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Functional Movement Screening

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Tandi Hawkey

on 2 May 2013

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Transcript of Functional Movement Screening

Standardization of Movement
Assessment Functional Movement
Screening Developmental Movement Functional (Purposeful) Movement Movement Screening "This is not about strength, power, endurance, or
agility. It is about basic movement patterns laying the foundation for higher movement skill."
Cook et al, 2010

3 Levels of Postural Control
Breathing, Grip, Head/Neck Control, Prone/Supine
Crawling, Kneeling, Squatting
Symmetrical/Assymetrical/Single Limb Stance, Walking Symmetrical Stance
Hip Hinge
Assymetrical Stance
Split Squat
Single Leg Stance
Hip Hinge
Running Injury Prevention
Identify Risk
Return to Play
Utilize objective measures to determine activity progressions Functional Movement is where dysfunction can be identified. Movement MOBILITY STABILITY Functional movement is not based on flexibility and strength. MOTOR
CONTROL Mobility Before Stability Mobility problems are movement dysfunctions.
1. Byproduct of inappropriate movement
2. Result of poorly managed injury
3. Physical stress
4. Emotional stress
5. Postural stress
6. Inefficient stabilization Mobility is reduced during the body's attempt to provide function at some level.
Loss of mobility is sometimes the only way the body can achieve a point of stability, but that stability is not authentic.
It is often seen as inflexibility but it is an engineered dysfunction to allow continued physical performance on a global level. Strength does not equal stability.
Stability is reflexive.
Stability is optimal recruitment.
Authentic stability occurs at the reflex level.
You cannot actively train stabilizers and hope they will perform in an athletic environment.
It has to be reflexive, not a conscious choice STABILITY What happens when someone doesn't have the stability for the movement they are trying to accomplish? COMPENSATION Humans are designed to compensate.
When we experience a problem or pain, we figure out how to move around it.

Compromises efficiency
Can cause microtrauma
Distorts proprioception
Disrupts sensory motor balance Movement Maps Everything we do is engraved in our brains as neural patterns -- not isolated movements.
We perceive our environment with the visual, vestibular, and proprioceptive systems and move according in that perceived environment.
Movement impairment is due to a corrupted program in the neural program.
Athletes are the corrupted at the highest level. Dysfunctional Patterns Serve a Purpose Sound movement patterns are not possible in the presence of poor mobility or poor stability. Without stability or mobility we get dysfunction. People develop dysfunctions at one level to remain functional at another.
They sacrifice movement quality for movement quantity.
Compensations cause stress to other regions and are far less efficient than the authentic movement they replace. INJURY PREVENTION Known Predictors of Injury Biggest risk factor for injury is prior injury. PAIN INJURY ALTERED
CONTROL INJURY PREVENTION Known Predictors of Injury ASYMMETRY ...no clear evidence was identified to implicate tightness or weakness of a particular muscle group with injury but a significant amount of injuries were noted in athletes with right to left sided strength and flexibility imbalances (asymmetries). ---Knapik Y-Balance Symmetry Test WE ARE WHAT WE REPEATEDLY DO. RETURN TO PLAY PROTOCOLS When to Use FMS? Where To Start? RESET
by removing restrictions/barriers.
Typically areas of mobility restrictions that affect movement patterns include the thoracic spine, ankle, and hips.
the optimal movement patterns.
Improve stability through proper motor control and timing.
the new movement patterns.
Add load. Repetition allows new pattern to become permanent. Lower Quarter Screen A medical diagnosis is physiologically or anatomically based. The medical diagnosis is valuable in determining contraindications to the therapeutic protocol, but not in guiding choices in that protocol. A functional diagnosis identifies the primary dysfunction that the rehabilitation protocol needs to be geared toward connecting.
Voight et al, Musculoskeletal Interventions Motor control is established as mobility and stability learn to work together to accomplish a given task. FUNCTIONAL MOVEMENT SCREEN Screen - Determine Risk/Grouping
Test - Analyzing Ability/Function
Assess - Inability/Dysfunction 1. Pre-season or off-season screening to guide strength and in programming.
2. Post-surgical and non-surgical patients who have progressed to the point that they can perform most or all of the screen.
3. Pre-surgical screening of patients whose symptoms do not adversely affect or alter the performance of the screen.
4. Individuals nearing discharge. **If individuals present with pain or complain of pain with activity, then the SFMA (Selective Functional Movement Assessment) should be utilized. FMS Restorative Strategy 1. Address mobility before stability
2. Address fundamental components of the FMS first, then transitional, then functional Fundamental
1. Active Straight Leg Raise
2. Shoulder Mobility
3. Rotary Stability
4. Trunk Stability Push Up
5. In-Line Lunge
6. Hurdle Step
7. Deep Squat 1. Score of 0 -- SFMA
2. Assymetrical 1's
3. Symmetrical 1's
4. Assymetrical 2's
5. Symmetrical 2's Use medical diagnosis in conjunction with movement assessments and performance measures in order to have comprehensive analysis of appropriate clearance for activity
Swelling/Effusion, ROM, Girth, Pain, Isolated Muscle Strength (HHD)
Y-Balance Test (Symmetry at End Range)
Hop Tests
Single Leg Squat Test
> 70 squats in 2 minutes x 3 UCLA Use of Movement Screen for Injury Prevention Example #1
Screen all athletes through Y-Balance Testing
Anyone with significant assymetry undergoes FMS Screen
FMS score determines attention from ATC or specific exercises during weights sessions Example #2
Screen all athletes through FMS
Any zeros or significant asymmetries referred to ATC, otherwise grouped during weights sessions
Must have strategy for re-screening UCLA Use of FMS for Return to Play Clearance for Running
Squat Test
FMS Score of at least 14 with no asymmetries
Most concerned about symmetrical ASLR, hurdle step, in-line lunge Clearance for Jumping/Cutting/Pivoting
Hop Tests
FMS Score of 14 Final Clearance for Participation
LEFT Test -- Assess Fitness
FMS Score of 14
Subjective Pyschological Preparedness Determine what screening tool best fits your program and resources
Standardize RTP Protocols for Safety
Keep approach holistic, don't narrow too much on one idea
Mobility AND Stability!
Understand the developmental movements and how they affect functional movement We can't run before we walk. In Summary: Upper Quarter Screen Screening and assessing movement allows us to identify global mobility and stability deficits that affect an individual's movement capabilities and create excessive stress in other areas of the body. Standardized & Holistic Approach To RTP Criteria Movement Quality & Symmetry
Y-Balance Test
Hop Tests
Single Leg Squat Test
Lower Extremity Functional Test (Neuromuscular/Agility/Metabolic)
Psychological Preparedness
Subjective Rating Scale
Oswestry, KJOC Shoulder Questionnaire Current Research Kiesel et al (2007) found that NFL athletes were 12 times more likely to suffer an injury when their scores were </= 14 compared to those who scored >14.

