CRITICALLY APPRAISED TOPICS

Journal of Sport Rehabilitation, 2014, 23, 360-364

http://dx.doi.Org/10.1123/jsr.2013-0027
© 201 4 Human Kinetics, Inc.

The Accuracy of the Functional Movement Screen

to Identify Individuals With an Elevated Risk
of Musculoskeletal Injury
Kirk Krumrei, Molly Flanagan, Josh Bruner, and Chris Durall

Clinical Scenario: Injuries are somewhat commonplace in highly active populations. One strategy for reduc­
ing injuries is to identify individuals with an elevated injury risk before participation so that remediative
interventions can be provided. Preparticipation screenings have traditionally entailed strength and flexibility
measures thought to be indicative of inflated injury risk. Some researchers, however, have suggested that
functional movements/tasks should be assessed to help identify individuals with a high risk of future injury.
One assessment tool used for this purpose is the Functional Movement Screen (FMS). The FMS generates a
numeric score based on performance attributes during 7 dynamic tasks; this score is purported to reflect future
injury risk. Expanding interest in the FMS has led researchers to investigate how accurately it can identify
individuals with an increased risk of injury. Focused Clinical Question: Can the Functional Movement Screen
accurately identify highly active individuals with an elevated risk of injury?

Keywords: preparticipation screening, injury prediction, muscle imbalance

C lin ic a l S c e n a rio
Injuries are somewhat commonplace in highly active
populations. One strategy for reducing injuries is to
identify individuals with an elevated injury risk before
participation so that remediative interventions can be
provided. Preparticipation screenings have traditionally
entailed strength and flexibility measures thought to
be indicative of inflated injury risk. Some researchers,
however, have suggested that functional movements/tasks
should be assessed to help identify individuals with a high
risk of future injury.1One assessment tool used for this
purpose is the Functional Movement Screen (FMS). The
FMS generates a numeric score based on performance
attributes during 7 dynamic tasks; this score is purported
to reflect future injury risk.1-4 Expanding interest in the
FMS has led researchers to investigate how accurately it
can identify individuals with an increased risk of injury.
S u m m a r y o f S e a rc h ,
“ B e s t E v id e n c e ” A p p r a is e d ,
a n d K e y F in d in g s
• The literature was searched for studies with level
1 or 2 evidence concerning the use of the FMS in
predicting injury risk.
• The search yielded 3 cohort studies (level 2 evi­
dence), which were deemed appropriate for helping
to answer the focused clinical question.
• Data from the 3 reviewed studies suggest that the
FMS can accurately identify individuals with an
elevated risk of musculoskeletal injury in certain
populations of physically active individuals.
• It remains to be seen if the FMS can accurately
identify individuals with an elevated risk of muscu­
loskeletal injury in other active populations.

F o c u s e d C lin ic a l Q u e s tio n
Can the Functional Movement Screen accurately identify
highly active individuals with an elevated risk of injury?
The authors are with the Dept of Health Professions, University
of Wisconsin-LaCrosse. Address author correspondence to Kirk
Krumrei at krumrei.kirk@uwlax.edu.
C lin ic a l B o tto m L in e
Preliminary moderate-quality evidence suggests that the
FMS can accurately identify individuals with an elevated
risk of musculoskeletal injury among male professional
football players, male marine officer candidates, and
female college basketball, soccer, and volleyball players.
Strength of Recommendation: Grade B evidence
suggests that the FMS can accurately identify individuals

