Potential limitations of the functional movement screen: a clinical commentary

Functional Movement Screening as a Predictor of Injury in Highly Trained Female’s Martial Arts Athletes

Objective. This research examines the emerging role of FMS™ in the context of predicting lower extremity injury in females University athletes. The secondary purpose of this study is to investigate the differences between FMS performance comparisons between three martial arts sports to establish baseline comparisons.

Method. Forty-seven university female athletes were recruited for this study, The data collected was separated into three groups based on their sports discipline (judo N=17 age: 19±4, wrestling N=15 age: 18±5, karate N=15 age: 19±3), Independent t-tests were performed on each group with significance being set at P<0.05 to determine difference in FMS™ scores between injured and non injured athletes during the successive competitive seasons. One-way analyses of variances were used to determine if there was a significant difference between sports, ‘body parts injured’ groups, and ‘mechanisms of injury’ groups.

Results. One-way analysis of variance revealed no statistically significant difference between the two (ankle, knee) injury groups, and non-injury group (F2,54= 2.34; p=0.106). There was no statistical difference between the pre-season FMS™ scores of the injured and non-injured groups (t47 = -1.68; P=.100; d=0.52; 95%CI: -0.11, 1.15). Finally, strong evidence of FMS score was found when comparing the three sports with one-way ANOVAs (F=5.83, df= 2, 54, p=0.005).

Conclusion. One of the more significant findings to emerge from this study is that FMS™ has emerged as a powerful tool for identifying lower extremity injury in female athletes. Further investigation and experimentation into FMS™ are strongly recommended before implementing them into a pre-participation physical examination (PPE) for combat sports. What is now needed is a cross-national study involving other sports.

Effect of Integrative Neuromuscular Training for Injury Prevention and Sports Performance of Female Badminton Players

Objectives

Investigate the effects of integrated neuromuscular training (INT) on injury prevention and the performance of professional female badminton athletes by comparing their preintervention and postintervention tests. The study hypothesized that integrated neuromuscular training can improve the asymmetry and improve the sport performance of female badminton players.

Methods

According to pretest value based on functional movement screening, 38 participants were divided into a high-risk group (HG) and a low-risk group (LG) with 22 and 16 people in each group. Two groups of athletes took part in an 8-week INT program consisting of four 90-min sessions each week. The asymmetries in movement, physical fitness, and special abilities were tested before and after the intervention. Independent sample t-test was used for the statistical analysis.

Results

This research found indicated that 8 weeks of INT influenced FMS scores in both groups (HG and LG). The change of inline lunge (ES_H = 0.42, ES_L = 0.21) and trunk stability push-up (ES_H = −0.58, ES_L = −0.20) showed significant differences (P < 0.05), and the change of the FMS scores (ES_H = 0.81, ES_L = 0.65), deep squat (ES_H = 0.6, ES_L = 0.3), and rotation stability (ES_H = −0.65, ES_L = −0.72) showed very significant differences (P < 0.01). Compared to the pretest, most of the physical fitness parameters improved significantly in the HG and LG groups except strength index, and special abilities of the HG and LG group women badminton athletes showed a substantial increase.

Conclusion

Integrated neuromuscular training can effectively improve the asymmetry of female badminton athletes' limbs, prevent sports injury, and improve the athlete's performance ability. However, athletes in different risk groups have certain differences in the degree of improvement in their motor skills.

Practicability of lower extremity functional performance tests and their measurement properties in elite athletes: protocol for a systematic review

INTRODUCTION

Lower extremity injury (LEI) is highly prevalent and its occurrence increases the risk of future injury in athletic populations. Identifying athletes at risk of injury is the key to target injury-prevention programmes. Functional performance tests (FPT) assess an athlete's ability to produce and accept forces during movement tasks reflective of those experienced in sport, and are used to identify deficits in physical qualities or neuromuscular control. This review aims to identify FPT which have potential to predict LEI and assess their measurement properties associated with reliability, validity, responsiveness and practicability (interpretability and feasibility).

