Evidence Based Application of the Functional Movement Screen: Part 4 - FITNESS PAIN FREE

Evidence Based Application of the Functional Movement Screen: Part 4

deep squatIn the fourth and final installment I wanted to briefly recap what the FMS has been shown to do and then direct some thinking toward figuring out how we can implement the FMS and where future research should be targeted. If you missed the previous articles, I’d recommend going back and reading them before moving onto this segment:

I wanted this portion of the series to serve as brainstorming for both therapists, coaches and trainers.  Where can we use the FMS and maybe where shouldn’t we be using the FMS?  Let’s put some thought into how we can best implement this tool!  Please if you have any comments or thoughts submit them to the comments section below.

To recap, What populations have been studied with the FMS and its relationship with injury risk?

  • Firefighters
  • Military
  • Professional Football Players
  • DII Collegiate female athletes

The FMS has been shown to be a significant predictor of injury in all of these populations

Key Notes:

  • The FMS shows low sensitivity and high specificity throughout the studies.
  • What constitutes an injury was not standardized throughout the studies
  • FMS scores did not correlate with athletes who had had ACL reconstruction surgery.  ACL patients scored higher then average.
  • Targeted programs will improve FMS scores but there is no gold standard treatment.  Keep in mind that in 1 study the control group improved.
  • To the best of my knowledge no studies have shown that improving FMS scores with a targeted program decreases injury risk
  • To the best of my knowledge there has been no study to determine if low FMS scores will correlate with increased injury risk in the general fitness population
  • Individuals with higher FMS scores (18+) in the military population were more likely to get injured
  • FMS scores did not predict overuse injuries in the military population
  • FMS scores were no better then PT (physical fitness test) test scores in the military population for assessing injury risk

How does the FMS fit into our physical therapy program?

1.  Valuable information about how our patients move:  I often find that in the clinic we can become pretty transfixed on the joint/muscle that gets injured.  Sure, we might check the joints above and below and maybe check a few functional movements but that is usually the end of it (Sorry if this isn’t your practice).  Generally, people get hurt because of the way they move (or don’t move) and the postures they assume on a daily basis.

Trainers and coaches watch their athletes move on a daily basis.  They  get the chance to assess movement efficiency through a wider degree of activity.  Although the FMS was designed to work in individuals without pain I’d make the argument that it may be even more effective in the injured population.  In this regard you may be better getting at the root cause of the injury.  I feel like you get a nice snap shot of how patients move if you can quickly run them through a larger degree of functional activity, similar to the way the FMS does.

2. Return to Sport: The FMS was originally designed to be a screen but ended up being a good tool to rule in the risk of injury.   If you have an athlete on your hands who scores poorly on the FMS, you can be pretty sure that this person is setting himself up for injury when he/she gets back on the field.  Keep in mind that neuromuscular control programs have become the bees knees when it comes to injury prevention.  In my mind this means that we should really be looking to assess movement and then make changes in the way we move to prevent injury.

Side Note: I’ve heard surgeons recommend using the FMS as a return to sport criteria for ACL rehab candidates.  I definitely don’t feel this is a bad idea but remember the research showing that ACL reconstruction patients actually had higher FMS scores then their fellow team mates.  This may give the false impression that these athletes are ready to return to play.  However, the FMS may be picking up this athlete’s risk of other injuries.

gray-stretching-patientHow does the FMS fit into our coaching and personal training program?

1. When to refer out:  When should an individual work with a trainer and when should they be sent to a therapist?  If they have pain, send them to a therapist.  The FMS provides clearing tests and an array of basic movement to determine if your client has pain anywhere.

2. Which exercises NOT to perform: This may be getting beyond the scope of this article but the FMS was partly designed to determine which types of activities should be avoided in certain individuals.  For example: Let’s say your client has a terrible range of motion asymmetry from left to right in their shoulders.  It may be a wise decision to hold off on barbell overhead press until this issue is resolved.  This asymmetry may have been otherwise missed if the athlete was given the go ahead to start pressing from the get-go.

3. Continuity of Care:  A therapist can only do so much before insurance runs up and a patient must be discharged and sent on their way.  This doesn’t mean the athlete is injury proof and ready to return to sport or fitness.  If an FMS can be performed by the therapist then an athlete can be sent to  a coach/personal trainer/athletic trainer where their care can be continued, then we’re probably going to improve our outcomes.

Th re-injury rate for ACL patients is very high.  This makes for a lot of unhappy patients and their parents.  We can help to prevent these injuries and we should be employing strategies to do just that.  I hear a lot of blame going to the therapists for this.  In reality, this is a team approach and in my opinion more coaches and trainers should be making this a priority.

4. As a beginning screen/assessment: I can’t really stress this enough.  Whether you do a screen at the start of working with your clients or you evaluate as they progress through their routine and modify accordingly, some type of evaluation should be performed.  The FMS can help fit the bill as an introductory assessment.

What I’d like to see in the future:

  • More research in different sport populations.  I’d also love to see how the FMS scores correlate with common injuries seen in the physical therapy clinic.  What types of injuries does the FMS predict?  What types of injuries can’t it predict?
  • More research in the fitness population:  To the FMS’s credit, there is currently quite a bit of normative data for FMS scores in the young active and middle aged populations.  However, it would be very nice to see some research to see whether a low score in the FMS is related to increased risk of injury in the general fitness population, or even just the general population.
  • FMS and Crossfit:  I work in a crossfit gym and would like to know whether or not improving the FMS in this population decreases risk of injury.  I guess I should be the one doing this work!
  • Does improving FMS scores with a targeted program reduce risk of injury?  To me this is really the elephant in the room.  Does improving FMS scores decrease risk of injury?
  • Is the FMS as effective or more effective then other screens to determine risk of injury?
  • If we add the Y-balance test or other risk assessment tools into our assessment are we better able to predict injury?  It seems as if this is where the FMS leaders are going.

Well I’m spent, that was a long and arduous article series.  Hopefully you came out with a better understanding of this tool from the series, I certainly did.  Please if you have any thoughts or comments post them below.  I want to hear everyone else’s thoughts on the matter.  How do you guy guys use the FMS?

FMS score off the charts,

Dan Pope

P.S. If you enjoyed this article then sign up for the newsletter to receive the FREE guide – 10 Idiot Proof Principles to Crossfit Performance and Injury Prevention as well as to keep up to date with new information as it comes out via weekly emails.


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