TABLE OF CONTENTS

1 The main principles of testing ..............................................................................................4

1.1 Movement must be evaluated ......................................................................................4
2 Identifying Qualities to Test .................................................................................................7
2.1 Time Motion Analysis ....................................................................................................9
2.2 Biomechanical Analysis – Assessment of the forces and loads placed on the body ........9
2.2.1 Biomechanical Analysis and Electromyography ....................................................11
2.3 Establish a list of Key Quality .......................................................................................11
2.4 Choosing Appropriate Tests ........................................................................................12
2.5 Establish normative data, considering age, gender, competition level, and position. ..13
2.5.1 Pass / fail Qualities ...............................................................................................13
2.5.2 Qualities that are directly related to performance ...............................................13
2.5.3 Standards Change ................................................................................................14
3 Limitations of Testing ........................................................................................................15
4 The Categories of Testing ..................................................................................................16
4.1 Anthropometric Qualities ............................................................................................18
4.1.1 Relative vs. Absolute ............................................................................................18
4.2 Movement Qualities ...................................................................................................19
4.3 Physiological Qualities .................................................................................................20
5 HOW WE EVALUATE MOVEMENT - 5-SITE INTEGRITY ........................................................22
5.1 Movement Evaluation Process ....................................................................................23
5.2 Principles of 5-SITE Integrity ........................................................................................24
5.3 Factors that Effect Movement Quality: posture, mobility, output, control and capacity
25
5.4 Part One: Basic Movement Testing .............................................................................27
5.5 Part Two: Power Movement Testing ...........................................................................27
5.5.1 Methods to evaluate expression ..........................................................................28
6 Analysis: Putting it all together ..........................................................................................28
6.1 5 Site Integrity Movement Analysis .............................................................................28
6.2 Performance Profile and Comparison Spectrum ..........................................................28
7 FIELD TESTS .......................................................................................................................30
References ................................................................................................................................32
8 Appendix B: Common Movement Dysfunctions .................................................................33
8.1 Foot and Ankle ............................................................................................................33
8.1.1 Pes Planus ............................................................................................................33
8.1.2 Limited Dorsiflexion .............................................................................................33
8.1.3 External Foot Flare ...............................................................................................34
8.2 Knee............................................................................................................................34
8.2.1 Dynamic Valgus ....................................................................................................34
8.2.2 Sagittal Control ....................................................................................................34
8.3 Lumbopelvis and Hip ...................................................................................................34
8.3.1 Hip Hinge .............................................................................................................34
8.3.2 Hip Mobility .........................................................................................................34
8.3.3 Hip Strength Quality .............................................................................................35
8.3.4 Spine Buckling ......................................................................................................35
8.3.5 Sandwich Movement ...........................................................................................36
8.3.6 Pelvic Control .......................................................................................................36
8.4 Scapulo-thoracic Humeral ...........................................................................................36
8.4.1 Thoracic Collapse .................................................................................................36
8.4.2 Thoracic Rigidity/Hyperkyphosis ..........................................................................37
8.4.3 Scapular Winging .................................................................................................37
8.4.4 Internal GH Rotation ............................................................................................37
8.5 Cranio-Cervical Junction ..............................................................................................37
8.5.1 Anterior Head Carriage ........................................................................................37
8.5.2 Lateral Shift..........................................................................................................37
8.5.3 Rotation ...............................................................................................................37
1 THE MAIN PRINCIPLES OF TESTING
Testing is purposeful evaluation of key qualities to reduce injury and to evaluate athletic factors
that contribute to sport performance.

The main principles of testing are summarized in the list below.

1) Establish baseline and to evaluate progress. Gather data consistently over time to
evaluate athletic strategies (rest and recovery, training, nutrition, etc.) to improve
performance and reduce injuries.
2) To compare and identify relative strengths and weaknesses. Compare results between
athletes at similar and different ages, and competition levels to give them an indication
of their strength, weaknesses, and relative athleticism or fitness.
3) Talent Identification
4) Education. Help the athlete to understand more completely his / her body and the
demands of the sport

1.1 Movement must be evaluated

Most testing is performed to measure an outcome - either the distance reached, the time taken
to perform a task, or the amount lifted. In more sophisticated testing force produced, power,
and other physiological parameters are measured. But there is a huge problem - a huge black
box surrounds the athlete.
Figure 1: The Black Box Effect. Assessing movement only for the outcome as opposed to the
quality of the movement.

That black box represents the movement that produces the outcome. Failure to assess the
movement neglects the cause, where the effect is the outcome. For example, a basketball
player jumps 34 inches, which is great considering an average NBA basketball player jumps 28
inches. Everyone is happy. The athlete is happy as well as those evaluating the athlete because
this score places him in the 95th percentile.

Great???

I work with this athlete and he has patella femoral pain and patellar tendinosis of the knee.
When he jumps his knee collapses inwards. This movement dysfunction (in ward movement of
the knee, called dynamic valgus) is present during all his movements - when he accelerates and
quickly changes direction, when jumps off one foot and during most single leg movements.

In fact, a recent MRI, revealed moderate degeneration of the patella femoral joint. This athlete
is in pain. You can image how this impacts his performance. He is unable to perform to his
potential. He walks around in constant discomfort.

