Functional Movement Screening
Functional movement systems is an inportant part of the solution to a common problem – CHRONIC PAIN. Whether the problem is Chronic Neck Pain or Chronic Shoulder Pain and also a inflammed damaged tissue which is continually being reinjured and not allowed to fully heal.
Pain syndromes are the end result of living with poor movement patterns (often painless) for an extended period of time. Movement dysfunctions place an excessive amount of pressure on joints, tendons, ligaments, muscles and fascia causing them to breakdown, degenerate and become inflamed.
If the movement dysfunction is not first identified and then corrected, the over-used body tissues become chronically painful and degenerative, and often lead to further movement dysfunction as the body compensates to avoid using the inflammed tissue.
So, identifying the movement dysfunction prior to chronic movement dysfunction which causes deformity of respective joint or body mechanics. Once the poor body mechanics are identified, exercises are recommended to greatly reduce the presuure poor body mechanics place on damaged tissue, finally allowing improved healing.
Functional Movement Screeing:
The Functional Movement Screeing or Functional Movement Screen (FMS) is a type of grading system that assesses essential movement patterns that are key to normal movement. By screening these patterns, the FMS readily identifies functional limitations and asymmetries that causes imbalances, reasons for decreased coordination and an increase in injury. These limitations reduce the effects of training and physical conditioning.
Current research on the FMS suggests that the test is a reliable way to objectively measure fundamental movement patterns that are modifiable and indicative of an elevated likelihood of sustaining a musculoskeletal injury. FMS examines fundamental movement control within those movements and movement patterns to access whether those baseline areas are competent and stable or whether there is a deficiency which needs to be corrected.
These fundamental movement patterns are designed to provide observable performance of basic loco motor, manipulative and stabilizing movements. The tests place the individual in extreme positions where weaknesses and imbalances become noticeable if appropriate stability and mobility is not utilized. It has been observed that many individuals who perform at very high levels during activities are unable to perform these simple movements. These individuals should be considered to be utilizing compensatory movement patterns during their activities, sacrificing efficient movements for inefficient ones in order to perform at high levels. If these compensations continue, then poor movement patterns will be reinforced leading to poor biomechanics. There are 7 different movements that the FMS analyzes, each movement will be Scored on an ordinal scale from 0 to 3. with the sum creating a score ranging from 0-21 points. These are: 1) Deep Squat
2) Hurdle Step
3) In-Line Lunge
4) Shoulder Mobility
5) Active Straight-Leg Raise
6) Trunk Stability Pushup
7) Rotational Stability
1. Deep Squat: (Used to screen Hips, Shoulders, Knees, Spine and Ankles)
The squat is a movement needed in most athletic events. It is the ready position and is required for most power and lifting movements involving the lower extremities. The deep squat is a test that challenges total body mechanics when performed properly. It is used to assess bilateral, symmetrical and functional mobility of the hips, knees and ankles. The dowel held overhead assesses bilateral, symmetrical mobility of the shoulders as well as the thoracic spine. The ability to perform the deep squat requires appropriate pelvic rhythm, closed-kinetic chain dorsiflexion of the ankles, flexion of the knees and hips and extension of the thoracic spine, as well as flexion and abduction of the shoulders.
2. Hurdle Step: (Used to screen Hips, Knees and Ankles)
The hurdle step is designed to challenge the body’s proper stride mechanics during a stepping motion. The movement requires proper coordination and stability between the hips and torso during the stepping motion as well as single leg stance stability. The hurdle step assesses bilateral functional mobility and stability of the hips, knees and ankles. Performing the hurdle step test requires stanceleg stability of the ankle, knee and hip as well as maximal closed-kinetic chain extension of the hip. The hurdle step also requires step-leg open-kinetic chain dorsifl exion of the ankle and fl exion of the knee and hip. In addition, the subject must also display adequate balance because the test imposes a need for dynamic stability.
3. In-Line Lunge: (Used t screen Ankle and Knee stability, as well as abductor and adductor weakness)
This test attempts to place the body in a position that will focus on the stresses as simulated during rotational, decelerating and lateral-type movements. The inline lunge is a test that places the lower extremity in a scissored position, challenging the body’s trunk and extremities to resist rotation and maintain proper alignment. This test assesses torso, shoulder, hip and ankle mobility and stability, quadriceps flexibility and knee stability. The ability to perform the in-line lunge test requires stance-leg stability of the ankle, knee and hip as well as apparent closed kinetic chain hip abduction. The in-line lunge also requires step-leg mobility of the hip, ankle dorsifl exion and rectus femoris flexibility. The subject must also display adequate stability due to the rotational stress imposed.
