The FMS: Awesome or Awful?

by Elsbeth Vaino and Bret Contreras

The FMS (Functional Movement Screen) is a divisive topic in the fitness world. Some people think it’s the cat’s pajamas, while other people think it’s utterly useless. In case you want to examine the science behind the FMS, THIS link will take you to a page by Chris Beardsley that summarizes all of the FMS research to date.

Unfortunately, discussions about the merits and shortcomings of the FMS tend to be very polarizing and emotional, with meaningful discussion taking a backseat. Bret Contreras and I decided to try to change that by taking a stab at an intelligent and respectful debate about it, so we came up with 5 questions that we both answered below.

1. Should personal trainers get FMS certified – will it help them gain clients, and will it help them be better trainers?

EV: I believe that FMS certification is an excellent option for all trainers, particularly new ones. I think the course will almost instantly make a new (or relatively new) trainer better, and for an experienced trainer, it can streamline the initial programming. Here’s why: it provides a simple and succinct method for identifying some movement strengths and weaknesses, as well as guidance as to what that can mean. This knowledge allows the trainer to set up a program that is appropriate for the individual, without exercises they are not ready for and with exercises that will help some of their movement limitations. Of course there are other ways to accomplish this, but I like the FMS as an option because it covers a lot in a little time and in a manner that seems to makes sense. For a new trainer in particular, having a well-defined guidance system will save them from fumbling around. For an experienced trainer, it is just a simple and efficient way to see a lot of what they will want to see anyhow. In addition to learning the system, a trainer will learn a lot about movement. Honestly, I would be very surprised if anyone who has taken the course has walked away thinking it was a waste of time.

I also think the FMS can be beneficial for gaining new clients, although not directly. I think in the past five years, I have had two clients seek me out because I do the FMS. Most people looking for a trainer don’t know or care about our certifications. But if a trainer wants to build up referrals from health care professionals, the FMS is an excellent certification to have. Some of the health care professionals who refer to me have said as much. I consider it a good way to open a dialog with them, but once the dialog starts; your ability as a trainer will be much more relevant than the FMS. I think the same is true for some sport coaches, but to a lesser degree. The other benefit is that there is a network of trainers who use and believe in the FMS, and in some cases they will have clients who move to your area, and will be looking for a trainer for them. In absence of knowing who the great trainers are in another city, many trainers who use the FMS, including myself, will suggest seeking out a trainer who also uses the FMS.

BC: My answer is: If the trainer wants to, then he or she should get FMS certified. I’m all for continuing education. I received my FMS certification several years ago and found it valuable at the time. Getting FMS certified cannot hurt a trainer, however, getting sucked into any system and exhibiting cult-like behaviour will definitely hurt a trainer by causing them to exhibit tunnel vision. People in the fitness industry seem to be highly skilled at spotting cult-like behaviour when it involves something that they’re not involved with, but they tend to be rather inept at spotting it when it involves something they’re engaged in. This applies to CrossFit, the RKC, the FMS, Olympic weightlifting, powerlifting, and bodybuilding. Several years ago, Michael Boyle wrote a tongue-in-cheek article about the FMS titled, “Will the FMS Cure Most Communicable Diseases?” because at that time the majority of subscribers on the strength coach forums seemed to be parroting the same answer to every question about an athlete experiencing issues…”have you FMS’d them?” There’s much more to screening and exercise form than the FMS, which I believe that Gray and Lee would agree with – more on that later. However, although this behaviour is a turn-off, it shouldn’t influence a rationale individual’s opinion on the screen.

One important reason to get FMS certified is simply because it will help personal trainers obtain and retain clients. Here’s why. Clients love to feel special. When you take a new client and put them through an official screen that has it’s own tools and scoring system, they eat it up. People also love to be told that they’re dysfunctional. I think every client I’ve ever trained starts out by telling me something that they’ve heard from their chiropractor or physical therapist, such as, “my TVA isn’t firing,” “my glutes don’t activate,” “I have a massive leg length discrepancy,” “my SI joint is out,” or “I have tight hip flexors.” Nine times out of ten, I test these individuals and find that they’re fine; they’re just weak and uncoordinated. The practitioner incorrectly speculated out of ignorance and ended up doling the client a giant Nocebo effect, which can alter movement patterns and create pain. But I digress… if you FMS a client they will feel special, and if you tell them that they have weaknesses that you’re going to hone in on, then you’re already miles ahead of most trainers in their eyes because it shows that you adhere to some sort of system and don’t just wing everything. The clients will keep coming back and exhibit confidence in you, which makes your job easier, and they’ll refer their friends to you. It can also help with professional referrals. All things being equal, I’d refer someone to the FMS certified trainer over the non FMS certified trainer because it shows that they value continuing education and are aware of a systematic approach to screening.

