The FMS's Influence on Strength and Conditioning (Part 3)

I wrote vaguely last week about how I use movement screens at Heilman’s Performance to facilitate our program design. I discussed that the individual scores we collect on each athlete provide guidance to three key factors of any well designed strength and conditioning program: initial prescription, regressions, and omittance. These scores give us just enough insight to decide which exercises to prescribe, which need to be altered to provide the most benefit, and which exercises to avoid entirely until a particular movement pattern can be cleaned up. I would like to discuss in this blog what exactly I’m trying to identify with a screen and more specifically how it helps us arrive at a decision concerning the three aforementioned factors.

Collecting FMS Scores

If you didn’t read the previous blog, I suggest you do so. Here is the link. Also, take time to watch the video that I posted on the FMS to get familiar with the 7 tests. If you watched the video you know that each test is given a score of 0, 1, 2, or 3. There are certain cues used to set up and guide a client or athlete through each pattern. 

If pain is reported with a movement – 0, that athlete or client is referred to a clinician.

If the whole movement is CLEARLY dysfunctional, there are positions that the athlete or client is CLEARLY unstable in, or there are OBVIOUS mobility restrictions throughout the pattern - That particular movement is scored a 1.

If the athlete/client is able to complete the movement in its entirety with no pain and limited difficulty - That movement is scored a 2.

If the athlete is able to complete the movement in its entirety with no restrictions, compensations or dysfunctions. – That movement score is a 3.

To put it into more layman’s terms, I like to think about the scoring like this:

It hurts. – 0, referral.

“That was terrible.” – 1

“That was OK, not terrible, but not perfect.” – 2

"Oh, that's what it's supposed to look like." - 3

Seeing your first perfect score on the overhead squat is like seeing a unicorn, you’ve never seen one before, but when you see it, you JUST KNOW. It’s beautiful. – Score THAT a 3.

How do we use the screen scores to create programs?

I’ve talked a lot about using the FMS as a “red flag mechanism” before designing our training programs at Heilman’s Performance. That means we’re using the standardized scoring of movement patterns to alert us of dysfunctional movement that could potentially be the cause of serious injury down the road. These “red flags” also alert us of movement dysfunctions, which if trained often and under significant load, could acquire an injury as a result of their training, which, I think most S&C Coaches would agree, is the ultimate no-no. 

What qualifies as a “red flag?”

Basically what we’re looking for first and foremost are people who score a 3 on one side of the body and a 1 on the other. These are obvious asymmetries and the first red flag we look for. If there are no asymmetries to address, we then look for movements that a score of 1 was given. These are the outliers. The movements that cause problems down the road. 

I think it’s important, before I get into specifics, to reiterate that we aren’t necessarily using the screen to apply a “movement profile” to every single athlete or client. But we’re trying to catch the outliers. We want to catch the few that have major dysfunctions before they turn those dysfunctions into a major injury. Or worse, we hurt them by asking them to perform something they aren’t ready for. I’m looking for the 3/1’s that are out there competing pain free. For now.

Now let’s talk about some more specific prescription, regression, and omittance examples from each individual screen.

Overhead Squat (OHS)

·      Prescription – If your athlete or client scores a 3 on the overhead squat, that’s a good sign. Chances are that they’ll have a fairly clean screen throughout. In my opinion, a 3 on the OHS clears the athlete for Back Squatting, Overhead Squatting and all of their regressions. In my program design, if I want to prescribe high intensity training, I use my 3’s to do it.

·      Regression – If the athlete or client can’t complete a quality OHS with his/her heels flat on the floor, but can with his/her heels lifted off the floor, their OHS is scored a 2. In my opinion, a 2 tells me that I can squat that athlete with a heel raise. We usually just slide 5 pound plates under their heels to assist with ankle dorsiflexion and the movement usually cleans up quite a bit. A score of 2 also tells me that a particular athlete may benefit from having the movement loaded anteriorly. Regressing the back squat to a front squat or goblet squat where the load is held in front of the body, will allow the athlete to load the big three joints involved (ankles, knees, hips) much safer.

·      Omittance – Any athlete or client who scores a 1 on the overhead squat at my gym doesn’t perform bilateral squatting until we can get them to a 2. This athlete may be dealing with serious mobility restrictions in the ankles, hips, or thoracic spine and until we can get those taken care of, loading the movement will likely be hard to watch and provide complications. These athletes generally get a steady dose of ankle, hip, thoracic spine mobility drills, breathing exercises, and unloaded squat patterning in their warm up before we dial up the intensity on the squat.

Shoulder Mobility (SM)

·      Prescription – The shoulder mobility screen is performed on both sides of the body and at my gym, provides us with guidance while prescribing their “pushing” exercises. Any athlete or client that scores a 3 on both sides, we allow to perform pressing exercises bilaterally (barbell bench pressing, military pressing.)

