If you’ve read my stuff before, then you know that I am, well, a big geek. I think I probably took fitness geek to a whole new level with my bench press assessment article, talking about the work value of a bench press based on arm span. I think this article will further raise the bar on geek in the fitness industry.
This article is about what typical problem areas I see based on the Functional Movement Screen (FMS for those who like to keep things short) assessments that I perform. Not familiar with the FMS? Check out functionalmovement.com, or read on for a brief overview. Then follow the article to see an overview of the results I’ve seen in terms of what functional movements tend to cause the most problems, and how the results are different based on gender and whether someone is an athlete.
Lastly, I’ll share my take on what this should mean for your training (or programming for trainers) if you do not have access to the FMS or other assessment options to help guide you.
I’ve been using the FMS for just over 2 years now, and have been using my Excel automated template to provide a quick way to give my clients nice looking output. Well, it turns out the team version of the tool that I created, along with my high GQ (geek quotient) has allowed me to keep some cool stats about what I’ve seen from more than 150 different clients. Here is the demographic of the people included in this article. As it turns out I have worked with quite a range of people. Note that I am keeping the results rolled up to ensure that no information could be estimated about any individual that I have worked with.
59% are women. First person who guesses the percentage of men, and the person with the answer that amuses me most each get a $10 itunes gift card.
Fifty plus: 21%
68% are athletes.
What do I consider an athlete? Basically, everyone who engages regularly in some variety of sport, regardless of the level gets the label athlete in my book. Some may say that it would have been better to refer to a active versus sedentary, but I think active understates the commitment a lot of these people have to their sport. But I want to be sure that it is clear that when I refer to athletes in this review, I am not talking about professionals, but rather recreational athletes. Although note that many of them are quite serious about their sport, and play it at quite a high level.
I have clients who participate in 25 different sports, so I rolled it up to the following:
Endurance athletes (cycling, running, triathlon): 25%
Team sports (hockey, ultimate, soccer, basketball, volleyball): 19%
Of the general public clients (not athletes), people tended to have the following goals:
Improved health and fitness: 65%
Reduced pain (primarily back and/or hip)*: 25%
Weight loss (fat loss): 16%
*Note that when I take on clients who want to reduce pain, I try to make sure I do so in conjunction with a health care practitioner as I believe they are critical for anyone with joint pain. I don’t strive to be the lead in that case, but rather the support.
It is a fairly varied population. The high number of people who are active and the relatively low number who come for weight loss should probably be taken into account when reading into these results.
I compiled the FMS results for all of the people above, and tied it to their gender, and whether they are athletes. I have the FMS results tied to age as well, but have not yet done that evaluation (who’s kidding who – I’m going to do it tomorrow now that I think of it). For those not familiar with the FMS, it is a set of 7 movements that trainers and therapists use to identify weakness or imbalances in the body that can help guide how we train people. Out of the 7 tests, we look for the two tests that cause the most difficulty or have the biggest difference from left to right, and put appropriate corrective exercises in the programs we create for these clients.
The seven tests are:
- Deep squat (DS): this is almost an overview test, and poor performance can indicate any of ankle, hip or thoracic spine mobility or core stability.
- Hurdle step (HS): this can provide insight into whether there are hip mobility or stability issues.
- In line lunge (ILL): poor performance can indicate calf, quad, hip or thoracic spine tightness, or glute weakness.
- Shoulder mobility (SM): Can indicate problems with mobility in the thoracic spine and scapular stability.
- Active straight leg raise (ASLR): this can point out problems with hamstring flexibility or hip stability.
- Trunk stability pushup (TSPU): this test can identify issues with core stability and upper body strength.
- Rotary Stability (RS): can tell us if there is a thoracic spine or hip mobility deficit, or a lack of stability in the rotary core muscles.
While each test gives us an idea about how well certain parts of the body move, it is important to note that just looking at one test without seeing the others is not advisable, as it prevents getting a full perspective.
I use the FMS for each of my clients (for online clients, I have them video themselves doing a modified functional assessment). To me, it is a very valuable tool, both to help me understand how my clients move, and for them to feel that they may not actually move that well, which can provide nice additional motivation for them to train. I find this to be particularly true when there is a significant difference from one side to another.
But unfortunately not everyone has access to the FMS. For those trainers who program for clients without the benefit of the FMS, and for those individuals who direct their own training, the trends I present here may be helpful.
Trends in FMS Results:
Please do note that this is not a controlled trial, but rather a compilation of results that I have seen.
The following trends show the “worst tests” that I typically see. Remember that when we use the FMS we identify and address the two weakest areas, so for each client, I take note of these weak areas.
The weakest links?
