Functional movement screen comparison between the preparative period and competitive period in high school baseball players

The Preseason Functional Movement Screen as a Predictive Tool for Shoulder and Elbow Injuries in High School Baseball Pitchers: A Prospective Cohort Study

Background

The Functional Movement Screen (FMS) is used to evaluate fundamental movement patterns in patients. It is unknown whether the FMS can be used as a predictive tool for the occurrence of pitching injuries in baseball players.

Purpose

To prospectively investigate the relationship between shoulder and elbow injuries and individual components of the FMS during the preseason in high school baseball pitchers and determine which components of the FMS can be used as screening tools to predict shoulder and elbow injuries.

Study Design

Cohort study; Level of evidence, 2.

Methods

Eligible participants comprised 133 male high school baseball pitchers aged 15 to 17 years who underwent a preseason medical examination in 2017. Included participants were right-handed pitchers who had been involved in preseason practices without restrictions in baseball activities. The physical examination included assessments of background factors, bilateral shoulder and elbow range of motion, and grip and shoulder strength as well as the FMS. A shoulder or elbow injury was defined as any condition causing the inability to pitch for ≥8 days. Injuries occurring in the season immediately after the preseason medical examination were recorded. Logistic regression analysis was performed to identify risk factors associated with an injury.

Results

Overall, 90 high school baseball pitchers were enrolled in this study. The incidence of injuries was 22.2%. A comparison of FMS scores revealed significantly higher values for shoulder mobility on both sides (dominant side: P = .025; nondominant side: P = .034) and lower values for rotary stability on the dominant side (P < .001) in the injured versus noninjured group. Logistic regression analysis identified poor rotary stability on the dominant side as a significant independent risk factor for baseball injuries (odds ratio, 5.30; P = .009).

Conclusion

In right-handed high school baseball pitchers, a low FMS score for rotary stability on the dominant side during the preseason was a significant independent risk factor for injuries in the following season. The FMS score for rotary stability may be used as a predictive tool for the occurrence of pitching injuries in high school baseball pitchers.

The Development and Content of Movement Quality Assessments in Athletic Populations: A Systematic Review and Multilevel Meta-Analysis

BACKGROUND

Despite their prominence in the sport and human movement sciences, to date, there is no systematic insight about the development and content of movement quality assessments in athletic populations. This is an important gap to address, as it could yield both practical and scientific implications related to the continued screening of movement quality in athletic contexts. Hence, this study aimed to systematically review the (i) developmental approach, (ii) movements included, (iii) scoring system utilised, and (iv) the reliability of movement competency assessments used in athletic populations.

METHODS

Electronic databases (SPORTDiscus, MEDLINE, CINAHL, Web of Science, Scopus) were searched for relevant articles up to 12 May 2023. Studies were included if they reported data about the developmental approach, movements included, scoring system utilised and reliability of assessment in an athletic population. A modified Downs and Black checklist was used to measure study quality.

RESULTS

From a total of 131 identified studies: (i) 26 (20%) described the developmental approach of an assessment; (ii) 113 (86%) included descriptions of the movements included; (iii) 106 (81%) included a description of scoring system and criteria; and (iv) 77 (59%) studies included reliability statistics. There were 36 assessments identified within these studies, comprising 59 movements in total. Each assessment scored movement quality through a Likert or binary classification system.

CONCLUSION

First, the results demonstrate that choosing an appropriate movement quality assessment in an athletic population may be a complex process for practitioners as the development approach, movements included and scoring criteria vary substantially between assessments. Second, academics could use these results to help design new assessments for novel applications that meet rigour and reliability requirements. Third, these results have the potential to foster guidelines of use for the reliable assessment of movement quality in athletic populations.

A Longitudinal Study of the Relationship Between Lower Extremity Field Tests and Medial Elbow Injuries in Elementary School Baseball Players

This study aimed to examine prospectively the relationship between the deep squatting test and medial elbow injuries in elementary school baseball players and to determine the usefulness of the lower extremity field test in throwing injuries. The participants were 254 players who had participated in preseason medical checkups in both 2019 and 2020 and had no problems with the 2019 medical checkups. The evaluation parameters included ultrasonography examination, physical examination, and three types of deep squatting tests. The success rate of deep squatting tests was significantly lower in the injured group than in the non-injured group in the medial elbow injuries. By the difficulty level, the backward test in the deep squatting test was more likely to predict medial elbow injuries than the forward and middle tests. Furthermore, there was a significant difference in the squatting test and medial elbow injuries by grades. In conclusion, this is the first prospective study to provide evidence that the deep squatting tests, classified by difficulty level, can predict the risk of subsequent medial elbow injuries in elementary school players. The deep squatting test may be useful as a field test for lower extremity flexibility that can be performed by athletes and instructors, as it can predict the risk of subsequent medial elbow injuries.

