Decrease Pain and Improve Performance with Pre-Exercise Movement Checks

Learning Objectives:

1. The readers will learn three strategies to help incorporate movement assessments into their clients' programs more effectively.
2. The readers will learn a pre-exercise movement check to assess the mobility of their clients' ankles.
3. The readers will learn how to communicate the teaching strategies outlined in this article when working with real clients.

Movement assessments, or more simply put, movement checks are important components of any health and fitness program. As a trainer, you may enjoy evaluating your client’s movement patterns.  More often than not though, your client probably just wants to get on with their exercise program and not have their perceived deficiencies highlighted before they even get started.  However, pre-exercise movement checks are crucial because they help you (and your client) identify musculoskeletal and/or movement imbalances that may cause pain or hinder performance. Successfully integrating pre-exercise movement checks into your programs so clients not only become intrinsically interested in the process, but can also benefit from the assessment results, involves three key principles: 1) Keeping things simple as you introduce movement checks; 2) Linking the part you are assessing to the overall function of your client’s body; and 3) Explaining how the results of the assessment can be used to help the client eliminate their aches and pains and/or improve their function/performance.

Keep It Simple

If you want to get your clients to understand the importance and value of performing pre-exercise movement checks, you have to encourage their participation by speaking their language. Using technical jargon to explain the benefits of a movement check/assessment may help you appear knowledgeable, but will likely go over the head of most of your clients.  Consequently, they may shut off from you and lose focus and interest in what you are saying.  The key to getting your client involved in the assessment process is to use language they can understand and teach movement checks in a simple and straightforward manner (Whitworth, 2007).  These strategies will pique the client’s interest in what you are teaching, thereby increasing their motivation toward participating in the program.  Also, by keeping your descriptions and language simple you may also see an increase in word-of-mouth marketing for your programs since your client will be able to explain to friends and family exactly what they're doing with their trainer and why it’s proving to be so successful.

Link the Part to the Whole

As a competent health and fitness professional you should be very aware of how movement and/or musculoskeletal imbalances in one part of the body can affect the function (or dysfunction as the case may be) in other parts of the body (American Council on Exercise, 2010).  Your client, on the other hand, may not understand the interconnectedness of their body as well as you do.  As such, they may be less motivated to pay attention to a specific pre-exercise movement assessment if they feel it doesn’t affect the overall outcome of their program goal(s).  When you introduce a movement check to your client’s program, help them understand how utilizing the assessment will enable you both to determine how the results may affect the function of their body as a whole.  Linking the performance of specific body parts to whole body function will increase a client’s long-term program participation because they will realize the massive impact the exercises they are performing has on how their entire body feels and functions, now and in the future (Price, 2010).

Explain How Assessment Results Relate to the Client’s Symptom(s)

Initially, your client is primarily only going to be interested in one thing about the pre-exercise movement assessment(s)/check(s) you show them: “How does this affect me specifically?”  A client with knee pain, for example, will want to know, “How is this going to help get rid of my specific pain?”  Alternatively, an athlete or avid gym-goer will want to know “How is this going to help me run faster, lift more weight, hit the golf ball further, etc.?” Therefore, in addition to explaining a movement check in simple terms and linking the assessment of the part to the function of their whole body, you also need to teach clients how the assessment results are directly related either to the pain that they are feeling or the improved performance they desire.  Employing this third technique will ensure your clients adhere to their corrective exercise homework because they feel empowered that you are teaching them something to address their specific issues (Bandura, 1986).

Movement Check: Toe Out Torso Rotations

The following pre-exercise movement check is an assessment for evaluating the mobility of your client’s ankle as it moves toward the midline of the body.  In addition to learning the assessment, you will see how to integrate all of the communication strategies previously discussed; namely how to teach it to your client using simple language, how to link the results of the assessment to the function of your client’s body as a whole, and how the results of the assessment pertain to the underlying reason why that client came to see you for help in the first place (i.e., decrease pain and/or improve performance).

