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Screening or screaming?
Movement Competency Screen(MCS) Functional Movement Screen (FMS) Pre participation Screen (PPS)

Duncan Reid DHSc, FNZCP Director of Rehabilitation High Performance Sport NZ

Movement screening

WHAT is Screening?
WIKIPEDIA

Screening is a process of identifying risk factors/predictors of an outcome in healthy individuals.

They can then be offered information, further tests and appropriate treatment to reduce their risk for the disease or condition (outcome). Outcomes = Injury
Performance measures Talent ID/success
Dr Angela Cadogan SPRINZ Conference 2012

WHY do Movement Screening?

1. Identify injury risk factors

Why is it important?
Other disciplines screen as matter of course e.g. Doctors BP, Dentists PT -No universal tool or gold standard 20% of those athletes who have passed a medical screen fail the FMS Full PT assessment - too few key test, inconsistent

2.

Sport-specific Injury-specific
Performance factors

3. 4.

Kinetic chain inefficiencies

Prescription of training loads (e.g MCS) Talent ID
Cook, G., Burton, L., & Hoogenboom, B. (2006a). Pre-participation screening: The use of fundamental movements as an assessment of function Part 1. North American Journal of Sports Physical Therapy, 1(2), 62-72 Cook, G., Burton, L., & Hoogenboom, B. (2006b). Pre-participation screening: The use of fundamental movements as an assessment of function Part 2. North American Journal of Sports Physical Therapy, 1(3), 132-139. Kiesel, K., Plisky, P., & Kersey, P. (2008). Functional Movement Test Score as a Predictor of Time-loss during a Professional Football Team's Preseason: 1525: Board# 72 May 28 3: 30 PM-5: 00 PM. Medicine and Science in Sports and Exercise, 40(5), S234. Maffey, L., & Emery, C. (2006). Physiotherapist delivered preparticipation examination: rationale and evidence. North American Journal Of Sports Physical Therapy: NAJSPT, 1(4), 176-186.

5.

Establish normative data

All of the above?
SPRINZ Conference 2012

Dr Angela Cadogan

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Injury prevention
Intrinsic risk factors

4 step sequence of injury prevention

Age Flexibility Previous injury Somatotype

Predisposed athlete

Exposure to extrinsic risk factors

Inciting event

1. Establish extent of injury problem Incidence severity Injury

2. Establish aetiology & mechanisms of injury

Susceptible athlete

4. Assess the Effectiveness repeat Step 1

3. Introduce a preventative measure

Meeuwisse, W (1994)

Van Mechelen et al (1992)

Biomarkers
Injury Risk Previous injury Asymmetry Motor control BMI Stupidity

Knee angle- what do you do about this?

PT interventions and exercise in general are a reset button (protective and corrective)
Cook, G., Burton, L., & Hoogenboom, B. (2006a). Pre-participation screening: The use of fundamental movements as an assessment of function - Part 1. North American Journal of Sports Physical Therapy, 1(2), 62-72 Cook, G., Burton, L., & Hoogenboom, B. (2006b). Pre-participation screening: The use of fundamental movements as an assessment of function - Part 2. North American Journal of Sports Physical Therapy, 1(3), 132-139.

Hewitt et al 2007

Injury

Gym programmes
http://www.youtube.com/watch?v=RQOwoy5-ysg

What is happening in this video? How would you rate the quality of the movement? What tool do you use? What rating do you use? What is contributing to this pattern of movement?

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What is screening?
Any athlete-generated movement in which the quality of movement is assessed

Screening Process
Healthy (Non-injured) Athletes

Screening tests

Functional- 1 leg squat or hop Training squat lunge or deadlift Sports specific- swim, run, throw

Further tests

Intervention

Monitor and Measure Outcomes

Dr Angela Cadogan SPRINZ Conference 2012

Where does Movement Screening fit?

Components Movement Result

Musculoskeletal Screening tests:

ROM Muscle length Muscle activation Strength Endurance Balance/ proprioception

Movement tests:
1 leg squat Hop Drop jump Squat Lunge Deadlift Push/pull Run/gait Sporting activity
SPRINZ Conference 2012

Field/capacity tests:
Strength Power Speed Agility

Screening tests

Dr Angela Cadogan

15

Functional Movement Screen

The FMS is comprised of seven fundamental movement patterns that require a balance of mobility and stability Provide observable performance of basic locomotor, manipulative, and stabilizing movements Place the individual in extreme positions where weaknesses and imbalances become noticeable if appropriate stability and mobility is not utilized Maximum score-21 (Cook et al, 2006)

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Normal Values
Variable Combined males Females Mean (SD) 15.7 (1.9) 15.6 (2.0) 15.8 (1.8) 95% (CI) 15.4- 15.9 15.2 -15.9 15.5 -16.2 Range 11-20 11-20 12-20 .329 P values