Detection of kinematic abnormalities in persons with knee osteoarthritis using markerless motion capture during functional movement screen and daily activities

Background: The functional movement screen (FMS) has been used to identify deficiencies in neuromuscular capabilities and balance among athletes. However, its effectiveness in detecting movement anomalies within the population afflicted by knee osteoarthritis (KOA), particularly through the application of a family-oriented objective assessment technique, remains unexplored. The objective of this study is to investigate the sensitivity of the FMS and daily activities in identifying kinematic abnormalities in KOA people employing a markerless motion capture system. Methods: A total of 45 persons, presenting various Kellgren-Lawrence grades of KOA, along with 15 healthy controls, completed five tasks of the FMS (deep squat, hurdle step, and in-line lunge) and daily activities (walking and sit-to-stand), which were recorded using the markerless motion capture system. The kinematic waveforms and discrete parameters were subjected to comparative analysis. Results: Notably, the FMS exhibited greater sensitivity compared to daily activities, with knee flexion, trunk sagittal, and trunk frontal angles during in-line lunge emerging as the most responsive indicators. Conclusion: The knee flexion, trunk sagittal, and trunk frontal angles during in-line lunge assessed via the markerless motion capture technique hold promise as potential indicators for the objective assessment of KOA.

Pilot Study: The Relationship between Foot Posture and Movement Quality in Non-Professional Male Football Players

(1) Background: This study focusses on establishing the relationship between quality of movement (based on the functional movement screen, or FMS) and foot posture (based on the foot posture index, or FPI-6). We hypothesised that a poor FMS test score may be derived from the foot position in the space measured by FPI-6. (2) Methods: a quasi-experimental and cross-sectional study was designed to analyse foot posture in 30 healthy football players, using the foot posture index and the functional movement screen. (3) Results: No significant relationships were found between movement quality and foot posture. Poor movement quality is present in more than half of all foot positions, supination, pronation, and neutral. Good quality seems to be more associated with a neutral foot position (23.3%) and supinated (16.6%) than a pronated foot position (6.6%). (4) Conclusions: this study found no relationship between the two tests; therefore, we cannot demonstrate that foot posture is relevant in the quality of the movement of the football players studied.

Functional Movement Screen™ in High School Basketball Players: Pre- and Post-Season

Pre-participation screening and tracking of an athlete's functional status during a competitive season is essential to maintaining optimal performance. The sport of basketball had the third highest number of boys and girls participating during the 2018-2019 season (23), which typically occurs October to March each year. The Functional Movement Screen™ (FMS; 10) has been administered to some youth athletes from various sports, however, both males and females from basketball have not been studied extensively. The purposes of this study were: 1) to assess functional movements before and after the natural progression of a high school competitive basketball season; 2) to determine if there were functional movement differences between male and female youth basketball players. Eighteen male (n = 10) and female (n = 8) high school basketball players completed the FMS pre- and post-season. Scores were analyzed using a mixed-model ANOVA. No significant differences were found for Time or Sex for composite FMS scores (Mean ± SD, Pre-season: 16.2 ± 2.1, Post-season: 17.1 ± 1.4; Males: 16.8 ± 1.8, Females: 16.5 ± 2.0). Specific FMS tests were compared pre- to post-season using Wilcoxon signed-rank tests and were not significantly different after the competitive season or between the sexes. Sex differences relating to overall FMS composite scores or specific test scores were not apparent in this age group or sport. In this small group of high school basketball players, participation in a competitive, high school basketball season did not limit nor enhance functional movement ability.

The Intra- and Inter-rater Reliability of an Arm Care Screening Tool in High School Baseball Coaches

BACKGROUND

Preseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time intensive testing procedures prevent high school coaches from accurately performing frequent movement screens on their players.

PURPOSE

To establish the intra-rater and inter-rater reliability of a novel arm care screening tool based on the concepts of the Functional Movement Screen (FMS™) and Selective Functional Movement Assessment (SFMA™) in high school coaches.

STUDY DESIGN

Methodological intra- and inter-rater reliability study.

