Understanding True Functional Movement

Tendon Elasticity

Most workout routines approach training by dividing the body into individual muscles or muscle groups, and assigning linear exercises that isolate those areas. While muscle-specific exercises have value in terms of toning, strengthening and increasing muscle mass, they overlook the interconnected and interdependent nature of the body’s structures as a whole. In many cases, we are performing high-level exercises while ignoring fundamental motor deficits, and attempting to add fitness to dysfunction.

Functional training exercises seek to bridge the gap by performing compound exercises using body weight or multi-planar resistance. But in many cases, functional training exercises are not truly functional, because they fail to take into consideration the ways your body needs to coordinate movements in different planes, to make truly functional gains. In essence, we are building muscle without enhancing movement.

Understanding the underlying principles of true functional movement will help trainers, therapists and fitness enthusiasts to create training programs that promote functional changes for more fluid movement and reduced risk of injury.

Why Functional Movement Matters

Muscle imbalances, restrictions in mobility and problems with balance and stability are common consequences of modern sedentary lifestyles. Most people ignore them until they begin to cause pain, and then treat the pain until it becomes unbearable. In active and athletic populations, the same issues arise, often due to overuse, or to past injuries that were never fully rehabilitated.

Going to a conventional medical doctor rarely resolves the problem, since few MDs have any understanding of dynamic movement, and most are prohibited by insurance providers from treating anything beyond the painful area. Instead, you end up with prescriptions for pain and anti-inflammatory medications, with instructions to rest and take it easy.

Why Functional Movement Matters

Treating the symptoms of mobility issues does nothing to resolve them, and they soon become a downward spiral that leads to injury and disability. Functional movement therapy seeks to resolve pain and dysfunction by identifying and correcting the underlying causes, to restore fluid and pain-free movement.

Principles of Functional Movement

In his book, Movement, physical therapist and athletic conditioning expert Gray Cook defines 10 underlying principles of functional movement.

  • Pain is not the same as dysfunction. You should never try to work through or work around pain, hoping it will self-resolve.
  • Alignment, mobility, stability and proprioception provide a foundation for learning how to move.
  • Performance and skills testing does not identify weak links in the kinetic chain.
  • Motor learning has a hierarchy that begins with mobility, followed by control, then static stabilization, and progressing to dynamic stabilization.
  • You cannot improve movement by rehearsing the desired result, without first establishing proper sensory inputs. We do that by presenting challenges that let us manage mistakes on a functional level.
  • Movement is driven by perception, which in turn is modulated by movement. Going through the motions of exercise without paying attention to sensory inputs does not foster functional movement.
  • Fitness is measured quantitatively, while movement is measured qualitatively. We should not try to improve fitness without first improving movement.
  • Skills performance must follow a natural progression of competency, capacity and specialization.
  • Corrective exercise should produce a rich sensory experience full of manageable mistakes.
  • Once movement has been corrected, you should preserve your quality of movement by adding challenging and engaging activities that require mobility and stability.

What is True Functional Movement?

True functional movement takes into account the integration of your body’s structures and systems, to produce coordinated movement patterns that reduce pain and enhance performance. When your upper and lower body coordinate, and your right and left appendages move with identical forces, joint angles and range of motion, your entire body is affected.

Understanding True Functional Movement
  • Your core provides optimal stabilization for your spine
  • Your diaphragm and rib cage optimize breathing
  • Your intrabdominal pressure is normalized
  • Your hip mobility and scapular stability are optimized
  • Your neuromuscular system functions as intended
  • Your brain’s limbic system rewards you with endorphins and other beneficial hormones
  • Your myofascial system is loaded in beneficial ways, becoming more elastic and responsive

Before we can optimize movement, we need to address pain. Once pain is eliminated, we can then proceed to work on proprioception, alignment, stability and muscle activation patterns.

Roadblocks to Functional Movement

When your upper and lower body are moving in different planes, your spinal stabilizers, core muscles, pelvic region and shoulder girdle need to coordinate their movements in an integrated way. You may recall from high school geometry that a plane is like a flat sheet of glass that extends to infinity in all directions.

Roadblocks to Functional Movement

All human movement occurs in three planes of motion:

The sagittal plane runs perpendicular to gravity and divides your body into right and left segments. Flexion and extension occur in the sagittal plane.

The frontal plane also runs perpendicular to gravity and divides your body into posterior and anterior segments. Abduction and adduction occur in the frontal plane.

The transverse plane runs parallel to gravity, and divides your body into lower and upper segments. Rotation takes place in the transverse plane.

Throughout the walking and running gait cycles, different segments of your body move in all three planes of motion. Coordinating motion in multiple planes requires specific muscle recruitment and firing patterns, as well as synchronicity of motion between the left and right sides of your body.

  • Past injuries that created neuroplastic changes to the CNS
  • Current injuries, however minor, that cause compensation patterns
  • Poor postural habits
  • Muscle weakness
  • Imbalanced muscle tension between the right and left sides
  • Reduced myofascial elasticity

When your movements are not coordinated, you reduce your body’s overall performance and increase your risk of injury.

  • Diagnostic musculoskeletal ultrasonography lets us view nerves, muscles and connective tissues in real time, with the patient in motion.
  • Sonoelastography lets us assess the stiffness/elasticity of muscles, tendons and fascia.
  • Superior microvascular imaging (SMI) helps us detect healing activity in its earliest stages.
  • 3D Gait and motion analysis lab gives us tools to assess and quantify gait and motor deficiencies.
  • Kineo artificial intelligence tests for concentric and eccentric muscle strength.
  • Neuromotor testing detects irregular neuromuscular signaling.
  • Surface electromyography (SEMG) assesses muscle activation patterns.
  • Motion capture video helps us detect abnormal motor patterns.

Once we weed out compensation patterns and dysfunctional motor patterns, we can move forward to the restorative phase of rehab. Once functional movement is restored, we can then enhance fitness and optimize performance.

Our Functional Training Toolbox at NYDNRehab

Passive physical therapy deprives patients of the benefits of dynamic movement. And after all, movement is life! But progressing a patient from passive care to active, and progressing beyond active care to freedom of motion, takes knowledge, skill and experience.

At NYDNRehab, we use quantitative data gathered during the assessment process as a baseline, and closely monitor each patient’s progress toward full functional movement.

Some of our functional movement treatment tools include:

  • 3D Gait Analysis and Retraining
  • Redcord Neurac System
  • DNS (Dynamic Neuromuscular Stabilization)
  • AIM (Anatomy in Motion)
  • C.A.R.E.N (Computer Assisted Rehabilitation Environment)
  • Rehabilitative Ultrasonography (RUSI)
  • Kineo Intelligent Load System
  • Proteus Motion System

If you want to move freely without pain and explore your peak performance potential, contact NYDNRehab today, and get moving toward a better, more active quality of life.


Cook, Gray. Movement: Functional movement systems: Screening, assessment, corrective strategies. On Target Publications, 2010.

Cook, Gray, et al. “Functional movement screening: the use of fundamental movements as an assessment of function-part 1.” International journal of sports physical therapy 9.3 (2014).

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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