Editor's Musings: To Screen or Not to Screen?
The old adage goes, “Fundamentals first”. A general truth that applies to so many aspects of life, but is a particularly crucial mentality to have for both athlete and sport scientist. Sometimes we get carried away, putting cart before horse, and have to force ourselves to bring it back to basics. In my own little world the fundamental I had neglected was screening. Recently, little feelings of guilt for neglecting screening were beginning to mount. However, I’ve stuck to my philosophy of addressing the “low hanging fruit”. What this means is that I try to effect change in areas that I believe will reap the most benefit with the most efficient use of time and resources. I did not regard screening as “low hanging fruit”. Hopefully this inspires a few gasps or head shakes. I admit that I enjoy the idea of being considered slightly rogue or rebellious. But before you reach for your pitchforks and torches, just hear me out. I have resisted the urge to dive right in, get accredited, set-up the screening process, and screen all who are under my supervision. Instead, like a good little scientist, I have begun to rummage through the literature concerning the Functional Movement Screen™ (FMS) specifically. I always raise an eyebrow when the research turns into a business. That’s not to say that business ventures shouldn’t be evidence-based, but I have questions. But I digress…
What is the FMS?
The FMS is a 4-point screening tool for fundamental movement patterns, with emphasis on stability and mobility[1,2]. Participants are scored from 0-3 on seven individual movement patterns; deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability push-up, and rotary stability, for a total score out of 211. The FMS is reportedly intended to be used for establishing a baseline of movement competence for assessing or predicting performance or injury risk[1,3].
At this point it is important to remember that the FMS is a screening tool, and not a tool intended for diagnosis[4,5]. Screening can precede diagnosis, simply indicating that something is wrong and requires further investigation for a diagnosis to be made.
Does it do what it claims?
Public opinion would seem to be in favour of the FMS, with backing from professionals and gurus from across the vast expanse of the internet. But this was also the case with the Power Balance bracelets circa 2010 before the rug got pulled from under the feet of their largely successful business. The first factor to consider would be the clinimetric properties of the screening tool. Clinimetrics can become a bit of a murky topic on its own, so I won’t go into detail here. However, in my brief search, I did find a paper reporting high inter-rater reliability for the FMS. This same paper suggested that experience or training did not influence reliability6. Interesting finding for a business offering levels 1 and 2 FMS training courses. Again, I digress… The next step would be to confirm if it’s accurate and valid. In short, it has been reported that the accuracy and predictive validity of the FMS is insufficient for injury prediction[1,3] and that it is not a valid tool for predicting athletic capability (albeit with golfers in this specific study).
Is it worth my time?
Another way to ask this would be, “Is a screening-based intervention superior to the intervention on its own?”. From what I’ve read so far, I don’t believe that including the FMS as part of my practices is the most efficient use of my time. Firstly, the evidence doesn’t seem to support it as a tool for predicting performance or injury risk[2,3,5]. Secondly, it is a bit of a stretch to try and nail down one risk factor as a predictor of injury risk, because injury risk is a complex interaction of multiple risk factors and situational events. Lastly, are there not some instances in which irregular movement patterns might be beneficial to performance? It was reported that in some cases higher FMS scores related to poorer performance. With these points in mind, I would rather look for other ways to better monitor and manage the athletes under my supervision, and ensure they are training and recovering effectively.
I’m sure that there’ll continue to be debate, but for now, the evidence just doesn’t seem to support the FMS. Now, I’m not suggesting that we throw baby out with the bathwater. I’ve just picked on the FMS because it’s in vogue and a business, but there are many other tests (Y-balance, single-leg drop, etc.) that practitioners might use which I haven’t touched on. Are these other tools useful? Maybe. Maybe not.
In this issue, Simone do Carmo introduces us to the three R’s of recovery, Dr Jason Tee discusses athlete maturity and training practices, and David Leith runs us through the central governor model. Then, our guest writers, Greg Purcell and Hanno van Vuuren deal with drug abuse and sport and the effect of coach burnout on athletes, respectively. I enjoyed reading all these contributions, and I’m sure that you will too.
1. Warren, M., Smith, C. A. & Chimera, N. J. Association of the Functional Movement Screen With Injuries in Division I Athletes. J. Sport Rehabil. 24, 163–170 (2015).
2. Parchmann, C. J. & McBride, J. M. Relationship Between Functional Movement Screen and Athletic Performance. J. Strength Cond. Res. 25, 3378–3384 (2011).
3. Dorrel, B. S., Long, T., Shaffer, S. & Myer, G. D. Evaluation of the Functional Movement Screen as an Injury Prediction Tool Among Active Adult Populations: A Systematic Review and Meta-analysis. Sports Health 7, 532–537 (2015).
4. Bahr, R. Why screening tests to predict injury do not work— and probably never will…: a critical review. Br. J. Sports Med. 50, 776–780 (2016).
5. Whittaker, J. L. et al. Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review. Br. J. Sports Med. 0, 1–7 (2016).
6. Leeder, J. E., Horseley, I. G. & Herrington, L. C. The Inter-rater Reliability of the Functional Movement Screen Within an Athletic Population Using Untrained Raters. J. Strength Cond. Res. 30, 2591–2599 (2016).