FMS, Circus Acts, and True Functionality
Functional this, functional that... The word has overrun my social media feeds, and is the subject of countless articles across reputable and not so reputable websites. To be 100% honest, it does my head in. Why? Because half (and that’s being generous) of this content is absolute rubbish and does not reflect function. By definition in the Oxford Dictionary:
- An activity that is natural to or the purpose of a person or thing.
- Practical use or purpose in design.
If function is natural and has a purpose, you have to ask yourself what a lot of trainers and physios are doing. They may say they’re doing functional training, but is it? Or is it just a simple movement pattern, or something they made up that does nothing and makes you look like a fool in the gym?
It is pretty damn difficult to identify true function in a specific sport. Attempts are made within sports to quantify certain aspects by applying a numerical value to a specific act. In rugby, for example, the tackle made by a player can be graded from 1-5, where 1 is a missed tackle and a 5 is a hit that forced a turnover. As you can imagine, there is a high degree of subjectivity or personal bias associated to such a scoring system, and gray areas will exist.
When a search for evidence in the literature is undertaken relating to function, the most common finding is the Functional Movement Screen (FMS). The FMS is a system devised by a group of American professors and physical therapists that attempts to quantify movement with a scoring system, where 0 represents pain that inhibits movement, and 3 represents perfect movement form for the seven movements prescribed: overhead squat, lunge, hurdle step, straight leg raise, push up, and rotary stability.
I have a decent amount of experience with the FMS (and the SFMA), as I was one of the first accredited practitioners in the UK and spent some time with Gray Cook and Kyle Kiesel (two of the developers). Both these guys are extremely clever and their thought processes are excellent. I have utter respect for what they are attempting to do with quantifying movement. However, it is movement they are quantifying, and I would argue the function part is equivocal. For sure, if you squat, lunge, step over, or do a push up, it is measuring your function, but only if these movements are functional to that individual. If you score badly on the FMS, does it mean you are destined to be injured or not be able to do a particular sport? Of course not, and I don’t think even Gray or Kyle believe that.
If a movement screen doesn't test things you need to do, can it be called functional?
Consider a recent study that investigated young fast bowler cricketers in Australia.1 Fast bowlers performed the FMS before the start of the season, and injury incidence was monitored monthly throughout the season. There was no difference between the non-injured group and the injured group in terms of FMS scores, and the composite score of <14 had no bearing on the injury rates. The conclusion of the authors: “A total FMS score of 14 does not provide the sensitivity needed to assess injury risk among adolescent pace bowlers and no other accurate cut-off score could be calculated.” The FMS composite score of <14 is now no longer viewed as the essential cut off point. Now, the individual movements and asymmetries are placed with a higher importance in predicting injury.
Another example comes from a study investigating the FMS and chronic low back pain.2 The study recruited 20 chronic back pain sufferers and 20 healthy subjects. Unsurprisingly, the chronic pain sufferers had a reduced capacity to perform the movements, specifically the squat, hurdle step, straight leg raise, and rotatory stability tests. The surprising thing from this study was that the authors concluded that the FMS could be used “as a functional assessment tool to identify functional deficits in chronic lower back pain patients.” But the FMS assesses specific movements, and unless these individuals do them all the time as part of their life, the FMS is not truly assessing their function, but merely a specific movement and their ability to do it.
Don’t get me wrong, the FMS can be useful for seeing what a patient can and cannot do. It is a great tool to use as a marker of their ability to do a squat, lunge, push up, etc. in order to create a baseline for them and get them towards exercise, but it is not looking into their function. Only when you investigate and decipher what is really going on in a chronic pain sufferer’s life (physical and psychological) do you get anywhere near what constitutes true function for them.
Training for Function
I am not bashing the FMS—I like it. I have a bastardized version I use that includes movements I believe are important for athletic ability. The take home message here is that functional training should reflect the function you require. So if you are doing functional training that involves walking handstands, I guess you are in the circus. Why not instead call it movement training, since that is what it is?
I work in professional sailing with Oracle Team USA as they attempt to defend the 35th Americas Cup. These guys are athletes—true athletes. They lift weights three times per week (power cleans, deadlifts, bench press, squats etc.), sail for 2-4 hours up to four times per week, and top up with pedestal grinding sessions for fun. The training they do is functional. The deadlift or RDL they do is used specifically to train the posterior chain. The posture they are in during these lifts is very similar to the posture they are in during grinding. We also know from several studies related to grinding performance that the involvement of the lower limb is paramount to performance.3 Therefore, a significant amount of their training involves squatting, deadlifting, and cleaning. It is built into their program because it improves their function. It has a purpose, which is to make them better athletes and better at grinding and sailing in order to win the America’s Cup.
Only when a movement helps you toward a goal can it be termed functional.
The other key principle to consider is Specific Adaptation to Imposed Demand (SAID). This principle states that if you do something enough times, you will positively respond and adapt to it. Therefore, grinding on grinding machines is perhaps the best example of functional training that the sailors can do in order to adapt and improve their performance. The strength training translates to improving grinding performance and can be considered additional work for a specific, functional task.
Am I against drills that improve mobility, co-ordination and proprioception? Absolutely not! Am I against calling every new exercise developed by someone with an interest in physical activity a functional drill just for the hell of it? Yes! So the next time you are doing a functional exercise, ask yourself—and the person giving it to you— “Is it really?”
It's not too late to rediscover what training should be:
1. Martin, Candice, Benita Olivier, and Natalie Benjamin. "The functional movement screen in the prediction of injury in adolescent cricket pace bowlers: an observational study." Journal of Sport Rehabilitation (2016): 1-30.
2. Ko, M.J., Noh, K.H., Kang, M.H. and Oh, J.S., 2016. Differences in performance on the functional movement screen between chronic low back pain patients and healthy control subjects. Journal of Physical Therapy Science, 28(7), pp.2094-2096.
3. Pearson, S.N., Hume, P.A., Cronin, J. and Slyfield, D., 2016. America’s Cup Sailing: Effect of Standing Arm-Cranking (“Grinding”) Direction on Muscle Activity, Kinematics, and Torque Application. Sports, 4(3), p.37.