In sports medicine and rehabilitation there always seems to be terminology, courses, and techniques that are in fashion (and just as often out of fashion).  An assessment and therapeutic method that is receiving a great deal of attention is the functional movement system (FMS).  The FMS was first described in a 2 part series by Gray Cook in 2006.  Since then there has been an explosion in the number of strength coaches and health care practitioners that utilize the FMS on athletes at all levels.  The FMS is a trademarked system with standard FMS courses and the Selective Functional Movement Assessment (SFMA), a  4 part course created for health care practitioners.  Below we will look at exactly what the FMS is, how it may be applied and as always…..what does the research say?

What is the FMS?

“Put simply, the FMS is a ranking and grading system that documents movement patterns that are key to normal function.  By screening these patterns, the FMS readily identifies functional limitations and asymmetries.  These are issues that can reduce the effects of functional training and physical conditioning and distort body awareness.”

The above quote is taken directly from the FMS website.  After my reading (see references below) to try and decipher some literature, here is my attempt at summarizing the FMS approach in a few coherent thoughts:

• There is a movement in sports rehabilitation away from an isolated assessment method toward an integrated functional approach….but what exactly is a “functional approach?”
• The FMS evaluates movements that occur in a variety of athletic endeavours
• The typical pre-participation exam is strictly for exclusion purposes, never to evaluate the basic movements necessary for sport.  Traditional testing is comparative to normative data but doesn’t assess for function (the often used example is that of performing 100 crunches which is above average, however the form may be horrible).
• The FMS tests were created to address ‘kinetic linking systems’ (it thinks of the body as a linked system of segments) so analyzes whole body movement patterns and looks for ‘breaks in the pattern’ or compensatory movements in the kinetic link.
• The movements challenge the body in a proximal to distal sequence as these are seen as more efficient.  The FMS argues that these patterns were formed during growth and development.
• The FMS is NOT MEANT to be used for diagnosis.  Instead it brings to light limitations and asymmetries in movement patterns.

How is the FMS applied?

The FMS is made of 7 fundamental movement patterns (and 3 ‘clearing screens’) that evaluate 2 main aspects: Mobility and Stability.  The tests work, as explained by Cook, by placing the body in extreme positions where weaknesses and imbalances become apparent.  Without appropriate mobility and stability, compensatory patterns are used instead of efficient ones which in the long term reinforces poor mechanics and raises the potential for injury.  The 7 movements are scored from 0-3 in a simplistic method for a total score of 21.  Some argue the scoring is too simplistic, however the ‘thinking part’ of the FMS is the interpretation of the tests and the corrective prescription.

The 7 movements are: deep squat, the hurdle step, the in-line lunge, the shoulder mobility test, the active straight leg raise, the trunk stability push up, and the rotary stability test.

What does the research say?

While many techniques and evaluative systems alienate themselves from academic critique, the FMS deserves praise as I found at least 10 scholarly articles on the topic.  While not all are on the upper echelon of quality (to say the least), there are a few decent papers out there.

Reliability

Minick et al looked at interrater reliability (how often raters agree with each other) utilizing 4 independent raters: 2 novice and 2 expert (expert helped develop the tool and novice took the standard course and used the tool under 12 months).  On a sample of 40 college students the novice and experts agreed 89.6 and 86.7% percent of the time and the novice and expert groups agreed on 14/17 tests (excellent!).  A second study looked at reliability between 2 testers on just 8 subjects and had a score of 0.976 (again excellent).  Like any studies there were limitations (primarily that it was video analysis instead of in-person) however it’s a step in the right direction and the reliability of the FMS appears quite good.

Identifying Injury Risk

There have been 3 main papers on the use of FMS to identify injury risk.  The first by Chorba et al in 2010 looked at female collegiate athletes (soccer, volleyball and basketball) at an NCAA division 2 school.  Players that sustained an injury in season had scored 13.9 out of 21 on average while those without an injury scored 14.7.  Overall, nearly 69% of those scoring under 14 sustained an injury in season.  Sounds great, however as a diagnostic tool it was not so hot based on sensitivity and specificity (but remember….it’s not supposed to be a diagnostic tool!).

A second study by Kiesel et al on professional football players had a strength coach (CSCS) perform the FMS on 46 players prior to the 2005 season.  With a fairly strict definition of injury, the authors retrospectively looked at FMS scores and injuries sustained in that season.  Overall, with the key finding was a cutoff of 14.  If players scord under 14 on the FMS they had an 11 fold increase in injury risk!  This study again had poor sensitivity numbers (but a high specificity).

A final study on 433 firefighters found that lower FMS scores were associated with increases in age, rank and tenure (fairly intuitive findings).

Overall, the cut-off point in the literature (which is very little right now), seems to be 14.  Score under this and there is a higher chance for injury.

FMS and performance

A recent 2011 study looked at the relationship between core stability (utilizing the side plank, extensor endurance and flexor endurance tests as outlined by McGill), the FMS and performance on measures such as vertical jump, single leg squat for endurance, T-Run agility test and overhead backwards medicine ball throw on 28 subjects.  It concluded that because the FMS is designed to evaluate the quality of human movement during dynamic movements that may cause injury, it does not correlate greatly with core tests or measures of performance.  The take home message was one of specificity of training meaning the FMS tests the FMS, and isn’t a measure to determine one’s performance.

Overall the FMS is growing in popularity.  Though it’s not terribly supported yet in the literature as an evaluation or intervention method, intuitively it seems to make some sense.  The most common complaint is the simplistic nature of its assessment approach, however it’s a qualitative assessment……it’s meant to be simplistic on its surface level!  It’s certainly something I’ll have my eye on as more research comes to light and we do utilize functional movements at The Proactive Athlete in the evaluation of athletes.  If you’re interested in more information, don’t hesitate to contact us.  (the references on this blog were many….below are the main 3 as I see them but if you want a list of them all, email me at drkissel@theproactiveathlete.ca)

Cook G, Burton L, Hoogenboom B.  Pre-Participation screening: The use of fundamental movements as an assessment of function – part 1.  North American Journal of Sports Physical Therapy 2006;1(2):62-73

Cook G, Burton L, Hoogenboom B.  Pre-Participation screening: The use of fundamental movements as an assessment of function – part 2.  North American Journal of Sports Physical Therapy 2006;1(3):132-139

Kiesel K, Plisky PJ, and Voight ML.  Can Serious Injury in professional football be predicted by a preseason functional movement screen?.  North American Journal of Sports Physical Therapy 2007;2(3): 147-158