ArticlePDF Available

Clinician Scoring of the Landing Error Scoring System is Reliable to Assess Jump-Landing Movement Patterns.

September 2014
Journal of Sport Rehabilitation 24(2)

DOI:10.1123/jsr.2013-0135

Source
PubMed

Authors:

Tamara Valovich McLeod

A.T. Still University

Cailee E. Welch Bacon

A.T. Still University

Clinical Scenario An individual’s movement patterns while landing from a jump can predispose him or her to lower-extremity injury, if performed improperly. The Landing Error Scoring System (LESS) is a clinical tool to assess jump-landing biomechanics as an individual jumps forward from a box. Improper movement patterns, which could predispose an individual to lower-extremity injuries, are scored as errors. However, because of the subjective nature of scoring errors during the task, the consistency and reliability of scoring the task are important. Since the LESS is a newer assessment tool, it is important to understand its reliability. Focused Clinical Question Are clinicians reliable at scoring the LESS to assess jump-landing biomechanics of physically active individuals?

Content uploaded by Tamara Valovich McLeod

Content may be subject to copyright.

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

Note: This article will be published in a forthcoming issue of

the Journal of Sport Rehabilitation. The article appears here

in its accepted, peer-reviewed form, as it was provided by the

submitting author. It has not been copyedited, proofed, or

formatted by the publisher.

Section: Critically Appraised Topic

Article Title: Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess

Movement Patterns

Authors: Lisa M. Stobierski, Shirleeah D. Fayson, Lindsay M. Minthorn, Tamara C.

Valovich McLeod, Cailee E. Welch

Affiliations: The authors are with the Athletic Training Program, A.T. Still University, Mesa,

AZ.

Journal: Journal of Sport Rehabilitation

Acceptance Date: July 15, 2014

DOI: http://dx.doi.org/10.1123/jsr.2013-0139

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

Clinician Scoring of the Functional Movement Screen is Reliable to Assess

Movement Patterns

Lisa M. Stobierski, AT; Shirleeah D. Fayson, AT; Lindsay M. Minthorn, AT, ATC;

Tamara C. Valovich McLeod, PhD, ATC, FNATA; Cailee E. Welch, PhD, ATC

Athletic Training Program, A.T. Still University, Mesa, AZ

Address Correspondence to:

Cailee E. Welch, PhD, ATC

Assistant Professor of Athletic Training

Department of Interdisciplinary Health Sciences

A.T. Still University

5850 E. Still Circle

Mesa, AZ 85206

(PH) 480-219-6178

(FX) 480-219-6100

cwmccarty@atsu.edu

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

CLINICAL SCENARIO:

Injuries are inevitable in the physically active population. As a part of preventative

medicine, healthcare professionals often seek clinical tools that can be used in real

time to identify factors that may predispose individuals to these injuries. The

Functional Movement Screen™ (FMS™), a clinical tool consisting of seven individual

tasks, has been reported as useful in identifying individuals in various populations

that may be susceptible to musculoskeletal injuries.1-5,9 If factors that may

predispose physically active individuals to injury could be identified prior to

participation, clinicians may be able to develop a training plan based on FMS™

scores, which could potentially decrease the likelihood of injury and overall time

missed from physical activities. However, in order for a screening tool to be used

clinically, it must demonstrate acceptable reliability.

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

Clinical Question: Are clinicians reliable at scoring the FMS™, in real time, to

assess movement patterns of physically active individuals?

Summary of Search, Best Evidence Appraised, and Key Findings:

 The literature was searched for studies of level 3 evidence or higher that

investigated both intra-rater and inter-rater reliability of the FMS™ in real time.

 The literature search returned six possible studies related to the clinical

question; three studies1-3 met the inclusion criteria and were included.

 All 3 studies1-3 reported good real time intra-rater reliability as well as good

real time inter-rater reliability of composite scores of the FMS™.

CLINICAL BOTTOM LINE: There is moderate evidence to support that clinicians are

reliable at scoring the FMS™ in real time to assess movement patterns among

physically active individuals. Regardless of the level of expertise in scoring the

FMS™ (eg, minimal training, FMS™ certified), clinicians can demonstrate good to

excellent intra-rater (ICC = 0.74-0.92) and inter-rater (ICC = 0.76-0.98) reliability.

The FMS™ is an inexpensive screening tool that requires minimal training to

administer. Since the FMSTM has been found to be a reliable tool that can be

conducted in real time, clinicians may consider incorporating this tool as part of pre-

participation physical exams (PPE).

Strength of Recommendation: Grade B evidence exists that clinicians are reliable

in scoring the FMS™ in real time to assess the movement patterns of physically

active individuals.

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

SEARCH STRATEGY:

Terms used to guide Search Strategy:

Patient/Client Group: Physically active individuals OR athletes

Intervention (or Assessment): Functional Movement Screen™ OR FMS™

Comparison: Not applicable

Outcome(s): intra-rater OR inter-rater reliability AND real time scoring

Sources of Evidence Searched

 The Cochrane Library

 Medline

 CINAHL

 Sport Discus

 Additional resources obtained via review of reference lists and hand search

INCLUSION and EXCLUSION CRITERIA

Inclusion criteria:

 Level 3 evidence or higher

 Studies that investigated intra-rater and inter-rater reliability of the FMS™ in

real time

 Studies that included participants who were physically active

 Limited to the past 10 years (2004-2013)

Exclusion criteria:

 Studies that included participants who were younger than 18 years of age

 Studies that only assessed intra-rater reliability or inter-rater reliability

 Studies that did not assess the FMS™ in real time

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

RESULTS OF SEARCH

Three relevant studies1-3 were located and categorized as shown in Table 1

(based on Levels of Evidence, Oxford Centre for Evidence Based Medicine, 2011).

