Monday, November 12, 2018

The (Inconvenient) Truth About the FMS and Injury Rates

The Functional Movement Screen (FMS) is a series of seven bodyweight tests designed to rate human movement quality/competency. Each test on the FMS is scored on a 0-3 scale. A perfect total or "composite score" would be 21 points.

The FMS's relationship with injury has been studied extensively in athletes. The thinking is that scoring low on the FMS (usually 14 points or lower) puts an athlete at increased risk for injury, which the research bears out to an extent.


When all the studies were pooled together (in 2015), scoring 14 or below did increase injury risk by about 50%. However, for every 100 athletes that got injured, the FMS only managed to correctly identify about 25 of them as being at risk. For this reason, the FMS should not be used to predict which athletes will get injured on an individual basis.


Despite the fairly conclusive evidence against the FMS's ability to predict injury, new studies keep coming out investigating this same tired research question. In the past two years alone there have been at least nine such studies on rugby, soccer, cricket, handball, volleyball, and basketball players.


Based on this continued proliferation of research, clearly not everyone has gotten the memo about the FMS's inability to predict injury. For this reason - and in an attempt to help put this issue to rest - my colleagues and I just published a critical review of the FMS. I break down the results of our review below.





Thursday, November 1, 2018

Are Passive Physical Therapy Treatments Worthless?


The other day, my mentor said something I thought was so profound that I asked him to elaborate on it for the entire first-year Doctor of Physical Therapy class I help out with.

“I tend to be a hands-off PT,” he said.

For context, we were discussing a case study in which a patient presented with several limitations. The patient couldn’t straighten or bend his knee all the way, and his kneecap wasn’t moving as much as it should.

The students were tasked with determining which restriction they’d go after first in the clinic. There were basically two camps: (1) the students who recommended bending and straightening stretches and exercises for the knee and (2) the students who recommended mobilizations for the kneecap.

Mobilizations for the kneecap

Now, both schools of thought are valid. Stretching and exercising the knee is a more “global” approach. It’ll address the flexibility of lots of structures around the knee, including the kneecap. Meanwhile, mobilizing the kneecap is a more “targeted” approach. Getting the kneecap moving more freely could also create more overall motion of the knee. Without any additional information, both approaches seem about equally likely to yield favorable outcomes.

That’s when my mentor piped up in favor of the global approach. “I tend to be a hands-off PT,” he said. I asked him to clarify for the class what he meant by “hands-off.”

Saturday, October 6, 2018

Guardian of Science [The Fitness Devil Podcast]


The other day I had the great pleasure of appearing on the Fitness Devil Podcast with hosts Andrew Coates and Dean GuedoOver the course of an hour, we spanned topics like
  • Injury prevention for gym goers and athletes
  • The utility of core training
  • My Paralympic swimming career
  • "Good" and "bad" exercises (for people over 50)
  • Misinformation in the fitness industry
  • Strategies for improving fitness professionals' communication with the masses

The episode, titled "Guardian of Science," is available now at the following link (or wherever you download podcasts):


Tuesday, October 2, 2018

Is Some Injury Risk Factor Research Worthless?


I recently read an interesting 2016 paper by Clifton et al. in the Journal of Athletic Training called Predicting Injury: Challenges in Prospective Injury Risk Factor Identification.

The premise of the paper is that some researchers screw up when concluding they've identified risk factors for injury. In the paper, the authors describe two of the most common screwups and how to address them.

Before I get to the screwups, a quick explanation is in order regarding the correct way to identify risk factors for injury, which is through a prospective study. It can be summed up in three steps:
Step 1. Examine a group of uninjured athletes at baseline (i.e. in the pre-season). 
Step 2. Track their injuries prospectively (i.e. over a period of time, usually a competitive season). 
Step 3. At the end of the study, break the sample into two groups -- the athletes who got injured and the athletes who didn’t -- and look for differences between the groups in their baseline measures.
And now for the common screwups, as per Clifton et al.:

Common Screwup #1) Retrospective Study Design

Prospective injury studies are difficult to do because they require careful and consistent follow-up regarding injury. A much easier approach is a “retrospective” one. With this type of study, you simply assess a group of athletes with and without injuries and compare the groups based on these previous injuries. With this design, there’s no need to follow the athletes over time.

The mistake that’s commonly made comes with the interpretation of the retrospective study. Researchers will often state that measures on which the injured athletes performed worse are risk factors for injury. The trouble is, there’s no way to know whether those factors were present prior to the injury OR if they are actually the result of the injury.

This isn’t to say retrospective research is worthless. It’s just that follow-up studies with prospective designs are needed to determine whether the differences seen in retrospect are true risk factors for injury prospectively.

Tuesday, August 28, 2018

Do You Need Direct Core Training?