METHODS

Thirty-one male high school baseball players (15.9 years ± 1.06) were independently scored on the Arm Care Screen (ACS) by three examiners (two coaches, one physical therapist) in real-time and again seven days later by reviewing video recordings of each players' initial screening performance. Results from each examiner were compared within and between raters using Cohen's kappa and percent absolute agreement.

RESULTS

Substantial to excellent intra-rater and inter-rater reliability were established among all raters for each component of the ACS. The mean Cohen's kappa coefficient for intra-rater reliability was 0.76 (95% confidence interval, 0.54-0.95) and percent absolute agreement ranged from 0.82-0.94 among all raters. Inter-rater reliability demonstrated a mean Cohen's kappa value of 0.89 (95% confidence interval, 0.77-0.99) while percent absolute agreement between raters ranged from 0.81-1.00. Intra- and inter-rater reliability did not differ between raters with various movement screening experience (p>0.05).

CONCLUSIONS

High school baseball coaches with limited experience screening movement can reliably score all three components of the ACS in less than three minutes with minimal training.

LEVEL OF EVIDENCE

Level 3, Reliability study.

Assessment of Dysfunctional Movements and Asymmetries in Children and Adolescents Using the Functional Movement Screen-A Narrative Review

The Functional Movement Screen (FMS) is a screening tool that identifies dysfunctional movements in seven test items requiring an interplay of cognitive, perceptual, proprioceptive, and motor functions that involve muscular strength/endurance, flexibility, mobility, coordination, and balance. The results of the FMS include an overall composite score, scores on the individual test items, and identification of compensatory movement patterns and left-right asymmetries on 5 bilateral test items. Although there is a plethora of literature on the use of the FMS in adults, there is a growing body of evidence indicating its use in children. The available research in children involves school children and young athletes in at least 20 different sports in over 20 countries and comparisons between pre- and post-pubescent children, and normal weight, overweight, and obese children. Studies that include measures of adiposity and physical activity levels, or report prevalence of asymmetries and dysfunctional movement patterns are not well represented in the children’s literature. The purpose of this paper is to synthesize the currently available literature in children and suggest potential uses of the FMS by coaches, physical educators, and other health/fitness professionals, appropriate interpretation of results, and future research in children.

Ankle dorsiflexion deficit in the back leg is a risk factor for shoulder and elbow injuries in young baseball players

The relationship between ankle joint function and throwing-related injuries has not been demonstrated. We hypothesized that limited ankle joint range of motion (ROM) was related to risk factors for shoulder and elbow injuries in young baseball players. This 12-month prospective cohort study evaluated the age, height, weight, playing position, shoulder, elbow, and ankle function of 228 enrolled baseball players. Shoulder and elbow injuries were tracked during the season. Univariate and multivariate analyses were performed to identify risk factors for shoulder and elbow injuries among participants divided into non-injured and injured groups. Univariate analysis showed that age, height, weight, ROM of elbow flexion in the dominant arm, muscle strength ratio of shoulder abduction, and the likelihood of being a pitcher or a catcher were significantly greater in the injured group than in the non-injured group. ROM of shoulder abduction-external/internal rotation, shoulder total arc on the dominant arm, ankle joint dorsiflexion, and plantar flexion on the back (non-lead) and front (lead) legs were significantly less in the injured group than in the non-injured group. In conclusion, ROM dorsiflexion deficits in the back leg, shoulder abduction-external rotation in the dominant arm, ROM increase in elbow flexion on the dominant side, older age, and being a pitcher were significant independent risk factors for injury.

Current Concepts in Arm Care Exercise Programs and Injury Risk Reduction in Adolescent Baseball Players: A Clinical Review

CONTEXT

Awareness of important injury risk factors associated with excessive pitching volume has been highlighted in the literature, but injury rates remain high. Shoulder pain in baseball players is associated with various changes in musculoskeletal movements, which presents as measurable impairments throughout the kinetic chain. Baseball coaches and rehabilitation professionals have utilized exercise programs targeting strength and flexibility of the throwing arm to prevent injuries. The purpose of this review is to summarize the current evidence regarding the effectiveness of arm care exercise programs in reducing upper extremity injury rates in adolescent baseball players.

EVIDENCE ACQUISITION

A search of electronic databases, including CINAHL with full text, MEDLINE, and SPORTDiscus was conducted to retrieve available articles in English from the years 2010 through 2020. The search terms injury prevention, exercise, and adolescent baseball were used.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Improving shoulder internal rotation range of motion by stretching the posterior shoulder muscles daily was associated with a 36% risk reduction of shoulder and elbow injuries. Group-based arm care exercise programs that target multiple musculoskeletal impairments demonstrated an approximately 50% reduced risk of elbow injury.

