The Year in Strength Science 2011

[stef]

by Jonathon Sullivan

This will be the first in an annual series surveying the scientific literature on strength training. Hopefully, it won’t also be the last, but that’s really up to you. It’s an experiment. I’m going to present a selection of papers published over the last year relating to That Thing We Do. While they’ll all have relevance, they won’t all have quality. The goal is to highlight some papers that may fruitfully change our practice, while exposing some papers which are just baloney, but which may be waved in your general direction as an excuse for doing something stupid.

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[Bronan the Barbarian]

Awesome article. I lost it at the rat squat apparatus. Hilarious.

[Michael Wolf]

This article was a great idea, and a huge undertaking on the part of Sully. Many thanks for the dozens (hundreds?) of hours the reading, research, and writing must have taken. I haven't made it through the whole thing yet, but have a comment on one of the pieces I covered: the FMS article (Article #3 in the TRAINING AND COACHING TECHNIQUES AND SPORTS MEDICINE section).

I think the study is actually a better example of the researchers asking the wrong question, than it is a black eye for the FMS. The FMS doesn't claim to predict athletic performance at all. It's supposed to be a screen to detect abnormalities (asymmetries or dysfunctions) in movement patterns, which the practitioner can analyze and then use to:
1) determine which exercises, if any, might exacerbate these issues if loaded before correction
2) create a corrective strategy to fix the underlying issues

Now, the efficacy of the FMS in doing those things is still a matter of debate. The creators (and many, many practitioners who have jumped on the bandwagon with zest and zeal) seem to treat it as if these issues have already been settled. Or, at worst, are a foregone conclusion that's just waiting for enough research to be built up to bolster their claims. And they certainly have a financial interest in doing so. But there are many others, even within the more therapy/pre-hab oriented groups, who view the FMS with more skepticism, and don't take it for granted that it can accomplish those things. It might, but the jury is still out.

However, what the FMS does not, and does not even claim to do, is predict athletic performance. The authors of the study don't even seem to know that, making their entire study irrelevant. But, unfortunately, it doesn't seem that Dr. Sullivan picked that up either, in his research for critiquing the article.

Rip might well be right that having someone squat and DL and press is enough of a screen to determine if they can do it. I will probably be "that annoying guy" who asks about this in Brooklyn in April, because I've taken the FMS workshop with one of its co-creators (Lee Burton), back when I was an employee of a gym-chain that pushes and backs the FMS with a lot of zeal. I was able to get in for free (instead of the $200 or something usual cost), and it was worth a lot of NSCA CEU's, which I unfortunately still have to deal with. Being in the distinct minority at places like this who are strong devotees of Rip, I was still impressed enough with the presentation not to dismiss it outright. I'm skeptical, but not entirely dismissive, and would like to hear more details about Rip's opinion.

But all that has nothing to do with this study, which concluded that the FMS is no good at doing something it was never intended to do. Which I see as an oversight both by the study designers/authors, and in this case, by Sully, who reviewed it without noting that fact.

[Jonathon Sullivan]

Thanks for your comments, Wolf.

Your points are fair, but I am conpelled to point a couple of things out. Actually, what I said was that the "fms is supposed to identify deficits in performance" (I didn't say athletic performance; I suppose I could have simply said movement) "and the potential for injury." I could have been more lavish in my description, but the article could only be so long, and the fms purports to be an expression of an entire philosophy of exercise and movement. Every paper in the review was an implicit invitation for folks to go out and explore on their own.

In any event, the real point is whether the authors of the paper ask a valid question. I think they do, because they aren't the first to ask and answer it. It is true that the fms has been applied to sports performance and injury prediction--the authors of the paper in question give several references, including, as I note, Okada's work. And in my research for the article, digging around other literature and looking at the various fms sites, I found not one single instance of anybody, including the fms developers, trying to disabuse us of the idea that the fms can be so used. Quite the contrary. And why would they? The fms is supposed to identify movement asymmetries that effect functional movement. Athletic performance is the very epitome of human functional movement. If fact, athletic performance is that expression of human movement in which we might expect to see the effects of movement dysfunction disproportionately magnified and have their greatest (and therefore most easily detectable!) manifestations. So looking at the stated use of the fms and its underlying philosophy and applying it to prediction of athletic performance seems to me to be an obvious line of investigation.

