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Movement Competency Screen(MCS) Functional Movement Screen (FMS) Pre participation Screen (PPS)

Duncan Reid DHSc, FNZCP

Director of Rehabilitation High Performance Sport NZ

Screening or screaming?

Movement screening WHAT is “Screening”?

WIKIPEDIA

“Screening is a process of identifying risk factors/predictors of an outcome in healthy individuals.”

Outcomes = Injury

Performance measures

Talent ID/success

They can then be offered information, further tests and appropriate treatment to reduce their risk for the disease or

condition (outcome).

Dr Angela Cadogan SPRINZ Conference 2012

WHY do “Movement Screening”?

1. Identify injury risk factors

• Sport-specific

• Injury-specific

2. Performance factors

• Kinetic chain inefficiencies

3. Prescription of training loads (e.g MCS)

4. Talent ID

• Establish “normative” data

5. All of the above?


Why is it important?

• Other disciplines screen as matter of course e.g. Doctors BP, Dentists

• PT -No universal tool or gold standard

• 20% of those athletes who have passed a medical screen fail the FMS

• Full PT assessment - too few key test, inconsistent

Cook, G., Burton, L., & Hoogenboom, B. (2006a). Pre-participation screening: The use of fundamental movements as an assessment of function - Part 1. North American Journal of Sports Physical Therapy, 1(2), 62-72

Cook, G., Burton, L., & Hoogenboom, B. (2006b). Pre-participation screening: The use of fundamental movements as an assessment of function - Part 2. North American Journal of Sports Physical Therapy, 1(3), 132-139.

Kiesel, K., Plisky, P., & Kersey, P. (2008). Functional Movement Test Score as a Predictor of Time-loss during a Professional Football Team's Pre-season: 1525: Board# 72 May 28 3: 30 PM-5: 00 PM. Medicine and Science in Sports and Exercise, 40(5), S234.

Maffey, L., & Emery, C. (2006). Physiotherapist delivered preparticipation examination: rationale and evidence. North American Journal Of Sports Physical Therapy: NAJSPT, 1(4), 176-186.

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Injury prevention

Predisposed

athlete

Age

Flexibility

Previous

injury

Somatotype

Intrinsic risk factors

Susceptible

athlete Injury

Exposure to

extrinsic risk

factors Inciting

event

Meeuwisse, W (1994)

4 step sequence of injury prevention

1. Establish extent

of injury problem

Incidence

severity

2. Establish aetiology

& mechanisms

of injury

3. Introduce a

preventative measure

4. Assess the

Effectiveness repeat

Step 1 Van Mechelen et al

(1992)

Biomarkers

• Injury Risk • Previous injury • Asymmetry • Motor control • BMI

Stupidity

• PT interventions and exercise in general are a reset button (protective and corrective)

Cook, G., Burton, L., & Hoogenboom, B. (2006a). Pre-participation screening: The use of fundamental movements as an assessment of function - Part 1. North American Journal of Sports Physical Therapy, 1(2), 62-72 Cook, G., Burton, L., & Hoogenboom, B. (2006b). Pre-participation screening: The use of fundamental movements as an assessment of function - Part 2. North American Journal of Sports Physical Therapy, 1(3), 132-139.

Knee angle- what do you do about this?

Hewitt et al 2007

Injury Gym programmes

• http://www.youtube.com/watch?v=RQOwoy5-ysg

• What is happening in this video?

• How would you rate the quality of the movement?

• What tool do you use?

• What rating do you use?

• What is contributing to this pattern of movement?

http://www.youtube.com/watch?v=RQOwoy5-ysg




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What is screening?

• Any “athlete-generated” movement in which the quality of movement is assessed

• Functional- 1 leg squat or hop

• Training –squat lunge or deadlift

• Sports specific- swim, run, throw

Screening Process

Healthy (Non-injured) Athletes

Screening tests

Further tests

Intervention

Monitor and Measure Outcomes


Where does Movement Screening fit?