METHODS/ANALYSIS

This protocol will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol and the COnsensus-based Standards for the selection of health Measurement INstruments Methodology. The search strategy has two stages: stage 1 will identify lower limb FPT used in athletic populations; and stage 2 will assess the measurement properties of the identified FPT. A sensitive search strategy will use MEDLINE, EMBASE, CINHAL and SPORTdiscus databases; from inception to June 2020. Hand searching reference lists, key journals and grey literature will be completed. One reviewer will complete search 1 and data extraction. Two reviewers will complete the search, data extraction and risk-of-bias assessment for search 2. Evidence will be pooled or summarised by individual measurement property by each individual study and grouped by FPT. Meta-analysis using a random effects model with subgroup analysis will be performed where possible. Pooled or summarised results for each FPT in relation to each measurement property will be rated against the criteria for good measurement properties. Two reviewers will assess the overall body of evidence per measurement property per FPT using the modified Grading of Recommendations, Assessment, Development and Evaluation guidelines. This review will enable clinicians to make an informed choice when selecting FPT.

ETHICS AND DISSEMINATION

No ethical approval is required for this review and the results will be disseminated through peer-reviewed publications and submitted for conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42020188932.

FUNCTIONAL MOVEMENT SCREEN™ (FMS™) SCORES DO NOT PREDICT OVERALL OR LOWER EXTREMITY INJURY RISK IN COLLEGIATE DANCERS

Purpose

Dance is a physically demanding activity, with 50-85% of dancers suffering injury during a single performance season. The majority of dancers' injuries are in the lower extremity (LE) and chronic in nature. These injuries often arise when causal factors are not identified early and addressed before they ultimately result in an injury. Practitioners often use movement screens such as the Functional Movement Screen™ (FMS™) to detect and quantify kinetic chain dysfunction. Prior researchers have suggested that these screens can stratify at-risk individuals and allow practitioners to devise targeted interventions to reduce their injury risk. However, whether the FMS™ can identify at-risk dancers remains unclear. Thus, the purpose of this study was to examine whether FMS™ scores predicted injury risk in collegiate dancers.

Methods

In this prospective study, 43 collegiate dance majors (34 female, 9 male; 18.3 ± 0.7yrs; 163.9 ± 7.3cm; 60.8 ± 8.1kg) in a program which emphasizes modern dance were scored on the seven FMS™ movements (scale 0-3, total maximum score=21) where 3=movement completed without compensation, 2=movement completed, but with compensation(s), 1=unable to complete movement, 0=pain during movement or during clearing tests as described in prior literature at the start of the academic year. An in-house certified athletic trainer documented dancer's overall and LE injuries over an academic year (40 weeks). Separate Receiver Operator Characteristic (ROC) curve analyses examined whether composite FMS™ score predicted (1) Overall or (2) LE injury status.

Results

The subjects FMS™ scores were 16.2 + 1.7 (range=11-19). Twenty dancers were injured, whereas 23 remained injury-free. Injured dancers had 55 overall (1.28 injuries/dancer) and 44 LE injuries (1.02 LE injuries/dancer). FMS™ score did not predict overall (AUC=.28, SE=.08, p=.02, 95%CI=.13-.43) or LE injury risk (AUC=.38, SE=.1, p=.21, 95% CI=.21-.56).

Discussion

While nearly half of the dancers in this group suffered from injury over the year, composite FMS™ scores did not predict overall or LE injury risk in collegiate dancers. Dancers face unique and challenging physical demands that distinguish them from traditional sport-athletes including greater ranges of movement during performance. Thus, the FMS™ may not be sensitive enough to distinguish 'appropriate' from 'excessive' mobility and adequately identify injury risk in dancers. Overall, it is suggested that practitioners should use caution before using the FMS™ as a primary screening mechanism to identify collegiate dancers at overall or LE injury risk.

Level of Evidence

2.

Comprehensive movement system screening tool (MSST) for athletes: Development and measurement properties

OBJECTIVES

Non-traumatic extremity injuries are particularly common in sports, representing a significant economic, academic, and psychosocial burden on athletes. Proposed musculoskeletal risk factors for increased injury and decreased performance in athletes include movement pattern inefficiency, decreased regional stability, decreased mobility, and asymmetrical movement. The Movement System Screening Tool (MSST) is a comprehensive screening tool designed to assess these factors. Thus, the purpose of this study was to describe the development and determine the content and construct validity and inter-rater reliability of the MSST.

