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Functional Movement Screen: Is it Really a Screen?

January 21 2011

FMS is a battery of 7 movement tests which claims to predict injuries and even prevent injuries. It is becoming very popular among NFL players and other fitness professionals.

functional movement screen gray cook

From what I have seen, the majority of people who use the screen are personal trainers. I wrote a review about FMS when I attended a 2-day seminar 3 years back here (Functional Movement screen).

Gray Cook, one of the brightest and most eloquent in the industry, in one of his recent podcasts talks about how FMS screen should be used on everyone just like a blood pressure screen. Let us see if FMS can be used as a screen or not.

What is the difference between a diagnosis test and screen?

Diagnosis: People are sick and they “come to you” because they want you to diagonoze why they are sick.

Screening: People are well and healthy and might be coming to you for some unrelated problems, and we are “soliciting them” telling that they will live longer or live better if they let you test them.

So what is the problem with FMS as a screen?

Screen Requirements: When you employ any type of screen, the validity of the screen should be of the highest quality since you are “labeling” people.And hence we should have some very solid proof that people will be better off in the long run. When someone scores less than the cut-off score in the FMS, you tell them that your chance of getting injured is extremely high. This is a great way to get someone move less or have fear of movement or spent their time and money trying to fix it with their trainer.

Injury Prediction: FMS has not been tested on the lay people, and hence we really don’t know if people will get injured if they scored less than the cut-off.

Injury Prevention:If they proved that FMS can indeed predict injury, then they will also have to prove that if you were to fix the movements that it will reduce the chance of getting injured. And FMS has not been shown to prevent injuries.  If you can identify injuries but can’t prevent injuries, then you better not label people or screen them in the first place.

Frequency & Severity: The importance of any screen will depend on the frequency and the severity of the problem. When FMS is used on lay people, you have to ask what is the severity and frequency of injuries. In NFL FMS study, 13 people out of 46 got injured in 4.5 months (28 in 100).  For the lay people, we might get 1-5 injuries out of 100 people in 1-3 years!

False positives & negatives: Every screen or test has false positiives & negatives since no test is 100% accurate. For example, even mammography screening will falsely diagnose of someone having breast cancer, when they don’t have it or falsely diagnose of someone not having breast cancer when someone has the disease. The measure of these are called the sensitivity & specificity of a test

In the FMS study for NFL players, the sensitivity was 46%. That means out of 100 people who will get injured, the test only identified 46 of them correctly, which is less for a screening test. A screening test needs high sensitivity (90%) because we want to identify as many people with the disease because we think this disease is of such importance that people need to be screened for.

Cost Vs Benefit: If we finally “prove that FMS indeed predicts injuries and prevents”, what is the cost vs benefits here? Imagine your client comes to get in shape as most lay people do. You do the FMS, finds dysfunctions, and tell them that their likelihood of getting injured is high. Though that wasn’t their goal or priority, you make them go through the FMS screen fixers for 10-15 minutes for which they have to pay 50-100 dollars an hour. 

So you have to ask yourself, with any screen, does all this time, money, and anxiety people have to go through, will it improve the quality of life in anyway? Will trying to minimize an injury which has the chances of next to nil in years improve her quality of life? Probably not. 

But what about an NFL player? For the NFL players, the benefits are huge. The severity and frequency of the problem is so high, the risk of getting injured is next to losing millions and their career. FMS also shown to predict injuries in NFL in one study. Injury prevention should be their primary goal.

Other: FMS is available, affordable & not that time consuming which is indeed a plus for any screen.

Practical Applications

  • For high impact sport athletes, FMS can be a worth while screen though this is not as black and white as most see it. 
  • For the lay people or the average joe who goes to gym, FMS cannot be justified as screen
  • What I wrote above is an integral part of evidence-based approach, which is not all about research studies as most people think.

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Kyle Waltz | Mon January 24, 2011  

I agree and disagree with the article. Through my education in functional performance I used FMS, and apply it today in my practice. I think where the screener or interpreter looses traction is in the application of the screens.  Just like when you have a patient with bilateral (0) DTR’s, this doesn’t mean they have bilateral neuropathy. Thus is true in the FMS screening procedure. You are looking for the aspect of the screen, that one thing that jumps out at you as the professional that will determine the likelihood of injury.  Say for instance a long distance runner scores low and fails quite a few screens but fails the deep squat exam due to restrictions in the ankle complex.  Giving that athlete the tools to fix that ONE problem will save the SI joints and the probability of their low back getting chewed up from poor biomechanics.  Take home message with FMS screens is to find the primary biomechanical fault and fix it!

Anoop | Tue January 25, 2011  

Hi John,

Thanks for the comment.

I don’t think you are interpreting FMS right. The whole point of FMS is not too look at isolated muscles & joints, but look at movements as a whole since it is based on the theory of regional interdependence. So an ankle problem could be due to a core stability problem and so forth.

