To Cue or not to Cue

When evaluating a patient or athlete, is there a difference between testing their capability and testing their movement pattern?

Put another way: Do we want to see what they are capable of – or what they habitually do?

Professor Vladimir Janda wrote “During movement pattern testing, minimal verbal cues should be used which test an individual’s habitual way of performing a movement. If the cues are too “leading” then the test will be of the subject’s ability to learn how to perform the movement correctly, rather than how they are habitually performing it.” Rehabilitation of the Spine, 2007

I recall learning from Prof. Janda how to test neck flexion movement patterns. It was a simple test: Have your subject lay supine and ask them to lift their head up off the table or mat. Watch how they perform the test.

But it really was not that simple.


Because we often inserted ourselves into the test and the words we chose often changed the test result!

For instance, we could ask, “Lift your head up, bringing your chin to your chest.”

Or we could ask, “Lift your head straight up.”

Or “Lift your head up.”

We don’t want a false positive or a false negative so what is best?

Professor Stuart McGill has also noticed that the cues we give have an influence on a subject’s test performance. He wrote:

“Aside from the standard verbal instructions, no specific cues were given and participants were blinded to the test objectives, scoring criteria and their screen results. The firefighters were graded on how they chose to perform rather than how they could perform the tasks given feedback or coaching. No rationale was given as to the general purpose of the screen to ensure that each individual’s task performance was as natural as possible.” Using the Functional Movement Screen to evaluate the effectiveness of training. David M. Frost, Tyson A.C. Beach, Jack P. Callaghan, Stuart M. McGill. Submitted for publication.

Prof. McGill goes on to say, “Our decision to grade how the firefighters chose to perform FMS tasks was based on our a priori assumption that the natural movement strategies observed might better predict how individuals would perform when performing physical activities of daily living.”

Habitual movement patterns are potentially very different from one’s functional capacity or performance. Even more interesting is that training to build capacity (ROM, strength, etc.) may not alter fundamental movement patterns! Moreside and McGill found that training-induced improvements in hip range of motion – changing what participants could do following 6 weeks of passive and active stretching – had no influence on what the participants actually did do during a battery of screening tasks. Moreside JM and McGill SM. The effect of hip flexibility and core stability on lumbar spine motion: A trial to enhance hip mobility and possible function. Journal of Strength and Conditioning Research

On P120 of his landmark text, “Movement,” Gray Cook, PT states, “The hallmark of the SFMA design is the use of simple basic movements to expose natural reactions and responses by the patient.”

Does this mean we should never assess capacity or performance? Is there a role for:

Functional Capacity Tests

  • ROM
  • Side plank endurance
  • Co-C1 flexion coordination
  • Single leg stance balance


Athletic Performance Tests

  • Broad Jump
  • Vertical Leap
  • 60 meter sprint
  • 5-10-5
  • 3-cone drill

Obviously there is, since such tests can serve as baselines from which to judge progress over time and establish a rehab/training program for the patient or athlete. Perhaps the key is to ensure that:

  1. First we know HOW a person moves.
  2. Then seek to help them improve the quality of their movement patterns.
  3. Finally, help them improve both their functional capacity and their performance.

As all the great leaders (Janda, McGill, Cook) have taught, begin by assessing movement.

The very quotable Karel Lewit, MD said it best:

  • “I don’t touch a patient until I have examined everything. I want to know what is the relevant chain. I begin with a general picture, not a single lesion.” 
  • “The objective of remedial exercise is a faulty motor pattern or stereotype which has been diagnosed and is considered relevant to the patient’s problem”
  • “Remedial exercise is always time consuming, and time should not be wasted…We should not attempt to teach patients ideal locomotor patterns, but only correct the fault that is causing the trouble.” 

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