EV: I agree fully with Mike Boyle’s perspective on that and in fact wrote my own tongue-in-cheek piece, The FMS for Cats.

Regarding people liking being told they are dysfunctional, I might put that differently, but you have a point. I wonder though about your note on people with issues noted by their health care professional. In my experience it is far from 9 out of 10 times that it’s just a matter of weakness, but I wonder if that is a reflection of us training different populations? The majority of my clients are high end recreational athletes in their 30s and older. Most are quite fit in the sense that they spend hours playing their sport each week, often without an off-season, and most don’t train for their sport other than actually playing their sport (or at least not until they started to train with me). Athletes also have a habit of not letting injuries heal properly before returning to play, which for an athlete’s mind and body, is an invitation for alternate movement patterns to develop. I just bring this up because to suggest that there are populations for which apparent movement dysfunction is not simply a factor of weakness, although there’s no question that sometimes it is. As someone who has a reverence for science and logic, I like to think that I’m not perpetuating a nocebo effect with my clients, but it is possible that I am.

BC: Sorry Elsbeth, I should have been clearer…what I meant was that I’ll test their core strength through various multiplanar tests of strength, or their glute firing through various supine, quadruped, and side lying drills, or their TVA function through abdominal hollowing, and I find that the chiropractor or physical therapist was flat out wrong with their assessment, I’m not suggesting that these dysfunctions do not exist; they do. What I am suggesting is that many practitioners throw these terms out too liberally.

2. Should personal trainers do pre-training assessments with their clients, and if so, what do you suggest?

EV:I do believe that pre-training assessments are a great idea for most clients, and I am a fan of the FMS for this purpose. I do acknowledge that there are some populations for whom the FMS is not an excellent choice. In particular, clients who will not be able to safely do a bodyweight squat or lunge, or who have difficulty with kneeling. If this describes most of the population you work with, then the FMS is probably not a great tool. Although even in that case, I still think the FMS is a good course for the quality knowledge you will pick up about movement and training.

I also have recently come to accept that some of the population will be intimidated by an assessment, and for them, just training and using that as your assessment may be a better option. This is definitely not an across the board issue, as my clients consistently note in customer satisfaction surveys that they loved that I did an assessment (unsolicited – I didn’t ask if they liked the assessment; I asked why they initially came to me).

BC: Yes, they should. Initially, most personal trainers are rather inept. They aren’t well versed in evaluating form. Go to any commercial gym and this will be painfully obvious. In New Zealand, the strength coaches utilize a variety of assessments, including functional movement assessments, tests that assess the athletes’ strength, power, reactive strength, and strength endurance, and numerous other tests. They use charts, graphs, and spider plots to depict multi-directional force-velocity profiles and strength and capabilities. The functional movement assessment is just one of many pre-training assessments.

Functional movement screens can help personal trainers identify glaring deficiencies and tailor their program design according to the individual. It helps them get better at noticing form degradation and predicting the restrictions responsible for those degradations. For example, an individual that can only raise his leg to 45 degrees during the active straight leg raise probably isn’t going to be able to perform a stiff leg deadlift with good technique due to insufficient straight leg hip flexion mobility.

The FMS is a great screen for this purpose, as is the MCS (Movement Competency Screen, developed by New Zealand strength coach Matt Kritz – the MCS is a nice alternative because it doesn’t cost any money, so it may be useful for coaches and trainers on a tight budget).

However, I don’t believe that many personal trainers need to be using the FMS, at least trainers working primarily with physique-based clients. I believe that it’s a bigger necessity for strength coaches since their athletes are performing greater amounts of exercise, and this exercise is associated with much higher momentums and impact forces.

I believe that over time, good trainers should realize that they’re likely going to be programming every major movement pattern, and they’ll simply place each client at the appropriate level on the continuum and progress accordingly. For example, all of my clients squat, deadlift, hip thrust, lunge, back extension, bench press, overhead press, chin, and row. Some of them have to start out at the easiest regressions such as bodyweight high box squats with counterbalance, but over time they will improve their competency (strength, stability, mobility, coordination, etc.), and eventually they’ll be performing barbell back squats (assuming they’re healthy and young) at least to parallel. I’m definitely not obsessive about any exercise and am not afraid to throw one out if it doesn’t fit the individual, but this rarely occurs with my clientele.