And why deep squat? Why not hurdle step or lunge which mimics the running motion way better than a deep squat? And if you have shoulder mobility issues, you will fail the deep squat too.

And just so that you know, running is the most simple sport. It is studied to death and the strongest predictor for injury was shown to be weekly mileag - the other variables looked at included stretching, warm up, hip abductor strength, eccentric strength, anatomical factors (leg length, cavus foot). So imagine the complexities for injury prevention in sports like football and such.

Kyle Waltz | Tue January 25, 2011  

I couldn’t agree with you more smile.  I guess my interpretation of the article was the fact FMS was not accurate in “finding” the problem, and posed a problem when practitioners wanted to treat the positive findings. It also stated that FMS has failed to prove its relevance in injury prevention. And that is what I couldn’t disagree with more.  My examples were arbitrary and not really to prove any point.

Gerrit Keferstein | Sat January 29, 2011  

The FMS is not only a screening tool. It is a program design tool.

It tells you what not to do, but it also tells what to do.

Corrective exercise can be hard work for the person who it is corrective for. And it doesnt have to be slow paced, lying on the ground stuff.

You just have to be creative in your movement choices and be aware of your communication with the client.

“You have a risk of injury” would not be something you should be saying. In fact dont say anything. Screen them, get them moving…the right way

Anoop | Sat January 29, 2011  

Hi Gerrit,

Thanks for the comment.

I am not sure what you are saying. FMS means functional movement “screen”.

I do get them moving but not the right way because I really don’t know the right way. Who defined the right way and on what basis? I can see plenty of people moving in the “wrong way” and still with no problems whatsoever.

Gerrit Keferstein | Sat January 29, 2011  

The Screen tells you the right way.

By letting you quantify fundamental movement patterns and their limitations, their intertwining, and their progressions, it gives you a powerful program design guideline.

Say somebody scores low on the inline lunge. From a program design perspective you know your gonna have him work in the half kneeling position and NOT in a split position. Since the Split position is too challening a good regression is the half kneeling position.

Med Ball tosses from half kneeling, presses and pulls from half kneeling. Make him do work within the functionality of his own body.

As he progresses you recheck the inline lunge. If its okay it gives you green light to progress him to split stance work or lunging patterns.

When you use the same process with all movement patterns you almost have a readymade program specifically designed for each individual client.

Follow this blueprint and you will be having your clients move better. And this will fit every definition of “better movement”.

Its not only a screen, but a program design blueprint

Gerrit Keferstein | Sat January 29, 2011  

and regarding your comment on “they move the wrong way but still dont have any problems”

Dont look for the car accident. Look for worn out brakes, slick tires, the broken AC, dirty car seats. Even though it could be this might not present a problem right now, but there is a chance it will present a problem in 10,15,20 or 40 years.
Good Program Design has to eliminate that chance.

P.S.: I give credit to Charlie Weingroff for the car accident analogy

Anoop | Sat January 29, 2011  

Hi Gerrit,

Thanks for the reply.

I used to give these examples 8-1o years back when I knew little about pain and such. The human body and the pain mechanisms are extremely complex to compare it with a car.

It is now pretty clear that the biomechanical model of pain has very little to do with pain. That is the reason why people who are moving the” wrong way” or have “bad postures” are doing fine.  That is also the reason why multiple studies have shown problems like disc herniations, spinal stenosis, tendonitis and other extreme dysfunction in asymptomatic people (with no pain ). That is also the reason why the physical therapy field is moving from a tissue based model to a neurological based model.

The whole thing of you won’t get pain now, but you will in 10, 15, and 40 years is just fear mongering. And if you didn’t get in 40, they say you will in 60!

And moving in a certain way might be more applicable to acute acute injuries & populations who are involved with extreme forces, like athletes. So there is big difference when you talk about pain and acute injuries and when you talk about the general population and athletes.

Gerrit Keferstein | Sat January 29, 2011  

I appreciate your response but I respectfully disagree. Although I certainly do not have the same experience as you have, we could have clinical conversation on that topic, but in my opinion we have to set a base before specifics even matter.

While actually everything is grey, to understand and organize it you have to first think black/white. In that realm : analogies a great tool to understand complex systems.

I think we agree on the importance of proper movement in athletes. High Velocity, High Forces, High Volumes. Little changes can become magnified. Seconds matter, little injuries can cost millions.

But dont you think it becomes hard drawing a line between athletes and general population?

And more important, and probably the only question that matters : What is a good reason NOT to care about movement in general population?


You are right, I dont want to have my clients pay me for 15 minutes of mobilizing&stabilizing; without knowing if it reduces their risk of injury.
But that is not what the screen forces you to do. It just gives you a guideline of how to program movement. How you design your sessions is still up to each individual trainer.

And I totally agree that “fear” is not an appropriate trigger and is not to be used to explain the benefits of a screen.
The benefits lie in setting a baseline, teaching proper movement and improving communication about movement with other professionals.

