In Basics, HD Videos, Medical/Injuries, Reference

October 13, 2011

Video Article

Join Kelly Starrett, owner of San Francisco CrossFit and creator of MobilityWOD, as he teaches coaches and their athletes how to diagnose dysfunction.

In Part 2, Starrett provides the four ways he diagnoses dysfunction. The first is “pathological” and needs medical intervention. The second is “catastrophic injury.” Luckily, only 1 percent of his patients come in with that level of dysfunction.

The next categories make up the majority of his cases. The third category is “over-tension”—being so tight that injuries result. The fourth is “open circuit faulting,” or lack of stabilization leading to compensations that create dysfunction.

According to Starrett, CrossFit exposes movement flaws and helps us correct them before injuries occur. As such, CrossFit is an effective movement screen or diagnostic tool.

“My strength-and-conditioning program is the test every single day, and that’s how powerful these functional movements are,” he says. “This stuff makes the invisible visible.”

In order to see movement faults, Starrett says, “I have to put my athletes in these positions that challenge them.”

16min 59sec

HD file size: 352 MB
SD wmv file size: 179 MB
SD mov file size: 94.3 MB

Please note: These files are larger than normal Journal videos. For smoother viewing, please download the entire file to your hard drive before watching it (right-click and choose Save Link As...).

Additional reading: Hamstrung by Kelly Starrett, published July 1, 2007.

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Comment

29 Comments on “A Language to Diagnose With Kelly Starrett: Part 2”

1

wrote …

The strongest cases for self-treatment, crossfit mobility, and Dr. Starrett's credibility I have seen in the journal.

A beautiful, elegant description of both the problem and the cure.

Thank you KStar.

2

wrote …

The level of knowledge, quality of instruction, and standards that Kelly embodies are second to none.

3

EC S wrote …

Yowza. Hands down one of the best videos yet. The ball in the towel demo was so helpful. Thanks, KStar!!!

4

wrote …

Great series!

5

wrote …

Awesome!

6

wrote …

K-Starr is the movement god...

Seriously, I was at this cert, and I just learned as much watching this video for a second time as I did at the cert the first time. Awesome stuff K-Starr!!

(FYI: If you haven't seen them yet, go look through the older videos in the ExPhys category for videos detailing a big chunk of Kelly's Mobility Cert)

- Cody

7

wrote …

That OHS video has always been my go to clip for newbies.

8

wrote …

Awesome teaching. I really enjoyed that and am eager for more.

9

wrote …

K-Starr saved my joints thx

10

wrote …

I can't wait to take this cert and be blown away in person!

11

wrote …

K-Starr these videos are awesome! You have helped me so much. I want more videos.

12

wrote …

K-STARR Awesome vid man. MORE MORE MORE pretty please.... :)

13

wrote …

i have a question. What is the likely problem for an athlete when during the pvc overhead squat they have a tilt or a very closed hip angle at the bottom of the squat versus being more upright? The athletes I see this alot in typically are female but we call it the "Trastevere Tilt" because a brother and sister both had the same issue. I'm assuming it is a combination of things like a weak posterior chain but I also wonder if it has something to do with flexibility and weakness. For instance does a relatively high capacity for flexibility combined with a weak posterior chain lead the athlete to compensate by tilting the torso forward?

Any help would be appreciated!

Great video series!

14

wrote …

KStarr = Awesome! The man is a freakin' genius. Thanks for everything KStarr!

15

wrote …


Kelly Starrett paints perfect pictures that perfectly clarify the problems atheletes experiencnce and the cures necessary!!

16

Olly Goddard wrote …

GENIUS!!!

17

wrote …

What are the other movements used to assess possible ACL tendon issue? Are they truly 100% accurate in predicting injury? That would be a great tool to have.

18

wrote …

Lots of great points and gems However to say that the FMS only has 1 functional movement is wrong. There is a trunk stability test (pushup), lunge, hurdle step. Gray Cook's corrective exercises are also genius and should be looked into by anyone. Understanding the system of FMS as well as the SFMA would go a long way in the Crossfit community.

19

wrote …

Ok, how would we fix Mike? Start him over on a box squat, step by step, getting the shin vertical and proceeding from there? Cue for weight on the heels? Neck position? just cue to look straight ahead with a neutral neck? Did Mike warm-up/prep before the workout in the video?

Awesome, amazing stuff. Please tell me there is a Level II mobility cert in the works Kelly.

20

wrote …

Ok, wait, I just figured out the answer; good coaching is how Mike gets fixed.

21

wrote …

"Categories of Disfuntion"?? I believe it's spelled "dysfunction". Otherwise, great stuff.

