{"id":1449,"date":"2012-06-27T03:42:50","date_gmt":"2012-06-27T10:42:50","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=1449"},"modified":"2012-06-27T03:42:50","modified_gmt":"2012-06-27T10:42:50","slug":"functional-movement-screening-what-does-it-really-tell-us","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=1449","title":{"rendered":"Functional Movement Screening &#8211; What does it really tell us?"},"content":{"rendered":"<p>Over the past several years, the trend in the health and fitness industry has been toward injury prevention and movement screening. \u00a0Gray Cook and Lee Burton have given us the FMS. \u00a0More recently, the Y-Balance test has emerged as another tool to assess asymmetry in the upper and lower quarter.<\/p>\n<p>I am currently FMS certified and planning to attend the SFMA course next month in Durham. \u00a0I routinely incorporate the FMS in both our rehab and sports performance work at the APC. \u00a0I like many things about the screening exam. \u00a0It provides a consistent tool to assess baseline movement and record asymmetry on a simple 4 point scale scale. \u00a0It also has been shown to have good intra and inter-rater reliability. \u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=JOSPT%20and%20functional%20movement%20screen\" target=\"_blank\">Click here for a recent study published in the Journal or Orthopaedic &amp; Sports Physical Therapy<\/a>.<\/p>\n<p>For those unfamiliar with the screen, it is 7 tests scored on a 0-3 scale as follows:<\/p>\n<ul>\n<li>0 = pain<\/li>\n<li>1 = unable to perform the movement pattern (or perform with marked dysfunction)<\/li>\n<li>2 = performs the movement with a mild compensation<\/li>\n<li>3 = performs the movement correctly<\/li>\n<\/ul>\n<p>I would say on average, most of the athletes I screen score between a 12 and 15. \u00a0My highest score was a 19 (9 year old gymnast) and my lowest was a 9 (NFL lineman). \u00a0As screeners, we are charged with uncovering asymmetry and faulty movement patterns. \u00a0What do you see in the following picture?<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-1464\" title=\"hurdle-step\" src=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/hurdle-step-300x168.jpg\" alt=\"hurdle-step\" width=\"300\" height=\"168\" srcset=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/hurdle-step-300x168.jpg 300w, https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/hurdle-step-1024x576.jpg 1024w, https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/hurdle-step.jpg 1280w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p>Clearly, the dowel is not level, thus we score it a 2. \u00a0She also had some ER in the right leg when stepping over the hurdle. \u00a0She was a symmetrical 2 on the hurdle step test. \u00a0This is a Division I soccer player who scored 17 on the exam.<\/p>\n<p>Most of the movements seem straightforward. \u00a0However, many question what the rotary stability test measures with respect to the ideal 3 score (ipsilateral movement)? \u00a0It assesses an unnatural movement pattern to be sure. \u00a0This athlete failed miserably on the ipsilateral pattern but scored a solid 2 with the contralateral pattern.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-1465\" title=\"rotary-stability\" src=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/rotary-stability-300x168.jpg\" alt=\"rotary-stability\" width=\"300\" height=\"168\" srcset=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/rotary-stability-300x168.jpg 300w, https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/rotary-stability-1024x576.jpg 1024w, https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/rotary-stability.jpg 1280w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p>I have yet to test someone who can score a legitimate 3. \u00a0I have seen some get a 3 on one side and 2 on the other (asymmetrical and a red flag in FMS land). \u00a0As one who naturally questions things, I find myself questioning how many are truly capable of scoring a 3.<\/p>\n<p><!--more--><\/p>\n<p>As I continue to evolve as a clinician and strength coach, I always question the real &#8220;why&#8221; and &#8220;how&#8221; behind everything. \u00a0My biggest questions remaining about the FMS itself are:<\/p>\n<p>1) Can athletes learn to beat the test without truly cleaning up imbalances? \u00a0In other words, how does cueing and familiarity change performance on the screen?<\/p>\n<p>2) Does asymmetry and\/or scores at or below 14 on the FMS really predict increased injury risk?<\/p>\n<p>3) Should it be used as a final tool to clear injured athletes for return to sport based on scoring?