Functional Movement Tests Research Articles

Lower Quarter Y-Balance Test Scores and Lower Extremity Injury in NCAA Division I Athletes.

Background:Functional movement tests that are predictive of injury risk in National Collegiate Athletic Association (NCAA) athletes are useful tools for sports medicine professionals. The Lower Quarter Y-Balance Test (YBT-LQ) measures single-leg balance and reach distances in 3 directions.Purpose:To assess whether the YBT-LQ predicts the laterality and risk of sports-related lower extremity (LE) injury in NCAA athletes.Study Design:Case-control study; Level of evidence, 3.Methods:The YBT-LQ was administered to 294 NCAA Division I athletes from 21 sports during preparticipation physical examinations at a single institution. Athletes were followed prospectively over the course of the corresponding season. Correlation analysis was performed between the laterality of reach asymmetry and composite scores (CS) versus the laterality of injury. Receiver operating characteristic (ROC) analysis was used to determine the optimal asymmetry cutoff score for YBT-LQ. A multivariate regression analysis adjusting for sex, sport type, body mass index, and history of prior LE surgery was performed to assess predictors of earlier and higher rates of injury.Results:Neither the laterality of reach asymmetry nor the CS correlated with the laterality of injury. ROC analysis found optimal cutoff scores of 2, 9, and 3 cm for anterior, posteromedial, and posterolateral reach, respectively. All of these potential cutoff scores, along with a cutoff score of 4 cm used in the majority of prior studies, were associated with poor sensitivity and specificity. Furthermore, none of the asymmetric cutoff scores were associated with earlier or increased rate of injury in the multivariate analyses.Conclusion:YBT-LQ scores alone do not predict LE injury in this collegiate athlete population. Sports medicine professionals should be cautioned against using the YBT-LQ alone to screen for injury risk in collegiate athletes.

Effects of a Periodized Training Program and a Traditional Military Training Program on Functional Movement and Y-Balance Tests in ROTC Cadets

Background: Functional movement screening (FMS) and Y-balance test (YBT) are assessment procedures used to examine the ‘quality’ of movement patterns and identify individuals that might have specific limitations or asymmetries. Low FMS and YBT scores have been linked with a higher risk of injury among athletic populations. Since FMS and YBT are becoming more widely used screening tools, it is important to examine the various training programs that could improve FMS and YBT scores. Purpose: This pilot study examined the effects of a 10-week periodized and traditional military training program on FMS, and upper and lower quadrant YBT scores of Reserve Officers Training Corps (ROTC) Cadets. Methods: Subjects consisted of 36 Army and Air Force ROTC cadets (male=24, female=12), Age 19.7(yrs)±5.96, Height (cm)=175.7±9.28, Weight(kg)=75.70±13.41. The periodized, intervention group (IG n=24) trained for 1 hour/day, 4 days/week and the control group (CG n=12) participated in traditional ROTC training protocol for 1 hour/day, 3 days/week. A 2×2 mixed factorial analysis of variance (ANOVA) was used to compare mean change values of the FMS, upper, and lower quadrant YBT scores for intervention and control groups. Results: A significant interaction (p≤0.05) was observed for FMS scores. The control group had a much lower initial FMS score and demonstrated more improvement than the intervention group. Both groups demonstrated a significant increase in left side YBT upper (p=0.03) and lower (p=0.02) quadrant scores after 10-weeks of training. Conclusions: Since FMS and YBT scores are being used more frequently as screening tools for risk of injury, it is important to study methods that will improve FMS and YBT scores in diverse athletic populations. This study found larger improvements in FMS scores in ROTC cadets participating in a traditional military training program compared to cadets participating in a periodized strength training program. Scores in the left side of the YBT upper and lower quadrants were improved in both groups suggesting multiple training programs can improve function in non-dominant sides or asymmetries. Future studies are warranted and should address certain limitations that this study encountered (sample size and length of training period). Further exploration of FMS and YBT scores and mechanisms of improvement in tactical athletic populations would be beneficial.

