The Functional Movement Screen (FMS) Reviewed

Can the Functional Movement Screen show your risk of injury? Science says “probably not.”

Has a coach, trainer, or physical therapist “screened” you for injury risk and dysfunctional or performance-limiting movement patterns? The Functional Movement Screen (FMS) is a set of seven physical tests of coordination and strength, especially “core” strength, invented in 1997 and now in widespread use around the world. It was originally proposed as a trouble-detection system, which is baked into the name: it’s a “screen.”

The basic idea is that subtle but objectively verifiable signals in how people move and function can predict their risk of injury in the future. From a bit of a distance, FMS looks like a fancy version of the much older practice of posturology, the pseudoscience of the role of posture in health.1

The validity of FMS is uncertain, but its use in the wild often seems to over-reach its stated purpose — which is almost inevitable with any branded, commercialized methodology. Once someone has paid real money to be certified in something, they are much likelier to exaggerate its importance. Manual therapists particularly2 eat the idea up and get evangelical about it — because it confirms their biases about how pain and injury work. And, of course, once you have paid for an expensive hammer…

But the science casts strong doubt on FMS. FMS founder Lee Burton in 2011: “The biggest critique we have gotten over the years is the lack of research to support use of the FMS” but “more and more research is becoming available relating to its scope and effectiveness.”3 But the state of the evidence then was not encouraging — the opposite, I fear — and meanwhile FMS continued to be promoted as though its powers are proven. Despite Burton’s statement, I think the marketing cart was always well out in front of the research horse — as so many carts are in the world of training, sports medicine, and manual therapy.

This isn’t a thorough review of FMS per se: it is focused on the abuse of FMS as a way to diagnose the average athlete or patient (consider the closely related “SFMA,” which is actually advertised as a “movement based diagnostic system”). However, these concerns do cast doubt on the validity of FMS in general, and also the broader idea of corrective exercises, which is based on hypothetical problems to correct (like core weakness).

Functional Movement Screening in theory

“To date [2016], there is no intervention study providing support for screening for injury risk.”

Bahr, 2016, British Journal of Sports Medicine4

A “screen” has a specific meaning, and it is not a diagnostic tool: it is just for detecting individuals who might need diagnosis in the future. This is a common concept in health care — think “mammogram” or “prostate exam”5 — but not so much in sport and rehabilitation. The complexities and ethics of screening are a bit exotic, normally debated in the context of vast public health initiatives. Many screens are of dubious value, especially because they are too good at generating false alarms.

Anoop Balachandran explains how screening is fundamentally a different ethical beast than diagnosis, because you are telling basically healthy people what might be wrong with them in time, and that raises the stakes6 (specifically the real risk of nocebo7):

The validity of screens should be of the highest quality since you are “labeling” people and hence we should have very solid proof that people will be better off in the long run. When someone scores less than the cut off in the FMS, you tell them their chance of getting injured is extremely high. This is a great way to get someone to move less or have fear of movement or spend his or her time and money trying to fix it with their trainer.

Anoop Balachandran, MSc Exercise Physiology, MSc Human Performance

Nevertheless, it was a fine idea to try to introduce FMS into the world of performance and rehab. Truly, we could use a good screen. It’s just not clear that FMS actually is a good screen … or that it is even being used as just a screen. Indeed, it’s seems clear that it’s not.

Functional Movement Screening in practice: a diagnostic tool?

Imagine if medical professionals used a screening test like a mammogram to tell patients, “You probably have cancer!” Rather than “we see a reason to check, but it could easily be a false alarm.”

That’s the difference we’re talking about here.

The FMS is officially not meant for assessing people who are already hurting or injured; it’s supposed to just be a way to identify “limitations” and risk factors for injury. And yet the people that gave us FMS also teach a closely-related (but less well-known) “movement based diagnostic system,” the SFMA. Whatever it’s called, professionals are definitely out their in the wild actually diagnosing based on movement, one way or another — either abusing the spirit of the FMS, or using SFMA as intended.