Musculoskeletal Screening tests:

• ROM • Muscle length • Muscle activation • Strength • Endurance • Balance/

proprioception

Movement tests:

• 1 leg squat • Hop • Drop jump • Squat • Lunge • Deadlift • Push/pull • Run/gait • Sporting activity

“Field”/capacity tests:

• Strength • Power • Speed • Agility

Components Result Movement

Dr Angela Cadogan SPRINZ Conference 2012 15

Screening tests

Functional Movement Screen

• The FMS™ is comprised of seven fundamental movement patterns that require a balance of mobility and stability

• Provide observable performance of basic locomotor, manipulative, and stabilizing movements

• Place the individual in extreme positions where weaknesses and imbalances become noticeable if appropriate stability and mobility is not utilized

• Maximum score-21

(Cook et al, 2006)

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Normal Values

Variable Mean (SD) 95% (CI) Range P values

Combined 15.7 (1.9) 15.4- 15.9 11-20

males 15.6 (2.0) 15.2 -15.9 11-20

Females 15.8 (1.8) 15.5 -16.2 12-20 .329

Schneiders, A. G., Davidsson, A., Hörman, E., & Sullivan, S. J. (2011). Functional movement screen normative values in a young, active population. International journal of sports physical therapy, 6(2), 75.

209 Normal subjects 108 females, 101 males

Reliability

Mean Min Max SD ICC P value

Intersession (n=19)

Total 16.63 16.58 16.68 1.78 0.92 < 0.01

Day 1 16.58 13 20 1.83

Day 2 16.68 13 20 1.76

Inter session N= 16

16.75 16.69 16.81 1.74 0.98 < 0.01

FMS cert 16.69 13 20 1.77

Non cert 16.81 13 20 1.75

Onate, J. A., Dewey, T., Kollock, R. O., Thomas, K. S., Van Lunen, B. L., Demaio, M., & Ringleb, S. I. (2012). Real-time intersession and interrater reliability of the functional movement screen. Journal of Strength and Conditioning Research, 26(2), 408-415.

19 volunteer civilians (12 male, 7 female)

Injury prediction

• Relationship between total FMS score and likelihood of serious injury

• FMS scores 46 professional American football players – followed over playing season

• Mean scores of those injured (14.3) (cut off score)

• Non injured 17.4

• Odds ratio of 11.67

Kiesel, K., Plisky, P. J., & Voight, M. L. (2007). Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen? North American Journal Of Sports Physical Therapy: NAJSPT, 2(3), 147-158

Does training change FMS?

0

0.5

1

1.5

2

2.5

3

DS HS ILL ASLR SM TSPU RS

Pre

Post

Kiesel, K., Plisky, P., & Butler, R. (2009). Functional movement test scores improve following a standardized off-season intervention program in professional football players. Scandinavian Journal of Medicine and Science in Sports, 21(2), 287-292

Movement competency screen (MCS) • Five components

• Squat

• Lunge and twist

• Bend and pull

• Push up

• Single leg stand

• Max Score 21

Squat

BODY WEIGHT SQUAT Perform a body weight squat with your fingertips on the side of your head and your elbows held inline with your ears. Squat as low and as fast as you comfortably can.

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Lunge and twist LUNGE & TWIST Cross your arms and place your hands on your shoulders with your elbows pointing straight ahead. Perform a forward lunge then rotate toward the forward knee. Return to center and then push back to Return to the starting position. Alternate legs with each repetition

Bend and pull

Bend & Pull Start with your arms stretched overhead. Bend forward allowing your arms to drop Under your trunk. Pull your hands into your body as if you were Holding onto a bar and performing a barbell rowing exercise. Return to the start position with your arms Stretched overhead.

Push up

PUSH UP Perform a standard push up

Single leg squat

SINGLE LEG SQUAT Perform a single leg body weight squat with Your fingertips on the side of your head your Elbows in line with your ears. Position the non--‐stance leg behind your Body as you squat. Squat as low and as fast as you comfortable can.

