A little while back I posted a review of a study looking at the interrater reliability of the Functional Movement Screen.  Today I’ll be looking at another study on the FMS to further elucidate the research that has been done on this popular system.

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Again, I’m not trying to rip anyone apart here.  I’m primarily looking the the research for my own benefit and in doing so have decided to share it with you.  If you care to read this study for yourself you can get the full text for free at the top right hand of the page HERE.

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Core strength: A New Model for Injury Prediction and Prevention

Peate WF, et al.   Journal of Occupational Medicine and Toxicology 2007, 2:3.

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Background

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Injuries to firefighters are among the highest of all occupations.  Research suggests that decreased core strength may contribute to injuries of the back and extremities, that training may decrease musculoskeletal damage, and that core stability can be tested using functional movement methods.  The purpose of this study was to use the Functional Movement Screen to better assess the risk of firefighter injury due to functional movement performance, and to decrease injuries by using that information.

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Methods Part 1: Screening

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Functional Movement Screen conducted on 433 active firefighters.  Analyzed correlation between FMS scores and data from fire department database including injury history, age, gender, tenure, and rank.

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Methods Part 2: Intervention

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Firefighters underwent 3 hour seminars (actual number attended by each firefighter hard to determine based on the way the study was written) covering causation and prevention of injuries.  During seminars each firefighter demonstrated proper body mechanics in sample work settings and taught how to minimize spinal load during work situations.

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“For example, firefighters were instructed to use an outstretched arm held against a firm surface as a prop to decrease mechanical load on the back when the firefighter’s spine is in lumbar flexion.”

Subjects were taught how to activate their transversus abdominis as well.

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“Participants were shown that muscle’s location in the anterior abdominal wall. Photos of various methods of recruiting and strengthening the TA with written explanations were provided, along with verbal reinforcement of the material.  Once the firefighter demonstrated competency in basic TA muscle tightening, physiotherapy balls and dowels were employed to challenge the firefighter in different positions that mimicked firefighting tasks.”

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Core exercises included three basic models which are similar to hamstring pushups, hamstring pushups with the upper back on a ball (hip thrusts?), and hamstring pushups with the feet on a ball.  Arm movement was added using weights of various amounts.  A detailed explanation of exercise variations, progressions, and how loading was used is lacking in this paper.  There are a few photos, but you’d be hard pressed to repeat this protocol by just reading the article.

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Injuries after one year were compared to injuries in the year previous to the addition of the intervention.

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Results Part 1: Screening

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Increasing age, rank, and tenure was associated with a lower functional movement score using linear regression.  After adjusting for age and using multiple regression, those with a previous injury tended to score an average of 0.24 points lower on the FMS, but this relationship was not significant (p = 0.25).  When the scoring on the FMS was observed as a pass or fail score (for some reason they said a fail was below 16) the odds of failing the FMS after having a previous injury was 1.68 times greater based on multiple logical regression (p= 0.033).
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Results Part 2: Intervention

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Compared to the previous year, lost time due to injuries was reduced by 62%!  The total number of injuries was reduced by 44%.  Injuries to the back and upper extremities were reduced, but injuries to the lower extremities were not reduced by the intervention.
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Funding
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Administration of the Tucson Fire Department
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My Thoughts

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I’ve noticed that this article is frequently used to support the Functional Movement Screen as a tool for screening for injury risk prior to physical activity.  However, when you look at the outcomes, the FMS was only able to determine that the risk of injury increases with age, tenure, and rank (the latter two are also typically related to age).  I don’t think I’m going out on a limb to suggest that most people could have told you this before even running the FMS.

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Although the authors do mention that there was a relationship between FMS score and previous injury based on linear regression, this relationship totally disappeared when corrected for age which appears to the major determinant of injury in this study.  The authors make a point of mentioning that they were indeed related but shy of statistical significance using multiple regression.  However, the p value (a measure of statistical probability) was 0.25 which is a LONG way from statistical significance at 0.05.  I would think it is fair to say that there is pretty much no relationship between FMS and previous injury in this study once you control for age.  Changing the FMS to a pass or fail criterion did make it better for determining risk after an injury.  As was mentioned earlier though, you don’t really need to do this if you just look at age as the primary predictor.
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I have also seen this study referenced to support the idea that the interventions based on the FMS are effective for injury prevention.  Taking a look at the study though, there are a few errors with this assumption.
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- The FMS was conducted at the beginning of the study and there was no follow up testing at the end to determine if there was an improvement in FMS score related to the 62% reduction in lost time due to injury.

