RESEARCH REVIEW: MOVEMENT SCREENS DON'T GIVE US ALL THE ANSWERS
If you want to reduce those niggling injuries, improve your athletic performance or golf swing - you need a movement screen right?
The fitness industry, and the golf industry, would certainly seem to say yes.
However, the fitness industry is often guilty of grabbing hold of the latest thing out there and turning it into the pancea of all ills. Screenings are often being used as a means of diagnosis of injury risk or a testing protocol to predict performance, but does the research actually bear this out as appropriate use?
With this in mind this article will take a look at the research surrounding the most popular movements screen used by golfers - namely the FMS and TPI movement screen.
Reliability and Validity (The simple version)
Screening, physical tests, or other scientific protocols should ideally be shown to be both reliable and valid.
This can be a confusing process, but for the sake of this article:
Reliability refers to the test being consistent. If a test is not consistent/reliable, we cannot trust any scores that come out of it because that means if tested again, the results could be completely different. A fair amount of research has been conducted on the reliability of FMS and has concluded it has moderate-to-strong reliability (Schneiders et al., 2011; Onate et al., 2012; Teyhen et al., 2012; Shultz et al., 2013).
Validity refers to how well the test examines what it is supposed to, or how precise the test actually is. The overall consensus is that the FMS is lacking validity in many regards:
One potential issue is that there is quite a bit of evidence that movement patterns change significantly when the load or speed is altered (Frost et al., 2013b; Beardsley & Contreras, 2014b). Movements that a golfer performs at high speed during a golf swing are, therefore, possibly very different than when tested with the FMS.
Research shows once an athlete knows what the raters are looking for, they achieve better scores (Frost et al., 2013b). So in effect if your FMS scores have improved it could be the result of learning the test, rather than improved physical ability.
Whiteside et al. (2014) showed that certified FMS testers gave significantly different scores presented with the same athlete doing the same movement captured on 3D motion capture video.
FMS and Movement Efficiency/Athletic Performance
Most reviewers note that scores on the FMS has had insignificant relationships with most measures of athletic performance (Okada et al., 2011; Parchman et al., 2011; Lockie et al., 2015b), though one author did find some positive correlations when looking at youth athletes rather than adult (Lloyd et al., 2015).
Another important aspect of a test of performance is that high level performers should do better than low level performers. For example, the Yo-Yo Intermittent Recovery Test Level 1 is the most studied and used test of intermittent fitness for football/soccer and rugby players. This test has been heavily validated and consistently shows that the elite athletes do better than the sub-elite, who do better than the average, who do better than recreational athletes (Bangsbo et al., 2008).
For the most part, the FMS has been unsuccessful in differentiating between skill level (Fox et al., 2014; Grygorowicz et al., 2013; Loudon et al., 2014). This hurts the validity of the FMS because if it does evaluate movement that is helpful to performance, we would expect the best athletes to score higher than worse athletes, which has not been in the case in the literature.
Ability to Predict Injury
Overall, the literature has extremely mixed results with using the FMS to identify athletes who are at a higher risk of injury.
One of the few risk factors that seems to have significant evidence is previous injury (Dvorak et al., 2000; Arnoson et al., 2004; Kucera et al., 2005). Most other factors such as performance on various tests, muscle strength, fitness levels, skill level, joint strength or laxity, etc… have only shown limited or inconsistent results.
Schneiders et al (2011) and Agresta et al (2014) both tested currently healthy individuals, some of whom had past injuries, the rest who had not. They found no difference in score between those who had past injuries and those who have not.
Kraus et al. (2014) and Beardsley & Contreras (2014) had previously noted that some studies found moderate predictive ability. For example, some studies note that there was high injury occurrence in those who score less than a 14 on the FMS (Kiesel et al., 2007; Garrison et al., 2015; Chorba et al., 2010). However, these are also mostly smaller studies with very homogenous groups that would not relate to other athletes or populations.
Most reviewers have stated that the evidence supporting the ability of FMS to predict those at risk for injury is limited at best (Beardsley & Contreras, 2014; Krumrei et al., 2014). The general consensus therefore is that the current literature DOES NOT support the ability of FMS to identify injury risk or performance.