How to Perform:

Instruct your client to stand with their feet slightly wider than hip width apart and their feet turned out to about 45°.  Ask them to stand upright with both arms lifted away from the sides of their body.  Now coach them to swing their arms to their right as they rotate their body to their right.  As they rotate their body, tell them it is okay if the left knee bends slightly as they turn.  Cue them in on the sensation they are feeling in their left ankle as they rotate to their right. Ideally, their left ankle should move easily to the right (i.e., roll in towards the midline of their body) as the arms and torso rotate.  Then have them swing their arms and rotate to their left (allowing the right knee to bend slightly).  Ask them to evaluate the feeling they experience in their right ankle.  Instruct them to rotate back and forth between from left to right until they get a feeling for how their ankles move toward the midline of their body as they rotate.  Ask them to evaluate if there is any difference in the movement ability between the two ankles. Additional Considerations:

1. This movement check is best performed in bare feet on a non-slip surface such as a rubber mat.
2. If your clients ankle(s) makes a “popping” noise while performing this assessment that is perfectly normal.  It means that their ankle joint is naturally adjusting and they will have more mobility as a result.
3. If your client’s knee(s) feel uncomfortable when performing this movement, simply instruct them to turn their feet out less.  This will take stress off their knees.

How to Explain the Assessment to Your Client

(watch the video to see Justin demonstrate the assessment and how to explain it to a client)

• Keep it Simple.“We are going to use this movement check to see how well your ankles roll inward.”
• Linking it to the whole body. “Whenever you walk/run you have to transfer your weight back and forth between your left and your right foot.  In order for you to be able to do this correctly, your ankles need to roll in.  That means your right ankle needs to roll in to the left and your left ankle needs to roll in to the right.  If one or both of your ankles don't move well then other parts of the body like your feet, knees, hips, spine, and even your shoulders have to move more to help your body transfer weight.  For example, if your right ankle does not roll in enough when you walk then your foot may have to flatten more (i.e., overpronate), your leg may have to rotate in more, or your spine and shoulders may have to rotate more to help you transfer weight from side to side. 
• How results affect symptom (for example, client in question has plantar fasciitis under their right foot and also wants to hit the ball further in golf) “As you can see, a lack of motion in your ankle can lead to aches and pains anywhere in the body - from your feet all the way up to your head.  You have pain on the bottom of your right foot, and we saw in the assessment that your right ankle doesn’t move as well as your left ankle.  It would stand to reason then, that your right foot has to work harder to make up for the lack of mobility in your right ankle whenever you transfer weight from side to side when walking, running or swinging a golf club.  As such, your poor right foot is getting overworked and is now sore.  If we can get your right ankle moving better, then we can take some of the unnecessary workload off the foot so it can recover and the pain will go away.  I also know how much you want to hit the ball further when you play golf, and performing this quick movement check before you hit the course will help you do just that. (The client in this hypothetical scenario is right-handed). Here’s why. As you come down from the backswing in golf your right ankle should roll inward as you hit the ball and continue through with your swing.  As we now know, your right ankle is a little bit locked up. Getting that part to move a bit better before you play will help you generate more speed and power through the contact point and follow-through which means you will be able to hit the ball even further!”

Conclusion

There are literally hundreds of posture and movement assessments available that can help you evaluate the condition of your client’s neuromuscular and musculoskeletal system prior to (and during) exercise. However, the secret for success in applying these assessments is to get your client to understand the assessment process and get them personally involved in their program. This is what motivates people to adhere to exercise programs in both the short and long-term. By following the simple strategies outlined in this article, you can use pre-exercise movement checks to both help clients achieve their overall pain-reduction or performance goals and empower them to take charge of the success they experience when it comes to utilizing movement assessments.

References

1. American Council on Exercise. 2010. ACE Personal Trainer Manual (Fourth Edition). American Council on Exercise.
2. Bandura, Albert. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall, 1986.
3. Price, J. 2010. Corrective Exercise Program Design. Module 4 Reference Manual of The BioMechanics Method Educational Program. www.thebiomechanicsmethod.com.
4. Whitworth, L., et al. Co-Active Coaching: New Skills for Coaching People Toward Success in Work and Life (2nd ed). Palo Alto, CA: Davies-Black Publishing, 2007.