So either FMS should change its name, or it should actually only be used as a screen, and not a diagnostic tool. But in the real world, FMS is often promoted as a tool that can “detect” biomechanical problems and therefore justify training or treatment methods to “correct” them. Again, founder Lee Burton: “FMS is designed to identify movement pattern dysfunctions, thereby helping create the best possible intervention.”8

That’s no screen. That clearly blurs the lines between screening, diagnosis, and treatment. You cannot choose an “intervention” (treatment) without thinking you know what’s wrong.

And the “best possible intervention” is often expensive, of course. Athletes and sports teams may invest heavily in following advice that is based substantially on FMS assessments.

FMS certification and exaggeration of its benefits is also often used to create an impression of diagnostic competency in professionals — coaches and trainers — who are trying to seem more like therapists and should not be diagnosing at all (or even seem to be). Athletes and fitness buffs are often “enablers” in this regard.9

This is a general problem with the industry, of course, but FMS certification is a prominent example.

A little searching on the Internet can quickly scare up examples of FMS being used diagnostically. In just a few seconds, I found a chiropractic website with the claim that FMS “uncovers limitations and asymmetries in the movements of healthy individuals.” It goes on “Corrective exercises can then be prescribed to overcome these deficiencies.”10 The overconfident use of FMS to justify specific treatment is blatant here.

Or look at this amusing example of overconfident promotion of FMS: big diagnostic and treatment promises, to the tune of cheesy 80s rock anthem “Eye of the Tiger.” (Admittedly, it’s a nostalgic classic. My foot taps … ) In the video, modestly titled FMS: Get Your Best Body, a chiropractor demonstrates FMS and explains:11

Depending on your score and asymmetrical results from left to right side I can determine your non-painful dysfunction. We correct that and you become a better athlete. Stronger, more flexible, stable, mobile and powerful. Oh, and you can get out of chronic pain…

Are these just isolated cases of FMS hype? Perhaps FMS training and certification would minimize such overstatement? Perhaps. There may well be FMS practitioners who overstate the claims of FMS, going beyond its intended use. But FMS certification is granted by a company that promotes it with language surprisingly similar to the examples above. The official FMS website is generally heavy with promotional language and light on the science:12

… the FMS readily identifies functional limitations and asymmetries … used to target problems … directly linked to the most beneficial corrective exercises to restore mechanically sound movement patterns … identify those exercises that will be most effective to restore proper movement …

“About” page of FunctionalMovement.com13

Visit FunctionalMovement.com, have a look around, and judge for yourself. Does it seem like they are promoting a screening tool with modest goals and appropriately limited scope? Or a diagnostic tool “directly linked” to treatment?

The Functional Movement Screen fails to detect recent injury

The use of FMS as a screen and a diagnostic tool has been particularly problematic because “normal” test results had never been defined. A low FMS score supposedly means that you are more likely to get hurt, but … lower than what? FMS needs a baseline — or even several of them, for a variety of well-defined populations.

A 2011 study in International Journal of Sports Physical Therapy set out to get the numbers for normal.14 According to Schneiders et al. the idea that FMS has diagnostic power is (emphasis mine):

… based on the assumption that identifiable biomechanical deficits in fundamental movement patterns have the potential to limit performance and render the athlete susceptible to injury.

However, their experiment could not even detect a difference in test results in people who had actually been injured recently. The results

demonstrated no significant differences on the composite score between individuals who had an injury during the 6 last months and for those who had not.

Past injury is probably a risk factor for future injuries — for instance, the reasons for the original injury may persist and cause re-injury, or a new injury. If FMS cannot detect any sign of recent injuries, it seems unlikely that it can detect the risk of future injuries, let alone be used as a basis for a specific therapy.

This is not surprising. In general, rehab science has generally been failing for decades to nail down correlations between even the most obvious-seeming “biomechanical bogeymen” and common injuries, let alone the smoking gun of a true cause. Even if there are biomechanical causes of pain and injury — and doubtless there are some — I wouldn’t expect a set of physical tests to reveal them in an exact or reliable way.

Anoop Balachandran criticizes the rationale for FMS in more detail:15

Why should mechanical stress caused by “faulty movement patterns” always “lead to microtrauma and injury”? Why can’t tissues just positively adapt and get stronger just like a normal biological tissue? If indeed faulty movement patterns were the cause of injury, all those cerebral palsy patients, stroke victims, people with neurological disorders and amputees should be in complete pain. There are double amputees who run faster than most of us and still feel no pain. The compensations and asymmetries are 100% in these amputees and they should be crying out loud in pain rather than running around. Maybe that movement pattern is “ideal” for them and the tissues have adapted to it.

