Functional Movement Screening for Rugby Players
In contact sports such as rugby it is critical for athletes to express force as optimally as possible, whether it be for speed purposes or for contact purposes. Good movement via mobility and stability allows the expression of optimal force production and is also linked with a reduction in the likelihood of injuries (Cook, 2001). A S&C programme for rugby should therefore track and measure an athlete’s capacity to produce force coupled with the ability to move well.
The Functional Movement Screen (FMS) is a method used to assess and document movement via a series of standardised and specific exercises. FMS was introduced by physical therapists over twenty years ago as a screening process to be used prior to exercise which can highlight problems in the movement system that potentially predispose individuals to injury (Cook & Burton, 2006a). The FMS is widely accepted by fitness professionals as a means to track movement quality and/or provide appropriate training interventions which mitigate injury risk (Cook & Burton, 2006b). FMS uses an ordinal scale for grading movement with 0 representing pain and 3 representing perfect movement. The seven FMS movements are:
Deep Squat
Hurdle Step
In-line Lunge
Shoulder Mobility
Active Straight Leg Raise
Trunk Stability Push up
Rotary Stability
In athletic preparation for rugby, there are several components of fitness to consider and several physical capacities that must be developed. Movement competency is essential prior to progressive overload for athletes to develop and express force with maximal stability and therefore minimal potential of injury. A screening protocol that highlights movement competency, asymmetries and imbalances is a useful process to include prior to commencing any rugby training intervention (Cook & Burton, 2006b). This article will discuss why FMS is not the optimal screening solution for rugby players and provide alterative suggestions.
FMS & Peak Height Velocity
The Long-Term Athletic Development model highlights stages where movement competency and skill acquisition should be prioritised to later develop optimal strength, power and speed in youth athletes (World Rugby, 2022). If an objective of a programme is to have athletes moving better, it is rational to have a standardised method of assessing movement to understand baselines and view progress over time.
In an investigation that studied the maturational effect on FMS it was found that peak height velocity and physical maturity have substantial effects on the overall FMS score (Balyi & Hamilton, 2013). Portas et al. (2016) reported that natural occurrences during the maturation process (increases in strength etc) effected the ability to perform the stability section of FMS and therefore the overall score was affected. It was suggested that FMS is invalid for young players who are at the pre-puberty stage of the maturation process (Balyi & Hamilton, 2013). These findings suggest that for age grade rugby players, FMS might not be the optimal solution to assess movement.
FMS & Injury Prediction?
In adult populations, several studies have investigated FMS to determine its authenticity in predicting injuries with mixed results. In research that looked at collegiate level athletes across a range of sports, it was reported that FMS had a 50% chance of correctly predicting athletes most at risk of injury (Dorrel et al., 2018). The authors of this study suggested the use of FMS only as a method for assessing movement quality and not predicting injury. In contrast, other research investigating the use of FMS within semi-pro and amateur rugby populations has reported an association with injury outcome mainly as a means to screen for pain and asymmetry. Attwood et al. (2019) advised prioritising players who reported pain during the screening process, and were observed to have asymmetries, to undergo further screening assessments. This suggests that FMS can be used as an initial basic screening process in the adult rugby population, or certain movements from the test could be implemented in another movement screening protocol.
Further research into FMS and injury prediction has also observed general fitness has an association with the FMS score. In an investigation that looked at over 800 Marine Officer Candidates (MOCs), researchers reported there was an association with a low FMS score (≤14) and injury risk (Knapik et al., 2001). Interestingly, this study also reported that a high FMS score (≥18) was associated with injury. Indeed, from the 108 MOCs who scored ≥18, 44% were injured during the 10-week training course. Additionaly, of the 283 MOCs who scored between 15-17 only 29.3% sustained injury. Researchers O’Conner et al. (2011) found that candidates with moderate to low levels of fitness were 2.2 times more likely to have low FMS score and significantly more likely to get injured. These findings demonstrate an association with general physical preparedness and risk of injury. Therefore the fitter an athlete is across general measures (press ups, pull ups, aerobic run protocol and sit ups) the potentially better prepared he/she is to perform various training and movement-based tasks. Thus, understanding and defining exactly what are high levels of fitness for rugby players can be a crucial step in mitigating injury risk. Such information can be found by looking at positional norms within squads, or even across a league if the information is available. Once the norms are established, a comparison can be made to understand where players rank.
