Functional Movement Screen (FMS): Testing Protocol, Scoring, and Benefits

How Do You Test FMS?

The Functional Movement Screen (FMS) is a standardized, seven-movement assessment designed to identify fundamental movement patterns, asymmetries, and limitations that may predispose individuals to injury or hinder performance, administered by trained professionals using a specific protocol and scoring system.

Understanding the Functional Movement Screen (FMS)

The Functional Movement Screen (FMS) is a pre-participation screening tool developed by physical therapist Gray Cook and athletic trainer Lee Burton. It evaluates seven fundamental movement patterns in individuals with no current pain or known musculoskeletal injury. The primary purpose of the FMS is not to diagnose specific conditions but rather to identify functional limitations and asymmetries that could indicate an increased risk of injury during physical activity or sports. By highlighting these inefficiencies, the FMS helps exercise professionals and clinicians design targeted corrective exercise programs to improve movement quality and reduce injury potential.

Essential Equipment for FMS Testing

Administering the FMS requires a standardized set of equipment to ensure consistency and accuracy:

• FMS Kit: This typically includes a hurdle, a dowel rod, and a measuring stick.
• Clear, Flat Space: Sufficient room for the individual to perform all movements unimpeded.
• FMS Score Sheet: To record the scores for each movement.
• Camera (Optional but Recommended): For video analysis and re-evaluation.

The FMS Scoring System

Each of the seven FMS movements is scored on a scale of 0 to 3, with a maximum total score of 21. The scoring criteria are objective and based on specific performance standards:

• 3 Points: The individual performs the movement pattern perfectly, meeting all established criteria without any compensations.
• 2 Points: The individual performs the movement pattern with slight compensation, or the movement is performed imperfectly but still within an acceptable range. This often indicates a limitation in mobility or stability.
• 1 Point: The individual is unable to perform the movement pattern as instructed, or is unable to achieve the critical position. This indicates a significant limitation.
• 0 Points: Pain is experienced during any part of the movement. If pain is present, the test for that specific movement is immediately stopped, and a score of 0 is assigned. Pain always trumps all other scores and requires further medical evaluation.

Asymmetries (a difference of one or more points between the left and right sides on bilateral tests like Hurdle Step, In-Line Lunge, Shoulder Mobility, and Active Straight-Leg Raise) are also noted as they are significant indicators of potential issues.

Administering the Seven FMS Movements

The FMS involves assessing seven distinct movement patterns. For each, the client is instructed on the specific task, and the administrator observes and scores based on predefined criteria. The client typically performs each movement three times, and the lowest non-painful score is recorded.

1. Deep Squat

   • Objective: Assesses bilateral, symmetrical, and functional mobility of the hips, knees, and ankles, as well as thoracic spine extension and glenohumeral mobility. It's considered a fundamental pattern for many activities.
   • Setup: Client stands with feet shoulder-width apart, toes pointing straight ahead, holding a dowel overhead with elbows locked, hands twice shoulder-width apart.
   • Execution: Client squats as deep as possible while keeping the dowel overhead and parallel to the feet, heels on the ground, and knees tracking over the toes.
   • Scoring Criteria:
     • 3: Torso parallel with shins, dowel over feet, heels down.
     • 2: Heels elevate, or torso not parallel with shins, or dowel not over feet.
     • 1: Unable to perform the squat, or significant compensation.

2. Hurdle Step

   • Objective: Assesses bilateral mobility and stability of the hip, knee, and ankle, as well as dynamic stability of the core.
   • Setup: Client stands with feet together, toes touching the base of a hurdle (or string). The hurdle height is set at the client's tibial tuberosity. A dowel is placed across the shoulders.
   • Execution: Client steps over the hurdle, touching the heel to the ground on the opposite side, then returns to the starting position. The knee of the stepping leg should align with the hip and ankle.
   • Scoring Criteria:
     • 3: Hips, knees, and ankles remain in alignment; no contact with the hurdle; minimal movement of the dowel.
     • 2: Slight contact with the hurdle, or slight loss of alignment/stability.
     • 1: Significant loss of balance, or inability to clear the hurdle.

3. In-Line Lunge

   • Objective: Assesses bilateral mobility and stability, hip and ankle mobility, and quadriceps flexibility. It challenges balance and coordination.
   • Setup: Client stands with one foot directly in front of the other, heel to toe, along a measuring stick. The front foot is at the zero mark. The dowel is held behind the back, touching the head, thoracic spine, and sacrum. One hand grasps the dowel at the cervical curve, the other at the lumbar curve.
   • Execution: Client lowers into a lunge until the back knee touches the measuring stick just behind the front heel, while maintaining dowel contact points and upright posture.
   • Scoring Criteria:
     • 3: Dowel contact maintained; back knee touches behind front heel; no loss of balance.
     • 2: Loss of dowel contact, or inability to touch knee to stick, or loss of balance.
     • 1: Significant loss of balance, or inability to perform the lunge.

4. Shoulder Mobility

   • Objective: Assesses bilateral shoulder range of motion, including internal and external rotation, adduction, and extension. It also evaluates scapular stability and thoracic spine mobility.
   • Setup: Client stands with feet together. One hand reaches over the head to touch the spine, and the other hand reaches behind the back to touch the spine.
   • Execution: Client attempts to bring the fingertips of both hands as close as possible. The distance between the fingertips is measured.
   • Scoring Criteria:
     • 3: Hands are within one hand length (client's hand) of each other.
     • 2: Hands are within one and a half hand lengths.
     • 1: Hands are further than one and a half hand lengths apart.