BEST EVIDENCE

The studies in Table 2 were identified as the best evidence and selected for

inclusion in this critically appraised topic (CAT). These studies were selected

because they were considered level 3 evidence or higher and investigated both intra-

rater and inter-rater reliability of the FMS™ in real time.

IMPLICATIONS FOR PRACTICE, EDUCATION and FUTURE RESEARCH

The FMS™ is a seven-task, movement screening tool, with each movement

scored on a scale of 0-3, and a composite score ranging from 0-21.1-4 The 7

movement patterns are the deep squat, in-line lunge, hurdle step, shoulder mobility,

active straight leg raise, trunk stability push up, and rotary stability.1-4 Three clearing

tests are included that assess for pain; shoulder impingement, spinal flexion, and

spinal extension.1-4 A score of 0 indicates pain during the movement or clearing

test.1-5,7,8 A “1” indicates loss of balance or failure to complete the movement.1-5,7,8 A

“2” indicates completion of the movement with compensation.1-5,7,8 A “3” indicates

completion of the movement without compensation.1-5,7,8

The goal of PPEs is to screen for conditions that may be life threatening or

predisposing to injury or illness.1 The ability of the FMS™ to detect abnormal

movement patterns can be useful when planning training programs.1 The FMS™ is a

low-cost and time-efficient screening tool that can be widely used in PPEs, and can

be conducted using multiple raters with varying experience. Scoring remains reliable

with both a single rater testing multiple patients (intra-rater) and multiple raters

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

testing a single patient (inter-rater). Additionally reliable data can be achieved

regardless of the raters’ training in FMS™.1-3

All three studies reviewed in this CAT assessed rater reliability of FMS™

scoring in real time, and reported both good to excellent intra-rater and inter-rater

reliability of composite scores.1-3 Intra-rater reliability is important because it shows

that one clinician can provide consistent scoring results over repeated

administrations of the FMS™. Conversely, inter-rater reliability is important because

it shows that multiple raters scoring the same test can report consistent results. 1-3

The findings from this CAT indicate that clinicians’ ability to score the FMS™ is

consistent regardless of the number of raters as well as the level of FMS™ training

the raters possess.1-3

While the FMS™ is a reliable screening tool, further research is needed to

better understand how to best use this tool. Future studies concerning the FMS™

should focus on collecting FMS™ scores over a longer period of time in order to

asses if changes in movement patterns can be detected. This can be useful for

tracking improvements in movement patterns during return to play following injury.9,10

Primary areas for future research include determining if FMS™ scores change over

time or throughout maturation without intervention, if scores change in response to a

standardized program, and if the duration of improvements are detected. This

critically appraised topic should be reviewed in two years or when additional best

evidence becomes available to determine whether additional best evidence has

been published that may change the clinical bottom line for the research question

posed in this review.

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

REFERENCES

1. Onate JA, Dewey T, Kollock RO, et al. Real-time intersession and interrater

reliability of the functional movement screen. Journal of Strength and

Conditioning Research. 2012; 26(2): 408-415.

2. Teyhen DS, Shaffer SW, Lorenson CL, et al. The functional movement

screen: a reliability study. Journal of Orthopaedic & Sports Physical Therapy.

2012; 42(6): 530-540.

3. Smith CA, Chimera NJ, Wright NJ, Warren M. Interrater and intrarater

reliability of the functional movement screen. Journal of Strength and

Conditioning Research. 2013; 27(4); 982-987.

4. Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of

fundamental movements as an assessment of function – part 1. N Am J

Sports Ther. 2006; 1 (2): 62-72.

5. Schneiders AG, Davidsson A, Horman E, Sullivan SJ. Functional movement

screen normative values in a young, active population. The International

Journal of Sports Physical Therapy. 2011; 6(2): 75-82.

6. Chorba RS, Chorba DJ, Bouillon LE, et. al. Use of a functional movement

screening tool to determine injury risk in female collegiate athletes. N Am J

Sports Phys Ther. 2010; 5 (2): 47-54.

7. Frohm A, Heijne A, Kowalski J, et al. A nine-test screening battery for

athletes: a reliability study. Scand J Med Sci Sports. 2012; 22: 306-315.

8. Minick KI, Kiesel KB, Burton L, et al. Interrater reliability of the functional

movement screen. J Strength Cond Res. 2010; 24: 479-486.

9. Bodden JG, Needham RA, Chockalingam N. The effect of an intervention

program on functional movement screen test scores in mixed martial arts

athletes. J Strength Cond Res. 2013; Jul 15, Ahead of Print.

10. Kiesel KB, Plisky P, Butler R. Functional movement test scores improve

following a standardized off-season intervention program in professional

football players. Scand J Med Sci Sports. 2011;21(2):287-292.

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

Table 1: Summary of Study Designs of Articles Retrieved

Level of

Evidence

Study Design

Number Located

Author (Year)

Individual Cohort

Onate et al (2012)1

Teyhen et al (2012)2

Smith et al (2013)3

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

CAT Table 2. Characteristics of Included Studies

Study Design

Onate, et al (2012)2

Individual Cohort

Teyhen, et al (2012)3

Individual Cohort

Smith, et al (2013)4

Individual Cohort

Participants

Raters

19 physically active individuals from a

university and surrounding area

16 participants, 10 men (25.00±3.59yrs)

and 6 women (25.67±2.87yrs) in the inter-

rater group

19 participants, 12 men (25.08±3.12yrs)

and 7 women (25.29±2.81yrs) in the intra-

rater group

Exclusion criteria: no incidence of upper

or lower extremity injuries within the last 6

months that had resulted in 2–3 days of

incapacity

2 raters: 1 rater certified in FMS and 1

novice rater

64 active duty service members

(25.00±3.80yrs)

Inclusion criteria: Individuals who were

between the ages of 18-35 or were

emancipated minors

No current medical or neuromuscular

disorder limiting participation in work or

exercises in the last 6 months

Exclusion criteria: Currently seeking

medical care for injury

History of surgery to lower extremity

History of fracture to femur, pelvis, tibia,

fibula, talus, or calcaneus

Individuals who were pregnant prior to

data collection

Pain upon completion of squat or single

leg hop

8 novice physical therapy student raters

20 healthy, injury free, physically active

individuals from a university

26 yrs (range 22-41)

10 men and 10 women for both inter-rater

and intra-rater groups

Exclusion criteria: answered ‘yes’ to any

of the answers on the PAR-Q

One female was excluded due to

unrelated injury the day before testing

resulting in 10 men, 9 women completing

the study

4 raters who completed a 2hr FMS

training session

Intervention

7 items of the FMS

3 clearing tests requiring flexibility,

strength, and balance.

