By Rob Shaul
Early in my coaching career – even before I opened up my own gym, I purchased a copy of Gray Cook’s “Athletic Body in Balance” and began self-educating in the tangental fitness field of movement and mobility.
Around 2011 I completed a week-long mentorship/course at Athlete’s Performance (no Exos) in LA, where I was introduced to Cook’s Functional Movement Screen. The Athletes’ Performance coaches were FMS kool-aid drinkers and loved foam rolling and supplements.
Mark Verstegen of EXOS, formerly Athletes’ Performance, is the coach who developed the ideas of “prehab” and “rehab” before and after training sessions. The FMS aligned nicely with his theory in general on the links between mobility and durability, and more specifically in the need to take the time and attention for foam rolling, patterning exercises, mobility exercises, etc.
In 2012 I attended a 2-day FMS course in Phoenix. Cook himself was there, and explained the theory behind the screen and described a Marine Corps OCS study of over 800 candidates which he said proved the FMS score of <14 was a science-based predictor of durability and injury potential.
I was convinced, purchased a couple of the FMS testing kits and upon return to Wyoming, quickly tested all my athletes, and began deploying the geeky, FMS corrective exercises.
While we were deploying the FMS and Cook’s predictive exercises, I saw the screen and theory behind it continue to gain authority and wide-spread use in the team sport, personal training and tactical strength and conditioning worlds. Kelly Starrett exploded in the CrossFit world with his mobility WOD, and I even drove to Vegas to attend one of his courses.
We continued to deploy the FMS, and patterning exercises for a couple years at least, and those MTI vets reading this will recognize patterning exercises such as the “squat to stand”, “toe touch complex” and others from our programming back then. We also included some extensive foam rolling, limited “trigger point work”, stabilizer strength exercises (Jane Fonda), and other work in the “prehab” and “rehab” veins.
But, after all this effort, I started having doubts.
MTI’s FMS Experience
First, anecdotally, it seemed the athletes who scored best on the FMS were also the most delicate.
At its foundation, the Functional Movement Screen assesses movement in space – and better athletes simply move better. So the best natural athletes, naturally score best on the FMS.
But these natural athletes are also the most “delicate” in my experience.
One of the reasons good natural athletes can move better is they are in more tune with their bodies. I found this meant that every little ding and strain was amplified, and as a result, these athletes were injury prone. What I considered a little bump or bruise would sideline them from training, or result in a modified session.
I found the average natural athletes, the “grinders” to be the most durable. They could take a ding and just keep on grinding – but didn’t score nearly as well on the FMS.
Also, I found a disconnect between a good FMS score and fitness. I understand the FMS is not a fitness test, but I still thought this was instructive. Yoga instructors did awesome on the FMS, for example, but were not strong, lacked good work capacity, etc. on the fitness side.
In terms of Cook’s corrective exercises, I found with attentive coaching and lots of practice, athletes could see moderate corrective exercise improvement. However, under load, or during actual movement, the old moving patterns immediately returned. The work and learning from these corrective exercises did not transfer to the real thing – or outside the gym.
The patterning and mobility exercises designed to improve FMS scores were dead ends.
What Research Says
Following up on what I was observing in the gym and my growing doubts, I went back and took a closer look at the Marine Corps OCS study (1) Cook had highlighted during his FMS course.
A total of 874 Marine Officer Candidates had an FMS performed during medical in-processing. The mean FMS composite score among all candidates was 16.6 plus or minus 1.7. Approximately 10% of the candidates had an FMS score of <14. Injury was tracked during OCS, and the study found that an FMS score <14 had a 95% confidence level of predicting injuries during training.
However, the candidates who scored <14 on the FMS were also relatively unfit. 79.8% of the candidates with an FMS score <14 had initial USMC PFT scores <280 (out of 300), whereas just 6.6% of the candidates in the group with fitness scores >280 scored less than 14 on the FMS.
A closer look reveals that incoming fitness was a far greater predictor or durability than the FMS score.
I’ll repeat, fitness was a far greater predictor of durability than mobility.
Other FMS studies have found differing results:
- A famous 2007 study (2) of professional football players by one NFL team found that a FMS composite score <14 was a reliable predictor of injury during the course of the season and today the FMS is administered to all the rookies at the NFL combine.
