Posts tagged functional movement screen
Triathlon Injuries and Functional Movement Screen

Are you wondering when it will happen to you? Not what , but when will you feel pain or develop an injury? Can you determine your injury risk? The answer is YES! There are screening tools that allow athletes to assess their injury risk. The Functional Movement Screen (FMS) is a valid indicator of injury risk among athletes. The FMS is a means of identifying your weak links and asymmetries in your basic functional movements.

As the triathlon season comes to a close, we finally have an opportunity to reflect on the season’s successes and create opportunities for improvement. During the offseason, we you are able to plan and prepare for the upcoming season. Prior research reports 10,000 athletes seek treatment for sports and exercise related injuries each day and over 7 million athletes receive medical attention over any 2 year span(2,3). In triathletes, up to 90% of individuals report at least one injury over the previous 1-2 seasons with the majority of these injuries occurring in the lower extremity(4). Unfortunately, the nature of these injuries leads to an inability to complete triathlon training in up to 75% of athletes causing an average loss of 2-3 months of training(5). Outside of traumatic events such as a bike collision, the vast majority of these injuries are diagnosed as overuse including achilles tendinopathy, medial tibial stress syndrome (shin splints), and plantar fasciitis, all which could have been prevented with a proper sport specific screening program and intervention. 

Screening programs for triathletes should focus on known, modifiable intrinsic and extrinsic risk factors for injury. Intrinsic (individual) risk factors such as prior injury and supinated foot type, as well as, extrinsic (environment) risk factors including training volume (duration, intensity, frequency, and distance) and competition distance (Ironman) have been shown to increase the likelihood of future injury(6). Conversely, this research has demonstrated the presence of strength training, coach/club participation and medical team support have reduced an triathlete’s risk of future injury(7,8). Expert opinion suggests athletes should consider cross training, equipment fitting, reasonable training schedules and techniques, and pre-participation screenings to reduce future risk.

Functional movement screen, triathlon injuries, prevention, physical therapy

In our clinic’s experience, the utilization of The Functional Movement Screen (FMS) is an essential part of our pre-participation screening. The FMS consists of seven different functional movements that assess the following: trunk and core stability, neuromuscular coordination, asymmetry in movement, flexibility, acceleration, deceleration, and dynamic flexibility(10).

This component of our screen allows our Physical Therapists to objectively score and grade individuals for injury risk prior to participation as well as follow and reassess these at-risk individuals after Physical Therapy treatment is initiated. 

Research has identified a score of 14/21 as an acceptable cut off for determining future injury risk. Athletes who score <14/21 are up to 11 times more likely to sustain an injury causing significant time away from training and competition(9). Lower scores may either reflect a current injury or a compensatory movement pattern, which will lead to a future injury. This data is then analyzed by the treating Physical Therapist to implement an intervention program consisting of corrective exercises that restore muscle balance and movement patterns, improve FMS scores, improve performance and reduce time away from their sport. These corrective exercises have been shown to improve FMS scores reducing time away from training and future injury risk(9,10). 

Single plane exercises including running and cycling have been shown to develop asymmetry throughout the body and athletes with these imbalances often train around or neglect these weaknesses(11,12). The results of the FMS can be used to identify injury risk and to guide training programs.

Off seasons are an excellent time to recover from the season and address both nagging injuries as well as prevent future injury. The FMS is an integral part of any pre-participation examination and can quickly and effectively identify modifiable risk factors in athletes. For more information on the FMS or how Physical Therapy can assist in your training and performance contact the experts at MEND PT. 

References

1. Dias Lopes, A. et al. What are the main running-related musculoskeletal injuries. Systematic Review. Sports Med. 2012;42(10):891-905.

2 National Center for Injury Prevention and Con- trol, Centers for Disease Control and Prevention. CDC Injury Research Agenda. Atlanta, GA: US Department of Health and Human Services; 2002.

3  Gotsch K, Annest JL, Holmgren P, Gilchrist J. Nonfatal sports- and recreation- related injuries treated in emergency departments—United States, July 2000–June 2001. MMWR Morb Mortal Wkly Rep. 2002;51(33):736-740.

4  O’Toole ML, Hiller WDB, Smith RA, et al. Overuse injuries in ultra endurance triathletes. Am J Sports Med 1989;17(4):514—8.

5  Vleck VE, Garbutt G. Injury and training characteristics of male elite, development squad, and club triathletes. Int J Sports Med 1998;19(1):38—42.

6  Gosling, C. Triathlon related musculoskeletal injuries. The status of injury prevention knowledge. J Science and Medicine in Sport. 2008. 11:396-406.

7  Egermann M, Brocal D, Lill CA, et al. Analysis of injuries in long-distance triathletes. Int J Sports Med 2003;24(4):271—6.

8  Aaltonen, S. Prevention of Sports Injuries. A systematic review of randomized controlled trials. Arch Phys Med Rehab. 2007. 167(1383-1396).

9 Chorba RS, Chorba DJ, Bouillon LE, Overmyer CA, Landis JA. Use of a Functional Movement Screening Tool to Determine Injury Risk in Female Collegiate Athletes. N Am J Sports Phys Ther. 2010; 5(2):47-54.

10 Peate WF, Bates G, Lunda K, Francis S, Bellamy K. Core strength: a new model for injury prediction and prevention. J Occup Med Toxicol. 2007; 2: 3.

11 Beckham, SG and Harper, M. Functional training: Fad or here to day? American college for Sports Medicine’s Health and Fitness Journal 14(6): 24-30, 2010.

