Functional Movement Screening (FMS) in Physical Therapy: Identifying Movement Deficiencies to Prevent Injury

Functional Movement Screening (FMS) in Physical Therapy: Identifying Movement Deficiencies to Prevent Injury

(Lecture Begins)

Alright, class, settle down, settle down! 🧑‍🏫 Today, we’re diving into the fascinating world of Functional Movement Screening, or FMS, as it’s affectionately known. Think of FMS as your movement detective hat 🕵️‍♀️, helping you uncover those sneaky movement deficiencies that are just waiting to turn into nasty injuries. It’s like pre-emptive physical therapy! And who doesn’t love preventing pain before it even starts? 🙅‍♀️➡️🙆‍♀️

Forget just looking at muscles in isolation. We’re talking about patterns. We’re talking about how your body actually moves in real-life situations. This isn’t your grandma’s flexibility test (no offense, Grandma!). This is about identifying and addressing the root causes of movement dysfunction.

Why Should You Care? (Besides the Obvious, Like, Avoiding Injury)

Let’s face it: injuries suck. They sideline you from your favorite activities, cost you money in medical bills, and generally make you grumpy. FMS helps you avoid all that! It’s like having a crystal ball 🔮 that shows you where you’re likely to break down. But instead of just accepting your fate, you can do something about it!

Here’s a quick rundown of the benefits:

• Early Identification of Risk: Detect movement dysfunctions before they become painful injuries.
• Personalized Exercise Programs: Tailor interventions to address specific needs and improve movement patterns.
• Objective Measurement: Track progress and objectively measure the effectiveness of interventions. No more guessing!
• Improved Performance: Enhance athletic performance by optimizing movement efficiency and reducing energy expenditure. Move smarter, not harder! 💪
• Educate Patients: Empower patients to understand their bodies and take an active role in their health. Knowledge is power! 🧠

The FMS: A Deeper Dive

The FMS itself is a series of seven movement patterns designed to assess fundamental movement abilities. These aren’t complex, Olympic-level moves. They’re basic movements that everyone should be able to perform reasonably well.

Each movement is scored on a scale of 0 to 3, with 3 being the best. A score of 0 indicates pain during the movement. The total score is the sum of all seven movements, with a maximum possible score of 21.

Important Note: The FMS is not a diagnostic tool. It doesn’t tell you why someone is struggling. It only identifies that they are struggling. Further evaluation is always necessary to determine the underlying cause of any movement dysfunction. Think of it as the first step in a much larger puzzle. 🧩

The Seven Deadly (Movement) Sins… er, I Mean, Tests:

Let’s break down each of the seven tests in detail, complete with witty commentary and helpful hints.

1. Deep Squat:

   • What it assesses: Bilateral, symmetrical, functional mobility of the hips, knees, and ankles. Also requires core stability and upper extremity coordination.
   • Description: The individual stands with feet shoulder-width apart, toes pointing forward. They hold a dowel rod overhead with their hands wider than shoulder-width. They then perform a deep squat, attempting to keep their heels on the ground and the dowel rod overhead.
   • Scoring:
     • 3: Performs the squat with good form, maintaining proper alignment and depth, and heels remain on the ground.
     • 2: Performs the squat with good form, but heels lift off the ground or dowel rod is compromised.
     • 1: Loses form significantly, cannot achieve proper depth, or struggles to maintain balance.
     • 0: Experiences pain during the movement.
   • Common Issues: Limited ankle mobility, tight hip flexors, weak core, poor shoulder mobility.
   • Humorous Analogy: Think of it as trying to sit on an invisible toilet seat. Do you gracefully lower yourself, or do you look like you’re about to fall into the abyss? 🚽

2. Hurdle Step:

   • What it assesses: Single-leg balance, hip mobility, and core stability.
   • Description: The individual stands with feet together, facing a hurdle that is placed at the height of the tibial tuberosity (the bony bump below your kneecap). They hold a dowel rod across their shoulders. They lift one leg over the hurdle, maintaining balance and keeping the dowel rod level.
   • Scoring:
     • 3: Maintains good balance, stable core, and proper alignment throughout the movement. Foot clears the hurdle, and maintains the dowel rod horizontally.
     • 2: Loses some balance, exhibits slight core instability, or foot briefly touches the hurdle.
     • 1: Loses significant balance, exhibits significant core instability, or cannot clear the hurdle.
     • 0: Experiences pain during the movement.
   • Common Issues: Limited hip mobility, weak glutes, poor balance, instability.
   • Humorous Analogy: Imagine you’re trying to step over a sleeping dragon without waking it up. Gotta be smooth and controlled! 🐉

3. In-Line Lunge:

   • What it assesses: Trunk and core stability, ankle and hip mobility, and quadriceps flexibility.
   • Description: The individual stands with one foot in front of the other, heel to toe. They hold a dowel rod vertically along their back, touching their head, upper back, and sacrum. They then perform a lunge, lowering their back knee towards the ground while maintaining the dowel rod’s contact points.
   • Scoring:
     • 3: Maintains good alignment, keeps the dowel rod in contact with all three points, and demonstrates good balance.
     • 2: Loses contact with one of the dowel rod points, or exhibits slight instability.
     • 1: Loses contact with two or more dowel rod points, or exhibits significant instability.
     • 0: Experiences pain during the movement.
   • Common Issues: Limited hip mobility, tight hip flexors, weak core, poor balance.
   • Humorous Analogy: You’re trying to walk a tightrope while carrying a very important (and fragile) vase of flowers. 💐