Criteria

Body

Region /

Capacity

MCS Task

MCS Task

MCS Task

Lunge &

MCS Task

MCS Task

Bend &

MCS Task

Single Leg

Held stable in a neutral

Held down away from ears. Slight flexion of thoracic spine OK.

Held down and away from ears. Elbows appear in line with ears. Thoracic extension is clear.

Held down and away from ears. Rotation appears to occur through thoracic spine. Elbow is at least inline with the lead knee at end range of rotation

Held down and away from ears during arm flexion and extension. Scapulae move balanced and rhythmic and are not excessively abducted at arm extension.

Held down and away from ears during arm flexion and extension. Scapulae move balanced and rhythmic and are not excessively abducted at arm extension.

Held down and away from ears. Elbows appear in line with ears. Thoracic extension is clear.

Held in neutral curve position. Held stable, neutral spine is

maintained throughout rotation. Rotation and/ or lateral flexion does not occur about the lumbar region during trunk rotation

Held stable in neutral spine position.

Held stable in neutral spine

position throughout trunk flexion and extension.

Held stable in a neutral spine position

throughout lower limb flexion and extension.

Appear to be

horizontally aligned.

Movement is initiated with hip

flexion. Remain horizontally aligned during flexion and extension. Obviously moving back and down during flexion.

Horizontally aligned, mobile

and stable to prohibit elevation and depression during rotation.

Held in line with the body

during arm flexion and extension.


flexion. Extension is obvious and controlled.


flexion. Remain horizontally aligned during flexion and extension. Clearly moving back and down during flexion, minimal weight shift over stance leg.

Knee caps pointing forward.

Aligned with hips and feet during flexion.

Aligned with hips and feet during flexion and do not move laterally with rotation

Extended and held stable Slightly bent and held stable Aligned with the hip and foot during flexion and extension.

NA. Mobility allows adequate dorsi-flexion during knee and hip flexion NA. NA. Mobility allows adequate dorsi-flexion during knee and hip flexion.

Pointing straight. Stable with heels grounded during lower limb flexion.

Heel of lead leg in contact

with the floor, trail foot flexed and balanced on forefoot.

Feet straight, heels not falling in or out

Pointing straight. Stable with heels grounded during lower limb flexion.

Evenly distributed. Maintained on each leg. NA. Maintained. Maintained on each leg.

NA. 90 degrees or greater of hip flexion

Lead thigh parallel with the floor.

Chest touches ground. 70 degrees or greater of trunk flexion

70 degrees or greater of hip flexion

Scoring system

Scoring instructions

Load level Scoring rationale Considerations

1 (assisted) 2 or more primary regions checked

Pay close attention to the primary regions for each movement task. The primary regions will have the most meaningful impact on movement competency To score unilateral patterns the load level should reflect the poorest side. For example: If an athlete scores a 3 on their right leg and a 2 on their left leg, that athlete would score a 2or their single leg squat pattern Athletes’ unilateral movement competency should be a reflection of their weakest side.

2 (body weight) 1 primary and 2 or more secondary

3 (external load) No primary and 1 secondary

4 (eccentric) 1 or more primary and and secondary regions failed on explosive MCS

5 (plyometric) No primary regions failed on explosive MCS

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“SCREENING AGE”

SCREENING AGE MINIMISING INJURY

RISK PERFORMANCE

Youth

Development

Representative

National

International

Functional Movement Patterns*

Individual Athlete Management & Reassessment*

Specific injury risk factors* (Sport/ position specific)

& Reassessment*

Functional Movement Competency*

Training Movement Patterns* & Reassessment*

Sport-specific Movements & Reassessment*


HPSNZ- Rehabilitation Model

MTR Maximise Training

Reliability

MIR Minimise

Injury Risk

NSO

Proactive MTR/MIR model

Screening of every HPSNZ athlete

Sport specific MCS Athlete ranked, 1,2,3

3 = Excellent 2= satisfactory 1 = poor or injured

No sig injuries

Full training load

More detailed Ax

PT &SC design training PT injury rehab

More detailed Ax

Ranked 3/3 • Athlete moves well and is biomechanically sound

• No major injuries in the past

• Would be able to tolerate a full S&C loading without any issues

• No further intervention warranted and full S&C programme developed

Ranked 2/3

– Athlete exhibits faults in movement patterns.