Anoop Balachandran, MSc Exercise Physiology, MSc Human Performance

A long, fragile chain of reasoning

FMS is a classic example of structuralism — the excessive preoccupation with biomechanical factors in injury and pain.18 In particular, it leans into the faddish notion that “core strength” is critical, an idea that has been harshly criticized by experts19 and has generally failed to live up to its reputation.20 At best, the value of core strength remains controversial. At worst, it’s been a serious red herring in the fitness and therapy industry.

Structuralism depends on complex chains of reasoning that are only as strong as their weakest links. For FMS to deliver what it promises, all of the following links must be sound:

• Non-obvious functional limitations must be consistent signs of “dysfunction.” If they are …
• Subtle dysfunction must in turn actually be a cause of injury and limited athletic performance. This theoretical foundation is highly controversial and complex. But even if it’s solid … which is a huge if …
• FMS practitioners must be able to reliably detect the existence of specific non-obvious functional limitations. Schneiders et al. found that this link is okay. If it really is …
• FMS practitioners must be able to reliably associate those functional limitations with a much more complex array of potential problems that could be causing them. Here again we see the problem with the difference between screening and diagnosing. Perhaps anyone can be trained to spot poor performance on FMS tests. But can anyone identify the cause of that poor performance? What if it’s an early sign of a slow-developing neurological disease? Diagnosis is a vastly more complex beast than screening. If FMS practitioners can diagnose reliably …
• The identified dysfunctions must actually be correctable in principle. A basic problem with many biomechanical theories of pain is that, even if true, there’s nothing that can be done about them. If they are correctable …
• The FMS practitioners must then be able to reliably prescribe appropriate correction.

If FMS practitioners can do all that — and do it reliably — then they can deliver what they are promising.

Is the FMS science here yet?

It’s trickling in. There’s probably enough for some tentative conclusions now. The first version of this article was written in 2011, mostly hype-griping, and it went untouched for three years while FMS promoters carried on making claims about a “growing body of research,” of course — all bogus citations to research that wasn’t actually persuasive (but great for marketing). And maybe things have gotten worse since.

A summer 2014 paper by Whiteside et al. echoes all my original concerns, but with harder data.21 The researchers focused on the accuracy of FMS grading in particular: “virtually no investigations have probed the accuracy of FMS grades assigned by a manual tester.” So they probed it! They compared “the FMS scores assigned by a certified FMS tester to those measured by an objective inertial-based motion capture system.” Alas for FMS, the results were “poor,” which is exactly what I’ve been betting on all along.

Manual grading may not provide a valid measurement instrument. The levels of agreement between the two grading methods were poor in all six FMS exercises. It appears that manual grading of the FMS is confounded by vague grading criteria.

The discussion section of the article is detailed, readable, and full of ominous understatement. “Dubious grading presents a concern for FMS clientele,” they write. They graciously allow that, with better objective criteria, FMS grading might “improve to acceptable levels.” Meanwhile, FMS testers are officially encouraged to aim for lower scores when in doubt, but in this test, even under scrutiny, apparently they didn’t have much self-doubt, consistently scoring “0.54 points higher than the IMU system.” (I’m shocked, simply shocked, to learn that FMS practitioners might be a tad overconfident!) The authors also point out that FMS has not only failed to reliably forecast injuries, but all FMS predictions may be “a product of specious grading.” Which is hardly surprising, since FMS fails to take into account “several factors that contribute to musculoskeletal injury.” These concerns must be addressed “before the FMS can be considered a reliable injury screening tool.”

Clearly more research is needed — of course! Naturally! But it’s worse than that:

The high potential for subjective and/or inaccurate grading implies that standard procedures must be developed before FMS performance and injury rates can be conclusively studied.

Before it can be studied. They seem to be saying that not only is the cart still in front of the FMS horse, the horse may now be falling well behind. FMS research so far may be a bit of a write-off, because it can’t inform us without better criteria, and everyone should probably just go back to the drawing board and try again. Which suggests that this article is still reasonably sound after three years without an update.