"Functional Movement Screen and Aerobic Fitness Predict Injuries in Military Training" -- Lisman et al
Slower 3-mile run times (>/= 20.5min) indicated a higher risk of injury
Lower FMS scores (</= 14) indicated a higher risk for injury

Gray Cook and Lee Burton (FMS Developers) have stated that the number may not be as important as obtaining a score of symmetrical “2s” on each of the 7 tests.
An individual with movement asymmetry is often at a higher risk of injury An injury can lead to a hypomobility, ineffective stabilization or asymmetry. Utilization of a Consistent Movement Evaluation Method Will Lead to Safe and Effective Outcomes Analysis/evaluation of movement is not a new topic
Rehab clinicians across all disciplines struggle because we do not have a common language or standardized evaluation process Functional Movement Screen and similar movement assessments are not stand-alone tools (After addressing pain, ROM, girth, strength) Federal Aviation Act of 1958
Significantly decreased air traffic accidents solely on the implementation of standardized safety regulation checklist and air traffic control regulations
Created a safe environment for air travel What standardized movement evaluation do athletic trainers utilize to determine if an athlete can safely participate in his or her respective sport? DISCLAIMERS Standardized and comprehensive assessment tools will allow for successful performance and return to play strategies Program Structure is Key Maintain Standard Benchmarks for Participation Across All Areas (Weight Room, MDs, ATCs, PTs) Red Light -- Swelling, 0's and 1's on FMS, Asymmetry Yellow Light -- 2's on FMS, etc MUST REASSESS TO ENSURE ATHLETE IS MAINTAINING NEW MOBILITY AND STABILITY Green Light -- Symmetrical 3's on FMS, Qualitative and Quantitative Completion of Other Benchmark Testing Assessment is an ongoing process. ATHLETES MUST DEMONSTRATE SYMMETRICAL, APPROPRIATE CONTROL. Decide Who is Involved in Screening Process and Ongoing Program (Retesting Strategy) Decide Between All Parties Involved Who Can Safely Participate and How to Address Movement Dysfunction How are PAC-12 Institutions Utilizing a Screening Program? UCLA chose to utilize FMS/SFMA because we recognize the need for standardization in our movement evaluation process. FMS provides an excellent structure and framework that allows our clinicians to utilize our skills and creativity in the corrective strategies and processes. It creates a solid foundation for an outcome measure.
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