4. Shoulder Mobility: (Used to screen shoulder ROM and Posture)
The shoulder mobility screen assesses bilateral shoulder range of motion, combining internal rotation with adduction and external rotation with abduction. It also requires normal scapular mobility and thoracic spine extension. The ability to perform the shoulder mobility test requires shoulder mobility in a combination of motions including abduction/external rotation, fl exion/extension and adduction/internal rotation. It also requires scapular and thoracic spine mobility.
5. Active Straight-Leg Raise: (Used to screen Hamstring flexibility, Hip mobility & Pelvic stability)
The active straight-leg raise tests the ability to disassociate the lower extremity while maintaining stability in the torso. The active straight-leg raise test assesses active hamstring and gastroc-soleus flexibility while maintaining a stable pelvis and active extension of the opposite leg. The ability to perform the active straight-leg raise test requires functional hamstring flexibility, which is the flexibility that is available during training and competition. This is different from passive flexibility, which is more commonly assessed. The subject is also required to demonstrate adequate hip mobility of the opposite leg as well as lower abdominal stability.
6. Trunk Stability Pushup: (Used to screen trunk stability and core strength)
The trunk stability push-up tests the ability to stabilize the spine in an anterior and posterior plane during a closed-chain upper body movement. It assesses trunk stability in the sagittal plane while a symmetrical upper-extremity motion is performed. The ability to perform the trunk stability push-up requires symmetric trunk stability in the sagittal plane during a symmetric upper extremity movement. Many functional activities require the trunk stabilizers to transfer force symmetrically from the upper extremities to the lower extremities and vice versa. Movements such as blocking in football and jumping for rebounds in basketball are common examples of this type of energy transfer. If the trunk does not have adequate stability during these activities, kinetic energy will be dispersed, leading to poor functional performance as well as increased potential for micro traumatic injury.
7. Rotational Stability: (Used to screen core stability and asymmetry)
This test is a complex movement requiring proper neuromuscular coordination and energy transfer from one segment of the body to another through the torso. The rotary stability test assesses multi-plane trunk stability during a combined upper and lower extremity motion. The ability to perform the rotary stability test requires asymmetric trunk stability in both sagittal and transverse planes during asymmetric upper and lower extremity movement. Many functional activities require the trunk stabilizers to transfer force asymmetrically from the lower extremities to the upper extremities and vice versa. Running and exploding out of a down stance in football and moving and carrying heavy equipment or objects are examples of this type of energy transfer. If the trunk does not have adequate stability during these activities, kinetic energy will be dispersed, leading to poor performance as well as increased potential for injury.
The mean FMS sum score is around 13 – 15 points in most groups of people, and substantially lower scores may indicate an increased risk of injury.
For Detailing of Scoring Sheet and Interpretation open the Links below:
Research Support:
1) Kiesel, Kyle, Phillip J. Plisky, and Michael L. Voight. "Can serious injury in professional football be predicted by a preseason functional movement screen." N Am J Sports Phys Ther 2.3 (2007): 147-158.
Background: Little data exists regarding injury risk factors for professional football players. Athletes with poor dynamic balance or asymmetrical strength and flexibility (i.e. poor fundamental movement patterns) are more likely to be injured. The patterns of the Functional Movement Screen™ (FMS) place the athlete in positions where range of motion, stabilization, and balance deficits may be exposed.
Objectives: To determine the relationship between professional football players’ score on the FMS™ and the likelihood of serious injury.
Methods: FMS™ scores obtained prior to the start of the season and serious injury (membership on the injured reserve for at least 3 weeks) data were complied for one team (n = 46). Utilizing a receiver operator characteristic curve the FMS™ score was used to predict injury.
Results: A score of 14 or less on the FMS™ was positive to predict serious injury with specificity of 0.91 and sensitivity of 0.54. The odds ratio was 11.67, positive likelihood ratio was 5.92, and negative likelihood ratio was 0.51.
Discussion and Conclusion: The results of this study suggest fundamental movement (as measured by the FMS™) is an identifiable risk factor for injury in professional football players. The findings of this study suggest professional football players with dysfunctional fundamental movement patterns as measured by the FMS™ are more likely to suffer an injury than those scoring higher on the FMS™.
2) Minick, Kate I., et al. "Interrater reliability of the functional movement screen." The Journal of Strength & Conditioning Research 24.2 (2010): 479-486.