NOT GREAT!
This could have been prevented. This athlete has been tested many times at college, and as a
professional. Interestingly his movement dysfunctions were never revealed, allowing the
problem to magnify over time.

The source of his problem is a very common movement dysfunction is dynamic knee valgus. I
must remind you to read the report on AOA Fall Fitness testing, where over 90 percent of the
athletes tested display this problem. We must stop this from happening. The impact on their
athletic development, and more importantly the impact on their quality of life are too large to
ignore.

Without question movement is the main quality to access. Interestingly, movement is poorly
evaluated if at all during most testing. Common evaluation processes in the NFL, NBA, and NHL
fail to evaluate movement.

We must incorporate movement into our testing protocols. How we evaluate movement will be
discussed in section 5 HOW WE EVALUATE MOVEMENT - 5-SITE INTEGRITY, pg. 22.
2 IDENTIFYING QUALITIES TO TEST
To determine what to test, requires an understanding of the demands of the sport. This
concept is called specificity, which is comprised of: a) mechanics; b) motor-coordination; and c)
energetics.

The demands of the sport are very different based on age, gender and competition level.
Therefore testing protocols must be progressive to reflect physiological development and the
demands of the sport based on competition.

For example the testing protocols for a recreational 8 year-old basketball player should be
different that a professional basketball player. Likewise the testing protocols for the
professional basketball player should be different than an Alpine Ski racer. The tests always
reflect the principles of testing that are sport, age, gender, and competition appropriate.

Overtime tests will change. Factors that necessitate the change in testing are based on:

a) Evolving demands of the sport. Athletes are becoming faster, more specialized, and
more powerful.
b) Improved diagnostics. As technology and our understanding of factors that effect
performance and injury risk develop, our tests will evolve. The shift to movement is one
example of how testing is changing. Some other key factors that need to be tested
include, references included for further information:

a. Power output, agility, and reactive abilities in response to a sport specific

decision challenge
b. Mental strength and resilience
c. Psychological status
d. Biochemical and Nutritional status
e. Hydration levels
f. Genetics
g. Injuries

To adhere to the principles of testing the following steps are performed:

1) Time motion analysis

2) Biomechanical Analysis – Assessment of the forces and loads placed on the body during
sport competition
3) Establish a list of key qualities. Notes these key qualities are organized into the
categories of testing which are explained in section 4.
4) Choose appropriate tests based on points 1 - 2
5) Establish normative data to evaluate if tests to evaluate key qualities can predict sport
performance and injury risk - considering age, gender, competition level, and position.
2.1 Time Motion Analysis

Identifying key qualities begins with time motion analysis of the sport that is specific for age,
gender and competition level. The purpose of the time-motion analysis is to understand the
physiological demands of the sport and dominant movement patterns of the sport. For a review
on how to perform time motion analysis I would refer you to the listed resources below.

Time motion analysis examines the movements occur during the sport, classified into high
powered or high intensity, moderate intensity, or low intensity or recovery. Based on the
amount of time within each intensity zone, gives us the energy profile for the specific group
that was tested. For example the energy profile of a recreational boy’s basketball team will be
much different than the intensity profile of an NBA Basketball team during the playoffs.

Resources:

1. Zatsiorsky VM. Kinematics of Human Motion Human Kinetics; 1997.

2. Hall S. Basic Biomechanics. Toronto: Mosby; 1995.
3. Baechle T, Earle R. Essentials of Strength and Conditioning Toronto: Human Kinetics;
2000.
4. Bartlett R. Introduction to Sport Biomechanics: Analysing Humnan Movement Patterns.
2nd Edition ed: Routeledge; 2007.
5. Griffths IW. Principles Biomechanics & Motion Analysis; 2005.
6. Schmidt R. Motor Control and Learning Toronto: Human Kinetics; 2005
7. Stone MH, Stone M, Sands WA. Principles and Practice of Resistance Training. Toronto:
Human Kinetics; 2007.

2.2 Biomechanical Analysis – Assessment of the forces and loads placed on the
body

Delving deeper into sport analysis requires an understanding of the kinetics being applied to
the body during sport and the forces and motions (kinematics) that are developed by the
athlete during the sport – see Table 1: Kinetic and Kinematic factors that are evaluated during
sport Biomechanical Analysis.

Kinetics – the study of the relationships
between forces and their effects on bodies at
rest (statics) and bodies in motion (dynamics).
Force, load, power, torque
Direction of Force: i.e. Compression, Shear,
Torsion
Kinematics – describes the motion of objuects
without considering the causes / kinetics
leading to the motion.
Position
Velocity, Acceleration, Speed
Frictional forces Displacement
Kinematic Chains Path
Joint Stiffness – Motor Control of the Joint
Centre of Mass
Inertia – control of body inertia / postural
control
Energy Expenditure for Motion

Table 1: Kinetic and Kinematic factors that are evaluated during sport Biomechanical Analysis

Biomechanical analysis helps us to prevent injuries and improve performance. Let’s give a
couple of examples of where understanding biomechanics is important for injury prevention
and for sport performance – see below.