Despite these limitations, a wave of research produced enough data to be worthy of review by 2015.

The early research reviews

The first review of the predictive validity of FMS was published in late 2015, with a predictably and resoundingly negative conclusion based on generally mediocre data from seven studies:22

Based on analysis of the current literature, findings do not support the predictive validity of the FMS. Methodological and statistical limitations identified threaten the ability of the research to determine the predictive validity of FMS.

A 2016 review in the British Journal of Sports Medicine surveyed 17 “mostly low quality” studies of the relationship between leg injuries and movement quality, concluding it is “inconsistent.”23 In other words, we still have no idea if we can tell who’s going to get leghurt based on screening people for quality-of-movement trouble. Standard caveats about garbage-in-garbage-out reviews seem to apply here: the results are officially inconclusive, but the absence of a clear positive signal is damning.

In 2017, another review in the British Journal of Sports Medicine reinforced the bad news:24 screening results of a few hundred soccer players were not associated with lower limb injury, and could not even distinguish between injured and uninjured players. As one of the authors put it, “Any way we sliced it, Functional Movement Screening was no help in predicting injured football players.” Quite damning.

And also in 2017, a systematic review and meta-analysis in British Journal of Sports Medicine concluded that the FMS composite score don’t have the predictive horsepower its popularity implies, and shouldn’t be used as an injury-prediction tool in sport.25

Any positive evidence?

A little here and there, but not enough to move the needle, as the reviews showed. And what positive evidence does exist seems to have major flaws. For instance, a good example is a 2017 study that loudly declared in its title that “scapular dyskinesis [“bad” shoulder movement] increases the risk of future shoulder pain by 43% in asymptomatic athletes.”26 This seems to defy skepticism about the importance of scapular dyskinesia — and therefore the value of screening for it, and so it was cited that way by FMS proponents.

But the headline is extremely misleading. This is a great example of lying with statistics: it’s only a 43% greater relative risk, relative to a small total count of injuries. The difference in absolute risk is very minor, and the authors concede in the body of the paper that “screening for scapular dyskinesia is not a useful approach to predict shoulder pain.” Many shoulder problems almost certainly are not announced by subtle scapular movement issues. For instance, frozen shoulder is a strange but common condition with metabolic roots, and probably there isn’t the slightest reliable clue that it’s coming before it does.

•sad trombone•

Several more years of evidence have not improved the picture

I think researcher interest is waning, but there are still lots of paper being published, many more trials of FMS since the first reviews in the 2010s. Some highlights (or lowlights)…

One looked at the role of pain. People often have aches and pains, and athletes often have more than their fair share and routinely play and compete with fairly significant ongoing episodes. How does pain affect movement, and therefore how does it affect FMS score?27 Researchers subjected more than 400 young Australian footballers to FMS testing, adjusting the scoring based on pain during the test for some of them in a couple different ways, or not at all. 170 of them had pain, and their pain did affect FMS scores to some extent… but regardless of how pain was factored in, FMS scores did not predict injury risk.

Pain did predict injury, though — not much, but a little bit. Imagine that!

A 2023 trial failed to reveal risk in junior Aussie football players.28 The authors conclude:

Whilst some small statistical relationships existed between prospective injury and the FMS composite score thresholds, all three thresholds were not associated with a clinically meaningful relationship with prospective injury and were no more effective than retrospective injury for determining athletes at risk of injury.

In 2022, Davies et al. reported a “tendency” for teens with higher FMS scores to be fitter (agility, running speed, strength, and cardiovascular endurance), but it was weak.29 The FMS probably doesn’t tell us any more about performance than injury risk.

And let’s consult a 2025 review of the relationship between FMS and “stability and joint mobility.”30 They evaluated over 700 studies, but whittled that down to just 43 that somehow still “all” had “weak methodological quality” and “revealed no significant correlations between the Functional Movement Screen scores and the results of other tests that evaluate stability and joint mobility.” And that’s in spite of a very high probability of bias in those studies that should have favoured “good news” results!

