Editorial
Copyright ©The Author(s) 2016.
World J Orthop. Apr 18, 2016; 7(4): 202-217
Published online Apr 18, 2016. doi: 10.5312/wjo.v7.i4.202
Table 1 Fundamental movement patterns of the Functional Movement Screen™ and the associated clearing tests
Fundamental movement patternClearing test
Deep squat
Hurdle step1
Inline lunge1
Shoulder mobility1Shoulder impingement test
Active straight leg raise1
Trunk stability push-upSpinal extension test
Rotatory stability1Spinal flexion test
Table 2 Results of studies using Functional Movement Screen™ score of 14 as a cut point to predict musculoskeletal injuries
Ref.SampleInjury definitionSensitivitySpecificity+LR-LR
Kiesel et al[22]46 male professional American football playersAthletic performance injury requiring injury reserve and time loss of 3 wk54%91%NRNR
Chorba et al[23]38 female Division II athletesAthletic performance injury requiring intervention58%74%2.20NR
O’Connor et al[24]874 male Officer candidatesAny injury: Physical training injury requiring intervention45%78%NRNR
Overuse injury: Long term repetitive energy exchange with cumulative microtrauma12%90%NRNR
Serious injury: Physical training injury requiring removal from training12%94%NRNR
Butler et al[25]108 firefight traineesPhysical training injury with time loss of 3 consecutive days84%62%2.200.26
Warren et al[26]195 male and females Division I athletesAthletic performance injury requiring intervention54%46%NRNR
Garrison et al[27]160 male and females Division I athletesAthletic performance injury requiring intervention, and 24 h missed time or splinting, to continue participation67%73%2.510.45
Hotta et al[28]84 competitive male runnersPhysical training injury with time loss of 4 wk73%54%NRNR
Knapik et al[29]1045 male and female military cadetsPhysical training injury55%49%NRNR
McGill et al[30]53 elite police officerBack injury not due to specific acute incidents28%76%NRNR
All injury42%47%NRNR
Table 3 Landing Error Scoring System scoring criteria
LESS itemOperational definition of error
Knee flexion: Initial contactKnee is flexed less than 30° at initial contact
Hip flexion: Initial contactThigh is in line with the trunk at initial contact
Trunk flexion: Initial contactTrunk is vertical or extended on the hips at initial contact
Ankle plantar flexion: Initial contactFoot lands heel to toe or with flat foot at initial contact
Medial knee position: Initial contactCenter of patella is medial to midfoot at initial contact
Lateral trunk flexion: Initial contactMidline of trunk flexed to left/right side body at initial contact
Stance width: WideFeet positioned > shoulder width apart at initial contact
Stance width: NarrowFeet positioned < shoulder width apart at initial contact
Foot position: External rotationFoot is internally rotated more than 30° between initial contact and maximum knee flexion
Foot position: Internal rotationFoot is externally rotated more than 30° between initial contact and maximum knee flexion
Symmetric initial foot contactOne foot lands before other or one foot lands heel to toe and other lands toe to heel
Knee flexion displacementKnee flexes less than 45° between initial contact and max knee flexion
Hip flexion displacementThigh does not flex more on trunk between initial contact and maximum knee flexion
Trunk flexion displacementTrunk does not flex more between initial contact and maximum knee flexion
Medial knee displacementAt maximum medial knee position, the center of patella is medial to midfoot
Joint displacementSoft: 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 impressionExcellent: 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
Table 4 Landing Error Scoring System scoring criteria real-time
LESS RT itemOperational definitionViewJump number
Stance widthParticipant lands with very wide or very narrow stance (+1)Front1
Maximum foot-rotation positionParticipants feet moderately externally or internally rotated at any point during the landing (+1)Front1
Initial foot-contact symmetryOne foot lands before the other or 1 foot lands heel-to-toe and other foot lands toe-to-heel (+1)Front1
Maximum knee-valgus angleParticipant moves into a small amount of knee valgus (+1); Participant moves into a large amount of knee valgus (+2)Front2
Amount of lateral trunk flexionParticipant leans to left or right so trunk is not vertical in the frontal plan (+1)Front2
Initial landing of feetParticipant lands heel to toe or with flat foot (+1)Side3
Amount of knee-flexion displacementParticipant goes through small (+2) or average (+1) amount of knee flexion displacementSide3
Amount of trunk-flexion displacementParticipant goes through small (+2) or average (+1) amount of trunk flexion displacementSide4
Total joint displacement in sagittal planeParticipant 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)SideAll
Overall impressionParticipant 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)
Table 5 i-Landing Error Scoring System criteria
Good movement patternPoor movement pattern
Lands with no knee valgus at initial foot contactLands with moderate to large knee valgus position at initial foot contact
Lands with no knee valgus displacement from initial contact to maximum knee flexionLands with moderate to large knee valgus displacement from initial contact to maximum knee flexion
Lands with > 30° of knee flexionLands with < 30° of knee flexion
Undergoes > 30° of knee flexionUndergoes < 30° of knee flexion from initial contact to full knee flexion
Minimal to no sound upon landingLoud 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 factorDescriptionTechnique 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 perfectionNot definedTechnique declines prior to 10 s