Why FMS Belongs in a Sport Practice
The Functional Movement Screen has a complicated reputation. In some circles it's treated as a near-universal injury predictor; in others it's dismissed as a fad. Both positions miss what the FMS is actually for, and both miss why we still use it as part of an intake process at Boreal Spine & Sport.
This post is partly for the students rotating through this spring, and partly for athletes who've gone through the FMS and want to understand what we did with the score afterward.
What the FMS is
The FMS is a seven-test movement battery — deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up, rotary stability — each scored 0 to 3 based on observable movement quality1. The composite is a 0-to-21 score, with a clearance test for shoulder, lumbar extension, and rotational stability that flags any pain provoked during testing.
It was designed to identify gross movement-pattern asymmetries and dysfunctions in asymptomatic individuals, primarily to inform training and corrective exercise selection. That's the niche it was built for.
What the evidence actually says
The injury-prediction claim is where the FMS gets the most criticism, and the criticism has merit. A 2017 systematic review and meta-analysis of FMS as an injury predictor across military, sport, and occupational populations found weak overall predictive value, with low sensitivity and specificity at the commonly used composite cutoff of ≤142. A more recent BJSM commentary made the same point: the FMS is not a stand-alone injury-prediction tool3.
That should retire the "score below 14 means you're going to get hurt" framing, which still gets repeated. It doesn't, however, retire the FMS itself.
Where it earns its keep
The FMS is genuinely useful as a structured starting point for movement assessment in athletes. Three specific roles:
Asymmetry detection. A 1-3 split between left and right on the hurdle step or active straight leg raise is a flag worth investigating, even when the composite score is otherwise good. Asymmetry has a more consistent relationship with injury than the composite score does in some sport populations4.
Common starting language. When an athlete is being seen by a chiropractor, a physiotherapist, and a strength coach, having a shared assessment baseline is useful. The FMS is widely enough used that "she scored a 1 on her in-line lunge" is meaningful across disciplines.
Corrective exercise selection. A 1 on shoulder mobility and a 3 on active straight leg raise leads to a fundamentally different mobility program than the inverse profile. Using the FMS to inform corrective exercise selection — its original intended use — is far better supported than using it as an injury predictor.
Where it doesn't fit
The FMS is not appropriate for symptomatic patients in pain. That's where the SFMA — its sister assessment for symptomatic populations — takes over. We've written more about the role of the SFMA in clinical practice; the short version is that asking a patient in pain to perform a deep squat for a movement-quality score doesn't tell you what you need to know.
The FMS is also not a substitute for sport-specific testing. A goalie's hip and groin demands aren't captured by an in-line lunge. A pitcher's shoulder demands aren't captured by the FMS shoulder mobility test. The FMS is a starting point — a screen — and should be paired with sport-specific assessments where the demands warrant.
How we actually use it
For an asymptomatic athlete coming in for a movement assessment — common in late spring and summer as players gear up for camps — we'll typically run the FMS, then layer sport-specific testing over the top. The FMS gives us the broad strokes. The sport-specific testing tells us what to do next.
The corrective exercise selection then follows the regional interdependence framing we use across the clinic. A poor shoulder mobility score that traces back to a stiff thoracic spine gets thoracic mobility work first, not shoulder work. An active straight leg raise that fails because of hip flexor tone gets hip flexor work, not hamstring stretches. Matching the intervention to the actual deficit is most of the job. There are no bad correctives — only ones aimed at the wrong driver of the dysfunction.
For the students
If you're learning the FMS this spring, the temptation will be to memorize the criteria, pass the certification, and move on. That's fine — but the test isn't the value. The value is the habit of looking at how someone moves before deciding what to do for them. The FMS happens to be one structured way of building that habit. Once it's built, you'll find yourself doing a quick movement screen on patients who'll never know you ran one. That's the point.
References
- Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function — Part 1. N Am J Sports Phys Ther. 2006;1(2):62–72.
- Bonazza NA, Smuin D, Onks CA, Silvis ML, Dhawan A. Reliability, validity, and injury predictive value of the Functional Movement Screen: a systematic review and meta-analysis. Am J Sports Med. 2017;45(3):725–732.
- Bahr R. Why screening tests to predict injury do not work — and probably never will: a critical review. Br J Sports Med. 2016;50(13):776–780.
- Kiesel KB, Butler RJ, Plisky PJ. Limited and asymmetrical fundamental movement patterns predict injury in American football players. J Sport Rehabil. 2014;23(2):88–94.
Author: Dr. Michael Minenna D.C., B.Sc., SFMA, FMS — Boreal Spine & Sport, Winnipeg, Manitoba.