Participants were tested on 2 days,

separated by 7 days

7 items of the FMS

The 3 clearing tests of the

FMS: the shoulder impingement test,

spinal extension test, and spinal flexion

test.

Participants were tested on 2 days,

separated by 48-72 hrs

Participants were allowed to perform

each item test 3 times, and the maximal

7 items of the FMS

The 3 clearing tests of the

FMS: the shoulder impingement test,

spinal extension test, and spinal flexion

test

Participants were tested on 2 days,

separated by 7 days.

Instructions and protocol were adapted

from most recent FMS text, recorded on

“Clinician Scoring of the Functional Movement Screen™ is Reliable to Assess Movement Patterns” by Stobierski LM et al.

Journal of Sport Rehabilitation

Study Design

Onate, et al (2012)2

Individual Cohort

Teyhen, et al (2012)3

Individual Cohort

Smith, et al (2013)4

Individual Cohort

Outcome Measures

Main Findings

FMS total score

FMS item scores

Inter-rater reliability was excellent,

ICC = 0.98 [95% CI: 15.81, 17.74]

Intra-rater reliability was excellent

ICC3,1 = 0.92 [95% CI: 15.83, 17.59]

score was recorded

FMS total score

FMS item scores

Inter-rater reliability was good, ICC2,1 =

0.76. [95%: 0.63, 0.85]

Intra-rater reliability was good ICC3,1 =

0.74 [95% CI: 0.60,0.83]

Intra-rater agreement scores

demonstrated moderate to excellent

agreement on 6 tests and moderate

agreement on one test

audio recorder

Pictures were taken on a digital

camcorder

Participants were asked not to practice

FMS and to wear same shoes for both

sessions

FMS total scores

FMS item scores

Inter-rater reliability was good between

session 1, ICC=0.89 [95% CI: 0.80, 0.95]

and session 2, ICC=0.87 [95% CI: 0.76,

0.94] in the mean score of the test battery

Intra-rater reliability was good for rater 2

ICC=0.81. [95% CI: 0.57, 0.92]

Intra-rater reliability was excellent for

rater 3 ICC=0.91 [95% CI: 0.78, 0.96]

Level of Evidence

Validity Score (if

applicable)

Conclusion

N/A

Inter-rater reliability was good to excellent

Intra-rater reliability was good to excellent

The results of this study cannot be

generalized beyond their own raters.

Studying the FMS manual without FMS

certification still results in good reliability

when compared with that of an

experienced FMS-certified examiner

N/A

Inter-rater reliability was moderate to

excellent

Intra-rater reliability was moderate to

excellent

The FMS has an adequate level of

reliability when assessed in healthy

service members by novice raters

N/A

Inter-rater reliability was good

Intra-rater reliability was good

Various professionals who work with

athletes and clients can reliably and

consistently score the FMS

The Landing Error Scoring System (LESS) and Lower Limb Power Profiles in Elite Rugby Union Players

Article

Full-text available

Oct 2021
Int J Sports Phys Ther

Background: The Landing Error Scoring System (LESS) is a clinical test that assesses landing biomechanics during a drop-jump task. Performance measures such as jump height, power, contact time and reactive strength index are used commonly in athletic populations. Comparing results from the LESS against these performance measures has not been reported in elite rugby union. Purpose: To report i.) normative LESS scores for elite rugby union players ii.) correlations between LESS scores and performance measures and iii.) differences in performance measures between LESS scoring groups. A secondary purpose was to report the intra- and inter-rater reliability of the LESS test when used in elite rugby union players. # Study DesignCross-sectional design. Methods: Thirty-six male, elite rugby union players participated. Each participant completed three trials of the LESS and performance measures were recorded concurrently using the OptojumpTM. LESS trials were scored independently by the authors. Statistical analyses were used to confirm reliability, data normality, and between group differences (p<0.05). Results: The LESS test is a reliable testing tool in elite rugby union players (excellent intra- (ICC=0.96) and inter-rater (ICC=0.94) reliability). One player demonstrated an excellent LESS score, six players had good scores, eight players moderate scores and the majority of the group, 21 players, scored poorly. LESS scores were correlated to contact time (r = -0.461, p = 0.005) only. Participants with moderate to poor LESS scores (a score ≤5) produced greater power (p=0.036, η2 = 0.139), contact time (p=0.002, η2 = 0.268) and reactive strength index (p=0.016, η2 = 0.180). There were no differences in jump height (p=0.842) between players scoring excellent to good and moderate to poor. Conclusion: The results of the current study demonstrate excellent intra- and inter-rater reliability for the LESS, supporting its use as a clinical assessment tool in elite rugby union players. The majority of players presented with moderate to poor LESS scores, indicating an area of concern in this population. Participants scoring moderate to poor in the LESS recorded significantly higher power and reactive strength index, increased contact time but not jump height. This suggests participants with high-risk landing biomechanics may also produce higher performance measures, but these do not necessarily result in an improved jump height.

