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Eric Scibek, MS, ATC, LAT, CSCS, PES

Sacred Heart University

• Discuss reliability of FMS and selected

movement screens• Discuss the meaning of FMS composite

score results

• Discuss Deep Squat dysfunction

• Discuss screening in a case

Patient

Evidence

Expertise

A battery of 7 “fundamental” movement patterns (tests) designed to evaluate movement dysfunction and asymmetries.

-Deep squat

-Hurdle Step

-Inline Lunge

-Shoulder Mobility

-Active Straight Leg Raise

-Trunk Stability Pushup

-Rotary Stability

In general:

3 = Able to perform the test correctly2 = Able to perform the test correctly in a

modified position or able to partially

complete the test1 = Unable to successfully complete the

test

0 = Pain during the test or clearing test

• Take highest score from three trials• Ex. Trial 1 = 2, Trial 2 = 1, Trial 3 = 3

• Score the test a 3

• When testing bilaterally, take the LOWEST score between sides

• Ex. Right = 3, Left = 2• Score the test a 2

• When in doubt, score low

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Reliability

• Mixed results

• Strong between novice and expert raters (Minick et al.,

2010)

• Mixed between disciplines (AT, EX, PT) (Scibek et al., 2013)

• Professional education may influence reliability of FMS tests (Scibek et al., 2013)

• Composite score reliability ranges from poor to excellent

• 46 NFL players• No demographic data• FMS done during preseason

• ROC curve analyzed and cut point set at 14• Score ≤14 results in 11.67x greater chance of injury

• 238 NFL players• Players with CS ≤ 14 = 1.87 relative risk related to

injury• Players with at least one asymmetry = 1.80 relative

risk related to injury

• Specificity for low composite and asymmetry= 0.87

• 100 physically active students

• 35 sustained lower extremity injury • ROC curve sets cutoff at 17

• Score ≤17 results in 4.7x greater chance of

injury

• 20 Major junior hockey players• Average FMS score = 14.7 ± 2.57• Score ≤ 14 no more likely to sustain an injury• Injured athletes mean CS = 15• Non-injured mean CS = 14.4• Inconsistent in methods…

• Firefighters with CS ≤ 14 at increased risk of injury (Butler et al., 2012)

• Firefighters with history of injury have 1.68x greater risk of sustaining injury

• Following intervention, lost time injuries reduced by 62%

• Cut point set at 16 (Peate, 2007)

• Military recruits with slow run times and low CS at increased risk of injury (Lisman et al., 2013)

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“The strength of association between FMS composite scores and subsequent injury does

not support its use as an injury prediction tool”

• Does not predict performance among healthy individuals and golfers (Okada, Parchman)

• FMS scores may predict future improvement in performance in track athletes from one season to the next (Chapman 2014)

• Scores can improve with training (Kiesel 2011)

• Training to correct FMS deficits have shown improvement in strength and flexibility in elite HS baseball players (Song 2014)

PROS

• Potential to identify individuals at risk

• It is the best of what we have?…right now

• Time

CONS

• Time • The evidence is not

overwhelming• Is not a predictor of

athletic performance• Do we need all tests for all

populations?• Some tests are difficult to

assess

• “An athlete’s ability to follow directions is as

important as their physical ability to successfully complete the FMS tests.”

• After testing, dig deeper

• ROM, strength, use other screens/tests

• Keep asking questions and contribute to the

body of evidence

The short answer…

YES!!!

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• Torso/Tibia Parallel

• Femur parallel or below• Knees over the toes

• Dowel move beyond toes

• Asymmetry

• Feet ER 1 – Knee displacement, 2 –Torso and tibia do not

remain parallel, 3 – Femur does not reach horizontal, 4 –

Bar extends beyond toes.

Bar beyond toes – 92.3%

Torso parallel with tibia – 76.9%Femur parallel – 50%

Medial Knee Displacement (MKD) – 26.9%

• Very mixed

• Ranges from Poor to Good/Excellent (H. Gulgin &

Hoogenboom, 2014; Minick et al., 2010; Onate et al., 2012; Scibek, Edmond, & Moran, 2013; Smith, Chimera, Wright, & Warren, 2013; Teyhen et al., 2012)

• Variability between Novice and Expert (Minick, et

al., 2012, Onate et al., 2012, Smith et al., 2013)

• Variability across the movement sciences (Scibek et al., 2013)

• Kinematic differences between 1, 2, 3

• Peak DF excursion is greater in those that score 3 (Butler et al., 2010)

• Those that score 3 have significantly greater

peak knee flexion and knee flexion excursion than those that score 2

• Those that score 3 or 2 have greater peak hip

flexion

• Dill et al., 2014

• No difference when classified by normal or

limited ankle ROM

• Sig. difference when reclassified by weight

bearing lunge performance

• Greater knee flexion displacement

• Greater ankle DF

• Mauntel et al., 2015

• Differences between males and females

• Males = greater knee valgus!!!

