- Image courtesy of functionalmovement.com
When I was interning at Northwestern University I was introduced to an assessment system called the Functional Movement Screen (FMS). This system was developed by Gray Cook and Lee Burton in an attempt to identify specific movements, or rather their compensatory counterparts, that may eventually lead to injury for an individual. But, just like all movement screens, there are issues that come up, not the least of which is figuring out what you are actually measuring with these tests.
The FMS was designed to try to evaluate an individual's quality of motion while performing certain "foundational" movements and then correlate those evaluations with a specific set of outcomes or results. From there, "corrective exercises" are prescribed to the individual in an attempt to improve their score when they retest at a later date.
- Image courtesy of exercisebiology.com
The screen consists of seven movement exams and each movement is given a score of 0-3 based on the athlete's ability to perform the movement according to Cook and Burton's standards, with 3 being the best score possible. Five of the movements are scored both on the right and left side of the body and then the lower of the two scores is counted as the overall score for that test; two movements (the trunk stability push-up test and deep squat test) are only given one score. A breakdown of the movement tests can be found here.
The scoring of the tests is said to be objective, however, it is all done by eye with the goal being to see and identify compensatory movement patterns. In my experience with this system, the scoring is almost completely subjective to the point of scores being given out based on whether a coach "feels" like giving the athlete a 2 or a 3, etc., as if Cook and Burton were not only attempting to measure movement pattern deficiencies, but also the generosity of the proctor.
Based on this scoring system, the highest score that can be achieved is a 21. If someone scores less than 14, it is said that their likelihood of sustaining an injury is up to 11 times greater than if someone scores 14 or above.* However, once someone achieves a score of 14, there doesn't appear to be reports of higher scores indicating a lesser likelihood of injury.
There are numerous issues I have with this method of evaluation. First, while evidence indicates that there is some type of correlation to the total score and likelihood of injury, there is no indication as to why an individual actually gets injured in the first place. This is for the very simple reason that the tests aren't measuring anything specific. They are only looking at if a movement can be performed to the satisfaction of the proctor. If the proctor is for some reason unsatisfied with the exam, there is nothing to even remotely lead them to determining what actually caused the movement deficiency.
- Image courtesy of fairfieldmemorial.org
Say someone's left knee dives in while performing the deep squat test. So what?? All you can gather from that is, "Hey, the knee dived in. It may make sense to not have them squat that deep." You cannot say if it was foot issue, ankle issue, upper thoracic issue, or maybe even a shoulder complex issue because the test is supposed to be performed in at least 180 degrees of humeral flexion so as to replicate an overhead squat. Maybe the person couldn't effectively dorsiflex their first ray. How would you know that? "Oh look, the knee dives in." What can you possibly conclude from that?
Second, the FMS program has a multitude of "corrective exercises" (found here) that can be picked from and prescribed to individuals based on their performance during the exam. There is SO much going on as far as movement in all of these exercises that the likelihood of addressing whatever issues there may be, assuming you could actually figure out what they were in the first place, is slim to none. So now we are combining our guess at what the issue is with a shotgun approach to solving it.
Third, and this has to do less with the program itself and more how it is being applied, the FMS seems to be very popular among collegiate and professional teams. I cannot speak to the professional level, but on the collegiate level, strength and conditioning programs are notorious for not having the amount of time they would like to with their athletes. Because of the alleged time limitation, and because these programs are trying to get large numbers of athletes through this testing protocol as quickly as they can, the actual accuracy of the tests as well as the ability to prescribe an individualized "corrective exercise" process is severely diminished.
So, even if these tests could always point us in the right direction regarding where to look for issues, which they cannot, and even if the "corrective exercises" prescribed were specific enough to accurately address these issues, which they are not, there would still be the requirement that the "corrective exercises" be performed frequently enough and with enough attention to detail to stimulate the intended adaptations, the latter of which is often not the case when time is already at a premium.
Can there still be some good derived from using the FMS? Yes, and here is my suggestion in how to go about it: omit the "corrective exercises". I keep putting quotations around this phrase because I am convinced you are not correcting what you are intending to with these exercises, and if something happens to improve it was more through dumb luck than an actual well thought out plan.
Yes. Drop the "correctives". Why? Well I think you could still do the movement exams and then have your athletes or clients go through a few months of their training and then retest the movement exams. If the score got worse, it may be reasonable to say that the program you gave them needs to be changed. So why not just put the "correctives" in as part of the program? Because if there is any improvement in the score, it will be thought that it is due to the "correctives" when in fact they are much too general for there to be a definitive correlation. (That last statement is purely speculation based on observation. I do not have an actual p-value to back my claim.)
However, by leaving them out, any changes in the FMS score may cause you to reevaluate how you are currently training people, which can be a very beneficial and eye-opening experience. Furthermore, if something is an issue before the "correctives", doing general "correctives" will more than likely just continue to improve what is already working well, which may in turn lead to better scores. So, once again, the underlying issue goes without being addressed.
What I would really like to see done is to have an experiment where people who appear to have the same issues based off of the FMS scoring be separated into four groups. Group 1 would do the regular FMS correctives along with their training program. Group 2 would be assessed by a MAT specialist and each person would be treated according to their individual needs. Their training programs would also be adjusted based off of what was found on the MAT table. Group 3 would do the regular training program only. Group 4 would do nothing. After a predetermined amount of time the FMS evaluation would be re-administered as well as any other strength or movement tests that were performed beforehand.
- Image courtesy of gigisfitnesscenters.com
Right now, most FMS scores are only being compared to other people who are doing the FMS assessment and correctives. I think it would be interesting to see how these stack up to other modalities, in particular Muscle Activation Techniques™.
What type of assessment system do you use with your clients or with yourself? What do you feel are the pros and cons of using your system of choice?
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