Dr Flanagan states that being in the bottom 10% of positional norms for strength and/or conditioning is one small factor that can contribute to a higher risk of injury. In a 2016 article he acknowledged that coaches can’t prevent or predict injury, however; there are systems that can be implemented to make more effective decisions in athlete management and assist in mitigating against injury (Flanagan, 2016). In this article he proposes six key considerations, which include fitness component gradings and assign a risk factor to players within a squad. These considerations are:
Injury History
Concussion
Strength
Conditioning
Explosive profile
Age
This simple system may provide a more accurate metric than a functional movement score alone in relation to injury prediction as it includes several factors that are associated with risk of injury, including grading fitness levels.
FMS: Fighting anatomy, not imbalances?
Strength training has been proven to reduce sports injuries significantly (Lauersen et al., 2014). An accredited strength and conditioning coach can demonstrate fundamental movements to an agreed industry standard and provide regressions and progressions for each movement. For example, to anchor a squat pattern a strength coach may prescribe the Goblet Squat for a period as this movement places the load in front of the centre of mass and allows for easier balancing when descending into the bottom of a squat than say the traditional back squat or overhead squat. A strength and conditioning practitioner will aim to maximise balance and stability with each fundamental movement before progressing and/or adding load. To achieve this, one must consider the anatomy of the athlete. In the squat pattern, an athlete with long femurs relative to their torso might not achieve the same torso angle as that of someone with shorter femurs relative to their torso, solely due to their structure. Cook (2006) states that the deep squat movement and all the movements of the FMS are to be thought of as screening tools and not exercises within themselves, however; this example of how anthropometry can impact on movement strategy would certainly influence the total score of the FMS without there necessarily being any muscular imbalances. Another example of how the FMS favours certain anthropometric structures is in the instructions for the deep squat: feet straight and shoulder width apart. It is well known that there are variances in hip socket depth which changes one’s strategy to squat low (Horschig, 2016). For example, an athlete with a deep hip socket may need to externally rotate at the hip to reach full depth. To achieve this, the athlete will need to have their toes pointed slightly out during the squat movement to allow external rotation of the hip which is a movement compensation during the FMS protocol. Indeed, researchers have demonstrated that the squat pattern is a skill and that athletes can use various strategies that accommodate their anatomy to improve their squat pattern and reach full depth without necessarily improving their flexibility (Cleather, 2012). This reinforces the point that the first movement of the FMS will always be performed poorly by certain athletes due to anatomical considerations and not necessarily muscle imbalances or asymmetries. Additionally, research has demonstrated that athletes can receive the same score on a movement of the FMS even if they perform the movement in different ways (Frost et al., 2015). This highlights that athletes may use less than optimal strategies to achieve FMS desirable postures which could reinforce risky movement behaviour and retract from the purpose of performing a screening protocol.
The Athletic Ability Assessment
Given the limitations and mixed findings using FMS, there have been several other screening protocols that have been proposed, researched, and implemented over the years (Woods et al., 2016; Rogers et al., 2019). One such protocol, the Athletic Ability Assessment (AAA), was proposed in 2014 and has been utilised by the Sport Scotland Institute of Sport in their quarterly athlete screening process (McKeown et al., 2014). This test screens a combination of bilateral and unilateral movements and includes basic general strength exercises such as the single leg squat and trunk endurance tests. Further variants of the AAA have included hinge patterns and basic strength exercises such as the chin up and push up (Rogers et al., 2019). This could be a more appropriate screening process for rugby players as it highlights a level of general physical preparedness in combination with movement competency which has been shown to be a better predictor of injury incidence than the FMS alone (O’Connor, 2011).
Conclusion
If an objective of a programme is to enhance movement quality of athletes and reduce the likelihood of injury a screening process should be performed periodically to ascertain if training interventions are making progress towards improvement of movement quality. The FMS provides a basic movement screen protocol which can highlight asymmetries within seven fundamental movements, however; a robust screening process should include some form of general physical preparation exercises to highlight fitness as well as global movement because both of these factors have been linked to better understanding injury risk (Lauersen et al., 2014).
In rugby populations, the AAA screening protocol would represent a more detailed process that could provide better information around athletic development and the training process.
References
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https://www.trainwithpush.com/blog/monitoring-injury-risk-factors-and-the-21st-century-strength-coach?rq=eamon
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