Kadın Voleybolcularda Q Açısının Sıçrama ve İniş Mekaniği İle İlişkisi

Article

Full-text available

Jun 2024

Sporculara yapılacak testler sırasında zamansal sınırlılıklar ortaya çıkmaktadır. Farklı yöntemlerin birbirleri yerine güvenle uygulanma durumu bilinmemektedir. Bu çalışmanın amacı, kadın voleybolcularda Q açısının sıçrama ve iniş mekaniği ile ilişkisini incelemektir. Araştırma grubunu İstanbul ve Kocaeli ilinde alt yapı düzeyinde oynayan 48 genç kadın sporcu oluşturmuştur. Araştırmaya katılan kadın voleybol sporcularına antropometrik ölçümler, Q açısı, İniş Hatası Puanlama Sistemi(LESS), Dikey Sıçrama (VJ) testleri uygulanmıştır. Q açısı ve LESS skorları Kinovea ücretsiz yazılımı ile belirlenmiştir. Dikey sıçrama yüksekliğinin hesaplanmasında My Jump 2 mobil ugulaması kullanılmıştır. Elde edilen veriler incelendiğinde Q açısı, LESS skorları ve VJ yüksekliği arasında pozitif ilişki bulunmamaktadır (p>0,05). Q açısı ile inişte ilk temastaki diz valgusu arasında pozitif ilişki bulunmuştur (r=0,292, p

The Impact of Visual Perturbation Neuromuscular Training on Landing Mechanics and Neural Activity: A Pilot Study

Article

Full-text available

Nov 2024
Int J Sports Phys Ther

Background Athletes at risk for anterior cruciate ligament (ACL) injury have concurrent deficits in visuocognitive function and sensorimotor brain functional connectivity. Purpose This study aimed to determine whether visual perturbation neuromuscular training (VPNT, using stroboscopic glasses and external visual focus feedback) increases physical and cognitive training demand, improves landing mechanics, and reduces neural activity for knee motor control. Design Controlled laboratory study. Methods: Eight right leg dominant healthy female athletes (20.4±1.1yrs; 1.6±0.1m; 64.4±7.0kg) participated in four VPNT sessions. Before and after VPNT, real-time landing mechanics were assessed with the Landing Error Scoring System (LESS) and neural activity was assessed with functional magnetic resonance imaging during a unilateral right knee flexion/extension task. Physical and cognitive demand after each VPNT session was assessed with Borg’s Rating of Perceived Exertion (RPE) for both physical and cognitive perceived exertion and the NASA Task Load Index. Descriptives and effect sizes were calculated. Results Following VPNT, LESS scores decreased by 1.5 ± 1.69 errors with a large effect size (0.78), indicating improved mechanics, and reductions in BOLD signal were observed in two clusters: 1) left supramarginal gyrus, inferior parietal lobule, secondary somatosensory cortex (p=.012, z=4.5); 2) right superior frontal gyrus, supplementary motor cortex (p<.01, z=5.3). There was a moderate magnitude increase of cognitive RPE between the first and last VPNT sessions. Conclusion VPNT provides a clinically feasible means to perturbate visual processing during training that improves athletes’ real-time landing mechanics and promotes neural efficiency for lower extremity movement, providing the exploratory groundwork for future randomized controlled trials. Level of evidence Level 3

Differences in Lower Extremity Movement Quality by Level of Sport Specialization in Cadets Entering a United States Service Academy

Article

Feb 2021

Background Sport specialization in youth athletes is associated with increased risk for musculoskeletal injury; however, little is known about whether sport specialization is associated with lower extremity movement quality. The purpose of this study was to examine differences in lower extremity movement quality by level of sport specialization in US Service Academy cadets. Hypothesis Cadets who report an increased level of sport specialization would have a lower level of movement quality than those who are less specialized. Study Design Cross-sectional analysis from an ongoing prospective cohort study. Level of Evidence Level 3. Methods Cadets completed the Landing Error Scoring System (LESS) and a baseline questionnaire evaluating level of sport specialization during high school. Data were analyzed using separate 1-way analysis of variance models. Results Among all participants (n = 1950), 1045 (53.6%) reported low sport specialization, 600 (30.8%) reported moderate sport specialization, and 305 (15.6%) reported high sport specialization at the time of data collection during the first week. Ages ranged from 17 to 23 years. Men (1491) and women (459) reported comparable specialization levels ( P = 0.45). There were no statistically significant differences in lower extremity movement quality by level of specialization for all subjects combined ( P = 0.15) or when only men were included in the analyses ( P = 0.69). However, there were statistically significant differences in movement quality by level of specialization in women ( P = 0.02). Moderately specialized women had the best movement quality (mean, 4.63; SD, 2.21) followed by those with high specialization (mean, 4.90; SD, 2.08) and those with low levels of specialization (mean, 5.23; SD, 2.07). Conclusion Women reporting moderate sport specialization had improved movement quality and significantly better LESS scores compared to those with high/low specialization. Clinical Relevance Athletes, especially women, should be encouraged to avoid early sport specialization to optimize movement quality, which may affect injury risk.