360

with an elevated injury risk in select physically active
populations.
Search Strategy
Term Used to Guide Search Strategy
• Patient/Client group: physically active or asymptom­
atic adults
• Intervention/Assessment: Functional Movement
Screen
• Comparison: N/A
• Outcome: injury
Sources of Evidence Searched
• PubMed
• The Cochrane Library
• CINAHL Plus
• SPORTDiscus
• Medline
• Additional resources obtained via manual search
Inclusion and Exclusion Criteria
Inclusion Criteria
• Studies investigating the use of the Functional Move­
ment Screen in predicting injury risk
• Highly physically active individuals
• Level 1 or 2 evidence
• Limited to humans
• Limited to adults (>18 y of age)
• Limited to English language
• Limited to the last 11 years (2002-2012)
Exclusion Criteria
• Studies authored by the originator of the Functional
Movement Screen due to inherent risk of bias
Results of Search
Only 3 studies that met eligibility requirements were
located.2-4 These studies are categorized in Table 1 in
accordance with recommendations from the Centre for
Evidence-Based Medicine (www.cebm.net).
Best Evidence
The three retrieved cohort studies were identified as
the “best” available evidence (level 2) pertaining to the
accuracy of the FMS to predict injuries in highly physi-
Accuracy of the Functional Movement Screen 361
Table 1 Summary of Study Designs of
Articles Retrieved
Level Num ber
of evidence Study design located Reference
2 Prospective 3 Chorba et al2
cohort Kiesel et al3
O’Connor et al4
cally active individuals. These studies are summarized
in Table 2.
Implications for Practice,
Education, and Future Research
All 3 of the reviewed studies reported that the FMS accu­
rately identified individuals who had a higher incidence of
future injury in the populations studied.2-4 These findings
suggest that the FMS may be able to identify at-risk indi­
viduals in these select populations. Kiesel et al3 studied
the FMS with 46 professional football players on a single
team. When using an analysis of the receiver-operating-
characteristic curve, the authors were able to maximize
specificity (91%) and sensitivity (54%) at a cutoff score
of 14 on the FMS. The authors reported that athletes with
an FMS score <14 had an 11-fold greater incidence of
injuries, and their probability of getting injured during
the season increased from . 15 to .51. Following Kiesel et
al,3 Chorba et al2 and O’Connor et al4 used a cutoff score
of 14 as indicative of elevated injury risk with the FMS.
O’ Connor et al4 studied the FMS in predicting future
injuries in a large cohort of Marine Corps officer candi­
dates before they began officer candidate training. When
cumulative FMS scores were categorized into groups of
<14, 15 to 17, or >18, risk of injury was significantly
higher for individuals who scored <14 or >18. Officer
candidates who scored <14 on the FMS had a 1.5-times
higher incidence of injury than those who scored >14.
The authors were unable to explain why injury incidence
was also significantly higher in study participants with a
score of 18 on the FMS versus those with a score of 17.
Of the 3 studies included in this review, this was the only
one in which the authors observed an apparent bimodal
distribution of FMS scores and injury occurrence. While
this finding may be attributable to the unique cohort stud­
ied, it nonetheless reinforces the need for additional study
of the relationship between FMS scores and injury risk.
In a study by Chorba et al,2a mixed sample of female
college basketball, volleyball, and soccer athletes were
tested via the FMS within 2 weeks of the start of their
competitive season. The authors reported that athletes
who scored <14 were 3.85 times more likely to develop
an injury over the course of the competitive season. Of
the injuries observed in this sample, 17 of the 18 occurred
in the lower extremity and the other injury involved the
 Table 2 Characteristics of Included Studies

362
 can tly le s s lik ely to su ffer any, o v eru se, or seriou s in ju ries than
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Abbreviations: ACL, anterior cruciate ligament; NCAA, National Collegiate Athletic Association; FMS, Functional Movement Screen; Cl. confidence interval; ROC, receiver operating characteristic.
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363
364 Krumrei et al
lower back; thus, none of the injuries involved the upper
extremity. When shoulder-mobility-test data from the
FMS were excluded from calculation, the correlation
between the composite FMS score and lower-extremity
injury increased from .761 to .952. This finding suggests
that the FMS may be more effective for identifying indi­
viduals with an elevated risk of lower-extremity injury,
at least in similar cohorts.
One major difference between the 3 reviewed studies
is the percentage of FMS scores <14. In the O’Connor et
al4 study only 10.6% of officer candidates scored £14,
compared with 21.7% of football players in the Kiesel
et al3 study and 42.1 % of female college athletes in the
Chorba et al2 study. The limited number of study par­
ticipants who scored <14 on the FMS in the O’Connor
study may explain the lower predictive value reported in
that investigation versus the other 2 (Table 2). Certainly,
differences between populations, sample sizes, and types
of activity could also account for the variability in the
FMS to predict future injury.
In summary, the 3 studies2^ analyzed in this CAT
provide level 2 evidence that the FMS may be able to
identify highly active individuals with an elevated risk of
injury, at least in the populations studied. Further studies
of the FMS are needed on other physically active popula­
tions. The types of injuries varied between the reviewed
studies, and it remains to be seen if FMS scores are more
predictive of particular types of injuries (eg, lower vs
upper extremity, knee vs hip, etc). Authors of the reviewed
studies reported that individuals who scored less than 14
had a higher likelihood of injury, although inexplicably,
1 group4 reported that individuals who scored 18 on the
FMS had significantly more injuries than those who
scored 17. Thus, it is plausible that the responsiveness
and predictive accuracy of the FMS may be enhanced
by using an alternative cutoff score, by weighting the
different components of the FMS, or by other modifica­
tions to the rubric.
References
1. Cook G s 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;1:62-72.
2. Chorba RS, Chorba DJ, Bouillon LE, Overmyer CA,
Landis JA. Use of functional movement screening tool to
determine injury risk in female collegiate athletes. N Am
J Sports Phys Ther. 2010;5:47-54. PubMed
3. Kiesel K, Plisky PJ, Voight ML. Can serious injury in
professional football be predicted by a preseason func­
tional movement screen? N Am J Sports Phys Ther.
2007;2:147-158. PubMed
4. O’Connor FG, Deuster PA, Davis J, Pappas CG, Knapik JJ.
Functional movement screening: predicting injuries in offi­
cer candidates. Med Sci Sports Exerc. 2011 ;43:2224-2230.
PubMed doi: 10.1249/MSS.ObOl 3e318223522d
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