I could go on, but the point is now made well enough: there isn't any compelling evidence that the FMS even does what it was originally intended to do — screen for injury risk — let alone that it can be used as a diagnostic tool. I have no doubt someone can cherry pick a study that makes it look better than this, but you’d really have to be determined to avoid and rationalize away all the negative signals in the literature.

There are no injury risk whisperers

Who is going to get hurt? We wish we could tell, but it probably just cannot be divined from subtle movement quirks. You certainly cannot generally explain (diagnose) the causes of injury with a standardized movement screen. It is just not a thing. There are no injury risk whisperers, no one who can figure out what’s wrong with wounded athletes just by watching them put on a little movement show.

I cannot definitively conclude that FMS has no value when used as intended and humbly — although I think we're about as close to that as we can get without actually being there. But I can certainly raise a strong concern that the FMS is being applied inappropriately by many trainers, and that it seems to be resting on a number of questionable and untested assumptions.

And now, from 2015-2025, their claims are ever more at odds with the science.

So please: take it with a huge grain of salt if anyone tries to tell you what’s wrong with you, or how you might get hurt, based on FMS testing.

I’ll give the last word to Tumminello, Silvernail, and Cormack, from their excellent article on this topic in Personal Training Quarterly:31

It is often assumed that identified so-called “dysfunctions” in posture, movement quality, or body function are reliably predictive of potential injury and performance, the preponderance of the scientific evidence casts a great amount of doubt on any claims about the strength and reliability of such relationships. This is because natural variations in human posture, movement and mobility/flexibility make identifying strict ideas of what is “correct” difficult and possibly invalid in many cases. Humans naturally move in different ways to accomplish different tasks, and identifying small variations in that movement as a “dysfunction” may not be very useful or helpful.

Worse yet, it could be harmful:

patients/clients with beliefs about their body that center on fragility/risk of harm, the importance of appropriate posture, or the need to move in specific ways to avoid injury are more likely to have pain and less likely to recover from a future problem.32 That is the opposite of the kind of physical and psychological resiliency that personal training is designed to build.

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About Paul Ingraham

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter., or subscribe:

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Notes

1. Poor posture is a minor factor in pain and injury, but gets far too much attention in physical therapy and rehab. Many habitual postures are adaptations to anatomical quirks that can’t be changed. Most other “poor posture” is just coping with bad ergonomics. “Posturology” is mostly misguided pseudoscience. When people seem to be vulnerable to postural stresses, the vulnerability is usually the problem. For more information, see Does Posture Matter? A detailed guide to posture and postural correction strategies (especially why none of it matters very much).

   I won't say that FMS and posturology are the "same," but they certainly have plenty of overlap: they are both based on the idea of subtle kinesiological defects and "inefficiencies" as risk faactors

2. “Manual therapy” refers mainly to massage, spinal adjustment, and other costly methods of using hands/tools to “fix” tissue, mainly treatments that are done to passive patients. Although mostly the domain of massage therapists and chiropractors, physical therapists also use many manual methods. Unfortunately, it is mostly a pseudoscientific dumpster fire based more on authority, tradition, and marketing than good research. And yet some practitioners are responsible, and the power of compassionate touch to comfort and inspire should never be underestimated. For more information, see Manual Therapy: What is it, and does it work? The science of "fixing" tissue with hands-on treatments like massage and spinal manipulation.
3. Burton, Lee. Research Statement and Review. functionalmovement.com Mar 7, 2011.
4. Bahr R. Why screening tests to predict injury do not work-and probably never will … : a critical review. Br J Sports Med. 2016 Jul;50(13):776–80. PubMed 27095747 ❐
5. Both of these well-known and little-loved procedures are used to flag individual who need further assessment. In no way can a mammogram or prostate exam ever actually diagnose. The distinction is clear in these cases. (Note: in Canada, we have screening mammograms; in other countries, they are used diagnostically. So perhaps it isn’t the best example for an international audience. But it’s also just another way of emphasizing the difference between screening and diagnosing.)
6. Balachandran, Anoop. Functional Movement Screen: Is it Really a Screen? exercisebiology.com, January 21, 2011.