- A 2015 study (3) of 160 collegiate athletes found that a FMS composite score <14, combined with a prior injury history had a 15 times greater chance of injury than an athlete with a FMS composite score >15, and no past history of injury.
However, a low FMS composite FMS score alone, <14, alone, was not a statistically significant predictor of injury.
- A 2016 study (4) of 167 injury-free college basketball, football, volleyball, cross country, track and field, swimming/diving, soccer, golf, and tennis athletes deployed the Functional Movement Screen (FMS) during a pre-sport examination with the goal of assessing the FMS’s effectiveness at predicting injury.The measure of “injury” was a non-contact or overuse injury which required intervention from the athletic trainer during a sport season. Results found that the FMS composite score (14/21 or less) “was not different between those injured and those not.” Also, “there was no association between FMS movement pattern asymmetry and injury.” Of the 7 different tests in the FMS, only the Lunge was associated with injury, “those scoring 2 were less likely to have an injury as those who scored 3.
- A 2017 Study (5) deployed pre-competition FMS on 257 Division II Collegiate athletes. Based on the FMS scores a <15 Composite score was used as the cutoff. “The overall prognostic accuracy of the FMS offered a slightly better than 50/50 chance of correctly classifying those most at risk for injury. As such, the FMS did not provide discriminatory prediction of musculoskeletal injury, overall injury, or severe injury in National Collegiate Athletic Association Division II athletes. Using the identified optimal cut score produced inadequate validity, regardless of the injury definition. We recommend using the FMS to assess movement quality rather than as a standalone injury-prediction tool until additional research suggests otherwise.”
- A 2021 Study of 124 high school athletes found that the FMS had no predictive value for lower extremity injuries.
So, with all the conflicting research on the FMS, plus the several studies which have found that the FMS does not predict durability, why all the continued attention and use of the FMS, and further the emphasis of the mobility and patterning-driven exercises and equipment?
Marketing and the promise of a quick fix.
Cook has proven to be a master marketer and has sold thousands of his $200, plastic FMS kits (I bought two), courses, and books. On the more general “prehab”, “rehab” and mobility sides, Starrett and others have helped develop a whole new market in the fitness, diet and wellness industry.
Few of these theories and exercises are simple, like good old front squats. Many are technically complicated and require extensive coaching. This is key. The “mobility” industry requires coaching, special equipment and lots and lots of practice. It’s a “sticky” product for those selling it.
There’s a true cost to this over-emphasis on mobility and movement, however. A cost to athlete durability.
What I’ve found with my athletes, and has been proven by research, is that mission-direct fitness is by far the greatest “armor” for mountain and tactical athletes against injury.
In general, I’m not against athletes getting massages, getting trigger point therapy, dry needling session, yoga, doing mobility work, etc. and despite my doubts about it’s effectiveness, I know that the stuff makes them feel good – at least in the short term. When asked my opinion of this stuff, I’ll answer, “if it’s working for you, keep doing it.”
The problem lays in time spent doing this stuff, which should be spent training mission-direct fitness. In this way, the FMS and the emphasis on mobility/patterning and industry-wide adoption have become a tyranny.
Athletes, especially military special forces with Exos-contracted coaches in garrison, and not familiar with my programming, will question MTI’s warm ups …. which will often have them completing a barbell complex, back squats, box jumps etc. right out of the gate. They’ll ask about “prehab” work and “rehab” cool downs.
I’ll answer that they are free to do that stuff on their own, after the training session, but I’ve only got them for 60 minutes or so and that time is best spent getting fit.
“What about a gentle warm up,” they’ll ask? “Prehab?”
“Do you get to warm up during the real thing?,” I’ll counter. “Before you hop out of the Humvee, our helicopter, or fire truck or squad car?”
I understand I’m a contrarian when it comes to this FMS and mobility/patterning stuff. Despite the shaky research, this stuff has become an established part of the fitness industry and entire businesses and careers are built on it’s continued use.
But I’m not a believer.
- OCS Study: 2011 https://www.ncbi.nlm.nih.gov/pubmed/21606876
- 2007 NFL Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953296/
- 2015 Study of 160 Collegiate Athletes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325284/