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- The intervention had nothing at all to do with the FMS.  Everyone virtually received the same intervention regardless of score on the testing.  I’m no expert, but I’m pretty sure this isn’t how the FMS is supposed to be used.

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- There were other factors within the intervention besides the physical training.  Subjects were taught about injury mechanisms, bracing, and how to move in the work environment.  Personally I agree that this is a great way to intervene to make a larger difference in the safety of the firefighters.  However, from a scientific perspective, it introduces a whole bunch of other variables that could have lead to decreases in injuries that had nothing to do with the FMS.

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- There was no control group.  Injuries were compared to previous years which makes sense from a operations perspective, but when doing a scientific experiment a group not recieving treatment is usually run alongside the group that does.  In this case, it wasn’t done making comparisons in injury rates pretty difficult.  Again, a 62% decrease in lost time is excellent, but it could be due to factors beyond the intervention itself (i.e., less fires this year).
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Summing Up

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At the risk of pissing off a lot of people, I’m going to suggest that the FMS did not play an integral role (actually any role at all) in the improvements seen in this study.  Moreover, age was seen to be the biggest predictor of future injury which could technically be used alone instead of having to run the FMS on such a large group each year.

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As far as the Functional Movement Screen is concerned, the intervention doesn’t really matter because they weren’t really linked in any way.  That said, if you’re a firefighter, you might want to find out what these people are doing because it just may prevent you from experiencing an injury.  If you’re a firefighter and you’re a little older, you might want to consider a good accident benefits plan.

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What do you think?

Okay…it has been a while since I posted one of these, but I figured I’d drop a couple things I think are worthy of reading.

1.  Optimal Rest Intervals for Strength and Hypertrophy

 So you’ve probably been told that long rest intervals during training are important for strength and shorter rest intervals are for hypertrophy.  Well, I just found this site this week and Bryan Chung (who writes the blog) takes a solid look at a study that is examining these very things.  He’s not a coach or trainer, but he is a medical science researcher and sits on the board for the Clinical Journal of Sports Medicine so he knows his stuff.  Check out the excellent research review HERE.

2.  Movement

As my readers probably know, I can be a little bit of a doubting Thomas when it comes to training and nutrition related information.  At the same time, I can appreciate when someone has contribued a lot of great stuff to this industry and I’m interested to see what Gray Cook will present in his new book Movement.  Recently Laree Draper posted the following three posts by Gray Cook on her blog and I think they made for some great reading.  Check out parts 1, 2, and 3.

3.  Webinar Notice

My friend (and PhD Candidate) Mike T Nelson has just posted a sale on three webinars this week and time is ticking as this is a limited time offer.  Although I have yet to review them, I’m excited to hear what Mike is going to say so I thought I’d share this with my readers as well.  Apparently there is a sport supplement review, a discussion on metabolic flexibility, and another on the neurology of movement.  If you’re interested you can check out his site HERE.   (Note this is not an affiliate link)

That’s it for me.  What are you reading?

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Anyone who reads this blog regularly knows that I’m a big fan of assessments prior to training and repeat assessments along the way to ensure results are coming as desired.  Recently though, it seems that the Functional Movement Screen which was created by Lee Burton and Gray Cook has become extremely popular among my colleagues in the fitness industry.

If you’re not familiar with the Functional Movement Screen, here’s a little excerpt from their website describing the system:

“Put simply, the FMS is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS readily identifies functional limitations and asymmetries. These are issues that can reduce the effects of functional training and physical conditioning and distort body awareness.

The FMS generates the Functional Movement Screen Score, which is used to target problems and track progress. This scoring system is directly linked to the most beneficial corrective exercises to restore mechanically sound movement patterns.