7. “Nocebo” is roughly the opposite of placebo: instead of relief from belief, it’s grief from belief. The word is Latin for “I shall harm” (great supervillain slogan). It refers to the harmful effect of … nothing but the belief in or fear of a harmful effect. Give someone a sugar pill and then convince them you actually just fed them a deadly poison, and you will probably witness a robust nocebo effect. Nocebo is one of the chief hazards of excessive X-raying and MRI scanning: showing people hard evidence of problems that often aren’t actually a problem is a great way to make them suffer.

   A screening test that reveals alleged problems might do it too.

8. Burton, Mar 2011, Op. Cit.
9. It’s truly amazing how much credit amateurs will give to medically unqualified and barely-regulated professionals like trainers, fitness instructors, and coaches. It can be difficult for a personal trainer, for instance, to resist the temptation to answer a question as if they have the knowledge that a client wants to give them credit for. My mother is a fitness instructor, and routinely amuses me with tales of the questions that class participants will ask her in all earnestness: real medical questions! Admirably, she refuses to even speculate, and decivisely refers them to actual health care professionals — which is exactly what a fitness instructor should do.
10. Functional Movement Screen. chiropractorincincinnati.net. No publication date. Accessed 7/11/11.
11. “Dr. Perry.” Functional Movement Screen: Get Your Best Body. YouTube.com, April 4, 2009, accessed 7/13/11.
12. FMS Research Articles functionalmovement.com, no publication date, accessed 7/09/11. This page lists four items. One is a blog post reviewing research, but not reporting on new research.
13. What is FMS? functionalmovement.com, no publication date, accessed 7/09/11.
14. Schneiders AG, Davidsson A, Hörman E, Sullivan SJ. Functional movement screen normative values in a young, active population. Int J Sports Phys Ther. 2011 Jun;6(2):75–82. PubMed 21713227 ❐ PainSci Bibliography 55282 ❐
15. Balachandran, Anoop. Functional Movement Screen. exercisebiology.com, November 29, 2008.
16. Tumminello N, Silvernail J, Cormack B. The Corrective Exercise Trap. Personal Training Quarterly. 2017 Mar;4(1). PainSci Bibliography 52905 ❐

    Tumminello, Silvernail, and Cormack decisively but gently and diplomatically tip over this most sacred cow of personal training and therapy: corrective exercise, which is based on the idea that there is something in-correct about patients — fragile, weak, or uneven — which can be both identified and fixed by specific, expertly prescribed exercises, mainly strengthening and stretching exercises, the staples of stereotypical physical therapy. The trap is the belief that this “technical” approach is inherently superior to good exercise in general.

    The danger here is that many fitness professionals might end up making their training process more about a formalized evaluation procedure and less about good personal training. …In order to spot a physical flaw that needs to be corrected, one must begin by having a reliable measure of whether or not it is actually problematic in the first place.

    Spoiler alert: there is no such reliable measure! Corrective exercise is built on wishful thinking. Screening for movement dysfunctions has been failing one fair scientific test after another. The importance of posture has been wildly exaggerated. The importance of anatomical variation has been virtually ignored.

    These authors all have excellent credentials and top notch clinical reasoning skills. These are smart guys tackling several thorny sub-topics like postural dysfunction, movement dysfunction, core stability, and — most important of all, I think — the “nocebo concerns” with corrective exercise: “when clients are told such things about themselves from an authority figure (as they might be during some corrective exercise evaluations), that this potentially makes one’s clients less resilient and more prone to injury and pain.”

    Translation sans diplomacy: stop #%&^ telling patients they are fragile and weak!

17. Parchmann CJ, McBride JM. Relationship between functional movement screen and athletic performance. J Strength Cond Res. 2011 Dec;25(12):3378–84. PubMed 21964425 ❐

    This experiment compared direct measures of athletic performance like sprinting speed and vertical jump with less direct measures like maximal squat strength (the most they could lift in one squat) and even less direct measure like scores on the functional movement screen (FMS). In theory, FMS testing can predict athletic performance. In practice, in this test, it did not “relate to any aspect of athletic performance.” But squat strength did!