·      Regression - Athletes that present with a shoulder mobility asymmetry, which we see in almost ALL of our baseball/volleyball athletes, are regressed from bilateral barbell movements. These athletes are prescribed exercises that are done unilaterally or where the thoracic spine is free to move naturally. Pinning the shoulder blades against a bench and bouncing a barbell off your chest is a really poor way to mobilize the thoracic spine. Landmine pressing, Turkish Get Ups (TGUs), Planks and push ups are all good options. Landmine pressing and TGUs allow the thoracic spine to move freely throughout the press and the scapulae to achieve full upward rotation as the humerus is flexed and elbow joint extended. Push-ups, likewise, allow full scapular range of motion throughout the push. These two exercises have worked well for me and my athletes and clients in training the press w/o exacerbating any underlying issues.

·      Omittance – Shoulder mobility can be a bit more complicated as it’s important to determine whether or not asymmetry has come from and underlying issue, or is simply an adaptation to outside stress (e.g. throwing your entire life.) Unless shoulder mobility scores are a 3/1 I don’t apply much corrective exercise. If the 3/1 score is because of structural adaptation, without a clinician on deck to assist in manual therapy techniques, trying to correct this asymmetry could do more harm than good. I do believe, however, that it is our job to not make things worse with our exercise prescription. These athletes with scores of a 3/1 or a 1/1 are generally held out of pressing exercises and prescribed breathing exercises and thoracic spine mobility drills in their warm up.

In Line Lunge (ILL)

·      Prescription – With the in line lunge screen I’m looking for one of two things. Can the athlete or client absorb momentum on their lead league with proper joint alignment and do they have the hip mobility necessary to complete a lunge. If you see instability in an athlete (we see it often in young ladies) as they shift their weight forward to the lead leg, you know this athlete needs to learn deceleration techniques before one of those joint structures takes such a beating is begins to fail. At Heilman’s Performance we do stationary split squatting and unloaded walking lunging to help a young athlete learn to absorb their momentum on a lead leg. If an athlete or client is unable to get their back knee all the way to the floor in a lunge, you likely need to prescribe some hip mobility drills. Brettzels and quad rocking (exercises that both extend the hip and flex the knee simultaneously) can provide elongation to the rectus femoris (the quadriceps muscle that spans both knee and hip) and really clean things up quickly.

·      Regression – Putting an athlete or client into a rear foot elevated split squat or loading up their walking lunges with heavy weight can be disaster for them if they don’t know how to absorb the stress of their body weight. Bringing them back stationary split squatting and challenging them rotationally in half kneeling positions can be a good way to make them more proprioceptively aware of the forces that keep them from absorbing stress properly.

·      Omittance – Athletes/clients that score 1/1 on their ILL screen will be held out of exercises that are concentrically dominant like plyometrics, sled pushing, and sprinting until they are taught to decelerate properly. These are athletes, I would warn, if made to perform these exercises in high doses are the athletes that turn up with tibial stress fractures in pre season (note to volleyball coaches.)

Hurdle Step (HS)

·      Prescription – An athlete who scores poorly on both sides of the hurdle step screen is likely dealing with a motor problem. Watching some one step up and over something and then back to start position can give us a pretty good idea of how much core control that person has. An athlete or client who scores a 1/1 will likely need to be retaught how to control their hips from a neutral pelvis and lumbar spine. Deadbugs, leg lowering, and other unloaded forms of anti extension exercises can be a great place to start. At Heilman’s Performance, any athlete who scores poorly on the hurdle step receives a heavy dose of anterior core training (where they are usually lying supine and mobilizing their extremities) and balance retraining. We actually keep it as simple and practicing hip flexion and toe touching while balancing on one leg in the warm up.

·      Regression – Athletes and clients who score poorly on the hurdle step are people who have a hard time stabilizing one side of the lower half while mobilizing the other. Expecting them to perform well in dynamic movements is pretty unrealistic. A good example of a regression for these athletes or clients would be prescribing a reverse lunge (where the athlete is stationary) instead of a walking lunge (where there is more dynamic stability involved.)

·      Omittance - Athletes and clients who score a 1/1 we keep away from high intensity unilateral plyometrics and strength exercises like box step ups until their motor control is cleaned up. Athletes or clients with an asymmetrical score on the hurdle step (3/1) are also held out of bilateral lower extremity exercises.

Active Straight Leg Raise (ASLR)

·      Prescription – The ASLR is a test that tests the athlete or client’s ability to hinge their hips unilaterally from a neutral pelvis and lumbar spine. It gives us a great inside into the types of hinging exercises we can prescribe. Athletes and clients with a clean score on the ASLR can do things like deadlift heavy weight from the floor. Athletes or clients who score poorly can benefit from some hip mobility exercises, re training the hinge pattern and re-teaching core control of the hips through flexion.