<\/p>\n<p>These are some of the big questions I find myself wrestling with and searching for answers to on a daily basis right now. \u00a0I recently had a 15 year old female reach the 6 month mark of her ACL rehab. \u00a0Her single leg squat was symmetrical. \u00a0Her timed hop and cross-over hop tests were even. \u00a0Her single leg broad hop was 95% of the uninvolved side. \u00a0She had no swelling and excellent graft stability. \u00a0Her only lingering issue was that she did not have full flexion in her knee.<\/p>\n<p>Here is the conundrum. \u00a0Her FMS score was a 12. \u00a0She got a 1 on the deep squat and a 1 on her trunk stability push-up. \u00a0All other scores were symmetrical 2&#8217;s. \u00a0Her deep squat was limited by some residual stiffness in knee flexion as she did no PT prior to surgery and did not start PT until 3 weeks post-op and had already developed a flexion contracture.<\/p>\n<p>In addition to her FMS scores, I looked at Y-Balance scores and she had only one true asymmetry out of the three reaching directions (defined as greater than a 4 cm difference). \u00a0We are testing some new software in our cliic that takes all of this data into account and then spits out a risk factor for injury. According to the software, my patient was at moderately increased risk for injury.<\/p>\n<p>Hmmm&#8230;.. \u00a0Does that mean she can not return to soccer training? \u00a0Should we wait until she gets a 2 or 3 on the deep squat? \u00a0Some would say yes. \u00a0While I agree that we need to get her deep squat better, I am not sure if I would classify her as at moderately increased risk for injury. \u00a0I think the jury is still out on that one. \u00a0I believe we have to look at everything. \u00a0She is currently continuing work with our sports staff to increase mobility, strength and movement patterns as she transitions back to soccer specific training\/technical work.<\/p>\n<p>Her gait, single leg stability, single leg strength and deceleration mechanics are solid. \u00a0Should this score on the FMS be considered strong enough to hold her back from return to sport? \u00a0Is she more likely to get hurt with her score of 12? \u00a0Well, I am not the only one wondering these things.<\/p>\n<p>In a recent study by Staurt McGill in the <em>Journal of Strength &amp; Conditioning Research<\/em>, he looked at FMS scoring. \u00a0He and the other authors also applied some other scoring to it with three groups (two receiving an intervention and one control group). \u00a0He essentially finds that the scores may provide a momentary picture of one&#8217;s movement, but that <strong>further work needs to be done to determine how to more effectively administer the test, interpret results and generate more reliable test scores<\/strong>. \u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=journal%20of%20strength%20and%20conditioning%20research%20and%20functional%20movement%20screen%20mcgill\" target=\"_blank\">Click here to read the abstract<\/a>.<\/p>\n<p>The authors in this study point out a few key things we must keep in mind:<\/p>\n<ul>\n<li>It is not perfectly clear what tasks should be graded when trying to predict injury risk<\/li>\n<li>Task performance can be impacted by coaching or feedback thus making it difficult to rank movement quality over multiple testing sessions<\/li>\n<li>Need to draw the distinction between what athlete &#8220;can do&#8221; and what they &#8220;choose to do&#8221; (habitual or fall back strategies)<\/li>\n<\/ul>\n<p>I think the neural contributions to movement cannot be understated. \u00a0People will tend to draw on natural feed forward mechanisms of movement. \u00a0Their inherent patterns may be flawed. \u00a0These patterns can certainly be impacted by flexibility, joint mobility, weakness and prior injury. \u00a0I think as we move forward, we must continue to study how screening is linked with exercise prescription and evaluation of the efficacy of said exercises.<\/p>\n<p>We must continue to question how we measure the quality of movement. \u00a0We need to critically evaluate how we use assessments to drive our rehab, training and corrective exercise selections. \u00a0Does the FMS truly predict injury across all populations? \u00a0Should low scores keep athletes off the field? \u00a0Finally, we must try to determine if and how our re-assessments measure the efficacy of our exercise interventions.<\/p>\n<p>In the meantime, I will continue to use the FMS and other screening tools to gather as much information as I can about how my athletes move. \u00a0The integration of this information and influence in my decision making as well as communications with my clientele that continue to require careful consideration. \u00a0I look forward to learning more and seeking the answers to many of these questions moving forward.