Nice article, Anoop.
Where i can read more articles (get more info) about functional movement screen ?
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.
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.
Related Articles
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.
Anoop | Wed December 21, 2011
Thanks guys for the comments. I will have another review about the new FMs study soon.
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.
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.