• Males = Greater hip flexion → protec�ve

mechanism

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• EMG

• Compare those with MKD and those without

• Bell et al., 2012 = Significantly greater hip ADD in MKD group

• Padua et al., 2012 = Significant increase in hip ADD, gastroc., and tib. ant. activation

• Elevate heels → decrease in glut max, hip ADD, tib ant, and

gastroc activation

• Decreased DF with knee extended may

contribute to MKD (Bell et al., 2012)

• Bell et al., 2008 found no difference in squat

when assessing passive DF knee ext

• Approached sig. when DF assessed with knee in

slight flexion

• Maybe “clinical significance”???? → 20% difference in

DF between conditions

• MKD group did have sig. dif. hip ER

• Mauntel et al., 2015

• Females have greater hip IR/ER compared to males

• Hip mobility impairments may influence kinetic chain distally

• Dill et al., 2014

• DF PROM does not influence knee & hip kinematics sig.

• Reclassify subjects by weight-bearing ROM…greater knee flex displacement and peak knee flexion. (Normal = >44.02 degrees)

• Bell et al., 2008

• Greater normalized isometric hip extension and

external rotation strength in MKD group

• What is interesting about these findings?

• Bell et al. 2012

• No difference in concentric and eccentric hip

strength between MKD and control

• Does not have strong predictive value in regard to sport performance (Lockie et al., 2015)

• Some prediction on Vert Jump – Deeper squat = Greater Glut Max activation???

• 54% of golfers with DS fault had loss of posture during swing, 29% demonstrate a “slide” dysfunction during swing (Gulgin et al., 2014)

• These lead to inconsistent performance

• Track athletes that score a “3” on DS have greater longitudinal performance (Chapman et al., 2014)

• DS demonstrates minimal injury predictive

value in firefighters and military recruits (Butler

et al, 2013; Bushman et al., 2015)

• Use caution when using this test alone for

predictive value (Bushman et al., 2015)

• Use of DS and ASLR has predictive value in

runners…better than entire FMS (Hotta et al., 2015)

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• Determine NM vs ROM• Unload the squat• Check PROM & AROM• Check closed chain

dorsiflexion• Assess Strength• Heels elevated or not?• Do they know how to

squat???• Select other tests/screens• Correct identified

dysfunction

You perform a Functional Movement Screen on

a 20 year old female Division I soccer player. She has had ankle sprains in HS, but otherwise

no significant history of injury. Additionally she

has limited resistance training experience. She was a three sport athlete in HS (Soccer,

Basketball, Softball).

• Her scores are as follows• DS – 1 (MKD, forward trunk lean, inability to reach parallel)

• ILL – 2 (Left front heel comes off ground, forward lean. Right side only has a forward lean)

• HS – 1 (Left foot kicks hurdle on the way over, Right = 2)

• ASLR – 2 (both sides)

• SM – 3• Push up – 1

• Rotary stability – 2

• What is the Composite Score & does she have an increased risk of injury???

• Maybe, maybe not…

• What do we do next?

1. Eliminate tests that you do not need

a) Shoulder Mobility

b) Pushup?

2. Identify tests that are a 1 and work to identify dysfunctions

a) DS, HS, Push Up

3. Identify other tests/screens that may help guide corrective exercise plan

• Mobility vs Stability

• Unload the squat

• Do they have ROM in unloaded position?

• Assess squat with arms down

• Assess ROM of ankle, knee, & hip• Assess strength at hip and knee

• Single Leg Squat

• Step up/Step down

Questions?

