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As many of my readers already know, I have previously reviewed a few of the studies on the Functional Movement Screen including:

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Interrater Reliability of the Functional Movement Screen

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Core strength: A New Model for Injury Prediction and Prevention

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Research Review: Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen?

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Today I’ve decided to start wrapping up my series by reviewing one final study on the FMS.  Tomorrow I’ll share more comment on the FMS that I think is worth addressing and that will be it for my discussion of the research piece.   However, I’m going to withhold my final thoughts on the system as a whole until I’ve finished reading and absorbing Gray Cook’s new book Movement as I feel this will contribute a lot more to the bigger picture than just reviewing the studies themselves.

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Let’s get to it!

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Functional Movement Test Scores Improve Following a Standardized Off-Season Intervention Program in Professional Football Players

Kiesel K, et al.  Scand J Med Sci Sports, 2009. 

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Background

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Previous research has shown that players scoring lower than a 14 on the FMS were more likely to be injured than those scoring above 14.  However, no studies have assessed whether changes in an individual’s FMS score can be achieved with a training program.

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Purpose

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1)  To determine if an offseason intervention program is effective in improving FMS scores in professional American football players.

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2)  To examine if there was a greater percentage of players above the injury threshold of a score of 14 at the after training than before.

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3)  Because, right and left asymmetry in the FMS has also been related to injury subjects were examined to see if more players were free of asymmetry at the end of the study compared with the beginning of the study.

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4)  To determine if it was possible to predict who would not improve their score above the injury threshold score of 14 using data from the pre-screen.

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Methods

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FMS scores were obtained prior to the start of an off-season training program for 62 professional American football players and each subject was prescribed an individualized training program based on their FMS score.  “Movement preparation” and “corrective exercises” were selected to improve movement scores and decrease assymetries.  After the 7 week training program FMS scores were collected and compared with the scores from prior to training.

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Results

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Linemen and linebackers tended to have slightly lower FMS scores both at the start and end of the study when compared to the other “skill positions” (my words not theirs). 

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As a whole, linemen and other players from ”skill positions” were able to increase their FMS scores from 11.8 to 14.8 and 13.3 to 16.3 respectively. 

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At the start of the study only 7 subjects had a score above the injury threshold of 14 on the FMS.  At the end of the intervention 30 subjects had a score above 14 on the Functional Movement Screen.  Keep in mind that this means that 32 people still failed to improve their FMS score above 14 over the training period.

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Prior to training 31 players were determined to have at least one assymetry on the FMS.  After training only 20 players had a remaining assymetry.

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The only significant predictor of whether a subject failed to improve their score above the injury threshold of 14 on the FMS was a low score on the deep squat.

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Funding

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None declared.

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My Thoughts

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I think there are a few things that need to be addressed when looking at this study, but the main thing that stands out to me is the complete lack of a control group.  Although the football players had some quite impressive improvements in their scores, it is hard to determine whether these were due to the FMS specific interventions, any off-season training program in general, or just becoming more proficient on the tests as a result of repeated practice.

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Moreover, there may have been other treatments (massage, chiropractic, etc) taking place during the same time from so it is possible that these contributed to the improvments in scores.  That is not to say that I don’t think the improvements are there, but I think a control group is one of the most important elements of the study design when evaluating the effectiveness of an intervention.  As a result, the results of this study (while promising) should be taken with a grain of salt until similar results are produced in the presence of a control group.

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The other thing that leaps out at me is that while the FMS score below 14 has been related to an increased risk of injury we must be cautious in interpreting the results of this study as they pertain only to the FMS and not to actual injury risk.  In other words, “It has yet to be determined if prospective improvements in the FMS actually reduce injury risk.”

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I should note that the authors of this study did acknowledge both of the limitations above so perhaps future research that addresses them will turn up eventually.

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Finally, I think it is interesting that the deep squat is such a powerful predictor of success or failure when it comes to reaching a score of 14 on the FMS.  I find this especially interesting because (as far as I know) this is not one of the patterns that is typically immediately addressed with an FMS specific intervention.

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Given the relatively large number of subjects who failed to reach the injury threshold of 14 on the FMS, perhaps this indicates a need for more intensive intervention for those who score low on the deep squat from the very beginning.  I’m also wondering if the lack of improvement in the total score (and assymetry) in some of the players is simply a result of a short intervention. 