I strongly believe in having something to quantify movement quality and using this data to modify program design. Be it athletes or general population.
Every performance coach tests performance (power output, energy systems), body composition and health parameters and modifies his programs according to these numbers. Why not quantify movement and modify movement according to these numbers?

Keith | Sat January 29, 2011  

I think if you have a better system, share it with us instead of trying to destroy something that has been in place for several years and proven to have had a positive benefit in several individuals who participate within the context of the entire system.  I think it is easy to try and discredit something as opposed to offering a better solution.  Give me that and I will listen, otherwise, take your poor spelling and bad grammer elsewhere!

Anoop | Sat January 29, 2011  

Hi Gerrit,

I do appreciate keeping the discussion to the point and civil.

We know it is extremely beneficial to keep a low back arch when you lift heavy weights. But do you keep a low back arch when you lift a pencil too? Probably not. Doesn’t quality of movement matter?

And it is not hard to draw the line when you evaluate the client goals and needs which you should know before working with any client, which I am sure you do.

“What is a good reason NOT to care about movement in general population?”

When you talk about good movement, you have to define why we need it in the first place. And if it for injury prevention (and it the reason why FMS is for),  then the above article clearly explains why not to care. If it for some other reason that cannot be defined, this article probably won’t apply.

And you are walking on very thin ice when you make statements like “strongly believe in quality of movements”. We don’t have very much evidence if the FMS movements will indeed carry over to other sports movements as claimed. We don’t know if indeed we changed movements, it will show up as improved quality or performance either. We know it can somewhat predict injuries in NFL players & firefighters from moderate quality studies. That’s all.

There is some value to the athletic population as I wrote because of the reasons in the article. Injury prevention is pretty complex and hence not as black or white to give a yes or no answer.

Anoop | Sat January 29, 2011  

Hi Keith,

Thanks for the comment.

If you read the article, I am saying why we don’t need this system in the first place. So there is no question arising of an alternative or a better system.

I wrote it is good for athletes even when I am sure many strength coaches would not even go that far. I said it is not beneficial to the lay people .What do you expect me to say? That we should teach FMS in school? And I do understand your frustration considering you charge $200.00 for this FMS.

And for the spelling and grammar. This isn’t a full time job for me nor this is a membership based site. It takes a few hours to write an article since I am not blindly copying what he said or what is written. After all that I am too impatient to sit through and check for grammar and spelling though many people have told me that I should. And you won’t understand considering your first and last post in your blog was in 2006.

Your comment about “taking it elsewhere” is only valid if I wrote that article in YOUR blog without invitation. I wrote it in MY blog. Makes sense?

Just a final note, grammer is spelled as “grammar”. Hope it helps.

Gerrit Keferstein | Sun January 30, 2011  

Anoop,

You do have some valid points and thank you for having this discussion as I am learning a lot.

The hypothesis is that having people move according to the Functional Movement System improves their functionality, their movement and significantly reduces their chance of musculoskeletal problems in the future.

This is what experts like Cook, Burton, Kiesel teach, this is my experience, this is the experience of a lot of other very successful trainers and from a logical standpoint it just makes total sense if you look at developmental kinesiology (innocent until proven guilty)

Until there is a valid Antithesis this is regarded as being true. This is how Science works and not the other way around.

I like the concept of your blog. There is probably too much anecdotal information out there, especially in the fitness world.

But when you want to be evidence based, what level of evidence based are you really looking to achieve?

According to the Oxford center for clinical evidence the entry level of evidence based is the opinion of an expert.

Im just a coach. And from a coaches perspective the screen helps me to have all my clients work hard within their capabilities. Athletes and Non-Athletes.

Anoop | Sun January 30, 2011  

Thanks, Gerrit. And really glad to hear you are learning.

Every treatment modality or exercise intervention, or for that matter, every exercise has some benefits and costs. You don’t try to squeeze in everything right? You pick the one based on your client goals, needs , availability, cost, scientific evidence and such.

As I said, if you think injury prevention is important for your client and your think the same, you should go ahead and work on it. FMS might be a good for that. Bu do understand the limitations too. For the reasons I said, it cannot be justified as a screen for everyone. And injury prevention definitely need more than FMS. If I am preventing ACL injuries, there is some clear research about specific prevention programs which I will have to include too. 

Usually the highest in the hierarchy is meta analysis and reviews. As we go lower in the level, the validity and reliability falls too. Expert opinion is considered the lowest form of evidence. There is a good reason because history has provided with countless examples of experts being wrong . It is also the large reason why evidence based approach evolved in the first place. Experts were getting it wrong, but couldn’t see through the cloud of confirmation bias.

It is also the reason Kyle and Burton are conducting studies on FMS. And that is good.

Gerrit Keferstein | Sun January 30, 2011  

Until these studies come out I will keep using the FMS. Not primarily to prevent injuries, but to design effective programs.

As Cosgrove said it :“Sports science is sports history”

Bill | Mon January 31, 2011  

I’d like to see any study of something like FMS be carried out by people who have no vested interest in its effectiveness. If not, I’ll be suspect of any positive result. Seems like something that would be very difficult to study in way that will give a reliable result. I mean, it can’t exactly be blind.

