The Functional Movement Screen has a unique continuum and sequence of correction generally beginning with enhancement of mobility via ASLR and SM work, if indicated. Nine times out of ten this has been the right answer and easily approachable. In most cases, it takes very few sessions to restore the pattern to a full, symmetrical pattern if I choose and execute the right soft tissue techniques and subsequent exercises.
Generally, I bank on 4 sessions being our typical duration necessary to bring up an FMS pattern to “normal” and stabilize it so they can go home and come back with the same mobility. Imagine my surprise, however, when after 4 weeks of training and 6 sessions, my client had only improved 1 inch on his weak side of a 3/2 (bordering on a 1) Shoulder Mobility asymmetry.
On initial assessment, he had a relatively unremarkable FMS scoring at a 14 with the 3R/2L asymmetry on shoulder mobility screen and a 2R/3L on HS. All clearing tests were unremarkable. His breathing patterns were apical and his breathing wave divided at about the T/L junction. He demonstrated a dysfunctional seated hip flexion and Janda shoulder abduction pattern bilaterally. His thoracic rotation in seated with his bar on his back and bar across the shoulders showed a slightly greater restriction going to the right. His standing lat length test demonstrated bilateral compensation going to TL extension.
As per the FMS hierarchy, I approached the shoulder mobility asymmetry first. Following some manual therapy to the pec major, minor, lat, subscap, infraspinatus, teres minor, psoas, and diaphragm, he performed a set of rib rolls with breath (initially asymmetrical), a shoulder packing drill for breaths, a contralateral single leg deadlift, and finally a cable row in series three times. We retested (small gain) and then went into training.
His second and third sessions were back to baseline. We followed the same approach, this time gaining only about an inch that stuck until the 4th session.
Session four and five, I added some PRI work for the Left AIC pattern to encourage more GH rotation and some additional NMT on the cervical spine in addition to our other work to entering our exercises. By this point his thoracic spine rotation in seated, breathing pattern and wave, and seated hip flexion were markedly improved. His standing lat length test approached perfect, displaying only a slight elbow bend in the last 10 or so degrees in the arc. Retesting following exercises, we were closer than ever, but still about 1 to 2 inches short of matching 3s by criteria.
Session six was much the same, and symmetry and perfection was established in lat length, t-spine rotation, hip flexion, his PPT on our manual work was extremely high and the soft tissues were generally “good” by feel, however, he maintained little improvement in his SM test. We retested his FMS today and found he had improved to a 16 with the SM asymmetry still existing (2 points via a 1 point improvement in ASLR and 1 via HS symmetry).
Curious as to why my runner could not improve shoulder mobility, I began to probe about his sports past, which, to this point, I only was informed of his rich running history to see if there was maybe indication for a potential bony morphology. He revealed to me that he had spent most of his life playing baseball, noting that he was probably 2 years old when he first started and didn’t stop playing competitively until well into high school.
At session 7, I checked total motion of the GH joint and found that the two numbers were quite similar, however, the arc was not.
While I have no direct evidence of its existence, we have an understanding that baseball players and other overhead athletes may exhibit bony changes–retroversion–on their dominant arms to facilitate throwing/swinging velocities with total motion holding relatively similar (Ellenbecker, 1997 and 2002).
The approach from here, thanks to some advice from Dr. Weingroff is to proceed without making it a priority and include more quadruped varieties (he’s 2/2 on RS) to engage the scapular stabilizer musculature while also challenging rotational stability and breathing in a different light. I’ll also perform two different screens to help delineate bony morphologies.
What would you do?