CONCLUSION

For adolescent baseball players, arm care injury prevention programs focusing on important musculoskeletal impairments are effective at reducing injury incidence rates. Multimodal injury prevention programs that improve multiple musculoskeletal impairments are more comprehensive and may result in better injury reduction than programs focusing on a singular impairment.

Effect of a Six-Week Core Conditioning as a Warm-Up Exercise in Physical Education Classes on Physical Fitness, Movement Capability, and Balance in School-Aged Children

Whether the implementation of feasible, equipment-free, and simple core exercises in warm-up routines in physical education classes for school-aged children is beneficial remains unclear. Therefore, this study investigated the effects of a core conditioning in the warm-up routine of physical education classes on trunk muscular endurance, movement capability, and flexibility in this population. In these pre- and post-test control group experiments, 52 healthy, school-aged children (aged 10-11 years) were cluster randomized allocated to either the dynamic core exercise (DCE) group or general physical education (GPE) group. The DCE group performed a 10-min core exercise routine twice per week for six consecutive weeks; the GPE group performed traditional physical education warm-up exercises regularly. The children were assessed by conducting the trunk muscular endurance test (i.e., dynamic curl-up, static curl-up, plank, and lateral plank), functional movement screen (FMS), and single-leg balance test before and after the intervention. At the end of the intervention, the DCE group demonstrated a significant effect on trunk muscular endurance, movement capability (i.e., FMS scores), flexibility, and balance (each p < 0.001, effect size: 0.38-1.3). Furthermore, the DCE group showed significant improvements in all outcome measurements compared with the GPE group (p < 0.05, effect size: 0.29-1.68). These data may provide a reference for incorporating additional core stability exercises in the warm-up routine of physical education classes in school-aged children in the future.

Factors Influencing the Relationship Between the Functional Movement Screen and Injury Risk in Sporting Populations: A Systematic Review and Meta-analysis

BACKGROUND

Studies investigating the association between the Functional Movement Screen (FMS) and sports injury risk have reported mixed results across a range of athlete populations.

OBJECTIVES

The purpose of this systematic review was to identify whether athlete age, sex, sport type, injury definition and mechanism contribute to the variable findings.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search was conducted in October 2018 using PubMed, EBSCOhost, Scopus, EmBase and Web of Science databases. Studies were included if they were peer reviewed and published in English language, included athletes from any competition level, performed the FMS at baseline to determine risk groups based on FMS composite score, asymmetry or pain, and prospectively observed injury incidence during training and competition. Study eligibility assessment and data extraction was performed by two reviewers. Random effects meta-analyses were used to determine odds ratio (OR), sensitivity and specificity with 95% confidence intervals. Sub-group analyses were based on athlete age, sex, sport type, injury definition, and injury mechanism.

RESULTS

Twenty-nine studies were included in the FMS composite score meta-analysis. There was a smaller effect for junior (OR = 1.03 [0.67-1.59]; p = 0.881) compared to senior athletes (OR = 1.80 [1.17-2.78]; p = 0.008) and for male (OR = 1.79 [1.08-2.96]; p = 0.024) compared to female (OR = 1.92 [0.43-8.56]; p = 0.392) athletes. FMS composite scores were most likely to be associated with increased injury risk in rugby (OR = 5.92 [1.67-20.92]; p = 0.006), and to a lesser extent American football (OR = 4.41 [0.94-20.61]; p = 0.059) and ice hockey (OR = 3.70 [0.89-15.42]; p = 0.072), compared to other sports. Specificity values were higher than sensitivity values for FMS composite score. Eleven studies were included in the FMS asymmetry meta-analysis with insufficient study numbers to generate sport type subgroups. There was a larger effect for senior (OR = 1.78 [1.16-2.73]; p = 0.008) compared to junior athletes (OR = 1.21 [0.75-1.96]; p = 0.432). Sensitivity values were higher than specificity values for FMS asymmetry. For all FMS outcomes, there were minimal differences across injury definitions and mechanisms. Only four studies provided information about FMS pain and injury risk. There was a smaller effect for senior athletes (OR = 1.28 [0.33-4.96]; p = 0.723) compared to junior athletes (OR = 1.71 [1.16-2.50]; p = 0.006). Specificity values were higher than sensitivity values for FMS pain.

