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.

The Two Most Common Misconceptions about the FMS

Over the past three years as part of my PhD, I’ve been researching the relationship between movement and injury. A recent Twitter discussion reminded me that people on either side of the great FMS social media debate are still confused. I figured I’d put my research efforts to good use to clear up a couple of common misconceptions.

Misconception #1: The FMS composite score can predict injury.

When the FMS first became popular in the late 2000s, its creators touted it as an injury prediction tool [1,2]. The trouble was, at the time they had zero scientific evidence to back that claim up.

It turns out scoring low on the FMS does increase a person’s risk of injury slightly [3,4], but it doesn’t guarantee it. In other words, while low scores are associated with injury, the FMS does not predict injury on an individual basis. Big difference [5].

Specifically, when the FMS is conducted on a large group of people, as in a scientific study, we tend to see a lot of false negatives (people who score high but still get injured).

The fact that the FMS can’t predict injury actually isn’t that surprising. There’s no one thing that predicts injury [6]. This is because injuries aren’t caused by just one factor. Instead, they’re the result of a complicated web of interrelating factors -- a web that’s different for every person based on the types of activities they do [7].

Bittencourt NFN, et al. Br J Sports Med 2016;50:1309–1314.

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?

The Three Dirtiest Words in Fitness

The three dirtiest words in fitness these days are "Functional," "Movement," and "Screen" -- especially when used in that order [1].

For anyone who's unfamiliar, the Functional Movement Screen (FMS) is a series of seven functional movements (e.g. squat, push-up, lunge) designed to screen (i.e. check for) for pain, movement quality, and injury risk.

By providing objective criteria for scoring the various movements (‘0’ for ouch, ‘1’ for shitty, ‘2’ for passable, and ‘3’ for perfection -- all my words, not theirs) the FMS enables practitioners to establish a movement "baseline," as well as to identify mobility/stability deficits and side-to-side asymmetries, which can then help guide program design.

The actual FMS scoring system

Sounds like a great idea, eh? In theory, yes. But it’s created a whole crap-ton of controversy.

Some trainers are diehard proponents of the FMS [2], using it on all of their clients at intake and follow-up assessments for comparison to baseline. Others think it's complete garbage, citing studies that have found the FMS’s injury prediction capabilities to be moderate at best.

It’s true: in many of the populations that have been tested, the FMS doesn’t do a very good job of separating people who are at risk for injury from people who aren’t. Potentially due to having too few data points (7 screens × 3 points = 21 total points possible), it fails to do what it was designed to do. Yikes!

Why not just change the scoring criteria to better differentiate between performance on each test, one might wonder? Instead of scoring from 0 to 3, why not make it, say, 0 to 5?

It turns out that by increasing that number, you actually decrease the reliability of each score. This is because when there are 5 possible points it’s much harder to come to a consensus about what a ‘1’ is versus a ‘2’ or what a ‘3’ is compared to a ‘4.’

Even the most skilled testers may not give a particular movement the exact same score on a scale from 0 to 5. At that point, chaos would ensue, and the results of the screen would have even less meaning than they do now. No bueno.

Guest Post: Core Training: Fact or Fiction?

by Kennet Waale

I want you to think about this phrase for a second:

“Move Better At 60 Years of Age Than You Currently Are.”

What do you attach to that? How would you feel if you could do exactly that, but more importantly, WHO would you be if you could Move Better At 60 Years of Age Than You Currently Are?

During our recent “Rehab X: Post-Rehabilitation and Injury Prevention” workshop, we had numerous therapists and trainers in the room. Needless to say, we shared a lot of experience and great insights into numerous relevant topics. One of the topics I felt needed to be covered was that of core training. The current state of the fitness industry (though slowly improving) is all about making money and not so much about sharing quality information helping individuals understand the true power of knowledge and implementation. It is for this reason I will share with you some eye-opening thoughts around the topic of core training -- and if there’s any sound evidence behind it whatsoever.

Podcast Ep. 8 - Chris Leib

In Episode 8 of the Fitness Pollenator Podcast, I welcome Dr. Chris Leib. I met Chris about a year ago at a workshop he did at our mutual friend Tom DeVietro’s gym. (As an aside, Tom happened to be the very first guest of this podcast, so if you haven’t listened to episode 1, you should!)

Not only is Chris a doctor of physical therapy, but he’s also a Certified Strength and Conditioning Specialist. While at Chris’s workshop, I was completely blown away by his hybrid approach to training, in which he fuses physical therapy, CrossFit, kettlebells, and more.

As I’ve gotten to know Chris, one of my favorite things about him is his voracious appetite for learning and assimilating new information. Lately, he can be found splitting his time between the physical therapy clinic, the personal training setting, and writing about exercise.

In this episode, Chris and I talk about...

Gumby Goals: Takeaways from the FRC Seminar

This past weekend, I was one of some eighty-odd personal trainers, strength coaches, physical therapists, chiropractors, and other movement professionals who descended upon Pitman, NJ, for the FRC seminar at Endeavor Sports Performance (the gym where I’m currently interning).

What’s the FRC seminar? It’s not for the Finnish Red Cross, nor is it on functional residual capacity (of the lungs). Rather, it’s Dr. Andreo Spina’s “Functional Range Conditioning.” The FRC course came highly recommended by my friend, esteemed colleague, and Instagram sensation Hunter Cook, so I was very excited for the opportunity to attend.

If you’ve ever seen Hunter move, you might assume that FRC is only for circus performers and people who want to be able to overhead press while doing a split (see video below). Moreover, the name itself, “Functional Range Conditioning,” kind of sounds like a bunch of buzzwords strewn together haphazardly. At least, it did to me when I first heard it. In actuality, each word in the name has a very precise meaning, and FRC isn’t just for people as Gumby-like as Hunter.