What Is Our Baseline for Movement? The Clinical Need for Movement Screening and Assessment

Gray Cook

The strongest predictor of future injury is previous injury.  Since it is known that injury adversely affects movement and that asymmetry and dynamic neuromuscular control are also predictors of injury, a systematic method is needed to screen active individuals for injury risk and identify potential weak links in performance.  Additionally, the current best evidence suggests that movement changes after an injury and these changes occur at multiple joints away from the injury site.  Pain adversely affects motor control and the results of pain related motor control changes are unpredictable and highly individualized.  Thus, the health care professionals need a systematic method to clinically assess and train movement patterns during the rehabilitation process. 

The Functional Movement Screen – The predictive system
The Functional Movement Screen (FMS) is a reliable5 screening system created to rank movement patterns that are fundamental to normal function. By screening these patterns, movement limitations and asymmetries are readily identified and measured. Basic movement pattern limitation and asymmetry are thought to reduce the effects of functional training and physical conditioning and recent data suggest these factors may be related to injury in sport. 3, 4 One goal of the FMS is to identify those athletes with movement pattern limitations so individualized correct exercise can be prescribed to normalize movement prior to an increase in physical training or a competitive sports season.2  The FMS is a screen and therefore designed for, applied to, those individuals who do not have a known musculoskeletal injury. 

The Selective Functional Movement Assessment – The diagnostic system
The Selective Functional Movement Assessment (SFMA) is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known musculoskeletal pain.1  When the clinical assessment is initiated from the perspective of the movement pattern, the clinician has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main musculoskeletal complaint, but contributing to the associated disability.  This concept, known as Regional Interdependence,6 is the hallmark of the SFMA which guides the clinician to the most dysfunctional non-painful movement pattern which is then assessed in detail.  By addressing the most dysfunctional non-painful pattern, the applications of targeted therapeutic exercise choices are not adversely affected by pain.

The SFMA serves as a clinical model for the musculoskeletal healthcare professional to address regional interdependence.  This approach is designed to complement the existing exam and should serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of movement into musculoskeletal practice.

Selected References

  1. Cook E, Kiesel K. Impaired Patterns of Posture and Function In: Prentice B, Voight M, eds. Techniques in Musculoskeletal Rehabilitation. 2nd ed. Chicago: McGraw-Hill; 2006.
  2. Kiesel K, P P, R B, Burton L, Cook E. Functional Movement Test Scores Improve following a Standardized Off-season Intervention Program  Scand J Med Sci Sports. 2009; In Review.
  3. Kiesel K, Plisky P, Kersey P. Functional Movement Test Score as a Predictor of Time-loss during a Professional Football Team’s Pre-season Paper presented at: American College of Sports Medicine Annual Conference, 2008; Indianapolis, IN.
  4. Kiesel K, Plisky P, Voight M. Can serious injury in professional football be predicted by a preseason Functional Movement Screen? North American Journal of Sports Physical Therapy. August 2007;2(3):147-158.
  5. Minick K, Burton L, Butler R, Kiesel K. A Reliability Study of the Functional Movement Screen. National Journal of Strength and Conditioning Research. 2009;In Press.
  6. Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther. Nov 2007;37(11):658-660.

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