Functional Dysfunction

Written by Gray Cook FMS

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A long time ago, some of the guys I worked with and I found what we thought was a hole in the continuum of training. We were working in rehab, working in fitness and performance, and decided there was a problem with how we made decisions and did programming.

I was inspired to look at things in a different way—from a functional standpoint.

Screening always comes before testing, and often testing comes before assessment.

An assessment means assembling the data you have, putting it against your expertise, and coming up with a professional judgment. In most situations, an assessment comes after screening tells you if there are problems, and after testing defines those problems.

In the assessment, you take your educational background, your professional wisdom, the particular situation, the time constraints, other historical information like a medical history or previous problems…and put all of that together. That’s an assessment.

I wanted to see those three stages applied to making people move, whether it’s making people move from a performance standpoint, a fitness standpoint or even making them move again after rehabilitation.

We saw holes in the continuum because assessments and testing weren’t used in a systematic way. There was nothing like a Functional Movement Screen until we came up with it. So we came up with a movement screen, and now we have a movement screen to put people into categories.

One of those categories is dysfunction—not just imperfection…dysfunction. If you have a ‘1’ anywhere on the movement screen—whether it’s symmetrical or asymmetrical—if any of your scores contain a ‘1,’ we consider that dysfunction.

That’s a movement competency problem.

And now we can at least discuss the words ‘function’ and ‘dysfunction’ with a baseline. Somebody has to set a baseline before we can have actionable discussions about dysfunction. Without that, our dysfunction levels or gauging of dysfunction are judgment calls.

We couldn’t build houses if an inch wasn’t an inch and a foot wasn’t a foot. It would be really hard to read x-rays if we didn’t agree on what constitutes a fracture. We need to have a gauge and a baseline for function.

That’s what the Functional Movement Screen is, and here’s the rub: We often find people who have dysfunction, yet aren’t plagued by problems.

So, what does dysfunction really mean? Are these people exceptions to the rule, or did we make the rule wrong?

We call this functional dysfunction.

I don’t really like talking about body parts; I’d rather talk about movement patterns. But when we talk about a limited active straight leg raise test, people often see that as tight hamstrings.

Just for the sake of argument, let’s talk about tight hamstrings, even though we agree there’s more going on in the leg raise test than tightness in the posterior chain.

Here we go.

Your tight hamstrings allow you to run a fairly respectable 5K. They have allowed you to get a kettlebell certification, and to enjoy skiing the slopes in the wintertime, all without a major problem. What’s happening is you’re partly relying on that tightness, because maybe that tightness is covering up another problem.

This is the most important information you can get from the Functional Movement Screen. The first thing you need to consider is that unless the person is plagued with issues, when you uncover a dysfunction on a movement screen in an otherwise apparently happy, healthy person…before you try to change it, hold yourself back. Remind yourself to wait a second.

The person is leaning on this problem, whether it’s tightness or an asymmetry. If it’s not causing readily visible problems, the client is in some way using the low back stiffness, the upper body asymmetry, the anterior chain tightness or the hip flexor tightness.

It’s part of function.

If you put this person on a corrective path and take that dysfunction away, you could actually complicate things.

Let’s go back to our tight hamstring example. We often find tight hamstrings coupled with tight hip flexors and weak glutes. If we were to stretch hamstrings and create some mobility, we don’t just send people out into activity with 15 degrees of extra hamstring flexibility. That would be inappropriate, because everything has been leaning and relying on that tightness.

Part of the corrective algorithm we have is, when you make some length, add some strength.

Once your active straight leg raise comes out of dysfunction and when your toe touch is considered normal,we take you right into deadlifting.

Deadlifting requires you to lengthen your hamstrings to a respectable point and makes you engage your glutes, probably far more than you would in a squat where you may have learned how to squat with other muscle groups.

We try to build into every one of our corrective strategies not just a way to undo that which is wrong, but to realize those dysfunctions are being used. We always consider things like that, and that’s a very important path to follow.

Don’t kick out that crutch without replacing it with something else.

It is not uncommon to find people who are operating at a certain level and still have dysfunction. Maybe they’ve never had an injury and aren’t really concerned about injury risk. What other professional principle would I need to lean on to say we still shouldn’t remove that dysfunction?

Here’s what I’ll tell you: The other reason you want to get that dysfunction off board is because if people plan on changing their exercise or they want to improve in any way, they’ll be going outside of their current abilities.

If they want to be exposed to a new experience, if they want to increase the speed, distance or cadence of their runs, if they want to press more, if they want to do something completely different like stand-up paddleboarding, MovNat or another similar activity, they could have a problem.

Those dysfunctions not only increase risk, but they also reduce adaptability—the ability to easily learn and move from one activity to another while the body molds itself in a new direction.

When we see people with dysfunctions, we think two things right off the bat. It may explain some of the injuries they’ve had in the past, but also, if they’ve never had an injury it means they’ve probably learned, perhaps unconsciously, how to work around the dysfunctions.

If people are very satisfied with everything in their lives and we find a flaw on the movement screen, the responsible thing is to say, “This is a dysfunction. It puts you at risk for injury and it reduces your adaptability, but if you’re never going to do anything more than you’re already doing, probably your best defense right now is never change anything.

“However, the minute you expect your body to do something different, to go a little further, enjoy a weekend hike or do something that’s not natural and routine, that new function will help you continue to grow and help your body move in a different direction.”

It’s absolutely true: You can be dysfunctional and still function. Just don’t plan on changing too much because your body has spent a long time getting to that function.

That’s the big irony in the Functional Movement Screen. We see dysfunctions in people who are moderately fit. We see dysfunctions in the world’s best athletes. We see dysfunctions in people who have been sedentary.

As long as those three groups never want to do anything different, the dysfunctional injury risk and the limitations to adaptability probably don’t play as importantly as they would if they were going to try to get more fit, perform better or switch up their routines in some way.

We’ve seen groups with low screens and high screens. When people with low screens get injuries, it takes them longer to get back to normal activity…if ever. This is simply because there are other problems on board that affect rehabilitation.

That’s my spin on two rehabilitation and fitness terms we’ve tried to help define by using a consistent baseline.

• Philosophy
• Fitness
• Correctives

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