Clinical Practice and the use of Functional Movement Systems app
[By Stuart Elwell, Physical Therapist in the UK] The Functional Movement Screen (FMS) has gained recognition as a screening tool for fitness evaluation across athletic and health professions. A functional movement screen provides a screen - a check of fundamentals - allowing for decisions to be made on readiness to train or return following injury. The screen allows for a clients movement to be appraised and a level of movement competence to be able to be conveyed in a common language between professions.
The FMS is not a diagnostic tool and often a common mistake by users of the screen is to use it as a means of diagnosis. Gray Cook compares it to a Blood Pressure cuff measurement - it provides information quickly and effectively about what someone's blood pressure is but the physician doesn't automatically assume they know the cause. Similarly a low screen score identifies that a client has a significant movement impairment but is not there to direct the sole cause of the problem.
So where does this leave us with clients in pain? How do we interpret their score? Where do we start to intervene? Should we apply corrective exercises?
For this situation and for a medical Practicioner - these are clients that we deal with on a daily basis. For a client in pain, the majority of the time they will automatically have pain on at least one of the FMS tests putting them below a cut point for exercising - in this case the FMS has served its purpose - it has filtered this client for not exercising and seeking further Assessment from the Evaluation that the FMS has done.
This is where the Selective Functional Movement Assessment (SFMA) is most appropriately used. The SFMA classifies people into 4 movement types through 7 top tier tests. With movements in the SFMA people are classified as being Functional or Dysfunctional. The use of the Functional Movement Screen (FMS) has gained worldwide recognition as an effective means of screening athletes and clients for movement dysfunction.
As a cross profession language it allows for medical professionals and trainers to work with clients and athletes appropriately and effectively to achieve their health and fitness goals. Those familiar with the FMS know that it is there to screen. It assists in determining whether someone is at risk of developing an injury.
The question is what to do of someone scores below threshold and what if they are in pain during the screen?
The majority of clients I see who are injured are either moving poorly since or prior to becoming injured - whether this be the sole cause of their current symptoms or not - it certainly has an impact on their long term recovery. Assessing a whole movement pattern before targeting specific regional tests, which traditionally therapists are taught, allows for the assessment to identify any potential areas of Regional Interdependence.
Assessing these areas - using SFMA flowcharts and a systematic approach towards dysfunction allows for pain to be acknowledged but not chased to form a treatment approach. We know the body moves differently in pain however poor movement patterns often perpetuate pain and commonly are overlooked through focussing on pain.
The Top Tier tests on the SFMA allow for a practical means of assessing a clients overall movement to determine their most dysfunctional pattern, allowing the medical professional to descent further into this pattern to identify the source of the dysfunction.
It does not tell you how to treat, it does however target your intervention, allowing the medical professional to utilize modalities to correct dysfunctions and restoring normal functional movement.
For further information on certifications in both the FMS and SFMA please visit the HumanMotion course overview page.
Stuart Elwel graduated in 2002 from Coventry University, and has developed a clinical focus on injury prevention and screening since. In his current role as a First Team Physiotherapist with West Bromwich Albion Football Club, he is part of a leading sports medicine department, priding themselves on player availability and career longevity. Stuart has progressed through the clubs academy medical structure where he led the medical provision to scholarship and academy players. The day-to-day assessment, treatment and rehabilitation of elite athletes and their performance management assists players to become professional Premiership footballers. Stuart pioneered a process of functional screening to the club to fully appraise a players physical condition, identifying assets and risks neuromusculoskeletally in full time athletes. After 5 years of retrospective research, Stuart has a keen interest in the effects of training load and volume on functional movement, notably its effects on a players Functional Movement Screen (FMS). Since refining his skills through the Functional Movement Systems Internship, Stuart utilizes his experience of addressing poor movement patterns to improve function, develop movement efficiency and reduce injuries on a daily basis. Stuart also works on a day-to-day basis treating acute and chronic musculoskeletal conditions are assessed and rehabilitated utilising a Selective Functional Movement Assessment (SFMA) approach. He is a member of the Association of Chartered Physiotherapists in Sport and Exercise Medicine (ACPSEM) and the Acupuncture Association of Chartered Physiotherapists (AACP).