22

replied to comment from David Martin

Yes I absolutely 100% agree. I am a huge fan of K* and I think he has a done an amazing job of increasing awareness of the importance of correct movement mechanics in CrossFit (because if there is one fitness community that REALLY needs it CrossFit is it). To poke fun at the FMS tool is doing it and Gray Cook et al a disservice. The reasons why are too numerous to outline here. If you are a CrossFit coach and have considered getting the FMS cert, do it. And do not just do the FMS level 1, do the level 2 course as well so you know how to address identified weak links with appropriate individualized corrective exercises. The latter are something you never hear about in CrossFit circles.

23

wrote …

Hey Tony and David,
You guys are absolutely correct. Gray Cook is a genius and very thoughtful. The FMS for a long time was the only tool available to help coaches and athletes make sense of their programming. And, Cook was talking about this back in '96/'97.

My main problems with the FMS are that it doesn't account for load, metabolic demand, cardio-respiratory demand, and competitive stress. And, most importantly, we really don't need to use correlates for movement when we can use the actual movement themselves, and applied under the former conditions.

The real failure in the FMS is what ends up happening with the data collected. I know first hand that many of the gyms that use it the first day generate a score that they never retest, or that they end up not really using. You pass the active straight leg raise for example, but the athlete still sucks at deadlifting and squatting. In the example I cite from the Sports PT Journal for example, all of the Division I women were predicted to have lower extremity injuries (ACL) and they did. Where is the breakdown between the coach, the program, and the athlete? Few programs that use the FMS (Like Mike Boyle's gym) actually Overhead squat or full snatch for example.

My main point, poorly made in the video I'm sure, is that the stimulus for adaptation is also the diagnostic tool. A good coach is going to know that if you break your trunk when you perform pushups, that you'll also likely break doing presses or pull-ups. But we still need to cue and cure your poor pushup. We don't need correlates to help us understand what we are seeing. We just need to understand what we are seeing. Programming that doesn't regularly expose athletes to to a broad pallet of movements that use and demand controlled full range of motion, by definition will hide holes athletic movement and capacity. If I'm doing cable twists for example, it's hard to see why my athlete is suffering from shoulder impingement.

Bottom line, Cook is a brilliant, thoughtful thinker/physio. The FMS should just include Fight Gone Bad, Helen, Cindy, Diane, Jackie, Grace, Isabelle, and Fran (and everything else.)

KStar

24

wrote …

Hey Tony and David,
You guys are absolutely correct. Gray Cook is a genius and very thoughtful. The FMS for a long time was the only tool available to help coaches and athletes make sense of their programming. And, Cook was talking about this back in '96/'97.

My main problems with the FMS are that it doesn't account for load, metabolic demand, cardio-respiratory demand, and competitive stress. And, most importantly, we really don't need to use correlates for movement when we can use the actual movement themselves, and applied under the former conditions.

The real failure in the FMS is what ends up happening with the data collected. I know first hand that many of the gyms that use it the first day generate a score that they never retest, or that they end up not really using. You pass the active straight leg raise for example, but the athlete still sucks at deadlifting and squatting. In the example I cite from the Sports PT Journal for example, all of the Division I women were predicted to have lower extremity injuries (ACL) and they did. Where is the breakdown between the coach, the program, and the athlete? Few programs that use the FMS (Like Mike Boyle's gym) actually Overhead squat or full snatch for example.

My main point, poorly made in the video I'm sure, is that the stimulus for adaptation is also the diagnostic tool. A good coach is going to know that if you break your trunk when you perform pushups, that you'll also likely break doing presses or pull-ups. But we still need to cue and cure your poor pushup. We don't need correlates to help us understand what we are seeing. We just need to understand what we are seeing. Programming that doesn't regularly expose athletes to to a broad pallet of movements that use and demand controlled full range of motion, by definition will hide holes athletic movement and capacity. If I'm doing cable twists for example, it's hard to see why my athlete is suffering from shoulder impingement.

Bottom line, Cook is a brilliant, thoughtful thinker/physio. The FMS should just include Fight Gone Bad, Helen, Cindy, Diane, Jackie, Grace, Isabelle, and Fran (and everything else.)

KStar

25

wrote …

Thanks for the response Kelly. It's always great to get it straight from the source. I comment and ask the following questions with respect so we can learn from some dialogue:

1. Not retesting or not using the initial FMS score is indeed a major mistake. That would seem to negate the whole point of testing in the first place. That is the fault of the gyms/trainers concerned, not the tool it would seem to me.

