Thoughts on the FMS Level 1 | Modern Manual Therapy Blog

Thoughts on the FMS Level 1


Had a blast over the weekend in Brampton, ON for FMS Level 1! Until I started blogging about OMPT, I didn't realize the collaboration the sports medicine world has with physical therapists, athletic trainers, strength coaches, massage therapists, and chiros! It is truly refreshing coming from a world where we try to defend our practice act against those who would limit either direct access or the ability to perform spinal manipulation.

The beauty of the FMS is that it's repeatable due to it's simplicity. It has been shown to have excellent reliability, even inter-rater. You don't have to think too hard, just analyze the movement and score. Among my group of 6, there were two PTs, one massage therapist, and three personal trainers. The scores we chose for each movement were mostly the same, and when in doubt, you score lower. We agreed for the most part to come up with the same score even our first attempt at using the FMS.

The course also makes it a point to "refer out" any time the client has pain, and that's important because the key demo for this course are not necessarily health professionals. Any movement is an assessment, and after the scoring, as a PT, I could do some further assessment, then corrective OMPT and exercise then re-test.
It really great to see an entire group of very diverse professionals and see how each has their unique take on movement and movement analysis. Everyone had something to bring to the table.

My FMS score was 13 initially - ouch! 45% more likely to injure myself according to research! After my scorer, Curd Hos of Hostyle Conditioning - (how can you not love that name - the one with the kettlebell skull t-shirt) told me what I was doing wrong, I was able to take cues from him and the other professionals during the inline lunge. Thomas Swales, PT of Concept of Movement gave me some great cues for the push up to improve the score to 3s on both instead of 2s. My score improved to 18 the next day!

I learned my thoracic mobility was even worse than I thought it was! It gave a new meaning to a joke I use on my patients all the time - you have a bad side, and a worse side. It was very enlightening and I also found out I was incorrectly stabilizing my trunk and not breathing correctly for one of my favorite exercises, the "open book" or sidelying trunk rotation stretch.

The instructor, Marcia had a great energy and came from a physio/kines background. She instructed a great point I will reference from now on. From the bottom to the top

shoulders --> mobility
scapula --> stability
t-spine --> mobility
l-spine --> stability
hips --> mobility
knees --> stability
ankles --> mobility

And even though when I assess, I inherently knew this, and looked for restrictions in those areas, I never knew it "stacked" up so neatly. The mobility joints often lose it, and cause problems for the joints that need stability.

I heard a great instructor once say, "Even if you can take away 1 thing from this course that you'll use every day, it will be worth it." Based on that, the course was worth it many times over!

FMS 2 and the SFMA will hopefully both be coming back within driving distance early next year. I'm excited to take them both and have some more collaboration with other like minded professionals who aren't necessarily PTs.



10 comments:

  1. Dr E-
    Keep the great posts going!
    But please refer to us as, Athletic Trainers.

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  2. Thanks Mark! Sorry! I wasn't even thinking in that context, as most of the class seemed to be personal trainers! I fixed it in the post already! A vid of my 13 is coming up as soon as it's finished uploading! I stink the first time!

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  3. Hey Doc!

    Great Post and Great Meeting you
    this weekend.

    I have already screened 2 clients and started the corrective exercises this morning in my own workout!!

    See you at FMS 2 !

    Curd Hos

    www.hostyleconditioning.com

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  4. You may want to check out this article by Gray on the Joint by Joint approach if you haven't yet. I took the SFMA I course 2 years ago and continue to use it in my practice. In reading the book "Movement" I am expanding the role this approach has on my movement diagnostic approach.

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  5. Forgot the link:
    http://graycookmovement.com/?p=119

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  6. Thanks, that is a great post! I will link back to it later today on my main blog page!

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  7. Do you think if you can drastically change your score in 1 day that FMS can accurately predict injuries. It seems to me that if a test is performed incorrectly simply because it is a novel movement, and thus unskilled movement then the test is going to be inherently give a fair amount of false positives. Nor is it very specific in any sense. Additionally, research regarding FMS and its predictive capacity is in general lacking. I encourage you to proceed with caution in your enthusiasm.

    The mobility, stability oversimplification you present of those joints also borders on conflation. If you watch enough movement of dancers, rock climbers, etc you will see that it is highly dependent on the goal of the movement which determines the plan of movement versus stability across multiple joints.

    Eric

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  8. You raise very good points about validity. Of course every screen/assessment should be valid as well as reliable.

    I would say that if I can drastically change my score in 1 day that I just needed some cueing and the dysfunction wasn't really there, or at least it wasn't anything that could not change rapidly without intervention anyway. Most of the participants in my group stayed the same and one got worse the next day!

    I see mostly a TMD, cervical, and spinal caseload of "normals" and not athletes; I haven't even screened anyone outside of students in my clinic. I planned on using the FMS as any tool in my belt. Since I am eclectic, I take and use the best out of any of the systems I have learned. If I actually get an athlete as I do once in a while, I may use it. But also, I am a different demo than the what the course is actually marketed to, it is marketed toward fitness professionals and those without the background. The test for me is a reliable way to screen functional movements, whether or not it prevents injury improving the score with corrective exercises has to be studied. The problem with taking any screen and then treatment, is that do we have to test/retest the validity across all populations? It drastically limits most of our treatments. So I take what works for me and my patients, use them as assessments, and then choose treatments based on my evaluation and to address their dysfunction. I didn't just come away from the course and begin to screen everyone from TMD pts to little old ladies with TKAs.

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  9. Thanks for the post Erson! I'm happy you took the course. I actually have a question for you that relates to both the FMS and manual therapy. As a budding manual therapist myself, I am finding hard to bring the FMS into my clinical practice. Most of my patients, like yours, are not athletes. They don't come to see me to enhance their performance. They want to get out of pain. I know Gray Cook argues that fixing aberrant movement patterns will ultimately resolve most pain. While I agree with that stance because I do like and agree with the joint by joint theory, I’m still finding it very hard to use it clinically. My patients with neck or back pain don’t want to do an in line lunge or overhead squat to assesses their movement patterns. They want me to mobilize/stretch/manipulate/acupuncture etc so they feel better. Not many of my elder clients would appreciate me taking them through a movement screen if they came in for manual therapy. I guess educating them is where it gets easier toe explain why I’m assessing the way I am, but at the end of the day, I need to be sure that I am doing both what the client needs and wants. Lastly, after taking some advanced manual therapy courses where we learn a zillion ligament stress tests, PIVM and PAM assessment for every little joint in the body and how to treat restrictions based on our findings, I’m finding it hard to abandon all of that in favour of watching clients move and prescribing exercises based on it. Maybe that’s more of a personal trainer’s domain? How do you implement the FMS clinically?

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  10. Thanks Jesse! I am attending a course soon on Advanced FMS and SFMA applications. I will also be taking the SFMA later this year. I have not used the entire FMS on my general ortho patients, but I have used the corrective exercises and some of the screens. I think inherently as PTs we already know a lot of what these screening tests show us, but they're more global movements as opposed to the joint by joint or area tests that we perform actively and passively. I often watch someone move, look for quality/quantity, assesss end range, perform IASTM/STM, JM then retest their function. Whether that test is something as simple as a head on neck movement, or a movement screen depends on the pt.

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