FMS, CAN WE PREVENT INJURIES?

The FMS test

"It was born in the second half of the 90s in the United States from the intuition and experience of the American therapist and trainer Gray Cook, collaborator of the US Olympic gymnastics team, as well as researcher and author of numerous internationally renowned texts. His starting question was: to improve my athlete's performance, should I increase his workload or correct his movement? And what are the parameters in evaluating the quality of his movement?

To find the answer to his question, he began to collaborate with his colleague Lee Burton in structuring a battery of tests that could be as objective a parameter as possible in evaluating basic movements.

Correcting or improving these patterns before training and overloading them would have ensured that everything else would be done better and with less risk.

So, they experimented with their work with college students to quantify athletic longevity and determine who could have the most expectations in a sporting career; fundamental data also for the economic value of the player ... not to be underestimated!

The results jumped in the eyes of the main American sports federations: to date, the FMS is a reference point in the NBA, NFL, NHL, as well as overseas in the field of football, volleyball, golf, tennis and many other sports. "

Always the same authors with regard to the potential of the test state:

"To understand it better, basic movements are those movements (not specific sports) that every active individual should be able to master, managing mobility, stability, proprioception and coordination.

If we take into consideration the Performance Pyramid (figure opposite), we are referring to the lowest piece - MOVEMENT.

The greater the competence in this range, the better the efficiency of the workouts aimed at the athletic part - PERFORMANCE - and the specific sport part - SKILL - reducing the risk of injuries and overloads.

Unlike most muscle tests, the FMS does not evaluate individual districts but movement sequences involving

body parts linked together. "

Obviously, what I contest are some of the statements mentioned above, let's see why from the biomechanical point of view these do not stand up.

1 - On proprioception, in general terms this quality, trainable, is the perception of our body and its position / relationship in and with space

2 - A trained proprioception determines many benefits including the total mastery of our three-dimensional balance, that is, in relation to the three planes of movement.

3 - Structural or anthropometric alterations, such as heterometries, modify attitudes, motor behaviors and consequently the resulting compensation. The FMS does not allow an evaluation by the observer on the three floors at the same time!

4 - Functional limitations:an impediment to movement of a different origin.

One thing that is widely known and accepted by the majority of professionals is that the injury is multifactorial and sport-specific, that is, determined by sports.

The test, which should be used to assess a possible risk of injury, must be a specific sport ( respect the majority of movements present in that sport, aware of the fact that even a simple alteration of a gesture would automatically recruit different motor chains, this because we would move masses different, as our body is made up of different masses with different weights)

 See down the different weight for the different part of the body, thus when we moving we move mass with different value, this require different muscle chain activation, using sport specific movement we reduce errors in our evaluation.

Thinking about the tests, it is also obvious that in addition to sport specificity, the test should also respect the performance model. That is?

Let's take an example, if we ask a footballer, basketball player, rugby player, American football player, etc. to change direction in a gym, which of these 4, will probably reflect both the requirements of sport specificity and respect for the performance model?

Assuming that "gymnastics" shoes are used in the gym, probably the one who comes closest to him is the basketball player.

For all 4 there is the specific sport gesture, but apart from the basketball player, the other specialties take place on different surfaces and with shoes very different from those worn during the test. As in the literature there are many articles that support the FMS as a preventive test against injuries, there are many others that support the influence of terrain and footwear in relation to the quality of movement and therefore on their importance in the study of the aetiology of injuries. . Therefore, respect for the game environment and its biomechanical conditions is closely related to injuries (we will talk about this in a few chapters later). So, translating, these conditions (performance model) must be present in the tests.

Have you noticed if there are these two conditions in the FMS? Why is there a free use of shoes with front / rear (drop) sole height not considered? This is an important variable in the test, linking to the increase or decrease of the physiological curves of the spine.

One of the validation articles of the method honestly admits:

Utility of FMS to understand injury incidence in sports: current perspectives, Journal of sport medicine, 2018 Sep 7;9:171-182. Meghan Warren , Monica R Lininger , Nicole J Chimera , Craig A Smith

“For an instrument to have wide applicability and acceptability, there must be high levels of reliability, validity, and accuracy. The FMS is certainly a reliable tool and can be consistently scored within and between raters. Although the FMS has high face and content validity, the criterion validity (discriminant and convergent) is low. Additionally, the FMS does not appear to be studying a single construct, challenging the use of the summed composite FMS score. The accuracy of the FMS in screening for injury is also suspect, with low sensitivity in almost all studies, although specificity is higher”

In short, contrary to what many have said, not so much in agreement on the effectiveness of the FMS in predicting injuries is beginning to appear in the literature as well.

Instead of "riding" a study apparently favorable to the theses that I would like to present to you, let's try to get there with reasoning.

We have said, and I believe no one disagrees on this, that for most sports, the FMS is not a specific sport nor does it respect the performance model.

There are also some variables that we would like to consider in our reasoning:

- The use or not of footwear, what we know is that they can deeply affect the complex muscle tendon mechanics. Think for example of the fact that often there is a coupling problem between foot and shoe, for convenience we tend (rightly) to choose comfortable shoes.

Does wearing shoes affect your biomechanical efficiency? J Biomech . 2015 Feb 5;48(3):413-7.Guillaume Rao , Nicolas Chambon , Nils Guéguen , Eric Berton , Nicolas Delattre

- The motor coordination aspects included in the various tests, we know that these are dependent on many factors, metabolic, muscular, due to sleep deprivation, gastrointestinal diseases, muscle neck pain, biorhythm or circadian cycle, previous trauma with analgesic contractions, functional limitations and cognitive aspects (is it possible that knowing that you are being tested and being observed does not disturb anyone's movement?).

- The classification or subjective vote of the test, therefore highly dependent operator and therefore not very repeatable.

- The non-specificity of the tests, as widely discussed above and as confirmed by the 2018 literature review on the subject.

- Impossibility for the single examiner to see and analyze the gesture on the three planes. Furthermore, the evaluation on the horizontal plane, eg rotation, is totally missing.

- It is not a field test; therefore, it requires time and collaboration on the part of the athlete. The very motivation to carry it out is a limiting factor. Dynamics are missing, eg speed and the forces associated with it, with related injuries.

So if the test has all these limitations, what is it useful for? It must be admitted that the FMS is certainly a simple and easily accessible tool for evaluating basic motor patterns and giving a rough indication of the quality of the gesture, although the FMS has scores, the result of the evaluation performed with this method does not it can only be qualitative, certainly not quantitative.

In my opinion, we can use this tool and these tests for the evaluation of basic motor patterns without forgetting that these are often influenced by factors that the FMS is not able to highlight. Therefore, the vision of an inappropriate gesture should be followed by a careful instrumental biomechanical evaluation to identify and remove the identified problem, the FMS is not able to give the examiner the distinct functionality of the different body quadrants and as such of the origin compensation or painful manifestations.

Therefore, stating "that following the inability to perform the FMS test correctly results in the impossibility of performing at higher levels" is physiologically and biomechanically wrong and deprives the subject under test of the necessary "motor justifications" precisely because this method leaves ignorant on the subject. Certainly, it is cheap and requires not to think much, but the evolved professional should go in the opposite direction, investing in his work in order to learn from what he examines, offering an increasingly high quality service to his customers.

In conclusion, I am certain in affirming that the test is not and will never be able to predict injuries, since it lacks a huge amount of information necessary to predict injuries, it primarily does not give us sufficient knowledge of our athlete.