Note understanding biomechanics is merely descriptive. To develop our athletes we must take
this knowledge and devise strategies to produce sound movements – this involves integrating
knowledge from many disciplines such as: motor skill acquisition, neuromuscular conditioning,
pediatrics, kinesiology, biomechanics, biochemistry, sports medicine, and many more
disciplines.

Injury Prevention
 What are the forces exerted on the body of an Alpine Ski Racer during a downhill event
o How does this differ based on the competition level of the skier?
 What are the loads necessary to cause and ACL rupture and what is the mechanism that
causes ACL ruptures?
o How much force is exerted on the knee during landing with dynamic valgus?
o How do we condition our bodies to improve our abilities to control against
dynamic valgus
 What are the load characteristics that contribute to low back pain?
 Why are the biomechanical factors that contribute to tendinopathies

Sport Performance
 How much force is necessary to jump 38”
 How do we train our force generating capabilities?
 What are the proper mechanics to hit a golf ball 300 yards?
 What is the trade-off between developing more force with increased weight.

The better we understand the sport, the better we can test our athletes to see if they possess
the force generating capabilities to execute the skill while remaining safe. For example, if an
athlete is unable to perform a single leg squat; are they capable of performing a proper turn?
Regardless the motivation of the athlete, or what equipment the athlete posses, if they can’t
produce adequate force they cannot perform turn properly. If they can’t turn properly, are they
at increased risk of injury?

2.2.1 Biomechanical Analysis and Electromyography

Associated with biomechanical analysis is electromyography (EMG). EMG examines the muscle
activation involved when a muscle contracts. During movement EMG provides additional
information about:

a) Timing of muscle firing

b) The percentage of muscle firing compared to maximal voluntary contraction

This information is helpful to understand how muscles are being recruited during an activity.
This is especially powerful when this information is combined with manual muscle testing, and
movement screening. Aberrant muscle recruitment patterns have been virtually all articulo-
myofascial problems, such as:

a) ACL ruptures1-3
b) Patella-femoral pain
c) Shoulder impingements
d) Low back Problems4, 5

2.3 Establish a list of Key Quality

Once steps 1 - 2 have been performed we are able to develop our key quality lists. This list is
prioritized, because not all qualities are equal – see section 2.5.1 - 2.5.3. The evaluation of all
key qualities gives us an overall impression of the athlete. Not all athletes will be strong in all
qualities, where weaknesses and strengths help us design strategies to aid in the development
of the athlete.

You can image this key quality list is much like playing a video game where there are various
attributes of a character. How you choose to develop the player is based on developing key
qualities – not all qualities are equal. For example, you can develop a large, powerful character
or a quick, agile character. How you develop each key quality is based many factors such as:
existing key qualities, age, sport, competition level, genetics, and adaptability.
2.4 Choosing Appropriate Tests

Now that we’ve determined the key qualities to test we must select appropriates test to
evaluate each key quality. Each test needs to fulfill the principles of testing that are age,
competition level, and gender appropriate. We want to keep testing to a minimum, where key
tests are administered. To accomplish this, each test need to posses:

a) Construct validity – refers to whether a tests measures what is purports to measure.

b) High Reliability – refers to the variability of tests results. High reliability occurs if you
perform the test identically you should measure the same result.
c) High inter-rater Reliability – different people performing the test should produce the
same results
d) Efficiency. How long does the take to explain, perform and analyze.
e) Predictive. Is the test correlated with performance or injury prevention.
2.5 Establish normative data, considering age, gender, competition level, and
position.

The importance of testing is to obtain information. This information is then analyzed against a
standard(s) to give us an impression of how that athlete performed within that quality
compared to others – see section 6: Analysis: Putting it all together. The standards are
organized based on:

a) Age
b) Competition level
c) Gender
d) Relative scales (relative to body weight, relative to some other quality)

It is very important to appreciate that in comparison to a standard, certain qualities are:

 Pass / fail qualities

 Directly related to performance
 Standards change based on age, level, position, and sport
 Must always be performed with ideal movements

2.5.1 Pass / fail Qualities

Pass / fail qualities are qualities that do not increase performance once a standard is reached.
Once the standard has been reached maintenance of the quality is needed. For example,
hockey is an explosive sport where shifts last 30 - 45 seconds. During this period the athlete will
engage in short high intensity bursts of action, mixed with coasting, hitting, grinding for a puck,
and sport specific skills. Most of the energy for this type of exercise comes from the anaerobic
alactic system. Recovery between shifts, which is typically 2 minutes, is facilitated by the
aerobic system. Studies reveal that once an athlete achieves a VO2 max of 50 ml / kg / min no
further improvement in recovery occurs with a higher VO2 max 6. In other, words if your VO2
max was 75 ml / kg / min (High VO2 max values range into the low 60s for NHL hockey players
with the average ranging from 55 – 58 ml / kg / min.6-9 you will be able to recover between
shifts just as well as an athlete with a 50 ml / kg / min. Therefore there appears to be a limit to
how much aerobic capacity we require for many explosive sports. However, the impact of
having a higher VO2 max may exist outside of just recovery.

2.5.2 Qualities that are directly related to performance

Qualities that are directly related to performance need to be continually developed. For
example, an Olympic Weight Lifter must always aim to improve their vertical power quality.
Their sport is based on how much they are able to lift, relative to their body weight. Vertical
power is essential, where possessing more vertical power only helps them lift more and directly
aids in performance.