Anoop | Tue February 01, 2011  

Hi Gerrit,

And “effective” for what?

Some of the norms and standards we usually go by are dictated by our culture and tradition than anything else. The “good” posture and movement is a good example of how we associate health with how people look. So if someone moves with a round back, we automatically associate it with bad, unhealthy, pain and so forth.

Hi Bill,

Good point. That’s why people usually wait for other independent studies to make conclusions. They can use common methods like concealed allocation and blinded outcome assessors to take out the bias. But I don’t want to go to study details and such.

Gerrit Keferstein | Tue February 01, 2011  

Effective for Aesthetics and Health while also improving functionality (static & dynamic posture, motor control & strength).

Every good coach/trainer intuitively follows the rules of the functional movement system, sometimes without even knowing this system exists.

Its just about proper progressions. Every coach/trainer should have a system that guides his programming decisions & tells him when to regress/progress. That is all I am saying.

Marco | Tue June 07, 2011  

Nice article, Anoop.
Where i can read more articles (get more info) about functional movement screen ?

Anoop | Wed June 08, 2011  

Thanks Macro.

You can read plenty of articles by authors who are just totally fascinated by FMS and feel like they found the answer to everything they have been looking for. I don’t think there is any article out there which takes a critical look at FMS.

Check www.somasimple.com. There are a couple of good discussions about FMS in the forum.

Matt Esrick | Mon August 29, 2011  

Great article Anoop.

I’ve actually read this a couple times over the past month, even though its old, and finally got around to reading the comments… wow what a discussion.

There were a couple things I wanted to say though in regard to your discussion with Gerrit. And I think it applies in both accounts.

1) The scientific approach does not mean “innocent until proven guilty” nor does it mean factual until proven discredited. In fact, science works on a system of theories, once validated through a battery of trials, they become laws. Realistically, almost every scientific law we have ever had has been replaced at some point by some other law. So, in regards to Gerrit’s comment about requiring a valid antithesis- that’s misguided. FMS is a theory, or an approach. just like the scientific method is a theory/approach. So if you can understand that quantitative backing comes from science, and scientific methodology is theoretical ( because it has never actually been 100% validated), and FMS is based on scientifically obtained quantitative data, then there should be no debate as to whether or not to use it. In short, it is theory- use your best judgement.

2) As we design client programs, we do so with the consideration of bio-individuality. Gerrit even argued this point, which is 100% true. However Anoop mentioned that the FMS is a standardized screening procedure, so how can one use a standardized measure to quantify movements of non-standardized individuals, thus why would we ever consider it valid? Well I believe the answer lies in the combination of both arguments. Programs are individual specific. Movement screening should therefore be as well. So it is up to the trainer to continue their education to understand testing validity in regard to the capable specificity of each client. In essence, what I am saying is that FMS is like Gerrit said, a roadmap- even it is wrong, it can narrow down the correct path. However, we must always bear in mind Anoop’s point, which is that FMS may not be the correct map to be viewing depending upon the client. And that is where society screws up the methodology because once someone pays $$$ for a certification to do whatever, they are going to use it and confirm its validity regardless of its relevance or not.

Anoop | Thu September 01, 2011  

Thanks Matt for the comments! And you make good points.

Deep | Thu September 08, 2011  

So which assessment tool would you recommend?

Matt Esrick | Thu September 08, 2011  

I think the lesson learned here is to make a judgement call. not one screen is particularly better than the other as they are all flawed in some way, however the situation may dictate that one is more relevant than another. so confirm its validity for your scenario and take it from there. perhaps later down the road a variety of screens during the course of the training regimen may be required. its like a tootsie pop, the world may never know.

 

Brent J Carter | Sat October 29, 2011  

What a great discussion/ debate.  Kudos to you guys for keeping it pro.

Erik Petersen | Wed December 21, 2011  

Yes, PT moving to a neurological model is a good thing!

Anoop | Wed December 21, 2011  

Thanks guys for the comments. I will have another review about the new FMs study soon.

Andre | Sat January 14, 2012  

Hi Anoop,

“It is now pretty clear that the biomechanical model of pain has very little to do with pain. That is the reason why people who are moving the” wrong way” or have “bad postures” are doing fine.  That is also the reason why multiple studies have shown problems like disc herniations, spinal stenosis, tendonitis and other extreme dysfunction in asymptomatic people (with no pain ). That is also the reason why the physical therapy field is moving from a tissue based model to a neurological based model. “

It appears to me that FMS and its corrective work are primarily used to address motor control issues. Someones body is ‘confused’, maybe due to previous injury without rehab, and there is a deeply ingrained compensation happening which is limiting their mobility and stability and perhaps contributing to pain. Addressing and solving these issues - is that not a neurological based model?