– These faults increase injury risk

– These movement fault may have a negative effect on performance

– May not tolerate a full conditioning load

– Athlete will have a modified ports Specific MBA by Lead Physiotherapist or Specified Provider in the region

• Results relate to IPP and performance of athlete and influence IPP

• Funding secured to develop appropriate intervention

• Lead Physiotherapist/Specific Provider work closely with S&C coach, athlete and coach where appropriate

• Intervention is monitored (ie must effect a change/have a positive outcome)

• Check points determined

Ranked 1/3

• Athlete exhibits significant faulty movement patterns (that are related to injury risk).

• These faults increase injury risk • These movement faults may have a negative effect on performance • Athlete will not tolerate a full conditioning load • Or has had a significant injury

– ACL Rupture – Disc prolapse

• Athlete will have an In-depth Sports Specific MBA by Lead Physiotherapist or Specified Provider in region – Results influence IPP – Funding secured to develop appropriate intervention – Lead Physiotherapist/Specific Provider work closely with S&C coach

and athlete and coach where appropriate – Intervention is monitored (ie must effect a change/have a positive

outcome)

• Check points determined

Next steps- screening passport

• Lower limb

• DF

• Active knee extension

• Thomas test

• Prone Hip IR / ER

• Hip – prone frog leg (McConnell test)

• Upper Limb

• ABIR (Chicken Wings) – standing against wall

• Shoulder IR / ER at 90 (supine)

• Shoulder x-adduction (PST – posterior shoulder tightness)

• Prone Streamline

• Thoracic rotation test –Trunk Endurance

• Biering Sorenson extension hold

• McGill 60 deg flexion hold

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Current Research -Netball

• Inter and intra-rater reliability of the Netball Movement Screening Tool (Van Weerd, Reid and Larmer)

• The primary aim of this study is to investigate the inter and intra rater-reliability of the Netball Movement Screening Tool in a group of secondary school netballers.

• A secondary aim is to collect the injury incidence data in the same cohort of netballers over one competition season.

Netball Screening tool

• All subjects were screened preseason with a Netball Movement Screen consisting of;

• MCS

• Single and double legged jumps

• Star Excursion Balance Test (SEBT)

• Active straight leg raise (SLR)

• 20 subjects inter rater (2 raters)

• 20 subjects intra rater

• 80 – 100 subjects injury surveillance

Other elements

Jumping components

Star Excursion Balance Test

Active straight Leg Raise

Provisional Results demographics

Mean SD Range (max) Range (min)

Age

16.2 1.1 17.8 13.11

Height

170.38 7.7 182 155

Weight

63.3 6.7 80 52

Age started playing

netball

7.8 1.9 12 5

Number of years

playing netball

8.3 1.8 12 3

Table Mean, SD and range of baseline data of all subjects

Inter-Rater Reliability Results Perfect

1 High >0.90

Good >0.80

Fair >0.70

Poor <0.69

ASLR

ICC: 1.0, Corr; 1.0

SEBT

Left: ICC: 0.99 Corr: 0.99

Right: ICC: 0.97 Corr: 0.91

Total NMST Score

ICC: 0.84 Corr: 0.84

MCS

ICC: 0.77 Corr: 0.77

Jump & Land

ICC: 0.65 Corr: 0.67

(McGuine, Greene, Best, & Leverson, 2000)

