Functional Movement Screen and Prior Disclosures …ortho.emory.edu/documents/Symposium 2016 Talks... · 4/20/16 1 Functional Movement Screen and Prior Injury in National Football

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Functional Movement Screen and Prior Injury in National Football League

Combine Athletes

Harris S. Slone, M.D., Spero G. Karas, M.D., Raj Shani, M.D., Megan East, M.A., L.A.T, O.T.C.,

William R. Barfield, Ph.D., Marty Lauzon AT-C, PT

Disclosures HS ›  Arthrex- Paid Instructor

SGK ›  DJO Surgical- Consultant, Royalties, Research Support, Institutional

Support ›  Arthrex- Consultant, Institutional Support, Research Support ›  Conmed Linvatec- Consultant, Institutional Support ›  Synthes- Research Support ›  Wright Medical- Consultant, Research Support ›  Ossur- Institutional Support ›  Smith Nephew- Institutional Support ›  Mimedx- Consultant

Others ›  None

Background: FMS

Functional Movement Screen (FMS) is an objective screening system intended to rank and categorize fundamental movement patterns and determine side-to-side asymmetries ›  Used in pre-participation physicals ›  Currently used at NFL combine ›  Used by some teams for objective return to play evaluation ›  Multiple studies have demonstrated good inter- and intrarater

reliability

Cook, NAJSPT 2006

FMS

Overhead Squat Hurdle Step

Active SLR

Trunk Stability

In-line Lunge Shoulder Mobility

Rotary Stability

Scored: 0-3 Total Possible Score: 21

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FMS and Injury Risk

In NFL Athletes ›  One NFL team for one season ›  Average FMS score = 16.9 ›  Difference in scores between those who were injured vs.

not injured (14.3 vs. 17.4) ›  Players with scores below 14 were >11x more likely to be

injured (placed on IR)

Kiesel, NAJSPT 2007

FMS and Injury Risk

In NFL Athletes ›  238 scores obtained before training camp ›  Players with scores ≤14 were >1.8x more likely to be injured (any

time lost from practice or games) ›  Any asymmetry, regardless of total score, had 1.8 x greater risk of

injury ›  Combination of total FMS score ≤14 and ≥1 asymmetry was specific

(0.87) for injury

Kiesel J Sport Rehab 2014

FMS and Injury Risk

In Soldiers ›  Prospective study of over 2476 men (ages 18-57) ›  Soldiers who scored ≤ 14 were at higher risk of injury

compared to those with FMS > 14 ›  Concluded that poor FMS performance was associated with

injury risk, but with low sensitivity, specificity, and PPV ›  FMS use “not recommended” due to “miscalculation of injury

risk”

Bushman AJSM 2015

Background: Prior Injury

Previous history of injury has been shown in multiple studies as the most significant risk factor for future injury

Hagglund, Br J Sport Med, 2006; Van Mechelen, Med Sci Sport Exercise, 1996

Is there a relationship between previous injury

and FMS score?

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Purpose

The purpose of this study was to determine whether the results of the FMS performed at the NFL Combine were associated with a history of previous injury in the elite collegiate athlete.

Our Study

Retrospective review of 1293 combine participants from 2009-2013 Recorded demographic data, position, injury history, the need for surgery, and number of games missed due to injury

Our Study ›  By Injury Type

›  Stinger ›  AC sprain ›  Mechanical low

back pain ›  Hamstring strain ›  Groin Strain ›  MCL sprain ›  Patellar Tendonitis ›  Lateral Ankle

Sprain ›  High Ankle Sprain ›  Turf Toe

›  By Body Part ›  Neck ›  Shoulder ›  Forearm/Hand ›  Lumbar Spine ›  Hip/Pelvis ›  Knee/Leg ›  Ankle/Foot/

Lower leg

›  By Surgery Type ›  ACL ›  Meniscus repair/

meniscectomy ›  Sports Hernia ›  Shoulder labral

repair ›  Ankle/Foot fx

ORIFs

Statistics A one-way analysis of variance was performed with Tukey post-hoc comparisons to compare FMS score and position. Chi-square was used for all categorical and dichotomous variable comparisons. ›  Also used previously established “cut-off” score of 14

Spearman correlation was also used to assess the relationship between FMS, number of asymmetries, number of games missed and number of injuries recorded. The a priori alpha level was established at p ≤0.05

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Results

Overall Injuries and FMS

Mean Range

Total FMS Score 13.8 ± 2.4 5-21

Total # of Injuries 3.5 ± 1.9 0-15

Games Missed 2.3 ± 3.6 0-24

Total # of Asymmetries 0.9 ± 0.9 0-4

Results

35 118

252 309

224 165

89 40 14 9 2 3 1 1 0 1 0

50

100

150

200

250

300

350

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

# of

Pla

yers

# of Injuries

Number of Injuries Reported Per Player

Results

46 88 111 136

178

0 20 40 60 80

100 120 140 160 180 200

Sports Hernia

ACL Tear Ankle or Foot

Fracture

Shoulder Labral Tear

Meniscal Tear

# of

Inju

ries

Injury Type

Number of Injuries Requiring Surgery

Results

64 86 89 130 134 168 221

315 376

474

0

50

100

150

200

250

300

350

400

450

500

Patella

r Ten

donit

is

Low B

ack P

ain

Groin S

train

High Ank

le Spra

in

Turf t

oe

Stinge

r

MCL Spra

in

AC Spra

in

Hamstr

ing S

train

Low Ank

le Apra

in

# of

Inju

ries

Injury Type

Number of Non-Surgical Injuries

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FMS by Position

Offensive and Defensive Linemen were significantly more likely to score lower on the FMS (p<0.001)