“The “good” posture and movement is a good example of how we associate health with how people look. So if someone moves with a round back, we automatically associate it with bad, unhealthy, pain and so forth.”

Of course we address posture when working with clients. In it’s optimal position the spine asserts it’s own inherent stiffness/stability. When a client is in hypo/hyper lordosis/kyphosis the rest of the body is compensating to do the job of the spine - inefficient, wear and tear, develops poor motor control

Anoop | Sat January 14, 2012  

Hi Andre,

I have wrote one long about it: here it is: http://bretcontreras.com/2011/03/a-revolution-in-the-understanding-of-pain-and-treatment-of-chronic-pain/

Terms like inefficient, wear and tear means nothing. What we worry about is pain.

Hopefully, once you read that article, you will have a better grasp of what I am trying to say.

Christer Dehlin | Wed May 30, 2012  

Hi,

I personally find great value in the FMS and disagree very much with most of what you are saying, but let’s say the FMS really is useless tool that spreads fear of movement and is full of logical fallacies, what sort of screen do you use on your clients that is better?

From the article it almost seems to me as if you don’t believe in screening at all. How then do you determine what a client is capable of doing safely?

Or are you stating that anyone not in pain at present should do anything as there is no real standard for movement functionality, and no proof that certain movement patterns can cause injury if for instance mobility or stability is lacking?

Would you have Quasimodo the hunchback do military presses is he is pain free on outset, but scores a 1 on the shoulder mobility test? Would you someone with an ankle or hip restriction do a back squat without any prior correction work?

If so, is that really wise, or would it be better to place some trust in the logic of what Cook says until Cook’s assertions are disproved?

It seems to me there is more to lose by not using the screen than there is by using it, even if the hypothesis it is based has not been rigorously tested.

Anoop | Wed May 30, 2012  

Hi Christer,

Thanks for the comment.

1. Do you have to use a screen? Lacking an option doesn’t make the existing option is right or better.

1. Just make them do the movement. How hard is that?

2. If you can sit, stand, walk and do other basic movements, that is enough movement for the modern man. If you are an athlete or you work in the circus, then it is a different story.

3. How do you fix a hunchback? You can’t. Once we figure that out, we will talk about the screen for it. Don’t test things which you cannot fix it.

4. Depends on the population. I wrote the logic about who to use it in my conclusions.  This article was even posted on the FMS webpage because I have looked at it from both sides in fair manner.

Hope it helps

Deep | Thu May 31, 2012  

“Just make them do the movement. How hard is that?”

Basic, but great answer Anoop.

Christer Dehlin | Thu May 31, 2012  

I never said anything about fixing the hunchback. I asked if you would have him military press, but okay. I can see that you are not quite as irresponsible as had you pegged. I recently had a run with a person who saw no reason to limit exercises in the face of dysfunction. Glad you’re not like him.

The problem with separating athletes from the regular population is that the regular population needs exercise as well, and even though we don’t prescribe the same volumes of work for them, we often use the same exercises. I have had elderly women do bulgarian squats with success, but I won’t have them do it unless they pass a few screening test. You just don’t get fit by limiting movement to sitting, standing and walking, unless you by sitting and standing mean a full squat which of course is arguably one of the most useful exercise movements available.

I used to determine if someone could do an exercise by testing them on the exercise just like you say. The problem is that I could very rarely figure out why they failed. On the odd occasion I could coach the person verbally or visually to perfom correctly when they on outset were unable to, but most of the time they would just repeat the mistake endlessly. It wasn’t until I learned proper screening that I figured out how to identify movement problems. Sometimes, as you point out, those problems are unlikely to get fixed with corrective work, but most of the time the corrective strategies help, which leaves us with a lot more options for getting clients in shape. Rather than say you can’t do this and you can’t do thatm which for some is very disappointing, I can say you shouldn’t do this now, but it give it some time and put in the work, and it’s likely that we’ll get there. That was a big step in the right direction for me. I don’t do scare mongering at. I empower people through corrective work, and through that get them fitter for the long run.

Anoop | Thu May 31, 2012  

Hi Christen,

I make people do a free squat before I add weight on bar. And if they have flexibility issues or coordination issues, I work on it.

This is totally different from doing an FMS on someone or the rationale for doing FMS. I don’t care if they could do a full deep squat. I don’t do over head squat to exaggerate the problem.

What is the value of FMS as test for the normal population when even NFL players fail on this test. And the NFL players are 100 times better than us in performance. And we are taking that exact same test, the exact same scoring criteria, and comparing to a regular Joe who goes to work and comes home every day. How weird is that?

Eanna | Tue September 18, 2012  

Hi Anoop,

I realise I’m very late in this conversation but I still find it fascinating none the less. Also I want to thank you for raising the question about the FMS and I fully agree with you that it’s validity and effectiveness is not challenged enough.

I’m at a point in my career where I’m still studying and don’t want to come across as arrogant I just wish to hear your side of the coin further so as to gain a better perspective and have in myself a more informed opinion of the FMS.Just to mention again you have made some great points thus far and made me view the system from a new viewpoint so thank you again.

