The Functional Movement Screen in football

In the last couple of years the Functional Movement Screen (FMS) has gained increasing popularity in sport. It was invented to evaluate movement pattern quality for athletes as it thought that poor neuromuscular control increases the risk of acute injuries (10).

Based on this ides the FMS therefore serve as the basis for more complex movements (23) and therefore would be useful to identify functional movement deficits such as muscular imbalances/asymmetries (32), flexibility deficits (mobility), balance or stability (6).

The tool was used in several investigations, such as:

  • a prediction tool for injuries in marine officers (24), track and field athletes (1), basketball players (8) or collegiate athletes (5)
  • as an evaluation of golf players athletic performance (27) and the effectiveness of intervention in America football players (16)
  • to provide normative data in Gaelic field sports (9).

How does the Functional Movement Screen work

The only equipment required is a (measurement) stick in addition to a measurement bar.

Seven exercises

  • In-line lunge
  • Hurdle step
  • Deep squat
  • Quadruped rotary stability
  • Active straight leg raise
  • Shoulder mobility
  • Trunk stability push-up

are used to test/rate individual players’ movements.


The players will receive a score for each exercise. The highest score is a “3” and the lowest a “0”. In this regards a “3” means “perfect execution of the task”, a “2” means “execution with compensation”, a “1” means “can’t perform the task” and a “0” means “pain” (12). Therefore the player can score up to a total of 21 points. There are five tests which require bilateral testing and therefore both scores are recorded (however, the lowest test score will be recorded for the overall score).

Reliability of the Functional Movement Screen

Several studies have investigated different types of reliability for the FMS and showed good reliability values (10, 25, 30, 32). There was no difference for intra-rater reliability (meaning the athlete receives the same score on day 1 vs. day 2) (25, 30), however, there was a less clear picture for the inter-rater reliability.


It was suggested that FMS scores for one athlete couldn’t be compared to another rater’s score of the same athlete (29), while experiences/additional knowledge with the FMS improved reliability/measurement (11, 14). However, it was also seen that FMS-certification of raters did not improve reliability in a different study (30) and there was no difference between raters score with different experiences with the test (23). Among novice raters, the inter-rater reliability showed moderate to good reliability (32).


Interestingly, the one-leg squat test and the hurdle step were seen as the least reliable measurements. The ICC scores were poor, ranging from 0.52 (10) to 0.30-0.35 respectively (30). Based on the original total score of 21, a 100-point scoring system was developed which also seemed to be reliable (3). In this system different exercises were scaled differently (3).

Validity of the Functional Movement Screen

It seems that the rating systems (1, 2 or 3) in which the athletes are getting rated holds its ground with regards to kinematic analysis (4).


Differences were seen in peak knee flexion and knee flexion excursion with the groups ranked 3 > 2 > 1. Furthermore, Group 3 exhibited greater peak hip flexion, hip flexion excursion and peak hip extension moment compared to group 1.

Can the Functional Movement Screen predict injuries?

First of all there seemed to be a debate, what constitute an “at risk player”.


Players scoring below 14 (16) seem to be “at risk” while a score of <18 was used to classify athletes into this category (10) in a different publication. The FMS scores were not related to injuries in track and field athletes (1), basketball players (8) and a cohort of high-school (2) and collegiate (33) athletes.

Despite the information that a score of <14 was associated with an 4.2 times (20) and 15 times (13) (in combination with injury history) increased risk of injuries.

It was also concluded that the FMS can accurately identify individuals with an elevated risk of musculoskeletal injury among male professional football players, male marine officer candidates, and female college basketball, soccer, and volleyball players (18).

The Functional Movement Screen in Football

A couple of investigations utilizing the FMS investigated football players. The FMS was used to test athletes self-perceived proximal stability in Division II female soccer players (26), the impact of functional limitations of muscles on the correctness of fundamental movement patterns in Polish elite football players (15), to investigate asymmetries in professional football players (28),  connections between maturation, physical performance and FMS scores (21), asymmetries and injuries mechanisms in Hungarian footballers (35) and changes in the FMS scores over the course of a NCAA soccer season (31).

