The Functional Movement Screen

Review of Literature

The study will critically analyze the Functional Movement Screen developed by Cook, et al., (2006). According to Schneiders, et al., (2010), “the Functional Movement Screen was developed as a comprehensive pre-participation and pre-season screen tool that challenges an individual’s ability to perform basic movement patterns ” (p.76). Cook, et al., (2006) developed the FMS when there was not a functional evaluation standard to make rehabilitation protocols that take into account how a patient functionally moves (p.62). The FMS is an evaluation tool that is comprised of 7 fundamental movements to assess an individual mobility and stability (Cook, et al., 2006, p.63). Observation has indicated that athletes cannot perform

these simple movements and still be able to perform at a high level (Cook, et al., 2006, p.64). The analysis will focus on the lower extremity tests of the FMS to determine the validity of each test.
What is Functional Movement?
Functional Movement Screen is primarily used to identify athletes that are more susceptible to injury. According to Teyhen, et al, (2012), the Functional Movement Screen is designed to identify functional movement deficits or asymmetries that can be predictive of general musculoskeletal conditions and injuries (p. 530-531). During human movement, there is an importance of core stability in producing efficient trunk and limb actions for the generation, transfer, and control of forces of energy during kinetic chain activities (Okada, Huxel, & Nesser, 2011, p.260). Several of the tests in the FMS rely on the athlete having strong core stability to perform the test properly (Cook, et al., 2006). Functional movement is defined as the ability to produce and maintain a balance between mobility and stability along the kinetic chain while performing fundamental patterns efficiently (Okada, Huxel, & Nesser, 2011, p.259-260).
Principles of Functional Movement Screen
Cook, et al., (2006) created the FMS tests on fundamental proprioception and body awareness principles (p.64). Each test is meant to test a specific movement that will require the body to fire a proper sequence of movements in the kinetic chain (Cook, et al., 2006, p.64). The body’s proprioceptive abilities are an important aspect of the kinetic chain because this will tell the body where the joint’s position is in space to perform a certain movement (Cook et al., 2006, p.64). According to Cook, et al., (2006), the correct movement patterns were initially formed during growth and development, but due to weakness or dysfunction in the kinetic chain, a poor movement is isolated by the FMS (p.64). If an individual’s development is disrupted it will affect how to move properly, they are more likely to experience an injury (p.64).
Scoring System of Functional Movement Screen
According to Cook, et al., (2006), the scoring system for functional movement screen has four possibilities:
“The scores range from zero to three; three is the best available score. If pain occurs, the score of zero is given. A score of one is given if the participant cannot complete the movement pattern or get into the movement position. A score of two is given if the participant is able to complete the movement, but has to compensate in some way to finish the movement. A score of three is given if the participant completes the movement correctly” (p.65).
While the scoring system is fair, a clinician must be trained to assess the participants properly whether through video tape or real time. According to Minick, et al (2010) and Onate, et al., (2012), the reliability of the interrater is an important aspect of FMS testing. Minick, et al. (2010) recruited 40 subjects (23 women, 17 men) to determine the reliability of the interrater using 4 raters (2 novice, 2 experts) (p.481). Each subject was recorded from an anterior and lateral view while performing the functional movement test (Minick, et al., 2010, p.483). The results from Minick, et al., (2010) found that the novice raters were in agreement on 6 of the 17 test components; while the experience raters varied in scoring by agreeing on 4 of the 17 test components (p.485). Onate, et al., (2012) recruited 19 subjects (12 men, 7 women) to determine the interrater reliability using 16 raters (10 men, 6 women) (p.409). A test-retest research design was used to assess the intersession and interrater reliabilities of the 7 FMS tests (Onate, et al., 2012, p.409). The results from Onate, et al., (2012) revealed that there was a “fair to high reliability across intersession and interrater reliabilities” with real time rating (p.412). A limitation of Onate, et al., (2012) study is that the two raters evaluate, at the same time, there could be discrepancies in their score because of the angle from which they were during the tests (p.412).
The Three Lower Extremity Tests on the Functional Movement Screen
Deep Squat
Cook, et al.

(2006) uses the fundamental movement deep squat during the Functional Movement Screen because it is a necessary movement in most athletic events. According to Cook, et al. (2006), the evaluation of the deep squat will assess both legs along with the functional movement at the hips, knees, and ankles (p.66). The ability to perform the deep squat requires closed-kinetic chain to start a sequence at the ankles, along with flexion of the knees, and hips, extension of the back, and flexion and abduction of the shoulders (Cook, et al. 2006, p.66). Execution of a proper form deep squat requires the participant to have coordination, strength, and mobility throughout their kinetic chain (Butler, et al., 2010). The results from Cook, et al. (2006) indicate that “poor performance can be caused by limited mobility in the upper torso attributed to poor shoulder mobility” (p.66). Hip or ankle instability can inhibit the successfulness of the deep squat, as well (Cook et al., 2006, p.66). Butler, et al. (2010) conducted a study with 28 participants (9 male and 19 female) investigating the biomechanics of the deep squat. The results from Butler, et al. (2010) found that participants’ stability and mobility at the ankle, knee, and hip joints correlated with their scores on the FMS. The results indicate that the differences between the three groups were from the different biomechanics that were exhibited by each group (Butler, et al., 2010, p.278). The deep squat test is a valid