Sprint Performance10, 11
Hockey12
Rugby
Acceleration11
Agility11
Basketball
Football
Weightlifting13

2.5.3 Standards Change

At times a major contributor to performance at one level may be a pass / fail quality at another
level. To continue with our previous hockey example, aerobic capacity is often a performance
limiter for hockey players during ages 14 – 16. However, as the athlete matures and rises up
competition levels the importance of aerobic capacity becomes less significant – in fact aerobic
capacity beyond a VO2 max score of 50ml/kg/min does not seem to improve recovery. This is
also true in study by Hoffman et al. (1996) that reported aerobic endurance above a minimal
standard does not increase playing time in elite college basketball players14. Therefore training
and testing need to reflect and consider the following factors:

 reference standard (age, competition level, gender, etc)

 Developmental windows of opportunity15
 The physiological and neurological development of the athlete
 The validity and reliability of the tests
Figure 2: Testing Qualities

3 LIMITATIONS OF TESTING
Of course there are limitations with athletic testing. Testing is not fool proof, and just because
you test well it does not guarantee that you’ll perform well. The following is a list of common
limitations of athletic testing:

 Predictive Validity - Factors outside of athleticism are related to performance, which

are not tested. These factors contribute to athletic performance and are factors in injury
development. For example:
o Failure to measure game decision making qualities.
o Procedural knowledge
o Cognitive Factors
o Psychological factors – anxiety and arousal
o Sport skill

 State during testing. What was the athlete exposed to prior to testing. For example, did
the athlete sleep well? Did they have adequate nutrition? Is the athlete fatigued
because of competition? Did the athletes taper or peak for testing? Does the athlete
care about how they test?
 Testing Anxiety. A phenomenon, usually
4 THE CATEGORIES OF TESTING
There are three broad categories to test during our basic testing – anthropometric, movement,
and physiological. As indicated in section 2 Identifying Qualities to Test, there are many
additional categories of testing. The additional tests are reserved for intermediate and
advanced testing protocols.

In this guide we will discuss each broad category during our basic testing and a few of the key
qualities within each broad category. Note as the athlete progresses through the competition
pathway, the same broad categories are used but with more sophisticated testing. Other
testing categories will be integrated based on the demands of the sport, age, the
appropriateness of the test – see section 2.4.

The analysis of each quality against appropriate standards and with the big picture in mind
gives us an overall impression of the athlete. The overall impression of the athlete will be
discussed in section 6. When there is an injury present, a full orthopedic evaluation will be
performed.

Anthropometric Movement Physiological

 Movement
Physiological
Power Movement Screen
Anthropometric
Basic Movement Screen
Vertical Lateral Horizontal Agility Acceleration Reactive Abilities Anaerobic Power Anaerobic Capacity Aerobic Capacity

Active Start
Basic Anthropometry Play Evaluation
0- 6
FUNdamentals
Basic Anthropometry Play Evaluation
6 - 8F, 6 - 9M
Tests according to LTAD Stages

Learn to Train Basic Movement Screen

Basic Anthropometry
8-11F, 9 - 12M Neutral Spine Control Multistage Fitness
Jump Index Pent Jump T-Test 10m Sprint
Single Leg Hop Single Leg Pent Jump
Train to Train Basic Anthropometry Basic Movement Screen Squat Jump
11-15F, 12-16M Body Composition Basic Trunk Evaluation CMJ
DJ
Multistage Fitness
Jump Index Drop Jump Profile
Train to Compete Basic Anthropometry Basic Movement Screen
Concentric Power
15-18F, 16-18M Body Composition Functional Trunk Evaluation
Profile 300m Shuttle Test Multistage Fitness

Learn to Win Basic Anthropometry Basic Movement Screen

18-23F, 18-25M Body Composition Functional Trunk Evaluation

Train to Win Basic Anthropometry Basic Movement Screen

23+F, 25+M Body Composition Functional Trunk Evaluation

Table 2: Example of the Testing Protocol across Competitive Pathways

4.1 Anthropometric Qualities

Anthropometry refers to the measurement of the human individual for the purposes of
understanding human physical variation. Common anthropometric qualities that are measured
are height, weight, reach height, leg length, etc. It is important to realize that there is very little
we can do to change many of these anthropometric qualities. Muscle cross-sectional area and
body composition are the most highly adaptable anthropometric qualities. These qualities can
be enhanced with appropriate strength and conditioning and nutrition habits.

4.1.1 Relative vs. Absolute

Anthropometric qualities are important to consider when athleticism. We need to make the
expression of the quality relative to each person.

For example:

 pent jump related to limb length

 Vertical power relative to body weight
 Aerobic capacity relative to body weight
 Wingspan relative to body height.
4.2 Movement Qualities

When we assess movement qualities we look at a) how our bodies produce force, b) respond to
forces being applied to the body, and c) how our bodies utilize forces to produce movement or
to control against force. Specifically we examine 5-SITE Integrity and the smoothness of the
movement. We will be discussing 5-Site Integrity in section 5. In the figure below you will notice
how movements are classified into modes and types - Figure 3: Movement Classification
System.