Active straight leg raise (ASLR) – 39%
Trunk stability pushup (TSPU) – 38%
In-line lunge (ILL) – 30%
Rotary Stability (RS) – 30%
It should be noted that there is a priority to the FMS results. That is, if someone scored the lowest score possible on each test, I would pick the straight leg raise (ASLR) and shoulder mobility (SM) as their worst tests. In other words, it is not surprising that ASLR made the top 2, because it is considered a high priority test. But it is interesting that the TSPU is much more prevalent than the SM.
Research based on the FMS suggests that anyone with a score lower than 14 is at a higher risk of injury in sports than those who score a 14 or above.
Average score from my population: 12.9 out of 21
59% scored below 14
Females: 12.9 (Female athlete: 13.4)
Males: 13.0 (Male athlete: 13.2)
Another factor that has been shown to have a correlation to higher injury rate is asymmetry. That is, if someone has a difference between left and right, they have a higher likelihood of injury in sports participation.
I have seen at least one asymmetry in 83% of people:
1 asymmetry: 41%
2 asymmetries: 25%
3 asymmetries: 15%
4 asymmetries: 1%
31% of people I have screened scored a 1 on the deep squat. I think it could be argued that a score of 1 on the deep squat would indicate a higher injury risk, as it indicates a significant limitation in movement. I believe this has been hypothesized in a study, but has not been proven. But in my opinion, definitely worth noticing.
Lastly, we look at pain. Or more accurately, we try to avoid pain. We find out what tests cause pain so that we can avoid it when we training. “No pain, no gain” is certainly not an expression I will ever use. For those that do use it, I sincerely hope they never use it when it comes to joint pain.
30% of people I screened had pain in at least one test
11% had pain in 2 or more tests.
The FMS teaches us that with one painful test, we can continue to train them, although referring them to a health care practitioner would be wise. With more than one painful test, there should certainly be a health care practitioner involved.
Now let’s see what the results look like when we break it down by gender, and whether they are an athlete. Note that these are not professional or collegiate athletes, but would better be described as “weekend warriors”. Many of them do train for their activity (or at least they do now!), and they tend to participate in their sport during the week as well, but their athletic pursuits have to fit around their jobs and their family.
Men vs women:
When we look at the results by gender, it is interesting to see that the top weakness is very different.
TSPU – 54%
HS – 32%
ASLR – 28%
RS – 26%
ILL – 25%
SM – 25%
DS – 11%
ASLR – 55%
ILL – 38%
RS – 36%
SM – 27%
HS – 20%
TSPU – 16%
DS – 9%
So we can see that the women are the reason pushups make the top 3 overall and men are the reason the straight leg raise made the top 3 overall. It is interesting to see that the results are quite different even beyond the worst test. I think for many this is probably not an entirely surprising result. Guys having tight hamstrings is almost a cliché, as is women having weak upper bodies. Unfortunately, I think these results show that these stereotypes often hold true.
It is important to note that the poor score on the straight leg raise (ASLR) for the guys may be due to instability in the hips. Based on my own observations from the test, most of the poor scores among men on the ASLR are actually due to lack of flexibility, not stability. There are two reasons I say that:
- When marking the ASLR, I look for how far they can lift their leg, but I also look at what the other foot is doing. If the other foot starts to turn out, that suggests that there is a stability issue at the hips rather than a flexibility issue at the hips. The person is likely using their other hip to stabilize through their full hip flexion range of motion. This is typically what I see with women who either score low, or who have asymmetries in the ASLR. I see this occasionally in men, but usually it happens in conjunction with limited range.
- When someone scores low on the ASLR, I usually do a passive straight leg raise test on them where I get them to relax and then I lift their leg up. In men who score poorly on the ASLR, the passive test rarely provides additional range of motion than the active test did. This suggests to me that the limitation is in range of motion, not stability.
Athletic vs sedentary
TSPU – 57%
ASLR – 36%
HS – 34%
ASLR – 58%
ILL – 36%
RS – 36%
I find it interesting to see the differences between the athletic and non-athletic population. Of particular interest to me is that athletic women do not fare much better than the general public women on the pushup (TSPU). Based on my observations, their pushups are better, but they still score low. Typically the general population women cannot get their body off the ground at all, whereas the athletic women can, but they often lack the core strength to be able to do so without upper and lower body separation. These two situations result in the same score on the FMS. You might think this is unfair, but I am glad it is the case, because core stability is so important that I want to know if there is weakness there.
I also looked at a few other factors:
Average # of asymmetries
Pain in any test?
I don’t think this final group of values shows any significant difference, although I find it interesting that 30% of the population I screened had pain in at least one test. That strikes me as unfortunately high, although I think that this number may not reflect the normal, as I get a lot of referrals from manual therapists (because they know I won’t hurt their clients). If I had primarily people walking into a gym on their own, I would hope to see fewer pain scores.