The functional movement test 9+ is a poor screening test for lower extremity injuries in professional male football players: a 2-year prospective cohort study

BackgroundThe 9+ screening battery test consists of 11 tests to assess limitations in functional movement.AimTo examine the association of the 9+ with lower extremity injuries and to identify a cut-off...

Muscle Force-Velocity Relationships Observed in Four Different Functional Tests.

The aims of the present study were to investigate the shape and strength of the force-velocity relationships observed in different functional movement tests and explore the parameters depicting force, velocity and power producing capacities of the tested muscles. Twelve subjects were tested on maximum performance in vertical jumps, cycling, bench press throws, and bench pulls performed against different loads. Thereafter, both the averaged and maximum force and velocity variables recorded from individual trials were used for force–velocity relationship modeling. The observed individual force-velocity relationships were exceptionally strong (median correlation coefficients ranged from r = 0.930 to r = 0.995) and approximately linear independently of the test and variable type. Most of the relationship parameters observed from the averaged and maximum force and velocity variable types were strongly related in all tests (r = 0.789-0.991), except for those in vertical jumps (r = 0.485-0.930). However, the generalizability of the force-velocity relationship parameters depicting maximum force, velocity and power of the tested muscles across different tests was inconsistent and on average moderate. We concluded that the linear force-velocity relationship model based on either maximum or averaged force-velocity data could provide the outcomes depicting force, velocity and power generating capacity of the tested muscles, although such outcomes can only be partially generalized across different muscles.

Automated Assessment of Dynamic Knee Valgus and Risk of Knee Injury During the Single Leg Squat.

Many clinical assessment protocols of the lower limb rely on the evaluation of functional movement tests such as the single leg squat (SLS), which are often assessed visually. Visual assessment is subjective and depends on the experience of the clinician. In this paper, an inertial measurement unit (IMU)-based method for automated assessment of squat quality is proposed to provide clinicians with a quantitative measure of SLS performance. A set of three IMUs was used to estimate the joint angles, velocities, and accelerations of the squatting leg. Statistical time domain features were generated from these measurements. The most informative features were used for classifier training. A data set of SLS performed by healthy participants was collected and labeled by three expert clinical raters using two different labeling criteria: “observed amount of knee valgus” and “overall risk of injury”. The results showed that both flexion at the hip and knee, as well as hip and ankle internal rotation are discriminative features, and that participants with “poor” squats bend the hip and knee less than those with better squat performance. Furthermore, improved classification performance is achieved for females by training separate classifiers stratified by gender. Classification results showed excellent accuracy, 95.7 % for classifying squat quality as “poor” or “good” and 94.6% for differentiating between high and no risk of injury.

Interseason variability of a functional movement test, the 9+ screening battery, in professional male football players

BackgroundThe Nine Plus screening battery test (9+) is a functional movement test intended to identify limitations in fundamental movement patterns predisposing athletes to injury. However, the interseason variability is unknown.AimTo...

Feature Selection and Predictors of Falls with Foot Force Sensors Using KNN-Based Algorithms.

The aging process may lead to the degradation of lower extremity function in the elderly population, which can restrict their daily quality of life and gradually increase the fall risk. We aimed to determine whether objective measures of physical function could predict subsequent falls. Ground reaction force (GRF) data, which was quantified by sample entropy, was collected by foot force sensors. Thirty eight subjects (23 fallers and 15 non-fallers) participated in functional movement tests, including walking and sit-to-stand (STS). A feature selection algorithm was used to select relevant features to classify the elderly into two groups: at risk and not at risk of falling down, for three KNN-based classifiers: local mean-based k-nearest neighbor (LMKNN), pseudo nearest neighbor (PNN), local mean pseudo nearest neighbor (LMPNN) classification. We compared classification performances, and achieved the best results with LMPNN, with sensitivity, specificity and accuracy all 100%. Moreover, a subset of GRFs was significantly different between the two groups via Wilcoxon rank sum test, which is compatible with the classification results. This method could potentially be used by non-experts to monitor balance and the risk of falling down in the elderly population.