If something doesn’t look right, the trainer can break away and check joint ROMs or conduct other simple tests. It is important to understand that joint ROM can usually be improved, but there’s also a large genetic component to anatomical ranges of motion, so at the end of the day, exercise variations and the ranges of motions utilized in those exercises will have to be modified per the individual. This is where the art of personal training exists; learning how to modify stance or grip width, foot flare or grip position, ROM, and other nuances so the individual can best tolerate the exercise.

I no longer FMS my clients because it wouldn’t alter the exercise selection component to my program design, which I determine by watching the client perform each individual movement pattern and deciding where to start them (example for squat pattern: counterbalance squat, goblet squat, sumo parallel squat, high bar full squat, etc.). Moreover, resistance training in general has been shown to improve FMS sum scores, and corrective exercise doesn’t appear to expedite the process in the research (however, I believe that a skilled coach could fast-forward improvements in exercise technique with a sound knowledge of specialized mobility, stability, and coordination drills), so I can sleep well at night knowing that even though I don’t use the FMS, my clients’ FMS scores improve.

Speaking of my clients, HERE they are in action. This year, I’ve regularly trained around 20 clients and so far none have experienced a single injury and their strength has vastly improved. Clearly my approach works well, but a newbie trainer can’t expect to be able to duplicate my system as it took me years of training others and studying biomechanics and sports medicine to master my system.

EV:Great points, Bret, and I fully agree that a good trainer can use the movements they train as their screen, and continue to do so at every session. That’s great, but I am a fan of formality and systems; maybe it’s my engineering background. That’s what drew me to the FMS from the start, and I still find it useful. But that doesn’t mean it is the only input to my programming. Realistically it only impacts 10 to 20% of it. The rest is based on their goals, any injuries they have (I get a lot of therapist referrals where they are still under the care of a therapist while they start training with me), and the sport they play (if any). Most of my clients start with some variety of squat, deadlift, pushing and pulling, and anterior, posterior, and rotary core exercises, as well as possibly some agility, power and conditioning options. I use what I learn from their initial consultation (including FMS) to determine which variations to start with, but it certainly hasn’t been a 100% predictor of what is the right option. I often make changes once we start training based on what I see of how they do those exercises. I should point out that while I remain a proponent of the FMS, I am also on the lookout for options that can help me train my clients better. While I acknowledge there are more comprehensive screening options available, there is a downside in terms of usability, which I consider an important consideration. I have come across one new screening concept recently that I want to test out for a few months (alongside the FMS) to get a perspective on which I find better helps me train my clients, although I have to figure out some logistics first. I’ll be writing about it soon – it’s an interesting take.

BC:Agree on all points.

3. Should coaches rely heavily on FMS data for assessing injury risk?

EV:First, thank you for not asking if the FMS should be used for predicting performance as many research studies erroneously do.

I think the question should be reworded to “should coaches take the FMS data into consideration for assessing injury risk” without the “rely heavily” part. The reason I didn’t just change the question, is that I think this is one of the myths of the FMS that is worth mentioning. There appears to be a perspective that those of us who use it, base everything we do on it, and spend most of our training time doing corrective exercise and assessments instead of actually getting our clients strong. This is just not the case. Or at least it is not the case for most of us. For the majority of our training, we rely on sound training principles. We just augment that with what we learned from the FMS to help us apply those principles.

To my re-worded question: yes, I do think coaches should take FMS data into consideration when assessing injury risk. An athlete client struggling significantly with any aspect of the FMS should raise an eyebrow. For example, if a sprinter struggled with the in line lunge, I would be concerned. Similarly when I see field sport athletes struggle with pelvic stability in the hurdle step, I wonder how much rotation their lumbar spine endures when they run. The FMS provides us some very valuable information!

The last consideration I’d like to raise and it is something I believe the FMS encourages very effectively, is that painful movement should be referred to a healthcare professional. This means that if you are implementing the FMS properly, you are referring your clients to health care practitioners when they have painful scores in the FMS. Now your client has the benefit of an assessment by a health care practitioner, which I believe is instrumental in assessing injury risk.

