Implementation of the Functional Movement Screen at Central Magnet School for Cross Country. Athletes. Lane Grizzard. Abby Graves

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1 Implementation of the Functional Movement Screen at Central Magnet School for Cross Country Athletes by Lane Grizzard Abby Graves A Senior Thesis Submitted in Partial Fulfillment of the Requirements for Graduation Central Magnet School April 2017 Thesis Committee: Dr. Jacob Hicks Sarah Esberger Dr. Lando Carter Eve Harrison 1

2 Acknowledgements We would like to thank many people, all of whom helped greatly with the creation of our thesis. Thank you to Dr. Jacob Hicks, who guided us along the way, advised us, educated us, helped us carry out our procedures, and was an astounding mentor. Thank you to Dr. Lando Carter and Ms. Eve Harrison who helped us complete our thesis with their guidance and feedback. Thank you to the six runners who participated in our experiment and allowed us to use their FMS scored in our thesis, without whom this thesis could not have been completed. 2

3 Abstract The purpose of our research was to observe common limitations in the movements of Central Magnet cross country athletes using the Functional Movement Screen and find connections between the Functional Movement Screen score and the areas with potential risk factors. We did this methodology in order to support our hypothesis that The FMS scores of the cross country athletes will correlate with injuries and should be used as a method of injury prevention in high school cross country teams. After surveying 6 runners before and after screening them using the FMS, the research shows that the FMS can accurately identify, through movements, areas on the athletes that might be at more prone to injury. The participants would like to have the FMS be a requirement to run at Central Magnet school, as it could identify injury-prone or weak areas that could be injured in the season, and used as a method of injury prevention. 3

4 Table Of Contents Acknowledgements... 2 Abstract.. 3 Introduction... 6 Research Question.. 6 Research Purpose... 6 Background Information. 6 FMS Tests Scoring.. 13 Hypothesis. 15 Methodology 16 Results.. 17 Key FMS Results.. 18 Individual Survey Results Discussion 26 Analysis of Data 29 Analysis of Limitations Conclusion Appendices Appendix A Appendix B

5 Works Cited. 34 5

6 Introduction Research Question How can injuries of high school cross country athletes be prevented? Research Purpose The purpose of the research was to conclude whether or not the implementation of the FMS, Functional Movement System, as a prerequisite to compete in cross country would prevent injuries in the athletes. Since the current methods of treating and preventing injuries in cross country athletes were not very effective at Central Magnet School, the experiment was done in order to conclude whether or not the FMS would decrease the rate of injuries in the athletes. Background Information In high school sports today, the injury rate is on the rise, but the funding for injury prevention and physical therapy is often swept under the rug. School sports injuries are one of the leading types of injuries in children These injuries can cause students to miss school time and cause parents to miss work; a study from L. Abernethy and D. Macauley studied the patients at the The Ulster Hospital Dundonald, Belfast and found that 10.7% [of patients missed] a full day, 9.3% parts of more than one day, 16% two or more full days, and 1.3% a combination of full days and parts of days, amounting to more than two full days (Abernethy, MacAuley). Yet still at Central Magnet School, there is only one available physical therapist to try and prevent and treat injuries. Even more concerning is that injuries are more likely to occur during a practice than meets, so there is need for more injury surveillance at practices than just the coaches during any athletic exposure in high school sports (Rauh). Due to the high chances of injury in cross country, there should either be injury surveillance at all times or injury 6

