Predicting injury is a very complicated topic. It’s not as simple as looking at a movement and saying that it is “good” or “bad.”
Poor movement may not predict injury, but that doesn’t mean we shouldn’t focus on optimizing movement.
Here’s why we still focus on movement quality, even if “poor” movement may not correlate with injury.
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#AskMikeReinold Episode 278: Does Poor Movement Predict Injury?
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Show Notes
Transcript
Student:
All right. Chet from new Orleans asks, “I don’t think there’s good evidence that poor movement predicts injury. Is this true? If it doesn’t, how do you guys think about the things in the clinic? Do you bother to educate your patients about these things?”
Mike Reinold:
Awesome. Nailed it, Cody. I like that. Good job. That was great. So, all right. Movement predicting injury. We’ve all been through this conversation before, right? Yeah, initially when this movement screen concept came about, right? And we had a lot of screens came to the market-some really good ones, some really well thought out designed ones. You know them, we don’t need to name them by names, they’re all excellent types of screens. There was some initial buzz as research started coming out, and some research was shown that you could predict injury with some of these screens. But it seems like to me, and I’m kind of curious if anybody else has a different thought, or if they’ve read something different, but it seems like the more we research these types of screens, and the more we try to do one generic screen on a large variety of athletes, and sports, and genders, and positions, right? And all these different things that you could have, that the harder it is to have one screen that predicts injury, right? So, I think we’re seeing that a lot of time.
Mike Reinold:
But I think what Chet is getting at here too is, if the evidence is showing that movement doesn’t predict injury, do we still work on movement in the clinic? Do we work on optimal movement? And again, this is where the early career professionals and the students, they have a hard time reconciling what they’re seeing on social media with people slamming all these concepts, and knowing what to do. So who wants to start this one? Does movement predict injury? And if it doesn’t, which it probably doesn’t predict injury, do we still care if a person moves good, bad, et cetera? Who wants to start that one?
Lenny Macrina:
I’ll take the obvious, right? We talk about ACL and decreasing injury rates, like Tim Hewetts-all of his studies, and just looking at jumping-landing techniques, and landing into a valgus knee. That’s the obvious way of social media. I feel like it’s just off with this one, and just trying to justify. They’ll put a classic picture of Usain Bolt sprinting with a valgus knee and I’m like, “Well, that’s different than jumping and landing in the middle of a basketball game, or a football game.” I mean, we’ve shown that if you jump and land with a valgus knee, if you fixed that landing technique, your risk of injury goes down 50 to 67 percent, I think is Tim’s meta-analysis of a meta-analysis.
Lenny Macrina:
And so, I think it goes back to the classic answer, it depends. Where some movement is okay, but in other situations, especially in this, the classic valgus jumping and landing female athletes, you think you put all the variables together where you got a female athlete, high school age jumping in a valgus knee, maybe quad dominant, and then you put that all together and yes, that movement could contribute to a faulty or an issue down the road with, higher increase of injury. So yes, I would say some movement like that is potentially detrimental and it’s a risky world thing, right? Like why would you want to land like that when we know if you land another way, it’s a little bit better for you.
Mike Reinold:
I don’t know. The human body is an amazing thing, Len it should be allowed to do whatever it wants.
Lenny Macrina:
Right. It’s always a classic social media answer.
Mike Reinold:
I think that’s a good general rule of thumb, for people as you’re trying to navigate opinions on social media, anybody that’s too always or never.
Lenny Macrina:
Right.
Mike Reinold:
Just be nervous of that person’s educational style on social media. I think that’s always a good one, too. So, Dan, what do you think?
Dan Pope:
Yeah, I try not to be too long winded just because this could be so huge.
Mike Reinold:
Oh, go long winded. Let’s make this a double hour. Let’s do it.
Dan Pope:
Well, my world’s all weightlifting, right? And I actually think that your worlds have a little bit more research to back up whether or not movement is good or bad. But the big ones for my world is low back grounding, right? The bottom of let’s say a dead lift and then knee in, in the bottom of a squat. Right? And you have those two ends of the spectrum. So, if your knees come in ever, that’s why your knees hurt, right? And you have the other end of the spectrum. It’s like, well, knees come in all the time. And the most elite athletes and it’s fine, right? That’s not a big deal. They do it all the time. Your body can adapt and prepare. And it’s funny because people are pointing at the research, showing that moving with a flex spine is fine, but I don’t think that’s great research.