Exercise professionals monitor the FMS score to track progress and to identify those exercises that will be most effective to restore proper movement and build strength in each individual.”

In short, you do 7 movements, get scored, and based on the outcome your potiential issues are identified and your training program can be designed.

 
Being the skeptic I am, I had to consult the research to determine what has and hasn’t been studied about the FMS.  And while I do believe that not everything worth doing is necessarily validated by science (yet), I’m also cautious when I see a pendulum swinging in one direction and when a great number of people are on board. It seems to me that the FMS has been accepted with little discussion as to whether it is valid or not. The more people that jump on board, the less people are apt to question it (especially when those people are big names).

So I’m not saying the FMS isn’t valid or useful or trying to discredit Lee, Gray, or anyone else who uses the system.  The next few posts are simply meant to be an examination of the existing body of scientific study on the FMS.  More to the point, I’ll be reviewing only the peer reviewed studies that have appeared in journals and not the unpublished stuff that is available on the internet (including at least one doctoral dissertation and a couple conference poster presentations).

Without further ado, let’s get to the first study.

Interrater Reliability of the Functional Movement Screen

Minik KI, et al.  J Strength Cond Res. 2010. 24(2): 479-486

While this isn’t actually the first published study on the movement screen, I thought it was important to present this first as it is indicative of the reliability of the scoring.  In a setting where different individuals would be scoring the FMS, you would need for them to be scoring the same way or the tool would be a lot less useful.

Background

To reduce injury risk, sports medicine professionals have begun to focus on improving movement patterns as opposed to focusing on rehabilitation of a specific joint.  The Functional Movement Screen has been put forth as a potential screening tool for these movement patterns.  The goal of this study is to establish interrater reliability of the FMS by comparing expert raters (who took part in the development of the FMS) with novice raters (who have completed the standardized FMS training program).

Methods

Forty students were filmed performing each of the 7 movements in the Functional Movement Screen.  Each of the subjects’ videos were then viewed by two expert and two novice raters and each of the 7 movements was independently scored as a 0, 1, 2, or 3 using the FMS criteria.  The scores were then compared using the weighted Kappa statistic.

Results

The pair of novice raters demonstrated excellent agreement on 6 of the 17 test components, including the deep squat and shoulder mobility tests, and portions of the trunk stability push-up and ASLR tests. Substantial agreement was evident on 8 of the 17 test components. The right and left components of the lunge and the final component of the rotary stability test each demonstrated moderate agreement.

The pair of expert raters varied more in scoring, with excellent agreement on 4 of the 17 test components, including the shoulder mobility test and the final component of the ASLR. Substantial agreement was seen in 9 of the 17 test components. Two components of the lunge and 2 components of the rotary stability tests demonstrated moderate agreement.

When comparing the average scores of the paired novice and expert raters, 14 of the 17 tests demonstrated excellent agreement. Substantial agreement was evident in 1 component of the rotary stability test and 2 components of the in-line lunge.

Funding

University of Evansville Honor’s Program grant and the University of Evansville’s College of Education and Health Science.

My Thoughts

The kappa statistic is actually a good choice in this case because it is fairly conservative and takes into account possible agreement of the raters due to chance.  They also used a weighted kappa which allowed them to rate larger disagreements between the raters less favorably.   However, it should be noted that the categories listed as excellent, substantial, and moderate are pretty aribitrary and are based pretty much on the personal opinions of some other researchers.  Other arbitrary guidelines exist that rate kappa values differently.   I’m not sure how much this really matters in this case, but it is important to note that these ratings aren’t universally accepted.

The most surprising thing to me was that the novice raters tended to have more agreement with each other than the expert raters.  You’d expect that over time your ratings would become more similar than different.  But why did the novice and expert rater’s results tend to agree with each other when they compared them?  My guess is that some of the differences disappeared when they averaged the two novice and two advanced raters before comparing them to each other which could possibly have masked some of the variability.