METHODS

A modified Delphi panel of experts determined content validity. 80 athletes (40 with and 40 without a current non-traumatic shoulder injury) completed 21 clinical tests, with exploratory factor analysis and known group analysis performed to determine construct validity. Two independent raters were used to establish individual item and composite score inter-rater reliability.

RESULTS

Exploratory factor analysis identified three of the four apriori constructs over 7 factors (14 tests), representing 63% of the variance. Known group analysis revealed a significantly lower composite score in athletes with vs. without a current non-traumatic shoulder injury (56.9±5.8 vs. 62.7±4.5, respectively). A preliminary cut score of 62 was chosen with sensitivity of 85% and specificity of 44%. Composite score inter-rater reliability was excellent ICC _(2,1)=0.94, 95% CI (0.91, 0.96) and item reliability ranged from κ=.57 to 1.00.

CONCLUSIONS

The MSST possesses constructs representative of injury risk and measurement properties acceptable for use in clinical settings. Comprehensive screens with construct validity and known measurement error are needed not only to identify athletes at risk of injury, but also provide an instrument that can be used in studies that seek to validate training approaches proposed to change movement impairment and injury risk in athletes.

The functional movement test 9+ is a poor screening test for lower extremity injuries in professional male football players: a 2-year prospective cohort study

Background

The 9+ screening battery test consists of 11 tests to assess limitations in functional movement.

Aim

To examine the association of the 9+ with lower extremity injuries and to identify a cut-off point to predict injury risk.

Methods

Professional male football players in Qatar from 14 teams completed the 9+ at the beginning of the 2013/2014 and 2014/2015 seasons. Time-loss injuries and exposure in training and matches were registered prospectively by club medical staff during these seasons. Univariate and multivariate Cox regression analyses were used to calculate HR and 95% CI. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity and identify the optimal cut-off point for risk assessment.

Results

362 players completed the 9+ and had injury and exposure registration. There were 526 injuries among 203 players (56.1%) during the two seasons; injuries to the thigh were the most frequent. There was no association between 9+ total score and the risk of lower extremity injuries (HR 1.02, 95% CI 0.99 to 1.05, p=0.13), even after adjusting for other risk factors in a multivariate analysis (HR 1.01, 95% CI 0.98 to 1.04, p=0.37). ROC curve analysis revealed an area under the curve of 0.48, and there was no cut-off point that distinguished injured from non-injured players.

Conclusion

The 9+ was not associated with lower extremity injury, and it was no better than chance for distinguishing between injured and uninjured players. Therefore, the 9+ test cannot be recommended as an injury prediction tool in this population.

Interseason variability of a functional movement test, the 9+ screening battery, in professional male football players

BACKGROUND

The Nine Plus screening battery test (9+) is a functional movement test intended to identify limitations in fundamental movement patterns predisposing athletes to injury. However, the interseason variability is unknown.

AIM

To examine the variability of the 9+ test between 2 consecutive seasons in professional male football players.

METHODS

Asymptomatic Qatar Star League players (n=220) completed the 9+ at the beginning of the 2013 and 2014 seasons. Time-loss injuries in training and matches were obtained from the Aspetar Injury and Illness Surveillance Program. No intervention was initiated between test occasions.

RESULTS

A significant increase in the mean total score of 1.6 points (95% CI 1.0 to 2.2, p<0.001) was found from season 1 (22.2±4.1 (SD)) to season 2 (23.8±3.3). The variability was large, as shown by an intraclass correlation coefficient (ICC) of 0.24 (95% CI 0.11 to 0.36) and a minimal detectable change (MDC) of 8.7 points. Of the 220 players, 136 (61.8%) suffered a time-loss injury between the 2 tests. There was an improvement in mean total scores in the injured (+2.0±0.4 (SE), p<0.001) group but not in the uninjured group (+0.9±0.5, p=0.089). The variability from season 1 to season 2 was large both in the injured (ICC 0.25, 0.09 to 0.40, MDC 8.3) and uninjured (ICC 0.24, 0.02 to 0.43, MDC 9.1) groups.

CONCLUSIONS

The 9+ demonstrated substantial intraindividual variability in the total score between 2 consecutive seasons, irrespective of injury. A change above 8 points is necessary to represent a real change in the 9+ test between seasons.