FMS and Golf Performance
One studied looked at the relationship between the FMS and various measures of athletic performance. There were no significant correlations between FMS scores and any of the measures of athletic performance, including golf club head velocity (r=-0.064) - that is practically ZERO relationship right there! Comparatively, 1 RM in squat had very strong relationship (r=0.805) with Club Head Velocity (Parchman & McBride, 2011).
Indeed, more broadly research has shown that general strength tests have very strong relationships with athletic performance and club head speed, while movement screens have been shown to have very little, if any, relationship.
Titleist Performance Institute Screening
The TPI screen is an to attempt to identify physical limitations that may hinder golf performance. However, very little published information about the TPI screen and its relation to golf swing performance, injury, or physical performance exists.
One study attempted to correlate performance on the TPI Level 1 movement screen to golf swing faults (Gulgin, Schulte, &C Crawley, 2014). This study had 36 male and female golfers perform the 12 tests of the TPI level 1 screen as tested by a TPI certified professional. They then each hit four 5 irons, with each swing videoed and analysed by a golf professional for 14 different golf swing faults.
Three significant correlations were seen:
Failure on the Toe Touch test correlated with early hip extension
Failure on Right side bridge test was associated with early hip extension
Failure on Right side bridge test was also associated with loss of posture.
Additionally, odds ratios found that those who failed overhead squat or left side single leg balance tests were 2-3 times more likely to have early hip extension, loss of posture, or lateral slide on the downswing than those who did not.
This study would indicate that there is some value to the TPI screen and its ability to identify potential limitations. But, only a few of the 12 tests showed significant correlations and only with a few of the 14 common swing faults that they chose to analyse for, additionally the study had experimental issues regarding the broad spectrum sample.
Much more research is needed to learn about the capabilities of the TPI screen with various skill levels, ages, and men vs women. It would also be useful to see if there are any correlations with TPI screen performance and injury risk as has been done with the FMS. Physical limitations could potentially be very important for golf injuries since they are almost always overuse-related. If a physical limitation leads to faulty swing mechanics that puts additional stress on the body, this could possibly lead to higher risk of overuse injury (Batt, 1992; Theriault & Lachance, 1998; McCarroll, 1996; Gosheger et al, 2003). To date there has been no attempt to see if the TPI screen could identify those at risk for overuse injury.
The TPI screen can still be incredibly useful for a golf fitness professional. Like the FMS, it could serve as a means to identify physical deficiencies that can help a physiotherapist or S&C specialist to modify and progress exercise programs accordingly.
Conclusion
The issue with both the FMS and TPI screens arises when it is used as a means of diagnosis of injury risk or performance rather than a tool to identify possible limitations in movement. Many authors would say that it can be very useful in recognising deficiencies in movement patterns, allowing a physio or S&C specialist to then adapt their training to address the issues, but should not be used as a means of predicting injury or performance (Bardenett et al., 2015; Cook et al., 2014b).
Research has shown time and time again the biggest factor in injury prediction is previous injury, so taking a detailed injury history will trump any movement screen in this regard. Additionally, performance predictions are much better off being done in a more specific manner too. In the case of golf the effectiveness of fitness programs for increasing golf performance should not be measured by a movement screen score but by data pertaining to golf performance such as clubhead speed/ shot dispersion and the strength and power tests such as squat 1RM that have been shown to support them.
After all no golfer cares how well they move or even how strong they are if it doesn’t help them get the ball in the hole in less shots.
Furthermore, this overuse/over-reliance on movement screens has lead to an increasingly isolationist approach to fitness and strength training with programs designed purely to improve the screening score. Such programs are often over-specific and under-loaded, even resulting in reduced training effect/ athletic performance, as more robust methods of predicting and improving athletic performance are glossed over.
The bottom line
Movement screens are a great tool in identifying deficiencies in movement patterns, allowing a physio or S&C specialist to adapt their training to address the issues, but movement screens don’t give us all the answers - a thorough testing protocol utilising a review of injury history, movement screens, robust strength and power testing protocols and analysing data from the golf swing just might though.
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