Coming June, 2017

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Bell, D. R., Padua, D. A., & Clark, M. A. (2008). Muscle Strength and Flexibility Characteristics of People Displaying Excessive Medial Knee Displacement. Archives of Physical Medicine and Rehabilitation, 89(7), 1323–1328. https://doi.org/10.1016/j.apmr.2007.11.048

Bell, D. R., Vesci, B. J., DiStefano, L. J., Guskiewicz, K. M., Hirth, C. J., & Padua, D. A. (2012). Muscle Activity and Flexibility in Individuals With Medial Knee Displacement During the Overhead Squat. Athletic Training and Sports Health Care, 4(3), 117–125. https://doi.org/10.3928/19425864-20110817-03

Bushman, T. T., Grier, T. L., Canham-Chervak, M. C., Anderson, M. K., North, W. J., & Jones, B. H. (2015). Pain on Functional Movement Screen Tests and Injury Risk. Journal of Strength and Conditioning Research, 29 Suppl 11, S65-70. https://doi.org/10.1519/JSC.0000000000001040

Butler, R. J., Contreras, M., Burton, L. C., Plisky, P. J., Goode, A., & Kiesel, K. (2013). Modifiable risk factors predict injuries in firefighters during training academies. Work (Reading, Mass.), 46(1), 11–17. https://doi.org/10.3233/WOR-121545

Butler, R. J., Plisky, P. J., Southers, C., Scoma, C., & Kiesel, K. B. (2010). Biomechanical analysis of the different classifications of the Functional Movement Screen deep squat test. Sports Biomechanics / International Society of Biomechanics in Sports, 9(4), 270–279. https://doi.org/10.1080/14763141.2010.539623

Chapman, R. F., Laymon, A. S., & Arnold, T. (2014). Functional movement scores and longitudinal performance outcomes in elite track and field athletes. International Journal of Sports Physiology and Performance, 9(2), 203–211. https://doi.org/10.1123/ijspp.2012-0329

Chimera, N. J., Swanik, K. A., Swanik, C. B., & Straub, S. J. (2004). Effects of Plyometric Training on Muscle-Activation Strategies and Performance in Female Athletes. Journal of Athletic Training, 39(1), 24–31.

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Clark, M., & Lucett, S. (2010). NASM Essentials of Corrective Exercise Training. Lippincott Williams & Wilkins.

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Dill, K. E., Begalle, R. L., Frank, B. S., Zinder, S. M., & Padua, D. A. (2014). Altered knee and ankle kinematics during squatting in those with limited weight-bearing-lunge ankle-dorsiflexion range of motion. Journal of Athletic Training, 49(6), 723–732. https://doi.org/10.4085/1062-6050-49.3.29

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Gulgin, H. R., Schulte, B. C., & Crawley, A. A. (2014). Correlation of Titleist Performance Institute (TPI) level 1 movement screens and golf swing faults. Journal of Strength and Conditioning Research, 28(2), 534–539. https://doi.org/10.1519/JSC.0b013e31829b2ac4

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Hotta, T., Nishiguchi, S., Fukutani, N., Tashiro, Y., Adachi, D., Morino, S., … Aoyama, T. (2015). Functional Movement Screen for Predicting Running Injuries in 18- to 24-Year-Old Competitive Male Runners. Journal of Strength and Conditioning Research, 29(10), 2808–2815. https://doi.org/10.1519/JSC.0000000000000962

Kiesel, K., Plisky, P. J., & Voight, M. L. (2007). Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen?, 2(3), 147–158.

Lockie, R. G., Schultz, A. B., Jordan, C. A., Callaghan, S. J., Jeffriess, M. D., & Luczo, T. M. (2015). Can selected functional movement screen assessments be used to identify movement deficiencies that could affect multidirectional speed and jump performance? Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 29(1), 195–205. https://doi.org/10.1519/JSC.0000000000000613

Lockie, R., Schultz, A., Callaghan, S., Jordan, C., Luczo, T., & Jeffriess, M. (2015). A preliminary investigation into the relationship between functional movement screen scores and athletic physical performance in female team sport athletes. Biology of Sport, 32(1), 41–51. https://doi.org/10.5604/20831862.1127281

Mauntel, T. C., Post, E. G., Padua, D. A., & Bell, D. R. (2015). Sex Differences During an Overhead Squat Assessment. Journal of Applied Biomechanics, 31(4), 244–249. https://doi.org/10.1123/jab.2014-0272

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Moran, R. W., Schneiders, A. G., Mason, J., Sullivan, J. (2017). Do Functional Movement Screen (FMS) composite scores predict subsequent injury? A systematic review with meta-analysis. British Journal of Sports Medicine. ePub before print. March 30, 2017

Onate, J. A., Dewey, T., Kollock, R. O., Thomas, K. S., Van Lunen, B. L., DeMaio, M., & Ringleb, S. I. (2012). Real-time intersession and interrater reliability of the functional movement screen. Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 26(2), 408–415. https://doi.org/10.1519/JSC.0b013e318220e6fa

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