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Summing Up

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I think what we can take away from this study as a definite is that FMS scores can be improved and assymetries can be eliminated.  While it is likely that this is due to a specific exercise protocol related to the FMS score, the results of this study should be taken as tentative or hypothesis generating until an intervention trial with a control group is performed.

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Again, I think it is important to reiterate that FMS scores are an injury prevention tool and there is no research yet to suggest that increasing these scores or eliminating assymetries will reduce injury.  I think it is pretty safe to say that this is possible…or even likely…but it certainly isn’t guaranteed. 

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Finally, I think it highlights the need to look at the deep squat when assessing our clients whether we use the FMS or not.  This movement is obviously related to global improvements in movement patterns and it should be carefully investigated if there are any limitations.

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What you you think?

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—

Speaking of injuries, don’t forget to grab your FREE copy of Mike Robertson’s Bulletproof Knees by dropping a comment on THIS POST before midnight tonight.

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And while you’re here, don’t forget to grab your FREE core audio interviews with Mike and other industry giants like McGill, Myers, Tumminello, and more HERE.

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This past week my good friend Mike Robertson has been absolutely KILLING IT with some great content.

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First, if you want to bench press big weights (don’t we all?) then you need to read his Step by Step Bench Pressing post.  This is absolutely stellar!  One of the best I’ve read on the subject really.

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Second, check out this video on chin up progressions.  I actually learned something brand spanking new about using isometric holds in this progression and I am totally swiping (errr…borrowing) this tip.

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Now I’m off to take our daughter to her very first Santa Claus parade and I am so pumped to see her little face light up.  And since I’m in such a Christmas-like giving mood, I’m going to throw down a FREE copy of Mike Robertson’s Bulletproof Knees product (courtesy of Mike obviously).

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If you haven’t heard me say it before, this is one of my favorite information products!  And you can own it for free.  Simply drop me a comment below letting me know that you want to get your paws on it and I’ll enter you in a draw to be held Monday at midnight.

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So have a great weekend and get to it!  Drop a comment and score BPK for FREE!

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Guest blog by Rick Kaselj

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In the last blog post, I talked about a common muscle imbalance that I see in the lower body.  Now I want to go through an exercise I use to address this problem.

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EXERCISE: Wide Knees Side to Side

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Purpose:

To improve internal and external rotation of the hip with dynamic movement.  The primary focus of the exercise is on improving the length of the internal rotation of the hip.

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Starting Position:

Lying on you back with your knees bent and your feet hip width apart.

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Start

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End

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How to Do the Exercise:

1.  Drop you knees to one side until you feel light resistance.

2.  Hold this end position for a second and drop the knees to the other side until you feel light resistance.

3.  Perform 5 times on each side.

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Progressions:

- Perform the exercises at different range of motions of hip abduction.  Begin with 0 degrees and progress to 15, 30 and 45 degrees of hip abduction on both sides.

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You can see me talk more about this exercise and go through the exercise in this video:

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Contraindication & Common Mistakes:

- Focus on breathing that leads to greater relaxation of the body.

- Visualize the area that you are stretching and imagine it loosening up.

- Movement is slow and controlled.

- You are looking for a light stretch, not trying to rip apart the muscle.

- The primary movement is in the rotation of the hips and minimal movement in the lumbar spine.

- Those with hip replacements should not do this exercise.

- Those with sacroiliac joint dysfunction should be cautious of this exercises as it may mobilize the SI joint and lead to irritation.

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I do this one exercise and I am cured?

It is a little more than that.  I find this exercise is a part of the solution.  Other things that I will do is activation of the frontal plane stabilizers of the hip and self massage of the structures around the hip.  This often times will set people on the right track to recovery.

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I enjoyed sharing and I hope you enjoyed the blog posts.  If you have any questions, just comment below and I will answer your questions.

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Take care and thanks, Mark.

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Rick Kaselj, MS

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Rick Kaselj is a personal trainer that focuses on helping his clients overcome injuries using exercise.  He shares his tips and tricks with trainers, coaches and therapists in his Muscle Imbalances Revealed Program.

