Which of the following is the best explanation for the fact that the average scores on standard motor skills tests?

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Movement Health

If movement health is defined as ability, then the opposite of that would be disability. When an athlete has structural changes, neurological insult, significant injuries involving inflammation, and acute, chronic, or permanent limitations to movement, then these should be investigated with a more sensitive movement tool than a screen. The FMS™ does not try to do this! Simply stated, it is not designed to be performed with people who demonstrate pain or other health‐related concerns.

Movement Competency

Movement competency is something that must be established and investigated because at this time risk factors for movement dysfunction are incompletely described. In contrast, assessable risk factors have been described for almost every other system of the body, and signs of dysfunction (risk factors) emerge before the symptoms of dysfunction and/or disease or disability present. Even though people are out of health risk or pain with regard to movement, it does not mean that they are necessarily optimally “functional”. This simple fact may explain why movement dysfunction is so prevalent. Consider an important example related to movement: the segment of the population that is at high risk for falls has been identified, however, fall risk assessment is typically not performed until the first fall occurs. This is missing an important opportunity for primary prevention. Health providers are more proactive with risk assessment in almost every other body system (cardiovascular, pulmonary, endocrine) than the movement system. The take home message: fundamental movement screening is intended to identify and describe movement competency (or lack thereof) and determine whether it needs to be further investigated (Figure 15).

The last level of movement screening is that of movement capacity, which is greater than competency. Competency simply means that the movement system is working proficiently, and a solid foundation exists upon which to build performance. In the presence of movement competency, positive adaptations related to training should occur. Whereas, in cases of movement dysfunction (limitations in mobility, stability, and motor control) the same stress might cause unnecessary risk or at a bare minimum, wasted exercise time without the associated benefits of that investment. Movement capacity or physical capacity is where deficiencies are common. For example, an athlete displays movement competency but has extremely low endurance (capacity), which can be explained by the lack of training. The same illustration works for decreased strength. It should be noted that with regard to strength, it is most relevant to compare an individual to an age relative, gender specific norm or expectation. Age and gender specific comparisons are the best way to examine specific deficiencies in power, work capacity, speed, agility, and quickness.

When movement is examined relative to these three categories, the thinking regarding utility of screening becomes apparent: a screen creates direction. The screen can alert a practitioner to movement health issues, movement competency issues, and also can clear the individual for greater investigation into movement capacity. A screen such as the FMS™ sits in a unique, central place, not as a diagnostic tool, or as a stand‐alone test, but as an appraisal of movement in both loaded and unloaded conditions, that represents some of the basic patterns of human movement. Screens exist in many other health and body systems but health providers lack clarity when it comes to screening of the movement system.

The authors of this clinical commentary are completely aware that screens, tests, evaluations, and assessments are simply methods that will grow, change, and become more refined toward specific goals. If the definitions of movement health, movement competency, and movement capacity are utilized, then the best screens, tests, and assessments will emerge. To initiate action and be a part of the process, the authors introduced the FMS™ and the SFMA as attempts to address movement patterns instead of isolated joint measurements.

The authors of this commentary have understood for quite some time that movement is a vital component of the human experience, because in human movement, the whole is greater than the sum of its parts. The recently adopted vision statement of the American Physical Therapy Association, statement for the profession of Physical Therapy in 2013: “Transforming society by optimizing movement to improve the human experience”21,p.18 illustrates the commitment of the profession of physical therapy to placing movement at the center of physical therapist practice. In fact, discussion began some time ago regarding the definition of the movement system, developed with the help of Florence Kendall:

The movement system is a physiological system that functions to produce motion of the body as a whole or of its component parts. The functional interaction of structures that contribute to the act of moving.22

Recently, Dr. Shirley Sahrmann has begun a profession‐wide discourse on promotion of movement as a physiologic system, promoting an emphasis on pathokinesiology versus pathoanatomy. She advocates for making the human movement system be the cornerstone for physical therapist practice, education, and research across the practice spectrum and lifespan.23 The authors of this commentary agree whole heartedly with Dr. Sahrmann, when she states: “We should incorporate more detailed observation and analysis of movement while patients perform functional activities into standardized physical therapist examinations”.23,p.1041 The authors believe that it is important for all PT's to assess fundamental movement competency, as a starting point, regardless of the screening system you use.

As other systems are developed they may add to the practice of movement assessment, and may be utilized in addition to or instead of the FMS™. After the “starting point” of fundamental movement competency is determined and deemed appropriate, this paves the way for use of higher‐level functional assessments that include > 1× BW strength and performance/skill assessments.

The Functional Movement Screen™ is the registered trademark of FunctionalMovement.com. Gray Cook and Lee Burton have disclosed a financial interest in Functional Movement Systems. The Editors of IJSPT emphasize (and the authors concur) that the use of fundamental movements as an assessment of function is the important concept to be taken from Part 1 and Part 2 of this series and can be performed without the use of trademarked equipment.

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Functional Movement Systems. This diamond‐shaped representation of related functional movement tools demonstrates where the FMS™ fits into the bigger picture of functional assessment. Note that it resides above the horizontal line indicating pain, and below specific performance tests and skill testing, indicating it's role as a screen for movement competency. Of note, below the line indicating pain is the SFMA and impairment‐based examination and assessment.