Lee Burton: The History of the Functional Movement Screen – It’s Conception and Misconceptions
The Functional Movement Screen has become a popular way to identify basic movement dysfunction. It’s currently used in a wide variety of sports medicine, strength and conditioning and fitness environments around the world.
However, you may not know it’s history.
- Where did the Functional Movement Screen come from?
- What’s the background?
- What’s the philosophy behind it?
I want to give you an idea of how the FMS came to be—from a guy who was there from the onset.
As more research and information comes out, many people may lose the intent of what the Functional Movement Screen was designed to do.
In fact, that’s happening now.
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As any test, assessment or exercise becomes popular, more people take the opportunity to punch holes in it. And so it is today with the FMS: People are arguing about things the Functional Movement Screen is not (and was never) designed to do.
First and foremost, it’s a screen. The Functional Movement Screen was designed to be a way to screen groups, much like blood pressure is designed to screen people. It’s designed to tell you that a problem exists, not to tell you what the problem is. It’s up to you as the professional to dig a little bit deeper and identify the problem.
The Functional Movement Screen is designed to give you an idea . . . to narrow down and rule out certain things. That’s the way every screen is designed to work. A screen is something that can be done quickly to start to narrow down certain things. Look at it as a filter.
How did we get to this point? Where did the FMS come from?
Let me take you back to 1996, where a guy—me—was coming out of graduate school and moving to Danville, Virginia. I got a phone call from Gray Cook asking me to come and talk to him about opening a sports medicine outreach program.
Gray and I are both from a small community in southern Virginia. We went to the same high school and have known each other all our lives. That’s pretty much why we have the dynamic we have. It’s almost like a marriage. We fight and we get after each other, but at the end of the day, we’re brothers.
That dynamic has allowed us to cultivate and create Functional Movement Systems the way we have. We’re our biggest critics, and that’s probably the best benefit we’ve had over the past 20+ years.
Even back then, Gray had a unique way of evaluating people, looking at the different parts of the body—not just how the parts worked, but how the parts affected other areas.
This way of thinking was not really new, but it was new to me.
My responsibility at our little clinic was sports medicine outreach. I was the athletic trainer at a high school. We had approximately 500 athletes; my job was that of the typical athletic trainer—to try to keep the kids on the field, doing whatever I needed to do and bring them into the clinic, whenever needed.
As a group in the clinic, we did high school physicals in the surrounding area. Often, I brought athletes to the clinic with chronic injuries, low back pain, knee pain and shoulder problems.
With Gray’s perspective, I started digging a little deeper myself:
‘This kid has a back problem. What might be causing it?’
Gray suggested we try to screen some of these athletes during the pre-participation physical to give the doctor a little more focus. This would also allow us, the sports medicine professionals, to suggest alternate ways of exercising or stretching.
Corrective exercise wasn’t a term people threw around back then. We were simply trying to identify some problems and help correct them in the pre-participation process during the pre-season.
This idea of a movement screen came out of us trying to go to the high school setting to see if we could make an impact. Gray’s movement screen idea was simple: Let’s look at the fundamental movements we have. Let’s look at some of the movements we’re using in day-to-day clinical practice and see if we can put them into a larger group setting, such as a high school pre-participation physical.
At the high-school setting, we were doing 500 physicals at one time, which was challenging. That led to our idea of taking the philosophy of looking at movement and putting it into a package we could carry out in the large groups. The ability to make that transition is the essence of a good screen or a good test.
Gray threw out his ideas of the tests, and at that point it included a squat, a rotation test and a step-over. From that idea, we—Gray, Kyle Kiesel, a couple of other colleagues and I—sat around a table, put stuff up on the whiteboard, played around with it, then went out and screened hundreds of athletes trying to discern what was working.
We quickly realized we couldn’t count repetitions, which was the original idea. We couldn’t count effectively and watch and identify the things we were trying to identify.
Then we started looking at a single repetition. Could we give a person one repetition that would give us a perspective into major dysfunction, which was what we were trying to identify.
That took us down a different path. We still liked the push-up. We liked the rotary stability test. In the crossover step, there were too many variables. We couldn’t figure out how to put it into the screening process.
Remember, the intent was never to assess the individual. The intent was to look at major fundamental patterns and find the biggest dysfunction. Our idea at the time was to implement it in larger groups. Try to make it quick. Try to make it easy.
If we were going to make it quick and easy, we couldn’t turn it into an assessment.
What we wanted to do was to give the physician, the sports medicine professional and the athletic trainer information, so they could then do a deeper assessment. We wanted to take 100 athletes and eliminate 75% of them who didn’t have major problems. Eliminate most of those who didn’t have pain.
In 1997, we came up with the seven tests you see today, but it took probably a year from the time Gray threw this screening idea out on the table and said, “Hey, let’s do this. Here are the seven tests I think we need to look at.”
Over the next years, we presented the Functional Movement Screen anywhere we could. We talked about the movement screen at different local, regional and national conferences. We were just presenting the idea because we were trying to get this information out so we could get a better perspective of what was working and what wasn’t working.
At first, we didn’t talk a lot about exercise until we fully understood what the movement screen told us. How do these people move? How do these athletes move? What are the major problems? Then, we began talking about exercise.
The first research study on the Functional Movement Screen didn’t come out until 2007, 10 years after we introduced the screen. That was 10 years of getting a lot of feedback and a lot of clinical research.
