What is movement screening?
Movement screens have grown in popularity, especially in the athletic field, due to the increased incidence of injuries (Mokha, Sprague, and Gatens 2016). The design and implementation of training programmes providing a pre-habilitation and conditioning element to reduce the rate of injuries purposefully, has increased (Gamble n.d.; Mokha et al. 2016). Practitioners can familiarize themselves with the mechanisms for injury and train accordingly (typically seen with dynamic warm-up derivatives like the FIFA 11+, and general strength training initiatives). All training plans must be individualized, based on a thorough assessment of the movement capabilities or incapabilities of the individual athlete or client. A movement screen is an assessment whereby the practitioner looks to challenge the athlete or client’s function and motor control during a range of “specific” movement tasks (Gamble n.d.; Mokha et al. 2016). If an athlete or client demonstrates high levels of movement function and motor control during these tasks, they have a reduced likelihood of experiencing an injury (Mokha et al. 2016). Additionally, they have heightened athletic prowess, resulting in efficiency and high levels of performance during running, cutting to change direction, and other athletic tasks (Mokha et al. 2016).
Is the use of movement screening widespread?
The Functional Movement Screen (FMS) and the Movement Competency Screen (MCS) are perhaps the two most consistently utilised movement screens and will be the focal point of this report. The FMS is highly commercial and has experienced plenty of success (Gamble n.d.; Mokha et al. 2016). It is used extensively overseas, particularly in the United States. Many successful American sports franchises, such as the NFL’s Green Bay Packers and Atlanta Falcons, and perhaps most notably the MLB’s Chicago Cubs, use the FMS (Mokha et al. 2016). The MCS, on the other hand, while not possessing the following of the FMS, is used by High-Performance Sport NZ (HPSNZ) within their athletic development programmes.
Functional Movement Screen
The FMS is the most renowned movement competency screen in existence today (Mokha et al. 2016). It is a point-based screen that assesses if an individual possesses efficient movement patterning, with the primary goal of reducing injury risk (Mokha et al. 2016). The FMS can help practitioners to identify limb asymmetries which are known to increase the likelihood of injury 2.73 times (Mokha et al. 2016). The premise behind identifying injury risk is to help remedy that risk to keep athletes competing at a high level. Secondarily, it is essential to understand how well an individual can move as we need to assess whether they are ready to exercise at all, let alone bear load.
The FMS reportedly offers insight into the presence of motor control, proprioception and balance issues. Identifying limb asymmetry is another reported benefit. A person with suboptimal movement capabilities or a limb asymmetry is at a higher risk of injuries such as thigh strains, hamstring tears, hip adductor pain, patellofemoral pain and ACL/MCL rupture (Mokha et al. 2016). Injury risk factors are multifactorial, so it is about understanding the most consistent risk factor for all injuries; that is, someone who has experienced trauma previously has an elevated injury risk. The FMS test results can guide a practitioner to progress an individual appropriately, particularly following an injury in pursuit of a return-to-play aspiration. Addressing an injury involves managing pain and alleviating movement restrictions, but the mechanism that caused it, e.g. poor motor control, must also be dealt with.
Scoring the FMS
A straightforward scoring system exists. Practitioners should ask the client to perform the exercises to the best of their abilities and tell them if anything hurts. Simple, right?
A zero (0) is recorded if the individual experiences any pain performing the movement, irrespective of their quality of movement.
A one (1) is recorded if the individual is unable to complete the movement.
A two (2) is recorded if the individual can perform the movement, but there are compensations or imperfections evident while doing so.
A three (3) is recorded if the individual can perform the movement as directed.
The composite score is the sum of all the individual movement scores together, e.g. 14 out of 21.
