Functional Movement Screen and Prior Injury in National Football League Combine Athletes Harris S. Slone, M.D., Spero G. Karas, M.D., Raj Shani, M.D., Megan East, M.A., L.A.T, O.T.C., William R. Barfield, Ph.D., Marty Lauzon AT-C, PT Disclosures HS Arthrex- Paid Instructor SGK DJO Surgical- Consultant, Royalties, Research Support, Institutional Support Arthrex- Consultant, Institutional Support, Research Support Conmed Linvatec- Consultant, Institutional Support Synthes- Research Support Wright Medical- Consultant, Research Support Ossur- Institutional Support Smith Nephew- Institutional Support Mimedx- Consultant Others None Background: FMS FMS Functional Movement Screen (FMS) is an objective screening system intended to rank and categorize fundamental movement patterns and determine side-to-side asymmetries Used in pre-participation physicals Currently used at NFL combine Used by some teams for objective return to play evaluation Multiple studies have demonstrated good inter- and intrarater reliability Cook, NAJSPT 26 Overhead Squat Hurdle Step In-line Lunge Shoulder Mobility Scored: -3 Total Possible Score: 21 Active SLR Trunk Stability Rotary Stability 1
FMS and Injury Risk FMS and Injury Risk In NFL Athletes One NFL team for one season Average FMS score = 16.9 Difference in scores between those who were injured vs. not injured (14.3 vs. 17.4) Players with scores below 14 were >11x more likely to be injured (placed on IR) Kiesel, NAJSPT 27 In NFL Athletes 238 scores obtained before training camp Players with scores 14 were >1.8x more likely to be injured (any time lost from practice or games) Any asymmetry, regardless of total score, had 1.8 x greater risk of injury Combination of total FMS score 14 and 1 asymmetry was specific (.87) for injury Kiesel J Sport Rehab 214 FMS and Injury Risk In Soldiers Prospective study of over 2476 men (ages 18-57) Soldiers who scored 14 were at higher risk of injury compared to those with FMS > 14 Concluded that poor FMS performance was associated with injury risk, but with low sensitivity, specificity, and PPV FMS use not recommended due to miscalculation of injury risk Background: Prior Injury Previous history of injury has been shown in multiple studies as the most significant risk factor for future injury Hagglund, Br J Sport Med, 26; Van Mechelen, Med Sci Sport Exercise, 1996 Is there a relationship between previous injury and FMS score? Bushman AJSM 215 2
Purpose Our Study The purpose of this study was to determine whether the results of the FMS performed at the NFL Combine were associated with a history of previous injury in the elite collegiate athlete. Retrospective review of 1293 combine participants from 29-213 Recorded demographic data, position, injury history, the need for surgery, and number of games missed due to injury Our Study Statistics By Body Part Neck Shoulder Forearm/Hand Lumbar Spine Hip/Pelvis Knee/Leg Ankle/Foot/ Lower leg By Surgery Type ACL Meniscus repair/ meniscectomy Sports Hernia Shoulder labral repair Ankle/Foot fx ORIFs By Injury Type Stinger AC sprain Mechanical low back pain Hamstring strain Groin Strain MCL sprain Patellar Tendonitis Lateral Ankle Sprain High Ankle Sprain Turf Toe A one-way analysis of variance was performed with Tukey posthoc comparisons to compare FMS score and position. Chi-square was used for all categorical and dichotomous variable comparisons. Also used previously established cut-off score of 14 Spearman correlation was also used to assess the relationship between FMS, number of asymmetries, number of games missed and number of injuries recorded. The a priori alpha level was established at p.5 3
Overall Injuries and FMS Mean Range Total FMS Score 13.8 ± 2.4 5-21 Total 3.5 ± 1.9-15 Games Missed 2.3 ± 3.6-24 Total # of Asymmetries.9 ±.9-4 # of Players 35 3 25 2 Number of Injuries Reported Per Player 15 252 39 1 224 165 5 118 89 35 4 14 9 2 3 1 1 1 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 2 18 16 14 12 1 8 6 4 2 Number of Injuries Requiring Surgery 46 Sports Hernia 88 ACL Tear 111 136 178 Ankle or Foot Fracture Shoulder Labral Tear Meniscal Tear Injury Type 5 45 4 35 3 25 474 2 376 15 315 1 221 168 13 134 5 64 86 89 Patellar Tendonitis Low Back Pain Number of Non-Surgical Injuries Groin Strain High Ankle Sprain Turf toe Stinger Injury Type MCL Sprain AC Sprain Hamstring Strain Low Ankle Aprain 4