Just on your previous comment ‘I make people do a free squat before I add weight on bar. And if they have flexibility issues or coordination issues, I work on it.’

What do you constitute as flexibility issues or coordination issues? The fact that you don’t add weight on if you see any of these issues seems an awful lot like a qualitative measure regardless of whether you constitute a squat as being parallel vs deep. This to me seems to be the foundation of the FMS. Why don’t you add weight on? Probably because you know the resistance will be applied in an area your not trying to train and worse case scenairo that will lead to injury regardless of what population your training, elite or lay.

To say the rationale is completely different for the FMS doesn’t quite make sense to me in what I have read and experienced with the FMS as its a qualitative method of ranking movement. You may have someone do a free squat and rank yourself on whether weights can be added or flexibility or coordination needs to be improved but that in itself is your way of ranking movement i.e. identifying a weakness(if you think one exists) and training the weakness or progressing to resistance. You may do it in a different way which is great for you but the FMS seems to be a great, standarised framework for qualifying movement.

I don’t think that because NFL players are elite and they fail in the tests that it automatically invalidates the FMS for everyone else. I heard Cook put it nicely that the tests are’species specific not sports specific.‘They’re based on fundamental patterns learnt through development as a baby onwards. At the same time though I agree that more studies need to be done particulary for general populations.

I’d just like to add that why I think a lot of people will adopt the FMS unchallenged is the fact that unlike other new fitness tools,phases etc. the FMS at it’s very worst will just get people to stretch more and also doesn’t pose as a threat to injury although I understand that isn’t an argument for it’s implemntation as it is more a response to a perhaps future removal of the system.

I hope I didn’t present myself as someone who thinks they know it all as I merely aim to identify and challenge some of the opinions you’ve put forward to gain a better understanding for myself.

Anoop | Thu October 11, 2012  

Hi Eanna

Sorry for the late reply. But welcome and good first post.

To answer your question, a flexibility issue might be a tight ankle joint which limits the depth in squat. So these issue are not always related to safety. And as I wrote, flexing the back is ok. Flexing the back with 500lbs is not ok.

If FMS gets any credit, its because of this common sense reason. I don’t know if you read my conclusion, but I wrote:
For high impact sport athletes, FMS can be a worth while screen though this is not as black and white as most see it. Also I talk about other aspects like cost vs benefit ( NFL player example), prevalance of injuries, false positives, cost effectiveness that also plays a big role when you choose a screen. So I never wrote that FMS is useless.

And just because Cook said it is species specific doesn’t make it species specific though it sounds nice.

If I change the ankle flexibility, will it change the way he squats. Sure. If I change the FMS, will it change the FMS score? Sure. But will it change the way he performs on the field? Nobody knows. And If I change the way he performs on the field based on what FMS think is the ‘right’ way, will it lower the injury or make him perform better. Nobody knows. There are too many if’s here which most people are missing.

And as you said we need more studies. And the only study FMS people have to do is, pick a few people, make them do FMS and improve the score and show that the injury rates are lower after a few years. It is as simple as that.

Colleen Broersma | Thu February 14, 2013  

Dear Anoop,
You make some salient points. As both a trainer of Personal Trainers, Spinning Instructors, Group Ex. Instructors and a Corporate Health and Productivity Management Consultant I can tell you that the FMS has great value in assisting “lay people” with injury prediction and prevention.  We utilize the FMS with all of our corporate clients as a means to customize corrective exercises for the population and to quantify progress.  It is administered concurrently with a battery of psychometric, pain and productivity assessments. To date we have realized the following results:
Pain reduction: Employees participating in corrective exercises based on the FMS an average of 15 days per month, for 9 months, reduced overall bodily pain by 41%, 39% in the low back, and 65% in the wrist. (Pain was reduced in all joints in the body 21% - 65% – Numeric Pain Scale was the assessment tool). Of note is the reduction in pain in the extremities following a mobility/stability/core strengthening intervention.
Increases in functional movement:
Participants’ ability to lunge, step and squat improved an overall average of 54%, while asymmetry, a predictor of injury was reduced by 71% in the lunge and 68% in the hurdle step. We moved all of the population over the cut off.

We are currently assessing (2 years of data) the relationship between FMS, interevnetions and slips, trips, falls and musculoskeletal disorders (based on claims utilization, absenteeism and STD, LTD claims).

Injuries in the lay population are very real and costly - From the “human costs” of MSD – unnecessary pain and suffering, loss of income, stress and conflict to the total estimated cost to business - over $200 billion in the United States every year, MSD’s affect over 40 million people age 45 and older. In addition the indirect costs of MSD, lost productivity - including presenteeism, absenteeism, etc. are estimated to range from 4.5:1 to 1:1 of direct costs.

We assessed productivity (SPS-6) and repeatedly showed an average of a 5% increase as a result of pain reduction.