7 surveillance prerequisite tests before competing in the sport (Rauh). Since it is impractical and time consuming to have a certified surveyor at all times, there should be a screening for each athlete to identify where each athlete would be prone to injury, so that that athlete could then take initiative to prevent that problem area from developing further. Without this current method being put into place, injury rates are only rising because the athletes do not know what injuries they are prone to. After becoming injured, the rehabilitation and therapy can be a long, grueling process, sometimes taking months, or even ending the running career (Rauh). The Function Movement Screen is a screening tool used to identify limitations or asymmetries in seven fundamental movement patterns that are key to functional movement quality in individuals with no current pain complaint or known musculoskeletal injury (Functional Movement Screen). The test is measured by an athlete s performance on seven various movement efficiency tests. Each test is focused on a specific movement that will make pain, weakness, and imbalances noticeable if motor control is low. The seven different movement patterns are each individually scored on a 4 point scale from 0 to 3: 0 being incapable of doing the test properly, 1 having many hindrances when performing the action, 2 having few hindrances when performing the action, and 3 being completely capable of performing the specific movement pattern. If the participant experiences any kind of pain or discomfort, or he or she has to force themselves into the position, then that person receives a 0 on the test. On the bilateral tests that require the movement on both sides of the body, each side receives a 0-3 score. Even though the best attempt is scored from each side, the lower score from the two sides is always taken for the final score in order to get the most accurate screening possible. In the FMS, the participant is given three attempts to perform the action to the best of their ability; the 7

8 score from that test is taken from their best attempt. The individual scores are added into a full scale measuring 0 to 21. According to the FMS, a score of 14 and lower means very high risk of injury, and 15 and higher is in the green zone, which means that there is not much risk of injury. The final score is an indicator of the athlete s movement efficiency. Test 1 The first movement pattern that is tested is the deep squat. It requires a dowel which is held over the individual s head while in a squat position, creating a full overhead squat movement. If the individual s heels are firmly planted on the ground, the dowel is parallel to the ground in the overhead position, and the back is straight, the score is a 3. If the heels are elevated, but the individual maintains the other qualification of a 3, the score is a 2. If the knees are bent inward, the back is not straight, and if the dowel is not aligned with the feet, then the score for the individual would be a 1. 8

with a dowel being rested behind the head on the back of the shoulders. The optimal result would be minimal spine movement during the test. The hips, knees, and ankles need to stay aligned.

9 Test 2 The second test is the hurdle step. Placed in front of the individual will be a small hurdle at the height of the participant s knee, and he or she will have to raise one leg above the hurdle and move it back to the original position with a dowel being rested behind the head on the back of the shoulders. The optimal result would be minimal spine movement during the test. The hips, knees, and ankles need to stay aligned. The dowel should also remain parallel with the ground. This would score a 3. If the knee leans off to the side when raising the leg, and there is movement in the spine, then the score will be a 2 for this test. If the individual s foot makes contact with the hurdle in anyway, if there is a noticeable loss of balance, or if the dowel is not parallel to the ground, then the score is a 1. Test 3 9

The inline lunge is a test in which the participant does a lunge where his/her legs are in line, one leg in front of the other, and the back knee touches the heel of the front foot.

10 The inline lunge is a test in which the participant does a lunge where his/her legs are in line, one leg in front of the other, and the back knee touches the heel of the front foot. A dowel is held flush against the back of the spine, one hand holding it above the shoulder, and one hand holding it in lower back region. If the dowel is flush with the back the entire time and remains vertical, the back knee touches the back of the front heel, and if the torso and feet remain stable and planted, the individual scores a three. If the back foot does not touch the front foot, the dowel is not vertical, and there is movement in the torso and feet, the score drops to a 2. If balance is not maintained, the score is a 1. Test 4 This test measures shoulder mobility. If the individual can reach one fist to the back above shoulder and one below the shoulder, and if the fists come within one hand length of touching, the result is a 3. If the fists are within one and a half hand lengths, then the score is a 2. If any farther apart, the score will be a 1. If there are some noticeable hindrances when performing this test, the participant will be asked to do a clearing test in order to ensure that nothing is physically wrong with him or her. The participant places one hand on the opposite shoulder, and lifts the shoulder up towards the ceiling, and this is done with both arms. If there is no pain, then the participant is still cleared for this test. 10

Test 5 The fifth test is called the active straight-leg raise. The individual lays on the ground and raises one leg as high as he/she can with one leg still resting on the ground.