Figure 3: Movement Classification System. Modes are classified into basic and power
movements. Types are based on anatomical planes – vertical, horizontal, lateral and rotational.

Movement modes classify movements into basic and power movement modes. This is a relative
category where low speed body weight movements are considered basic movements, and
movements with high speed movements are power movements. You can see in the Figure 3:
Movement Classification System. Modes are classified into basic and power movements.
Types are based on anatomical planes – vertical, horizontal, lateral and rotational. are
examples of basic movements and powered movements organized according to the movement
types.

Movement types are movements classified according to anatomical planes. In the figure below
you can observe the four movement types. Agility and change of directions are combinations of
various movement types. It is important to appreciate that each movement type is distinct.
Movements in the vertical plane are distinct qualities from horizontal and lateral. For example,
high jumpers (vertical type) are not elite sprinters (horizontal type) and just because you are a
good sprinter (horizontal type) does mean you can run an effective run a wide receiver route in
football (agility / COD). The take home message is each movement type needs to be tested
separately.
4.3 Physiological Qualities

Physiological qualities look at how our bodies produce energy to meet the demands of the
activities. During sport there are times where we have short explosive activities, followed by
periods of coasting. The profile of all the movements, between high intensity or high powered
movements with low powered movements (and movements in between) determines the
energy or physiological demands of the sport. We call this the energy profile of the sport or
activity. As we discussed in section 2.1, we determine this by performing time motion analysis.

There are three main energy systems that produce varying amounts of ATP or energy, which
are named in the chart below. Note the three energy systems have been described using
different names. The rows are all the same energy system.

System
1 Anaerobic Alactic ATP - PC Immediate
2 Anaerobic Lactic Lactic Acid Non-oxidative
3 Aerobic Aerobic System Oxidative

Figure 4: Energy sources for muscle as a function of activity duration. The figure shows how
long each of the major energy systems can endure in supporting all-out work.
The energy profile of the activity will determine how much energy is required. Our bodies will
utilize the appropriate energy systems to match the activities’ energy demands. Figure 4 shows
how long each of the major energy systems can endure in supporting all-out work.

Notice how performance drops with sustained all-out work. The reason is based on how much
each energy each energy system produces. The highest and most immediate energy system is
the ATP-PC system, followed sequentially by the lactic acid, and aerobic system.
5 HOW WE EVALUATE MOVEMENT - 5-SITE INTEGRITY
When we are evaluating movement we are examining two components: 1) movement quality
and 2) output (expression). Output is expression of the movement, for example the distance
travelled, speed, the force or power produced during movement – see Table 1: Kinetic and
Kinematic factors that are evaluated during sport Biomechanical Analysis. To efficiently and
effectively produce optimal movement output the movement quality must be optimal or ideal.

Movement quality is how the movement was performed. To assess movement quality we:

1) Compare the movement to ideal movements – see

2) Assess the range or depth of movement. This gives us an indication of mobility between
and within joint, muscles and fascia. We call this system the articulo-myofascial system,
where there are 5 key areas – 5-Site Integrity.
3) Asses the ease or smoothness of the movement.

Output

Quality

Figure 5: Components of Movement Evaluation

For example, during a single legged squat we examine how each site moves in comparison to a
movement dysfunction looking for:
 a) Presence of a movement dysfunction
b) Depth or range of motion

All movements place a unique load to the body. By testing the athlete through a battery of tests
we can understand the strengths and weaknesses of the each respective area. These tests are
based on the movement modes and types– see section 4.2 for modes, types and common
movement examples.

Movement Output α Movement Quality

5.1 Movement Evaluation Process

The evaluation process of movement is two parted – 1) basic movement screen and 2) power
movements. As discussed earlier these parts differ based on the speed, load and expression
required to perform the movement. What is consistent during both parts is the evaluation of
the body – 5-Site Integrity. By analyzing basic movements first, we evaluate how the body
response to low loads, which are progressively increased until part two. During part two we
want the athlete to produce maximum power, where we examine 5-Site Integrity and
expression. Each part will be discussed section 5.4 and section 5.5, respectively.
 Basic Power
Movements Movements

5.2 Principles of 5-SITE Integrity

5-Site Integrity is based on several key principles - see table below. The ability of the body to
maintain 5-Site integrity during any movement is based on these principles. Interestingly when
we are evaluating each of the 5 key areas during movement we observe common movement
dysfunctions – see Appendix 1 Common Movement Dysfunctions. Note in addition to looking
for the presence of common movement dysfunction during power movements we are also
looking for proper explosive execution of the movement, which is movement specific.

