The FMS results I have seen and what they mean

by Elsbeth Vaino

If you’ve read my stuff before, then you know that I am, well, a big geek. I think I probably took fitness geek to a whole new level with my bench press assessment article, talking about the work value of a bench press based on arm span. I think this article will further raise the bar on geek in the fitness industry.

This article is about what typical problem areas I see based on the Functional Movement Screen (FMS for those who like to keep things short) assessments that I perform. Not familiar with the FMS? Check out functionalmovement.com, or read on for a brief overview. Then follow the article to see an overview of the results I’ve seen in terms of what functional movements tend to cause the most problems, and how the results are different based on gender and whether someone is an athlete. Lastly, I’ll share my take on what this should mean for your training (or programming for trainers) if you do not have access to the FMS or other assessment options to help guide you. I’ve been using the FMS for just over 2 years now, and have been using my Excel automated template to provide a quick way to give my clients nice looking output. It also allows me to keep some cool stats about what I’ve seen from more than 150 different clients. Here is the demographic of the people who’s results are included in this article. As it turns out I have worked with quite a range of people. Note that the results are provided at a summary level to ensure no information could be estimated about any individual that I have worked with.

Demographics:

Gender: 59% are women.

Age:

Teens: 5%
Twenties: 15%
Thirties: 28%
Forties: 31%
Fifty plus: 21%

Athletes?

68% are athletes.

What do I consider an athlete? Basically, everyone who engages regularly in some variety of sport, regardless of the level gets the label athlete in my book. Some may say that it would have been better to refer to a active versus sedentary, but I think active understates the commitment a lot of these people have to their sport. But I want to be sure that it is clear that when I refer to athletes in this review, I am not talking about professionals, but rather recreational athletes. Although note that many of them are quite serious about their sport, and play it at quite a high level.

What sport?

I have clients who participate in 25 different sports, so I rolled it up to the following:

Endurance athletes (cycling, running, triathlon): 25%
Team sports (hockey, ultimate, soccer, basketball, volleyball): 19%
Skiing/snowboarding: 8%
Tennis/golf: 6%
Other: 6%

Goals:

Of the general public clients (not athletes), people tended to have the following goals:

Improved health and fitness: 65%
Reduced pain (primarily back and/or hip)*: 25%
Weight loss (fat loss): 16%

*Note when I take on clients who want to reduce pain, I try to make sure I do so in conjunction with a health care practitioner as I believe they are critical for anyone with joint pain. I don’t strive to be the lead in that case, but rather the support.

It is a fairly varied population. The high number of people who are active and the relatively low number who come for weight loss should probably be taken into account when reading into these results.

The FMS:

I compiled the FMS results for all of the people above, and related it to their gender, and whether they are athletes. I have the FMS results tied to age as well, but have not yet done that evaluation. For those not familiar with the FMS, it is a set of 7 movements that trainers and therapists use to identify weakness or imbalances in the body that can help guide how we train people. Out of the 7 tests, we look for the two tests that cause the most difficulty or have the biggest difference from left to right, and put appropriate corrective exercises in the programs we create for these clients.

The seven tests are:

Deep squat (DS): this is almost an overview test, and can indicate any of ankle, hip or thoracic spine mobility or core stability limitations.

Hurdle step (HS): this can provide insight into whether there are hip mobility or stability challenges.

In line lunge (ILL): can indicate calf, quad, hip or thoracic spine tightness, or glute weakness.

Shoulder mobility (SM): Can indicate limited mobility in the thoracic spine and/or scapular stability.

Active straight leg raise (ASLR): can point out reduced hamstring flexibility or hip stability.

Trunk stability pushup (TSPU): can identify issues with core stability and/or upper body strength.

Rotary Stability (RS): can indicate if there is reduced thoracic spine or hip mobility, or a lack of stability in the rotary core muscles.

While each test gives us an idea about how well certain parts of the body move, it is important to note that just looking at one test without seeing the others is not advisable, as it prevents getting a full perspective. I use the FMS for each of my clients (for online clients, I have them video themselves doing a modified functional assessment). To me, it is a very valuable tool, both to help me understand how my clients move, which, in conjunction with a conversation about their goals and any relevant injury or health issues, helps me put together a quality training program for them.