11 Test 5 The fifth test is called the active straight-leg raise. The individual lays on the ground and raises one leg as high as he/she can with one leg still resting on the ground. If the raised leg is vertical, and if a vertical line through the ankle would be between the mid thigh and hip bone, then the individual receives a 3. If the vertical line through the ankle comes to the joint line in the knee and the mid thigh, the score is a 2. If the vertical line resides below the joint line of the knee, the individual receives a 1. Test 6 The sixth test is the trunk stability pushup. The form differs between male and female. In order to score a 3, males need to have their thumbs aligned with the top of their head, in a pushup position. Females needs to have their thumbs aligned with the chin, in the same position. Also, the person needs to push themselves in these specific positions, fully extending their arms 11

without a dip or curve in the spine. If the person can do the same exercise, but male participants have their thumbs aligned with the chin and females with the clavicle, the score is a 2.

12 without a dip or curve in the spine. If the person can do the same exercise, but male participants have their thumbs aligned with the chin and females with the clavicle, the score is a 2. If the thumbs align anywhere below these points, and the spine is not straight, the participant receives a 1. If the participant cannot sufficiently perform this test, then he or she will be asked to do the spinal extension clearing test, which requires the participant to push up from the ground but leave their hips and legs on the ground. If the participant can perform this without pain, then he or she passes the clearing test. Test 7 The last test is called the rotary stability test. For this movement pattern, the individual get on the ground on his/her knees with hands also flat on the ground. To score a 3, the individual should be able to lift an arm and a leg on the same side, touch the knee and elbow together, then fully extend both out. If the participant cannot do the unilateral test, but he/she can extend and touch the elbow and knee on opposite sides of the body, then he/she receives a 2. If unable to do the correct form of the diagonal repetition, then the score will be a 1. If the individual is unable to perform this test sufficiently, the clearing test to ensure there is no pain is the spinal flexion clearing test. This clearing test requires the participant to get on all fours and 12

13 bring the buttocks back to the feet and touch the forehead to the ground with arms stretched above the head. If there is no pain, then the participant passes the clearing test. Scoring Each of the tests of the FMS is scored on a 0-3 scale, 3 being the most ability to perform the motion, and 0 being the least amount of ability. If the participant experiences any kind of pain or discomfort, or he or she has to force themselves into the position, then that person receives a 0 on the test. On the bilateral tests that require the movement on both sides of the body, each side receives a 0-3 score. Even though the best attempt is scored from each side, the lower score from the two sides is always taken for the final score in order to get the most accurate screening possible (Cook). The Functional Movement Screen was developed by Gray Cook and Lee Burton and established in These two individuals started the Functional Movement Screen as an injury prevention method, and later, Cook wrote a book called Movement: Functional Movement Systems: Screening, Assessment, Corrective Strategies, published in 2010 and is currently used in many professions involving physical endurance. Kyle Kiesel, PT, PhD, performed a study on professional football players whose teams had utilized the FMS as part of pre-season physical performance testing prior to the 2005 season in order to determine if the FMS could accurately predict injuries before they happen. H e analyzed the results of the players who attended a proffessional training camp, and placed their results in an ROC curve, the FMS score compared to the player s sensitivity to the test, it was concluded that it was determined that an FMS score of 14 maximized specificity and sensitivity of the test, meaning that the test correctly identifies the greatest number of subjects 13

