I have a question about Gray Cook’s Reebok Movement Screens. I noticed on the active straight leg raise assessment that if the client is not able to raise the leg 80 to 90 degrees, it is assumed this is a result of tightness in the hamstrings. Could someone have sufficient flexibility in his hamstrings but be unable to lift the leg to 90 degrees due to extreme tightness in the hip flexors and illiopsoas?
You asked a great question, and it often comes up in my lectures. First, the Reebok screen is based on the Functional Movement Screen (FMS) that I introduced in 1998. It is for more advanced populations, and therefore, I created a modified version for Reebok with only five tests instead of the original seven. The FMS also has a three-point scoring scale and is much more objective for exercise prescription and data collection. The Reebok screen uses many of the same positions but functions more as a pass/fail "quick screen." The active straight leg raise is one test that is common to both screens because it reveals great information. First and foremost, there should be no asymmetry between the right and left. Research indicates that the asymmetry is a bigger problem than generalized limitation on both sides. The asymmetry creates a need to compensate during exercise, and we don't need that.
Now let me get to your question. It is not simply a hamstring test, although hamstring tightness can cause you to do poorly on the test. Two other problems can cause a poor active straight leg raise:
- Poor core stability will allow the leg lifted to rotate the pelvis and create early hamstring tension. The problem is stability but feels like tightness to the client.
- The second problem can be a tight or overactive hip flexor on the opposite side, which can also cause excessive anterior pelvic tilt and extension of the spine. Since multiple factors can cause a problem with this test, don't look at the problem or correction from the isolated muscle point of view. Always look at the pattern. The pattern basically says that the client cannot lift one leg while the other remains on the floor. To some degree, all three problems can contribute’ even though one problem may be more obvious, all are present. The correction I use in my book addresses all three problems at once. This seems to be the best approach because breaking the old pattern creates new motor awareness and reinforces mobility and stability simultaneously - the way we need to in the "real world."
Great question and it shows me that you are screening - bravo! If you look deeper into screening and some of the work I have done since the Reebok screen days, you will see that I am moving more and more toward addressing the patterns not muscles - the muscles just take care of themselves. It actually makes me look much smarter than I am, and I like that!