By

Tim Pelot MS, CSCS

Strength and Conditioning: Sport Physiologist | Team Sports | United States Olympic Committee

Anthony Darmiento BS, CSCS

Assistant Strength and Conditioning Coach

The Functional Movement Screen (FMS) has recently become a popular subject for discussion in the sport performance community. The FMS screen consist of 7 tests, this screening tool was created to evaluate movement pattern quality for all individuals. The question that remains to be answered is: does the FMS screen have a place in screening and assessing elite athletes? Currently available research looks at the relationship between FMS and predicting injury and FMS and performance. Thus, the purpose of this article was to review some of the peer reviewed literature regarding FMS and further relate commonly accepted scientific principles to the FMS tests to determine if FMS has a place in performance training of elite athletes.

FMS as a test to predict or assess athletic performance

The first topic of interest was the relationship between FMS and Performance. Searching the terms “functional movement screen AND performance” using the Web of Science database resulted in a total of nine studies. Of the studies found only two actually investigated the relationship between performance and FMS scores (10, 12).Of the remaining seven studies, three found the FMS studies reliable because scores were reproducible (8, 11, 13), two explored biomechanical qualities of the deep squat test (1, 5) and one attempted to use the FMS to measure the effectiveness of a training program (3). Of the two studies looking directly at performance neither was able to find a relationship between FMS scores and performance. Although Mcgill et al. were not able to relate FMS score to performance variables of basketball players over a 2 year timespan there did seem to be something regarding injury and FMS, but more data and studies were necessary(6). In conclusion, the FMS is not an accurate way to measure athletic performance.

FMS as a test to predict the likelihood of injury

However, Mcgill’s findings relate to the second topic of interest; The ability of FMS to predict injury. In some cases it could be argued that reducing injury is an indirect way of improving performance. If a coach or practitioner is able to reduce injury then performance will inherently be better than if an athlete were to become injured. Of the studies looking at predicting injury three were chosen because of their specific findings. In a study looking at 46 professional football players, those with an FMS score of ≤14 were 11 times more likely to experience injury during one competitive season than those who scored 15 or greater (4). Chorba et al. found that female collegiate athletes with a score of ≤14 had a 4-fold increase risk of injury(2). Furthermore, of the female athletes in the study, 69% of those with a score of ≤14 sustained an injury over the course of the study. Lastly, in a study of 874 marine officer candidates a score of ≤14 doubled a candidate’s risk of injury (9). However, it is important to note that unlike the other aforementioned studies this study also looked at physical test scores (consisting of pull up test, 1.5mile test, etc.) and found that these scores were just as predictive of injury as the FMS test.

Another thought from the FMS community is that FMS could be used as a baseline. For example, having a video of an athlete performing specific movements in a healthy condition could be valuable during rehabilitation post-injury. In fact, video of any commonly used exercises in training could prove valuable in such a scenario. Thus, it seems that FMS may have practical application within sports medicine, but practitioners should review scores with caution, especially considering that the seven tests are hardly telling of an athlete’s overall movement competency, ability and potential.

The role of stiffness in elite sport

To define elite sport, we will refer to Anders Erisson’s research on expert level performance. Ericsson’s research has found that expert level performance can be closely associated with length of time an individual participates in deliberate practice. His research has found that 10 years or 10,000 hours of deliberate practice leads to expert performance (22).

There are a number of performance impacting factors that have been researched and some of these factors may have a negative impact on an athlete’s ability to perform well in an FMS screen. Two specific examples are; the effect of joint stiffness and musculotendon tightness. There are plenty of well documented studies that have investigated the relationship of muscle stiffness and performance (17) (18) (19) (20). From the literature done in this area, it is concluded that muscle and tendon stiffness can have a positive influence on dynamic and explosive movement (20). It has been well established that when there is high level of tightness there is an increase in the ability to store more elastic energy. This increase in energy storage (similar to how a rubber band gets pulled back prior to snapping back to its original shape), leads to an increase in peak force output resulting in more rapid and powerful movements. This is crucial in elite competitive environments, where the difference between 1st and 4th place lies within .16 seconds; as this was the case for the Olympic final for the men’s 100m sprint. To briefly summarize; research in the area of muscle and joint stiffness and its relationship to performance has demonstrated that muscle and joint stiffness becomes a necessary characteristic for success in most elite athletic environments since it can help improve running velocity, jumping ability, and movement economy(14)(15)(16)(19).

Does the test provide a true measure within the elite athlete population?

An ideal amount of stiffness could be mistaken for lack of flexibility or result in a poor FMS score, in which could lead to an emphasis on trying to change or correct a positive athletic quality. Furthermore, it is widely accepted that strength and motor control are velocity dependent. Because almost all athletic performance occurs at high velocities or under high forces it is hard to relate the scores of a slow moving test and characterized by low forces such as the FMS to qualities of athletic movement: especially when such movements may be foreign to an athlete or an athlete has developed specific movement patterns that allow them to perform optimally in sport.

