RG-There seems to be revolution right now in “physical medicine” where there is a potpourri of treatment applications and practitioners like personal trainers that perhaps aren’t diagnosing back pain but certainly treating back pain and other physical ailments. The information age is upon us and many different practitioners from many disciplines are treating these ailments. Can you speak to that?
GC-Treatment without diagnosis, in my opinion is irresponsible. It’s almost like going to a pharmacist and asking for a medication. That pharmacist does not have the clinical ability to diagnose you but right behind them they can dispense a “potpourri” of things to make you feel different. Now, don’t get me wrong I truly appreciate for example what a massage therapist can do. I think that they have skilled hands and can get in there and work the tissue like nobody else. But, you and I have been trained to find the driver of bad movement, to find the source of the pain. Sometimes rubbing on the sight of discomfort distracts you from making an appropriate diagnosis. You know, we have innovative, aggressive ways to treat soft tissue. Dry needling and A.R.T. (Active Release Technique) are on the forefront of aggressively treating soft tissue so you don’t have to go to a massage therapist for a year to get rid of unnecessary tightness for instance in the “traps”. So, literally think that just because somebody may have had previous success getting people in shape or whatever, the treatment does not justify the lack of a diagnosis. I can give you morphine right now and you will feel significantly better but it does not mean I have diagnosed you or you have a lack of morphine in your system! (RG Note: Chiropractors have said the exact same thing since day one!) So I am a proponent, that is if I had to dedicate myself to expert diagnostic abilities or expert treatment abilities and you could only pick one, it would be expert diagnostic abilities. This is because I would soon figure out and how to change the baseline. If all I had was treatment, then I would try to force every patient into my treatment zone. So if you are good at diagnostics, one of the first things you will figure out is that you may not have the skill set to fix the person if front of you but I am a phone call away from being able to network that and I have never found a patient yet or a referral source that didn’t appreciate a well diagnosed, well managed referral and it usually comes back to me ten-fold. I do think that diagnosis is a lost art and movement screening and movement assessment are sort of my contributions to get us back to that critical thinking.
RG-So talk to me then about the use of the FMS with organizations, professional sports teams and some of the people you have personally worked with.
GC-I’m very honored that the FMS has made it into the special populations of the military, the NFL and many other professional sports. And I think there is a certain “dogma” that surrounds the movement screen. It is either the savior of everything or it is the worst thing that ever happened! And it is neither. It is simply a tool that did not previously exist in our toolbox. Once you introduce a new tool it doesn’t mean you lose all of the other effective tools. It lays right beside the other tools. And, I’m not saying that there are some tests that we should probably delete. As a matter of fact, there are a lot of innovative orthopedic books out that say some of those tests we used to do are either unreliable or not valid. So if we were to delete at least those, and not based on my opinion but current evidence, then we have plenty of space to add a new tool or “app” into what we do.
RG-It seems to me that that is the revolution Craig Liebenson, D.C. spoke about in a course he was teaching a few years ago when he said that everything in rehab and the functional approach to patient care changes every 5 years. Could you talk about that and where you see all of this going with the FMS and all of the new approaches in health, fitness and movement ?
GC- Well, the first thing I see is that as soon as the FMS gets a little more popular than it already is, you will see a lot of “movement screens” come out. You will see a lot of copy cats. You see exercise videos, exercise equipment and protocol get copied. So I would say we will see some new screens come out. And I would at least throw down the sword out front and say listen, if you are going to beat me, then beat me. But copying me ain’t gonna beat me. I see people doing that, they take the movement screen and delete two tests, add one and then brand it as something else. I think that is closer to seeking popularity instead really trying to change the baseline. I am absolutely sure that we will have a better way to screen movement one day. Until we had a GPS we had to be good at using a compass. That GPS isn’t available now and until it is, lets use the compass and wear it out so as not to get lost! I think the one thing we have to be vigilant for is a lot to copycats that are going to come around just because screening is popular. And what will happen is that the pendulum will swing. First of all, people will take the simple screening concept that we have offered to the exercise profession and do exactly what you talked about in terms of getting into assessment and diagnosis. That is the pendulum swinging too far, taking irresponsible liberties with a skill set that is not designed to be clinical. Secondly, we could swing the other way and say we should not do any screen at all and all we should be doing is counting “reps”. I think that is irresponsible as well. As time goes on and the FMS gets more popular it may polarize people saying it is too invasive or not thorough enough. The movement screen is here to categorize people in both function and dysfunction. And if we can at least agree that we shouldn’t lump a bunch of fitness on top of dysfunction, then it has done its job.
RG-Gray you have worked very well with other professions, especially the chiropractic profession. Given our respective profession’s competition with each other, you even have chiropractors as FMS instructors. Tell me about them.
GC-I think it is a breath of fresh air because the one thing that I think about chiropractors, and I am going to speak specifically about the chiropractors that help us, is that they seem to be significantly more “fitness savvy” than a physical therapist would be that work with us. Unless a P.T. has a previous athletic background or sports medicine background, they don’t really feel comfortable in a fitness environment. I think it is because P.T.’s come out and they don’t go into independent practice. They work under the umbrella of a hospital or large clinic. Whereas chiropractors come out of school and realize “ I’ve got to be a community resource right away. I‘ve got to distinguish myself right away and if that means I have to give all Pilates and yoga instructors a discount for care so I can educate them about the service I might provide to their clients, if I am going to work with the local tri-athlon club or be a resource for personal trainers and maybe even offer them continuing education twice a year, then I am going to become a resource in my community that appreciates fitness and wants to keep the active population moving ”. I mean, it’s a good business model. Active people are going to get hurt more by the simple fact that they do more. If you can position yourself to be there and make that injury a temporary inconvenience instead of this long term issue requiring medication, then wean off of it and all that. The chiropractors we have had had not all just been competent clinicians but somehow in their communities have become a role model that this how you manage a clinic and fitness side-by-side.
RG-What value would the FMS bring to a chiropractic practice today?
GC-I mentioned before about being a community resource. Often the sports medicine specialist or the orthopedist show up on sports physical day at the local high school and they do their thing and they are looking for medical contraindications for participation in sports. Where as if the chiropractor teamed up with the school’s athletic trainer and did movement screening, it will not interfere with the pre-participation physical conducted by the medical physician. But the chiropractic physician, the P.T. and athletic trainer can collaborate on the screen.
RG-You talk about this in your lectures that we all have been told to ”see your doctor before starting an exercise program”. You follow this with how many people are told to “see you movement specialist before starting exercise” and who better than chiropractors and physical therapists to assess and be the “go to” professionals for movement?
GC-I just spoke at the International Federation of Orthopedic Manual Therapy in Quebec and said isn’t ironic that dentists look into your mouth for prevention once or twice a year. They demonstrated they can prevent costly care just with an ounce of prevention. Wouldn’t you like it if chiropractors could do a yearly musculoskeletal checkup? We would love that, especially if insurance gave us about a hundred bucks to do it! I’d crank them out about every 20 minutes! And, I would uncover some stuff that I would go into clinic to treat. The deal is, every dentist has a standardized, accepted checklist. Here is the disappointing thing. We are a long ways from getting that wellness checkup because everyone of use does something different. We need to standardize that procedure.
Robert “Skip” George owns La Jolla Sport and Spine in La Jolla, CA where he integrates chiropractic, rehabilitation and sports performance training. He is also a Functional Movement Screen instructor. He can be contacted at firstname.lastname@example.org