BC:It is certainly one component to consider. However, if all you have is a hammer, everything looks like a nail. If you believe that functional movement patterns are the sole key to injury prevention, then you’re going to be missing out on a lot of important alternative information. As Spanish physical therapist and researcher Jurdan Mendiguchia and New Zealand sports scientist Matt Brughelli discussed in their classic hamstrings paper titled, “Hamstring strain injuries: are we heading in the right direction?” (click HERE for the full text pdf), it is the interrelationship between at least 6 factors that determines injury risk to the hamstrings, which include:

1. Flexibility
2. Strength
3. Core Stability
4. Architecture
5. Fatigue, and
6. Previous Injury

Their article was in reference to the hamstrings, so in reality each individual type of injury will have it’s own separate risk factors. However, the point is that an individual can have a stellar FMS score and still experience injury. For example, sticking with our hamstring example, let’s say that an individual scored a 3 on the active straight leg test, indicating that he has good hamstring flexibility, he could still tear a hammy due to weak hamstrings, poor pelvic control which could place greater strain on the hammies, fatigue and subsequent altered motor patterns, a prior injury that yielded inferior scar tissue upon healing, poor glute activation and strength as a synergist, and more. I know that Gray and Lee know this, but sometimes the zealots who champion the FMS fail to see the big picture with regards to injury prevention strategies in sports performance.

EV:Absolutely, and great point.

4. What are the three primary strengths and weaknesses of the FMS?

EV: I’ll take the strengths then…

Strengths:

1. It is a complete system that can be implemented in very little time and requires little equipment and space, and is easily communicated.

2. It provides quality input to program creation by identifying areas needing work. The FMS system also has a corrective strategy tied to the tests, which further assists in exercise selection for the individual.

3. It also identifies movements where the quality is such that loaded training of a specific exercise may not be advisable initially.

BC: The three main strengths are:

1. It’s a simple system that can easily be taught to personal trainers, strength coaches, and physical therapists

2. It has a high intra-rater and inter-rater reliability

3. It will help from a business-standpoint by improving client retention and referrals

The three main weaknesses are:

1. It measures just one of several important factors for assessing injury risk

2. No 7-tests, no matter how well chosen, can comprehensively summarize an individual’s functional movement capacity

3. It has low validity (this includes all types of validity, see HERE for more information)

5. Could the FMS be improved, and if so, how?

EV:The biggest thing I’d like to see is an improvement in the way hip and pelvic stability is addressed. Currently I think it is a bit lacking, and in fact I have all of my clients perform a single leg squat test (to a bench) as an add-on to the FMS. I find it gives me clues as to stability, left to right differences, as well as basic strength – some people just can’t do it.

BC:I think so, but I confess to not being privy to much of the current dialogue and material involving the FMS. It is very possible that Gray and Lee have addressed and thought of most of the things I’ve listed below. Nevertheless, some of the ideas that I believe that FMS advocates should consider in order to improve the FMS over time include:

1. Better explain the role of anthropometry/body segment proportions on the FMS. To list just one example, how does femur length influence the deep squat score?

2. Better explain the role of anatomy on the FMS. For example, how do variances in hip anatomy affect deep squat and hurdle step scores?

3. Better explain in their material how functional movement integrates into the broader scope of injury risk, relying not just on theory but also on evidence from peer-reviewed published studies.

4. Better explain some of the rationale for exercise test performance. For example, is posterior pelvic tilt accounted for in the deep squat and active straight leg tests, and what is the rationale behind this approach?

5. Is there a better test that could measure whole body rotary stability, maybe one that didn’t require the kit? For example, instead of utilizing the rotary stability test included in the FMS, would it be better for a trainer to just see how well his client performs during a cable anti-rotation hold to determine how well they can stabilize the body when placed under axial twist torques?

EV:You raise some good points, in particular the parts about anthropometry and hip anatomy. For instance, the need for both feet to point straight forward in the deep squat never really sat well with me. In my opinion, that aspect of the test only makes sense if you are operating under the premise that all hips have the same structural neutral, which we know is not the case.

BC:Yes, another great point. It actually hurts my knees and hips when I squat with feet straight ahead. Several of my powerlifting friends have noted the same thing, and this is probably due to differences in anatomy.

Final Word

EV:The FMS is not a perfect tool, but I still see the combined benefits of program guidance and usability outweigh the shortcomings.

BC:The inventors of the FMS did a great job in coming up with a simple 7-screen test to help practitioners identify potentially problematic and/or inefficient movement patterns and asymmetries in their clients and athletes, however, the FMS should not be thought of as a comprehensive tool for predicting injury or athletic ability, nor should advanced trainers who don’t utilize the FMS but are well-versed in exercise form and proper regressions be labeled as morons by some of the hard core FMS proponents.