4. Shoulder Mobility:

   • What it assesses: Shoulder range of motion, flexibility, and coordination.
   • Description: The individual stands with feet shoulder-width apart. They make a fist with each hand and reach one arm over their shoulder and the other arm up their back, attempting to touch their fists.
   • Scoring:
     • 3: Fists are within one hand length.
     • 2: Fists are within two hand lengths.
     • 1: Fists are further than two hand lengths apart.
     • 0: Experiences pain during the movement.
   • Common Issues: Tight shoulder muscles, limited shoulder joint mobility, poor posture.
   • Humorous Analogy: Trying to scratch an itch in the middle of your back when you’re wearing a straightjacket. 🤪

5. Active Straight-Leg Raise:

   • What it assesses: Hip mobility, hamstring flexibility, and core stability.
   • Description: The individual lies on their back with their legs straight. They hold a dowel rod above their knees to keep them straight. They then lift one leg as high as possible, keeping their knee straight and the other leg flat on the ground.
   • Scoring:
     • 3: The raised leg reaches a vertical position (90 degrees) or higher.
     • 2: The raised leg reaches between vertical and the mid-point between the ground and vertical.
     • 1: The raised leg does not reach the mid-point.
     • 0: Experiences pain during the movement.
   • Common Issues: Tight hamstrings, limited hip mobility, weak core.
   • Humorous Analogy: Pretending you’re a ballerina…but your hamstrings are made of steel. 🩰

6. Trunk Stability Push-Up:

   • What it assesses: Core stability, upper body strength, and coordination.
   • Description:
     • Males: Start in a standard push-up position with hands shoulder-width apart.
     • Females: Start in a push-up position with knees on the ground.
     • The individual then performs a push-up, maintaining a straight line from head to knees (or toes).
   • Scoring:
     • 3: Performs the push-up with good form, maintaining a straight line.
     • 2: Performs the push-up with good form, but the lower back sags slightly.
     • 1: Cannot perform a push-up with good form, or the lower back sags significantly.
     • 0: Experiences pain during the movement.
   • Common Issues: Weak core muscles, poor upper body strength.
   • Humorous Analogy: Trying to hold a plank while simultaneously juggling chainsaws. (Don’t actually do that!) 🪚

7. Rotary Stability:

   • What it assesses: Core stability, coordination, and balance in a rotational pattern.
   • Description: The individual starts on their hands and knees. They place a dowel rod across their back, perpendicular to their spine. They then simultaneously extend one arm and the opposite leg, maintaining balance and keeping the dowel rod level.
   • Scoring:
     • 3: Performs the movement with good form, maintaining balance and keeping the dowel rod level.
     • 2: Performs the movement with good form, but struggles to maintain balance or the dowel rod tilts slightly.
     • 1: Cannot perform the movement with good form, loses significant balance, or the dowel rod tilts significantly.
     • 0: Experiences pain during the movement.
   • Common Issues: Weak core muscles, poor balance, limited coordination.
   • Humorous Analogy: Trying to balance a stack of pancakes on your head while riding a unicycle. 🥞

Table Summarizing the FMS Tests

Test	What it Assesses	Scoring Criteria (Simplified)	Common Issues
Deep Squat	Bilateral Mobility, Stability, Coordination	3: Good form, heels down, dowel overhead; 2: Good form, but heels lift or dowel compromised; 1: Poor form, can’t achieve depth; 0: Pain	Limited ankle mobility, tight hip flexors, weak core, poor shoulder mobility
Hurdle Step	Single-Leg Balance, Hip Mobility, Core Stability	3: Good balance, stable core, foot clears; 2: Some balance loss, slight instability, foot touches; 1: Significant balance loss, significant instability, can’t clear; 0: Pain	Limited hip mobility, weak glutes, poor balance, instability
In-Line Lunge	Trunk Stability, Ankle/Hip Mobility, Quad Flexibility	3: Good alignment, dowel contact maintained; 2: Dowel point lost, slight instability; 1: Multiple dowel points lost, significant instability; 0: Pain	Limited hip mobility, tight hip flexors, weak core, poor balance
Shoulder Mobility	Shoulder ROM, Flexibility, Coordination	3: Fists within 1 hand length; 2: Fists within 2 hand lengths; 1: Fists further than 2 hand lengths; 0: Pain	Tight shoulder muscles, limited shoulder joint mobility, poor posture
Active Straight-Leg Raise	Hip Mobility, Hamstring Flexibility, Core Stability	3: Leg reaches vertical (90 degrees+); 2: Leg reaches between vertical and midpoint; 1: Leg doesn’t reach midpoint; 0: Pain	Tight hamstrings, limited hip mobility, weak core
Trunk Stability Push-Up	Core Stability, Upper Body Strength, Coordination	3: Good form, straight line; 2: Good form, slight back sag; 1: Poor form, significant back sag; 0: Pain	Weak core muscles, poor upper body strength
Rotary Stability	Core Stability, Coordination, Balance (Rotational)	3: Good form, maintains balance, dowel level; 2: Good form, struggles to balance/dowel tilts slightly; 1: Poor form, significant balance loss/dowel tilts significantly; 0: Pain	Weak core muscles, poor balance, limited coordination

Interpreting the Results: Putting on Your Detective Hat

Okay, you’ve performed the FMS. Now what? What does it all mean?

