5/22/2017. Discuss reliability of FMS and selected movement screens Discuss the meaning of FMS composite score results Discuss Deep Squat dysfunction

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1 Eric Scibek, MS, ATC, LAT, CSCS, PES Sacred Heart University Discuss reliability of FMS and selected movement screens Discuss the meaning of FMS composite score results Discuss Deep Squat dysfunction Discuss screening in a case Expertise Evidence Patient A battery of 7 fundamental movement patterns (tests) designed to evaluate movement dysfunction and asymmetries. -Deep squat -Hurdle Step -Inline Lunge -Shoulder Mobility -Active Straight Leg Raise -Trunk Stability Pushup -Rotary Stability In general: 3 = Able to perform the test correctly 2 = Able to perform the test correctly in a modified position or able to partially complete the test 1 = Unable to successfully complete the test 0 = Pain during the test or clearing test Take highest score from three trials Ex. Trial 1 = 2, Trial 2 = 1, Trial 3 = 3 Score the test a 3 When testing bilaterally, take the LOWEST score between sides Ex. Right = 3, Left = 2 Score the test a 2 When in doubt, score low 1

2 Reliability Mixed results Strong between novice and expert raters (Minicket al., 2010) Mixed between disciplines (AT, EX, PT) (Scibek et al., 2013) Professional education may influence reliability of FMS tests (Scibek et al., 2013) Composite score reliability ranges from poor to excellent 46 NFL players No demographic data FMS done during preseason ROC curve analyzed and cut point set at 14 Score 14 results in 11.67x greater chance of injury 238 NFL players Players with CS 14 = 1.87 relative risk related to injury Players with at least one asymmetry = 1.80 relative risk related to injury Specificity for low composite and asymmetry= physically active students 35 sustained lower extremity injury ROC curve sets cutoff at 17 Score 17 results in 4.7x greater chance of injury Firefighters with CS 14 at increased risk of injury (Butler et al., 2012) 20 Major junior hockey players Average FMS score = 14.7 ±2.57 Score 14 no more likely to sustain an injury Injured athletes mean CS = 15 Non-injured mean CS = 14.4 Inconsistent in methods Firefighters with history of injury have 1.68x greater risk of sustaining injury Following intervention, lost time injuries reduced by 62% Cut point set at 16 (Peate, 2007) Military recruits with slow run times and low CS at increased risk of injury (Lisman et al., 2013) 2

3 Does not predict performance among healthy individuals and golfers (Okada, Parchman) The strength of association between FMS composite scores and subsequent injury does not support its use as an injury prediction tool FMS scores may predict future improvement in performance in track athletes from one season to the next (Chapman 2014) Scores can improve with training (Kiesel 2011) Training to correct FMS deficits have shown improvement in strength and flexibility in elite HS baseball players (Song 2014) PROS Potential to identify individuals at risk It is the best of what we have? right now Time CONS Time The evidence is not overwhelming Is not a predictor of athletic performance Do we need all tests for all populations? Some tests are difficult to assess An athlete s ability to follow directions is as important as their physical ability to successfully complete the FMS tests. After testing, dig deeper ROM, strength, use other screens/tests Keep asking questions and contribute to the body of evidence The short answer YES!!! 3

