Injury Prevention and the FMS

///Injury Prevention and the FMS
Injury Prevention and the FMS2019-08-26T13:39:34-05:00

About Injury Prevention and the FMS™

Injury prevention is an important consideration for all types of athletes. While you never know when or how an injury may occur, there are ways to determine your risk for injury. Using the Functional Movement Screen™ (FMS™), a screening tool that determines an athlete’s risk for injury, we can identify imbalances and asymmetries in common movements and use that information to locate areas of weakness. The FMS™ is a helpful tool in proactive injury prevention.

When your training season has ended, it’s time to assess how well you performed. For triathletes, this means taking a critical look at your performances. Identifying areas where you didn’t perform as well and those where you excelled makes it easier to create a new training plan for next season.

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According to research, there are 10,000 athletes each year who seek treatment for sports or exercise related injuries, and over a 2-year period, over 7 million athletes will receive medical attention. Triathletes seem to suffer the most injuries, with 90% of participants reporting injuries over the last 1-2 seasons, most often in the lower extremities(4). These types of injuries make it difficult to finish triathlon training, with up to 75% up triathletes losing 2-3 months of training (5). Most of these injuries are related to overuse, and include conditions like Achilles tendinopathy, medial tibial stress syndrome (also known as shin splints), and plantar fasciitis. These and many other related conditions can be avoided with a proactive screening program that is sport-specific, along with physical therapy intervention.

When it comes to protecting the health of triathletes, participants should consider factors that are intrinsic (individual) and modifiable, such as prior injury and supinated foot conditional, and extrinsic (environmental) risk factors, like training volume and competition distance. These factors have been shown to increase the chance of a future injury occurring (6). The same research has shown that utilizing a program that includes strength training, participation by the coach and club and support from a full medical team reduces future injury risk in triathletes (7,8). According to experts, athletes can benefit from pre-participation training, cross training, equipment fitting and using sensible training schedules and techniques to reduce their chance of injury.

What is The Functional Movement Screen™ (FMS™)

We use The Functional Movement Screen™ (FMS™) in our pre-participation screening process. Through the FMS™, we can assess seven different functional movements that measure the following critical elements of movement, including stability of the trunk and core, flexibility, acceleration and deceleration, dynamic flexibility and neuromuscular coordination (10).

This element of our patient screening lets us look at your injury risk by objectively scoring and grading you before undergoing any treatment activities. Follow-up and reassessment for those who are at-risk for injury is also a part of the process.

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  1. Deep Squat
  • This exercise assesses bilateral and symmetrical stability of the hips, knees, ankles, shoulders and thoracic spine.
  • Instructions:
    • Stand up tall with your feet shoulder width apart and toes pointing forward.
    • Hold the dowel in both hands and place horizontally on top of your head so that your shoulders and elbows are at 90 degrees.
    • Press the dowel so that it is directly above your head.
    • While maintaining an upright pose, keep your heels and the dowel in position as you descend as deep as possible.
    • Hold the position for a count of one and return to the initial position.

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  1. Hurdle Step
  • This exercise assesses the bilateral single left stance stability, open kinetic chain hip and knee flexion, OKC dorsiflexion and closed chain hip flexion.
  • Instructions:
    • Align the hurdle with your feet together and your toes touching the test kit.
    • Stand up tall and grasp the dowel with both hands and place it behind your neck and across the shoulders.
    • While maintaining an upright posture, raise the right leg and step over the hurdle, making sure to raise the foot towards the shin while maintaining foot alignment with the ankle, knee and hip.
    • Touch the floor with the heel and return to the starting position, while keeping proper foot alignment with the ankle knee and hip.

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  1. In-Line Lunge
  • This exercise assesses ankle and knee stability hip abductor and adductor weakness, step leg mobility, and balance in a narrow base of support.
  • Instructions:
    • Place the dowel along the spine so it touches the back of your head, upper back the middle of the buttocks.
    • While grasping the dowel, your right hand should be against the back of the neck, and your left hand should be against your lower back.
    • Step onto the 2×6 with a flat right foot with the toe on the zero mark.
    • The left heel should be placed at the tibial measurement marker.
    • Both toes must be pointing forward with flat feet.
    • Maintaining an upright posture so the dowel stays in contact with your head, upper back and top of the buttocks, descent into a lunge position so that the right knee touches the 2×6 behind your left heel.
    • Return to starting position.

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  1. Shoulder Mobility
  • This exercise assesses the bilateral shoulder flexion, abduction, adduction, internal rotation and external rotation. It also assesses thoracic spine extension and rotation.
  • Instructions:
    • Stand up tall with your feet together and arms hanging comfortably.
    • Make a fist so that your fingers are around your thumbs.
    • In one motion, place the right fist overhead and down your back as fast as possible while also taking your left fist up back as far as you can.
    • Don’t creep your hands closer after their initial placement.