Reliability
Mean
Intersession (n=19)

Min

Max

SD

ICC

P value

Total Day 1 Day 2

Inter session N= 16

16.63 16.58 16.68 16.75

16.58 13 13 16.69 13 13

16.68 20 20 16.81 20 20

1.78 1.83 1.76 1.74 1.77 1.75

0.92

< 0.01

0.98

< 0.01

209 Normal subjects 108 females, 101 males

FMS cert 16.69 Schneiders, A. G., Davidsson, A., Hrman, E., & Sullivan, S. J. (2011). Functional movement screen normative values in a young, active population. International journal of sports physical therapy, 6(2), 75. Non cert 16.81

19 volunteer civilians (12 male, 7 female)

Onate, J. A., Dewey, T., Kollock, R. O., Thomas, K. S., Van Lunen, B. L., Demaio, M., & Ringleb, S. I. (2012). Real-time intersession and interrater reliability of the functional movement screen. Journal of Strength and Conditioning Research, 26 (2), 408-415.

Injury prediction
Relationship between total FMS score and likelihood of serious injury FMS scores 46 professional American football players followed over playing season Mean scores of those injured (14.3) (cut off score) Non injured 17.4 Odds ratio of 11.67
Kiesel, K., Plisky, P. J., & Voight, M. L. (2007). Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen? North American Journal Of Sports Physical Therapy: NAJSPT, 2(3), 147-158

Does training change FMS?

3 2.5 2 1.5 1 0.5 0 DS HS ILL ASLR SM TSPU RS Pre Post

Kiesel, K., Plisky, P., & Butler, R. (2009). Functional movement test scores improve following a standardized off-season intervention program in professional football players. Scandinavian Journal of Medicine and Science in Sports, 21 (2), 287-292

Movement competency screen (MCS)

Five components
Squat Lunge and twist Bend and pull Push up Single leg stand

Squat
BODY WEIGHT SQUAT Perform a body weight squat with your fingertips on the side of your head and your elbows held inline with your ears. Squat as low and as fast as you comfortably can.

Max Score 21

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Lunge and twist

LUNGE & TWIST Cross your arms and place your hands on your shoulders with your elbows pointing straight ahead. Perform a forward lunge then rotate toward the forward knee. Return to center and then push back to Return to the starting position. Alternate legs with each repetition

Bend and pull

Bend & Pull Start with your arms stretched overhead. Bend forward allowing your arms to drop Under your trunk. Pull your hands into your body as if you were Holding onto a bar and performing a barbell rowing exercise. Return to the start position with your arms Stretched overhead.

Push up

Single leg squat

SINGLE LEG SQUAT Perform a single leg body weight squat with Your fingertips on the side of your head your Elbows in line with your ears. Position the non--stance leg behind your Body as you squat. Squat as low and as fast as you comfortable can.

PUSH UP Perform a standard push up

Criteria
Body Region / Capacity MCS Task MCS Task MCS Task Lunge &
Held stable in a neutral Held down away from ears. Slight flexion of thoracic spine OK. Held down and away from ears. Elbows appear in line with ears. Thoracic extension is clear. Held down and away from ears. Rotation appears to occur through thoracic spine. Elbow is at least inline with the lead knee at end range of rotation Held stable, neutral spine is maintained throughout rotation. Rotation and/ or lateral flexion does not occur about the lumbar region during trunk rotation Horizontally aligned, mobile and stable to prohibit elevation and depression during rotation. Held down and away from ears during arm flexion and extension. Scapulae move balanced and rhythmic and are not excessively abducted at arm extension. Held stable in neutral spine position. Held down and away from ears during arm flexion and extension. Scapulae move balanced and rhythmic and are not excessively abducted at arm extension. Held down and away from ears. Elbows appear in line with ears. Thoracic extension is clear.

Scoring system
MCS Task MCS Task Bend & MCS Task Single Leg

Scoring instructions Load level 1 (assisted) 2 (body weight) 3 (external load) 4 (eccentric)

Held in neutral curve position.

Held stable in neutral spine position throughout trunk flexion and extension.

Held stable in a neutral spine position throughout lower limb flexion and extension.

Appear to be horizontally aligned.

Movement is initiated with hip flexion. Remain horizontally aligned during flexion and extension. Obviously moving back and down during flexion. Aligned with hips and feet during flexion.

Held in line with the body during arm flexion and extension.

Movement is initiated with hip flexion. Extension is obvious and controlled.

Movement is initiated with hip flexion. Remain horizontally aligned during flexion and extension. Clearly moving back and down during flexion, minimal weight shift over stance leg. Aligned with the hip and foot during flexion and extension.