The ‘DEEP’ Landing Error Scoring System

Article

Full-text available

Jan 2020

Featured Application The Landing Error Scoring System, an injury-risk screening tool used in sports to detect high risk of anterior cruciate ligament injury, can be automated using deep-learning-based computer vision on 2D videos combined with machine learning methods. The successful application of this method paves the way for the automatic detection of individuals at high risk of injury using smartphone-based applications and opens doors to addressing other related injury prevention problems. Abstract The Landing Error Scoring System (LESS) is an injury-risk screening tool used in sports; but scoring is time consuming, clinician-dependent, and generally inaccessible outside of elite sports. Our aim is to evidence that LESS scores can be automated using deep-learning-based computer vision combined with machine learning and compare the accuracy of LESS predictions using different video cropping and machine learning methods. Two-dimensional videos from 320 double-leg drop-jump landings with known LESS scores were analysed in OpenPose. Videos were cropped to key frames manually (clinician) and automatically (computer vision), and 42 kinematic features were extracted. A series of 10 × 10-fold cross-validation experiments were applied on full and balanced datasets to predict LESS scores. Random forest for regression outperformed linear and dummy regression models, yielding the lowest mean absolute error (1.23) and highest correlation (r = 0.63) between manual and automated scores. Sensitivity (0.82) and specificity (0.77) were reasonable for risk categorization (high-risk LESS ≥ 5 errors). Experiments using either a balanced (versus unbalanced) dataset or manual (versus automated) cropping method did not improve predictions. Further research on the automation would enhance the strength of the agreement between clinical and automated scores beyond its current levels, enabling quasi real-time scoring.

Is the Landing Error Scoring System Reliable and Valid? A Systematic Review

Article

Jan 2020

Context The Landing Error Scoring System (LESS) is a clinical tool often used in research and practice to identify athletes presenting high injury-risk biomechanical patterns during a jump-landing task. Objective To systematically review the literature addressing the psychometric properties of the LESS. Data Sources Three electronic databases (PubMed, Web of Science, and Scopus) were searched on March 28, 2018, using the term “Landing Error Scoring System.” Study Selection All studies using the LESS as main outcome measure and addressing its reliability, validity against motion capture system, and predictive validity were included. Original English-language studies published in peer-reviewed journals were reviewed. Studies using modified versions of the LESS were excluded. Study Design Systematic literature review. Level of Evidence Level 4. Data Extraction Study design, population, LESS testing procedures, LESS scores, statistical analysis, and main results were extracted from studies using a standardized template. Results Ten studies met inclusion criteria and were appraised using Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. The overall LESS score demonstrated good-to-excellent intrarater (intraclass correlation coefficient [ICC], 0.82-0.99), interrater (ICC, 0.83-0.92), and intersession reliability (ICC, 0.81). The validity of the overall LESS score against 3-dimensional jump-landing biomechanics was good when individuals were divided into 4 quartiles based on LESS scores. The validity of individual LESS items versus 3-dimensional motion capture data was moderate-to-excellent for most of the items addressing key risk factors for anterior cruciate ligament (ACL) injury. The predictive value of the LESS for ACL and other noncontact lower-extremity injuries remains uncertain based on the current scientific evidence. Conclusion The LESS is a reliable screening tool. However, further work is needed to improve the LESS validity against motion capture system and confirm its predictive validity for ACL and other noncontact lower-extremity injuries.

Landing Error Scoring System: a scoping review about variants, reference values and differences according to sex and sport

Article

Full-text available

Jul 2024

Abstract Objective The Landing Error Scoring System (LESS) is a movement analysis tool proposed to identify the risk of anterior cruciate ligament injuries, very useful for injury prevention. The aim of this study is to review the variants of the LESS, their normative scores and the differences according to sex and sport practiced. Methods PubMed, Scopus and ScienceDirect databases were searched from inception to October 19, 2023. Studies were eligible if the objective was finding normative or reference scores for the LESS, analyze the differences between sexes or sports, or used some variant of the test. Results were limited to available full-text articles published in English in peer-reviewed journals. Results Of the 360 articles identified, 20 were included for a full analysis (18,093 participants, age=8-30 years, males=70.6%). The military population was the most frequently analyzed (7 studies, n=16,603). Results showed six variants of the LESS and average values ranged from 2.56 to 7.1. Males and females showed different pattern landing with errors in different planes. Conclusions Our findings highlight the need for more field studies on LESS reference scores, particularly for females and basketball or hockey players. Further research is required before conducting a systematic review and meta-analysis. Keywords: landing error scoring system, reference values, injury risk, injury prevention.

The effect of plyometric exercises with feedback on the landing mechanism of taekwondo athletes prone to anterior cruciate ligament injury.

Conference Paper

Full-text available

Jul 2023

یکی از الگوهای غلط اندام تحتانی والگوس داینامیک زانو است که پدیده ای چند بعدی است و درواقع به کینماتیک تغییر یافته ران و زانو اطلاق میشود. بنابراین هدف از پژوهش حاضر اثر تمرینات پلایومتریک به همراه فیدبک بر روی مکانیسم فرود تکواندوکاران مستعد آسیب لیگامنت متقاطع-قدامی است. پژوهش حاضر از نوع نیمه تجربی میباشد. از میان جامعه آماری، ۳۰ نفر آزمودنی در دامنه سنی۱۸ تا ۲۵ سال به صورت هدفمند و بر اساس معیارهای ورود و خروج به تحقیق انتخاب شده و سپس به دو گروه کنترل و تجربی تقسیم شدند.استفاده از تمرینات پلایومتریک ، تمرینات پرش – فرود و همچنین تمرینات ایزومتریک و ایزوتونیک با تعدیل و بهبود فعال سازی عضلات و کاهش اعمال بارهای وارد بر زانو در کاهش و پیشگیری از وقوع آسیبACL سودمند می باشند. در این میان نقش تمرینات پلیومتریک از نوع هاپینگ برای بهبود اجرا در ورزشکاران مشاهده شده است. به منظور تجزیه و تحلیل آماری از آزمون شاپیرو ویلک و برای تعیین تفاوت های درون گروهی و بین گروهی از آزمون آنکواو تی زوجی با سطح معنی داری ۰۵/۰ درنظر گرفته شد.نتایج نشان داد که شش هفته تمرینات پلایومتریک به همراه فیدبک باعث بهبود مکانیسم فرود تکواندو کاران مستعد آسیب لیگامنت متقاطع قدامی از مرحله پیش آزمون تا مرحله پس آزمون شده است. همچنین نتایج نشان داد که میانگین خطاهای مکانیسم فرود تکواندوکاران مستعد آسیب لیگامنت متقاطع قدامی بطور معناداری نسبت به گروه کنترل کاهش یافته است (۰۵/۰ > p). نتایج تحقیق حاکی از اثر بخشی تمرینات پلایومتریک همراه با فیدبک برالگوی حرکتی و مکانیسم فرود زانو بوده که با اثر بخشی انواع روشهای دیگر توانبخشی و اصلاحی همخوانی دارد.