2. I attended the 4-5 day CK-FMS (Certified Kettlebell FMS) course offered by the RKC in the Spring offered by Cook himself and Brett Jones. Cook himself would be the first to admit that his screen has limitations, it's not perfect. But what it does allow is different individuals working in a fitness setting a system for communicating in a common language (S&C coaches, trainers, therapists, etc) and an algorithm for addressing the major weak links through focussed/progressive correctives. That would seem to be a significant step forwards, esp for those of us who do not have a physiotherapy or athletic therapy background.

3. Your comment in the vid about the only functional movement in the FMS being the overhead squat - why is that any more "functional" than the hurdle step test? Why is testing someone for mobility and stability in single leg stance "non functional"? We do that hundreds and thousands of times when we run and walk every day.

4. Should someone who has fundamentally poor movement and significant assymetries (through inactivity, too much sitting, chronic poor posture, past injury, etc.) be encouraged to subject themselves to high threshold/aggressive workouts like the ones you mention? Sure they will gain fitness, potentially fast. But it's a ticking injury time bomb if all they are doing is stacking fitness on basic movement dysfunction(s). The poor movement will simply become further ingrained. Just because fitness is improving, that doesn't guarantee the movement pattern is improving. Not to mention the form breakdown with fatigue that is likely if they (a) move poorly to start with, (b) are out of shape and (c) are competitive (ie. just keep pushing cos that's "what you do" in the WODs).

5. Lastly why is there not any discussion of corrective exercise in CrossFit? I would suggest it is because there is an underlying assumption that the "functional movements" as defined by CrossFit are AUTOMATICALLY corrective if done "correctly". After the FMS course I am not sure if this a fair assumption. Fatigue and form breakdown in a high intensity WOD will, if anything, further compound the movement problem.

I personally like the FMS tool because, as a non therapist, it has given me a structured method by which I can look for movement issues and then attempt to solve the problems in a (somewhat) predictable order. Does it tell me everything I need to know about the person's movement? No. But it's a darn good start!

Keep up the good work, I enjoy reading and watching your stuff. I look forward to your response so we can all learn here on the CFJ. That's what this whole thing should be about: learning, getting people fitter and injury proofing them at the same time.

26

wrote …

I should clarify in point 3 that I meant to say "less functional" re the hurdle step test.

27

wrote …

KStar,

Thanks for the reply and clarification!! As a PT and a trainer as well as cross fitter in my home garage box, I use the FMS and SFMA in my PT practice and when screening athletes I agree that if we do not retest that is an essential flaw. If we do not implement the correctives prior to loading a movement that is also a flaw. I feel that with the CrossFit community we can implement correctives in beginner classes and when teaching or cueing to correct a movement. Cooks Reactive Neuromuscular Training exercises are genius!

Tony, I agree with your analysis of Gray Cook. He is so down to earth and will admit in his courses that he feels this screen is not perfect but may be all we have at this time to screen. However, retesting as KStar has said is essential to any research or corrective strategy.

Great stuff KStar! I love your mobility WOD and also feel that it is a greta tool to have and learn from as a PT and as a client myself :)

Dave

28

replied to comment from Tony Webster

Tony--
As someone who has done work with Kelly over the last couple years to rebuild a solid foundation to build from which was no longer in place from an accident that I was involved in and several months of recovery yes someone who has incorrect movement patterns and has significant asymmetries should be encouraged to do the things Kelly suggests.
From the first time I worked with Kelly I began to see things start to come around and change that I was told would not improve or change. Yes, I was back doing CrossFit wods at the time. We started pretty basic changing the way I stood after he coached a class that I did. I was seeing the improvements/changes that were not happening with other approaches. All workouts were not rx’d, but even in a scaled wod you are doing movements/skills/elements that bring the inefficiencies and movement pattern problems to light. As Kelly has noted CrossFit makes the invisible visible. All wods are scalable so working where you are currently at is a key factor. I was fortunate to have coaches who understood this.
You are able to identify what specific things need attention. Identifying these things is the first step to addressing and correcting them. The bottom line will always be progression and improvements on what you are doing. Learning to do it correctly and identifying the root of the problem is the beginning.
Kelly understands more than most.
The improvements and lasting changes that result from working with Kelly are game changing.

29

wrote …

Great video Kelly! I just wanted to say that the FMS screen Kelly was citing was published in 2010 in the North American Journal of Sports Physical Therapy in case anyone wanted to find it, the link is right here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953387/

I've got to say, if the results from this study can reproduced in a larger scale across more sports and men as well, then we can really say we've hit a goldmine in terms of injury prevention and every sports physical therapist and trainer should be using it.

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