14 at risk (true positives) while minimizing incorrectly identifying subjects not at risk (false positives). With the results withholding as many false positives as possible, Kiesel is able to claim that, on average, a player [has] an eleven-fold increased chance of injury when their FMS score is 14 or less compared to a player whose score which was greater than 14 at the start of the season. (Kiesel) Again, the FMS is proven to be highly accurate and telling if an athlete will develop a certain injury or is prone to a certain weakness, as it was proven to predict the injuries of professional football players, apparently for 11 years. Using the FMS in Central Magnet High School would only be an accurate predictor of injuries, providing more injury prevention to the cross country athletes. In a study performed on military participants by Lisman, O Connor, Deuster, and Knapik, [it] examined the predictive power of physical fitness, self-reported exercise modality training frequencies and history, previous history of lower limb injury, and FMS scores in an effort to improve injury prediction. The seven tests were done and then a questionnaire was given to the participants in regards to the strenuous physical activities they do in the millitary, previous injuries, and how often they exercised before joining the military. The results from the FMS and the questionnaire were compared, and the results show[ed] that the odds of sustaining any injury were over fourfold times higher among those with FMS scores 14. So, the participants with the lowest scores in the FMS were also found to be very prone to injuries in the past, and unable to do as much strenuous exercise as some of the other participants with FMS scores >14. (Lisman) The results from this controlled, seemingly unbiased experiment can be trusted, and with the use of the FMS on the United States military, can be used to guide our research and methodology. 14

15 Today, the FMS is widely used and relied on by many esteemed organizations. The Functional Movement screen has been and currently is being used on the United States Olympic team; the man who implemented this screen in the US National Team was Dave Tilley, a former competitive gymnast for 18 years, who has a doctorate in Physical Therapy, recently became Board Certified in Sports Physical Therapy, currently [is]studying to obtain [his]certified Strength and Conditioning Specialist credentialing, [and has] been coaching both Men s and Women s competitive gymnastics for 12 years (Tilley). These highly professional athletes and their coaches depend on this test for their jobs and their performance. The same attitude and results they have can easily be applied to any high school sport. In order to prevent injuries, the proposition is to insert the Functional Movement Systems (FMS) as a mandatory screening before becoming eligible for the cross country team at Central Magnet School. Hypothesis The FMS scores of the cross country athletes will correlate with injuries and should be used as a method of injury prevention in high school cross country teams. 15

16 Methodology In order to test the Functional Movement Screen s reliability and accuracy in injury prevention methods of high school cross country runners, Dr. Jacob Hicks, a physical therapist (certified in the FMS) screened 6 athletes on the Central Magnet cross country team, all of whom volunteered to be part of the research. The participants were females and males between the ages of 14 to 18. The athletes did not take part in any strenuous activity before the conducted research. Before the survey, each participant was given a number. The number was used on their FMS scoring sheet and the two surveys to provide anonymity and to keep the survey results in order. The athletes were given the first survey (Pre-FMS survey found in Appendix A), which asked about their injury history, personal fitness, daily life, etc. Each participant performed the deep squat, hurdle step, inline lunge, shoulder mobility movement, active straight-leg raise, trunk stability pushup, and rotary stability test to the best of their ability. When doing the tests, all the athletes were required to use a dowel (to hold above the head for the deep squat and hurdle step, and behind the back for the inline lunge), a plank with measurements to stand on (for the inline lunge), and a hurdle (for the hurdle step), and the testers used a ruler (to measure the shoulder mobility movement), a yardstick (to measure the active straight-leg raise) and participant spreadsheets (to score the movements on). Dr. Hicks assigned a score for each athlete based for each exercise, and we finalized the scores. The runners received their scores and then they were surveyed again post-fms (Post-FMS survey found in Appendix B) in order to gather an idea about the general consensus of the runners experience with the FMS, and if they think it should be a requirement to compete. The data (the two surveys and the FMS score of each runner) were 16

17 compiled. The correlations of risk factors identified in the pre-fms surveys and FMS scores of each runner identified and recorded, and then compared to the post-fms surveys. Results Key: #: Participant s number DS: Deep squat HS: Hurdle step ILL: In-line lunge SM: Shoulder mobility AI: Arm raise clearing test ASLR: Active straight leg raise TSPU: Trunk stability push-up RS: Rotary stability EX: Spinal extension clearing test FLX: Spinal flexion clearing test 17