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Over the past several years, the trend in the health and fitness industry has been toward injury prevention and movement screening. \u00a0Gray Cook and Lee Burton have given us the FMS. \u00a0More recently, the Y-Balance test has emerged as another tool to assess asymmetry in the upper and lower quarter. I am currently FMS certified [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[188,3,4,7,8],"tags":[440,89,271,272,273],"class_list":["post-1449","post","type-post","status-publish","format-standard","hentry","category-acl-knee","category-fitness","category-health","category-injury-prevention","category-rehab","tag-acl","tag-acl-rehab","tag-fms","tag-movement-screening","tag-return-to-play"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.10 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Functional Movement Screening - What does it really tell us? - Brian Schiff&#039;s Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.brianschiff.com\/?p=1449\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Functional Movement Screening - What does it really tell us? - Brian Schiff&#039;s Blog\" \/>\n<meta property=\"og:description\" content=\"Over the past several years, the trend in the health and fitness industry has been toward injury prevention and movement screening. \u00a0Gray Cook and Lee Burton have given us the FMS. \u00a0More recently, the Y-Balance test has emerged as another tool to assess asymmetry in the upper and lower quarter. 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I am currently FMS certified [&hellip;]","og_url":"https:\/\/blog.brianschiff.com\/?p=1449","og_site_name":"Brian Schiff's Blog","article_published_time":"2012-06-27T10:42:50+00:00","og_image":[{"url":"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2012\/06\/hurdle-step-300x168.jpg"}],"author":"Brian Schiff","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Brian Schiff","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/blog.brianschiff.com\/?p=1449","url":"https:\/\/blog.brianschiff.com\/?p=1449","name":"Functional Movement Screening - What does it really tell us? - Brian Schiff's Blog","isPartOf":{"@id":"https:\/\/blog.brianschiff.com\/#website"},"datePublished":"2012-06-27T10:42:50+00:00","dateModified":"2012-06-27T10:42:50+00:00","author":{"@id":"https:\/\/blog.brianschiff.com\/#\/schema\/person\/d7ecfca77bb5641821016294c8190473"},"breadcrumb":{"@id":"https:\/\/blog.brianschiff.com\/?p=1449#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blog.brianschiff.com\/?p=1449"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blog.brianschiff.com\/?p=1449#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blog.brianschiff.com\/"},{"@type":"ListItem","position":2,"name":"Functional Movement Screening &#8211; What does it really tell us?"}]},{"@type":"WebSite","@id":"https:\/\/blog.brianschiff.com\/#website","url":"https:\/\/blog.brianschiff.com\/","name":"Brian Schiff's Blog","description":"Injury Prevention, Sports Rehab &amp; Performance Training Expert","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blog.brianschiff.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/blog.brianschiff.com\/#\/schema\/person\/d7ecfca77bb5641821016294c8190473","name":"Brian Schiff","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blog.brianschiff.com\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/cfb4d8d97e576039b5949885812b9a4199eafdf93f5da9ccf83f9b671aac22f2?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/cfb4d8d97e576039b5949885812b9a4199eafdf93f5da9ccf83f9b671aac22f2?s=96&d=mm&r=g","caption":"Brian Schiff"},"sameAs":["http:\/\/www.brianschiff.com"],"url":"https:\/\/blog.brianschiff.com\/?author=2"}]}},"_links":{"self":[{"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/posts\/1449","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1449"}],"version-history":[{"count":3,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/posts\/1449\/revisions"}],"predecessor-version":[{"id":1468,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=\/wp\/v2\/posts\/1449\/revisions\/1468"}],"wp:attachment":[{"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1449"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1449"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.brianschiff.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1449"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}