Functional Movement Screen (FMS)
Kathleen Lautzenheiser, SPT
Virginia Commonwealth University
Objectives
Define FMS
Patient population
Components of the FMS
Exercises to improve dysfunctional movement patterns
Evidence to sport populations and validity of the screen
What is the Functional Movement
Screen?
The FMS philosophy started by Gray Cook- orthopedic
PT and strength and conditioning specialist
FMS- A set of movement tests that screen for quality
movement patterns as well as asymmetrical movement
patterns
SFMA- Selective functional movement
assessment- used on those with known pain
For some people, asymmetries between the L and R
sides exist at very basic levels of movement. Over time,
these limitations may lead to compensations, inefficient
movement patterns, and potential injury. 2
The idea of the FMS is to find the “weak link” in a
movement pattern and improve it through therapeutic
exercise 2
By addressing the limitations, the athlete will be more
efficient, improve performance, and will decrease risk
for injury
These imbalances and asymmetrical movement patterns
should be addressed prior to training and competition
Performance Pyramid
“Mental image” of human movement
Building of one movement type on another
First level- Functional Movement- the foundation,
represents mobility and stability
Second level- Functional Performance- general power or
gross athleticism; the efficiency of movement (ex. test
vertical leap)
Third level- Functional Skill- the ability to participate in a
specific sport or play a specific position within that sport
Cook, 2003
Optimum Performance Pyramid
Large foundation- full
range of movement
Body control and
awareness in a variety of
positions
Movement efficiency and
sport skill are balanced
Movement patterns
without compensations
Cook, 2003
Overpowered Performance Pyramid
Poor score on mobility and
stability tests, high on power
production, adequate in skill
Free movement limited by
poor flexibility or poor
stability
Need to focus on the
foundation work in order to
see greater improvement in
sport/skill AND prevent
injury
Yoga, massage, ROM over
weights
Cook, 2003
Underpowered Performance Pyramid
Excellent freedom of
movement, but with poor
efficiency and power
The training for this type of
athlete should focus on
efficiency and power without
negatively affecting
movement patterns
Ex. plyometrics, power
training, weight training with
free weights; work on sport-
specific skills as power, speed,
and agility improve
Cook, 2003
Underskilled Performance Pyramid
Appropriate functional
movement patterns and
good power production but
poor sport skill
These athletes would
benefit from technique
training to refine or
improve mechanics
Maybe need to address
anxiety, psychological
factors
Cook, 2003
Mobility and Stability
Mobility- combination of Athletes will always
muscle flexibility and joint sacrifice the quality of
ROM motion for the
Stability- ligamentous quantity of motion,
integrity- static and and in turn develop
dynamic (ex. SLS vs. compensatory
abdominal stabilization movement patterns in
during sport) order to overcome
their movement
deficits 2
FMS Scoring
The screen is comprised of seven fundamental movement patterns
that require both mobility and stability 2
Scoring (0-3)
3- perfect completion
2- completion with compensation
1- inability to complete
0- pain with the movement pattern
Total composite score out of 21; if the R and L sides are tested,
take the lowest score to count towards the composite score
Score all patterns prior to coming up with a conclusion on
functional deficits
First evaluate painful tests, then R or L asymmetries
If asymmetries are present, address the pattern and perform
exercises and skills to strengthen or correct that pattern
If the same score for all patterns (ex. score of 2), use best
judgment where to begin depending on the requirement of
the sport (ex. hurdles for a hurdler)
Further testing with goniometers and special tests to
determine the weak links
Movement Pattern: Deep Squat
Deep squat- hip, knee, ankle mobility and stability;
dowel overhead assesses flex and ABD of the shoulders
extension of the thoracic spine
Form-dowel overhead, squat down while holding the
dowel with extended elbows OH; passing is heels flat,
feet parallel, hips below knees, knees over feet, arms
must stay overhead
Exercises: Deep Squat
Corrective exercises:
1. Prone Quad stretch
2. Standing rectus stretch
3. Kneeling dorsiflexion
4. Squat progression with heel lift (1-2”) and heel platform
(2-6”), decreasing the size of the heel lift/platform as able
until performing on floor (Ex. deep squat with rotation,Y
squat)
Patient population- swimmers, volleyball, rowers, etc.
Squat Progression
Deep Squat, arm raise to ceiling Y squat, arms extended overhead
Movement Pattern: Hurdle Step
Hurdle step- test of hip, knee, and ankle mobility and
stance leg stability
The hurdle step is designed to challenge the body’s
proper stride mechanics during a stepping motion.
