Use of clinical movement screening tests to predict injury in sport

Table 1 Fundamental movement patterns of the Functional Movement Screen™ and the associated clearing tests

Fundamental movement pattern	Clearing test
Deep squat
Hurdle step1
Inline lunge1
Shoulder mobility1	Shoulder impingement test
Active straight leg raise1
Trunk stability push-up	Spinal extension test
Rotatory stability1	Spinal flexion test

¹Performed and scored separately for the right and left side.

Table 2 Results of studies using Functional Movement Screen™ score of 14 as a cut point to predict musculoskeletal injuries

Ref.	Sample	Injury definition	Sensitivity	Specificity	+LR	-LR
Kiesel et al[22]	46 male professional American football players	Athletic performance injury requiring injury reserve and time loss of 3 wk	54%	91%	NR	NR
Chorba et al[23]	38 female Division II athletes	Athletic performance injury requiring intervention	58%	74%	2.20	NR
O’Connor et al[24]	874 male Officer candidates	Any injury: Physical training injury requiring intervention	45%	78%	NR	NR
		Overuse injury: Long term repetitive energy exchange with cumulative microtrauma	12%	90%	NR	NR
		Serious injury: Physical training injury requiring removal from training	12%	94%	NR	NR
Butler et al[25]	108 firefight trainees	Physical training injury with time loss of 3 consecutive days	84%	62%	2.20	0.26
Warren et al[26]	195 male and females Division I athletes	Athletic performance injury requiring intervention	54%	46%	NR	NR
Garrison et al[27]	160 male and females Division I athletes	Athletic performance injury requiring intervention, and 24 h missed time or splinting, to continue participation	67%	73%	2.51	0.45
Hotta et al[28]	84 competitive male runners	Physical training injury with time loss of 4 wk	73%	54%	NR	NR
Knapik et al[29]	1045 male and female military cadets	Physical training injury	55%	49%	NR	NR
McGill et al[30]	53 elite police officer	Back injury not due to specific acute incidents	28%	76%	NR	NR
		All injury	42%	47%	NR	NR

LR: Likelihood ratio.

Table 3 Landing Error Scoring System scoring criteria

LESS item	Operational definition of error
Knee flexion: Initial contact	Knee is flexed less than 30° at initial contact
Hip flexion: Initial contact	Thigh is in line with the trunk at initial contact
Trunk flexion: Initial contact	Trunk is vertical or extended on the hips at initial contact
Ankle plantar flexion: Initial contact	Foot lands heel to toe or with flat foot at initial contact
Medial knee position: Initial contact	Center of patella is medial to midfoot at initial contact
Lateral trunk flexion: Initial contact	Midline of trunk flexed to left/right side body at initial contact
Stance width: Wide	Feet positioned > shoulder width apart at initial contact
Stance width: Narrow	Feet positioned < shoulder width apart at initial contact
Foot position: External rotation	Foot is internally rotated more than 30° between initial contact and maximum knee flexion
Foot position: Internal rotation	Foot is externally rotated more than 30° between initial contact and maximum knee flexion
Symmetric initial foot contact	One foot lands before other or one foot lands heel to toe and other lands toe to heel
Knee flexion displacement	Knee flexes less than 45° between initial contact and max knee flexion
Hip flexion displacement	Thigh does not flex more on trunk between initial contact and maximum knee flexion
Trunk flexion displacement	Trunk does not flex more between initial contact and maximum knee flexion
Medial knee displacement	At maximum medial knee position, the center of patella is medial to midfoot
Joint displacement	Soft: Participant demonstrates large amount of trunk, hip, and knee displacement Average: Participant has some but not large amount of trunk, hip, and knee displacement Stiff: Participant goes through very little, if any, trunk, hip, or knee displacement
Overall impression	Excellent: Participant displays soft landing with no frontal or transverse plane motion Poor: Participant displays large frontal or transverse plane motion, or participant displays stiff landing with some frontal or transverse plane motion Average: All other landings

Flaws 1-15 scored as present: 1 and absent = 0; Flaw 16 scored as soft: 0, average = 1, stiff = 2; Flaw 17 scored as excellent: 0, average = 1, poor = 2. LESS: Landing Error Scoring System.

Table 4 Landing Error Scoring System scoring criteria real-time

LESS RT item	Operational definition	View	Jump number
Stance width	Participant lands with very wide or very narrow stance (+1)	Front	1
Maximum foot-rotation position	Participants feet moderately externally or internally rotated at any point during the landing (+1)	Front	1
Initial foot-contact symmetry	One foot lands before the other or 1 foot lands heel-to-toe and other foot lands toe-to-heel (+1)	Front	1
Maximum knee-valgus angle	Participant moves into a small amount of knee valgus (+1); Participant moves into a large amount of knee valgus (+2)	Front	2
Amount of lateral trunk flexion	Participant leans to left or right so trunk is not vertical in the frontal plan (+1)	Front	2
Initial landing of feet	Participant lands heel to toe or with flat foot (+1)	Side	3
Amount of knee-flexion displacement	Participant goes through small (+2) or average (+1) amount of knee flexion displacement	Side	3
Amount of trunk-flexion displacement	Participant goes through small (+2) or average (+1) amount of trunk flexion displacement	Side	4
Total joint displacement in sagittal plane	Participant goes through large displacement of trunk and knees, score soft (0); Participant goes through average displacement of trunk and knees, score average (+1); Participant goes through minimal displacement of trunk and knees, score stiff (+2)	Side	All
Overall impression	Participant displays soft landing and no frontal plane motion at knee, score excellent (0); Participant displays stiff landing and large frontal plane motion at knee, score poor (+2); All other landings score average (+1)

LESS: Landing Error Scoring System.

Table 5 i-Landing Error Scoring System criteria

Good movement pattern	Poor movement pattern
Lands with no knee valgus at initial foot contact	Lands with moderate to large knee valgus position at initial foot contact
Lands with no knee valgus displacement from initial contact to maximum knee flexion	Lands with moderate to large knee valgus displacement from initial contact to maximum knee flexion
Lands with > 30° of knee flexion	Lands with < 30° of knee flexion
Undergoes > 30° of knee flexion	Undergoes < 30° of knee flexion from initial contact to full knee flexion
Minimal to no sound upon landing	Loud sound upon landing

Table 6 Technique flaws of the Tuck Jump Assessment

Lower extremity valgus at landing

Thighs do not reach parallel (peak of jump)

Thighs not equal side-to-side (during flight)

Foot placement not shoulder width apart

Foot placement not parallel (front to back)

Foot contact timing not equal

Excessive landing contact noise

Pause between jumps

Technique declines prior to 10 s

Does not land in same footprint (excessive in-flight motion)

Table 7 Categorization of 10 technique flaws from the Tuck Jump Assessment into modifiable risk factors

Modifiable risk factor	Description	Technique flaws
Ligament dominance	“Imbalance between the neuromuscular and ligamentous control of the dynamic knee stability”	Lower extremity valgus at landing
		Foot placement not shoulder width apart
Quadriceps dominance	“Imbalance between knee extensor and flexor strength, recruitment, and coordination”	Excessive landing contact noise
Leg dominance or residual injury deficits	“Imbalance between the 2 lower extremities in strength, coordination, and control“	Thighs not equal side-to-side (during flight)
		Foot placement not parallel (front to back)
		Foot contact timing not equal
Trunk dominance/core dysfunction	“Imbalance between the inertial demands of the trunk and core control and coordination to resist it”	Thighs do not reach parallel (peak of jump)
		Pause between jumps
		Does not land in same footprint (excessive in-flight motion)
Technique perfection	Not defined	Technique declines prior to 10 s