Lessons and thoughts from the Functional Movement Screen Seminar

Last weekend, I had the pleasure of attending the Functional Movement Screen (FMS) seminar, presented by Gray Cook and Lee Burton and held by Perform Better.

I first heard of the FMS whilst studying at University and a few years later, witnessed its use whilst working at the Better Body Shop by coach and trainer, Christo Koukoullis.

The FMS comprises of a screening of 7 different movements:

Overhead Squat

Hurdle Step

In-Line Lunge

Lying Leg Raise

Shoulder Mobility

Core Stability Push-up

Rotatory Stability

A score of 0-3 is then given to each movement (0=pain, 3=perfectron).

From this, the scores are added to give a total out of 21. But the real interest for the assessor is not necessarily the total score, but any movement that the client had an inability to do. 

According to the manual, there are 4 intended purposes of movement screening: 

1)  Identify “at risk” individuals 

2) Using corrective exercise to normalise fundamental movement patterns, thus assisting in programme design 

3)  Monitoring progress and movement pattern development 

4)  Creates a functional movement baseline

One key study by Kiesel et al. (2007) showed that by having a score of less than 14 was positive to predicting injury in NFL football players.  Another study by Okada et al. (2011) attempted to correlate FMS scores with performance predictors (backwards overhead medicine ball throw, T-test and single leg squat). This study showed that the FMS scores were weakly correlated to the performance tests; however, Lee Burton drew attention to the fact that the study only looked at the overall FMS score and that the scores of some of the individual FMS tests were, in fact, significantly correlated with some of the performance tests.

The beauty of the FMS is its simplicity - it takes about 10-15 minutes to perform and has a high inter-rater reliability, meaning that if 2 different people perform the FMS on the same individual, they will most likely score the same result, regardless of experience (Minick et al., 2010).

Whilst studying for my Masters, I completed the ACSM’s Corrective Exercise Module, which consists of an overhead squat and a single leg squat in its movement screen. Any dysfunction seen in these movements is due to either a muscle tightness or a muscle weakness. Apparently, unless you do an EMG, there is no way of ever knowing this as a single muscle cannot be blamed for a movement dysfunction. For example, if the arms fall forward during the overhead squat, tightness of the lats is frequently blamed. However, Gray pointed out that the lats may not be tight and could, in fact, be contracting in order to protect the low back.

Gray Cook - 1 ACSM - 0

If I’m honest, I did have some doubts about the use of the FMS. For example, whilst the 7 movements do cover a lot, they may not provide specific information that you may require of an athlete, such as the difference in hip internal rotation between the left and right hip or any strength discrepancy of hip extension between left and right sides. However, every issue that I had with the FMS was resolved during the lecture, and if a movement is faulty, then testing the specific joint ROM is always an option.

The one test that caused the most grief is the rotary stability test.

At the Better Body Shop, we believed that this test was a load of rubbish (mostly, but not entirely, owing to the fact that none of us could do it). The other issue with the test is that no one could work out what it actually showed. Well, this is the purpose of the test as described in the manual:

"The rotary stability pattern observes multi-plane pelvis, core and shoulder girdle stability during a combined upper- and lower-body extremity movement. This pattern is complex, requiring proper neuromuscular coordination and energy transfer through the torso."

So, uh, Gray Cook – 2, Better Body Shop – 0. 

As it happens, one girl in our group actually managed to nail this test on her right side. This photo shows her second attempt, which she did complete (although not as good as her first, which was perfect).

In terms of correcting the movement, a specific order must be followed. This was important as correcting one of the movement screens had the potential to correct other movements. For example, correcting the leg raise first can actually improve shoulder mobility (although you need to be pretty proficient in functional anatomy to be able to explain why).

The movement corrections involved a combination of increasing mobility and stability simultaneously at various joints in a way that the body would be able to "remember" the new movement, so that corrective exercise wouldn't have to be done every time they visited the from then on.  

An important thing to understand is that when training a client, the purpose is to train them to achieve their specific goal. Therefore, if doing the squat will help them achieve their goal and their technique is not up to scratch, it may be possible to get it near perfect by using a few corrective exercises. In other instances, an alternative (or regression) to the squat may used and the necessary corrective exercises can be integrated into rest periods, with the aim of achieving a squat in the very near future.

However, corrective exercise should not comprise the WHOLE SESSION (with very few exceptions) as A) this is not why the client has come to the gym and B) unless you’re a physiotherapist (or in a related field), this is not the role of a personal trainer/strength and conditioning coach when trying to enhance aesthetics/performance.

When I return to work, I will use the FMS as it’s a very simple procedure and can give a lot of helpful information. That said, I don’t believe I would ever use it as a stand-alone and am likely to use it identify areas of attention that may warrant further assessment. I should say though, that it is completely possible that I will change my mind on it after I start using it – only time will time.

Therefore, as of present, I would recommend the FMS seminar to any trainer who is considering taking it, and I would DEFINITELY recommend it to any trainer who does not currently use any sort of assessment procedure (because it's better than what they're currently doing).

5 things I learnt from the FMS: 

1)  Pain = cortisol. If a client suffers from joint pain, they will produce cortisol as a stress response, thus wrecking their fat loss/muscle gaining efforts. We were told a strength coach who recently lost 5 inches off his waist following hip surgery – apparently his cortisol levels were through the roof prior to being operated on. 

2)  Some clients may want a fitness solution to a medical problem. In these instances, these clients must be referred. 

3)  If obese people learn to move properly, thus improve their mechanics then they will have increased energy in the gym, which can be put towards better use in training. 

4) Eating foods that you have a sensitivity to cause gastrointestinal stress, which tells the abdominal muscles to relax and stop them from doing their job properly. 

5) Motor learning cannot occur under stress. Therefore, training an individual who should actually be recovering is not a wise move as strength training is all about motor learning.

Bonus

6) An imbalance on one side of the body forces the other side to work harder which increases the risk of injury. Thus, asymmetry is rated as the second biomarker of injury risk (first is previous injury).