The Functional Movement Screen (FMS) is a series of 7 tests that categorize fundamental movement. Each test is scored on an ordinal scale with 4 categories. The purpose of this study was to determine the interrater reliability of the FMS. Forty healthy subjects were videotaped while performing the FMS. The videos were independently scored by 4 raters, including 2 experts who instruct FMS training courses and 2 novices who completed a standardized training course on the FMS. Interrater reliability was analyzed using the weighted kappa statistic. The novice raters demonstrated excellent or substantial agreement on 14 of the 17 tests, whereas the expert raters did the same on 13 of the 17 tests. When the novice raters were paired with the expert raters, all 17 components demonstrated excellent or substantial agreement. These data indicate that the FMS can confidently be applied by trained individuals. This would suggest that the FMS can be confidently used to assess the movement patterns of athletes and to make decisions related to interventions for performance enhancement, and the FMS may assist in identifying athletes at risk for injury.
3) Chorba, Rita S., et al. "Use of a functional movement screening tool to determine injury risk in female collegiate athletes." North American journal of sports physical therapy: NAJSPT 5.2 (2010): 47.
Background: Athletes often utilize compensatory movement strategies to achieve high performance. However, these inefficient movement strategies may reinforce poor biomechanical movement patterns during typical activities, resulting in injury.
Objectives: This study sought to determine if compensatory movement patterns predispose female collegiate athletes to injury, and if a functional movement screening (FMS™) tool can be used to predict injuries in this population.
Methods: Scores on the FMS™, comprised of seven movement tests, were calculated for 38 NCAA Division II female collegiate athletes before the start of their respective fall and winter sport seasons (soccer, volleyball, and basketball). Seven athletes reported a previous history of anterior cruciate ligament reconstruction (ACLR). Injuries sustained while participating in sport activities were recorded throughout the seasons.
Results: The mean FMS™ score and standard deviation for all subjects was 14.3±1.77 (maximum score of 21). Eighteen injuries (17 lower extremity, 1 lower back) were recorded during this study. A score of 14/21 or less was significantly associated with injury (P=0.0496). Sixty-nine percent of athletes scoring 14 or less sustained an injury. Odds ratios were 3.85 with inclusion of all subjects, and 4.58 with exclusion of ACLR subjects. Sensitivity and specificity were 0.58 and 0.74 for all subjects, respectively. A significant correlation was found between low-scoring athletes and injury (P=0.0214, r=0.76).
Discussion: A score of 14 or less on the FMS™ tool resulted in a 4-fold increase in risk of lower extremity injury in female collegiate athletes participating in fall and winter sports. The screening tool was able to predict injury in female athletes without a history of major musculoskeletal injury such as ACLR. Conclusion. Compensatory fundamental movement patterns can increase the risk of injury in female collegiate athletes, and can be identified by using a functional movement screening tool. Key Words. female athlete, sports injury, Functional Movement Screen™, injury risk factors.
4) Letafatkar, Amir, et al. "Relationship between functional movement screening score and history of injury." International journal of sports physical therapy 9.1 (2014): 21.
Background and Aim:
The Functional Movement Screen (FMS™) is a screening instrument that evaluates selective fundamental movement patterns. The main aim of this study was to investigate the relationship between the FMS™ score and history of injury, and attempt to determine which active students are prone to injury.
Methods:
One hundred physically active (50 females and 50 males) students, between 18 and 25 years of age, with no recent (<6 weeks) history of musculoskeletal injury were recruited. All participants performed the FMS™ and were scored using the previously established standardized FMS™ criteria. The chi square, independent t‐test, one‐way analysis of variance, and POSTHOC Bonferroni tests were used for data analysis with a preset alpha value of p < 0.05.
Results:
Of the 100 subjects, 35 suffered an acute lower extremity (ankle = 20, knee = 15) injury in practice or competition. An odds ratio was calculated at 4.70, meaning that an athlete had an approximately 4.7 times greater chance of suffering a lower extremity injury during a regular competitive season if they scored less than 17 on the FMS™. There were statistical differences between the pre‐season FMS™ scores of the injured and non‐injured groups, the ankle injury, knee injury, and non‐injured groups, and also between contact injury, non‐contact injury, and non‐injured groups.
Discussion and Conclusion:
This cross‐sectional study provides FMS™ reference values for physically active students, which will assist in the interpretation of individual scores when screening athletes for musculoskeletal injury and performance factors. More research is still necessary before implementing the FMS™ into a pre‐participation physical examination (PPE) for athletics, but due to the low cost and its simplicity to implement, it should be considered by clinicians and researchers in the future.
Dr. Srinivas. P.T (Reg No. L-39682)
Head Of Department (Kaggadasapura branch)
Spectrum Physio Pvt Ltd
Bangalore.
