If you have been shopping around for a personal trainer or a physiotherapist, you may have come across trainers who are FMS certified. FMS stands for Functional Movement Screen – one of the functional movement tools developed by acclaimed physiotherapist Gray Cook.

With all the fluff around functional movement, what exactly is a functional movement screen and what does it mean for you?

What is functional movement?

functional movement screen, bosu ball training

There are tons of trainers, physiotherapists, or chiropractors who worked under the functional trainer umbrella without actually fitting into any accepted definitions of what is functional.

For example, doing ski jumps on an inverted bosu ball as part of “functional training”.

Tell me when exactly in your life would you ever need to perform such a task?

(Yet at the same time, it could very well be considered functional by some.)

Indeed, as you may have noticed by now, “functional movement” is a highly contentious catchphrase.

As described by the American Physical Therapy Association, having good function is about being able to support your own physical, social, and psychological well-being and to create a personal sense of meaningful living.

Functional movements could therefore be interpreted as movements required to carry out these activities.

In that sense, sitting on a chair could very much be a functional activity for you if it contributes to your well-being!

What is functional can differ from individual to individual. Heck, it SHOULD differ from individual to individual based on our own values, needs, wants, desires, goals, etc.

With all of this in mind, there is no exhaustive or definitive list to what are functional movements.

In fact, Vern Gambetta, often attributed to be the founding father of functional sports training, would insist that all movements are functional!

What is functional training?

“Functional training” is another catchphrase that you may come across in your search for a personal training or workout class.

Remember, all movements can be considered functional. In that sense, functional training is more of a person-centred approach to exercising than an absolute set of exercises.

According to Gambetta, functional training exists along a continuum.

The more functional your training is, the closer the movements or exercises are to what is required to promote your well-being. To a huge extent, it is no different from athletes performing in sports-specific training (i.e., plyo box jumps for a basketball athlete).

An overhead press could very well be as functional for a shelf stacker the same way it is functional for the housewife with lots and lots of overhead storage at home! On the other hand, an overhead press is less functional for a soccer player despite their familiarity with the exercise.

Hence, what is considered functional training is highly specific to what is important to an individual.

What is the functional movement screen (FMS)?

According to the Mosby’s Medical Dictionary, a screen is “a preliminary procedure, such as a test or examination, to detect the most characteristic sign or signs of a disorder that may require further investigation.”

There are twelve principles to what makes a good screen. For any injury prevention screen to work, at least four of these criteria should be met:

1. The condition or disorder being screened for is important
2. It is possible to detect the disorder at an early stage
3. Treating the disorder at an early stage is more beneficial than treating it at a later stage.
4. There is a suitable screening test that can detect the disease at an early stage.

The FMS being a screen of functional movement patterns implies that dysfunctional movements would detect signs of a possible condition or identify risk factors that may lead to an injury in the future.

As health and fitness professionals, being able to screen for injury risk would be a game changer!

An injury is ridiculously disruptive. It can come with pain (not always, check out pain neuroscience education) and can affect function. This in turn also affects mood, productivity, sense of well-being.

Injury has also been linked to sedentary behaviour.

There are tons and lots of upside to an injury prevention screen!

The FMS is developed by physical therapist Gray Cook back in 2001. The idea was to create a screening process for movement, which will determine what areas an individual should work on to decrease their risk for injury.

The screen, a series of seven movement tests, is a system which grades movement-pattern quality to determine areas of deficiencies, limitations, or asymmetries. The tests are scored on a scale of 0 to 3 based on both objective measurements and subjective interpretation by the assessor. The general guidelines of each ability level is described in the table below:

Score Description
3 Ability to complete movement pattern according to description
2 Ability to complete movement pattern with some deviation from the test description, either through faulty form, loss of alignment or compensation
1 Inability to complete movement pattern
0 Pain is present

What are the 7 functional movements?

The seven movements in the FMS are divided into two groups. The first is known as the big three (not to be confused with McGill’s big three) which assesses “higher-level movement patterns” and the second is known as the small fours which assess “primitive movement patterns”.

Let us go through the seven tests starting with the big three:

Deep Squat

The deep squat is really an overhead squat. It tests for mobility and stability of the hips, knees, ankles, as well as shoulders, scapulae, thoracic spine, and of course the core.

During the test, the participant would be asked to perform a deep squat with their feet shoulder-width apart and a dowel (wooden stick) held overhead.

The assessor would want to see the torso being held as upright as possible and is preferred if the torso is vertical and parallel to the shin. The dowel should also be aligned over the feet.

The depth of the squat should be past parallel (i.e., thigh is below parallel to the ground) with the knees not caved inside.

Hurdle step

hurdle step, functional training, FMS
Justin working with one of our clients through the FMS assessment. The client was performing a hurdle step.

The hurdle step is like a stepover. According to FMS, it tests the coordination and stability of the hips as well as the stability and alignment (not sure how) of the pelvis and core.

The hurdle height is set at right below the knee joint (tibial tuberosity to be exact). The participant would stand with the dowel across the back of the shoulders and would be asked to stepover to tap the floor on the other side of the hurdle with their heel before returning to the start position.

