3.3 Movement & Dynamic Mobility Screening

The Shift from Static to Dynamic

While static postural assessments provide valuable clues about resting muscle lengths, they do not tell the whole story. Human bodies are designed to move. Dynamic movement screens evaluate how the nervous, muscular, and skeletal systems work together to produce functional movement. When a client moves against gravity and manages momentum, structural imbalances that were hidden during static standing often become glaringly obvious.

Movement screening is not about grading the client's strength or endurance; rather, it assesses movement quality, joint range of motion (ROM), core stability, and neuromuscular control.

The Overhead Squat Assessment (OHSA)

The Overhead Squat Assessment is arguably the most comprehensive movement screen available to personal trainers. It evaluates bilateral symmetry, mobility of the ankles, hips, and shoulders, and dynamic core stability.

Setup and Execution:

• Position: The client stands with feet shoulder-width apart, pointing straight ahead. Shoes should be removed to clearly observe the foot/ankle complex.
• Arms: The client fully extends their arms overhead, keeping the biceps aligned with the ears.
• Movement: The client squats down as if sitting in a chair, aiming to lower the hips parallel to the floor, and then returns to the starting position. This is repeated for roughly five repetitions per viewing angle.

What the Trainer Observes: The trainer must evaluate the movement from three vantage points: Anterior (front), Lateral (side), and Posterior (back).

Anterior View Compensations

From the front, the primary focus is on the feet and knees.

1. Feet Turn Out:
   • Overactive/Tight: Soleus, lateral gastrocnemius, biceps femoris (short head).
   • Underactive/Weak: Medial gastrocnemius, medial hamstring complex, gracilis, popliteus.
2. Knee Valgus (Knees Move Inward): This is one of the most common and dangerous compensations, heavily linked to non-contact ACL injuries.
   • Overactive/Tight: Adductor complex, biceps femoris (short head), tensor fasciae latae (TFL), vastus lateralis.
   • Underactive/Weak: Gluteus medius/maximus, vastus medialis oblique (VMO).

Lateral View Compensations

From the side, the focus shifts to the lumbo-pelvic-hip complex (LPHC) and the upper body.

1. Excessive Forward Lean: The client bends at the waist rather than hinging and dropping the hips.
   • Overactive/Tight: Soleus, gastrocnemius, hip flexor complex, abdominal complex.
   • Underactive/Weak: Anterior tibialis, gluteus maximus, erector spinae.
2. Low Back Arches (Anterior Pelvic Tilt):
   • Overactive/Tight: Hip flexor complex, erector spinae, latissimus dorsi.
   • Underactive/Weak: Gluteus maximus, hamstring complex, intrinsic core stabilizers (transversus abdominis).
3. Arms Fall Forward:
   • Overactive/Tight: Latissimus dorsi, teres major, pectoralis major/minor.
   • Underactive/Weak: Mid/lower trapezius, rhomboids, rotator cuff.

Posterior View Compensations

From the back, the trainer re-evaluates the feet and the hips.

1. Asymmetrical Weight Shift: The client shifts their body weight to one side (usually the stronger or less painful side).
   • Overactive/Tight: Adductors on the side being shifted toward; TFL/Piriformis on the opposite side.
   • Underactive/Weak: Gluteus medius on the side being shifted toward.

OHSA Modifications & Modifications for Differential Diagnosis

When a compensation is observed during the OHSA, the trainer can modify the setup to isolate the root anatomical cause:

• Heels-Elevated Modification: Place a 2x4 board or small weight plates under the client's heels. If the excessive forward lean or foot pronation corrects immediately, the root cause is restricted ankle dorsiflexion (tight gastrocnemius/soleus). If the forward lean persists, the limitation lies in the hip flexors/LPHC.
• Hands-on-Hips Modification: If arms fall forward, repeat the squat with hands on the hips. If the squat form improves, the limitation is in the shoulder girdle (tight lats/pecs). If form remains poor, the core/LPHC is the primary limitation.

Dynamic Flexibility & Specific Mobility Assessments

To complement global movement screens, trainers utilize targeted flexibility tests:

• Thomas Test: Evaluates hip flexor length. The client lies supine with knees bent over the edge of the table and pulls one knee to the chest. If the opposite leg lifts off the table, the iliopsoas is tight; if the knee extends, the rectus femoris is tight.
• Weight-Bearing Ankle Dorsiflexion Lunge Test: Client lunges towards a wall with the front foot 5 inches away. If the knee cannot touch the wall without the heel lifting, ankle dorsiflexion is restricted (<35-40 degrees).

The Functional Movement Screen (FMS) & Clearing Tests

Developed by Gray Cook and Lee Burton, the FMS is a proprietary system consisting of seven specific tests designed to identify compensatory movement patterns and asymmetries.

The Seven FMS Tests:

1. Deep Squat
2. Hurdle Step
3. Inline Lunge
4. Shoulder Mobility
5. Active Straight-Leg Raise
6. Trunk Stability Push-Up
7. Rotary Stability

FMS Clearing Tests: Pain during screening requires immediate referral. Three specific clearing tests check for underlying pathology:

1. Shoulder Clearing Test: Placing a hand on the opposite shoulder and lifting the elbow checks for subacromial impingement.
2. Spinal Extension Clearing Test: Performing a press-up (cobra pose) checks for lumbar spine irritation (e.g., spondylolysis).
3. Spinal Flexion Clearing Test: Bringing knees to chest in a child's pose checks for discogenic lumbar pain.

Scoring the FMS: Each test is scored on a scale from 0 to 3:

• 3: The client performs the movement perfectly without compensations.
• 2: The client completes the movement but with some visible compensation.
• 1: The client is unable to complete the movement pattern.
• 0: The client experiences pain during any part of the movement or clearing tests.