The Landing Error Scoring System Real-Time (LESS-RT) As a Predictive Tool for Overuse Injuries and Ankle Sprain: A Historical Cohort Study.

Preprint

Full-text available

Jun 2021

Background: Overuse injuries and ankle sprains are commonly sustained by soldiers and athletes during conditioning programs and may have significant ramifications on both individuals and organizations. The Landing Error Scoring System (LESS), and its expedited real-time version (LESS-RT) were developed to assess risk for ACL injuries, but have never been used to assess overuse or ankle injuries which are of high priority in a military or athletic settings. The purpose of this study was to evaluate predictive value of The Landing Error Scoring System Real-Time (LESS-RT) for overuse injuries of the lower limb and ankle sprains among Israel Defense Forces (IDF) combat soldiers. Methods: A historical cohort study was conducted on 2,474 IDF combat soldiers from different service units with a wide range of fitness levels and training requirements. The predictive variable was LESS-RT score and the outcome variables were the incidence of overuse injuries and ankle sprains. Receiver operator characteristic curves were used to assess the predictive value of LESS-RT for both outcomes. Results: The AUC for overuse injuries and ankle sprains were 0.537, 95% CI 0.514-0.560 and 0.523, 95% CI 0.491-0.556 respectively. Conclusions: The results of this study shows no predictive value of LESS-RT score for both overuse injuries of the lower limb and ankle sprains.

The Landing Error Scoring System Real-Time test as a predictive tool for knee injuries: A historical cohort study

Article

Jan 2020
CLIN BIOMECH

Purpose: To assess the value of the Landing error score system - real time test as a predictive tool for knee injuries among combat soldiers in the Israeli defense forces. Methods: All 2474 Israeli defense forces' combat soldiers enrolled at the Israeli defense forces Injury Prevention and Rehabilitation Center were included. A retrospective cohort study was conducted. The predictive variable assessed was the landing error score system - real time score. The three main outcome variables were the incidence of overuse knee injuries, the meniscal injury, and the anterior cruciate ligament injury. Receiver operator characteristic analysis was performed to evaluate the test's potential as a predictive tool and in order to establish optimal cutoff scores. Results: The area under the curve of the receiver operation curves demonstrated no predictive value of the landing error score system - real time test for all three outcome variables (knee injuries: area under the curve 0.526, 95% confidence interval 0.498, 0.554, anterior cruciate ligament injuries: area under the curve 0.496, 95% confidence interval 0.337, 0.656, meniscus injuries: area under the curve 0.515, 95% confidence interval 0.454, 0.576). Interpretation: Based on the results of this study, the landing error score system - real time test has no predictive value for knee overuse injuries, meniscal injuries, and anterior cruciate ligament injuries. However, due to the small number of cases of anterior cruciate ligament injuries, the predictive value for anterior cruciate ligament injuries of this test should be further investigated.

The Functional Movement Screen: A Reliability Study

Article

Full-text available

May 2012
J ORTHOP SPORT PHYS

Reliability study. To determine intrarater test-retest and interrater reliability of the Functional Movement Screen (FMS) among novice raters. The FMS is used by various examiners to assess movement and predict time-loss injuries in diverse populations (eg, youth to professional athletes, firefighters, military service members) of active participants. Unfortunately, critical analysis of the reliability of the FMS is currently limited to 1 sample of active college-age participants. Sixty-four active-duty service members (mean ± SD age, 25.2 ± 3.8 years; body mass index, 25.1 ± 3.1 kg/m2) without a history of injury were enrolled. Participants completed the 7 component tests of the FMS in a counterbalanced order. Each component test was scored on an ordinal scale (0 to 3 points), resulting in a composite score ranging from 0 to 21 points. Intrarater test-retest reliability was assessed between baseline scores and those obtained with repeated testing performed 48 to 72 hours later. Interrater reliability was based on the assessment from 2 raters, selected from a pool of 8 novice raters, who assessed the same movements on day 2 simultaneously. Descriptive statistics, weighted kappa (κw), and percent agreement were calculated on component scores. Intraclass correlation coefficients (ICCs), standard error of the measurement, minimal detectable change (MDC95), and associated 95% confidence intervals (CIs) were calculated on composite scores. The average ± SD score on the FMS was 15.7 ± 0.2 points, with 15.6% (n = 10) of the participants scoring less than or equal to 14 points, the recommended cutoff for predicting time-loss injuries. The intrarater test-retest and interrater reliability of the FMS composite score resulted in an ICC3,1 of 0.76 (95% CI: 0.63, 0.85) and an ICC2,1 of 0.74 (95% CI: 0.60, 0.83), respectively. The standard error of the measurement of the composite test was within 1 point, and the MDC95 values were 2.1 and 2.5 points on the 21-point scale for interrater and intrarater reliability, respectively. The interrater agreement of the component scores ranged from moderate to excellent (κw = 0.45-0.82). Among novice raters, the FMS composite score demonstrated moderate to good interrater and intrarater reliability, with acceptable levels of measurement error. The measures of reliability and measurement error were similar for both intrarater reliability that repeated the assessment of the movement patterns over a 48-to-72-hour period and interrater reliability that had 2 raters assess the same movement pattern simultaneously. The interrater agreement of the FMS component scores was good to excellent for the push-up, quadruped, shoulder mobility, straight leg raise, squat, hurdle, and lunge. Only 15.6% (n = 10) of the participants were identified to be at risk for injury based on previously published cutoff values.