The hips, knees, and ankles should remain aligned from the sideview and the dowel should remain parallel to the ground during the movement (no leaning to one side).

Inline lunge

As the name suggests, this is a lunge movement. Besides assessing joint function such as spine stabilisation, mobility and stability of hips, knees, ankles, and feet, FMS specifically highlighted that the inline lunge also looks at flexibility of multi-articular muscles such as the latissimus dorsi and quadricep muscles group.

This is the only test in the series that looked at specific muscles.

At the start position, the participant would stand in a lunge position with the toe of the back foot one shin length (yes, they do insist you measure it) away from the heel of the front foot. The hands would be holding on to the dowel at the back of your spine. During the test, you will lower your back knee to touch the board before returning to the start position.

The assessor would look for a vertical dowel that is always in contact with your back. According to the FMS people, you would want to be able to do it with minimal torso rotation/movement with your front foot firmly planted on the FMS kit — yes, you lunge on the kit.

Primitive Movement Patterns

As for the primitive movement patterns, there are assessments: shoulder mobility, active straight-leg raise, trunk stability pushup, and rotary stability.

To be updated. 

Does FMS prevent injury?

In 2016, Bahr pushed a commentary to explain why movement screens do not predict injury.

There are three things that need to be addressed before a screening tool is able to accurately predict injury.

First, the relationship between risk factors being tested and actual injury rate.

Will I get injured just because I can’t lunge on an awkwardly plastic or wooden box?

Does being able to perform a 3/3 score hurdle step mean my hips are perfectly aligned?

None of the movements in within the FMS system considered load management.

I promise you that a sedentary office worker who scores perfect 3/3 for every movement will still get injured if you make them run 10km per day for 100 days straight.

All of us have have a tissue load capacity. What a young, sedentary office worker can support is dramatically different from a 70-year old or 90-year old CrossFitter can do!

If the physical loading of an activity exceeds your tissue capacity, you are likely to get injured regardless of how well you can do a squat, lunge, or push up.

This is not hypothetical criticism. A systematic review published in 2017 questioned the validity of the Functional Movement Screen and found the association between FMS scores and injuries to be poor i.e., does not predict injury.

A subsequent study was able to find that individuals who were considered high risk based on FMS scores were up to 51% more likely to get injured. However, the authors cautioned that the level of evidence to support this is very poor.

Second, there should be different criteria or different scoring for people of different demographics. For example, it may not be reasonable to expect the everyday worker to have the same shoulder mobility as a professional baseball player.

Similarly, just because an everyday individual score poorer than a professional tennis player doesn’t mean that that they are more likely to get injured.

Again, one of the biggest criticism against FMS is that it is not person-specific and it does not take into account the unique circumstances of the individually.

This is especially ironic since function, functional movement, and functional training have person-specific as the underlying common denominator!

Third, there needs to be interventions available to modify the risk factors before injury occurs.

A systematic review by Andujo et. al. (2020) found that there was no evidence that interventions after physical evaluation or injury preventions screens (e.g. FMS) resulted in a reduction in injury.

TL;DR working on your core stability, hip mobility may in theory give you a stronger core and better hip range of motion. However, it is unclear if this translates to any meaningful outcome as far as injury management is concern.

All in all, the very well-marketed and well-designed FMS kit doesn’t seem to prevent injuries as its supports would so claim!

Should I go for FMS?

Here is the golden question – should I go for a functional movement screen?

Why does Square One Active Recovery use FMS in our physical training space?

The reason is simple: FMS does indeed measure some very specific movements and is one of the most used standardised scoring tools used in the world today.

While the score by no means will tell us how injured you may be, it could tell us how much better you are with lunging today compared to three months ago.

It may also tell us if you are closer to your goal of being able to perform an overhead squat or a clean and jerk.

The devil is not in the tool. It is the false assumptions and fearmongering practices fitness instructors or physiotherapists may engage in to warn clients about their impending physical dysfunction (i.e., can never walk again).

With the FMS, we are able to assess your movement ability and agility. This information gives us insights into how your exercise programming  should look and what we can do to help you reach your own physical well-being goals.

Furthermore, some studies are suggesting that using movement quality specific training can reduced your perception of training intensity. This could potentially allow you to train harder or train more comfortably (depending on your personal preferences)!

FMS still holds value and has a purpose in the health and fitness industry. While it does not serve its intended purpose of preventing injuries, the tool — when used appropriately within an evidence-based framework — can help you find your own physical well-being.

This article was contributed by Justin Chew and revised by Jesse Cai. Justin is certified in both Functional Movement Screen and Functional Range Conditioning. He was not coerced in the making of this post.

Your Recovery Journey Begins Now

Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, chiropractor Jesse Cai founded Square One Active Recovery to deliver recovery goals in just 12 weeks.

Not getting results from your chiropractor, TCM doctor or physiotherapist? Book an appointment to discover the difference the right care can make.

*We do not offer short-term pain solutions such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.

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