In any case, the work of Okada alone was sufficient to justify the work of the present paper, and make the question they asked the right one.

That's the paper. My bigger problem with the fms, notwithstanding its anemic scientific support, is my nagging suspicion that what the fms really does is identify problems with the fms, and then prescribes exercises that make the fms better (and there is research to show that this can be done). Which is great, I suppose, if improvement of your fms and reduction of "functional asymmetries" is what you want to do. The actual benefit of doing so is, as you point out, undetermined at best.

If I fell down on the job here, I think it was by not explicitly pointing out that the current study did not look at the ability of the FMS to predict injury, which is one of its stated intentions.

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[Carlos Daniel]

I actually used the mouse-shock thing apparatus a couple of time. I've worked in a lab and there were some people that worked on exercise physiology. People who never worked with science in a first-hand basis don't know how hard the small things can be. Do you people have any idea how hard it is to strap a mouse to such an apparatus, specially after it's been shocked a bunch of times and therefore it isn't particularly fond of it? You'd strap the poor thing there, as tight as you can possibly do, with the mouse's eyes bulging out and stuff, only to turn away for a couple of seconds and then you turn back to see the mouse hanging out by the apparatus like nothing happened.

About the FMS, I've seen some people discussing this paper and this was one of the criticisms. Now, I understand that the whole point of the FMS is not to assess athletic performance, but if someone is unbalanced in some way, wouldn't you expect this to reflect on athletic performance? If it doesn't affect performance, what does it affect? injury rates? (it's possible, who knows, maybe someone even did a study on it).

[Jonathon Sullivan]

Working with rats is painful, in more ways than one. The difficulties are manifold: ethical, emotional, administrative, logistical and technical. We're ramping up to some very difficult experiments in my lab right now that will use the rat. Sometimes I envy my colleagues who restrict their work to cell culture models.

And yeah, Carlos, I think you echo my standpoint on the FMS: if it is supposed to detect functional movement deficiencies, its applicability as a diagnostic for athletic performance would seem to be a reasonable question, and worthy of investigation.

As I mention in the article, I think the biggest problem with that paper was not the hypothesis itself, which I think was valid, but the conduct of the study, which introduced sources of potential bias.

If Rip decides that we should do another review for 2012, there will probably be more papers on FMS at that time.

[matclone]

For those knashing their teeth at unfamilar acronyms, as I was, FMS = functional movement screen, which is discussed beginning on p. 26 of the article.

I confess I was reluctant to delve into a long article discussing scientific abstracts, but now that I've noticed more than a few signs of humor in the material, I'm going to have to read the whole damn thing.

Extract:
[The author is] a physical therapist, and we'll simply have to take his word for it, just as we'll have to trust that the goofy exercises he presents in a series of photographs will make football players better at tackling. These exercises all involve a pully machine, some dumbbells, a step-up box, and...a towel. That's it...No footballs were harmed in the production of this article.

[Michael Wolf]

My understanding, based on the website and the FMS certification workshop, is that they do intend it solely as a screening tool to detect asymmetries and movement dysfunctions that can lead to injury. Not at all as a predictor of athletic performance. Sully, I assumed when you wrote "deficits in performance" that you were referring to athletic performance, not basic movement patterns, so apologize if I put words in your mouth, or, well, your pen, that you didn't actually intend.

Regarding all the rest of it: I don't think they're incorrect in believing that high level athletic performance can be sustained for various periods of time even in the presence of these asymmetries and dysfunctions. That our bodies are good at solving short term movement problems, at the expense of long term tissue health seems to be agreed upon by many, many experts in the field. I don't know that it's "proven," but I and many other coaches have observed it anecdotally in our practices.

So, the FMS peoples' assumption that these issues will eventually lead to injury in a high % of athletes/people, if untreated, is not necessarily a bad one, even if those issues have no bearing on current athletic performance. Or, the issues do have a bearing on current athletic performance, and the performance would be THAT much better if the issues were resolved. Kind of like Rip's analysis of pulling mechanics: just because people at a high level excel at lifting heavy weights inefficiently, doesn't mean their method is efficient. So too here, just because they can sustain a high level of athleticism even with these issues, doesn't mean they wouldn't be a lot better without them. (not an exact analogy, but close enough, I think) In addition to the injury risk reduction benefits they tout.