Early in this process, professional sports teams started using the movement screen. High level sports teams weren’t doing the movement screen because the research said to do it. They’re doing the movement screen because they have seen some benefits in using it.
That’s when I knew these seven tests told us something. That’s when I felt we had created something unique because a professional strength coach, a professional athletic trainer or a professional athlete doesn’t necessarily rely on research. They rely on what’s getting the job done. Those were some of the first places it was implemented successfully—at some of the highest levels.
With all that feedback, we started designing better corrective strategies. We already had a lot of corrective exercise based on Gray’s unique way of functional evaluation, but how we laid things out continued to evolve as we got more feedback.
The exercise and the interventions continue to change to this day. There originally was a lot of change in how we looked at exercise and how we took the information from the movement screen.
Early on, we thought the deep squat was the best thing to look at because it gave us such a good perspective of basic movement fundamentals. It looks at everything, but over the course of a few years, we soon realized the four bottom screens—active straight-leg raise, shoulder mobility, rotary stability and trunk stability push up—the more primitive screens—actually gave us a better perspective on how we needed to correct the things the squat told us.
As an example, if you have poor shoulder mobility and you have a poor deep squat, that shoulder mobility may be creating the squat problem. Those were the types of things we looked at as far as intervention and this continued to evolve.
The seven tests became pretty rock solid in 1997, but the information we gathered over the course of the next years helped create a better corrective exercise philosophy. We use the information to try and figure out the best way to create a better corrective intervention and a better way to train an individual.
There’s much more research out now, with more on the way. The research is like that of any test or assessment. There’s some that’s positive and some that’s negative. Obviously, and fortunately for us, there’s much more positive research on the movement screen than negative.
The reliability of the Functional Movement Screen is rock solid. One of the biggest things I think has come out of the research to this point is the fact it is a reliable way to look at movement.
We have a very interesting research lit review up at functionalmovement.com. If you’re interested in seeing more about the research, it’s well worth a read.
Let’s go back to the intent of the movement screen: The number one thing you need to think about is whether the person has pain. Why would anybody debate that? Why would anybody say it doesn’t matter? If someone has pain with the tests, that needs to be addressed.
Secondly, does the person have any major dysfunctions? If a person has a major dysfunction and can’t even get into the position of a movement screen or can’t complete the pattern, is that person ready to take exercises up to the next level?
Those two things have always been the major objectives of the Functional Movement Screen:
Does the person have pain?
Where is the biggest dysfunction?
When we added the 0–3 scoring system, people became confused. What do the scores mean? It takes time to delve a little deeper into those scores, but at the end of all of this, does the person have a significant dysfunction or does the person have pain?
If you can appreciate that, the movement screen can tell you a lot the more you get into this type of philosophy and methodology. The scoring system can be as complicated or as easy as you want to make it.
3 – able to perform pattern as directed
2 – able to perform pattern with compensation/imperfection
1 – unable to perform pattern
0 – pain with pattern regardless of quality
Depending on your setting and depending on how you’re looking at things, it can be quite simple. You can look at the basic scoring system 0–3 and give your score of a 15. You can look at the different movements within the score of 15 and quickly identify where you need to start. You can just look at the score of 15. What does it tell you?
A lot of research right now and some people come back and say, “I need to be above a 14.” However, you need to dig deeper than that.
You need to look at what makes up that 14.
The original research that came out in 2007 said if you were below a 14, you’re twice as likely to be injured. That was in professional football, which is a very good place to start because we know they’re setting themselves up for injury. What makes up that 14? Because we score each individual pattern, there are a lot of ways to get to a score of 14.
A 21 is a perfect score, but you can have an 18, which is a very high score. This is above what the research is alluding to as a 14 being a good score. But if you’re above that 14, let’s say at 18, does this mean you’re less likely to be injured? Some of the research suggests this.
But my point is, what makes up that 18?
You could have a 0 on one test. You could have pain.
You could have a 1. You could have a significant dysfunction, but still have a score of 18.
Point being . . . You need to dig a little bit deeper.
You can use the screen differently, depending on your setting. A personal trainer working in a typical personal training studio is probably going to look at all seven tests, then dig a little bit deeper and maybe do a deeper assessment.
A person in a collegiate setting with 100 football players walking in the door may use the information from the Functional Movement Screen differently. That’s what makes this test unique.
That has allowed this test to go under the scrutiny more from ourselves—Gray, myself, some of our other colleagues, some other professionals who have used it—and now it’s coming under scrutiny with research. The seven tests haven’t really changed since 1997. What has changed is how we use the information the movement screen gives us—how we create our corrective strategies. That’s always going to change. It’s always going to be up for debate.
Once you get that baseline, my only other question is, “Have you improved that baseline?” More importantly, in some cases, “Have you not created a bigger dysfunction?”
Okay, but what’s a good score on the movement screen?
A 16 with no asymmetries is a good score.
A 16 with no asymmetries is telling us that the person is ready to work out. As a fitness and exercise professional, your job at that point is to work the person hard, but never to the point that you create dysfunction. Maintaining that margin can be just as difficult (and important) as working with a person to correct a significant dysfunction.
Take your clients or athletes who move very well . . . and get them bigger, faster and stronger in a manner that helps them achieve their fitness and exercise goals without adversely affecting their movement screen.
The Functional Movement Screen is the baseline. What you do with that information is quite different depending on your setting.
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