Assessed Movement Competencies
There are seven movement competencies assessed in the FMS; these are:
- Overhead Squat
- Feet shoulder-width apart
- Knee over foot
- Dowel over foot
- Torso and tibia parallel
- No valgus collapse in the knee
- NB:Butt-wink is not an issue
- Hurdle Stepping
- Adopt a single leg stance
- Line up the string or top of the hurdle with the tibia tuberosity
- Assess if they can maintain stable torso and head
- Step over and clear hurdle
- In-line Lunge
- Adopt a split stance
- Keep dowel touching: Head, thoracic spine and sacrum
One joint, e.g. hip, knee, ankle or poor core stability, could affect the whole movement pattern. Correcting the dysfunction will correct the movement pattern.
These first three movements are challenging and can expose limitations and compensatory movement. The hurdle step and in-line lunge mimic the split stance, unilateral nature of life and many athletic tasks.
- Shoulder Rotators
- Reach one hand/arm over the top of your shoulder
- Reach the other hand/arm behind your back
- Make a fist with both hands and try to touch each one
- If the hands are within: one hand length = 3; 1 and ½ hand lengths = 2; > 1 and ½ hand lengths = 1; pain = 0
The shoulder rotator test is a clearing test that measures shoulder health and mobility as well as thoracic spine mobility, both of which help the overhead squat. If the squat is poor, it could be the result of the shoulder rotators and dysfunction through the thoracic spine.
- Hamstring ROM Lift
- Position the client in neutral, e.g. no external or internal rotation through the hip
- Place the dowel at “mid-thigh,” e.g. halfway between the knee and the ASIS of the non-assessed limb.
- If the malleolus of the ankle on the assessed limb, can reach past mid-thigh with no knee bend and hips remain neutral, record a 3
- Between the knee and the dowel, record a 2
- Can’t go past the knee, record a 1
- If pain is evident record a 0
If a client demonstrates incompetency during the hurdle step or in-line lunge, it could be due to poor hamstring ROM. If the client cannot get their leg 6 inches off the ground, then there is the mobility issue.
- Push up
- Position client in the push-up position. Hands should be just outside shoulder-width apart
- Hand placement should result in thumbs being just above the forehead
- The client must maintain good posture through the torso and spine
- If the client cannot perform one repetition in this position, or if they are female, position hands so that thumbs are in line with the chin
- If the client cannot perform one repetition in this position, position their hands so that their thumbs are in line with the shoulder joint
- If the client cannot perform one repetition in this position, they achieve a 1.
An assessment of trunk stability.
- Rotary Stability
- Get the client positioned on all fours.
- Get the client to extend the arm and leg on the same side of the body.
- From this extended position, get the client to bring their arm and leg back towards the starting position and ask that they attempt to touch the elbow to knee.
- If the client can perform this with minimal issue or loss of balance, then they score a three. If they do not score a three then have the client perform the same movement with alternate sides, e.g. left arm and right leg. Doing this would result in a score of 2.
Movement Competency Screen
The MCS also helps determine an individual’s movement competency to help practitioners gain an understanding of how their clients move and whether or not the movement they produce is free of dysfunction and pain. Numerous variables can influence the movement competencies of an individual (Gamble n.d.). However, the premise behind the screen is to develop an understanding of how an individual can move, so their prescribed training does not exceed their capabilities (Gamble n.d.). Therefore, the MCS is a tool used to ascertain if a practitioner can assertively load a particular pattern, or if a developmental approach would be better suited to the individual.
There are 11 movement tasks within the MCS:
- Bodyweight Squat
- Countermovement Jump
- Lunge and Twist (Slow)
- Lunge and Twist (Fast)
- Bilateral broad jump with unilateral landing
- Push up
- Explosive push up
- Bend and pull (Slow) NB: Performed like a Pendley row.
- Bend and pull (Fast)
- Bodyweight single leg squat
- Bilateral countermovement jump with single-leg landing
The unilateral tasks are completed on both sides of the body. Instruct the individual to perform 2-4 repetitions of each movement task.
For a video on how to complete these movements, please refer to the following link.