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And speaking of the Muscle Imbalances Revealed program, thank you to everyone for your comments!  It is great to see so many readers coming out of the woodwork.  I’ve just awarded the FREE copy of MIR 2.0 to Harry Fisher who commented on the original giveaway post.  However, if you’re still interested in a copy of Muscle Imbalance’s Revealed, just remember that it is only on sale until midnight tonight (Friday).  After that the price jumps by $50 so make sure you pick it up HERE.

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Have a great weekend!

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As you probably know, my friend Rick Kaselj is giving away a copy of Muscle Imbalances Revealed 2.0 and you only have a few more hours to drop a comment HERE to score your copy for free.  In the meantime, here is a great post from Rick himself looking at hip internal rotation deficits and tomorrow I’ll throw up a post on how to correct them.

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The Problem

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It is difficult to find anyone that does not have any kind of muscle imbalance, especially in the lower body.

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I look at muscle imbalance being very similar to parachute.  When you jump out of a plane and pull your parachute, you want the parachute to be balanced.  You want it to move straight compared to hooking in one direction.  If one of the straps of the parachute is tight, it will affect your balance, pull you in the wrong direction and you may end up on the freeway.  If one of the straps is too relaxed, you will move away from that side and could end up hung up on a telephone line.

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The body is very much the same.  Muscle can become over/under active or over/under used.   This all leads to potential inefficient movement, poor performance, increase risk of injuries and slower recovery.  Now that we have landed from our parachute ride, lets look at the lower body.

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Looking at the lower body, the area that I look at when it comes to muscle imbalances is the hip.  Specifically the internal and external rotation of the hip.  The most obvious thing we can look at in the hip is the muscles involved in external and internal rotation so let’s start there.

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External rotators of the hip (lateral rotators):

Gemellus superior

Gemellus inferior

Obturator internus

Obturator externus

Quadratus femoris

Piriformis

Gluteus maximus

Sartorius

Gluteus medius, posterior fibers

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Now the internal rotators of the hip (medial rotation):

Tensor fasciae latae

Gluteus medius

Gluteus minimus, anterior fibers

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(Yes, we can argue about the list above on what muscle should be added and not be added to the list but really will this help out our clients or our ego?)

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The most common issue we will see in most people is normal external rotation (45 degrees) range of motion and a decrease in internal rotation (less than 45 degrees).

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Geraci commented about this in runners:

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“These functional biomechanical deficits would lead to inadequate internal rotation of the tibia and femur and result in inhibition or decreased recruitment of the gluteal muscles, in particular the gluteus medius. Restoring pronation throughout the lower extremity would require joint play techniques or functional joint mobilizations for the foot and ankle.”

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Lets make it simple though.  What will often be seen is a decrease in internal rotation at the hip (shortened hip external rotator) due to poor movement in the ankle and poor stability at the hip.  Most times what trainers, coaches and therapist will do is just address the frontal stability (side-to-side) stability of the pelvis but it is also important to address the mobility in the ankle and decrease range of motion of the internal rotators of the hip.

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There has been a lot of discussion when it comes to ankle mobility but I will go through an exercise that I do that address the internal rotation of the hip.  I will have it for you in the next blog post tomorrow.

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Until then.

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Rick Kaselj, MS

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Rick Kaselj is a personal trainer that focuses on helping his clients overcome injuries using exercise.  He shares his tips and tricks with trainers, coaches and therapists in his Muscle Imbalances Revealed Program.

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Reference – Geraci MC Jr, Brown W. (2005). Evidence-based treatment of hip and pelvic injuries in runners. Phys Med Rehabil Clin N Am. 2005 Aug;16(3):711-47.

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Last Friday I offered up an excellent ebook by my good friend Bret Contreras that was awarded by random draw to Jacob who commented on the post.  Congrats Jacob!

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And yesterday I talked a bunch about the great new product by my friend Rick Kaselj called Muscle Imbalances Revealed that he’s offering up at a tremendous discount until the end of this week.

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However, Rick (being the great guy that he is) has also offered to throw down a FREE premium copy of his product including DVDs of all the webinars, CEUs, and all the bonuses for my Christmas giveaway series.

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If you’re interested in this incredible product (and you should be) leave a comment below and you’ll be in the running to have it shipped directly to your door!

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Of course, if you’re as impatient as I am, you can just buy the product right now at the discounted price before it goes up.

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Comments close tomorrow (Thursday) at the end of the day when I’ll do the draw.  Want it?  Get at it!  Comment below. 

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