The authors did suggest that since the tests were only filmed from two angles there was a third dimension missing and this could have influenced the degree of agreement between raters.  Having evaluated people in person, I can definitely see how this could have an impact.  In person you can move around and get a better view of each movement.  Perhaps one reason the expert raters had more disagreement is because they’re more used to looking at movements in three dimensions that novice raters who are less likely to be able to make as much use of this additional information.

All in all, I think the study was fairly well conducted and the results indicate that the scoring of the FMS is relatively reliable.  It did highlight that perhaps work needs to be done to ensure expert raters are scoring similarly.  Another important point to take home is that both sets of raters tended to struggle with agreement on the lunge and rotary stability tests so if you’re using the FMS you might want to pay extra attention when scoring these movements.

I personally would have liked to have seen the same raters score the same subject numerous times to see if the same rater would come up with the same scores each time.  In personal training settings I believe this scenario would be more likely.  Perhaps this could be a route for future investigation.

One final thing I want to mention is that two of the people conducting the study have a personal stake in the outcome since they are involved with the FMS.  This is not to suggest that they would deliberately alter the outcome, but the possibility is always something to be congizant of.  Testing by independent researchers always carries more weight (at least in my mind).

What are your thoughts?

This week I was going to post another Friday Awesomeness blogs, but what could be more awesome than an interview with me?

I know what you’re thinking.  Not much.

Or else you’re thinking I’m an arrogant bastard.

Hopefully the first one though.

In any case, check out my interview on my friend Carson Boddicker’s blog where I discuss what I think makes good science, where most fitness professionals are dead wrong, and how to use the Functional Movement Screen to determine if someone would make a good spouse.  Okay…maybe not the last one.

Check it out HERE.

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Hey Mike!  Thanks for taking the time to drop some knowledge bombs on us today.  Obviously I’m already sold on your new product Assess and Correct, but why don’t you give the readers a little rundown on what exactly it is so we know just what we’re talking about here?

Thanks for having me, Mark!

I think Assess and Correct is a powerful tool, as it allows each client to go through over 25 assessments to determine what exactly their specific movement limitations are.

Beyond just telling you what’s tight, weak, stiff, etc., we build off that knowledge with specific corrective exercises to help address those issues!  So if your glutes test weak, we have developed specific exercises to help correct those issues.

And finally, we know and understand that everyone who purchases this product has different levels of dysfunction, so we’ve created progressions to work through instead of just pre-canning one or two exercises.  Quite simply, everyone from the weekend warrior to the elite-level athlete will be able to assess themselves and create a warm-up routine that addresses their specific needs, with an exercise routine that’s specific to their current level of fitness.

It seems that a growing segment of the fitness industry is already using The Functional Movement Screen.  What do you think is the major difference between this and Assess & Correct?

Damn Mark, are you trying to get me in trouble with Gray and Lee?  The last thing I need is a pipe-bomb sitting in my mailbox when I get home someday!

In all seriousness, I have great respect for what Lee and Gray have done with the FMS.  Quite simply, they’ve brought assessment to the forefront of the industry, and you have to applaud them for that.

I think with A&C, our goal has been to not only make the assessment more comprehensive, but more convenient as well.  The beauty of the FMS is its simplicity – seven tests and you’re done. However, you need to find someone with knowledge of the FMS to assess and score you.  

With A&C, there’s a little bit more work involved up front – you have to take static pictures of yourself, along with videotaping yourself perform the various assessments.  However, you can do everything yourself!  Without ever leaving your home, you can determine your specific movement limitations from head-to-toe, along with how to address them.
 

Obviously you don’t want to spend all day assessing people.  Do you think that anyone currently using the movement screen should switch to A&C?  If not, how could they combine the two resources to get the best possible assessment and treatment protocol for themselves or their clients?
 

I think it’s going to be hard to convert people over – many people like the FMS due to its ease of use, along with the fact that you can screen people fairly quickly.

Again, with A&C the biggest difference is it’s going to take more time, but it’s also more comprehensive.  Whether it’s with A&C or a new client at IFAST, I would always like to err on the side of more information, using a more comprehensive testing system, than not.

Could you combine the two products?  Sure.  However, I think on some levels that may be redundant, as we’re looking for a lot of the same issues. 