CONCLUSION

Athlete age, sex and sport type explained some of the variable findings of FMS prospective injury-risk studies. FMS composite scores and asymmetry were more useful for estimating injury risk in senior compared to junior athletes. Effect sizes tended to be small except for FMS composite scores in rugby, ice hockey and American football athletes.

PROTOCOL REGISTRATION

CRD42018092916.

Comparison of Functional Movement Screen, Star Excursion Balance Test, and Physical Fitness in Junior Athletes with Different Sports Injury Risk

Objectives

The aim of this study was to assess the relationships between functional movement screen (FMS), star excursion balance test (SEBT), agility T test, and vertical jump test scores and sports injury risk in junior athletes. We compared these assessments and the differences between groups with high and low risks of sports injury. Subjects and Methods. Eleven volleyball, 12 basketball, and 9 handball athletes were recruited. All participants followed the routine training in school sports teams. Weekly training schedules followed a similar pattern. The 32 junior athletes (age = 16.06 ± 0.21 years; height = 167.28 ± 6.32 cm; and body mass = 68.45 ± 9.67 kg) were assessed using the FMS, SEBT, agility T test, and vertical jump test in random order. The correlations of composite and individual item scores of these assessments were analyzed, and the differences between groups with high and low risks of sports injury were compared.

Results

All participants completed the study protocol. No significant differences were observed between FMS, SEBT, agility T test, and vertical jump test scores in groups with high and low risks of sports injuries. Fair and moderate-to-good correlations were observed for anterior reach maximum of SEBT and deep squat (r = 0.47, P = 0.02) as well as inline lunge (r = 0.53, P = 0.01) of FMS. The hurdle step of FMS also exhibited moderate-to-good (r = 0.52, P = 0.01) and fair (r = 0.42, P = 0.04) correlations with posterior medial and posterior lateral reach maximum of SEBT, respectively. A fair correlation was observed between posterior lateral reach maximum of SEBT and rotary stability of FMS (r = −0.23, P = 0.03). Fair and moderate-to-good correlations were identified for agility T test and maximum anterior reach in the SEBT (r = −0.42, P = 0.04) and trunk stability push-up in the FMS, respectively (r = −0.57 and P = 0.006).

Conclusions

Junior athletes with a high risk of sports injury did not exhibit differences in terms of FMS, SEBT, and physical fitness test scores. Deep squat, hurdle step, inline lunge, and rotary stability scores in the FMS were correlated with the item scores in the SEBT, which may be due to the use of similar movement patterns. Scores for anterior reach maximum in the SEBT and trunk stability push-up in the FMS were correlated with agility T test scores, suggesting a similar task requirement of trunk stability and dynamic weight shifting ability.

Functional Movement Screen Pain Location and Impact on Scoring Have Limited Value for Injury Risk Estimation in Junior Australian Football Players

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. J Orthop Sports Phys Ther 2020;50(2):75-82. Epub 17 Sep 2019. doi:10.2519/jospt.2020.9168.

The Functional Movement Screen total score and physical performance in elite male collegiate soccer players

The objectives of this study were to compare the differences in physical performance of elite male collegiate soccer players according to the Functional Movement Screen (FMS) total scores and to investigate the association between the FMS total score and physical performance. A total of 20 elite male collegiate soccer players (mean age, 19.6±0.7 years; height, 173.4±4.4 cm; body weight, 66.9±7.3 kg; and body mass index, 22.0±2.0 kg/m²) participated in the present study. The subjects were divided into two groups: the high FMS (FMS total score ≥14 points, n=10) and low FMS (FMS total score <14 points, n=10). All participants completed 10-m and 30-m sprint tests, the arrowhead agility test (right and left), and a coordination test. The statistical methods used to verify the study results were the independent sample t-test and Kendall’s Tau b correlation test. There were significant differences between the high and low FMS groups in the 10-m (P=0.014) and 30-m sprint (P=0.002) and arrowhead agility tests (right, P=0.039). Conversely, there were no significant differences in the arrowhead agility (left) and coordination tests between the two groups (P>0.05). Moreover, the FMS total score was found to have significant negative correlations with the 10-m sprint (r=−0.444, P=0.017), 30-m sprint (r=−0.425, P=0.016), and arrowhead agility tests (right, r=−0.389, P=0.023). These results suggest that higher FMS total scores could have a positive effect on the physical performance of the players.