Can fitness and movement quality prevent back injury in elite task force police officers? A 5-year longitudinal study

Elite police work has bursts of intense physically demanding work requiring high levels of fitness, or capacity, and movement competency; which are assumed to increase one's injury resilience. The purpose of this study was to follow members of an elite police force (N = 53) to test whether back injuries (N = 14) could be predicted from measures of fitness and movement quality. Measures of torso endurance, relative and absolute strength, hip ROM and movement quality using the Functional Movement ScreenTM and other dynamic movement tests were obtained from every officer at baseline. When variables were grouped and considered holistically, rather than individually, back injury could be predicted. Seven variables best predicted those who would suffer a back injury (64% sensitivity and 95% specificity for an overall concordance of 87%). Overall, the ability to predict back injury was not high, suggesting that there is more complexity to this relationship than is explained with the variables tested here.Practitioner Summary: Members of elite police forces have exposure to intense physically demanding work. Increased levels of fitness and movement competency have been assumed to increase injury resilience. However, complexity in the interactions between exposure, movement competency, training, fitness and injury may occlude the true relationship between these variables.

Star Excursion Balance Test Predicts Performance On Lower-Limb Movement Tests In Women With Knee Pain

Dynamic postural control is achieved by maintaining a stable base of support whilst undertaking upright tasks. For individuals with lower limb injury or pain, an inability to control balance may be a contributing factor to their condition. Nonetheless, clinicians tend to consider that poor movement patterns arising during functional movement tests are due to a lack of control (e.g. at the hip or knee), which undermines the contribution of global balance to observed movement patterns. PURPOSE: To determine the contribution of postural control to performance on 3 common functional movement tests. METHODS: Women with anterior knee pain (AKP) and age- and sex-matched uninjured controls were recruited. Dynamic postural control was examined using the Star Excursion Balance Test (SEBT) where participants stood on their most affected leg and reached for maximal distance with the other leg in 8 directions. SEBT scores were normalised to leg length, summed for an overall score, and also separated into scores for ‘away’ and ‘toward’ the affected leg. Participants also performed 3 common lower limb musculoskeletal screening tests, including a single leg squat (SLS), single leg hop (SLH) and drop vertical jump (DVJ). Each test was captured using 2D video and rated for movement quality using a validated global 10-point ordinal scale by 10 trained physical therapists. Mean ratings of performance for each participant and test were compared between groups using one-way ANOVA. Linear regression was used to determine the ability of SEBT scores to predict lower limb function. RESULTS: Ten women with AKP (age: 23.2±2.8 years) and 10 women free from musculoskeletal impairment (age: 23.1±1.8 years) participated. Total SEBT score (345±32cm vs 377±19cm, p=0.015) and SEBT score ‘away’ from the affected leg (134±10cm vs 150±8cm, p=0.002) were lower for those with AKP compared to controls. There was no difference in SEBT score ‘toward’ the affected leg for the AKP group compared to the controls (121±15cm vs 131±9cm, p=0.114). Total SEBT score predicted variance in SLS performance (R2 = 0.525, p< 0.001); but not SLH (p=0.861) or DVJ performance (p=0.335). CONCLUSION: Young adult women with AKP exhibit poorer lower limb dynamic postural control than healthy controls. Further, balance is positively related to single leg squat performance.