5. Active Straight-Leg Raise

   • Objective: Assesses active hamstring and gastrocnemius-soleus flexibility while maintaining pelvic stability.
   • Setup: Client lies supine on the floor with arms by their side, palms up. A measuring stick is placed perpendicular to the thigh at the midpoint.
   • Execution: Client actively lifts one leg as high as possible, keeping the knee extended and the other leg flat on the floor.
   • Scoring Criteria:
     • 3: Malleolus (ankle bone) reaches between the mid-thigh and the ASIS (anterior superior iliac spine).
     • 2: Malleolus reaches between the knee and the mid-thigh.
     • 1: Malleolus is below the knee.

6. Trunk Stability Push-up

   • Objective: Assesses core stability in the sagittal plane while a symmetrical upper body movement is performed. It tests the ability to stabilize the spine during an upper body movement.
   • Setup: Client lies prone with hands flat on the floor, thumbs at the level of the chin (males) or clavicle (females). Legs are together, toes tucked.
   • Execution: Client performs a push-up, lifting the body as a unit, without any lag in the lumbar spine.
   • Scoring Criteria:
     • 3 (Males): Lifts body with hands at chin level.
     • 3 (Females): Lifts body with hands at clavicle level.
     • 2 (Males): Lifts body with hands at clavicle level.
     • 2 (Females): Lifts body with hands at mid-forehead level.
     • 1: Unable to lift body as a unit, or performs with significant compensation (e.g., sagging low back).

7. Rotary Stability

   • Objective: Assesses multi-planar trunk stability, including dynamic stability of the core with combined upper and lower extremity movement.
   • Setup: Client is on hands and knees, with hands directly under shoulders and knees directly under hips. A dowel is placed on the back, touching the head, thoracic spine, and sacrum.
   • Execution: Client simultaneously extends one arm and the opposite leg, maintaining contact with the dowel and keeping the extended arm and leg parallel to the torso. Then, the elbow and knee of the extended limbs are brought together under the body.
   • Scoring Criteria:
     • 3: Performs diagonal extension and flexion (elbow to knee) with ipsilateral elbow and knee touch; dowel contact maintained.
     • 2: Performs diagonal extension and flexion (elbow to knee) with contralateral elbow and knee touch; dowel contact maintained.
     • 1: Unable to perform, or significant loss of balance/dowel contact.

General Testing Protocol

A certified FMS administrator will guide the client through each movement. It's crucial that the instructions are clear and consistent. The administrator observes closely for the defined criteria for each score, noting any compensations or pain. Often, clients are allowed three attempts per movement, with the best non-painful score being recorded. If pain is reported at any point, the test for that movement is stopped, and a score of 0 is assigned, indicating the need for a pain-focused assessment by a healthcare professional.

Interpreting FMS Scores and Next Steps

After all seven movements are scored, a total score out of 21 is calculated. More importantly than the total score, the FMS highlights:

• Any score of 0: Indicates pain, which requires immediate referral to a qualified healthcare provider for further diagnosis.
• Any score of 1: Represents a significant limitation in a fundamental movement pattern. These are prioritized for corrective strategies.
• Asymmetries (e.g., 2 on one side, 1 on the other): Indicate a difference in mobility or stability between the left and right sides, which can be a strong predictor of injury.

The FMS is a screening tool, not a diagnostic one. It doesn't tell you why a movement is limited, but that it is. The insights gained from the FMS help professionals tailor exercise programs, focusing on improving the identified weak links, restoring fundamental movement patterns, and addressing asymmetries before progressing to more complex or high-intensity training.

Who Benefits from FMS Testing?

The FMS is beneficial for a wide range of individuals, including:

• Athletes: To identify movement inefficiencies that could impact performance or increase injury risk.
• General Population: For individuals starting a new exercise program, to establish a baseline of movement quality and guide safe progression.
• Clients with a History of Injury: To determine if underlying movement dysfunctions contributed to past injuries or could lead to future ones.
• Individuals Seeking Performance Enhancement: By improving fundamental movement, more advanced training becomes safer and more effective.

Limitations and Professional Considerations

While valuable, the FMS has its limitations and should be viewed as one component of a comprehensive assessment:

• Not a Diagnostic Tool: It does not diagnose specific injuries or conditions. A score of 0 (pain) indicates the need for further medical evaluation.
• Requires Training: Proper administration and interpretation of the FMS require specific training and certification from Functional Movement Systems.
• Context is Key: FMS scores should be considered alongside a client's health history, goals, and other physical assessments.
• Focus on Quality, Not Quantity: The FMS assesses movement quality, not strength, endurance, or power. These components require separate assessments.

Conclusion

Testing the FMS involves a systematic process of observing and scoring seven fundamental movement patterns. By adhering to the standardized protocol for each movement – Deep Squat, Hurdle Step, In-Line Lunge, Shoulder Mobility, Active Straight-Leg Raise, Trunk Stability Push-up, and Rotary Stability – exercise professionals can effectively identify movement limitations, asymmetries, and potential pain points. This structured assessment provides invaluable insights, serving as a powerful guide for developing individualized, evidence-based exercise programs aimed at improving movement competency, reducing injury risk, and optimizing physical performance.