5 (plyometric)

Scoring rationale 2 or more primary regions checked 1 primary and 2 or more secondary No primary and 1 secondary 1 or more primary and and secondary regions failed on explosive MCS No primary regions failed on explosive MCS

Considerations Pay close attention to the primary regions for each movement task. The primary regions will have the most meaningful impact on movement competency To score unilateral patterns the load level should reflect the poorest side. For example: If an athlete scores a 3 on their right leg and a 2 on their left leg, that athlete would score a 2or their single leg squat pattern Athletes unilateral movement competency should be a reflection of their weakest side.

Knee caps pointing forward.

Aligned with hips and feet during flexion and do not move laterally with rotation

Extended and held stable

Slightly bent and held stable

NA.

Mobility allows adequate dorsi-flexion during knee and hip flexion

NA.

NA.

Mobility allows adequate dorsi-flexion during knee and hip flexion. Stable with heels grounded during lower limb flexion.

Pointing straight.

Stable with heels grounded during lower limb flexion.

Heel of lead leg in contact with the floor, trail foot flexed and balanced on forefoot. Maintained on each leg.

Feet straight, heels not falling in or out

Pointing straight.

Evenly distributed. NA. 90 degrees or greater of hip flexion

NA. Chest touches ground.

Maintained. 70 degrees or greater of trunk flexion

Maintained on each leg. 70 degrees or greater of hip flexion

Lead thigh parallel with the floor.

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SCREENING AGE
SCREENING AGE
International National Representative Development Youth
Dr Angela Cadogan

HPSNZ- Rehabilitation Model

PERFORMANCE
MTR Maximise Training Reliability

MINIMISING INJURY RISK

Proactive MTR/MIR model Screening of every HPSNZ athlete

MIR Minimise Injury Risk

Individual Athlete Management

& Reassessment*

Sport-specific Movements
& Reassessment*

NSO

Sport specific MCS

Athlete ranked, 1,2,3

3 = Excellent

2= satisfactory

1 = poor or injured

Specific injury risk factors*

(Sport/ position specific)

Training Movement Patterns*

& Reassessment* No sig injuries More detailed Ax More detailed Ax

& Reassessment*

Functional Movement Patterns*

SPRINZ Conference 2012

Functional Movement Competency*

Full training load

PT &SC design training

PT injury rehab

Ranked 3/3
Athlete moves well and is biomechanically sound No major injuries in the past Would be able to tolerate a full S&C loading without any issues No further intervention warranted and full S&C programme developed

Ranked 2/3
Athlete exhibits faults in movement patterns. These faults increase injury risk These movement fault may have a negative effect on performance May not tolerate a full conditioning load Athlete will have a modified ports Specific MBA by Lead Physiotherapist or Specified Provider in the region
Results relate to IPP and performance of athlete and influence IPP Funding secured to develop appropriate intervention Lead Physiotherapist/Specific Provider work closely with S&C coach, athlete and coach where appropriate Intervention is monitored (ie must effect a change/have a positive outcome) Check points determined

Ranked 1/3
Athlete exhibits significant faulty movement patterns (that are related to injury risk). These faults increase injury risk These movement faults may have a negative effect on performance Athlete will not tolerate a full conditioning load Or has had a significant injury
ACL Rupture Disc prolapse

Next steps- screening passport

Lower limb
DF Active knee extension Thomas test Prone Hip IR / ER Hip prone frog leg (McConnell test) ABIR (Chicken Wings) standing against wall Shoulder IR / ER at 90 (supine) Shoulder x-adduction (PST posterior shoulder tightness) Prone Streamline

Upper Limb

Athlete will have an In-depth Sports Specific MBA by Lead Physiotherapist or Specified Provider in region

Results influence IPP Funding secured to develop appropriate intervention Lead Physiotherapist/Specific Provider work closely with S&C coach and athlete and coach where appropriate Intervention is monitored (ie must effect a change/have a positive outcome)

Thoracic rotation test Trunk Endurance

Biering Sorenson extension hold McGill 60 deg flexion hold

Check points determined

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Current Research -Netball

Inter and intra-rater reliability of the Netball Movement Screening Tool (Van Weerd, Reid and Larmer) The primary aim of this study is to investigate the inter and intra rater-reliability of the Netball Movement Screening Tool in a group of secondary school netballers. A secondary aim is to collect the injury incidence data in the same cohort of netballers over one competition season.