Form- hurdle set to height of tibial tuberosity; step over
hurdle, touching heel to floor and return to the start;
must have the hip, knee, and ankle aligned forward, the
dowel cannot tip L or R, and the spine has little
movement
Exercises: Hurdle Step
Corrective exercises:
1. Stride stretch (with hip ER, spinal rotation),
2. Standing hip-hug stretch (across front of body, then outside
body)
3. Mountain climber with flex/ext of hip
4. Lunge stretch on board plank position spinal
extension
Patient population- runners, cyclists, climbers, jumpers
Standing hip hug stretch
Lunge-plank-spinal extension
Movement Pattern: In-line Lunge
In-line lunge- to assess hip and ankle mobility and
stability, quad flexibility, and knee stability
Form- The feet should face forward and the foot on the
ground; passing is minimal upper body movement, feet
on tape, back knee touching back of front heel, no
tipping R or L
Places the body in a position that challenges the body’s
trunk and extremities to resist rotation and maintain
proper alignment.
Exercises: Lunge
Corrective exercises:
1. Lunge stride and twist progression,
2. Half kneel dowel twist
3. Lock-leg bridge (one knee to chest, SL bridge)
Patient population- field and court athletes, athletes that
perform quick direction changes
Half kneel dowel twist
Lunge stride and twist progression
Shoulder Mobility
Shoulder mobility- requires scapular and thoracic
spine mobility; pt may have tight pecs or lats or ST
dysfunction
Form- first measure distance from the wrist to the tip of
third finger; make a fist with each hand with thumb in
fist and max ext, IR, and ADD on one shoulder and max
flex, ER, and ABD with the other-- measure the distance
apart
Exercises: Shoulder Mobility
Corrective exercises:
1. Open up anterior chest wall-stretch pecs, lats;
2. Wall sit (both hips ER) with arm raise (keeping back of
hands against wall),
3. Foam roller “snow angles”
4. S/L “torso twist” with shoulder ROM
Patient population- throwing athletes
S/L torso twist with shoulder ROM
Active Straight Leg Raise
Active straight leg raise- to assess active hamstring
flexibility, movement of opposite hip (limitation due to
an anterior tilted pelvis) AND also core stability
Form- in doorway, pelvis in the center of the doorway,
raise one leg while keeping the other flat on the ground
Corrective exercises:
1. Leg-lowering progression (keeping spine elongated, scissor
movement), may use support against a wall
2. Single leg bridge- hips up, extend leg, perform SLR
3. Dip bridge
An open chain movement- requires core training for
stability
Leg lowering progression- wall
Single leg bridge Dip bridge
Trunk Stability Push Up
Trunk stability push-up- requires trunk stability in
sagittal plane during UE movement
Form- prone- feet together, hands shoulder width apart,
thumbs in line with forehead (male) or chin (female) or
clavicle (if cannot perform); pt performs one push up;
there should be no lag in the lumbar spine
Exercises: Trunk Stability
Corrective exercises:
1. Incline push up
2. Push up walk out
3. Push up with leg curl
4. Push up with hand clap as able
Patient population- basketball, volleyball, football, where
blocking is common and forces are transferred from the
trunk stabilizers to the extremities
Rotary Stability
Rotary stability- assesses multi-plane trunk stability
during a combined UE and LE motion- requires NM
coordination and transfer of energy through the torso from
one body segment to the other
Form- quadruped- knees 90 and ankles in DF- board
between hands and knees so they are in contact with the
board; touch one knee to the same elbow
Looking to have a neutral spine, straight arms and legs that
stay along the length of the board; do alternate arm and leg if
cannot perform
Exercises: Rotary Stability
Corrective exercises:
1. Leg fall out (knees bent or straight)
2. Bird dog
3. Rolling (initiate with arm or leg)
4. Chops/lifts
Patient population- running, sprinting, explosive
movements
Leg fall out
Rolling example
Application to PT Patient Population
Patients are already coming to us injured but we can help
them safely return to sport
Consider those with chronic, repetitive injuries through
work or sport- why do they keep getting injured? Is there a
neuromuscular component? Flexibility/stability component?
Return to sport? FMS may not predict injury BUT
compensations will occur in order to participate in the sport
Consider the goals of the patient, activity level
“Association Between the Functional Movement Screen
and Injury Development in College Athletes” International
Journal of Sports Physical Therapy 2015
Prospective cohort, 168 athletes, DI- swimming/diving,
rugby, female soccer players
All athletes received a composite score and individual scores
Injuries recorded must be due to athletic participation, limit
training for 24 hours and require medical attention
Results- FMS score for injured was 13.6 while the
uninjured score was 15.5
Athletes with an FMS composite score ≤14
combined with a self-reported past history of
injury were at 15 times increased risk of injury.