What do you know about Z-Health and what do you think about their mobility drills vs those in A&C?

I have the utmost respect for Dr. Cobb and his system.  The biggest issue with Z isn’t the system or the drills, but rather the “in-your-face” nature of some of their practitioners.

Even though I think A&C is a fantastic product, I never want to box myself into thinking there’s only one way to do things.  I’m only R-Phase certified in Z, so I can’t speak for the entire system, but I really liken some of the R-Phase drills to micro-mobility.  The goal is to really isolate out each individual joint to promote better movement.  I can definitely see value in this, and I think there’s as much value in the improvements you’d see in motor control/body awareness as there is in the improved mobility.

To summarize, I think A&C would be superior to the end-user in the fact that you have a specific idea of your limitations and what you need to address when it’s all said and done.  Unless you meet with a Z-Health trainer for an assessment, you can’t do this with the current DVD’s and manuals they have available.

I’ve recently heard a lot of people suggesting that the fitness industry has become too much about mobility and activation these days and too little about just getting strong and sexy.  Are we spending too much time on “corrective movements”?  And how do you think mobility work and activation fit into the bigger picture?

I think it all depends on who you’re reading and listening to!

I’ve heard both sides argued lately – some say we’re too caught up in “fixing” things, and others who say we still aren’t good enough at it yet.

I think many of the corrective naysayers are minimalists at heart, and I can understand that to a degree.  However, when you start digging into the research, there’s actual evidence that often it’s not just the strength of a muscle that’s important, but your neuromuscular/motor control.  In other words, who cares if it’s strong if you can’t use it!

This is where that whole mindset goes – I don’t care if you want to lose fat, add muscle, get strong or perform at a high-level.  I want to help you get there, but I also see the big picture.  If I assess you up front and notice specific movement limitations, why would I not address them?

Why would I assume that I can train around them, or somehow magically make them disappear?

This is the “corrective” mindset – to assess limitations and correct them via training.  This could include foam rolling, mobility work, or even the dreaded activation work.  The part you have to focus on, however, is that this is just part of the programming – not all of it.  It’s all pieces to the puzzle.

At the risk of sounding arrogant, Bill and I get some really beat up people at our gym.  Same thing goes for Eric.  I think between the three of us, we have a pretty good idea of what works and what doesn’t.  If foam rolling, mobility, or activation drills didn’t work, we wouldn’t use them.  Period.
 

And finally, a little word association:
 

Squats – Fantastic, when performed and programmed appropriately.  And we use all types: Plate, front, back, safety bar, to a box, free squat, pause squats, full ROM, limited ROM, etc. 
 

Beer – My favorite calorie-laden beverage.  Ever since my Australia trip I’ve been hooked on Heineken, but only because I can’t get my hands on Victoria’s Bitter (VB’s) around here!
 

Crunches – A horrible exercise that not only wrecks backs, but wrecks posture as well.  If your goal is neutral spine and a healthy back, crunches shouldn’t be in your vocabulary, let alone your program.
 

Fat Loss – The “new” hot topic.  Fat loss is always going to be at the fore-front of the fitness industry, but I’m fed-up with fitness marketing.  Fat loss promotions tend to be the worst.
 

Twitter – Not sure on this one.  I can see where some people would really enjoy it, but I guess I’m not that interested in talking about myself all day.  Plus, I’m more of a Facebook whore than a Twitter whore.  What can I say, I’m old-school!
 

That Mark Young clown – A great up-and-coming coach, with a balanced view on training.  I love the fact that you’re willing to read and/or listen to anything, even if it’s out of your comfort zone.  That’s what will make you successful.
 

Thanks Mike for the interview.  Where can people learn more about you or pick up a copy of Assess & Correct?
 

Thanks for having me Mark!  Sorry if I tend to ramble a bit, but your questions got me fired up!

My blog, newsletter, articles and Podcast can all be found at RobertsonTrainingSystems.com.  If you’re interested in picking up a copy of Assess and Correct, check out the Assess and Correct Website.  There you’ll find testimonials from other coaches, more info about the product, as well as video clips directly from the video so you can see how things work.