18 FMS Participant Results: Age/ # Sex: Sport: DS HS ILL SM AI ASLR TSPU EX RS FLX Total 1 16/f xc/track /f xc/track /m xc/track /f xc/track /m xc/track /m xc/track Participant 1: Survey 1: Has been injured from running cross country and some other sport in the knee (muscular injury). No significant health complications. Mildly active child. Started participating in sports at age 11 (cross country, track, and soccer). 18

19 No broken bones or athletic-related surgeries. Frequent joint pain when running (3 on a scale of 1-10), but no muscle pain and it has never hindered her performance. Coach does not personalize workouts based on her abilities. Coach standardizes workouts for her entire team. Coach stresses the importance of injury prevention methods and includes injury prevention methods/exercises/stretches. Has not heard of the FMS before and likes the idea of making an injury screen mandatory for all cross country athletes. Survey 2: 15 minutes to complete the FMS. Feels more aware of weaknesses/places where she might be more prone to injury. Would recommend a fellow athlete to perform the Functional Movement Screen before competing/training for the season. Likes the idea of making the Functional Movement Screen a requirement to participate in high school cross country. Would not make any changes to the FMS. Participant 2: Survey 1: Has not been injured from running cross country or some other sport. No significant health complications. 19

20 Mildly active child. Started participating in sports at age 7 (softball). Broken arm in the past; no surgeries. Frequent joint pain when running (4 on a scale of 1-10), but no muscle pain and it has hindered her performance. Coach does personalize workouts based on her abilities. Coach standardizes workouts for her entire team. Coach stresses the importance of injury prevention methods and includes injury prevention methods/exercises/stretches. Has not heard of the FMS before and likes the idea of making an injury screen mandatory for all cross country athletes. Survey 2: Less than 10 minutes to complete the FMS. Feels more aware of weaknesses/places where she might be more prone to injury. Would recommend a fellow athlete to perform the Functional Movement Screen before competing/training for the season. Likes the idea of making the Functional Movement Screen a requirement to participate in high school cross country. Would not make any changes to the FMS. Participant 3: Survey 1: 20

21 Has not been injured from running cross country or some other sport. No significant health complications. Not an active child. Started participating in sports at age 11. No broken bones or surgeries. No frequent joint pain when running (1 on a scale of 1-10), and no muscle pain and it has never hindered his performance. Coach does personalize workouts based on his abilities. Coach standardizes workouts for his entire team. Coach stresses the importance of injury prevention methods and includes injury prevention methods/exercises/stretches. Has not heard of the FMS before and likes the idea of making an injury screen mandatory for all cross country athletes. Survey 2: minutes to complete the FMS. Feels more aware of weaknesses/places where he might be more prone to injury. Would recommend a fellow athlete to perform the Functional Movement Screen before competing/training for the season. Likes the idea of making the Functional Movement Screen a requirement to participate in high school cross country. Would not make any changes to the FMS. 21

22 Participant 4: Survey 1: Has been injured from running cross country and some other sport in the hips and shins (muscular injury). No significant health complications. An active child (danced from age 2-10). Started participating in sports at age 2. Broken wrist in past, no sports-related surgeries. Frequent joint pain when running (3 on a scale of 1-10), but no muscle pain, and it has hindered her performance. Coach does personalize workouts based on her abilities. Coach standardizes workouts for her entire team. Coach stresses the importance of injury prevention methods and includes injury prevention methods/exercises/stretches. Has heard of the FMS before and likes the idea of making an injury screen mandatory for all cross country athletes. Survey 2: 10 minutes to complete the FMS. Feels more aware of weaknesses/places where she might be more prone to injury. Would recommend a fellow athlete to perform the Functional Movement Screen before competing/training for the season. 22