 

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  1. Active Straight Leg Raise
  • This exercise assesses the functional hamstring flexibility, core stability and hip extension mobility.
  • Instructions:
    • Lay flat with the back of your knees against the 2×6 with your toes pointing up.
    • Place both arms next to your body with the palms facing up.
    • Pull the toes of your right foot toward your shin.
    • With the right leg remaining straight and the back of your left knee maintaining contact with the 2×6, raise your right foot as high as possible.injury-6-web
  1. Trunk Stability Push-Up
  • This exercise assesses symmetrical trunk stability, scapular stability and upper extremity strength.
  • Instructions:
    • Lie face down with your arms extended overhead and your hands shoulder width part.
    • Pull your thumbs down in line with the forehead for men, or the chin for women.
    • With your legs together, pull your toes toward the shins and lift your knees and elbows off of the ground.
    • While maintaining a rigid torso push your body as one unit into a push-up position.injury-7-web
  1. Rotational Stability
  • This exercise assesses asymmetrical trunk stability, scapular, stability and upper extremity strength.
  • Instructions:
    • Get on your hands and knees over the 2×6 so that your hands are under your shoulders and your knees are under your hips.
    • The thumbs, knees and toes must contact the sides of the 2×6 and the toes must be pulled into the shins.
    • At the same time, reach your right hand forward and right leg backward, as if you are flying.
    • Then, without touching down, touch your right elbow to you knee directly over the 2×6.
    • Return to extended position.
    • Return to start.

What does the evidence say?

When it comes to determining an individual’s future risk for injury, research has found that a score of 14/21 is the appropriate cut off point. Those who reach a score of more than 14/21 have been found to be 11x more likely to become injured and lose valuable time away from their training program. A score that is lower than the cut off is typically the result of a current injury or compensatory movement pattern, which could indicate the possibility of a future injury.

We use this knowledge to create a program designed to intervene before an injury occurs. These programs include corrective exercises designed to help restore natural movement patterns, muscle balance, reduce the amount of time spent unable to train and improve your overall performance. Using these types of exercises has proven to improve FMS™ scores, reduce the amount of time that you are unable to train and reduce your risk for future injury (9,10).

One type of exercises known as single plane exercises, that include running and cycling, have been proven to help restore or develop asymmetry throughout the body. Athletic individuals who have muscle imbalances typically neglect these weaknesses or train around the area (11,12). By utilizing the FMS™ results, we can identify potential injury areas and risk, and use that information to develop training programs.

A great time to work on restoring your health by healing from injuries and building up strength to prevent future injuries is during the off-season. Using the FMS™ to evaluate your situation before diving into physical therapy makes it easy to locate modifiable risk factors.

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Are you interested in learning more about the FMS?

To learn more about the FMS™ or to see how the right physical therapy plan can aid you in healing and increase your athletic performance, contact Total Motion Physical Therapy.

References

  1. Dias Lops, A. et al. What are the main running-related musculoskeletal injuries. Systematic Review. Sports. Med. 2012;42(10):891-905.
  2. National Center for Injury Prevention and Control Centers for Disease Control and Prevention. CDC Injury Research Agenda. Atlanta, GA: US Department of Health and Human Services; 2002.
  3. Gotsch K, Annest JL, Holmgren P, Gilchrist J. Nonfatal sports and creation related injuries treated in emergency departments United States, July 2000-June 2001. MMWR Morb Mortal Wkly Rep. 2002;51(33):736-740.
  4. O’Toole ML, Hiller WDB, Smith RA, et al. Overuse injuries in ultra endurance triathletes. Am J. Sports Med 1989;17(4):514-8.
  5. Vleck VE, Garbutt G. Injury and training characteristics of male elite, development squad and club triathletes. Int J. Sports Med 1998;19(1):38-42.
  6. Gosling, C. Triathlon related musculoskeletal injuries. The status of injury prevention knowledge. J Science and Medicine in Sport. 2008. 11:3960406.
  7. Egermann M, Brocal D, Lill CA, et al. Analysis of injuries in long-distance triathletes. Int J Sports Med 2003;24(4):271-6.
  8. Aaltonen, S. Prevention of Sports Injuries. A systematic review of randomized controlled trials. Arch Phys Med Rehab. 2007. 167(1383-1396).
  9. Chorba RS, Chorba DJ, Bouillon LE, Overmyer CA, Landis JA. Use of a Functional Movement Screening Tool to Determine Injury Risk in Female Collegiate Athletes. N Am J Sports Phys Ther. 2010; 5(2):47-54.
  10. Peate WF, Bates G, Lunda K, Francis S, Bellamy K. Core strength: a new model for injury prediction and prevention. J Occup Med Toxicol. 2007;2:3.
  11. Beckham, S.G. and Harper, M. Functional training: Fad or here to stay? American college for Sports Medicine’s Health and Fitness Journal 14(6):24-30, 2010.
  12. Jaffe, L and Cook, G. One frame at a time. Training and Conditioning 16:8, 2006.