Functional Movement Screen: Is it Really a Screen?

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!

Kyle Waltz | Tue January 25, 2011  

I couldn’t agree with you more 😊.  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

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

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!

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.

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 | Tue February 01, 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.

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 ?

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.

Deep | Thu September 08, 2011  

So which assessment tool would you recommend?

Matt Esrick | Fri September 09, 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 | Sun October 30, 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!

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

Christer Dehlin | Thu May 31, 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.

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.

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.

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.

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.

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

Shane | Tue January 07, 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.

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!

Results Driven | Thu December 31, 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