The execution of all movement is based on the principles of 5-Site Integrity which are:

 The body is made fascial, osseous (bone) and muscular links / chains where motor
control and muscular capacities are necessary to maintain proper area relationships.
 There are 5 key areas in the body that are interconnected by the fascial system and
controlled through complex motor programs and primal reflexes.
 Fascial structures must be able to slide relative to each other during movement
otherwise force transmission is disrupted leading to impaired movement dysfunctions
 Each area must control against loads being applied to each area, where if any key area
is unable to control against those loads the system is disrupted
 No movement is identical. Movements create unique loads at each key area.
 Posture and what we are exposed to effects the mobility, stability and force output of
the system
 Movement requires proper mobility of all joints and the fascial system throughout the
body, where loss of mobility at one joint or a fascial restriction will effect the entire
chain.
 Fatigue or poor work capacity will effect 5 site integrity
 The degree that the system fails is identified by progressive adding specific loads to the
system.
Figure 6: 5-SITE Integrity:

5.3 Factors that Effect Movement Quality: posture, mobility, output, control
and capacity

There are many factors that affect movement. The main factors are highlighted on the
following page, which are posture, mobility, output, control and capacity. Each factor has a
large impact on our abilities to properly perform movement. How each factor effects
movement independently and via interaction effects with other factors beyond the scope of
this guide. A great deal of research on movement development exist and this model attempts
to conceptually integrates all. A book highlighting how to identify and correct each movement
factor is in development.
5.4 Part One: Basic Movement Testing

Basic movement testing are tests to evaluate qualities within the basic movement mode. For
example, the single legged squat is a commonly used basic movement test where we evaluate
the presence of common movement dysfunctions and the expression of the movement – learn
how we assess the single legged squat.

Neutral Spine
Mode / TYPE Vertical Horizontal Lateral Endurance and Control

Hip Hinge Gait Analysis Lateral Lunge Plank

Squat In-Lunge Side Shuffle Side Bridge

Overhead Squat Hurdle Over Cross-Over Back Extension Hold

Basic Movements
Plank with extremity
Step-up / Down
movements

Single Leg Squat Body Control I

Body Control II

Figure 7: Basic Movement Tests grouped according to types

5.5 Part Two: Power Movement Testing

During performance testing we are interested in the output qualities of the athlete. But of
course, we are equally interested in the movement qualities as they develop their output –
avoid the black box effect. The difference between performance testing and basic movement
testing is the speed and output of the movement. During performance testing we are asking the
athlete to perform movements as fast and as explosively as possible. We want to test their
output.

In this phase we are evaluating force output capabilities, specifically the athletes' ability to
produce power, utilize force (reactive abilities), and to control force. Unlike the previous phase;
where the body is exposed to low loads, this phase is max output. But like the previous phase
we use planar movements (but at max output) to begin our evaluation followed by more
complex movements that occur in multiple planes (agility / change of direction capabilities).
5.5.1 Methods to evaluate expression

6 ANALYSIS: PUTTING IT ALL TOGETHER

During the previous sections we discussed the categories of testing, how we evaluate
movement focusing on basic movement screening and power movement testing. Now that
we’ve gathered all this information we must analyze the data by comparing the results to
known standards that are age, sport, and competition appropriate. Specifically there are three
reports that are generated.

1) 5-Site Integrity Movement Analysis

2) Performance Profile
3) Comparison Spectrum

These reports are based on years of data, collected by FITS and by sport centres, researchers,
from around the world. Currently there are over 10,000 unique data sets in the database, which
is constantly growing.

6.1 5 Site Integrity Movement Analysis

We evaluate movement to observe the presence of a movement dysfunction across 5 Key
areas. Each movement dysfunction is graded on severity and injury likelihood – see Table 3. If
there is no movement dysfunction, the movement is considered ideal, with no likelihood of
injury. How we arrive at these grades is based on ongoing research on how to evaluate the
body utilizing 5-Site Integrity. Note because each area and each dysfunction is unique, each
dysfunction has a unique scale.

Movement Screen is clear. No problems.

Attention is necessary. The dysfunction is at the early stages and correction
now will help the dysfunction from progressing.
Moderate dysfunction. This dysfunction is concerning because if left
unaddressed it will lead to problems. If there are current problems, this
dysfunction may be the source of the problem.
Severe attention is needed immediately. Pain that you are experience is the
result of this dysfunction.

Table 3: Grading System for Common Movement Dysfunctions

6.2 Performance Profile and Comparison Spectrum

The output of your power movements will be recorded. These results will be compared to an
appropriate reference group, based on your age, competition level, sport and goals. This will
give you an impression of where your strengths and weaknesses are relative the reference
group. From here a program can be developed to improve your overall athleticism, prioritized
to the needs of your sport, age, development windows, phase of sport competition, existing
injury, the qualities to develop, and other factors.

Multiple reference groups can be used during the analysis for the purposes of comparison.
Where a deficiency exists, the degree of difference and the requirements to achieve the target
can explained.