Functional Movement Screen Normative values in a young active population

Article

Full-text available

Jun 2011
Int J Sports Phys Ther

The Functional Movement Screen(TM) (FMS(TM)) is a screening instrument which evaluates selective fundamental movement patterns to determine potential injury risk. However, despite its global use, there are currently no normative values available for the FMS(TM). To establish normative values for the FMS(TM) in a population of active, healthy individuals. Secondary aims were to investigate whether performance differed between males and females, between those with and without a previous history of injury, and to establish real-time inter-rater reliability of the FMS(TM). Two hundred and nine (108 females and 101 males) physically active individuals, aged between 18 and 40 years, with no recent (<6 weeks) history of musculoskeletal injury were recruited. All participants performed the FMS(TM) and were scored using the previously established standardized FMS(TM) criteria. A representative sub-group participant sample (28%) determined inter rater reliability. The mean composite FMS(TM) score was 15.7 with a 95% confidence interval between 15.4 and 15.9 out of a possible total of 21. There was no statistically significant difference in scores between females and males (t(207) = .979, p = .329), or those who reported a previous injury and those who did not (t(207) = .688, p= .492). Inter-rater reliability (ICC(3,1)) for the composite FMS(TM) score was .971, demonstrating excellent reliability. Inter-rater reliability (Kappa) for individual test components of the FMS(TM) demonstrated substantial to excellent agreement (0.70 - 1.0). This cross-sectional study provides FMS(TM) reference values for young, active individuals, which will assist in the interpretation of individual scores when screening athletes for musculoskeletal injury and performance factors.

Use of a Functional Movement Screening Tool to Determine Injury Risk in Female Collegiate Athletes

Article

Full-text available

Jun 2010

Athletes often utilize compensatory movement strategies to achieve high performance. However, these inefficient movement strategies may reinforce poor biomechanical movement patterns during typical activities, resulting in injury. This study sought to determine if compensatory movement patterns predispose female collegiate athletes to injury, and if a functional movement screening (FMS™) tool can be used to predict injuries in this population. Scores on the FMS™, comprised of seven movement tests, were calculated for 38 NCAA Division II female collegiate athletes before the start of their respective fall and winter sport seasons (soccer, volleyball, and basketball). Seven athletes reported a previous history of anterior cruciate ligament reconstruction (ACLR). Injuries sustained while participating in sport activities were recorded throughout the seasons. The mean FMS™ score and standard deviation for all subjects was 14.3±1.77 (maximum score of 21). Eighteen injuries (17 lower extremity, 1 lower back) were recorded during this study. A score of 14/21 or less was significantly associated with injury (P=0.0496). Sixty-nine percent of athletes scoring 14 or less sustained an injury. Odds ratios were 3.85 with inclusion of all subjects, and 4.58 with exclusion of ACLR subjects. Sensitivity and specificity were 0.58 and 0.74 for all subjects, respectively. A significant correlation was found between low-scoring athletes and injury (P=0.0214, r=0.76). A score of 14 or less on the FMS™ tool resulted in a 4-fold increase in risk of lower extremity injury in female collegiate athletes participating in fall and winter sports. The screening tool was able to predict injury in female athletes without a history of major musculoskeletal injury such as ACLR. Compensatory fundamental movement patterns can increase the risk of injury in female collegiate athletes, and can be identified by using a functional movement screening tool.

Pre-participation screening: The use of fundamental movements as an assessment of function - Part 1

Article

Full-text available

Aug 2006
N Am J Sports Phys Ther

Unlabelled: Part 1 of this two-part series (presented in the June issue of IJSPT) provided an introduction to functional movement screening, as well as the history, background, and a summary of the evidence regarding the reliability of the Functional Movement Screen (FMS™). Part 1 presented three of the seven fundamental movement patterns that comprise the FMS™, and the specific ordinal grading system from 0-3, used in the their scoring. Specifics for scoring each test are presented. Part 2 of this series provides a review of the concepts associated with the analysis of fundamental movement as a screening system for functional movement competency. In addition, the four remaining movements of the FMS™, which complement those described in Part 1, will be presented (to complete the total of seven fundamental movements): Shoulder Mobility, the Active Straight Leg Raise, the Trunk Stability Push-up, and Rotary Stability. The final four patterns are described in detail, and the specifics for scoring each test are presented, as well as the proposed clinical implications for receiving a grade less than a perfect "3". The intent of this two part series is to present the concepts associated with screening of fundamental movements, whether it is the FMS™ system or a different system devised by another clinician. Such a fundamental screen of the movement system should be incorporated into pre-participation screening and return to sport testing in order to determine whether an athlete has the essential movements needed to participate in sports activities at a level of minimum competency. Part 2 concludes with a discussion of the evidence related to functional movement screening, myths related to the FMS™, the future of functional movement screening, and the concept of movement as a system. Level of evidence: 5.

