Why I Use the Functional Movement Screen
For the last two years, I have been learning to master the Functional Movement Screen (FMS). For those of you who don’t know what the FMS is, it’s a screen used to collect data and analyze human movement patterns in terms of functional performance and injury risk. It was created in 1995 by Gray Cook and Lee Burton. It is meant as a tool for improved communication between the different health and fitness professions. Until the FMS, there was no established tool to identify asymmetries and restricted functional movement patterns. Asymmetries and limited movement patterns can increase the potential risk of injury in an individual.
So how does it work? There is a series of seven movements that are graded on a scale of 0 to 3, 3 being close to perfect and 0 being unable to perform the movement due to pain. If a score falls below 14 (an average of 2 on all movements), it is believed that the risk of injury is significantly increased. There is likely an increased risk of injury when there is asymmetry also. The seven movements consist of the Deep Squat (DS), Hurdle Step (HS), Inline Lunge (IL), Shoulder Mobility (SM), Active Straight Leg Raise (ASLR), Trunk Stability Push-Up (TSPU), and Rotary Stability (RS). These movements can be sorted into three groups by order of importance, mobility (ASLR, SM), stability (RS, TSPU), and functional movements (IL, HS, DS). In looking to correct assymetries and low scores, it’s always best to start with mobility, then stability, and finally correct functional movement. Correcting mobility in the first group, may correct the other patterns. If somebody suffers from pain during the movement screen, it is best to refer out to the proper medical professional. Included in the screen are three clearing tests. One for the shoulder, and two for the spine. If there is pain provoked by these tests, it is once again, best to refer out.
There have been several research studies using the FMS. A study out of the North American Journal of Sports Physical Therapy (NAJSPT) suggested that functional movement as measured by the screen is an identifiable risk factor for injuries in professional football players. Dysfunctional fundamental movement patterns appeared to put players at a higher risk for injuries than those that scored higher on the screen. Research out of Bethesda, MD on the prediction of injuries in the military based on the FMS and aerobic fitness found a measurable link between an increased injury risk, and the combination of poor aerobic fitness and and a low FMS score. And finally, a 2010 study out of the NAJSPT found the FMS to show a significant correlation between a low score and injury risk for a group of female collegiate athletes. Even though I have found these studies that support the use of the FMS as a tool for predicting injury risk, there are still people that question its value and wonder if a different type of screen would be better predictor. The FMS is by no means a slam dunk when it comes to predicting injuries, but at the very least, I believe it’s a very useful tool for appropriate exercise selection. In the military study previously mentioned, the physical fitness testing appeared just as effective as the FMS at predicting injuries. However, I would argue that participating in an FMS screen itself would have a low risk of injury while PFT may cause an injury, if used as a screen. It’s possible that some of the officer candidates shouldn’t have been performing a specific PFT (pull-ups to exhaustion, 2 minute abdominal crunch, and 3 mile run for time) in the first place, which could be identified in the screen. As the FMS is studied more, it will be interesting to see what the future research will reveal.
Here is a quick screen from Smart Group Training that is based off of the FMS and can be used if a person doesn’t have access to a certified FMS expert, or someone who does an equivalent type of functional screen.
- Overhead Squat- Look for any excessive forward bend, hands in front of toes, knee valgus (knee collapses inwards), or feet rotating outwards. Notice if they can’t make it below parallel. If any of these are present, then weighted squats are not recommended until the pattern is corrected.
- Overhead Split Squat- Take note if they can’t get up from the bottom, they have knee valgus, they are leaning forward or lose their balance. Split squats and lunges are not recommended if it is done poorly.
- Toe Touch and Reaching Hip Hinge- It’s a red light if they can’t toe touch. If they can reach their toes, have them hip hinge with the arms reaching out overhead. Look for a neutral spine, hips back, and weight on the heels. If these are not present, deadlifts and Romanian Deadlifts (RDL), are not recommended.
- Overhead Press Screen- Have them stand with their back and head against the wall, and a neutral posture. Have them exhale and drop the ribcage, then bring the arms overhead until their posture changes or they reach the wall with their thumbs. They need to get their arms in line with their ears, otherwise overhead lifting is not recommended until they improve.
- Push-Up- Have them lay face down on the floor and with arms at shoulder level, perform a push-up. If they can’t get up or their hips sag, push-ups and hard planks are not recommended until they build better core stability.
I have heard trainer’s and coaches say they assess their clients or athletes as they perform an exercise. Here’s the problem. How do they decide what exercises to start them with in their program? If a person does not perform a movement or exercise well and you load them up with resistance, they may tweak a muscle and the assessment has already failed. As I see it, even if the research is inconclusive for injury prediction, the FMS is still an extremely useful tool in identifying whether or not a client is healthy enough to train, and what exercises to select or omit from a program. Ultimately, as a fitness professional, it’s our responsibility to give our athletes and clients, safe and appropriate workouts. I have heard it said before, if you’re not assessing, you’re just guessing!