Okay thanks to the program committee for asking me to be here audio visual staff they do a lot of work behind the scenes to make these things go and make our videos play Jaguars medical staff for let me be here and then my PFAS colleagues who are a lot of the thought people in the in the space we live in today when I first went to school the first thing you did when you were doing screening was a postural screening you looked at people from the back the front and then you came across something by yonder called upper and lower cross syndrome and that's what basically existed today there's so many different options out there for people to look at to decide what it is they need to do for their players there was a term that came out called regional interdependence it was coined by a guy named Wayner in 2008 but it dates back to years ago from again from two people up in Pittsburgh by the name of Dick Earhart who is a chiropractor and PT and a guy named Rick Bowling who was a PT and they basically showed that something could happen in one part of the body that affects the other part of the body the injury could have been at that point or somewhere along the chain we could see when we look at sagittal frontal and transverse planes all the things that could happen and that's why screening slows everything down that we could see certain things a little bit better so when I look at a screen can you can it help you identify the path of the target tissue that's affected if I look at it from the inside out of the body bone and chondral is it worn is it healthy is it congruent does it fit the way it's supposed to is it inert tissue is it loose or tight is it contractile is it over or under active is it kinematic now that's not it it's not misspelled it's just combining kinematics and kinetic so you got forces and it's movement linking and coordination and then the cognitive piece that's that's what everybody's exploring now is the neuroplasticity how do you make something go back and be coordinated after it's been injured well we see people in the world that we work with that a lot of times they have the perfect storm they have bad bone they have instability so they got inert insufficiency they've got neuromuscular amnesia they've got kinematic collapse and then they've got cognitive uncertainty that sometimes it looks like it's done pretty well and then other times it's not done well at all I broke it down into three different areas I broke it down into movement I broke it down in the clinical things that I've seen over my 35 years of doing this and I broke it down into performance as Kyle talked about people needing to communicate very well so here's something called Dory motion capture system sensorless system where 16 teams in the NFL have been collecting the data it has algorithms you do a series of seven to eight tests and those algorithms help you predict what's going to happen the one big thing that came from the data capture that occurred during this season is that they were able to see that ankle dorsiflexion was a big thing so if you want to take something to start working on when you go home make sure people their ankles are moving good I always tell people you you move from the ground up and you strength and your strength comes from the core out so that ankle prediction that they look for injury prevention with the Dory motion capture actually was something that they they talked about functional movement system that's been around for years seven tests score 21 greater than 14 great Cook started that many many years ago and then his spinoff from that with Mike Voight and and Greg Rose was the SFMA which was more clinically based where you did a top tier system and then broke it down and then you had breakout sections but these are all available now depending on what you want to do and ASM screening Mike Clark that's been around for years you look at something as simple as an overhead squat and a single leg squat and it tells you where the breakdown point is they do pronation distortion syndromes and again it gives you the summary of things that you could actually look at and begin to work on if we look at kinetic control a lot of people haven't heard of this this is from over in Europe it's the people that designed it was Comerford Macharum and now a guy named Blanford that's been doing it and this is looking at people that can't control motion these instability cases that you sometimes see and they have it for shoulder here's just dissociating his hip from his pelvis all he's doing is doing transverse plane internal external rotation to make sure that it's occurring in the hip joint and how many times do we see people when they do hip extension they go into their back to get the motion so here's just one simple way of starting to train it but breaking it down and looking at these screens to say okay this person doesn't move right what do we give them to me to correct that applied functional science Gary Gray when the foot hits the ground how many years ago was that I think in 1989 I saw him do his first course okay and here he's come up with a system called maps and again it's a series of 12 tests but it's available to you true stretches on the right and then if you look at the test that he did you know how he actually came up with the true stretch but it's right and left crossover same side rotation same side lateral movement and then anterior and posterior chains star excursion balance test that goes back as far as 2000 and looking at anterior medial posterior medial all of those motions and what it meant to the different sports if we look at what plisky tried to do then as he took the an instrumented the star excursion balance test and basically it's a series of three tests that you could do you could do it upper and lower okay the inner rater and interrater reliability is very high and again it can be used you got those ankle problems and just looking at dorsiflexion and seeing what people get it gives you a measurement greater than greater than four centimeters that put you at higher risk another thing that's been out there a long time is MAT muscle activation and that's a comparative assessment mobility so this is the I've been doing this a couple years now too and it's just part of the toolbox but basically you allow people to see that strength can actually be a reason why they have loss of motion and if you take the classes it's been pretty effective for us again doesn't work on everybody but again there's so many things out there if I look at clinically the things that have existed scan wise okay upper and lower quarter screening we're taught that if you're old enough you remember the old book by Hoppenfeld that was probably in every athletic training room it's probably in some libraries now yet but again it's what you went by with the upper and lower lower quarter screens the one thing you never want to forget is the red flag screens when you got people that have those referred pains from visceral regions again something very important to remember when you're looking at screening algorithms that could be based on structure and based on feedback from MRIs or x-rays this was up at HSS a girl named Jamie Edelstein just looking at hip structure and deciding on how to go about treating her patients with osseous overcoverage and inert instability either positive or negative and it lets you start shooting when you get these scans and you get good at them it lets you start shooting with a rifle instead of a