For those trainers who program for clients without the benefit of the FMS, and for those individuals who direct their own training, the trends I present here may be helpful.

Trends in FMS Results:Please note this is not a controlled trial, but rather a compilation of results that I have seen.The following trends show the “worst tests” that I typically see. Remember that when we use the FMS we identify and address the two weakest areas, so for each client, I take note of these weak areas.

The weakest links?

Active straight leg raise (ASLR) – 39%
Trunk stability pushup (TSPU) – 38%
In-line lunge (ILL) – 30%
Rotary Stability (RS) – 30%

It should be noted that there is a priority to the FMS results. That is, if someone scored the lowest score possible on each test, I would pick the straight leg raise (ASLR) and shoulder mobility (SM) as their worst tests. In other words, it is not surprising that ASLR is on top, because it is considered a high priority test. But it is interesting that the SM is not in the top four.

Average score

It has been suggested that anyone with a score lower than 14 (out of 21) is at a higher risk of injury in sports than those who score a 14 or above. More recent studies, including this meta analysis, suggests the current body of evidence does not support this statement (but it also doesn’t refute it). At Custom Strength, we don’t place any focus on the score.

Asymmetry

There is some evidence that if someone has a difference between left and right in at least one test (even more evidence if it’s 2 or more tests), they have a higher likelikhood of injury in sports participation.

I have seen at least one asymmetry in 83% of people:

1 asymmetry: 41%

2 asymmetries: 25%

3 asymmetries: 15%

4 asymmetries: 1%

Pain?

We also look at pain when we do the FMS. Or more accurately, we try to avoid pain. We find out what tests are painfu so we can tread lightly around them when we train. This aligns with my training philosophy: “No pain, no gain” is not an expression I use.

30% of people I screened had pain in at least one test.
11% had pain in 2 or more tests.

The FMS manual suggests we continue to train someone with one painful test, and that recommending the person see a health care practitioner would be wise. With more than one painful test, the FMS guidance is that a person should see a health care practitioner before they start training.

Looking at the data relative to gender and athlete status

Note these are not professional or collegiate athletes, but would better be described as “weekend warriors”. Many of them do train for their activity (or at least they do now!), and they participate in their sport during the week as well, but their athletic pursuits have to fit around their jobs and their family.

Male vs female:

When we look at the results by gender, it is interesting to see that the limiting tests are very different.

Females:

TSPU – 54%
HS – 32%
ASLR – 28%
RS – 26%
ILL – 25%
SM – 25%
DS – 11%

Males:

ASLR – 55%
ILL – 38%
RS – 36%
SM – 27%
HS – 20%
TSPU – 16%
DS – 9%

We can see that pushups (TSPU) make the top 3 overall based on female results, while the straight leg raise made the top 3 overall based on male results.

It is interesting to see that the results are quite different, by gender, across all tests. This may not be an entirely surprising result. Males having tight hamstrings is almost a cliché, as is females having weaker upper bodies.

Unfortunately, these results suggest these stereotypes often hold true.

Note with a poor score in the straight leg raise (ASLR), we will follow up by doing a passive straight leg raise test (we ask the person to relax and then we lift their leg until they tell us to stop). If the passive test shows more range of motion than the active test, that suggests the limitation is hip stability (hip flexor strength to actively lift the leg further), and if they are about the same, it suggests the limitation is in hamstring flexibility.

In males who score poorly on the ASLR, the passive test rarely provides more range of motion than the active test did. Conversely, when females score low on the ASLR, the passive test almost always shows significant additional range.

This suggests that males who score poorly in the ASLR, usually do so due to limitation is in hamstring flexibility, while (the few) females who score poorly in the ASLR, usually do so due to limitation in hip flexor strength.