4 Torso/Tibia Parallel Femur parallel or below Knees over the toes Dowel move beyond toes Bar beyond toes 92.3% Torso parallel with tibia 76.9% Femur parallel 50% Medial Knee Displacement (MKD) 26.9% Asymmetry Feet ER 1 Knee displacement, 2 Torso and tibia do not remain parallel, 3 Femur does not reach horizontal, 4 Bar extends beyond toes. Very mixed Ranges from Poor to Good/Excellent (H. Gulgin& Hoogenboom, 2014; Minicket al., 2010; Onate et al., 2012; Scibek, Edmond, & Moran, 2013; Smith, Chimera, Wright, & Warren, 2013; Teyhen et al., 2012) Variability between Novice and Expert (Minick, et al., 2012, Onate et al., 2012, Smith et al., 2013) Variability across the movement sciences (Scibek et al., 2013) Kinematic differences between 1, 2, 3 Peak DF excursion is greater in those that score 3 (Butler et al., 2010) Those that score 3 have significantly greater peak knee flexion and knee flexion excursion than those that score 2 Those that score 3 or 2 have greater peak hip flexion Dill et al., 2014 No difference when classified by normal or limited ankle ROM Sig. difference when reclassified by weight bearing lunge performance Greater knee flexion displacement Greater ankle DF Mauntel et al., 2015 Differences between males and females Males = greater knee valgus!!! Males = Greater hip flexion protecve mechanism 4

5 EMG Compare those with MKD and those without Bell et al., 2012 = Significantly greater hip ADD in MKD group Padua et al., 2012 = Significant increase in hip ADD, gastroc., and tib. ant. activation Elevate heels decrease in glut max, hip ADD, tibant, and gastroc activation Decreased DF with knee extended may contribute to MKD (Bell et al., 2012) Bell et al., 2008 found no difference in squat when assessing passive DF knee ext Approached sig. when DF assessed with knee in slight flexion Maybe clinical significance???? 20% difference in DF between conditions MKD group did have sig. dif. hip ER Mauntel et al., 2015 Females have greater hip IR/ER compared to males Hip mobility impairments may influence kinetic chain distally Dill et al., 2014 DF PROM does not influence knee & hip kinematics sig. Reclassify subjects by weight-bearing ROM greater knee flex displacement and peak knee flexion. (Normal = >44.02 degrees) Bell et al., 2008 Greater normalized isometric hip extension and external rotation strength in MKD group What is interesting about these findings? Bell et al No difference in concentric and eccentric hip strength between MKD and control Does not have strong predictive value in regard to sport performance (Lockie et al., 2015) Some prediction on Vert Jump Deeper squat = Greater Glut Max activation??? 54% of golfers with DS fault had loss of posture during swing, 29% demonstrate a slide dysfunction during swing (Gulgin et al., 2014) These lead to inconsistent performance Track athletes that score a 3 on DS have greater longitudinal performance (Chapman et al., 2014) DS demonstrates minimal injury predictive value in firefighters and military recruits (Butler et al, 2013; Bushman et al., 2015) Use caution when using this test alone for predictive value (Bushman et al., 2015) Use of DS and ASLR has predictive value in runners better than entire FMS (Hotta et al., 2015) 5

6 Determine NM vs ROM Unload the squat Check PROM & AROM Check closed chain dorsiflexion Assess Strength Heels elevated or not? Do they know how to squat??? Select other tests/screens Correct identified dysfunction You perform a Functional Movement Screen on a 20 year old female Division I soccer player. She has had ankle sprains in HS, but otherwise no significant history of injury. Additionally she has limited resistance training experience. She was a three sport athlete in HS (Soccer, Basketball, Softball). Her scores are as follows DS 1 (MKD, forward trunk lean, inability to reach parallel) ILL 2 (Left front heel comes off ground, forward lean. Right side only has a forward lean) HS 1 (Left foot kicks hurdle on the way over, Right = 2) ASLR 2 (both sides) SM 3 Push up 1 Rotary stability 2 What is the Composite Score & does she have an increased risk of injury??? Maybe, maybe not What do we do next? 1. Eliminate tests that you do not need a) Shoulder Mobility b) Pushup? 2. Identify tests that are a 1 and work to identify dysfunctions a) DS, HS, Push Up 3. Identify other tests/screens that may help guide corrective exercise plan Mobility vs Stability Unload the squat Do they have ROM in unloaded position? Assess squat with arms down Assess ROM of ankle, knee, & hip Assess strength at hip and knee Single Leg Squat Step up/step down Questions? Coming June,

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