In the first study the researcher investigated if perception (pre- and post-FMS assessment) was correlated with the FMS. The players rated themselves significantly different pre- vs. post-testing. Interestingly, pre-test scores were not related to FMS score, however, the perception of the players post-FMS were significant correlated with the FMS score (26).

There were significant differences between elite and sub-elite for the tests. Elite players scored higher in the rotational stability, however the sub-elite players scored higher in the deep-squat, in-line lunge and active straight leg raise. The authors concluded that there are different functional reasons affecting values obtained in the FMS (15).

The deep-squat was shown as the exercise with the lowest score and the active straight leg raise with the highest score in general. A score of 14 was set to distinguished between a “good pattern” and “poor pattern”. Interestingly, only the “poor-performers” showed differences between the dominant and the non-dominant side for the unilateral tests (28).

Older youth players scored significant higher on all FMS scores compared to younger peers (21). Deep overhead squat, in-line lunge, active straight leg raise and rotary stability test were significantly correlated to all performance tests. In-line lunge performance explained the greatest variance in reactive strength index (47%) and reactive agility cut (38%) performance, whilst maturation was the strongest predictor of squat jump performance (46%). The conclusion of the study was that variation of physical performance in youth soccer players could be explained by a combination of both functional movement screen scores and maturation (21).
Limb asymmetries were discovered in 40% of the investigated Hungarian footballers (35).

Longitudinal assessment of the FMS was performed in collegiate soccer and volleyball players (31). However, four individual tests did show significant change. The deep squat and inline lunge scores improved across all athletes, and the active straight leg raise and rotary stability scores worsened across all athletes. A reduction in the number of asymmetries and scores of 1 was also found. The authors concluded that individual changes in FMS occur through the course of a competitive season.
Furthermore, a survey showed that the FMS was used in various Premier League Football clubs (22).

Additional thoughts

Despite the text given above, it was also mentioned that the FMS was not purported to be a diagnostic tools, however, can be used to recognize movement deficiency (2) and did not predict injuries (2, 7, 34), it therefore might not be the choice to guide exercise prescription (12). As mentioned more attention should be paid to each task compared to the sum of all scores (19).

Conclusion

It seems debatable if the FMS can be seen as a diagnostic tool to predict injuries. However, small research suggests its feasibility for specific populations (17, 18) with football possibly one of them. However, and not only due to the limited data, its utilization seems questionable. Despite, it is a reliable tool that is cost-efficient and very easy to administer, it is very time-consuming (~10-15 minutes are needed to assess one player with all seven exercises). There is definitely more research needed with regards to a football context.

Despite a lack of scientific knowledge in the mentioned areas, application of the FMS might be more useful longitudinally, compared to short-term applications of the tool. As the exercises above are described as functional movements it seems warrant to test these capacities in footballers, also with regards to functional strength training as the exercises are close to the actual exercise prescription.

References

1.    Appel, B.M., The Capability of the Functional Movement Screen to Predict Injury in Division I Male and Female Track and Field Athletes, 2012, Utah State University: Logan.

2.    Bardenett, S.M., et al., Functional Movement Screen Normative Values and Validity in High School Athletes: Can the Fms Be Used as a Predictor of Injury? Int J Sports Phys Ther, 2015. 10(3): 303-8.

3.    Butler, R.J., P.J. Plisky, and K.B. Kiesel, Interrater reliability of videotaped performance on the Functional Movement Scree using the 100-point scoring scale. Athletic Training & Sport Health Care, 2012. 4(3): 103-109.

4.    Butler, R.J., et al., Biomechanical analysis of the different classifications of the Functional Movement Screen deep squat test. Sports biomechanics, 2010. 9(4): 270-279.

5.    Chorba, R., et al., Use of a functional movement screening tool to determine injury risk in female collegiate athletes. North American Journal of Sports Physical Therapy, 2010. 5(2).

6.    Cook, G. and L. Burton The Functional Movement Screen.

7.    Dorrel, B.S., et al., Evaluation of the functional movement screen as an injury prediction tool among active adult populations: A systematic review and meta-analysis. Sports Health, 2015.

8.    Etzel, C.E., A literature review of the Functional Movement Screen as a predictor of injury in the sport of Basketball, 2012, Oregon State University.

9.    Fox, D., E. O'Malley, and C. Blake, Normative data for the Functional Movement Screen in male Gaelic field sports. Phys Ther Sport, 2014. 15(3): 194-9.