So the value of the FMS in the lay population as others have mentioned; is a tool like blood pressure and other biometric screenings to be used as a means to design interventions.

Anoop | Fri February 15, 2013  

Thanks Collen.

It is good that people are researching the question simply because we are not sure. That was my whole point.

And I would wait for the studies than believe you since you were a ‘trainer’ of trainers and group fitness instructors. I was one too so I know it doesn’t mean a thing!

Sep Rafiee | Thu April 18, 2013  

Hey Anoop-

Really, really late into this thread but just wanted to drop you a line as a show of solidarity in your views regarding the FMS. 

How you keep your cool in responding to some of these posts is beyond me!

I’ve spent the last (almost) ten years as a physio in professional rugby, first with premiership UK sides and now in an Australian Super 15 side.  And as you may know rugby is a sport with some impact. 

I can say that not one franchise here in Australia utilises the FMS, for the vary exact reasons as you put forward.

Not only that, we tend to steer away from any system which simplifies complex movement to a few tests, and then promises no injuries should you execute the tests well.

The only thing you improve by doing/training the FMS, is the FMS.

I really wish movement & performance was that easy to quantify and improve- there’d be a lot of us out of a profession.

I feel sorry for you to have to post responses to people who are so hook, line and sinker (fanatical) on the FMS model.

That’s my two cents, not wading in any further- good luck with future posts which are no doubt going to give me laughs a plenty.

Craig | Tue May 21, 2013  

Interesting commentaries…  Thanks to all for your input and Anoop for facilitating the conversation.

I’m in the industry, always try to stay abreast of new/recent developments, shifts in thoughts re training, always question anything and experiment with it before jumping aboard, currently looking at CrossFit & CF endurance, MovNat and FMS… History has proven, particularly in the field of nutrition, new research often alters today what was recommended yesterday. And of course we are all individuals and there isn’t a one size fits all way to eat/live/train!

I think as long as we have some kind of movement/fitness/health/history assessment tools (even if it’s a workout) then that’s a good starting point. FMS may well be a useful tool as part of this, which doesn’t mean we have to use it or shouldn’t do anything else or investigate further if we think it is relevant.

Achieving your athletic/genetic potential!
Do you or should you want to or need to? For a professional athlete you would hope so, for an average person well for those driven individuals why not, others may not be as interested. So how far you move towards trying to help optimize an individuals posture, mechanics, nutrition etc depends on the outcome they want to achieve. Obviously injury and potential for injury has to be considered depending on the goal and what they are wanting to do. Should anything discovered in a consultation with the potential to cause future injury/pain/limit performance etc be highlighted and discussed? I think it would be negligent not to, we’re not saying this will definitely happen but highlighting a potentially increased chance, and of course you can present it in a positive way e.g. Weight loss client - ‘ankle/hip mobility is currently restricting your ability to perform some movements optimally, if we can improve that then we can train through greater ROMs, we’ll have more exercise options available and the ability to train at higher intensities that will get you to your goal quicker! How does that Sound?’ There is such a thing as optimal posture and body mechanics! Can everyone achieve it? No! But if you’re in a position to be able to help someone get closer to it and you can work that in alongside helping them achieve their main goals then I think you should. It also usually enables you to set more goals, gauge a clients progress and make them feel great about themselves. e.g. 6 months ago you were 11kg heavier, had tight calves and struggled to stand from seated, now you’re leaner, stronger, more functional and can do a full ROM squat with a 40kg barbell how does that make you feel?

re FMS I think having a widely recognized, industry standard screen/assesment tool available to use that’s simple and quick to carry out, doesn’t require lots of expensive equipment, and produces reliable and consistent results regardless of the tester is valuable if it provides results that are valuable re highlighting the need for further investigation or assists with programming that can improve a client’s performance. Test retest ability to gauge improvement is also important. Is FMS that tool?  I don’t know, but if not not what else is available?  Until I’m convinced it’s worth investing in I’ll continue to do my own thing.

Anoop | Sat June 01, 2013  

Thanks Craig for the comment.

First, there is no such thing as optimal posture and body mechanics.

Second, what else? Look at your specific sport,look at the bio-mechanics, look at the what injuries are more common in your sport, then look at protocols that have shown to prevent it. For ex, ACL injuries.there are specific protocols that have been tested and shown to prevent injuries. They don’t just rely on endless philosophy like FMS.

For the general population, there are specific tests to evaluate function tested on thousands of people and correlated with disability and self-reported function. The most valid, sensitive and reliable one includes, getting up the chair, balance test, and walking speed.

