Are you wondering when it will happen to you? Not what , but when will you feel pain or develop a sports injury? Does the question can I prevent a sports injury hang over your head? We’ve got some good news for you. You can determine your injury risk which means you can prevent a sports injury.

The Functional Movement Screen

There are screening tools that allow athletes to assess their injury risk. The Functional Movement Screen TM (FMS) is a valid indicator of injury risk among athletes. The FMS is a means of identifying the weak links and asymmetries in your basic functional movements.

As the triathlon season comes to a close, we finally have an opportunity to reflect on the season’s successes and create opportunities for improvement. During the offseason, we you are able to plan and prepare for the upcoming season. Prior research reports 10,000 athletes seek treatment for sports and exercise related injuries each day and over 7 million athletes receive medical attention over any 2 year span2,3. In triathletes, up to 90% of individuals report at least one injury over the previous 1-2 seasons with the majority of these injuries occurring in the lower extremity4.

Unfortunately, the nature of these injuries leads to an inability to complete triathlon training in up to 75% of athletes causing an average loss of 2-3 months of training5. Outside of traumatic events such as a bike collision, the vast majority of these injuries are diagnosed as overuse including achilles tendinopathy, medial tibial stress syndrome (shin splints), and plantar fasciitis, all which could have been prevented with a proper sport specific screening program and intervention.

Injury Risk Screening Programs for Athletes

Screening programs for athletes should focus on known, modifiable intrinsic and extrinsic risk factors for injury. Intrinsic (individual) risk factors such as prior injury and supinated foot type, as well as, extrinsic (environment) risk factors including training volume (duration, intensity, frequency, and distance) and competition distance (Ironman) have been shown to increase the likelihood of future injury6. Conversely, this research has demonstrated the presence of strength training, coach/club participation and medical team support have reduced an athlete’s risk of future injury7,8. Expert opinion suggests athletes should consider cross training, equipment fitting, reasonable training schedules and techniques, and pre- participation screenings to reduce future risk.

In our clinic’s experience, the utilization of The Functional Movement Screen TM (FMS) is an essential part of our pre-participation screening. The FMS consists of seven different functional movements that assess the following: trunk and core stability, neuromuscular coordination, asymmetry in movement, flexibility, acceleration, deceleration, and dynamic flexibility10.

This component of our screen allows our Physical Therapists to objectively score and grade individuals for injury risk prior to participation as well as follow and reassess these at-risk individuals after Physical Therapy treatment is initiated.

7 Components of our Functional Movement Screen

A Functional Movement Screen can help you prevent a sports injury by allowing a physical therapist to assess your injury risk.

Component 1: Deep Squat

Assesses bilateral, symmetrical stability of the hips, knees, ankles, shoulders, and thoracic spine.

Deep Squat Instructions:

  • Stand tall with feet shoulder width apart and toes pointing forward
  • Grasp the down in both hands and place it horizontally on top of your head so your shoulders and elbows are at 90 degrees
  • Press the dowel so that it is directly above your head
  • While maintaining an upright torso, keep your heels and the dowel in position as you descend as deep as possible.
  • Hold the position for a count of one and return to the initial position

 

Component 2: Hurdle Step

Assesses bilateral single leg stance stability, open-kinetic chain hip and knee flexion, OKC dorsiflexion, and closed chain hip flexion.

Hurdle Step Instructions:

  • Align the hurdle with your feet together and toes touching the test kit
  • Stand tall and grasp the dowel with both hands and place it behind your neck and across the shoulders
  • While maintaining an upright posture, raise the right leg and step over the hurdle, making sure to raise the foot towards the shin while maintaining foot alignment with the ankle, knee, and hip
  • Touch the floor with the heel and return to the starting position, while keeping proper foot alignment with the ankle, knee, and hip

 

Component 3: In-Line Lunge

Assesses ankle and knee stability, hip abductor and adductor weakness, step leg mobility, and balance in a narrow base of support.

In-Line Lunge Instructions:

  • Place the dowel along the spine so it touches the back of your head, your upper back, and the middle of your buttocks
  • While grasping the dowel, your right hand should be against the back of your neck, and the left hand should be against your lower back
  • Step onto the 2×6 with a flat right foot and the top on the zero mark
  • The left heel should be places at _____ mark. (the tibial measurement marker)
  • Both toes must be point forward, with flat feet
  • Maintaining an upright posture so the dowel stays in contact with your head, upper back, and top of the buttock, descend into a lunge position so the right knee touches the 2×6 behind your left heel
  • Return to starting position

 

Component 4: Shoulder Mobility

Assesses bilateral shoulder flexion, abduction, adduction, internal rotation, and external rotation. Also assesses thoracic spine extension and rotation.

Shoulder Mobility Instructions:

  • Stand tall with your feet together and arms hanging comfortably
  • make a fist so your fingers are around your thumbs
  • In on motion, place the right fist overhead and down your back as fast as possible while simultaneously taking your left fist up your back as far as possible
  • Do not “creep” your hands closer after their initial placement

 

Component 5: Active Straight Leg Raise

Assesses functional hamstring flexibility, core stability, and hip extension mobility.

Active Straight Leg Raise Instructions:

  • Lay flat with the back of your knees against the 2×6 with your toes pointing up
  • Place both arms next to your body with the palms facing up
  • Pull the toes of your right foot toward your shin
  • With the right leg remaining straight and the back of your left knee maintaining contact with the 2×6, raise your right foot as high as possible

 

Component 6: Trunk Stability Push-Up

Assesses symmetrical trunk stability, scapular stability, and upper extremeity strength.

