AN INJURY PREVENTION INITIATIVE BASED UPON RESULTS FROM THE FUNCTIONAL MOVEMENT SCREEN (FMS)

written by Bill Utsey, Director of Athletics, Greenville County Schools, Greenville, South Carolina

This past school year saw our accident insurance premiums for our athletes go up 100% over the previous year. This was a traumatic adjustment for us, and more so for our parents as the premium is a fee that is paid by the athlete in our school district. We caught a lot of flak from our parents on this cost change. As the district's director of athletics, I was trying my best to come up with a solution of any kind.

One of my answers came when our athletic trainers, provided to us by the Greenville Hospital System, mentioned a test called the functional movement screen (FMS). I immediately began asking questions, and diligently researched to find out what this test was all about. Although a relatively new concept, my reading quickly told me that scoring below average on this test is a high indicator for injury susceptibility. The research showed that those who scored below a 14 on the seven-item FMS had a high propensity for injury.

A research article (Kiesel, et al) linked high risk of injury to National Football League players with low FMS scores. Seeing how the NFL uses the FMS in its annual NFL combine went a long way in convincing me the value of FMS screening. When I read further that this test, because of its ability to locate those individuals with high risk of injury, was being used by the United States Marine Corps, I was sold on it as a potential tool for an injury prevention initiative in our school district.

It was revealed to me through my research into the Functional Movement Screen that each of the assessment items were indicators for weaknesses in the specific areas of functional movement, core strength, stability, and balance. In another study the FMS was administered to firefighters in Tucson, Arizona, and, after a core strengthening program was implemented, there was a 42% decrease in injuries along with a 62% decrease in lost time due to injuries. All of these uses and findings were highly encouraging and convinced me that we needed to change directions in our strength and conditioning programs and in our warm-up routines.

We are fortunate in our school district to have a wonderful partnership with our hospital system. Under the auspices of the Greenville Hospital System, we have full-time certified athletic trainers in our schools administered by the Steadman Hawkins Clinic of the Carolinas (a nationally renown orthopedic practice). The Steadman Hawkins team includes their physical therapy partner, Proaxis Therapy and their high performance sports fitness partner, Acceleration Sports Institute (ASI). We contacted both of these health and fitness practices - Mike Osler and Ryan Geary with Proaxis and Darren Holmes with ASI - to inquire as to how we can put together a comprehensive injury prevention initiative using the FMS as our baseline of thinking.

Our initial thought was to administer the FMS to all 8,000+ athletes in our school district. Although the test only takes about five minutes to administer, we could not possibly make this happen given our personnel limitations. Mike and Ryan, using their professional expertise and through their connections, came up with a series of prescriptive exercises designed specifically for each area of weakness that the seven-item FMS highlights. This "Universal Prevention Program" consisted of eleven exercises to be incorporated into the team or athlete's warm-up routine.

Mike and Ryan, based upon their discussions with Dr. Darin Padua of the Department of Exercise and Sports Health at the University of North Carolina and their findings on the common deficits in the overall high school athlete population, selected the exercises for our program. The idea, of course, is that these exercises would work to rehab those areas that were indeed deficient and maintain high proficiency for those that were already proficient. In other words, we were going to assume that everyone was deficient on the FMS and then institute a program that would consist of corrective exercises proven to improve one's performance score in the FMS.

The injury prevention exercise regimen consisting of five dynamic warm-up exercises, four functional intervention exercises, one exercise that worked on balance and stability, and one that worked on agility and bodily control. Combined, the "Universal Prevention Program" exercises could be completed in seven to ten minutes.

We met with all of our coaches, provided them with a laminated sheet of the prevention exercises, and showed them a video that gave an introduction and basis for the program along with a demonstration of each of the eleven exercises. The videos can be accessed at the Steadman Hawkins Clinic of the Carolinas website.

Additionally, Proaxis personnel along with our certified athletic trainers will be testing a number of our athletes on the deep squat item of the FMS. This item is the strongest indicator of functional deficiency. The deep squat is performed with the hands holding a stick or PVC pipe above the head and squatting all the way down. Keeping the stick directly above the head and keeping the heels on the ground are critical indices. Additionally, the feet should be under the shoulders and the thighs should go well below parallel.

Athletes showing significant deficiencies in the deep squat will be placed on an additional set of rehabilitative exercises. Again, the goal of the program is to reduce the incidences of injuries in our athletes. The objective is to have the athletes be proficient enough in the end to hypothetically score above 14 on the FMS. Such a proficiency or score on the FMS would place the athletes in the category current research shows will have fewer incidences of injuries.

Additionally, we will be looking at selecting supplemental exercises to incorporate into our off- and pre-season strength and conditioning programs. These exercises, of course, will be focused on corrective approaches to functional movement, balance, stability and core strength. Our Proaxis partner will be working with ASI to develop these exercises.

Of course, there are skeptics on the FMS and the findings associated with its concept. Mike is quick to point out the fact that there is no program that will prevent all injuries. However, if studies of FMS results and corrective programs continue to show positive correlations regarding injury prevention and athletic performance, we will be on the high road and cutting edge. In deciding whether or not to take this new, innovative approach to warm-up routines and supplemental exercises for athletes, we simply asked ourselves, "Is this good for kids, and will it at value to our program?"

With the answer affirmative to both questions, the decision was easy for us. In the end, we are aiming for a significant change in the incidence of injury to our athletes and, when they do get injured, a much faster recovery time. We are excited about this new approach, and are glad that we have dependable partners such as Proaxis Therapy and Acceleration Sports Institute at our side as we move forward.

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