Functional Tests Do Not Differ Between Injured and Not Injured in Division I Female Athletes

The Y-balance Test (YBT), single (SLH), triple (TH), and crossover (XH) hop test for distance and the tuck jump assessment (TJA) are functional movement tests that assess single leg limb control and dynamic movement performance, which has been suggested to influence injury rates. Identifying risk factors for non-contact injury may help with injury prevention. Purpose: To describe functional tests performance in Division I (DI) female college athletes and to compare performance between those who sustained a non-contact injury with those who did not. METHODS: 82 female athletes (age: 19.3 yrs ± 0.3, ht: 168.6 cm ± 1.9, wt: 66.3 kg ± 3.5) were screened and excluded if currently injured or not in appropriate testing attire. Participants completed YBT anterior reach (n=82), hop tests (n=60) and TJA (n=51) during pre-participation examination. Athletes competed in the sport season and non-contact injury data was collected from injury reports created by athletic training staff. Asymmetry with YBT anterior reach and hop tests was calculated as the difference in performance between the right and left leg. Hop tests were also normalized to leg length. The TJA assessed 10 standardized flaws with a total score as the sum of the 10 flaws. The difference between those injured and uninjured with all tests was calculated using independent t-tests. RESULTS: 17 student-athletes reported a non-contact injury. No associations were found between non-contact injury and functional tests (Table 1). Results for left leg hop tests were similar to results on the right. CONCLUSIONS: No statistically significant differences were found between the occurrence of DI female athlete’s non-contact injury and YBT scores, SLH, TH, XH, or TJA scores. In this cohort of DI female athletes, the functional tests had limited utility in identifying individuals at risk for non-contact injury.

A Functional Movement Screening on 6th Grade Students of a Caribbean Elementary Laboratory School

The purpose of this study was to examine the functional body movement of sixthgrade students of a Caribbean Elementary Laboratory School. A total sample of 39 students, including special education, participated in the study. The Functional Movement Screening Test was used to identify the functional movement body profile of the students and the strength and areas to be improved in their body movement after completing a Physical Education Program K6. The participants completed a series of movement exercises (Deep Squat, Hurdle Step, Inline Lunge, Shoulder Mobility, Active Straight-Leg Raise, Trunk Stability Pushup, and Rotary Stability) of seven different skills of the Functional Movement Screening (FMS). An independent t-test analysis and descriptive data was used to analyses the collect data. The findings of the study show that 87.3% students from the Elementary Laboratory School of the University of Puerto Rico scores 14 points or more on the Functional Movement Test. The results of the study reflect that students of laboratory school that experiences different learning practices in Physical Education Program benefits their body functional movement.

Mobile Sensor Application for Kinematic Detection of the Knees.

ObjectiveTo correctly measure the knee joint angle, this study utilized a Qualisys motion capture system and also used it as the reference to assess the validity of the study's Inertial Measurement Unit (IMU) system that consisted of four IMU sensors and the Knee Angle Recorder software. The validity was evaluated by the root mean square (RMS) of different angles and the intraclass correlation coefficient (ICC) values between the Qualisys system and the IMU system.MethodsFour functional knee movement tests for ten healthy participants were investigated, which were the knee flexion test, the hip and knee flexion test, the forward step test and the leg abduction test, and the walking test.ResultsThe outcomes of the knee flexion test, the hip and knee flexion test, the forward step test, and the walking test showed that the RMS of different angles were less than 6°. The ICC values were in the range of 0.84 to 0.99. However, the leg abduction test showed a poor correlation in the measurement of the knee abduction-adduction movement.ConclusionThe IMU system used in this study is a new good method to measure the knee flexion-extension movement.

Functional movement test scores improve following a standardized off‐season intervention program in professional football players

The purpose of this study was to determine if an off-season intervention program was effective in improving Functional Movement Screen(™) (FMS) scores in professional American football players. Pre- and post-intervention FMS scores were obtained on 62 subjects who completed a 7-week off-season intervention program. A repeated measures ANOVA was conducted to determine the effectiveness of the training program on FMS scores. A chi-square was performed to determine if there were a greater number of players who met the injury threshold and if asymmetries were reduced following intervention. Logistic regression was used to predict what factors were associated with failure (post-test score of <14). There was a positive main effect for time (P<0.01) and a greater number of individuals with a score >14 following the intervention. At post-test, 41 players were free of asymmetry as compared with 31 at the pre-test. The strongest predictor of program failure was a low squat score at pre-test. This study demonstrated that fundamental movement characteristics do change with a standardized intervention. Further research is required to determine if injury risk is reduced when a player's score improves beyond the established cut-off of 14 and/or asymmetry is resolved.