18. Ingraham. Your Back Is Not Out of Alignment: Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. PainScience.com. 21878 words.
19. Lederman E. The Myth of Core Stability. J Bodyw Mov Ther. 2010 Jan;14(1):84–98. PubMed 20006294 ❐ PainSci Bibliography 55669 ❐
20. Unsgaard-Tøndel M, Fladmark AM, Salvesen O, Vasseljen O. Motor Control Exercises, Sling Exercises, and General Exercises for Patients With Chronic Low Back Pain: A Randomized Controlled Trial With 1-Year Follow-up. Phys Ther. 2010 Jul. PubMed 20671099 ❐

    This study tested two popular exercise options for chronic low back pain — core coordination, core strengthening — and compared them to a neutral third type, general exercise. Over a hundred participants worked with “experienced physical therapists” once a week for eight weeks. This is a particularly good test, because it is a good approximation of what a motivated patient might do: paying for eight weekly sessions of training is a greater and more disciplined effort than many people make, and yet still reasonably affordable and achievable.

    Pain and disability were measured before and after, and at a one year follow-up. Unfortunately, there were no differences: “This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.”

    Perhaps more training would have yielded better results, but it’s hard to imagine that it would be worth the additional expense and effort for what would surely be a minor difference. And perhaps a different exercise therapy would have performed better, but the ones tested here are exactly the kind of thing that is almost always recommended to patients — so if there’s a better kind of exercise therapy, it’s certainly unknown and unproven.

21. Whiteside D, Deneweth JM, Pohorence MA, et al. Grading the Functional Movement Screen™: A Comparison of Manual (Real-Time) and Objective Methods. J Strength Cond Res. 2014 Aug. PubMed 25162646 ❐
22. Dorrel BS, Long T, Shaffer S, Myer GD. Evaluation of the Functional Movement Screen as an Injury Prediction Tool Among Active Adult Populations: A Systematic Review and Meta-analysis. Sports Health. 2015;7(6):532–7. PubMed 26502447 ❐ PainSci Bibliography 53719 ❐ Dorrel et al. found seven studies to review: one of them they rated fair, two mediocre, four poor. Garbage in garbage out? Maybe — but enough to get a strong sense that there’s not much here to find.
23. Whittaker JL, Booysen N, de la Motte S, et al. Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review. Br J Sports Med. 2016 Dec. PubMed 27935483 ❐
24. Bakken A, Targett S, Bere T, et al. 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. Br J Sports Med. 2018 Aug;52(16):1047–1053. PubMed 28512188 ❐

    Bakken et al. studied over 500 injuries in 362 players (this wasn’t an underpowered test), testing the validity of an FMS-like functional movement screening test, the “9+”, which is an expanded, modified version of the FMS, identical in spirit, but the developers notably added five new tests to cover movements they felt the FMS neglected.

    The 9+ was not associated with lower limb injury and could not distinguish between injured and uninjured players. A major part of the analysis was an explicit search for a “danger zone” score — a threshold below which players would be at higher injury risk — and the authors couldn’t find one. The ROC curve was flat (AUC = 0.48, technically worse than chance), and even the best-performing cut-off they could extract (≤23/33) produced sensitivity and specificity barely above chance. In other words, there was no meaningful way to divide players into high- and low-risk groups based on movement-screen results.

    The null results held for all major injury subtypes. Hip/groin, thigh, knee, lower leg, ankle — same story everywhere, highlighting just how comprehensively the tool failed.

    The test didn’t just fail as a predictor — it also wasn’t especially reliable (“moderate” inter-rater reliability)

    As one of the authors put it, “Any way we sliced it, Functional Movement Screening was no help in predicting injured football players.” Quite damning.

25. Moran RW, Schneiders AG, Mason J, Sullivan SJ. Do Functional Movement Screen (FMS) composite scores predict subsequent injury? A systematic review with meta-analysis. Br J Sports Med. 2017 Dec;51(23):1661–1669. PubMed 28360142 ❐

    This systematic review digs through 24 prospective cohort studies testing the injury-prediction powers of the Functional Movement Screen, with a negative conclusion. Across most athletic groups — runners, hockey players, college athletes, high-school athletes, even professional football and basketball — and most of the evidence was either limited or showed no clear relationship at all between FMS scores and later musculoskeletal injuries, and only a little evidence was conflicting. In football (soccer), for example, there was “moderate evidence” against using the FMS for prediction. The only population with anything resembling a signal was male military personnel, where three reasonably solid studies showed a “small” association (risk ratio ~1.47, landing it between “trivial” and “moderate”). But that effect size is just too weak to justify screening.