23 Likes the idea of making the Functional Movement Screen a requirement to participate in high school cross country. Would not make any changes to the FMS. Participant 5: Survey 1: Has not been injured from running cross country or some other sport. No significant health complications. An active child. Started participating in sports at age 11 (cross country). Broken arm and toe in past, no sports-related surgeries. Frequent joint pain when running (3 on a scale of 1-10), but no muscle pain, and it has hindered his performance. Coach does personalize workouts based on his abilities. Coach standardizes workouts for his entire team. Coach does stress the importance of injury prevention methods and includes injury prevention methods/exercises/stretches. Has not heard of the FMS before and likes the idea of making an injury screen mandatory for all cross country athletes. Survey 2: 20 minutes to complete the FMS. Feels more aware of weaknesses/places where he might be more prone to injury. 23

24 Would recommend a fellow athlete to perform the Functional Movement Screen before competing/training for the season. Likes the idea of making the Functional Movement Screen a requirement to participate in high school cross country. Would not make any changes to the FMS. Participant 6: Survey 1: Has been injured from running cross country and some other sport (Shin splints, tendonitis, sprained ankle). No significant health complications. An active child. Started participating in sports at age 5 (soccer). No surgeries or broken bones. Frequent joint pain when running (3 on a scale of 1-10), and muscle pain, and it has hindered his performance. Coach does not personalize workouts based on his abilities. Coach standardizes workouts for his entire team. Coach does not stress the importance of injury prevention methods but he does include injury prevention methods/exercises/stretches. Has not heard of the FMS before and likes the idea of making an injury screen mandatory for all cross country athletes. 24

25 Survey 2: 12 minutes to complete the FMS. Does not feel more aware of weaknesses/places where he might be more prone to injury. Would recommend a fellow athlete to perform the Functional Movement Screen before competing/training for the season. Likes the idea of making the Functional Movement Screen a requirement to participate in high school cross country. Would not make any changes to the FMS. 25

26 Discussion Only one of the six participants could perform the deep squat completely, and that participant had never been injured from cross country or another sport. Both people who scored 1 s in the deep squat had been injured from cross country and another sport, one in the knee, and the other in the shins, ankle, and had tendonitis, and both of them were active as children to some degree. Another participant that scored a 2 in the deep squat had previous injuries from cross country and another sport in the hips and shins, as well as was an active child. This means that all these runners who scored lower have a higher risk factors to develop injures. The lack of ability to perform in this test could be because of and predisposition of weak hips, which could be caused by inadequate stretching, previous injuries, or having an active childhood, and these factors are present in every runner. All the runners scored very well in the hurdle step, with no one scoring below a 2. This could be because it is a motion all the participants are very used to doing, considering it mimics a running motion. All the runners scored perfectly in the in-line lunge, and this could be because this motion also mimics a running motion because it uses the same muscles and movements required in running. Every participant except for one outlier scored perfectly in the shoulder mobility motion. This could be because of something unrelated to running and stretching at practices, considering shoulder movements are not very strenuous when competing in cross country, so it can be detached from the rest of the data. Every participant passed the arm raise clearing test, so there was no noticeable movement problems in the shoulder with any runner. 26

27 Each of the runners could complete or mostly complete the active straight leg raise motion. This could be because the straight leg motion requires a certain degree of flexibility in the legs and hips, which each of the runners most likely have, since they run most days. Only two participants could complete the trunk stability push-up. The other four received a 1 because they could not lift themselves off the ground. This could be because of past injuries, such as broken bones in the arms and participant 4 s low score may be as a result of previous hips injuries, but one of the runners that scored a 3 had a broken arm as well. Also, every participant passed the arm raise clearing test, so the lack of ability in this test is most likely not caused by arm pain. All of the runners passed the spinal extension clearing test without any pain, which means that the runners most likely do not have any movement problems in the shoulders/arms/hips, so this could be because strength training has not implemented into their cross country workouts and their upper body is weak as a result. All the participants scored a 2 in the rotary stability test, so they could mostly do the movement, but did not have enough strength or center of balance to complete the test in a unilateral movement, but could complete it bilaterally. The hindrance could be because of the individual's knee injury (P. 1), hips/shin injuries (P.4), or shin splints, tendonitis, sprained ankle (P.6). But, the participants with no injury history scored the same, and everyone passed the spinal flexion clearing test, so the partial ability to perform the movement could also be indicative of a lack in certain exercises done in cross country training. The individual who had the most injuries responded that his coach never personalized workouts based on his abilities or stressed the importance of injury prevention methods. The participant with a history of knee injuries also responded that her coach never personalized your 27