Netball Screening tool

All subjects were screened preseason with a Netball Movement Screen consisting of;
MCS Single and double legged jumps Star Excursion Balance Test (SEBT) Active straight leg raise (SLR)

20 subjects inter rater (2 raters) 20 subjects intra rater 80 100 subjects injury surveillance

Other elements
Jumping components
Star Excursion Balance Test

Provisional Results demographics

Mean Age 16.2 SD 1.1 Range (max) 17.8 Range (min) 13.11

Height

170.38

7.7

182

155

Weight

63.3

6.7

80

52

Age started playing netball

7.8

1.9

12

Active straight Leg Raise

Number of years playing netball

8.3

1.8

12

Table Mean, SD and range of baseline data of all subjects

Inter-Rater Reliability Results

Perfect 1 High >0.90 Good >0.80 Fair >0.70 Poor <0.69
(McGuine, Greene, Best, & Leverson, 2000)

Inter-rater reliability results Individual components

ICC Fair 0.70-0.79 0.59-0.69 MCS Lunge & Twist Squat Pull Poor <0.69 <0.59 Bend Push up Single leg squat Broad jump

ASLR

SEBT

Total NMST Score ICC: 0.84 Corr: 0.84

MCS

Jump & Land

ICC: 1.0, Corr; 1.0

Left: ICC: 0.99 Corr: 0.99 Right: ICC: 0.97 Corr: 0.91

ICC: 0.77 ICC: 0.65 Corr: 0.77 Corr: 0.67

Jump & Land

Vertical jump 2 leg land

Vertical jump 1 leg land

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Inter-rater
ICC
Lower Bound

Intra-rater
ICC 95% CI
Upper Bound

95% CI
Lower Bound Upper Bound

Spearmans r 0.77

Spearmans r MCS 0.77 Jump 0.65 0.77

0.49

0.90

MCS Jump ASLR SEBTL SEBTR NMST

0.77 0.65 1 0.99 0.97 0.84

0.49 0.29 0.98 0.93 0.65

0.90 0.84 0.997 0.989 0.93

0.29

0.84

0.67

0.67 ASLR 1 SEBTL 0.99 SEBTR 0.91 0.84 NMST 0.84 0.65 0.93 0.84 0.97 0.93 0.989 0.91 0.99 0.98 0.997 0.99 1 1

Table 4: Interclass correlation, two-way mixed effects model where people and effects are random and measures effects are fixed using absolute agreement coefficient and Spearmans rho correlation significant at the 0.01 level (2 tailed) for inter-rater reliability of overall scores for NMST components.

Table : Interclass correlation, two-way mixed effects model where people and effects are random and measures effects are fixed using absolute agreement coefficient and Spearmans rho correlation significant at the 0.01 level (2 tailed) for inter-rater reliability of overall scores for NMST components.

Discussion
Training & standardised instructions = Inter-rater reliability Difficult movements for the athlete Inter-rater reliability
Push-up, Bend & Pull, Single Leg Squat

Discussion
Push-up
Difficult movement for participants Floor effect Multiple movement strategies Insufficient scoring time Poor inter-rater reliability

(Unknown, 2012)

Complex movements Inter-rater reliability

Jumping components

Recommendations
Minimal performance standard Alternative movements
e.g. Modified push-ups
(Colourbox, 2012)

(Minick et al., 2010; Onate et al., 2012; Schneiders et al., 2011; Teyhen et al., 2012)

Delivery of Interventions
SCREENING AGE
International National Representative Development Youth FUNCTIONAL MOVEMENTS Squad SPORT/TRAINING SPECIFIC Squad
Small groups Individual

Individual Athlete Intervention

PERFORMANCE

MINIMISING INJURY RISK

ONE ATHLETE : ONE PROGRAMME

COHESIVE
Discussed by ALL prior to delivery

ATHLETE SPECIFIC
Individual Small groups

INTEGRATED
Optimise compliance Realistic number of exercises

REVIEWED
Repeat measures/tests

PROGRESSIVE
Dr Angela Cadogan

Physio and S/C

SPRINZ Conference 2012

54

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Monitor & Report Outcomes

EFFECTIVENESS & RETURN ON INVESTMENT

Movement Screening Summary

Healthy (Non-injured) Athletes

Injury Rates
Injury surveillance

WHY? Injury Risk Performance factors Appropriate for Screening Age Sport/position specific K.I.S.S One athlete: One Programme Review and Progress Report results

Which ones?

Performance
Individuals: PBs Teams:
Win/loss Individual KPIs

Screening Tests

COHESIVE (Physio/ SC

Further tests

Talent ID
success/ selection Treatment Intervention

Report Outcomes
Dr Angela Cadogan

Funding bodies Boards

SPRINZ Conference 2012

Monitor and Measure Outcomes

Acknowledgments
Dr Angela Cadogon- NZ Cricket Sharon Kearny High Performance Sport NZ HPSNZ rehabilitation providers Dr Matt Kritz

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