Trunk Stability Push-Up Instructions:

  • Lie face down with your arms extended overhead and your hands shoulder width apart
  • Pull your thumbs down in line with the forehead for me, chin for women
  • With your lefts together, pull your toes toward the shins and lift your knees and elbows off the ground
  • While maintaining a rigid torso push your body as one unit into a push-up position

 

Component 7: Rotational Stability

Assesses asymmetrical trunk stability, scapular stability and upper extremity strength.

Deep Squat Instructions:

  • Get on your hands and knees over the 2×6 so your hands are under your shoulders and your knees are under your hips
  • The thumbs, knees and toes must contact the sides of the 2×6, and the toes must be pulled to the shins
  • At the same time, reach your right hand forward and right leg backward, like you are flying
  • Then, without touching down, touch your right elbow to your knee directly over the 2×6
  • Return the extended positions
  • Return to start

What does the research say about sports injury prevention?

Research has identified a score of 14/21 as an acceptable cut off for determining future injury risk. Athletes who score <14/21 are up to 11 times more likely to sustain an injury causing significant time away from training and competition9. Lower scores may either reflect a current injury or a compensatory movement pattern, which will lead to a future injury. This data is then analyzed by the treating Physical Therapist to implement an intervention program consisting of corrective exercises that restore muscle balance and movement patterns, improve FMS scores, improve performance and reduce time away from their sport. These corrective exercises have been shown to improve FMS scores reducing time away from training and future injury risk9,10.

Single plane exercises including running and cycling have been shown to develop asymmetry throughout the body and athletes with these imbalances often train around or neglect these weaknesses11,12. The results of the FMS™ can be used to identify injury risk and to guide training programs.

Off seasons are an excellent time to recover from the season and address both nagging injuries as well as prevent future injury. The FMS™ is an integral part of any pre-participation examination and can quickly and effectively identify modifiable risk factors in athletes. For more information on the FMS or how Physical Therapy can assist in your training and performance contact the experts at One on One Physical Therapy.

Toe Touch Progression

1
Video Link

½ Kneeling Dorsiflexion

1
Video Link

Squat with Support

1
Video Link

 

 

This article was submitted by Karen Davis Warren PT, MPT, OCS, ATC, CSCS, and Jeff Ryg PT, DPT, OCS, FAAOMPT, ATC, CSCS from One on One Physical Therapy.

Karen David Warren, Founding Partner, One on One Physical Therapy, brings a wealth of knowledge to her patients incorporating over 20 years of physical therapy and sports medicine experience and education. Karen holds a Master of Physical Therapy degree from Emory University and a Bachelor of Science in Exercise Science from the University of Southern California. She is an Adjunct Faculty and guest lecturer for the Doctorate of Physical Therapy Program, a Clinical Instructor at the Doctorate of Physical Therapy Program, Emory University, and on the Advisory Board for the Physical Therapy Program at Mercer University. Karen’s email address is Karen@onetherapy.com and more information can be found at www.onetherapy.com.

REFERENCES

  1. Dias Lopes, A. et al. What are the main running-related musculoskeletal injuries. Systematic Review. Sports Med. 2012;42(10):891-905.
  2. National Center for Injury Prevention and Con- trol, Centers for Disease Control and Prevention. CDC Injury Research Agenda. Atlanta, GA: US Department of Health and Human Services; 2002.
  3. Gotsch K, Annest JL, Holmgren P, Gilchrist J. Nonfatal sports- and recreation- related injuries treated in emergency departments—United States, July 2000–June 2001. MMWR Morb Mortal Wkly Rep. 2002;51(33):736-740.
  4. O’Toole ML, Hiller WDB, Smith RA, et al. Overuse injuries in ultra endurance triathletes. Am J Sports Med 1989;17(4):514—8.
  5. Vleck VE, Garbutt G. Injury and training characteristics of male elite, development squad, and club triathletes. Int J Sports Med 1998;19(1):38—42.
  6. Gosling, C. Triathlon related musculoskeletal injuries. The status of injury prevention knowledge. J Science and Medicine in Sport. 2008. 11:396-406.
  7. Egermann M, Brocal D, Lill CA, et al. Analysis of injuries in long-distance triathletes. Int J Sports Med 2003;24(4):271—6.
  8. Aaltonen, S. Prevention of Sports Injuries. A systematic review of randomized controlled trials. Arch Phys Med Rehab. 2007. 167(1383-1396).
  9. Chorba RS, Chorba DJ, Bouillon LE, Overmyer CA, Landis JA. Use of a Functional Movement Screening Tool to Determine Injury Risk in Female Collegiate Athletes. N Am J Sports Phys Ther. 2010; 5(2):47-54.
  10. Peate WF, Bates G, Lunda K, Francis S, Bellamy K. Core strength: a new model for injury prediction and prevention. J Occup Med Toxicol. 2007; 2: 3.
  11. Beckham, SG and Harper, M. Functional training: Fad or here to day? American college for Sports Medicine’s Health and Fitness Journal 14(6): 24-30, 2010.
  12. Jaffe, L and Cook, G. One frame at a time. Training and Conditioning 16:8, 2006.