FMS by Position Offensive and Defensive Linemen were significantly more likely to score lower on the FMS (p<.1) FMS Test Score By Position Position Number Mean OL 21 12.8 ± 2.5** DL 233 12.9 ± 2.6** LB 123 14.4 ± 2.3 DB 217 14.2 ± 2.4 RB 12 14.1 ± 2.1 WO 178 14.1 ± 2.1 QB 64 14.6 ± 2.4 TE 82 14.4 ± 2.1 ST 36 15.2 ± 1.9 Total FMS and FMS vs. Injury History Total FMS Score 25 2 15 1 5 2 4 6 8 1 12 14 16 No significance FMS Total Score FMS Asymmetry FMS Score and Injuries/Games Missed FMS Injuries/Games Missed p-value Total FMS score Total.86 Total FMS Score Total # of Games Missed.714 FMS Score 14 vs > 14 Total.513 FMS Score 14 vs > 14 Total # of Games Missed.74 No significance FMS Asymmetries and Injuries/Games Missed FMS Injuries/Games Missed p-value # of Asymmetries Total.362 # of Asymmetries Total # of Games Missed.2** The # of FMS asymmetries was associated with total number of games missed 5
: Summary FMS Total Score Offensive and defensive lineman were more likely to score lower on the FMS (p<.1) No significant difference was seen between total FMS score and # of injuries (p=.86) or # of games missed due to injury (p=.714) FMS score did not correlate with # of games missed (r=.6; p=.845) or total # of injuries (r =-.8; p=.778) : Summary FMS Asymmetries No significant difference between FMS asymmetries and # of injuries (p=.362) A statistical relationship was noted between the # of asymmetries and # of games missed (p=.2) Large range of games missed (-24) The # of asymmetries did not correlate with games missed due to injury (r=.16; p=.574) or total # of injuries (r=.1; p=.982) Limitations Retrospective study Players may specifically train for the FMS prior to the NFL combine Injury history is based on collegiate medial records and volunteered information by the player The number of games missed due to injury may be dependent on the time of year at which the injury occurred Conclusion The results of this study suggest that within elite athletes at the NFL Combine, no relationship exists between prior injury history and FMS score Caution should be exercised when attempting to evaluate an athlete s FMS performance perceived to be reflective of past injury. 6
4/2/16 Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. 1. 11. 12. Cook G, Burton L, Hoogeboom B. Pre-Participation Screening: The Use of Fundamental Movements as an Assessment of Function Part 1. N Am J Sports Phys Ther. 26a; 1: 62 72. Cook G, Burton L, Hoogeboom B. Pre-Participation Screening: The Use of Fundamental Movements as an Assessment of Function Part 2. N Am J Sports Phys Ther. 26b; 1: 132-139. Frohm A, Heijne A, Kowalski J, et. al. A nine-test screening battery for athletes: a reliability study. Scand J Med Sci Sports. 212 Jun;22(3):36-15. Onate JA, Dewey T, Kollock RO, et. al. Real-time intersession and interrater reliability of the functional movement screen. J Strength Cond Res. 212 Feb;26(2):48-15. Shultz R, Anderson SC, Matheson GO, et. al. Test-retest and interrater reliability of the functional movement screen. J Athl Train. 213 May-Jun;48(3):331-6 Kiesel K, Plisky PJ, Voight M. Can serious injury in professional football be predicted by a preseason Functional Movement Screen? N Am J Sports Phys Ther. 27; 2(3):76-81. Kiesel KB, Butler RJ, Plisky PJ. Prediction of injury by limited and asymmetrical fundamental movement patterns in american football players. J Sport Rehabil. 214 May;23(2):88-94. Chorba RS, Chorba DJ, Bouillon LE, et. al. Use of a functional movement screening tool to determine injury risk in female collegiate athletes. N Am J Sports Phys Ther. 21 Jun;5(2):47-54. O'Connor FG, Deuster PA, Davis J, et. al. Functional movement screening: predicting injuries in officer candidates. Med Sci Sports Exerc. 211 Dec;43(12):2224-3. Hagglund M. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons Br J Sports Med 26;4:767 772 Van Mechelen W. Subject-related risk factors for sports injuries: a 1-yr prospective study in young adults. Medicine & Science in Sports & Exercise. 1996: 28(9): 1171-1179 Duncan MJ, Stanley M. Functional movement is negatively associated with weight status and positively associated with physical activity in British primary school children. J Obes. 212. Thank you! 7