Dante | Mon September 09, 2013  

Good article, I actually use FMS but I still have plenty of doubts (thats why I´m here). I´m a physical therapist and, as I study movement, I just use it as an extra tool, I don´t instantly use in every patient that comes to me. All (few) tests I´ve learned during my formation where too “isolated”, they didn`t tell me so much about “how moves” a person.
I know there´s still lack of evidence but in my profession we are constantly moving in a “thin line” and subjective paths, we just can pay attention what we´ve actually got, browse some evidence and use common sense and experience to create the best we can a treatment for our patient. This is not maths, it´s biological science and it´s in constant change, for example, 30 years ago doctors used aspirin to relieve every single pain. Today we know thats probably not a good choice…

Thank you and sorry for my English, it´s not my mother language

Anoop | Sun September 15, 2013  

Hey Dante,

Thanks for the comment. And why sorry? English is my third language haha

You should check out www.somasimple.com. It is amazing forum and you will like it a lot. Lots of discussion about pain and FMS there. Tell my name if you posting there ok

Shane | Mon January 06, 2014  

Anoop and readers,

Great discussion and thanks for staying professional. I am an ACSM-HFS and Massage Therapist. I am not FMS Certified but am intrigued by these systematic ideas for movement quality I have been seeing lately.

I would like to talk about this statement made above.

“there is no such thing as optimal posture and body mechanics”

I have been looking for the answer to this issue for some years. I agree with your statement in that as long as their is proper range of motion and no pain a client should be fine to follow the recommendations for physical activity (which is not what most trainers and general public do). However, I am starting to believe that proper posture and body mechanics both exist.

What are peoples thoughts on proper muscle recruiting patterns if we consider Thomas Myers’s functional lines of muscle and facia with training left right stability and recruitment patterns (FMS, Kelly Starrett’s system, Pavel’s Kettlebell system) and relationship between the order, timing and combination of muscular contractions which lead to safe movement?

For this question to be relevant we have assume that our bodies have changed for the worse. My example is sitting in a chair habitually for 12-24 years of school and then entering a 20 year career where the primary activity is to sit changes how a human contracts muscle groups to stand (from the foot to the neck). This lifestyle is a biological anomaly for humans. I just spent 2.5 years in rural Africa and all people sat into and stayed in deeps squats 10-30 times a day, even the chief. I and most people I know cannot do this basic movement without causing pain. Another fact is that people in the working age group where I lived in Africa were had a drastically increased prevalence of back pain if they worked for the government behind a desk or at a clothes factory sewing for long shifts.  Therefore, I would hypothesize movement has changed and new movement compensations (order, timing and muscle combinations are being used) are in need of correcting at least to increase quality of life and decrease back pain in a population that is constantly living longer than their parents.

Is it possible that posture and body mechanics are actually a result in how and when we contract, hold and release musculature? And based on training theory in combination with human development of movement that the FMS is restoring “proper muscular contraction for posture and bio-mechanics”?

Thanks,

Shane

Michael | Mon February 03, 2014  

The problem that I’m seeing with this article, and articles arguing against the FMS is that the arguments are based on 2 things. The first being that the screen shows whether or not the client will get injured, 0% or 100%, black and white, no in between. And the second problem is that the authors assume that the ones providing the screen agree with these blanket statements. Do people score poorly on the screen and go about their lives without any issues? Yes. Do people score well on screens and still get injured? Yes. The issue is that the screen is a probability tool. Probabilities by definition, are just that, inexact guesses of what MAY happen, not guaranteeing what will or will not happen. No screen/test/idea/system/assessment can perfectly predict the future. We live in an imperfect world with imperfect movement, and imperfect procedures. All we can do is use the tools of our chosen craft because there will be problems with every single system out there in some way.

Anoop | Sat February 15, 2014  

Hey shane,

Check the latest article on the site about pain. You might like it a lot. Thanks for the comment.

Thanks Michael. Please look at the false positive and negatives in the article and the prevalance. A sensitivity of less than 50% is worse than a coin toss!

Fred Barbe | Tue February 17, 2015  

I love to see how your opinion has evolved since your article in 2008! Funny though, for me, as a bodyworker and personal trainer , the FMS is really useful for the average Joe who wants to get in shape after 5 years of being a couch potato. Even without assuming that the FMS is an accurate predictor for injuries, it just give us a safe and nice place to start for Joe before getting into serious business. I see that as a 8-12 weeks prehab cycle to improve Joe’s movement and build his confidence. It just works wonder for me and my clients and I haven’t found a better tool so far!

Anoop | Wed February 18, 2015  

Hi Fred,

It hasn’t changed much. And I don’t think the FMS research hasn’t shown any thing different either. In fact, now they are combining with others test like the Y-balance to predict injuries. I will write a review looking at it.

If you think it helps, use it. That cannot be used to back up FMS. Just too anecdotal. You clearly don’t need FMS for people who want to lose and get back in shape.

Results Driven | Wed December 30, 2015  

From all the research I’ve done poking around it seems the main issues are: Administering the test properly and what do the results mean.  Seems its a way to point out key weaknesses in how people move and thus reduce the risk for injury.  Considering my own injury history I wonder if someone could have spotted the weakness I obviously had and given me extra work to address it, what that could have meant for me.

I think I’m sold.  Going to go ahead and knock out the online course and get this test passed.  I work with athletes exclusively right now, so this is a no brainer

What do you think?

Smileys

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