehabilitation in the closed-kinetic chain, you need to test in the closed kinetic chain as well: trunk stability push up, Upper Quarter Y Balance Test, plank, CKCUEST, and one-arm hop test.

Goldbeck TG, Davies GJ. Test-retest reliability of the closed kinetic chain upper extremity stability test: a clinical field test.  J Sport Rehabil. 2000;9:35-45.

Trunk Stability Push UpY-Balance Test - Infero Lat

I spend a lot of time discussing that the Functional Movement Screen (FMS) and Selective Functional Movement Assessment (SFMA) are not intended to be sport specific or even “Functional” measures. The FMS and SFMA are used to determine if a person has the underlying movement competency to serve as the foundation for his or her activity.
So why are there age, gender, and sport/activity specific norms and risk cut points for the Y Balance Test? Isn’t that a contradiction?

When it comes to higher level testing (such as dynamic balance), there can be an activity specific balance adaptation that occurs. To see how this plays out as different norms and injury risk cut points, check out this short video

 

Move2Perform chart

 


About Phil

Phil Plisky

I want to change peoples lives through dialogue about injury prevention research and return to activity testing.

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