Expert marketers have long known that two things sell better than most anything else: sex and absolutisms. Unfortunately, dear reader, this blog post isn't either of those. As polarizing and juicy as it would be to write about how you should "NEVER do crunches again" or "the one core exercise EVERYONE should be doing," none of that stuff is true.

The only way to answer the question of whether YOU need direct core training is to identify who "you" are.

Before we do that, though, let's get on the same page about what I mean by the core and direct core training:
  • The core: the anatomical region comprised of the torso, pelvis, and hips, including the abs, obliques, spinal erectors, glutes, hip flexors, hip adductors, transverse abdominis, multifidus, diaphragm, etc. As the link between the lower and upper extremities, the role of the core is to transfer, generate, and absorb force between the upper and lower body.

  • Direct core training: any exercise for which the primary purpose is to train the core muscles to improve their size, strength, endurance, or control. Direct core training can come in many forms, from positional breathing to static exercises to dynamic ones, either where the limbs are moving around a stable trunk or the trunk itself is moving. (I'll give a few specific examples of each shortly.)

Now back to the who-are-you question. To aid introspection, here's a smattering of things you should ask yourself to guide your direct core training decision:
  • Are you a competitive athlete? A weekend warrior? A couch potato?
  • Do you want to lose weight? Get stronger? Reduce your risk of injury? Get on stage for a bodybuilding show?
  • Do you already have a strong midsection, or is it your weak link?
  • What types of exercises are you already doing, if any?
  • Do you enjoy direct core training?

In relation to those questions, let's consider some conditions under which you could benefit from direct core training:

Monday, July 9, 2018

How to Design a Workout Program [Free Webinar]


A few months ago, I was asked to deliver the exercise prescription lecture for the 2nd year Doctor of Physical Therapy students at my university.

In preparation for the talk, I spent a good chunk of time reflecting on my own process for designing training programs versus what the textbooks recommend.

I knew this would be one of the students’ only exposures to the topic. So I wanted to pass on as much essential information as I could in the hour and change I had with the students.

The lecture was a hit, so I decided to make a recorded version of it so more people could benefit. Here it is in all its glory. Please don’t hesitate to reach out with questions.

Monday, May 21, 2018

How to Train More Without Getting Hurt [SimpliFaster]



Training for peak performance is tricky business. Push too hard, and you get hurt. Don’t push hard enough, and you still get hurt (from being unprepared for the rigors of competition).

Luckily, there’s a new way to measure how hard you’re working. And amazingly, the research shows it actually protects against injury. That’s right: sports scientists have finally figured out How to Train More Without Getting Hurt.

I break down all the latest research -- and show how to implement it -- in my brand new article for SimpliFaster:


Monday, May 14, 2018

5 Ridiculous Claims About the FMS


Let me start by saying I’m actually a proponent of movement screening. I even recommend the Functional Movement Screen (FMS) for new personal trainers.

But that doesn’t mean the FMS is blameless -- far from it. When it comes to marketing their product, they put the cart before the horse. They sold certifications and made claims about the screen before they had any evidence to back them up. That’s not good science, and for this people have a right to be peeved.

A new Facebook video by Dr. Greg Rose of Functional Movement Systems (watch it here) is yet another great example of why people get so frustrated with the FMS. Let’s break it down point-by-point, shall we?

Wednesday, February 21, 2018

Are There Good and Bad Exercises? [Lift the Bar Podcast]


Three years ago, I almost quit school for good. I’d become disillusioned with biomechanics and academia in general. Hardly anyone in my master’s program was talking about the topics I was interested in — athletes and sports science — and it seemed like all the research dollars were going towards geriatrics and disease.

As I took some time off from school to reflect on my career trajectory, my path slowly started to take shape. I realized my true passion was bridging the gaps between training and rehabilitation as well as research and practice.

It wasn’t long after that I met my current mentors and started my PhD program in Rehabilitation Sciences — a subject area ideally suited for my aptitudes and interests. 

In this program, I’m able to do the exact research that gets me excited  research on athletes, pre-participation screening, and injury risk. As clich├ęd as it may sound, it hardly feels like work when you’re doing what you love.

One of the coolest parts of this whole process has been taking what I’m learning in the research and sharing it with people in the field who can use it and apply it in their daily work. That’s what it’s all about.

So when Stuart Aitken, host of Lift the Bar podcast, contacted me recently to appear on the podcast and talk about this stuff, I was tickled. Moreover, I was blown away by how thoughtful his questions were. It was like he had ESP in terms of asking me about all the topics I’ve been mulling over for the last couple of years.

Friday, January 12, 2018

Does It Matter If You Can Deep Squat?

A friend asked me an excellent question last night:

“How do you feel about the deep squat as a movement screen and the information you get from it?”

I’ve actually been preparing a talk on movement screening for the upcoming Inland Empire Fitness Conference (April 7, 2018, in Spokane, Washington). So I’ve been thinking a lot about the deep squat (among other movements). As a result, I went a little buckwild with my answer to his question. Here’s what I told him…