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Functional movement screen norms

“However, the common misconception that screens by themselves can prevent injury has been challenged because they only provide individual information that is often based on standardized exercise recommendations, and may or may not suit an athlete’s specific needs”

Screening tools can be helpful in terms of setting up expectations and who should be monitored over time, but so far a screening tool is not a good measure of who will get injured.

For instance, I’ve written extensively about the Start Back Screening Tool, but this tool is used after a person experiences an injury or pain. It doesn’t attempt to predict who will experience an injury or pain.

“Assessing basic fundamental movement provides an opportunity to create a more individualized training program that focuses on changing or modifying movement patterns, instead of focusing on the rehabilitation of specific joints and muscles.”

Assessing basic fundamental movements…let’s stop here. Who gets to judge basic fundamental movement?

If we listen to Paul Chek then we would include walking, running and pulling movements into an assessment.

If we listen to USAW, then the screen looks eerily similar to the movements that will be performed in sport, only with less speed and weight.

The goal of screening an athlete, or anyone for that matter, is to determine if the person has characteristics that would prevent them from participating in their life activities due to injury.

I also believe that we can modify movements and change motor patterns, but only to an extent.

For example, someone with biomechanical issues, such as a different angled neck of the femur, long femur or short torso will not squat/lunge in the same fashion as those with different levers.

Meaning that we can stretch the ankle until we are blue in the face, but at some point a person just runs out of dorsiflexion due to joint mechanics.

“The FMS (TM) was developed as a comprehensive pre-participation and pre-season screen, and consists of seven tests/movements which challenge an individuals ability to perform basic movement patterns that reflect combinations of muscle strength, flexibility, range of motion, coordination, balance, and proprioception.”

This sounds great! Unfortunately “pre-participation” in curling requires different mobility, strength and balance when compared to wrestling or archery. We can’t just hang our hat on a one-size-fits all approach.

“Five of the seven FMS (TM) tests are scored separately for left and right sides, and can therefore be used to locate asymmetries which have been identified as an injury risk factor. An FMS (TM) specific cut-off value of 14 or below is suggested to indicate an elevated risk of injury”

I don’t have data for this, but some sports are inherently asymmetrical. Look at tennis, bowling, curling, baseball, golf and so many others…would we increase risk of injury by making these players symmetrical?

I know that there is follow-up research on the FMS stating that the asymmetries on the test are more predictive than the score cut-off, but I would like to see a specific study done on a mostly asymmetric sport, one that limits forward running, but maybe emphasizes lateral movement and only use of 1 arm or leg.

“…small sample size…ability to generalize this cut-off value to other sport and recreation participants may be limited”

The ability to generalize the results from one study is limited to the participant demographics within that study attempting to cite. For instance, the FMS (TM) has a cut-off score of 14, but this only applies to profesional football players. That’s a very narrow field, with which to apply the results.

“To date, there are no published normative values for score on the FMS (TM) to help sports physical therapists, coaches, and athletic trainers interpret the raw data collected during testing”

Typically, we would see normative data or studies performed before we see abnormal, or predictive of injury studies, performed.

An example would be this:

If the norms for the FMS is 15, but injury risk increases at 14, there is a very narrow window of error on the tester’s ability that could take one from healthy/normal to high risk for injury.

“convenience sample…approximately 200 females and males…between 18 and 40 years…recruited from tertiary population”

“Exclusion criteria…use of mobility aid or prophylactic device, or if they had reported a recent musculoskeletal or head injury”

“Each participant was given three trials on each of the seven tests (deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push up, and rotary stability)”

To be certain, I do like some of the movements in the screen, but I’m not sure if I like the scoring and I believe that the screen is limited in scope. Here is a video of Grey Cook describing the movement screen. I enjoyed the video and I included it for your viewing pleasure.

“The combined composite mean score on the FMS (TM) was 15.7 with a standard deviation of 1.9 and a median of 16.”

Let’s break this down. Many people, both Physical Therapists and personal trainers, were taught to use the cut-off score of 14 as a sign of dysfunction.

The mean (average score) was 15.7, but the standard deviation could actually place the average in the same range as someone considered dysfunctional. If this is the case, then this testing is not very specific for finding dysfunction because the norm is dysfunctional.

“31% of the participants, had a composite score of 14 or below which indicates a heightened risk of injury according to Keivel et al.”

One-third of normal-healthy people are considered dysfunctional based on this test. We can’t extrapolate (assume that data from one study can be used on other people that don’t fit the study from which we obtained the data).

We can’t state thy this population is at risk of injury because of their score. Just because they scored 14 on the test doesn’t mean that they are at a higher risk for injury. They are not professional football players and can not be held to the same standards.

“The cutoff score of 14 was determined in a study on 46 professional football players…used with caution. “

The reason it has to be used with caution is simple.

This test is purportedly used to determine if someone is as risk of injury.

The average person doesn’t put themselves through the same type of activities and stresses as a professional football player. They shouldn’t use the same testing procedure to determine if they are at the same risk of injury.

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Categories: Physical therapy, Written BlogsTags: , , , , ,

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