The functional movement test ‘9+’ does not predict football injuries

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Lower limb injuries are common in professional football and can cause time loss, impaired performance and a significant financial cost to a professional team. Screening tools, like the functional movement screen (FMS) are popular, however there is little evidence that those tools are valid and applicable.

The functional movement 9+ test consists of 11 exercise ‘tests’ designed to assess a player’s movement patterns. It was designed as a tool for clinicians to use to assess athletes with a view to predicting future lower limb injury. In general terms these tests assess a player’s stability, mobility and neuromuscular control. The exercises included in the test battery are: a deep squat, in-line lunge, shoulder mobility assessment, a trunk stability push-up, active hip flexion and diagonal lift, one-legged squat and deep one-legged squat, drop jump test, seated rotation and a straight leg raise. 

This study followed 362 professional players, over a total of 508 player-seasons (216 played one season, 146 played two seasons).1. The participant’s score on the 9+ was collected along with prospective data relating to each player’s injury history and match and training exposure. 

In total, at least one lower extremity injury was sustained by 203 (56%) of the 362 players. Thigh muscle strains were the most common injury type. There was no relationship found between the 9+ total score and the risk of sustaining a lower extremity injury (both overuse injury and acute injuries). This outcome was the same even when adjusted for other risk factors and site of injury. Subsequent analysis did not find any cut-off point that could be used to identify an at-risk player. Age, player position and season were however associated with a significant increased risk of lower extremity injury.

This study shows that the 9+ test does not appear to be a useful tool to predict those at risk of injury.

To learn more about injury prevention strategies that might be useful in football complete the ‘injury prevention’ module.

Bakken A, Targett S, Bere T, et al The functional movement test 9+ is a poor screening test for lower extremity injuries in professional male football players: a 2-year prospective cohort study Br J Sports Med 2018;52:1047-1053.

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01 octubre 2018 0:00

Buenas tardes.
No logro encontrar datos estadisticos de lesiones deportivas en entrenamiento como asi tambien en competencia?
Alguien podria facilitarlo?

muchas gracias.

27 agosto 2018 16:30

The FMS was not created to predict injury, it was designed clinically as a «discharge» criteria for fundamental movement patterns. So it’s really not surprising that it has not shown validity with respect to injury prediction, but that certainly does not dispell its place with assessing baseline movement [positions]. Like the founder of the FMS, Gray Cook, says it’s like taking someone’s blood pressure; we have «normal» ranges and anything outside of that leads us to determine whether we need to administer other tests to see if anything is actually an issue, or if that is just how their body… Read more »

Mark Fulcher
30 agosto 2018 6:47
Reply to  Ross

I guess the point here is that it is often being used clinically to try to identify those at risk of injury. As you, and these authors suggest, this is probably not useful.

In your practice if you find something that is «outside» the normal range what does this mean to you? Do you do something to try to address that? If so are your doing that to try to prevent injury? To enhance performance? What is this finding telling you?

30 agosto 2018 18:55
Reply to  Mark Fulcher

1. dockees is correct – these FMS based movements are not for injury prediction. Adding something like the Y balance test may help. Unfortunately, there are too many confounding factors (training load, surface/weather, athletes risk-taking behavior pattern, internal biochemistry/hydration/hormones, etc.) 2. The summary above describes «overuse and acute» injuries when a more useful categorization of injuries would be «contact and non-contact.» Someone’s risk of injury on a slide tackle is likely only influenced a tiny bit by their functional movements – it’s mostly a force/location equation. Even with this separate categorization, FMS is still not a good injury predictor. 3.… Read more »

28 agosto 2018 16:27

Using FMS to predict injuries perhaps is not working possibly (as mentioned Dockees in a previous comment) because it is not designed for that purpose but one can use it (I did it in a little bit modified way) to detect abnormalities in posture and in movement patterns. Later on, based on the findings and the scores, the therapist can prescribe certain exercises to improve stability and mobility. As the injuries happen in a very complicated set of variables, one single tool can not give us a solid evidence for prediction. Finally don’t forget to follow your therapeutic instincts –… Read more »

Mark Fulcher
30 agosto 2018 6:54

Nice comments Iliyan. This paper is not saying don’t use the FMS – just interpret the results with caution. I especially like this… «Finally don’t forget to follow your therapeutic instincts – sometimes are better any tool ;)» It is very important to recognise the limitations of the available evidence, and to remember that the absence of evidence (when something hasn’t been studied well) does not mean that something is not effective. The effectiveness of parachutes is often used to illustrate this point (there are no studies to show that they help when you fall out of a plane). Expert… Read more »

Bert Ameloot
27 agosto 2018 21:10

Does muscle weakness predict injury? There was a weak association with the risk of lower extremity injuries for 2 strength variables: greater quadriceps concentric muscle strength at (1) high and (2) low speeds. These associations were too small to identify an «at-risk» player. Therefore, strength testing, as performed in the present study, cannot be recommended as a screening test to predict injuries in professional male soccer. AND Meta-analyses revealed a small, significant predictive effect for absolute (SMD=-0.16, P=0.04, 95% CI -0.31 to -0.01) and relative (SMD=-0.17, P=0.03, 95% CI -0.33 to -0.014) eccentric knee flexor strength (60°/s). Despite an isolated… Read more »

Mark Fulcher
30 agosto 2018 6:50
Reply to  Bert Ameloot

Thanks for sharing these papers Bert.

It is hard to identify which single component is the most important when it comes to preventing injury. Strength is likely to be one factor (consider eccentric strength and hamstring injury) however multimodal programmes, including some strength, proprioception and other balance exercises, seem to be the most effective strategies.

Faminu John
28 agosto 2018 9:42

Very enlightening work.

28 agosto 2018 0:36

Contrairement au 11 qui était un moyen d échauffement d étirement de streching des exercices préparatoire à l effort le 9+ est un moyen de détection et de prévention des lésions musculaires des lésions osteo
articulaires et des lésions MUSCULO ligamentaires.
En un mot un test pour les sportifs pendant le test médical d usage pour s assurer de la stabilité de la mobilité et du contrôle neuro MUSCULAIRE avant les signatures de contrat.
Ce test nous permet de choisir des sportifs aptes pour les grandes competitios

Bungu Kakala Jean Pierre
27 agosto 2018 23:28

Prediction of injuries

Greg Mirt
27 agosto 2018 20:40

I cannot understand this.

27 agosto 2018 19:58

can we learn 9+ test and 11 exercises from injury prevention ?

Dr Shahnawaz Gazi
26 agosto 2018 15:40

Well all these tests are not done in any functional way for example in soccer what is the functional position, lying is not, so apart from their validity how these tests could simulate the actual body position during the play.

Min Zaw
22 agosto 2018 5:33

where can be learn 9 test and 11 exercises ?