test for functional movement because it takes into account the way the whole body moves (Butler, et al., 2010).
Hurdle Step
According to Cook, et al., (2006) the evaluation of the hurdle step will assess both legs ability to perform functional movement along with the stability at the hips, knees, and ankles (p.67). The ability to perform the hurdle step correctly requires proper coordination and stability between the hips and torso, during the stepping motion, as well as the single leg stance stability (Cook, et al., 2006, p.67). Kiesel, et al., (2007) viewed “the hurdle step through the body’s strides mechanics during an asymmetrical pattern of a stepping motion” (p.147). According to Cook, et al., (2006), poor performance can be due to instability in the stance leg or immobility of the step leg (p.67-68). An, Miller, Mcelveen, & Lynch (2012) investigated the effect of using Kinesio tape on the scores of the lower extremity tests during a functional movement screen. The study used 32 participants (16 Division II women basketball players and 16 non-varsity female college students (p.197). The hurdle step involves using “a fixed extremity while the other extremity is freely moving” (An, et al., 2012, p.202). According to An, et al., (2012) the study revealed that the hurdle step was the only lower extremity test to have a significant interaction with the Kinesio tape (p.202-203). There is little research on the validity of the hurdle step in the FMS, but the use of the screen is valid because the movement requires stability and coordination to perform correctly (Cook, et al., 2006, Kiesel, et al., 2007, An, et al., 2012).
In-line Lunge
According to Cook, et al., (2006), the in-line lunge is used “to place the body in a position that will focus on the stresses as simulated during rotational, decelerating and lateral type movements” (p.69). The evaluation of the in-line lunge will assess the hip and trunk mobility, quadriceps flexibility, and ankle and knee stability (Kiesel, et al., 2007, p.148). Cook, et al., (2006) viewed the in-line lunge as a test “that places the lower extremities in a scissor style position challenging the body’s trunk and extremities to resist rotation and maintain proper alignment” (p.69). Substandard performance may be caused by hip mobility being inadequate along with the stance-leg knee or ankle may not have the required stability as the athlete performs the lunge (Cook, et al., 2006, p.69). The athlete might have an imbalance between adductor weakness or abductor tightness in one or both hips to cause poor performance (Cook et al., 2006, p.69). According to An, et al., (2012) found no significance between the control and treatment group when it came to the in-line lunge and the deep squat (p.201). An, et al., (2012) believes that the reason for no significant change is from both groups being full weight bearing throughout the movement (p. 202). A limitation of this study is that it does not differentiate between a fixed and non-fixed extremity (An, et al., 2012, p.203). While the test puts the body in an unstable position, the body could have limiting factors such as poor core stability or hip flexor tightness (Cook et al., 2006, p.69). Future research should focus more on the validity of the in-line lunge, based on the lack of evidence.
Physical Fitness Tests
According to Hill and Leiszler, (2011), core stability in athletics involves dynamic control and transfer of large forces from the upper and lower extremities thorough the core in order to maximize performance and promote efficient biomechanics (p.1). Hill and Leiszler, (2011) viewed the “strength of the core allows the system to stabilize the spine mechanically and distribute and deliver compressive, translational, and shear forces to and from the rest of body” (p.1). Sharrock, et al., (2011), recruited 35 volunteer subjects that were all student athletes at Asbury College (p.67). The study was designed to evaluate the relationship between core stability and athletic performance (Sharrock, et al., 2011, p.67). The subjects were tested at five different stations: abdominal leg lowering test, 40 yard dash, vertical jump, T-test, and medicine ball throw (Sharrock, et al., 2011, p.67). Sharrock, et al., (2011) revealed that the T-test, 40 yard dash, vertical jump were not significantly correlated with abdominal strength (p.70-71). Abdominal strength was closely related with the medicine ball toss because the participant has to engage his core to throw the ball (Sharrock, et al., 2011, p.71-72). A limitation of this study can be that some of the tests that are not considered a test for athletic performance (Sharrock, et al., 2011).
Physical fitness tests are used to assess certain components of fitness, such as cardiorespiratory fitness and muscular strength (Lisman, et al., 2013).

Lisman, et al., (2013) enlisted 874 Marine Corps officer candidates, that were in a 6 week (n=447) or 10 weeks (n=427) training course (p.637). The study is examining the correlation between fitness level, prior injury history, and FMS scores (Lisman, et al., 2013, p.637). According to Lisman, et al., (2013), physical fitness tests were considered to be pull ups, abdominal crunches, and a 3 mile run (p.637). The results revealed that physical fitness tests and the FMS scores correlated with the FMS tests that require a significant amount of strength, such as the deep squat and in line lunge ( Lisman, et al., 2013,p.638-639). Lisman, et al., (2013) also incorporated a questionnaire to determine a participant’s previous history of injury (p.637). The results from the questionnaire revealed that any previous history of injury leads to lower FMS scores and increase risk of re-injury (Lisman, et al., 2013, p.638-639). A limitation of this study is that the population is young and physically fit (Lisman, et al., 2013, p.641). Since this study focus on physical active military servicemen; future research should investigate the FMS scores in a non-athletic

population.