Dan Pope:
And it’s not specific to the populations we’re talking about at all. You have these big studies and let’s say nurses and other professionals, and they watch how they bend down. It picks up off the floor. And if they have a flex spine, they’re looking at the correlations between pathology and functional disability. And there is none, but how are you going to design a study with, let’s say a power lifter and try to figure out the exact amount of flexion they have in the bottom of a deadlift, and then try to control all the other variables in their training and study them over the course of like 50 years and ask them when they’re 80. “Hey, does your back hurt at this point?” Right? I think it’d be incredibly hard to design a study that actually answers this question for us. So it’s not really fair on either end of the spectrum to say, Hey, it’s safe or it’s not safe, right?
Dan Pope:
So for me, I think it comes down to performance as well. So if I want to deadlift a lot of weight, like how are the best pliers in the world dead lifting? And if they’re trying to keep a relatively neutral spine, then I’m going to try to create that same technique over the course of time. And if I’m noticing more folks are not handling, let’s say a little more flexion their spine. I might try to take them away from that position. But I think the argument is not really fair because people are pointing at research. It doesn’t help to answer the question. It’s just, I don’t know, more Jabber and more confusing to people out there that are trying to learn.
Mike Reinold:
Right. Right. And it always comes down to the situation of can you ever design a research study that perfectly includes and excludes all variables to make it completely relevant? And the answer is, its so hard to do that, but it does amaze me though, how some people do like latch onto something, like you said, there are like posture and nurses, and then apply that to power lifting, right? It’s amazing how some people kind of do that, but Kevin, what do you think?
Kevin Coughlin:
Yeah, this just reminds me of a conversation I was having with Dan last week when we were out for a run together and we saw just the craziest form on some people. And we were just saying, at what point do we consider intervening and a runner like that, where the form is just, we’ve all seen it in various recreational runners. And I think what we kind of said was if it’s someone who’s completely new to the sport, we potentially consider how do the most elite runners run, right? And take tips from them to optimize their performance. I don’t know if we can say that, that runner’s going to go ahead and get hurt, but I think this is kind of the style we use here at champion is, I don’t know if you’re going to get hurt moving that way, but you’re definitely not running optimally.
Kevin Coughlin:
And there’s probably ways that we can make that better. So that was just an interesting thing. And I guess I’d go with that approach, if it’s someone who’s been running for a very long time, several marathons under their belt and they haven’t got hurt to this point, maybe you let them keep running that way. But if they’re coming to us and they’re saying, how can I run a little more optimally? We’ll break out some certain movements, see if we can increase capacity in certain areas and look at how the most elite runners run and try to make it a little similar to that. So that’s probably the approach I take with movement, but to say that someone’s going to get hurt, I think is tricky. I wish it was more clear cut than that. Especially being a newer PT. It would’ve been nice.
Mike Reinold:
I hate that. I hate trying to say that this is going to cause injury. It may increase stress, right? It may increase force, that sort of thing, but that doesn’t mean it necessary results in injury. I would say if I were to start jogging right now and my knees went in, and every time my knee went in awkwardly into a valgus position. Sure. I could do that once. But what if I did that and just started jogging 10 miles out of the blue? I mean, maybe that would be annoying afterwards, right? If I were to take a hammer and just hit my thumb lightly, that wouldn’t be fun, right? But I could handle it once, right? But if I did that over the course of the day, that would probably get fairly annoying to my thumb, right? That was a bad example, but I think you get my point, right? Lisa, Lisa, what do you think?
Lisa Lowe:
I mean, when Kevin said watching bad running form, that’s one of those things, I think any rower who knows how to row and goes to a gym and sees someone try and use an urge it’s kind of that same, Ooh, do you say something? Are they going to hurt their back? Are they going to hurt their whatever? And especially the PT brain in me is always yeah, do I say something? Because there’s just that pretty big potential for something not going quite right. But like we’ve been saying, right. Someone who is recreationally rowing like that, the amount of force they can produce, the amount of time they’re spending doing it, all of those things, right. They might just be fine, they’re not spending 70 minutes sitting on an urge, like pushing as hard as they can. So maybe it’s fine.
Mike Reinold:
Right.
Lisa Lowe:
And I think that goes a pretty far away, but this time of year, it’s interesting because I feel like a lot of rowers shift from on the water rowing to winter training mode of mixture, of running, and urging and this and that and whatever. So I almost see more running overuse injuries, all of a sudden, because their hips now have this running demand and they’re not used to it. So now their knees start to bother them or this or that. And so that’s where I’ve found, usually when I’m screening a rower, even during kind of more of their peak on the water mileage, I’ll point out to them like, Hey, it doesn’t, doesn’t super impact you as much when you’re rowing. But whenever you shift to more of a running time you’ll be like your amount of hip stability and knee control and this and that, you got to be careful when you’re upping your running mileage because you might be then fighting a knee pain or this or that. So I feel like depending on right, the loads and the activities and how much those movement patterns either impact or don’t, but.
