Movement Diagnosis Over Medical Diagnosis
Treat how the body moves, not just the label on the scan
- Difficulty
- Moderate
- Time to result
- ~weeks to results
- Steps
- 4
- Confidence
- 90%
Eric Cressey's central lens, drawn from Shirley Sahrmann's movement-impairment work, is to add a movement diagnosis on top of any medical diagnosis. Instead of stopping at 'you have biceps tendonitis' and treating the biceps, he asks what movement fault put that tissue under stress, because one impairment (say scapular downward rotation) can present as a lat strain, a biceps issue, or a cuff irritation. The workflow always begins with a conversation and history (people under-report acne meds, statins, old fractures), moves to static posture, then to general and region-specific movement screens. The diagnosis then routes the person: some just need better coaching or a deload, others need to be escalated for imaging. The goal is to relate how someone moves to what is happening beside their symptoms, so the fix targets the cause rather than the label.
Origin
Cressey traces this to Shirley Sahrmann's 'Diagnosis and Treatment of Movement Impairment Syndromes' and to his own shoulder rehab: treated as a generic rotator-cuff patient he did not improve, but re-framing himself as a movement problem (poor scapular positioning and end-range cuff control) is what finally resolved it.
Core principles
- 01A single tissue label (e.g. 'biceps tendonitis') tells you what hurts, not why it hurts
- 02One faulty movement pattern can generate several different pathologies
- 03Imaging is one piece of the diagnostic puzzle, never the whole answer without a physical exam and history
- 04Fixing the pattern that drives the symptom is what makes relief stick
How to run it
- 1
Begin with conversation and history
Take a full history before touching anyone, because people consistently under-report prescription meds, past fractures, and prior failed treatments that change the whole picture.
Pro tip Ask specifically about acne medication, statins, and old accidents — the things people assume are unrelated.
Watch out Skipping the history burns months chasing the wrong intervention.
- 2
Read static posture
Observe how gravity is loading the body and what shapes it defaults to, using posture as a clue rather than a verdict.
Pro tip Very low, down-sloped shoulders predict poor scapular upward rotation once the arms go overhead.
Watch out Posture hints at where someone starts; it does not on its own predict injury.
- 3
Run general and specific screens
Combine broad screens (overhead squat, overhead lunge walk, push-up, toe touch) with screens specific to the painful region so nothing is missed.
Pro tip If you look for everything you see nothing — use a deliberate, repeatable screen set.
- 4
Relate the pattern to the symptom, then route it
Decide whether the person needs coaching and exercise changes, a volume deload, or clinical escalation for imaging and a specialist.
Pro tip Use a manual-therapy test-retest to see if a transient change is even possible before building a plan around it.
Watch out Treating the scan instead of the person leads to unnecessary surgery on findings that are asymptomatic.
In the wild
A young baseball player had mundane posterior labral fraying (present in essentially 100% of MLB pitchers) plus some symptoms, and a doctor wanted to operate. Cressey pushed to rehab instead, reasoning the movement picture did not warrant surgery.
→ Four weeks of PT and a return-to-throwing program later, the athlete played four years of college baseball with no further shoulder issues.
Diagnosed with a painful partial rotator-cuff tear and scheduled for surgery in grad school, he instead redesigned his training and added targeted soft-tissue work rather than being managed as a generic cuff patient.
→ He became asymptomatic and called the surgeon's office on Halloween 2003 to cancel the operation.
Common mistakes
Treating the MRI instead of the patient
Acting on incidental imaging findings that are common and asymptomatic drives interventions and surgeries that were never needed.
Stopping at the tissue label
Naming the injured tissue without finding the movement fault that loaded it means the same problem returns after treatment.
Is it for you?
Best for
Anyone navigating a stubborn musculoskeletal issue, and coaches who want durable rather than transient outcomes.
Not ideal for
Acute trauma or red-flag conditions that need immediate medical imaging and intervention.
From the transcript
“I talk a lot more about not just having a medical diagnosis but also having a movement diagnosis having an ability to relate how you…”
“it changed the perspective from that medical diagnosis to a movement diagnosis instead”
“they treated the MRI instead of the kid in front of him”
From the episode
#675: Eric Cressey, Cressey Sports Performance — Tactical Deep Dive on Back Pain, Movement Diagnosis, Training Principles, Developing Mobility, Building Power, Fascial Manipulation, and Rules for Athletes