Scoring the MCS
The scoring is a little more sophisticated than it is for the FMS, although it is still relatively easy to perform from a practitioner’s stand-point. There are five levels commonly used to design and implement strength training and rehabilitation programmes; the scoring is based on these levels:
- Assisted Bodyweight
- External load at slow movement speeds
- Eccentric training
The practitioner needs to determine which level the observed movement capabilities would allow the individual to perform safely. Then guide any programme design moving forward.
Below is the MCS scoring sheet as developed by Dr Matt Kritz.
Below is the MCS rationale sheet developed by Dr. Matt Kritz.
FMS and MCS: Rationale for movement screening
As mentioned above, the FMS and MCS feature movement patterns with characteristics of significant sporting and athletic tasks. Both screens indicate the function and motor control that an athlete or client possesses concerning executing these movement tasks, and are point-based systems, that is, for each movement task within the screen, a score of competency is recorded. The overall score (a summation of all individual movement task scores) is believed to relate to the individual’s risk of injury and performance capabilities (Mokha et al. 2016). Higher total scores reportedly indicate a reduced likelihood of the client experiencing an injury and more considerable athletic prowess (Mokha et al. 2016). Individual task scores for both tests are indicative of the intrinsic injury risk to specific regions of the body, which is particularly advantageous if a particular body part is susceptible to injury in a specific sporting discipline, e.g. knee injuries in football or netball.
Any observed movement deficiency is interpreted as evidence of issues of motor control or musculoskeletal structure. When one considers the third Newtonian law, the law of reaction, motor control issues that present in faulty movement patterns could lead to injury through improper force application wearing out tendons, ligaments, muscles and joints. It is crucial to have an understanding of the client’s previous injury history, as any movement deficiency could be the result of an earlier injury leading to the dysfunctional movement pattern (Gamble n.d.; Mokha et al. 2016). To further highlight the need for understanding of previous injury history, many clients do not complete their rehab – this is evident in clients who have had surgically repaired ligaments in their knee. Finally, a previous injury is the highest risk factor predisposing an individual to future injury, so practitioners must be mindful of this when assessing a movement competency as it may affect the training approach or corrective exercises prescribed by the practitioner. If any faults are present, the screen should guide the practitioner towards suitable programme design and implementation (Gamble n.d.; Mokha et al. 2016).
FMS and MCS: Evidence supporting movement screens
At the time of writing, there was no research on the MCS, and its benefits, or a correlation with injury risk or athletic prowess on performance test measures (Gamble n.d.). However, there is research on programming relating to the MCS and how it can be used to break down a client’s training based on their competency score (Gamble n.d.). Research on the FMS is available, albeit scarce. Mixed results exist and reportedly, neither screen is overly reliable with many fundamental issues evident (Gamble n.d.; Mokha et al. 2016).
- The FMS does not correlate to performance on the 20m sprint test, vertical jump tests (CMJ and SJ), core stability or agility tests.
- The FMS cannot discriminate between performance levels, e.g. elite vs amateur etc.
- To date, only two studies have investigated the effects of the FMS on injury risk or incidence of injury. A composite score of < 14.0 was reportedly suggestive of an increased injury risk. FMS critics claim it is unreliable because a composite score of 14 out of 21 is representative of an individual scoring 2 out of 3 on much of the movement tasks within the screen.
- Reported mean values for a sample of team sport athletes is 15.56.
- A study by the American College of Sports Medicine (ACSM) determined that a sample of 170 collegiate sportsmen and women with a composite score of < 14.0 did not correlate with an increased likelihood of injury.
- Only the in-line lunge movement task shows any correlation to injury incidence, and this was fair at best.
Issues with Implementation
There are issues with the implementation of the FMS, which subsequently affects the reliability and sensitivity of the screen. Firstly, there is no general agreeance concerning the amount of technical information provided to the client performing each of the movement tasks. Some believe that no information should be provided regarding the proper form or what the assessor is looking for; that way, the athlete or client will be more inclined to demonstrate their natural movement.
The problem with providing a lack of technical support in the completion of the tasks is that minimal direction is said to lead to false negatives. Some clients have the capabilities required to complete the tasks but are scored lower, indicating that they exhibit dysfunctional patterning. The question is: Do movement screens merely tell us how an athlete chooses to move?
