The Functional Movement Screen (FMS®) was created in 1997 and since that time it has undergone tremendous scrutiny. This has and always will be a positive benefit, since it has allowed us to continue to refine and improve the Functional Movement Screen System. Ironically, the professionals and colleagues Gray and I work with and look to for feedback are the FMS’ biggest critics. The FMS continues to grow and gain in popularity within the exercise profession, and with this growth brings on more and more criticism concerning its effectiveness. The biggest critique we have gotten over the years is the lack of research to support use of the FMS. In the beginning this was a fair criticism, however, more and more research is becoming available relating to its scope and effectiveness. Dr. Rob Butler just completed a brief literature review, which is below.
It seems at this point we have accomplished three things with the FMS.
1. It is a reliable tool that can be quickly and easily administered in almost any setting.
2. It can be used to identify individuals who are at risk for injury within certain population groups.
3. We can improve the FMS score with interventions.
However, even with the research suggesting these are true, there are still areas we must continue to research in an attempt to determine the effectiveness of the FMS. For example, in response to Anoop T. Balachandran’s recent website post, http://www.exercisebiology.com/index.php/site/articles/functional_movement_screen_is_it_really_a_screen/
The observations and comments are fair, and represents what the research suggests at this point. However, implying the FMS is not a valid screen for the non-athlete or general fitness population is not entirely accurate. We must remember first and foremost what the FMS is actually intended to do: The FMS is designed to identify movement pattern dysfunctions, thereby helping create the best possible intervention.
The FMS may never be able to determine injury risk in the layperson, mainly due to the difficulty in setting up an injury study with the general population. Currently, there is no consistent research on injury prevention within the general population. The best population groups to use for injury research are those who get hurt and perform clearly defined activities (athletes, military, firefighters, etc), and this is what we did with the FMS.
Knowing this, the purpose of using the FMS in the general population shouldn’t simply be to determine injury risk, but to identify and “screen” movement pattern dysfunction. The question then remains - does this screen accomplish that? Based on the feedback we have gotten from the exercise professionals who use the FMS within the general population, we feel it does. For those of us who appreciate a functional approach to exercise a functional movement baseline is the most logical starting point.
However, we must continue to work on providing the best possible evidence through research. Currently there are quite a few FMS research projects underway that will hopefully continue to validate the FMS as an effective tool for the exercise professional.
Lee Burton, PhD, ATC, CSCS
Summary Literature Review
Robert J. Butler, PT, PhD
Doctor of Physical Therapy Division
Department of Community Health and Family Medicine
DUMC Box # 104002
Durham, N.C. 27708
So what does the scientific literature tell us about the Functional Movement Screen?
The Functional Movement Screen was developed in its current form over a decade ago and has gained support in the fitness community as a way to efficiently screen and develop a corrective exercise program to improve movement patterns. As the tool has gained in popularity clinically, research has begun to be conducted that has added to the support of the screening tool. Current research on the Functional Movement Screen 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.
Reliability of the Functional Movement Screen has been established by two separate studies that have been conducted on the 21 point screen (Minick et al., 2010) and the newly developed 100 point screen (Butler et al., in review). Both studies revealed high reliability between raters who have been trained in the Functional Movement Screen and who used videotaped performances for scoring. At this point, the 21 point test is recommended for fundamental screening purposes and corrective exercise prescription and can be used reliably between individuals trained on the screen. The use of the 100 point FMS has been recommended in a research setting to improve precision of the screen but it has yet to be utilized in an injury prediction study. An initial analysis suggests a strong correlation between the 21 point and 100 point FMS (r2 = 0.52). No studies have been conducted on the reliability of the real-time scoring of the Functional Movement Screen; however, research is currently in review that addresses this missing piece.
Clinical validity of the Functional Movement Screen has been established in its ability to identify individuals at risk for musculoskeletal injury through the use of an evidenced based cut off score as well as identifying the presence of an asymmetry during the testing. Three studies have utilized diagnostic statistics to establish the cut off score of <= 14 as being appropriate to identify individuals who have greater odds for sustaining an injury (Kiesel et al., 2007, Kiesel et al., in review, Butler et al., in review). Four studies have validated the use of the Functional Movement Screen as a tool to identify individuals who are more likely to sustain an injury. Odds ratio in these studies have ranged between 2.3-8.3 in professional football players, female collegiate athletes and firefighters in training. All of these studies utilized the cut point of <= 14 (Kiesel et al., 2007, Chorba et al., 2010, Kiesel et al., in review, Butler et al., in review). Additionally, one research study has validated that the presence of asymmetry on the FMS is associated with an elevated risk for injury in professional football players (Kiesel et al., in review). Other research examining the cut score of the FMS has suggested that failure on the FMS, operationally defined as <= 16 in this study, in firefighters was strongly associated with an injury in the previous year (Peate et al., 2007). Additionally, a recent study in Marines reported that recruits who fail the FMS, evidence based cut off of <= 14, were twice as likely to fail to complete basic training as a result of an injury (Raliegh et al., in review).
While establishing the clinical validity of the screen is beneficial it would have little clinical relevance if performance on the Functional Movement Screen was not modifiable. Three studies have reported that scores on the Functional Movement Screen can be improved with a 6 week training program (Goss et al., 2009, Cowen et al., 2010, Kiesel et al., 2010). Improvements in the composite FMS score ranged from 2.5-3.3 on average. It was interesting to note that in one study low performance on the deep squat (FMS DS = 1) was strongly associated with lack of ability to improve an individual’s score beyond the threshold that identified an elevated injury risk (Kiesel at al., 2010). An additional point of interest from this study that was no matter what subtest of the FMS was focused on for the corrective exercise progression, the largest improvements in scores were observed in the core stability tests.
It is often asked how performance on the fundamental movement screen correlates with performance. To date, only two studies have been conducted that have correlated performance on the Functional Movement Screen with measures of core stability and performance (Okada et al., 2010, Shaffer et al., 2010). Okada et al. (2010) observed that, in recreational college aged athletes, the subtests of the FMS correlated poorly with certain measures of core stability, however, some of the subtests of the FMS correlated highly with certain performance tests. A moderate correlation was observed for the HS, SM, PU and RS of the FMS with a backwards medicine ball throw. This study also observed that the SM, ILL and HS of the FMS was moderately correlated with performance on the T run. Finally, these researchers observed that performance on the single leg squat correlated with SM. Shaffer et al. (2010) found that in active members of the military, performance on the FMS lunge and shoulder mobility were strongly related to performance on the Y balance test. It is interesting to note that in both of these studies performance in unilateral stance was associated with the SM test which supports the regional interdependence model of the FMS.
Finally, one study bas validated performance on the Deep Squat of the FMS using motion analysis techniques (Butler et al., in press). It was observed that individuals who scored a 3 on the FMS DS went through greater knee flexion and exhibited a greater knee extension torque than individuals who scored a 2 or 1 on the FMS DS. At the hip, it was observed that individuals who scored a 3 on the FMS DS went through greater hip flexion and produced greater hip extension torque than individuals who scored a 1 on the FMS DS.
In summary, the Functional Movement Screen is a reliable tool that can be used to identify individuals who are more likely to become injured. It has also been observed that improvement in the composite FMS score can occur through movement related training programs. Future research should identify whether utilizing the Functional Movement Screen as a baseline for movement in a rehabilitative setting can remove the primary risk factor of the previous injury in predicting subsequent injuries.