Gender Differences In Functional Movement Screen And Y-balance Test Scores In Middle School Aged Children

Poor static and dynamic postures have been related to musculoskeletal injury. These postures can cause poor arthrokinematics, which in time may lead to pain and disability. Recent research has suggested that better functional movement and dynamic balance are associated with reduced injury rates. However, there are no published reports in this area on middle school aged children and whether gender differences exist in this age group. PURPOSE: To examine gender differences in functional movement quality and dynamic balance, as measured by the Y-Balance testing protocol, in middle school aged children. METHODS: Two physical education classes of middle school aged students (13 boys and 19 girls) were recruited for the study. Informed consent was obtained from the students and the students' parents. All students participated in dynamic balance testing using the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test as measured by the Y-Balance testing device. Scores on anterior, posteromedial, posterolateral, and composite reach distances were normalized to leg length. In addition to Y-Balance testing, all students participated in the Functional Movement Screen. The Functional Movement Screen consisted of 7 tests: squat, lunge, hurdle step, push up, shoulder mobility, active straight leg raise, and rotary stability test. Independent samples t-tests were used to examine differences between boys and girls for the Y-Balance Test scores while Mann-Whitney U tests were used to examine differences in the functional movement tests due to the rank-order nature of the data. RESULTS: Girls performed better on the squat, lunge, straight leg raise, and shoulder mobility compared to boys (p<0.05). There were no statistically significant differences between girls and boys for the hurdle step, push up, rotary stability or any of the Y-Balance Test reach scores (p>0.05). CONCLUSION: Girls and boys of middle school age may exhibit different qualities of functional movements. Studies focused on improving functional movements in middle school aged children should consider these findings when developing interventions aimed at improving functional movements. Supported by the Welborn Baptist Foundation, Inc.

Functional Movement Test Score as a Predictor of Time-loss during a Professional Football Team's Pre-season

PURPOSE: Researchers have reported that athletes with poor dynamic balance or asymmetrical strength and flexibility (i.e. poor fundamental movement patterns) are more likely to be injured. There is no gold standard measurement tool available to assess these risk factors. The fundamental movement patterns tested in the Functional Movement Screen (FMS) place the athlete in positions where ROM, stabilization, and balance are assessed simultaneously. It has been reported that professional football players with a composite score of ≤ 14 on the FMS are more likely to be injured over the course of a season. The purpose of this study was to determine if fundamental movement characteristics and power have a relationship with time-loss injury over the course of the pre-season in professional football. METHODS: FMS scores and upper and lower body power were obtained prior to the start of training camp for one professional football team (n = 81). The previously established cut-off score of ≤ 14 on the FMS, the presence of asymmetries on the FMS, upper and lower body power, and rookie/veteran status were examined using odds ratio and logistic regression analyses to determine if a relationship exists with time-loss injury. RESULTS: Logistic regression models indicated that players with an FMS score ≤ 14 were approximately 11 times more likely to be injured and players with an asymmetry were 3 times more likely to be injured (p < 0.05). There was no significant relationship with rookie/veteran status or power. When diagnostic testing statistics were applied, having one risk factor was highly sensitive .80 (CI95 .64-.91) LR- = .37 (CI95 .16-.77) and having both risk factors was highly specific .98 (CI95 .93-.99) LR+ = 13.4 (CI95 2.3-84.2) to time-loss injury. CONCLUSIONS: The results of this study suggest fundamental movement and movement asymmetry (as measured by the FMS) were independent identifiable risk factors for time-loss injury during the preseason in professional football players and that power and rookie/veteran status were not. These results are consistent with previous research in professional football demonstrating higher injury risk for individuals with inferior fundamental movement patterns. Future research should investigate whether these risk factors are modifiable and if modification results in reduced injury risk.