Issues with Reliability
As previously mentioned, very few studies have investigated either the FMS or the MCS. Reliability scores are low to moderate with both intra and inter-rater reliability questionable. The FMS’s inline lunge is fair as is the MCS lunge and Twist. However, all other movements demonstrate poor reliability at best.
Issues with over Interpretation
Neuromuscular control is generally accepted to be task-specific, that is, specific to both the nature of the task and any constraints the task imposes. Research has demonstrated an alteration to the kinematics of a countermovement jump if a target is introduced and changes to movement mechanics when a dummy or defender is added to a change of direction speed drill. Therefore, it is naive and perhaps unsafe to assume that a corrective programme based on a stationary task like an overhead squat, could transfer to a reactive task such as a side-step or cutting manoeuvre typical of opponent or hazard evasion in a sport like American Football.
Practical Recommendation for the use of the FMS and MCS
- The FMS and MCS do have their place despite their limitations. Personally, in the gym with a regular client, we do not need to perform overly dynamic athletic tasks. We may perform some ballistics or plyometric work, but again these aren’t excessively dynamic. As a result, I feel that the FMS and MCS have their place as the tests help to assess the function and motor control of patterning related to most if not all, gym-based exercise programming.
- In a broader sense, it has a role to play in the wider pre-participation test battery of athletes. Athletes should be provided full technical instruction regarding what constitutes proper form to eliminate the potential for false negatives to occur, thus immediately improving the reliability of the assessment.
- The assessment should be filmed and performed by the same assessor where possible.
Stationary movement patterns provide the foundation that technical improvement is based. Assessment of these patterns can highlight the misalignment of limbs, particularly in the lower portion of the body. Misalignment is undesirable from a movement efficiency standpoint, and often these deficiencies are further pronounced during dynamic movement, e.g. running. Misalignment and other evident flaws can trickle down to inefficient motion, leading to sub-optimal performance. Furthermore, deficiencies result in the body utilizing more energy to move. They can lead to the improper application of force, i.e. ground reactions forces, which based on the third Newtonian law can lead to wear and tear and physical injury. By discovering movement-related abnormalities practitioners can strive for movement improvements in their programming, vastly influencing movement efficiency by achieving a heightened functionality.
Point-based movement screening widely used in the athletic population, such as the FMS and MCS, are not without their limitations. The primary limitations include a lack of scientific evidence in support of claims that test results can highlight injury risk and performance impairments. Technical information provided to the athlete being screened, regarding what is considered correct movement, is an issue that could influence test outcomes with inaccurate representations of that client’s capability. Practitioners should use screening tests not as a diagnostic tool but as an informative tool that can help identify potential areas of weakness, which can guide programme design and implementation, that is, safe and effective training programmes. This will allow for better programming to improve performance, limited injury risk and ultimately will help keep our athletes from missing competition and our clients from missing gym time.
From a general population standpoint, all the above applies, particularly when one considers that gym users just wish to improve their strength or overall health and well-being. Whether that be via fat loss or not is irrelevant, resistance training has its place. Unless someone can move well and exhibit functionality and heightened levels of mobility, then we cannot load them. The FMS and MCS can help us identify whether a dysfunctional movement pattern exists and allows us to correct it. After that, the foundation will be in place to load our clients and help them reach their goals and not waver from doing so due to an easily remedied movement pattern deficiency.
Gamble, Paul. n.d. “Movement Screening Protocols: Rationale versus Evidence.” Journal of Sports Med 83–87.
Kritz, Mathew. 2015. The Movement Competency Screen (MCS).
Mokha, M., Sprague, P. A., and Gatens, D. R., 2016. “Predicting Musculoskeletal Injury in National Collegiate Athletic Association Division II Athletes from Asymmetries and Individual-Test versus Composite Functional Movement Screening Scores.” Journal of Athletic Training 51(4):276–82.