    The authors also point out that many primary studies were methodologically shaky: inconsistent injury definitions, poor reporting, and the dubious assumption that movement “competency” is stable over time. A forest plot on page 6 shows how modest the pooled military effect really is.

    The conclusion is blunt: the FMS composite score doesn’t have the predictive horsepower its popularity implies, and shouldn’t be used as an injury-prediction tool in sport. In their words, “The strength of association between FMS composite scores and subsequent injury does not support its use as an injury prediction tool.”

26. Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2017 Jul. PubMed 28735288 ❐
27. Fuller JT, Lynagh M, Tarca B, et al. Functional Movement Screen Pain Location and Impact on Scoring Have Limited Value for Injury Risk Estimation in Junior Australian Football Players. J Orthop Sports Phys Ther. 2020 Feb;50(2):75–82. PubMed 31530068 ❐

    ABSTRACT

    
    

    OBJECTIVE: To describe the location and severity of pain during Functional Movement Screen (FMS) testing in junior Australian football players and to investigate its effect on FMS composite score and injury risk.

    DESIGN: Prospective cohort study.

    METHODS: Junior male Australian football players (n = 439) completed preseason FMS testing. Pain location and severity (on a 0-to-10 numeric pain-rating scale [NPRS]) were assessed for painful subtests. The FMS composite score was calculated using 3 scoring approaches: "traditional," a score of zero on painful subtests; "moderate," a score of zero on painful subtests if an NPRS pain severity was greater than 4; and "raw," did not adjust painful FMS subtest scores. Players were monitored throughout the competitive season and considered injured when 1 or more matches were missed due to injury.

    RESULTS: One hundred seventy players reported pain during FMS testing. The pain-scoring approach affected mean composite score values (raw, 14.9; moderate, 14.5; traditional, 13.6; P<.001). Sixty-eight percent of pain was mildly severe (NPRS of 4 or less). Back pain (50%) was more common than upper-limb (24%) or lower-limb (26%) pain (P<.001). Upper-limb pain was associated with a small increase in injury risk (hazard ratio = 1.59, P = .023). No other FMS pain location influenced injury risk, nor did pain severity (P>.280). The FMS composite score was not associated with injury risk, regardless of pain-scoring approach (P≥.500).

    CONCLUSION: Pain was common during FMS testing in junior Australian football players and had a notable effect on the FMS composite score, but minimal effect on subsequent injury risk.

28. Moore E, Fuller JT, Milanese S, et al. Does changing the Functional Movement Screen composite score threshold influence injury risk estimation in junior Australian football players? J Sports Sci. 2023 Jan;41(1):20–26. PubMed 36966351 ❐
29. Fitton Davies K, Sacko RS, Lyons MA, Duncan MJ. Association between Functional Movement Screen Scores and Athletic Performance in Adolescents: A Systematic Review. Sports (Basel). 2022 Feb;10(3):28. PubMed 35324637 ❐ PainSci Bibliography 49390 ❐ “Tendencies” and “trends” are scientific weasel words for statistically insignificant results, and these authors had to admit that “the strength of associations was weak to moderate in nature” (and I think “moderate” was pushing their luck). The idea here is that higher performance might also imply lower injury risk, but of course that’s not an entirely safe assumption, and the authors also caution that “they are not the same thing and should be considered conceptually different constructs.” But meanwhile we have all that evidence that there isn’t really a useful relationship between FMS scores and injury risk either!
30. Bhudarally M, Martins R, Atalaia T, Abrantes J, Aleixo P. Convergent validity of the functional movement screen regarding stability and joint mobility: A systematic review. J Bodyw Mov Ther. 2025 Jun;42:902–918. PubMed 40325772 ❐
31. Tumminello 2017, op. cit.
32. Darlow B, Dean S, Perry M, et al. Easy to Harm, Hard to Heal: Patient Views About the Back. Spine (Phila Pa 1976). 2015 Jun;40(11):842–50. PubMed 25811262 ❐