The Functional Movement Screen (FMS) is a very popular assessment system used by personal trainers. The intent is to rank and grade different movement patterns that cover a wide spectrum of human movement and to guide the appropriate corrective strategies based on the tests. After having received questions on it, I decided to expand on why I am not a fan of the FMS and why I do not use it with my personal training clients. And further, how after having gone through a FMS test by a trainer who was a bit of an evangelist for the omnipotence of the screen, I actually now consider it a bit of a “yellow flag” if a trainer uses the FMS.
In the FMS, a series of 7 movement tests are used where you’re graded from 1-3 on your performance of these exercises (or a “0” in the case of pain). At the end, the numbers are added together with the intention of predicting your injury risk. While I’m personally not a fan of “grading” my clients as for my audience it seems more condescending than helpful, so far so good.
So why is that if I’m looking for a trainer to hire for myself or recommend to others, little alarm bells go off in my head if the trainer I’m reading about uses the FMS? They could in fact be a great trainer, but the reason it makes me cautious is that often where the FMS rears its head, there’s junk science nearby. The test is okay – information itself can never be bad – but the application of it or the methodology can be highly suspect.
In the FMS, there are 3 different clearing tests that are used to see if a simple movement related to the tested movement provokes pain. If there is pain associated with the movement in the clearing test, the FMS protocol is to give the tested movement pattern a “0” and to “perform a more thorough evaluation or refer out”. 
So In the case of the trunk stability pushup test, the clearing test is essentially an upward facing dog type position from Yoga where the spine is in extension. In terms of spinal movement, extension refers to what we refer to as “arching” the back whereas flexion would be what we often call “rounding”. When you do the trunk stability push up, you’ll get your score of 1-3. If you have pain in the clearing test, you automatically get a “0” for the trunk stability test. 
The reason that this is bullshit is that back pain and core strength have little to no relationship with each other – and if they do in your particular situation, that should be determined by a physical therapist – not a personal trainer. If you put someone’s spine into an extended position and it hurts, all that proves is that their back hurts when they’re put into extension. While chronic back pain is definitely cause for concern – from a training perspective if someone presents with extension-based back pain then the application is really simple – be careful about putting the spine in excessive extension and coach a more neutral spine position.
This concerns me as it demonstrates an inaccurate understanding of both pain and the role of core strength and therefore it could negatively impact the intelligence of the resulting training program. If a trainer observes that you have extension-based back pain and they flirt with the line between trainer and physical therapist while clinging to an over simplistic and outdated belief about back pain, there is a risk that your training time will become less about your goals and more about their fitness ideology.
This segues into my other concern – a weak scientific foundation for the application that may be applied to a training program based up on the observations made in the test. As the founders and teachers of the FMS teach methods that are claimed to retrain the firing pattern of the transverse abdominis, this can mean that trainers who use the FMS – at least if they hold unsubstantiated beliefs about the role of the transverse abdominis – may have a bit of a fixation on core training methods that are an unnecessary waste of your time for your goals…unless you really like rolling on the floor. I guess it can be kinda fun.
Here’s what you need to know about the transverse abdominis: it fires automatically to stabilize your spine with the onset of a planned movement. The only case that I’m aware of for where there is a delay to this firing pattern is with people who have low back pain, and the evidence suggests that the delay is a response to the back pain rather than the back pain a response to the timing delay. The timing delay is still rather small….
“If movements are planned, slow, and the CNS can predict potential displacement, there is no need to consciously pre-contract TVA. Even in the presence of back pain when TVA is delayed, it automatically activates within 50-90ms of starting to move the arm, leg, or spine. There are almost no situations in the gym where load will be taken faster than this.” – Comferford (2006) 
The third main reason the use of the FMS gives me concern ties in with the above mentioned issues regarding back pain, and that is the nocebo effect. The nocebo effect is like the placebo effect, but with bad things. You’re told by an expert that you’ll experience a symptom – and then you find yourself experiencing it.
If you’re told your back pain is the result of poor transverse abdominis timing, you’re now more likely to believe that your back pain will continue to be an issue until you “correct” this. And as a result, it does in fact become true. Belief is a very strong force when it comes to the perception of pain.
But another consideration is that if you have a low score, you are then TOLD you have a low score. If you’re told that a low score equals an increased injury risk, how does that influence your future perception of pain? Highly unlikely to be for the better.
It’s not within the scope of practice for a personal trainer to “fix pain”. We may educate about the evidence related to decreasing pain (like I aim to do with the links in this post). But most importantly, we need to exercise caution with our phrasing to not increase the potential or persistence of pain in our clients via the nocebo effect.
“…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
Eye Witness Testimony
I can’t speak for the quality and methods of all trainers who use the FMS and all anecdotal evidence should be taken with a grain of salt – even anecdotes from me – but I was put through the FMS and a training session by a trainer who is an FMS practitioner and it’s really a struggle for me to find nice things to say.
I was put into positions that are contraindicated for my structural limitations in my hips (not exactly super relevant to actual training), after getting a “3” on the trunk stability push up (don’t act like you’re not impressed…) I was given a “0” because oddly enough jamming my facet joints together in spinal extension was uncomfortable, and then told outdated claims about the transverse abdominis for back pain and told that “retraining the firing pattern” of my transverse abdominis would improve my hip impingement (ummm…no).
Here are some more resources on the transverse abdominis, and on the science of back pain, so you can see why I hold all these claims in such a low regard:
On transverse abdominis firing delays being a consequence of low back pain rather than cause:
http://en.wikipedia.org/wiki/Transverse_abdominal_muscle (see “Function” section)
On back pain as it relates to core strength (and other topics):
And again I repeat that if a trainer uses the FMS, it doesn’t mean they’re a bad trainer. Actually, the fact that they pursued continuing education and have a desire to understand how their clients move is something that says great things about them.
However, knowing what I know about the FMS and having had a rather underwhelming experience myself, I would instantly become very curious (and cautious) about what the belief systems are of any trainer I was considering hiring or recommending if their marketing materials talk about their use of the FMS. If the core of one’s training philosophy and the bulk of your time training are based upon a poor understanding or commitment to training science (and scope of practice), you could find yourself, at best, with less time and money without moving closer enough to your goals.
Related reading on the science of the FMS:
1) Cook, Gray – 2010. Movement: Functional Movement Systems
Page 6 – under “Clearing Test”
2) Scott M, Comerford MJ, Mottram SL – 2006. Transverse Training – A Waste of Time in the Gym?