28 workout based on her abilities. Every participant responded that the coach standardized workouts for the entire team. All responders except one said that they had never heard of the Functional Movement Screen, but all of them responded that they would like to make an injury screen mandatory for all cross country athletes. This shows that they all would like to have an injury screen done, but one was never offered, as well as doing non specialized workouts, all of which could lead to a greater risk of injury. After the FMS, all but one participant felt more aware of areas more prone to injury, all would recommend the screen to a fellow athlete, and all would like to make the FMS a requirement to compete in cross country at Central Magnet. This indicates that the screen was informative as well as trustworthy. No responders said they would make a change to the FMS, meaning that, as is, the participants felt there was so gaping flaw in the process.... Throughout interpreting results, many unique correlations and relationships were noticed between each individual s injury history and their scores on the Functional Movement Screen. Participant 1 had difficulty performing the deep squat, only receiving a 1 on the deep squat assessment. Participant 1 also had an injury history with a knee injury. The place of the injury could have directly affected her performance on the deep squat exercise as one must have quality range of motion and movement efficiency in the knee to perform the deep squat perfectly. Participant 4 reported a previous injury in the hips and shins due to running. She scored a 2 on the deep squat and a 2 on the hurdle step. A score of 2 means that the exercise was performed well, but there is room for improvement. In order to complete both the hurdle step and the deep squat, excellent movement efficiency is necessary in especially the hips to receive a three. In the 28

29 hurdle step and the deep squat, the hips must move efficiently to stay in line. This previous injury in the hips and shins could have been a hinderance for the participant to receive a 3 on both tests. The only other participant that reported previous injuries was Participant 6. Participant 6 reported in the first survey that he had shin splints, tendonitis, and a sprained ankle in the past. In addition, Participant 6 also scored a 1 on the deep squat and a 2 on the hurdle step. These both test ankle and leg mobility directly. Scoring low on these two exercises could be a direct result of his past injuries. While three out of six participants reported injuries, Participant 2, 3, and 5 reported no previous injuries. Participants 2 and 5 both scored 17 out of 21 on the FMS, which was the highest score reported from this test group. Participant 3 scored a 15 which was on the lowest end of the test group due to an abnormality in the shoulder mobility test, only scoring a 1 on shoulder mobility (He was the only one to score this low on shoulder mobility out of all of the participants.). Another important trend to note is that four of the six participants scored a 1 out of 3 on the trunk stability push up. The other two scored a 3 out of 3 on the trunk stability push up; however, they were 17 year old males, which could be an indicator of more upper body strength. This general trend of low scoring could be directly due to the negligence of upper body training in cross country. Analysis of Limitations Time was a large limitation in this experiment. Due to time constraints and deadlines, only six runners could be tested for the experiment. The small amount of runners was able to show correlation but not at a larger scale. 29

30 Conclusion Overall, the results of this study showed a correlation between previous injuries and lower FMS scores, especially when looking at the specific exercises. In addition, potentially dangerous abnormalities are brought out by the Functional Movement Screen such as hip or shoulder mobility. These are all risk factors that could lead to more injuries. These injuries can lead to a cross country runner potentially sitting out a season; or, it could end a runner s career. The results of this study have shown that the Functional Movement Screen can act as a great prerequisite to a high school cross country season to identify risk factors in a runner that could potentially injure the runner. A runner scoring 0-14 on the FMS, used as a prerequisite, should not be prohibited from being on the team; however, he or she should be advised to see a physical therapist to improve mobility in weak areas. According to the research done in this study and the data collected from the experiment, we believe that using the Functional Movement Screen as a prerequisite for cross country runners to participate in the season would save many runners an injury and many families money, creating a safer environment for cross country runners to enjoy the sport they love without the increased risks of getting hurt. 30