FMS Test Score By Position Position Number Mean OL 210 12.8 ± 2.5** DL 233 12.9 ± 2.6** LB 123 14.4 ± 2.3 DB 217 14.2 ± 2.4 RB 120 14.1 ± 2.1 WO 178 14.1 ± 2.1 QB 64 14.6 ± 2.4 TE 82 14.4 ± 2.1 ST 36 15.2 ± 1.9

0

5

10

15

20

25

0 2 4 6 8 10 12 14 16

Tota

l FM

S Sc

ore

# of Injuries

FMS vs. Injury History

Total FMS and # of Injuries

No significance

FMS – Total Score

No significance

FMS Score and Injuries/Games Missed FMS Injuries/Games Missed p-value Total FMS score Total # of Injuries 0.806

Total FMS Score Total # of Games Missed 0.714

FMS Score ≤ 14 vs > 14 Total # of Injuries 0.513 FMS Score ≤ 14 vs > 14 Total # of Games Missed 0.074

FMS Asymmetry

The # of FMS asymmetries was associated with total number of games missed

FMS Asymmetries and Injuries/Games Missed

FMS Injuries/Games Missed p-value

# of Asymmetries Total # of Injuries 0.362

# of Asymmetries Total # of Games Missed 0.002**

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Results: Summary

FMS Total Score ›  Offensive and defensive lineman were more likely to

score lower on the FMS (p<.001)

›  No significant difference was seen between total FMS score and # of injuries (p=.806) or # of games missed due to injury (p=.714)

›  FMS score did not correlate with # of games missed (r=.006; p=.845) or total # of injuries (r =-.008; p=.778)

Results: Summary

FMS Asymmetries ›  No significant difference between FMS asymmetries

and # of injuries (p=.362)

›  A statistical relationship was noted between the # of asymmetries and # of games missed (p=.002) ›  Large range of games missed (0-24)

›  The # of asymmetries did not correlate with games missed due to injury (r=.016; p=.574) or total # of injuries (r=.001; p=.982)

Limitations

Retrospective study Players may specifically “train” for the FMS prior to the NFL combine Injury history is based on collegiate medial records and volunteered information by the player The number of games missed due to injury may be dependent on the time of year at which the injury occurred

Conclusion The results of this study suggest that within elite athletes at the NFL Combine, no relationship exists between prior injury history and FMS score Caution should be exercised when attempting to evaluate an athlete’s FMS performance perceived to be reflective of past injury.

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Bibliography

1.  Cook G, Burton L, Hoogeboom B. Pre-Participation Screening: The Use of Fundamental Movements as an Assessment of Function – Part 1. N Am J Sports Phys Ther. 2006a; 1: 62–72.

2.  Cook G, Burton L, Hoogeboom B. Pre-Participation Screening: The Use of Fundamental Movements as an Assessment of Function – Part 2. N Am J Sports Phys Ther. 2006b; 1: 132-139.

3.  Frohm A, Heijne A, Kowalski J, et. al. A nine-test screening battery for athletes: a reliability study. Scand J Med Sci Sports. 2012 Jun;22(3):306-15.

4.  Onate JA, Dewey T, Kollock RO, et. al. Real-time intersession and interrater reliability of the functional movement screen. J Strength Cond Res. 2012 Feb;26(2):408-15.

5.  Shultz R, Anderson SC, Matheson GO, et. al. Test-retest and interrater reliability of the functional movement screen. J Athl Train. 2013 May-Jun;48(3):331-6

6.  Kiesel K, Plisky PJ, Voight M. Can serious injury in professional football be predicted by a preseason Functional Movement Screen? N Am J Sports Phys Ther. 2007; 2(3):76-81.

7.  Kiesel KB, Butler RJ, Plisky PJ. Prediction of injury by limited and asymmetrical fundamental movement patterns in american football players. J Sport Rehabil. 2014 May;23(2):88-94.

8.  Chorba RS, Chorba DJ, Bouillon LE, et. al. Use of a functional movement screening tool to determine injury risk in female collegiate athletes. N Am J Sports Phys Ther. 2010 Jun;5(2):47-54.

9.  O'Connor FG, Deuster PA, Davis J, et. al. Functional movement screening: predicting injuries in officer candidates. Med Sci Sports Exerc. 2011 Dec;43(12):2224-30.

10.  Hagglund M. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons Br J Sports Med 2006;40:767–772

11.  Van Mechelen W. Subject-related risk factors for sports injuries: a 1-yr prospective study in young adults. Medicine & Science in Sports & Exercise. 1996: 28(9): 1171-1179

12.  Duncan MJ, Stanley M. Functional movement is negatively associated with weight status and positively associated with physical activity in British primary school children. J Obes. 2012.

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