Mike Reinold:
Yeah. Awesome.
Lisa Lowe:
No you just pointed out because just for that chance of like Hey, if you go on vacation and you decide, instead of rowing, you’re going to run every day, might not be the best thing.
Mike Reinold:
And you’re not, your body’s not used to those movement patterns that may be either efficient or inefficient, right? That’s a different stress applied to the body, a different load, Mike, of all sports in all athletes we see, right. I would say golfers probably have the ugliest movement patterns, right? And still try to play their sport, right? Probably because you can play golf at later stages in life as our movement quality continues to decrease. But I mean, how much somebody comes into you for evaluation and they move poorly. How important is that to you?
Mike Reinold:
Yeah. I mean, I would definitely say I was going to start off by touching on the concept of why we use the screen in the first place. And I think we know there’s so many variables and factors that contribute to an injury, right? Sleep recovery, nutrition, there’s workload, kind of intensity. There’s all these variables that contribute that are not part of the screen. So I think right off the bat, the screen is not going to be a huge tool for me to predict injury. I think the other thing is that we tend to see people that have already had some type of injury or have an injury history in the past. So maybe we look at the screen through kind of a bias lens in general, just because we’re a physical therapist, they’re coming to see us for a reason. So I use the screen to try and guide their training program and what we’re going to work on.
Mike Reinold:
So yeah, I think we do use the screen to identify movement abnormalities or suboptimal movement. And we’re definitely going to address those in our training program and will that correlate to decrease risk of injury in their sport? That’s the hope, but I think the factors that we can control are what are we going to do with them in a training program. But going back to golf, I forgot the last part of your question, but yeah, we tend to see some movement that is, especially in older golfers, they’re relatively stiff and immobile. And I think if you’re lacking a baseline of mobility, rotational mobility through the hip, rotational mobility through the thoracic spine, that has implications in terms of where we’re placing the stress, especially on our spine. We know that certain moves can put more compressive and more sheer loading through your lumbar spine.
Mike Reinold:
Some certain moves in the golf swing. And if they’re lacking mobility, that could increase that stress on the spine. But it also seems to be correlated with performance, right? There’s a study that came out that showed lower handicapped golfers or higher proficient golfers tend to have better mobility, rotational mobility through the hip and rotational mobility through the thoracic spine. So you can kind of look at it from a performance standpoint, what sets these people apart. They tend to be more mobile and have more mobility proficiency. So I think that’s definitely something that we’re looking to improve, whether it’s reducing the risk of injury or trying to improve their performance. We’re obviously trying to do both.
Mike Reinold:
Yeah, no, I think that’s really well said. And I can say for a golf study with an N of one of myself, no, wait, N of two, let’s include Lenny. So the two of us here.
Lenny Macrina:
I’m in this. I’m in this.
Mike Reinold:
Right? Yeah. I get it, right? If I’m super tight one day and I’m not feeling it, my hips are tight, I’m sore or whatever, something like that. And I go golf on it. I am positive, 100% correlation that I’ll have back pain tomorrow. It’s a 100% correlation. So in an N of three, we have a 100% correlation that my hip mobility correlates to my low back pain. There we go. Let’s publish that. Let’s get that deal. We can find some crappy journal, that’ll publish anything nowadays, right? Let’s get that published and that’ll be our study and we’ll kind of go from there.
Mike Reinold:
So, awesome I was going to call on YouTube Dewey, but because I wanted to get your perspective here too, because we deal with a lot of kids, right? And a lot of sports performance clients. And I know you wanted to talk too, but I want to hear your thoughts on this. I think we’d be doing a huge disservice to our athletic population if we didn’t focus on their movement quality, right? And I think a lot of people have hit on this. It’s not just predicting injury, but it’s also efficiency of performance and stuff. But I wanted to get your thoughts too just from the athlete perspective. Diwesh.