Again, I'm not at all saying they're correct. Just that what they set out and purport to do isn't what the study actually studies. Or Okada's for that matter. I'm not familiar enough with Sports Science Published Literature to know the etiquette on this one, but I would think that just because one (or several) people attempt to use your invention/system for something that it wasn't intended, doesn't mean you have to go out of your way to say, "Hey guys, NO, that's not what it's for!" As long as YOU only promote it for what it's intended for. Nowhere on their website did I see any reference to the FMS itself predicting actual athletic performance. The closest I saw comes in their "Who Should Get Certified" section, where they say:

The system is the product of years of innovation and groundbreaking research. The FMS provides a standardized approach to assessing fundamental movement, identifying limitations and asymmetries, and developing individualized corrective exercise programs.

The philosophy behind the FMS is rooted in the concept that, in order to maximize performance, the whole body must be functioning properly. When the body is considered as a chain of individual elements, it’s reasonable that a weak link weakens the entire chain. Ignoring a weak link increases the potential for disaster, and strengthening the wrong links will not improve the integrity of the chain. The FMS provides the means to identify and resolve any weak links that may be jeopardizing the body and its healthy motion.

The FMS is applicable to any population in fitness or sports conditioning. Its standardization streamlines assessment and makes recommending exercises more efficient. And the language of FMS makes it easy to communicate with physicians, reducing the risk of misdiagnosis and redundant work.

The implication is that a bad FMS score can hinder the individual reaching their athletic potential, and that a good FMS score unlocks the ability to fully express their potential. Not that the FMS itself has any bearing on the actual athleticism of the person, but just removes barriers from whatever their athletic level is, from being expressed.

When I took the workshop, Lee Burton several times said to me that you TRAIN by lifting heavy weights at low reps. They use the FMS as a screen to determine which movements the athletes aren't yet ready to load heavily (or at all), and to determine a corrective strategy to implement to allow them to get back to loading those movements so they can get stronger/faster/more powerful/whatever. I realize that is my personal experience with Lee, not emphasized in the official marketing materials - because they are, admittedly, definitely trying to hawk as much FMS product as possible. And emphasizing its role as minimalist wouldn't serve that purpose. But that is what he said, several times, over the course of the weekend.

I guess it comes down to what level of responsibility the creators have to how their words and product are interpreted and used by other people.

[matclone]

Great article, doctor. I don't pretend to understand everything discussed but the potential study questions you pose at the end are excellent.

I've been working out without creatine, caffeine, or music, but will probably look into the first two.

The late, great Joe Henderson (sax player) was an alumnus of Wayne State.

[Jonathon Sullivan]

I guess it comes down to what level of responsibility the creators have to how their words and product are interpreted and used by other people.

Perhaps. I guess I approach this the way a clinician would. For example, the d-dimer assay is frequently used as a screening instrument in patients judged at low risk (not high risk or no risk) for venous thromboembolism. Recent studies have evaluated its potential for screening for aortic catastrophes (dissection), and some are promising (I don't believe it, myself). There are many critiques that could be leveled at that literature, but "it wasn't intended for aortic catastrophes" wouldn't be one of them, because there are theoretical reasons why a test designed to detect d-dimers in VTE would also be a useful screen for aortic tears.

Similarly with many drugs. Insulin is used to regulate blood sugar in diabetics. That is what pharmaceutical insulin was developed for. But thanks to some novel research, it has also proven useful for other conditions, like, say, beta blocker overdose. We wouldn't want to dismiss such research on the basis that it evaluated insulin for an "unintended" or off-label use.

The FMS purports to screen for functional deficits in movement. That being so, I cannot discount the hypothesis that it should also predict athletic performance, since functional deficits in movement may very well be rationally hypothesized to affect athletic performance. What if the paper had showed that FMS was a highly sensitive and specific indicator of athletic performance? I doubt there would have been much objection; FMS advocates would have embraced the results, of that I have no doubt.

In any event, Wolf, I am grateful for your thoughtful engagement with the article and your input is most welcome.