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.

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.”