10.    Frohm, A., et al., A nine-test screening battery for athletes: a reliability study. Scandinavian journal of medicine & science in sports, 2012. 22(3): 306-315.

11.    Frost, D.M., et al., FMS scores change with performers' knowledge of the grading criteria - Are general whole-body movement screens capturing "dysfunction"? Journal of Strength and Conditioning Research, 2013.

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13.    Garrison, M., et al., Association between the functional movement screen and injury development in collegiate athletes. International Journal of Sports Physical Therapy, 2015. 10(1): 21-28.

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15.    Grygorowicz, M., T. Piontek, and W. Dudzinski, Evaluation of functional limitations in female soccer players and their relationship with sports level--a cross sectional study. PLoS One, 2013. 8(6): e66871.

16.    Kiesel, K., P. Plisky, and R. Butler, Functional movement test scores improve following a standardized off-season intervention program in professional football players. Scand J Med Sci Sports, 2009.

17.    Kraus, K., et al., Efficacy of the Functional Movement Screen: A review. Journal of Strength and Conditioning Research, 2014. 28(12): 3571-3584.

18.    Krumrei, K., et al., The Accuracy of the Functional Movement Screen to Identify Individuals with an Elevated Risk of Musculoskeletal Injury. J Sport Rehabil, 2014.

19.    Li, Y., et al., Exploratory factor analysis of the functional movement screen in elite athletes. J Sports Sci, 2015. 33(11): 1166-72.

20.    Lisman, P., et al., Functional movement screen and aerobic fitness predict injuries in military training. Medicine and Science in Sports and Exercise, 2013. 45(4): 636-643.

21.    Lloyd, R.S., et al., Relationships between functional movement screen scores, maturation and physical performance in young soccer players. J Sports Sci, 2015. 33(1): 11-9.

22.    McCall, A., et al., Injury risk factors, screening tests and preventative strategies: a systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues. British Journal of Sports Medicine, 2015: 1-8.

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24.    O'Connor, F.G., et al., Functional movement screening: predicting injuries in officer candidates. Medicine and Science in Sports and Exercise, 2011. 43(12): 2224-2230.

25.    Onate, J.A., et al., Real-time intersession and interrater reliability of the functional movement screen. Journal of Strength and Conditioning Research, 2012. 26(2): 408-415.

26.    Palmer, T.G., et al., Self-perceptions of proximal stability as measured by the functional movement screen. Journal of Strength and Conditioning Research, 2013. 27(8): 2157-2164.

27.    Parchmann, C.J. and J.M. McBride, Relationship between functional movement screen and athletic performance. Journal of Strength and Conditioning Research, 2011. 25(12): 3378-3384.

28.    Schmidtlein, O., M. Keller, and E. Kurz, Asymmetric FMS patterns in Germany's Bundesliga soccer players, in World Congress on Science and Soccer2012: Ghent.

29.    Shultz, R., et al., Test-retest and interrater reliability of the functional movement screen. Journal of Athletic Training, 2013. 48(3): 331-336.

30.    Smith, C.A., et al., Interrater and intrarater reliability of the functional movement screen. Journal of strength and conditioning research / National Strength & Conditioning Association, 2013. 27(4): 982-987.

31.    Sprague, P.A., G.M. Mokha, and D.R. Gatens, Changes in functional movement screen scores over a season in collegiate soccer and volleyball athletes. J Strength Cond Res, 2014. 28(11): 3155-63.

32.    Teyhen, D.S., et al., The Functional Movement Screen: a reliability study. The Journal of orthopaedic and sports physical therapy, 2012. 42(6): 530-540.

33.    Warren, M., C.A. Smith, and N.J. Chimera, Association of the Functional Movement Screen with injuries in division I athletes. Journal of Sport Rehabilitation, 2015. 24(2): 163-70.

34.    Wiese, B.W., et al., Determination of the functional movement screen to predict musculoskeletal injury in intercollegiate athletics. Athletic Training & Sport Health Care, 2014. 6(4): 161-169.

35.    Zalai, D., et al., Quality of functional movement patterns and injury examination in elite-level male professional football players. Acta Physiologica Hungarica, 2014.


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