Diwesh Poudyal:
Yeah. So my thought is, especially for the younger athlete, I think movement quality does matter a ton, right? Because they don’t have a ton of sport experience or a ton of repetitions built up to be a master at something. So whatever we teach is going to have a huge impact. So if we let them move poorly forever, they’re going to move poorly. And maybe suboptimal movements lead to injury down the road, right? We kind of talked about the whole can we predict injury thing? Again, we don’t really know. It’s not really my thing to look from that lens anyways. But I think especially for a younger athlete, if you have less of a training age overall in your sport and in a gym, movement quality does matter a lot. Now I think if we kind of look a little bit further into an athlete’s future, let’s say we have someone that is a very good athlete in their sport, but have never really worked out before, then we got to kind of look at it from two different lenses.
Diwesh Poudyal:
Do they move well in their sport? And then do they move well in a gym? Because I think those are two very different things, right? The first thought that pops in my head is, I don’t know if you guys have all seen that, picture of LeBron back squatting he’s in the super wide stands, like super, super arch’s and extended, you look at him and you’re like, oh my God. I don’t even know if you can get a spandy from a back squat, but he might get a spandy from back squat, know what I mean? It looks bad, but he’s historically one of the most durable players in the league. So can we say that poor movement leads to injury? Maybe not because that squatting is not necessarily super specific to his sport of basketball, right?
Diwesh Poudyal:
We know squatting can get you a little bit better increase leg power, whatever, but it’s not at the end of the day, that’s specific to basketball because if you look at him on the court, he moves phenomenally well and doesn’t get injured, right? So I think that’s kind of the big difference is you have a LeBron, who’s got a couple decades of experience being really good at basketball and probably just moving well in his sport. We can’t make that same comparison to a 13 year old kid that doesn’t have that much experience in basketball or in a gym. So now we got to be able to separate and say, all right, this younger kid needs more repetitions on learning how to move better. Whereas LeBron, maybe we don’t freak out and say, all right, we got to change everything that he does and how he does it in the gym, where at the end of the day for him probably doesn’t matter.
Mike Reinold:
Right. Yeah. I think that’s really well said and a good comparison into how we can’t compare like professional athletes with our 13 year old kids that are just learning how to move. So I love everybody’s thoughts. I guess I’ll summarize it this way on kind of why we focus on optimizing movement at champion. And this is what we do with PT. This is what we do on the performance side. It’s a big part of our CPS program that we kind of teach what we do, and I think this summarized everybody really well. But I’m not sure that poor movement can predict injury, but I think we can say that there is one optimal way to move in terms of, is this the least amount of stress applied to a tissue?
Mike Reinold:
Is this the most energy efficient pattern to perform that? Is this the movement pattern that results in the ultimate end performance that you have? There is one way to move that will do that. Now, anything away from that is just slowly less optimal. That doesn’t mean it’s terrible, it just means it’s not that one pattern. So let me use this as an example. I think if you move poorly, let’s say a squat. Squat with knees in, to kind of go to Dan’s example again, with knees caving in, during the squat, right? We do know that that changes the stress. So that changes the contact points of your Patel femoral joint that decreases the surface area of that and increases the amount of Patel femoral joint compressive forces on a smaller surface area that’s facts, right? That’s research that shows that it does that. Is that bad?
Mike Reinold:
I don’t know, but it changes stress, right? So I don’t know if that’s good or bad, but it changes stress, right? The other thing we know is that that is probably not going to end in the ultimate performance of that athlete. That is not the most efficient movement pattern to increase the ground reaction forces, to have a vertical displacement of your bar, right? That’s what you’re trying to do. So it’s going to be an inefficient movement pattern to maximize your performance. But then lastly, again, it goes down to energy efficiency. You’re going to have to use other compensatory strategies to be able to perform that movement. It is going to have a higher energy cost to your body to do that. And that’s what your body doesn’t want to do. So changing the way you move changes the stress, it changes the energy efficiency and it changes your ultimate end performance.
Mike Reinold:
Does it predict injury? No. Does it predict performance? Sometimes, right? Sometimes no. Sometimes yes, it depends. But I think it’s kind of shortsighted to say that focusing on movement doesn’t do anything. I think it would definitely do those three things really well. Was that a good summary of kind of what you guys all said, if you break it down into those three things? So, keep that in mind with optimal performance and optimal movement patterns. I think we do that for those reasons. It’s not always just simply because it predicts injury. I’m not really looking to predict injury. I’m trying to help people in the other direction.
Mike Reinold:
So keep that in mind, good long episode I think this was important to have a bit of a longer episode for this, because I think it’s a good topic to cover. So really appreciate that one Chet. That was a good one. Good thought provoking one, if you have a question like that again, keep them coming. Head to mic round.com, click on that podcast link and keep rating, reviewing, subscribing to us on wherever you listen to us. See you in the next episode.