How can this information affect your programming or your training?
If I had to stop using the FMS tomorrow, and had to instead start training people blindly and without assessments, here is what I would do:
- I now know that 59% of clients will score below 14, which we believe means they are at an increased risk of injury when they play sports. This tells me that almost 2/3 of people who play sports really need my help. I will continue to recommend that everyone who plays sports also trains. For those who continue to play their sport to get fit, I sincerely hope you are one of the 41% who would have scored above the risk threshold.
- More than 8 out of 10 people who walk through my door have some kind of imbalance between their left and right. Since I will not know which 2 people are balanced, I will use single-limb exercises with everyone to overcome those asymmetries. I still love bilateral movements (especially deadlifts!), but my clients will have to earn the right to deadlift by showing me how strong they are on each leg in single leg exercises.
- I know that 30% of the people I see will find at least some basic movement painful. This is tough to know without knowing who are the ones with pain. The easy answer to this is that I will ask, and I will continue to advocate that “no pain, no gain” is a flawed expression, especially if the pain is related to a joint. If someone continues to have pain in some movements, I will strongly encourage them to see a health care professional. I am a trainer; I train people. I am not a physical therapist or a doctor. If someone has pain, ideally they should see someone trained in dealing with pain. I am fortunate to know some excellent health care professionals, to whom I can send people with confidence.
- 31% of the people who see me have no business squatting with weight. They lack some combination of hip, ankle and thoracic spine mobility, and core stability to do them well just supporting their body. If someone can’t do a proper squat with just their body, it’s really not a good idea to do them with weight on their back. If I don’t know which clients shouldn’t squat, then I would make an easy decision that nobody squats for at least the first month. That would be easy to implement considering item 2 (single limb training) above.
- Almost 4 out of 10 of my clients have movement limitations at the hips. Remember that hips and backs are VERY closely related (some might go so far as to say they are connected 🙂 ). And there is no shortage of back problems in our society. Since I won’t know which 4 of 10 people will have limitations in hip mobility or stability, and I also don’t know which 8 of 10 people will likely end up with low back pain, it’s a pretty easy decision to include hip mobility and stability exercises for everyone.
- 54% of my female clients will not be strong enough to do a single core pushup. Admittedly a core pushup (TSPU above) is harder than a regular pushup. But certainly this level of weakness suggests that I will not throw a new client into a bootcamp class and have them do 100 pushups, because 99 of them will likely bear little resemblance to a pushup. Instead, I will show them perfect pushup form and have them try it with their hands elevated. If they nail it, we will lower the elevation; if they have trouble, we will raise it. We’ll progress until they have amazing pushups on the ground. Then we’ll get them doing fun variations like alternate medicine ball pushups. As an aside, the term “girl pushup” is neither welcome, nor used in my gym. Elevated pushups from the feet are a much better option, and avoids the need to use such a ridiculous term. If you like pushups from the knees, that’s fine, but please don’t call them “girl pushups”. They’re pushups from the knees. (end rant)
- More than half of the female athletes who come to see me will not have a strong enough core to do a single core pushup, but many of them will be out playing sports that require a lot of stability. Women athletes are at high risk of ACL tears. I think there is a very strong correlation between core strength and ACL tears. I have thought this since reading a journal study this past winter that showed just that. Now I know that 57% of female athletes perform poorly on a core pushup versus 12% of male athletes, and I am 100% convinced that this is a huge factor in the higher rate of ACL tears among female athletes. Maybe a bigger factor than the high Q angle that is commonly implicated in ACL tears for women. The good news is that we can train core strength; we can’t train Q angle (the Q angle is the angle between the hip and knee, which, due to wider hips, tends to be larger for women than for men). Every female athlete who comes through my door will work on core strengthening.
- More than half of the men will have limitations in their hamstring range of motion. This one is a bit tough, because I know there are a lot of theories that people who get hamstring strains get them as a result of glute weakness that causes the hamstrings to overwork. Many of these people suggest that we shouldn’t stretch hamstrings, but rather we should stretch hip flexors and strengthen glutes. I agree with that conceptually, but I can’t pretend that more than half of my male clients perform very poorly when asked to lie on the ground and raise their leg. I think that shows hamstring tightness, and so if I don’t have the luxury of using the FMS on my clients, I will assume all men need to stretch their hamstrings. And so I will give them hamstring stretches. Since I also agree that tight hip flexors and weak glutes are a problem, I will also address that with hip flexor stretches and glute activation exercises.
- Please note that the “what to do” list above is not a complete list of what I think people need in their training; it is simply key points that I think anyone who does not use the FMS with their clients should consider.Elsbeth Vaino is an FMS certified personal trainer in Ottawa, Canada.Did you enjoy this article? If so, please click one of the icons below to tell the social networks about it.