Inter-rater reliability results Individual components

ICC Fair 0.70-0.79

Poor <0.69

0.59-0.69 <0.59

MCS • Lunge & Twist

• Squat • Pull

• Bend • Push up • Single leg

squat

Jump & Land

• Vertical jump 2 leg land

• Vertical jump 1 leg land

• Broad jump

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Inter-rater

ICC 95% CI

Lower Bound Upper Bound

Spearman’s r

MCS

0.77 0.49 0.90 0.77

Jump

0.65 0.29 0.84 0.67

ASLR

1 - - 1

SEBTL

0.99 0.98 0.997 0.99

SEBTR

0.97 0.93 0.989 0.91

NMST

0.84 0.65 0.93 0.84

Table 4: Interclass correlation, two-way mixed effects model where people and effects are random and measures effects are fixed using absolute agreement coefficient and Spearman’s rho correlation significant at the 0.01 level (2 tailed) for inter-rater reliability of overall scores for NMST components.

Intra-rater ICC 95% CI

Lower Bound Upper Bound

Spearman’s r

MCS

0.77 0.49 0.90 0.77

Jump

0.65 0.29 0.84 0.67

ASLR

1 - - 1

SEBTL

0.99 0.98 0.997 0.99

SEBTR

0.97 0.93 0.989 0.91

NMST

0.84 0.65 0.93 0.84

Table : Interclass correlation, two-way mixed effects model where people and effects are random and measures effects are fixed using absolute agreement coefficient and Spearman’s rho correlation significant at the 0.01 level (2 tailed) for inter-rater reliability of overall scores for NMST components.

Discussion • Training & standardised instructions = Inter-rater reliability

• Difficult movements for the athlete Inter-rater reliability

• Push-up, Bend & Pull, Single Leg Squat

Complex movements Inter-rater reliability

Jumping components (Minick et al., 2010; Onate et al., 2012; Schneiders et al., 2011; Teyhen et al., 2012)

(Colourbox, 2012)

• Push-up

• Difficult movement for participants

• Floor effect

• Multiple movement strategies

• Insufficient scoring time

• Poor inter-rater reliability

• Recommendations

• Minimal performance standard

• Alternative movements • e.g. Modified push-ups

(Unknown, 2012)

Discussion

Delivery of Interventions

SCREENING AGE MINIMISING INJURY

RISK PERFORMANCE

Youth

Development

Representative

National

International

FUNCTIONAL MOVEMENTS Squad

SPORT/TRAINING SPECIFIC Squad

Small groups Individual

ATHLETE SPECIFIC Individual

Small groups

Individual Athlete Intervention

• COHESIVE

• Discussed by ALL prior to delivery

• INTEGRATED

• Optimise compliance

• Realistic number of exercises

• REVIEWED

• Repeat measures/tests

• PROGRESSIVE

• Physio and S/C

ONE ATHLETE : ONE PROGRAMME

Dr Angela Cadogan SPRINZ Conference 2012 54

http://www.crossfitsouthbay.com/wp-content/uploads/2012/03/Bad-Push-Up-photoexpress-40.jpg

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Monitor & Report Outcomes

• Injury Rates • Injury surveillance

• Performance • Individuals: PB’s

• Teams: • Win/loss

• Individual KPI’s

• Talent ID • “success”/ selection

• Report Outcomes • Funding bodies

• Boards

EFFECTIVENESS & RETURN ON INVESTMENT


Healthy (Non-injured) Athletes

Screening Tests

Further tests

Treatment Intervention

Monitor and Measure Outcomes

WHY? Injury Risk Performance factors

Movement Screening Summary

• Appropriate for “Screening Age”

• Sport/position specific • K.I.S.S

Which ones?

• One athlete: One Programme • Review and Progress

• Report results

CO

HESIV

E (Ph

ysio/ SC

Acknowledgments

• Dr Angela Cadogon- NZ Cricket

• Sharon Kearny High Performance Sport NZ

• HPSNZ rehabilitation providers

• Dr Matt Kritz

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