Functional Movement Screening
The FMS is a battery of 7 tests that assess one’s ability to produce basic multi-joint movements. It was developed by a group of Physical Therapists and Athletic Trainers as a means of evaluating
Correctly adjust dynamometer for hand size. Have athlete squeeze slowly and hold for 2 to 3 seconds. Repeat 3 times and take best score (www.topendsports.com/test-ing/tests/handgrip.htm).
Weight Machine, Bench Press, or Squat Rack
Have athlete warm up by selecting a weight they car lift comfortably for 12 to 15 reps. Find the 10 rep max by increasing the weight by 10%. Ask athlete to lift as many times as possible with good form. If they can only complete 10 reps, divide that load by .75. This is their estimatec 1 rep max. For every rep above 10 add .025 to the denominator. Divide the 1 rep max load by the athlete’s weight to create a strength ratio. Scoring is specific to the lift and not available for all machines, ages or genders (www. sport-fitness-advisor.com/strengthtests.html).
Mat and partner
Athlete will attempt 4 progressively harder forms of a sit up. The quality of the movement is graded from 0 to 4 based on easy of contraction. The 4 sit ups are; knees bent and feet held, knees bent and feet not held, legs straight and feet held, legs straight and feet not held. Only one rep of each form is needed (www.topendsports.com/test-ing/tests/ab-strength.htm).
The 7 tests are simple movements that require dynamic balance, core stability, and flexibility to accomplish. A full description of the tests can be found in the suggested reading by Cook, Burton, Hoogenboom, and Voight.
Four of the movements assess the right and left sides individually and 3 include a clearing test to check for the presence of pain. Each movement is scored from 0 to 3 and the total of the 7 tests is recorded out of a possible 21 points. Pain with any of the movements results in a score of 0. A score of 3 represents no biomechanical compensations in the movement pattern and no modifications were needed. Compensations are joint actions that assist in accomplishing the movement but are inefficient. For example in order to get the foot over the barrier in the hurdle step test, a patient may externally rotation their hip and bring the foot over the hurdle at an angle rather than straight across. The substitution of the gluteal muscles allows the patient to step over the hurdle but points to a lack of core stability, hip flexor strength, and flexibility in the posterior muscles. Common FMS compensations include side-bending to maintain balance trunk flexion to complete a deep squat and pelvic rotation. Three tests can be modified if a compensatory action is produced on the first try. A score of 2 is given if the patient can complete the movement but uses a compensatory action or can do the movement correctly once it’s been modified. A test is graded a 1 if the patient cannot complete the full movement even with a modification or cannot hold the correct starting position without losing balance. The difference between the muscular fitness test described earlier and the FMS is that the quality of the movement pattern is being graded rather than the volume of work.
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Assessing Risk of Injury
The FMS assumes that muscular compensations indicate underlying biomechanical inefficiencies (muscular imbalances, limited ranges of motions, lack of core stability) that predispose athletes to injury. A number of longitudinal cohort studies have been conducted to determine if lower scores on the FMS are predictive of sport-related injury. The initial test was conducted by Kiesel and colleagues on 46 professional football players.62 Screenings were done during pre-season training and injuries resulting in 3 or more weeks of lost time were included. The authors found that those with a score of 14 or lower had a much greater chance of serious injury than those with higher scores (OR = 11.87). The study was repeated in 2013 with a larger sample (N = 238). This time any musculoskeletal injury that resulted in lost time was added to the analysis. The relative risk of injury decreased to 1.8763. An additional finding was that athletes that lacked symmetry (different scores for right and left sides) on one or more tests also had an increased risk of injury (RR = 1.8).63 A study of female college basketball, soccer and volleyball athletes found a higher risk level for scores < 14 (OR = 3.85). The risk increased when athletes with repaired ACLs were excluded (OR = 4.58).64 And, when the shoulder mobility test was removed from the analysis, the relationship between FMS score and lower extremity injuries was very strong (r = .95, p = 0.0003). These studies helped establish 14 as the threshold for increased risk, but that cut point is debatable. Recently, Shojaedin et al65 saw an increased risk of musculoskeletal injury in soccer, handball, and basketball athletes scoring < 17 (OR = 4.7). Knapik and colleagues66 even suggest different cut points for male (< 12) and females (< 15) after studying military academy cadets during their initial training.
Military personnel and firefighters are also frequently used as participants in FMS studies. Injuries during training are costly and result in fewer graduates and increased medical and salary expenses. A study of 108 recruits at a firefighting academy found that those with scores < 14 were 8 times more likely to be injured over the 16 week training period. And, individual scores of the deep squat and the trunk stability push up were also predictors of future injury.67 The functional movements of 874 Marines were scored prior to 68 days or 38 days of training. Again, scores < 14 were associated with higher risks of injury; RR = 1.65 in the longer training group and 1.91 in the shorter training group.68 O’Connor and colleagues also highlighted the relationship between overall fitness and FMS scores. Only 6.6% of the high-fit Marines had FMS scores < 14. While 79.8% of the subpar FMS scorers were in the lower fit category.68 When low FMS scores were combined with slower times on a 3-mile run test the relative risk of injury increased to 4.2.48
Studies of athletes have also looked at relationships between other performance and screening tests. Lehr and colleagues69 strengthened the predictive ability of the FMS by combining scores from the Lower Quarter Y-Balance Test. They divided athletes (N = 63) into high and low risk categories based on an algorithm developed from the 2 tests. The high-risk athletes sustained lower extremity injuries 3 times as often as the low risk group. Correlations between sprint times, leg strength, and power measures and FMS scores are small and non-significant in a group of college golfers.70 Waist circumference in adults71 and weight in children72 were inversely associated with FMS score. Measures of core stability did not correlate well to the 7 FMS movements73 despite Cook et al’s focus on maintaining spinal alignment.