The Functional Movement Screen (FMS) is a screening tool developed by the Functional Movement Systems to be used by clinicians, trainers and coaches to assess movement. It has gained popularity in the past decade among clinicians and hence gained attention of some researchers. Some have adapted the principles of FMS while others have investigated the credibility of FMS as an injury risk predictor. In this blog, I will talk about how I would use the FMS regularly as a clinician –as what it is: a movement screen.
What Is The FMS And Why?
For the benefit of practitioners who are less familiar with the FMS and researchers who do not use the FMS in practice, let use cover the basics of the FMS. The FMS is a movement screen that assesses 7 movements in quality and categorises them into 4 levels. They have specific criteria for each test to assess the quality of movement divided into 4 scores (0-3):
0. Pain is present in the movement
1. Unable to perform the movement adequately
2. Able to perform the movement adequately
3. Able to perform the movement optimally
As it should be obvious to people looking at the scores, 0s and 1s are of concern, while 2s and 3s would not be too much of a concern, as long as it is not largely asymmetrical between left and right. As part of the screening process, a composite score is added up from the 7 movements giving a maximum of 21 (all movements optimal), and lowest of 0 (all movements painful). However, the score on individual components is more important than the composite score as it points to which movement may be an issue and warrants further assessments– this is a screen, not a detailed assessment.
It is also worth pointing out for those more statistically minded, these scores are ordinal. This means the numbers were given for qualitative criteria set upon the tests, a 2 does not mean two times higher than a 1 and two 1scores does not equal to a 2 in total. Which becomes relevant when discussing statistics of the research.
Why the FMS though? Why do any movement screen at all? Why do we test sit to stands and running instead of hip and knee extension strength in isolation?
It is usually obvious, but the principle is that while the parts (e.g. hip and knee) have sufficient mobility and strength in isolation, but they may not be able to perform together in a functional sequence or pattern (e.g. sit to stand). This is the reason we do any functional tests, not just isolated muscle and range of movement testing.
What Happened To Injury Prediction?
Injury prediction is commonly agreed as a multi-factorial issue and cannot be addressed by a movement screen alone. Based on the resources available on their website, Functional Movement Systems never pushed the FMS as an injury prediction tool (Rose, 2018). Movement quality is one part of a multi-factorial injury prediction issue.
“High-quality” research that puts FMS in the limelight as a poor injury predictor also did account for the basics of the FMS discussed above. There are7 separate movements which are all scored independently with 4 ordinal scores –the composite scores are not overly useful compared to the individual scores. Moran et al. (2017) and Attwood et al. (2017) have put work into researching this, but possibly onto the less important area: the composite scores. I have put a table below to illustrate how composite scores are less important than the individual scores.
Table 1. Example Good and Bad FMS Scores
Deep Squat 3 2
Hurdle Step 3 2
Inline Lunge 3 2
Shoulder Mobility 3 2
Active Straight Leg Raise 1 (Inadequate) 2
Trunk Stability Push Up 0 (Pain) 2
Rotary Stability 3 2
Total Composite Score 16 (Pain and Inadequate) 14
It should be fairly obvious with the table above that the good score may have a lower composite number than the bad score as they are able to do every movement adequately compared to someone with a higher score that has pain and unable to do certain movements, possibly already injured. Research trying to link composite scores to injury would then predictably lead to disappointing results.
In conclusion, the FMS is a useful tool as a movement screen to understand if parts can work together to perform a functional movement and was never intended as an injury prediction tool. However, the research trying to link FMS and injury used composite scores which are less relevant than 0s and1s present in each movement and hence inconclusive. As a clinician, this means I would continue using FMS as what it is: a movement screen, not as an injury prediction tool.
Budiman Pranjoto is a physiotherapist undertaking his studies in University of Otago for a Post Graduate Diploma in Orthopaedic Manipulative Therapy.