The Functional Movement Screen: A Review

THE FUNCTIONAL MOVEMENT SCREEN (FMS) IS A PREPARTICIPATION SCREENING TOOL COMPRISING 7 INDIVIDUAL TESTS FOR WHICH BOTH INDIVIDUAL SCORES AND AN OVERALL SCORE ARE GIVEN. THE FMS DISPLAYS BOTH INTERRATER AND INTRARATER RELIABILITY BUT HAS BEEN CHALLENGED ON THE BASIS OF A LACK OF VALIDITY IN SEVERAL RESPECTS. THE FMS SEEMS TO HAVE SOME DEGREE OF PREDICTIVE ABILITY FOR IDENTIFYING ATHLETES WHO ARE AT AN INCREASED RISK OF INJURY. HOWEVER, A POOR SCORE ON THE FMS DOES NOT PRECLUDE ATHLETES FROM COMPETING AT THE HIGHEST LEVEL NOR DOES IT DIFFERENTIATE BETWEEN ATHLETES OF DIFFERING ABILITIES. T he functional movement screen (FMS) is a pre-participation screening tool comprising 7 individual tests for which both individual scores and an overall score are given (11). The 7 tests are rated from 0 to 3 by an examiner and include the deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up, and rotary stability (11,12). The score of 0 is given if pain occurs during a test, the score of 1 is given if the subject is not able to perform the movement, the score of 2 is given if the subject is able to complete the movement but compensates in some way, and the score of 3 is given if the subject performs the movement correctly (11). It has been suggested that a less-thanperfect score on a single individual test of the FMS reveals a “compensatory movement pattern.” Such compensatory movement patterns have been proposed to lead to athletes “sacrificing efficient movements for inefficient ones” (11), which implies the replacement of either amore economical ormore effective pattern with a less economical or less effective one. It has also been proposed that such compensatory movement patterns predispose an athlete to injury and reduced performance and may be corrected by performing specific exercises. As a designer of the FMS states: “an athlete who is unable to perform amovement correctly. has uncovered a significant piece of information that may be the key to reducing the risk of chronic injuries, improving overall sport performance, and developing a training or rehabilitation program .” (9). This seems to imply that the FMS is put forward as a valid test for identifying certain movement patterns that lead to greater injury risk and reduced athletic performance. In the course of our review, we did not identify a formal definition of the concept “compensatory movement pattern.” We suggest that it can be defined as a kinematic feature or sequence of features observed during the performance of a movement that deviate from a template that is thought to represent the least injurious way of performing the movement. In the FMS, the individual scores for each movement are combined into a final score out of 21 total possible points. It has been suggested that lower overall scores predict individuals who are at a greater risk of injury than those with higher scores (11). In practice, researchers have generally identified 14 points as the ideal cut-off point for those at greater or less risk of injury (5,8,36,38,41,43). The cut-off value of 14 points was in certain studies identified by means of a statistical method known as a receiver-operator characteristic (ROC) curve (5,38,43). This technique allows researchers to identify the numerical score that maximizes the correct prediction of injury classification (66). However, in other cases (8,36), the researchers simply adopted the cut-off value of 14 points based on the findings of previous studies. Although this may not maximize the predictability of the cut-off point in those individual studies that elected not to use a ROC curve, it does have the advantage of enhancing comparability between trials. Studies investigating the norms for FMS overall scores have identified that the normal FMS score in healthy but untrained populations ranges from 14.14 6 2.85 points (51) to 15.7 6 1.9 points (53). This suggests that most untrained people are slightly above the cut-off score of #14 points, which is thought to be indicative of prevalent compensation patterns and which is also believed to be predictive of increased risk of injury and reduced performance.