shotgun something so simple shaytow posh from England a do basically just sits people down years ago they used to do a test where it was a sit and reach test and there was a box that you got measured on that was objective but basically if you just look at this he's looking to see if your hamstrings are tight your calf is tight your low back's tight thoracic is moving too much but these are all things that are available for you to examine people and then again table pelvis and ankle check we do this so much every day on players that come in especially players that might have tissue breakdown during camp and we're just going to check to make sure the pelvis is level make sure the ankles are moving correctly make sure that their alignment at the medial malleolus have them do a bridge check the pelvis again have them sit up a nice rule is if if you load it you check it again the reason I did this slide before was because what does the trend Ellenberg tell us when I went to school many years ago it told me that you had a weak gluteus medius right but just think about what that means when your pelvis drops on the opposite side it means everything on the stance leg to the outside is stretching we deal with the Holy Grail of of the hamstring so if let's say I lay the person on the table and I see their anteriorly rotated so now they've got an anteriorly rotated pelvis so it's going to cause the hamstring to stretch it's going to lengthen posteriorly up near the glute now they stand up and they do this and they we they're weak in the gluteus medius what does that mean it means that the hamstring is stressed laterally because the pelvis is going up it means it's going to be stressed in the sagittal plane because it's rotating anterior and just pronation and supination means that it has the potential if you over pronate that you're going to be moving it in a longer excursion by going into pronation not coming out of it so when we look at some of these things that may give us a reason why a person is getting some of the injuries that they do simple little tasks single leg squat by Crossley and Skage we've all seen this performance rating good poor trunk poor pelvis poor hip and knee so you could see the kinetic collapse of the knee you could see the adduction of the femur you could see the lateral tilt of the pelvis and you could see when somebody's doing it pretty well and then those results basically demonstrated what what we would expect to see the bunky test that was used mainly for runners but it's the fascia lines and they do a series of five tests and again it's just another way of looking at how you might evaluate a core in a scan sports-specific screening I was in hockey a lot before before I came to football a couple years ago but we always saw adductor injuries and Tim Tyler up in in New York he was able to do a study that showed that if the adductors weren't at least 80% as strong as the abductors in professional hockey players that your chance of injuring the groin was 17 times greater that's a good screen to do when you got sports specificity and you got results like that one of the things that we see in the clinical world today is what they call clinical prediction rules that's something to the left there called low back classifications so if you have those symptoms you're going to manipulate if you have the other symptoms you might stabilize maybe that's something we should be looking at when we start looking at testing clusters when we're looking at movement maybe two or three of the different types of movements would be a better indicator for us than just picking one thing just like it would be for core strength power fitness or load management from a performance standpoint the Nord board that's the big thing you've heard people talk about this morning and again this was a study that again looking at structure that this was opposed to put out by Mike Voigt and Chris Wolfe and basically the effect of the pelvic tilt and weight-bearing of hamstring on force production and it showed that if you were in an anteriorly rotated position or a posteriorly rotated position your strength levels were less so again when we the application of that is do we actually go and correct the pelvis before we do the Nord board or do we just interpret it to make sure that we check the pelvis and say okay this is why this might have occurred a couple things in there for you just with hamstring training so that you can take something away I'm not big about raising us raising a problem and not given a little bit of a solution but these are some good articles that you could actually look based on fascicle length based on structure of the hamstring and then running as well the vault force frame again we could look at so many different things to test but we have abduction adduction and some of the things that we've seen in abduction everybody uses bands band around the forefoot recruited gluteal group better than TFL something to take with you mean normalized EMG signal amplitude that it was better to start the affected side as the stance leg as opposed to the moving leg okay but again the NFL the vault company they collect the data and it tells us where everybody is from a percentile standpoint and how you compare against people in your position and people around the league so that's pretty valuable for us when we look at that from an adductor standpoint the test that the best exercises were to Copenhagen which was the bottom exercise and then just squeezing a ball if we look at velocity based training that we see in in the performance centers now there's some norm normative values for what happens when you're working at different strength levels here's a ground reaction force and meters per second squared how fast he's moving so these are things that are scans that allow you to take and evaluate your players on a day-to-day basis very quickly lastly force plates something else that we're really big into and we'll do jumps probably at least once a week now in the weight room just to identify people and this the things to the right there tell you the breaking position of the person are they going equal on both sides how's their push-off you can see how when he lands he's rotated a little bit to the right lands on the right foot faster so again now we've got ways of qualifying this like Joe talk Joe are quantifying this like Joe talked about it more times than not it's still it confirms what my eye test does but it's really a good way of identifying numbers for people and the athlete I'm sorry how do I go back to basically the the conclusion then is you have all these different types of scans get good at one or two of them but remember that the big part of it is you're going to have people that are tight you're going to have people that have too much motion you got to know what to do for him afterwards and the big part of the let's see the conclusion screenings can be done with movement clinical eval or performance screening can be used to identify deficiencies movement compensations they can help direct treatment and establish baselines they can lead to the development of correctives or buckets for groups of players who may be experiencing the same problem screenings can help to identify a weak link or escape route as part of the chain kinematics and then activation can increase mobility just as easily as flexibility can increase strength thank you

screenings

deficiencies

performance

regional interdependence

corrective measures