“Prediction of Injury by Limited and Asymmetrical
Fundamental Movement Patterns in American Football
Players” Journal of Sport Rehabilitation, 2014
Authors speculated that asymmetries in basic body
weight tasks would also present in more complex
movements
Purpose- 1. to determine whether asymmetrical
movement patterns R vs. L have a relationship with
injury during preseason and 2. to validate the cutoff
score of 14
The composite score and any asymmetries were
collected from two professional football teams over the
course of two years, 238 players total
Results: 25% became injured over the course of the
preseason- most common were knee and hamstring injuries
The mean FMS score for those injured and uninjured was 16
and 17.4
Relative risk for injury= 1.87 for those with a score ≤
14; 1.80 for those with an asymmetry
Conclusion: having at least 1 asymmetry increases
risk for injury, regardless of composite score AND a
score of ≤14 is valid in predicting time lost due to
injury
Composite vs. Individual Cut Off Scores
Cohort study- Mokha et al. 2016
84 rowers, volleyball players, soccer players, DII athletes
Purpose- to determine if an asymmetry or score of 1 on an
individual FMS test or a composite score ≤14 predicts MSI in
collegiate athletes
Preseason administration- tracked injury throughout the season
(MSI- required medical help and altered training)
Composite scores were low (≤14) or high (>14)
Results- Athletes with FMS scores of ≤14 were not more
likely to sustain an injury than those with higher scores
(RR= 0.68). However, athletes with an asymmetry or
individual score of 1 were 2.73 times more likely to
sustain an injury (RR= 2.73)
“Reliability, Validity and Injury Predictive Value of the
Functional Movement Screen” American Journal of
Sports Medicine 2016
Systematic review- search in the MEDLINE and
ScienceDirect databases
Purpose: to determine whether or not the FMS is a reliable
and valid screening tool to identify functional asymmetries
and what specific score correlates with higher risk for injury
Inclusion criteria- English language studies, use of the screen
to assess uninjured people prior sport participation
Exclusion criteria- any reviews, case reports, or abstracts
Results/Discussion
Reliability: “The FMS as a composite score has excellent
interrater and intrarater reliability and can be effectively
administered by raters of varying experience with the FMS,
with and without certification”
Injury Predictive Value: “A pooled quantitative synthesis
using 9 studies was performed using a cutoff score of ≤14;
An OR of 2.74 was found, indicating that those who scored
≤14 on the FMS had 2.74x greater probability of sustaining
an injury during subsequent activity than those who scored
>14”…so scores ≤14 are valid to indicate that there
is increased risk for injury
Validity: Some studies showed that the FMS composite
score is not as valid as is often used; Frost et al showed that
educating those being screened on the criteria can
significantly affect scores, suggesting that the scores may
reflect more than physical characteristics (learned behavior)
Comparisons with other measurements of movement and
balance also did not find a correlation to FMS scores
Therefore, more studies are needed to confirm the
screen’s validity in predicting injury
Where does that leave us?
More quality studies need to be conducted to determine the
validity of the FMS and its ability to predict injuries in specific
athletic populations
However, obvious asymmetries in movement patterns may point
us in a direction to start
May pay closer attention to asymmetrical scores than composite
score- asymmetries are something we can detect and address
Further goniometric, strength and special testing may be needed
Would be beneficial to see studies relating the FMS and
return to sport
References
Bonazza, Nicholas A., et al. "Reliability, Validity, and Injury
Predictive Value of the Functional Movement Screen A Systematic
Review and Meta-analysis." The American journal of sports medicine
(2016): 0363546516641937.
Cook, Gray. Athletic Body in Balance. Champaign, IL: Human
Kinetics, 2003. Print.
Cook, G., Burton, L., & Fields, K. (2009). The Functional
Movement Screen and Exercise Progressions Manual. www.
functionalmovement, com.
Frost, D. M., Beach, T. A., Callaghan, J. P., & McGill, S. M. 2015.
FMS Scores Change With Performers' Knowledge of the Grading
Criteria—Are General Whole-Body Movement Screens Capturing
“Dysfunction”?. The Journal of Strength & Conditioning Research,
29(11), 3037-3044.
Garrison, M., Westrick, R., Johnson, M. R., & Benenson, J.
(2015). Association between the functional movement screen and
injury development in college athletes. International journal of sports
physical therapy, 10(1).
Kiesel, K. B., Butler, R. J., & Plisky, P. J. (2014). Prediction of
injury by limited and asymmetrical fundamental movement
patterns in american football players. Journal of sport rehabilitation,
23(2).
Mokha, M., Sprague, P. A., & Gatens, D. R. (2016). Predicting
Musculoskeletal Injury in National Collegiate Athletic Association
Division II Athletes From Asymmetries and Individual-Test Versus
Composite Functional Movement Screen Scores. Journal of athletic
training, 51(4), 276-282.