The Effect of an Intervention Program on Functional Movement Screen Test Scores in Mixed Martial Arts Athletes

Article

Jul 2013
J STRENGTH COND RES

This study assessed the basic fundamental movements of Mixed Martial Arts (MMA) athletes using the Functional Movement Screen™ (FMS) assessment and determined if an intervention program was successful at improving results. Participants were placed into 1 of 2 groups: intervention and control group. The intervention group was required to complete a corrective exercise program 4 times per week and all participants were asked to continue their usual MMA training routine. A mid-intervention FMS test was included to examine if successful results were noticed sooner than the 8 week period. Results highlighted differences in FMS test scores between the control group and intervention group, p=0.006. Post hoc testing revealed a significant increase in the intervention groups FMS score between weeks 0-8, p=0.00 and weeks 0-4, p=0.00 and no significant increase between weeks 4-8, p=1.00. A chi square analysis revealed the intervention group participants were more likely to have an FMS score >14 than participants in the control group, at week 4 χ² = 7.29, p<0.01 and week 8 χ² = 5.2, p<0.05. Finally, a greater number of participants in the intervention group were free from asymmetry at week 4 and week 8 compared to the initial test period. The results of the study suggested that a 4 week intervention program was sufficient at improving FMS scores. Most, if not all the movements covered on the FMS relate to many aspects of MMA training. The knowledge that the FMS can identify movement dysfunctions, furthermore, the fact that the issues can be improved through a standardised intervention program could be advantageous to MMA coaches. Thus, providing the opportunity to adapt and implement new additions to training programs.

Item Specific Reliability Analyses Of The Landing Error Scoring System (LESS)

Article

May 2005

Real-Time Intersession and Interrater Reliability of the Functional Movement Screen

Article

Feb 2012

Onate, JA, Dewey, T, Kollock, RO, Thomas, KS, Van Lunen, BL, DeMaio, M, and Ringleb, SI. Real-time intersession and interrater reliability of the functional movement screen. J Strength Cond Res 26(2): 408–415, 2012—The purpose of this study was to examine the real-time intersession and interrater reliability of the functional movement screen (FMS). The overall study consisted of 19 volunteer civilians (12 male, 7 female). The intersession reliability consisted of 12 men and 7 women, whereas 10 men and 6 women participated in the interrater reliability test session. Two raters (A and B) were involved in the interrater reliability aspect of this study. The FMS includes 7 tests: deep squat (DS), hurdle step (HS), in-line lunge (IL), shoulder mobility (SM), active straight leg raise (ASLR), trunk stability push-up (TSPU), and rotary stability (RS). Researchers analyzed the data via intraclass correlation (ICC). To determine the reliability of the intersession scoring of the FMS and the intrasession interrater scoring of the FMS a 2-way mixed effects model intraclass correlation coefficient (ICC3,1) was used for the continuous data, whereas a weighted Cohen's kappa (κ) was used for the categorical data. The dependent variables were FMS total score (0–21 scale) and associated tests were DS, HS, IL, SM, ASLR, TSPU, and RS. Intersession reliability (ICC, SEM) and κ were as follows: FMS total score (0.92, 0.51), DS (κ = 0.69), HS (κ = 0.16), IL (κ = 0.69), SM (κ = 0.84), ASLR (κ = 0.69), TSPU (κ = 0.77), and RS (no covariance). Interrater reliability (ICC, SEM) and κ were as follows: FMS total score (0.98, 0.25), DS (κ = 1.0), HS (κ = 0.33), IL (κ = 0.88), SM (κ = 0.90), ASLR (κ = 0.88), TSPU (κ = 0.75), and RS (no covariance). The FMS total scores displayed high intersession and interrater reliabilities. Finally, with the exception of HS, all tasks displayed moderate to high intersession reliability and good to high interrater reliability.

Sex Comparison of Jump Landing Kinematics and Technique

Article

May 2004

Interrater and Intrarater Reliability of the Functional Movement Screen

Article

Jun 2012
J STRENGTH COND RES

The purpose of this study was to investigate interrater and intrarater reliability of the Functional Movement Screen (FMS) with real time administration with raters of different educational background and experience. The FMS was assessed with real time administration in healthy, injury-free men and women and included a certified FMS rater for comparison to other raters. A relatively new tool, the FMS was developed to screen seven individual movement patterns to classify subjects' injury risk. Previous reliability studies have been published with only one investigating intrarater reliability. These studies had limitations in study design and clinical applicability such as the use of only video to rate or the use of raters without comparison to a certified FMS rater. Raters (n=4) with varying degrees of FMS experience and educational levels underwent a 2 hour FMS training session. Subjects (n=19) were rated during two sessions, one week apart using standard FMS protocol and equipment. Interrater reliability was good for session one (ICC = 0.89) and for session two (ICC = 0.87). The individual FMS movements showed hurdle step as the least reliable (ICC=0.30 for session 1 and 0.35 for session 2) while the most reliable was shoulder mobility (ICC=0.98 for session 1 and 0.96 for session 2). Intrarater reliability was good for all raters (ICC=0.81-0.91), with similar ICC regardless of education or previous experience with FMS. The results showed the FMS could be consistently scored by people with varying degrees of experience with the FMS following a two hour training session. Intrarater reliability was not increased with FMS certification.

Reliability of the Landing Error Scoring System-Real Time, a Clinical Assessment Tool of Jump-Landing Biomechanics

Article

May 2011

There is a need for reliable clinical assessment tools that can be used to identify individuals who may be at risk for injury. The Landing Error Scoring System (LESS) is a reliable and valid clinical assessment tool that was developed to identify individuals at risk for lower extremity injuries. One limitation of this tool is that it cannot be assessed in real time and requires the use of video cameras. To determine the interrater reliability of a real-time version of the LESS, the LESS-RT. Reliability study. Controlled research laboratory. 43 healthy volunteers (24 women, 19 men) between the ages of 18 and 23. The LESS-RT evaluates 10 jump-landing characteristics that may predispose an individual to lower extremity injuries. Two sets of raters used the LESS-RT to evaluate participants as they performed 4 trials of a jump-landing task. Intraclass correlation coefficient (ICC2,1) values for the final composite score of the LESS-RT were calculated to assess interrater reliability of the LESS-RT. Interrater reliability (ICC2,1) for the LESS-RT ranged from .72 to .81 with standard error of measurements ranging from .69 to .79. The LESS-RT is a quick, easy, and reliable clinical assessment tool that may be used by clinicians to identify individuals who may be at risk for lower extremity injuries.