• Pain is King (or Queen): Any score of 0 is a red flag. Pain trumps everything. Address the painful movement first. Refer out to a physician if needed.
• Asymmetry Alert: Significant differences in scores between the right and left sides (e.g., a 3 on the right and a 1 on the left for the Active Straight-Leg Raise) indicate imbalances that need to be addressed.
• Low Total Score: While there’s no magic number, a total score below 14 is generally considered a warning sign. However, remember that the FMS is just one piece of the puzzle. Consider the individual’s activity level, injury history, and overall health.
• Prioritize Corrective Exercises: Based on the FMS results, develop a targeted corrective exercise program to address the identified movement deficiencies.

Corrective Exercises: Your Arsenal of Awesomeness

Corrective exercises are specific exercises designed to improve movement patterns and address underlying dysfunctions. The goal is to restore proper muscle activation, improve joint mobility, and enhance overall movement efficiency.

Here are some examples of corrective exercises that can be used to address common FMS findings:

• Limited Ankle Mobility (Deep Squat): Ankle mobility drills (e.g., calf stretches, ankle dorsiflexion exercises).
• Tight Hip Flexors (Deep Squat, In-Line Lunge): Hip flexor stretches (e.g., kneeling hip flexor stretch, Thomas test stretch).
• Weak Core (All Tests): Core strengthening exercises (e.g., planks, bird dogs, dead bugs).
• Limited Shoulder Mobility (Shoulder Mobility): Shoulder stretches (e.g., cross-body shoulder stretch, doorway stretch).
• Tight Hamstrings (Active Straight-Leg Raise): Hamstring stretches (e.g., towel stretch, standing hamstring stretch).
• Weak Glutes (Hurdle Step): Glute strengthening exercises (e.g., hip thrusts, glute bridges, clamshells).

Important Considerations: The Fine Print

• Proper Technique is Key: Ensure that the individual performs the FMS correctly. Poor technique can lead to inaccurate results.
• Don’t Chase Perfection: The goal is not necessarily to achieve a perfect score of 21. Focus on improving movement patterns and addressing underlying dysfunctions.
• Re-Test Regularly: Re-test the FMS periodically to track progress and adjust the corrective exercise program as needed.
• Individualize the Approach: The FMS is just a starting point. Tailor the evaluation and treatment plan to the individual’s specific needs and goals.
• Collaboration is Crucial: Work with other healthcare professionals (e.g., physicians, athletic trainers) to provide comprehensive care.
• Specificity: While the FMS looks at overall movement patterns, it is important to remember the importance of specificity of training. If someone is, for example, a powerlifter, their movement patterns during a squat will be different than someone who is just trying to squat to pick something up off the floor.
• Screening vs. Assessment: The FMS is a screening tool. It identifies potential problems. It is NOT a diagnostic tool.

The FMS and the Real World: Case Studies (Hypothetical, of Course!)

Let’s look at a couple of hypothetical case studies to see how the FMS can be applied in the real world.

• Case Study 1: The Weekend Warrior (🏃‍♂️):

  • Individual: A 40-year-old male who enjoys running on the weekends.
  • FMS Results: Low score on the Deep Squat (1), Hurdle Step (2 on the right, 1 on the left), and Active Straight-Leg Raise (1).
  • Interpretation: Limited ankle mobility, tight hip flexors, weak glutes, and tight hamstrings.
  • Corrective Exercises: Ankle mobility drills, hip flexor stretches, glute strengthening exercises, and hamstring stretches.
  • Outcome: Improved movement patterns, reduced risk of injury, and enhanced running performance.

• Case Study 2: The Desk Jockey (👩‍💻):

  • Individual: A 30-year-old female who spends most of her day sitting at a desk.
  • FMS Results: Low score on the Shoulder Mobility (1), Trunk Stability Push-Up (1), and Rotary Stability (2).
  • Interpretation: Tight shoulder muscles, weak core, and poor posture.
  • Corrective Exercises: Shoulder stretches, core strengthening exercises, and postural exercises.
  • Outcome: Improved posture, reduced neck and back pain, and increased overall well-being.

Conclusion: Embrace the Power of Movement

The Functional Movement Screen is a valuable tool for identifying movement deficiencies and preventing injuries. By understanding the principles of the FMS and implementing targeted corrective exercises, you can help your patients move better, feel better, and perform better.

Remember, folks, movement is medicine! Use it wisely. 💪

(Lecture Ends)

Now, go forth and screen! And try not to fall off that invisible toilet seat. 😉