·      Regression – When we have an athlete with a poor score on the ASLR, we know that they’re unable to hinge their hips through sufficient range of motion while keeping their lumbar spine in a stable position. These athletes, during their hinging exercises, such as deadlifts and Olympic lifts, could benefit from starting in the top position or having their barbell brought closer to them by using blocks. Romanian deadlifts are a great regression, because the athlete starts with the barbell in the top position and only hinges as deep as his/her hips will allow. Just before his/her lumbar spine breaks neutral, the barbell is hinged back to the start position. Olympic lifts from the hang also work great, because of the top position start. Expecting athletes/clients with 1’s on the ASLR screen to pull heavy weight off the floor without involving their lower back in unrealistic.

·      Omittance – As I said earlier, athletes with a  1/1 on ASLR don’t deadlift from the floor at my gym. We work with their hinge patterns in the range of motion they can currently control while we work in their warm up to create new ranges of motion. An athlete that is asymmetrical (3/1) receives no bilateral lower extremity training. Yes I said it, these athletes don’t jump, squat, or deadlift off of two legs until we have them to a 3/3 or a 2/2. I believe the asymmetrical ASLR score is the most important score to respect. Ignoring this glaring asymmetry in such an important fundamental movement can be catastrophic down the road.

Trunk Stability Push Up (TSP)

·      Prescription – At Heilman’s Performance we use the TSP just to give us feedback on the athlete or client’s upper body strength and ability to stabilize their core through a pressing motion. We keep it pretty simple, a low score tells us we need more anterior core work and press work while a good score tells us that athlete’s probably been doing plenty of pressing and probably doesn’t need a real heavy dose of it.

·      Regression – An athlete or client who scores low on their pushup test needs to learn to stabilize their core in space and create force with their upper extremity simultaneously. Allowing them to lie down on a bench and press an implement like a barbell or dumbbell probably isn’t going to teach them that. Regressing these pressing movements to plank holds and push up variations is our go to. An athlete that scores low on their TSP will generally learn to do push ups with their hands on a bench or with a coach assisting the movement with a super band.

·      Ommittance – As I said before, these athletes and clients don’t have a very good idea how to stabilize their core and push simultaneously. Staying away from exercises that stabilizes their core for them, like a seated chest press machine or a bench press is probably best until they have mastered the plank and the push up. That’s not to say that these exercises are going to do any damage to the athlete, they probably just aren’t going to provide the most bang for your buck.

Rotary Stability (RS)

·      Prescription – The rotary stability screen gives us a good look at how opposing extremities work together and “communicate with each other,” and also how our core responds to rotational forces. A low score on the RS tells me that there is a break in communication between the left side upper extremity and the right side lower extremity or vise versa. Re-training the way these extremities interact with each other through the core can be taught easily through exercises like deadbugs and birddogs.

·      Regression – A young athlete or a client with a poor RS score is probably the kid that starts pushing a sled aimed straight ahead and some how ends up with the sled finishing 12 feet to the right or left of where he/she originally started. Or the athlete who can’t seem to stay in their own damn lane at track practice. Helping them understand how to resist the rotational forces on their pelvis and core through things like reactive neuromuscular training (RNT) exercises can be of great benefit. That being said, I don’t know that you have to wait on dynamic movements, but you should at least make sure you’re aware of why their sled push started on the turf and ended up in the bathroom.

·      Omittance – Some may tell you different, but I personally don’t omit any exercises depending on and athlete’s RS score. I do, however, let it dictate how much anti rotation and RNT work I give to an athlete. An athlete with poor RS gets a heavy dose of Anti-Rotation holds, Half Kneeling RNT exercises, Deadbugs, birddogs, and glute activation exercises.

I should note that these are just the ideas that I apply to the programming at Heilman’s Performance. They are in no way anything other than my opinions on the matter. I am just hoping to provide some guidance as to how strength coaches and personal trainers can put this information to work for them. Usually if I have a reason, via my screen scores, to avoid a certain exercise, I can find away to elicit the response I’m looking for with a different exercise. I think the biggest benefit we’ve had at Heilman’s Performance of using screen driven programming is that our technique has become much more sound. Working with young athletes is always going to be a struggle on the “technique” front, but when you work with a system that allows to you decipher what they will and will not handle well, it really seems to clean up. Using the screen scores to design programs has allowed my athletes to train with less knick knack injuries and achieve great progress in the weight room. I know this blog got pretty long winded, but I’m hoping it can provide guidance to any strength coach or personal trainer who might be looking to implement pre-design screens into their program.

As always, thanks for reading,

Caleb Heilman