Sports Medicine Research: In the Lab & In the Field: FMS is Not a Crystal Ball (Sports Med Res)

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Wednesday, January 10, 2018

FMS is Not a Crystal Ball

The Functional Movement Screen as a predictor of injury in National Collegiate Athletic Association Division II athletes.

Dorrel B, Long T, Shaffer S, and Myer GD. J Athl Training. 2017. [Epub Ahead of Print].

Take Home Message: The Functional Movement Screen is slightly better than flipping a coin at predicating who will get an athletic injury.

Businessman Consulting Glowing Crystal Ball The Functional Movement Screen (FMS) is a tool which helps clinicians identify body asymmetries and identify inefficient movement patterns. While FMS may differentiate injured and uninjured people some investigators have challenged the notion that FMS could identify athletes at risk for injury. Therefore, Dorrel and colleagues completed a prospective study to examine the prognostic accuracy of FMS to predict injury among NCAA Division II athletes. The authors included 257 athletes from a single NCAA Division II institution and were uninjured at the start of the current season. Trained members of the strength and conditioning staff completed the FMS on all included athletes prior to the start of the season. The institution’s athletic training staff then tracked injuries throughout the season. An athlete was considered “injured” if the injury affected their ability to practice. In total, 124 athletes were identified as “injured” while 117 athletes were identified as specifically having a musculoskeletal injury. The authors found that among the 257 athletes, an FMS score of 15 was the best cut-off for identifying athletes who would get injured during the season. The area under the curve score for overall injury and musculoskeletal injury was 0.53 and 0.54. To help put this in context, an area under of the curve of 0.50 would mean there’s a 50/50 chance of predicting who would get an injury. The data also demonstrated that FMS was more sensitive (0.61) than specific (0.49).

The current study is interesting because the authors suggests that FMS is only slightly better than flipping a coin at predicting injuries. This supports a recent systematic review by these authors, which challenged the predictive validity of FMS. While the authors fail to support the use of FMS as an injury prediction tool, more analyses would help clinicians further understand this. Future studies should attempt to look to widen the scope of the study from a single institution and more specifically track how soon an injury occurs after completing the FMS. While the authors focused on FMS predicting injury they did not assess the FMS with regards to its accuracy of identifying body asymmetries or identifying inefficient movement patterns. The FMS may still be used for these purposes; but, clinicians may be weary of using FMS to identify athletes at high risk for injury.

Questions for Discussion: What has been your experience with FMS? Do you feel it has been a predictor of injuries in your current position?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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2 comments:

Kevin said...

Hi Kyle,

Thanks for sharing. Although the idea of FMS is to identify athletes at risk of injury, I wonder if the athletes in this study were actively attempting to improve their asymmetries rather than solely doing the FMS screen. If not, I wonder if there should be simply a modification to the normative scores rather than a complete overhaul of the product.
Personally, I think it is important to screen for potential injury risk factors whether it be from the FMS or (name your clinical tool). It is difficult to manage what you do not measure. But then again, does the FMS measure what we are thinking it is?

What are your thoughts?

Kyle said...

Kevin,

Great point. I appreciate the thoughtful question. From the study, there was no indication that the athletes were attempting to correct any asymmetries. While it would require more research there could be an opportunity to modify the scoring but even before that, I would want more detailed studies such as the one above. Primarily I would be interested to have more demographic data on those included in the study as well as more detail regarding the injury sustained. In this study, due to blinding of the researchers, there was no way to discern what injuries were sustained as a result of athlete to athlete contact and which were not. A future study who looks at which injuries were caused by movement-quality could give us a different understanding. Ultimately though, to your point, “it is difficult to manage what you do not measure,” I couldn’t agree more. Thanks again for the thoughtful comment.

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