Figure 8: Example of a Performance Profile and Comparison Spectrum

7 FIELD TESTS
 REFERENCES
1. Barber-Westin SD, Noyes FR, Galloway M. Jump-land characteristics and muscle
strength development in young athletes: a gender comparison of 1140 athletes 9 to 17
years of age. Am J Sports Med. Mar 2006;34(3):375-384.
2. Alentorn-Geli E, Myer GD, Silvers HJ, et al. Prevention of non-contact anterior cruciate
ligament injuries in soccer players. Part 2: a review of prevention programs aimed to
modify risk factors and to reduce injury rates. Knee Surg Sports Traumatol Arthrosc. Aug
2009;17(8):859-879.
3. Alentorn-Geli E, Myer GD, Silvers HJ, et al. Prevention of non-contact anterior cruciate
ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk
factors. Knee Surg Sports Traumatol Arthrosc. Jul 2009;17(7):705-729.
4. Cholewicki J, Silfies SP, Shah RA, et al. Delayed trunk muscle reflex responses increase
the risk of low back injuries. Spine (Phila Pa 1976). Dec 1 2005;30(23):2614-2620.
5. McGill S. Ultimate Back Fitness and Performance Waterloo: Waterloo Press; 2005.
6. Carey DG, Drake MM, Pliego GJ, Raymond RL. Do hockey players need aerobic fitness?
Relation between VO2max and fatigue during high-intensity intermittent ice skating. J
Strength Cond Res. Aug 2007;21(3):963-966.
7. Cox MH, Miles DS, Verde TJ, Rhodes EC. Applied physiology of ice hockey. Sports Med.
Mar 1995;19(3):184-201.
8. Green H, Bishop P, Houston M, McKillop R, Norman R, Stothart P. Time-motion and
physiological assessments of ice hockey performance. J Appl Physiol. Feb
1976;40(2):159-163.
9. Farlinger CM, Kruisselbrink LD, Fowles JR. Relationships to skating performance in
competitive hockey players. J Strength Cond Res. Aug 2007;21(3):915-922.
10. Young W, McLean B, Ardagna J. Relationship between strength qualities and sprinting
performance. J Sports Med Phys Fitness. Mar 1995;35(1):13-19.
11. Hori N, Newton RU, Andrews WA, Kawamori N, McGuigan MR, Nosaka K. Does
Performance of Hang Power Clean Differentiate Performance of Jumping, Sprinting, and
Changing of Direction? Vol 22; 2008:412-418 410.1519/JSC.1510b1013e318166052b.
12. Ham DJ, Knez WL, Young WB. A deterministic model of the vertical jump: implications
for training. J Strength Cond Res. Aug 2007;21(3):967-972.
13. Carlock JM, Smith SL, Hartman MJ, et al. The relationship between vertical jump power
estimates and weightlifting ability: a field-test approach. J Strength Cond Res. Aug
2004;18(3):534-539.
14. Hoffman JR, Tenenbaum G, Maresh CM, and Kraemer, WJ. Relationship between
athletic performance tests and playing time in elite college basketball players. Journal of
Strength and Conditioning Research. 1996;10:67-71.
15. Balyu I, Cardinal C, Higgs C, Norris S, Way R, Bluechardt M. Long Term Athletic
Development In: Centres CS, ed.
8 APPENDIX B: COMMON MOVEMENT DYSFUNCTIONS

8.1 Foot and Ankle

8.1.1 Pes Planus

During the movement screen, we examine your foot to determine if the movement in your foot
is optimal. Specifically, the most common type of dysfunction in the foot that can lead to
energy leaks is a pes planus. Pes planus, or flat feet, is a very common finding among the
general population. When dynamically tested, individuals with pes planus will exhibit turning
out of their feet and a collapse of the main arch of their feet (longitudinal arch). This finding
can also contribute to the other findings within the movement screen.

8.1.2 Limited Dorsiflexion

This finding represents a limitation ankle joint’s range of motion. Specifically, it means that the
top of the foot does not get as close to the shin as it should while being loaded such as while
performing a squat. What this means is that those who have limited dorsiflexion in their ankle
are likely make up for this lack of range by compensating somewhere else to get to the same
depth of a squat. Often times, people will use their backs predisposing them to injury due to
overuse/misuse, or they may simply not be able to achieve the same range of movement while
performing the specific movement in question.

8.1.3 External Foot Flare

This finding represents turning out of the foot while under dynamic load. This may be a result
of poor foot posture stemming from over pronation or pes planus.

8.2 Knee

8.2.1 Dynamic Valgus

This finding represents the knees inability to maintain its dynamic integrity (position during
movement) while under load. What we see is a collapsing medially (inward) of the involved
knee representing poor control, weakness of the hip musculature, and/or poor foundational
support from poorly controlled foot motion.

8.2.2 Sagittal Control

This concept represents the importance of muscular control of one’s knee while under dynamic
load. What we see at times is a “shimmy” in the knee while the patient attempts to control
knee movements such as a single leg squat. This can represent poor muscular control and
coordination of the knee, hip and foot musculature.

8.3 Lumbopelvis and Hip

Where your spine and hip attaches to your pelvis

8.3.1 Hip Hinge

This finding represents the correct way to perform a squat and generally to “bend at the hips”.
A good “bend” is initiated at the hip and not the low back where, as the name implies, you
literally hinge your movement at your hips. Those who cannot perform this movement and
tend to favour bending through their back are predisposed to developing low back pain and
poor performance, because instead of using their legs they use their spines to lift. Correcting
this movement yields tremendous improvements for patients or athletes in terms of low back
pain and performance.

8.3.2 Hip Mobility

This finding represents your hip range of motion in flexion, extension, internal and external
rotation, and all combined movements of the aforementioned ranges. As a car needs lubricant
to function properly you need hip mobility to keep your hips, low back and knees functioning
properly. Tightness in the hips lead to stress and strain into joints that can create many
musculoskeletal conditions that overtime can easily lead to arthritis in the previously
mentioned sites. Sitting and our normal activities of daily living reduce our hip mobility.
Therefore to be able to achieve your full athletic potential combined with staying injury proof
requires you to constantly maintain proper hip mobility.