12 Jaffe, L and Cook, G. One frame at a time. Training and Conditioning 16:8, 2006. 

 

Sports Injuries and the Functional Movement Screen

Athletic Injuries

More than 10,000 athletes seek treatment for sports, recre- ation, and exercise based injuries on a daily basis(12).

7 million Americans received medical attention for sports and athletic injuries between 1997-1999(1).

Incidence of athletic injuries has been reported as 15.4-25.9 injuries per 1000 in the population(2,3).

50-80% of these injuries have been described as overuse in nature and may be prevented through the utilization of pre-participation screens(13). 

Functional Movement Screen                                

FMS is a ranking and grading system that documents move- ment patterns that are key to normal function3. It requires individuals to move through all 3 planes of motion allowing the examiner to document both the quantity and quality of the movement pattern.

Risk factors associated with injury in athletic events including muscle imbalances, balance and proprioception impairments, and pain are assessed with each movement.

The screen allows Physical Therapists to objectively score and grade individuals for injury risk prior to participation as well as follow and reassess these at risk individuals after Physical Therapy treatment is initiated. 

FMS Evidence

Plisky et al. identified an anterior side to side reach difference of greater than 4 cm on the star excursion test placed a high school basketball athlete at a 2.5 times greater risk of lower extremity injury in their season. Further, in females a compos- ite reach <94% of their limb length placed them at a 6.5 times greater risk(11).

Kiesel et al. reported a score of <14/21 was able to predict serious injury in a group of professional football players. (Specificity .91, Sensitivity .54 (+) LR 5.92 (-) LR .51)(4).

These individuals were almost 12 times (odds ratio 11.67) more likely to sustain a serious injury versus an athlete scoring higher on this testing(4).

Chorba et al. found similar findings among a group of female Division II athletes where a score of <14/21 placed the individual at a 4 times greater risk of lower extremity injury(5).

Authors have reported a 7 week (4-6/week) supervised off season conditioning program was able to improve professional football players FMS scores in previously at risk athletes. A low score on the deep squat was most predictive of a lack of success with this program(6).

Peate et al. has also reported on the impact of the FMS screen and an 8 week intervention program on a group of 433 inter- national firefighters. This program reduced the time off work due to injury by >60%(8).

Lower sensitivity values (.08), but higher specificity (.95) were found among recreational runners training for a half mara- thon scoring < or > 14/2110. These higher specificity scores may be explained by a low number of individuals scoring <14.

Letafatkar et al. indicated an almost 5 times greater risk of injury among recreationally active college students scoring <17/21(7). 

Boulder FMS testing, sports and athletic injuries, screening, prevention

Testing

The 7 tests utilize a variety of basic positions and movements, which are though to provide the foundation for more complex athletic movements to be performed efficiently(4).

Individuals are graded and assigned a level of injury risk based on these 7 movements with a total possible score of (21).

Teyhen et al. has described moderate to good inter and intra rater reliability and acceptable levels of measurement error with the FMS(9). 

References

1. Conn JM, Annest JL, Gilchrist J. Sports and recreation related injury episodes in the US population, 1997–99. Inj Prev. 2003;9(2):117-123.

2. Gotsch K, Annest JL, Holmgren P, Gilchrist J. Nonfatal sports- and recreation- related injuries treated in emergency departments—United States, July 2000–June 2001. MMWR Morb Mortal Wkly Rep. 2002;51(33):736-740.

3. Functional Movement Systems. Functionalmovement.com

4. Kiesel, K. et al. CAN SERIOUS INJURY IN PROFESSIONAL FOOTBALL BE PREDICTED BY A PRESEASON FUNCTIONAL MOVEMENT screen? N Am J Sports Phys Ther. 2007. 2(3):147-158

5. Chorba RS, Chorba DJ, Bouillon LE, Overmyer CA, Landis JA. Use of a Functional Movement Screening Tool to Determine Injury Risk in Female Collegiate Athletes. N Am J Sports Phys Ther. 2010; 5(2):47-54.

6. Kiesel K, Plisky P, Butler R. Functional movement test scores improve following a standardized off- season intervention program in professional football players. Scand J Med Sci Sports. 2011; 21(2):287-92.

7. Letafatkar, A. et al. Relationship between functional movement screening score and history of injury. International J Sp Phys Ther. 2014. 9(1):21-27.

8. Peate WF, Bates G, Lunda K, Francis S, Bellamy K. Core strength: a new model for injury prediction and prevention. J Occup Med Toxicol. 2007; 2: 3.

9. Teyhen DS, Shaffer SW, Lorenson CL, Halfpap JP, Donofry DF, Walker MJ. The functional movement screen: A Reliability Study. J Orthop Sports Phys Ther. 2012; 42(6): 530-540.

10. Hoover D, Killian CB, Bourcier B, Shannon L, Jenny T, Willis R. Predictive validity of the Functional Movement Screening in a population of recreational runners training for a half marathon. Med Sci Sports Exerc. 2008; 40(5): 219.

11. Plisky et al. Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players. JOSPT. 2006. 36(12):911-919.

12. National Center for Injury Prevention and Con- trol, Centers for Disease Control and Prevention. CDC Injury Research Agenda. Atlanta, GA: US Department of Health and Human Services; 2002.

13. Almeida SA, Williams KM, Shaffer RA, Brodine SK. Epidemiological patterns of musculoskeletal injuries and physical training. Med Sci Sports Exerc. 1999;31:1176-1182.