Specificity of the FMS for Elite Athletes

It is also important to mention how the neuro-muscular system operates in relation to movement and speed. Depending upon speed and resistance of a movement, the body will either increase of decrease the number of muscles needed to perform a task. In order to prevent this article from diving into an in-depth write-up on the nervous system, let’s just refer to the activation of muscle fibers as either being fast twitch or slow twitch. When speeds are slow and when resistances are low the body recruits the slow twitch fibers to perform the task and when movements are dynamic, fast and take place under greater forces, the nervous system recruits fast twitch fibers. In addition, some fibers are more resilient

to being activated and it may take higher speeds and higher resistances for them to be recruited (21). The activation patterns at these speeds and intensities are difficult to measure and assess, but based upon the speed and intensity of sport, we know explosive movements recruit muscles completely different than the activation patterns required to perform slow and controlled movements. Being aware of these concepts leads to a few important questions; is the FMS screen an accurate tool to evaluate elite athletes? Does the FMS measure an elite athlete’s level of “functional ability”, as it relates to speeds and forces experienced in sport and training?

Tonicity and the elite athlete

Understanding muscle tone (tonicity) and the body’s adaptation response to daily stress is another important concept to take into consideration when investigating the rationale of the FMS test in the elite athlete population. Tonicity is described as normal elastic tension of living muscles. For everyday movement actions there is a neuromuscular response that is responsible for one’s level of tonicity: Man’s adaptations to gravitational forces and erect postures are evolved mechanisms in skeletal muscle tissues that help to improve economy and enhance stability. For the average human being, normal passive muscle tone helps to maintain relaxed standing body posture with minimally increased energy costs and often for prolonged durations without fatigue (21). The activation of these daily stabilizing muscles is done involuntarily. Since the average person does not introduce their body to additional resistance other than everyday movements in a gravity rich environment, the level of tonicity is fairly low in comparison to the tonicity within the elite athlete. Elite athletes are required to withstand and overcome high resistance stressors for hours each day, the stresses lead to neural adaptations that create an increase in tonicity. Further research needs to be done on the impact of training history and tonicity. In a training environment, training history (length of time spent training for sport) has a significant impact on how successful an athlete becomes in sport. It is common knowledge that elite athlete’s posses the highest of all training histories. These large volumes of training over long periods of time have resulted in neural adaptations (sport specific) that have helped lead to the success of the athlete. Lastly, it could be hypothesized that athletes with longer training histories could have a higher level of tonicity. It is important not to confuse tonicity with hypertonicity. Hypertonicity is a when a muscle is in a state of abnormally high tension. For example, elite athletes often experience some sort of hypertonicity following training sessions.

Voluntary and involuntary muscle contractions

As we understand neural function and tonicity, it provides us with a more approachable understanding of what specific adaptations athletes acquire from their training and helps us learn the differences in how their bodies operate in comparison to the average person. What we know about low threshold and high threshold muscle contractions can be carried over into muscle flexibility and joint mobility (fast twitch and slow twitch activation patterns). If a muscle is involuntarily contracted it may not be able to fully relax on its own. In order to help release this tonic state, it may require the voluntary activation of higher threshold motor units to allow the muscle to relax from a partial and involuntary contraction. If the applied external resistance is high enough to meet the involuntary contraction threshold, the contraction then switches from an involuntary muscle contraction to a voluntary contraction. This overriding of the nervous system is one of the premises that supports PNF stretching. Once a muscle is voluntary contracted, typically there is a reduction in the tonic state of the muscle at rest, thus improving joint range of motion and muscle flexibility. How does this apply to the elite athlete? If an

athlete is asked to perform a movement under low resistance they may test poorly due to tightness (tonicity), but when placed in an environment where resistances simulate that of their sport, they may have a completely different testing score(due to an increased level of neural activation). This outcome provides evidence that the sport specific adaptations that athletes posses is likely to positively impact their abilities in sport, but may lead to a poor FMS score and inaccurate assessment of an athlete’s movement quality.

Does the FMS test sport specificity?

For example, when digging (low squat position) in a volleyball match or the deep squat position that a baseball catcher assumes is not what an FMS test would dictate as correct or good quality resulting in a poor score. For this reason, FMS itself does not have enough scientific support to justify changing an effective movement pattern to a less effective one. This leads the topic of what does functional mean as it relates to sport specific positions within each discipline of sport. Although FMS may claim to use “functional” every day movements that relate to what athletes may experience in sport and training FMS should not be considered an accurate way to measure physical preparedness for sport involvement. In fact, the use of FMS to prepare an athlete for sport and training may not be valid either. It is commonly known that there are specific adaptations to imposed demands (SAID principle). Therefore, the SAID principle does not justify the use of FMS movements to prepare athletes for anything other than an FMS test.

It is important to note that a spectrum of athletes exist; ranging in age, from youth to adult, and level of play, from weekend warriors to professional and elite. FMS is likely more relevant for the younger or less experienced athletes and could be a mode of improving body awareness and control. However, some believe that FMS loses application and practicality when moving across the spectrum to more advanced athletics with a longer training history.

The FMS is not anything new, physical therapists, athletic trainers and experienced strength and conditioning coaches are fully aware of the movement qualities tested by FMS in every day training sessions. Thus, experienced professionals are aware of specific techniques and form during all exercises in training. Additionally these experts are capable of recognizing movement deficiencies and making proper adjustments through queuing and coaching while implementing long term modifications to mobility and flexibility if necessary. With this in mind, FMS seems to have more practical application for less knowledgeable coaches and less experienced athletes.

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