8.3.3 Hip Strength Quality

This finding examines the strength and ease of movement the athlete or patient displays during
the various movements assessed. It is seen during low load testing as the depth the individual is
able to achieve for example during the squat, lunge, and single leg squats. During high load
conditions it is the individuals' ability to absorb forces through the muscular system and to
develop power (rate of force development)

8.3.4 Spine Buckling

This finding represents the spines inability to handle load. What this means is that the spine is
unable to support itself due to poor core musculature support. Much like a mast on a ship, the
spine requires guide wires to tightly hold the mast upright otherwise it will crack and the ship
will lose its sails. Similarly, without appropriate conditioning of the core muscles around the
spine and pelvis, the body’s mast (your spine) will buckle causing you to lose the wind in your
sails and the spring in your step. Simple movement such as bending forward becomes painful.
This finding tends to become apparent while perform any bending movement.
8.3.5 Sandwich Movement
This finding represents when a person has does not display a hip hinge, has poor mobility
through their hips, and favours using their back while perform a specific movement.
Essentially, what is seen is the torso and legs form the “bread” of the sandwich while the space
in between becomes the filling. A well conditioned pattern finds that the torso is in a neutral
position with the chest up; while a “sandwich pattern” finds the chest bent into the legs and
facing down – they look like a sandwich. In this position the low back is doing the lifting not the
legs. Adopting this pattern negates the most powerful muscles in your body in favour of the
back which predisposed the individual to developing chronic low back pain. Correcting this
movement pattern and developing a proper hip hinge would be tremendously beneficial. In
fact, most people with low back pain display this dysfunction that once corrected no longer
have back pain.

8.3.6 Pelvic Control

Much like the above three findings, pelvic control reflects the patient’s ability to dynamically
(through movement) maintain a stable pelvis (foundation) while performing various
movements. Dysfunctions are seen as aberrant movements of the pelvis; shifting, tilting, hiking
and rotating. These dysfunctions occur largely because of an inability to maintain neutral spine
control and are linked to the findings throughout the other anatomical sites, such as your ankle
and foot.

The impact of poor pelvic control relates to its’ central position in the body. Your pelvis is the
transfer point for forces generated in your hips (the main power centre in the body) combined
with force contributions from other areas of the body. Pelvic control is like the drive train of a
car which functions to transfer power developed from the engine to the wheels. Many
problems throughout the body will occur with poor pelvic control such as low back pain, hip
problems, knee problems, and even shoulder problems.

Something to Think About:

Regardless of whether you are an athlete or not, pelvic control is essential. If you are an athlete
the demands for pelvic control are much higher and are reflective of the demands of your
sport. For example it well known that hip and leg contribution to pitching velocity and tennis
serve velocity is over 50 percent. This is only possible through pelvic control, or “THE CORE”.
Many athletes that fail to develop the core suffer injuries by trying to make up the power
elsewhere, such as the elbow and shoulder for both pitchers and tennis players.

8.4 Scapulo-thoracic Humeral

Where your arms attach to your spine

8.4.1 Thoracic Collapse

This is a secondary finding often times associated with sandwich movement. This finding
indicates that the patient is not hinging from the hips resulting in a back dominant initiation of
movement resulting in thoracic or mid back collapse. Essentially, the mid-back often times
follows the lead of the low back; if the low back is poorly supported, then the same will be seen
in the mid-back.

8.4.2 Thoracic Rigidity/Hyperkyphosis

This finding is the opposite of the thoracic collapse. It represents the inability of the patient to
maintain a “chest up” position while under load and undergoing specific movements,
irrespective of the stability of the low back. In chronic situations, this finding can contribute to
thoracic outlet syndrome, neck pain, and headaches.

8.4.3 Scapular Winging

This finding represents poor posture of your should blades (aka scapulae). This finding
indicates that you are chest dominant in your posture with likely tight, forward rolled shoulders
and weak mid-back muscles. This can predispose patients to developing chronic rotator cuff
tendons, mid-back, shoulder, and neck pain.

8.4.4 Internal GH Rotation

Internal glenohumeral rotation represents a finding that is often associated with hyperkyphosis
and scapular winging. This can also predispose the patient to chronic rotator cuff injuries
leading to pain and poor function while attempting to participate in their chosen activity or job.

8.5 Cranio-Cervical Junction

Where your neck meets your head

8.5.1 Anterior Head Carriage

This represents the general finding found in almost all people to some degree or another. It’s
what I call the modern cave man position in which our head juts forward in front of our bodies
when we primarily sit in a poor position in front of the computer, read or slouch. This finding
can represent poor muscular control of the deep muscles of your neck and may lead to chronic
neck and jaw pain as well as headaches due to hyperactive posterior neck musculature.

8.5.2 Lateral Shift

Lateral shift of your head on your shoulders may represent a muscle imbalance present at your
shoulder, neck, or upper back. It may also represent a favoured motor pattern that if not
corrected can lead to over stressing specific structures and tissue, resulting in breakdown and
injury.

8.5.3 Rotation
Rotation is very similar to the finding of lateral shift and is often found in conjunction with it.
Rotation may also represent a favoured motor pattern that can indicate the presence of weak
and tight neck muscles.