31 Appendix A. Survey pre-fms: Participant's number: Have you been injured from running cross country? Have you been injured from any other sport? If yes to #2 and/or 3, where was your injury? If yes to #2 and/or 3, was the injury muscular or skeletal? Do you have any significant health complications? If yes to the previous question, what is the health complication? Were you an active child? How old were you when you started competing in organized sports? What sports? (please say the age along with the sport) Have you ever had any surgeries? If so, elaborate. Have you ever had any broken bones? If so, please state where and the cause. Do you have frequent joint pain when you run? What joints? Rate pain on a scale of Has joint or muscle pain ever hindered your running performance? i.e. sitting out of practice. Has your coach ever personalized your workout based on your abilities? Does your coach ever standardize workouts? (Make the team do the same workout)? Does your coach often stress the importance of injury prevention methods? 31

32 Does your coach often include injury prevention methods/exercises/stretches? Have you heard of the Functional Movement Screen? Do you like the idea of making an injury screen mandatory for all cross country athletes? 32

33 B. Survey post-fms: Participant's number: About how long did the Functional Movement Screen take? Do you feel more aware of your weaknesses (i.e. places where you might be more prone to injury)? Would you recommend a fellow athlete to perform the Functional Movement Screen before competing/training for the season? Do you like the idea of making the Functional Movement Screen a requirement to participate in high school cross country? Would you make any changes to the Functional Movement Screen? If so, what? 33

34 References Cook, G. (2010). Movement: Functional movement systems: Screening, assessment, and corrective strategies. Aptos, CA: On Target Publications Cook, G. & Burton, L. Functional Movement Screen. (2016). Retrieved September 14, 2016, from Cook, G. & Burton, L. The Application of the FMS in Track and Field. (2016). Retrieved September 26, 2016, from theapplication_of_ the_fms_in_track_and_field Kiesel, K., Plisky, P. J., & Voight, M. L. (2007). Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen? North American Journal of Sports Physical Therapy : NAJSPT, 2 (3), Lisman, P., O Connor, F. G., Deuster, P. A., & Knapik, J. J. (2013). Functional movement screen and aerobic fitness predict injuries in military training. Med Sci Sports Exerc, 45 (4), Mokha, M., Sprague, P. A., & Gatens, D. R. (2016). Predicting musculoskeletal injury in National Collegiate Athletic Association Division II athletes from asymmetries and individual-test versus composite functional movement screen scores. Journal of Athletic Training, 51 (4), Rauh, M. J. "Epidemiology of Musculoskeletal Injuries among High School Cross-Country Runners." American Journal of Epidemiology (2005): Oxford Journals [Oxford UP]. Web. 28 Sept

35 Tilley, Dave. "The Benefits of Using the FMS within USA Gymnastics." The Benefits of Using the within USA Gymnastics. Functional Movement Screen, 10 Aug Web. 28 Sept Voight, M. (2015). Are Your Athletes Really Ready to Return to Play? Retrieved September 26, 2016, from return_to_play 35

DEEP SQUAT. Upper torso is parallel with tibia or toward vertical Femur below horizontal Knees are aligned over feet Dowel aligned over feet

DEEP SQUAT. Upper torso is parallel with tibia or toward vertical Femur below horizontal Knees are aligned over feet Dowel aligned over feet APPENDIX 9 SCORING CRITERIA DEEP SQUAT Upper torso is parallel with tibia or toward vertical Femur below horizontal Knees are aligned over feet Dowel aligned over feet Upper torso is parallel with tibia