Athletic vs sendentary

Female athletes:

TSPU – 57%
ASLR – 36%
HS – 34%

Male athletes:

ASLR – 58%
ILL – 36%
RS – 36%

I find it interesting to see the differences between the athletic and non-athletic population. Of particular interest to me is that athletic women do not fare much better than general public women on the pushup (TSPU). Based on my observations, their pushups are better, but they still score low. Typically general population women cannot get their body off the ground at all, whereas the athletic women can, but they often lack the core strength to be able to do so without upper and lower body separation. These two situations result in the same score on the FMS. You might think this is unfair, but I am glad it is the case, because core stability is so important that I want to know if there is weakness there.I also looked at a few other factors:

Average # of asymmetries

Females: 1.4

Males: 1.5

Pain in any test?

Females: 30%

Males: 30%I don’t think this final group of values shows any significant difference, although I find it interesting that 30% of the population I screened had pain in at least one test. That strikes me as unfortunately high, although I think that this number may not reflect the normal, as I get a lot of referrals from manual therapists. If I had primarily people walking into a gym on their own, I would hope to see fewer pain scores.

How can this information affect your programming or your training?If I had to stop using the FMS tomorrow, and had to instead start training people without assessments, here is what I would do:

More than 8 out of 10 people who walk through my door likely have some kind of imbalance between their left and right. Since I will not know which 8, I will use single-limb exercises with everyone to improve those asymmetries.

30% of the people I see will likely find at least some basic movement painful. This is tough to know without knowing who are the ones with pain. The easy answer to this is that I will ask, and I will continue to advocate that “no pain, no gain” is a flawed expression, especially if the pain is related to a joint. If someone continues to have pain in some movements, I will strongly encourage them to see a health care professional. I am a trainer; I train people. I am not a physical therapist or a doctor. If someone has pain, ideally they should see someone trained in dealing with pain. I am fortunate to know some excellent health care professionals, to whom I can send people with confidence.

Almost 4 out of 10 of my clients have movement limitations at the hips, and considering how importan the hips are for low back health and sports performance, it’s a pretty easy decision to include hip mobility and stability exercises for everyone.

54% of my female clients will not be strong enough to do a single core pushup. Admittedly a core pushup (TSPU above) is harder than a regular pushup. But certainly this level of weakness suggests I will not throw a new client into a bootcamp class and have them do 100 pushups, because 99 of them will have little resemblance to a pushup. Instead, I will start them with cable presses to develop more strength for pushup-ability, and I will show them perfect pushup form and have them try it with their hands elevated. If they nail it, we will lower the elevation; if they have trouble, we will raise it. We’ll progress until they have amazing pushups on the ground. As an aside, the term “girl pushup” is neither welcome, nor used in my gym. Elevated pushups from the feet are a much better option, and avoids the need to use such a ridiculous term. If you like pushups from the knees, that’s fine, but please don’t call them “girl pushups”. They’re pushups from the knees (end rant).

More than half (57%) of the female athletes who come to see me will not have a strong enough core to do a single core pushup (vs 12% of male athletes), but many of them will be out playing sports that require a lot of stability. Additionally, female athletes are at a higher risk of ACL tears than male athletes. There is evidence, such as this journal study that core stability and ACL tears are related. This is why every female athlete who comes through my door will work on core strengthening.

More than half of the men will have limitations in their hamstring range of motion. This one is a bit tough, because I know there are a lot of theories that people who get hamstring strains get them as a result of glute weakness that causes the hamstrings to overwork. Many of these people suggest that we shouldn’t stretch hamstrings, but rather we should stretch hip flexors and strengthen glutes. I agree with that conceptually, but I can’t pretend that more than half of my male clients perform very poorly when asked to lie on the ground and raise their leg. I think that shows lack of hamstring flexibility, and so if I don’t have the luxury of using the FMS on my clients, I will assume all men need to stretch their hamstrings. And so I will give them hamstring stretches. Since I also agree that tight hip flexors and weak glutes are a problem, I will also address that with hip flexor stretches and glute activation exercises.

Please note the “what to do” list above is not a complete list of what I think people need in their training; it is simply key points that I think anyone who does not use the FMS with their clients should consider.

By : elsbethv