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The Case for Retiring Flexibility as a Major Component of Physical Fitness

DOI:10.1007/s40279-019-01248-w
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James L. Nuzzo at Edith Cowan University
James L. Nuzzo
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Abstract

Flexibility refers to the intrinsic properties of body tissues that determine maximal joint range of motion without causing injury. For many years, flexibility has been classified by the American College of Sports Medicine as a major component of physical fitness. The notion flexibility is important for fitness has also led to the idea static stretching should be prescribed to improve flexibility. The current paper proposes flexibility be retired as a major component of physical fitness, and consequently, stretching be de-emphasized as a standard component of exercise prescriptions for most populations. First, I show flexibility has little predictive or concurrent validity with health and performance outcomes (e.g., mortality, falls, occupational performance) in apparently healthy individuals, particularly when viewed in light of the other major components of fitness (i.e., body composition, cardiovascular endurance, muscle endurance, muscle strength). Second, I explain that if flexibility requires improvement, this does not necessitate a prescription of stretching in most populations. Flexibility can be maintained or improved by exercise modalities that cause more robust health benefits than stretching (e.g., resistance training). Retirement of flexibility as a major component of physical fitness will simplify fitness batteries; save time and resources dedicated to flexibility instruction, measurement, and evaluation; and prevent erroneous conclusions about fitness status when interpreting flexibility scores. De-emphasis of stretching in exercise prescriptions will ensure stretching does not negatively impact other exercise and does not take away from time that could be allocated to training activities that have more robust health and performance benefits.
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Vol.:(0123456789)
Sports Medicine (2020) 50:853–870
https://doi.org/10.1007/s40279-019-01248-w
CURRENT OPINION
The Case forRetiring Flexibility asaMajor Component ofPhysical
Fitness
JamesL.Nuzzo1,2
Published online: 16 December 2019
© Springer Nature Switzerland AG 2019
Abstract
Flexibility refers to the intrinsic properties of body tissues that determine maximal joint range of motion without causing
injury. For many years, flexibility has been classified by the American College of Sports Medicine as a major component of
physical fitness. The notion flexibility is important for fitness has also led to the idea static stretching should be prescribed
to improve flexibility. The current paper proposes flexibility be retired as a major component of physical fitness, and conse-
quently, stretching be de-emphasized as a standard component of exercise prescriptions for most populations. First, I show
flexibility has little predictive or concurrent validity with health and performance outcomes (e.g., mortality, falls, occupa-
tional performance) in apparently healthy individuals, particularly when viewed in light of the other major components of
fitness (i.e., body composition, cardiovascular endurance, muscle endurance, muscle strength). Second, I explain that if
flexibility requires improvement, this does not necessitate a prescription of stretching in most populations. Flexibility can
be maintained or improved by exercise modalities that cause more robust health benefits than stretching (e.g., resistance
training). Retirement of flexibility as a major component of physical fitness will simplify fitness batteries; save time and
resources dedicated to flexibility instruction, measurement, and evaluation; and prevent erroneous conclusions about fitness
status when interpreting flexibility scores. De-emphasis of stretching in exercise prescriptions will ensure stretching does
not negatively impact other exercise and does not take away from time that could be allocated to training activities that have
more robust health and performance benefits.
* James L. Nuzzo
j.nuzzo@neura.edu.au
1 Neuroscience Research Australia, Barker Street, Randwick,
NSW, Australia2031
2 School ofMedical Sciences, University ofNew South Wales,
Sydney, NSW, Australia
1 Flexibility Dened
Flexibility refers to the intrinsic properties of body tissues
that determine maximal joint range of motion (ROM) with-
out causing injury [1, 2]. Static flexibility refers to joint
ROM usually in relaxed muscle [2, 3]. Static flexibility is
subjective, as the limit ROM is determined by the tester or
the patient and their stretch tolerance [2, 3]. Tools used to
assess static flexibility include rulers, goniometers, electro-
goniometers, inclinometers, fleximeters, photography, vis-
ual estimations, and three-dimensional kinematics [4–11].
Dynamic flexibility refers to stiffness of the muscle-tendon
unit within normal ROM [2, 3]. Dynamic flexibility is more
objective [2, 3] and is assessed with force sensors, isokinetic
dynamometers, and shear wave elastography.
The current paper is concerned with static flexibility and
the sit-and-reach test. The sit-and-reach requires participants
to sit on the floor or in a chair and reach toward their toes.
This test is used in school fitness batteries in the United
States [12, 13]. The American College of Sports Medi-
cine (ACSM) states the sit-and-reach should be included in
health-related physical testing due to the “relative importance
of hamstring flexibility to activities of daily living and sports
performance…” [14]. Numerous studies have examined the
validity and reliability of the sit-and-reach [4, 15–50]. The
test is reliable andprimarily measures hamstrings flexibility.
2 Brief History ofFlexibility intheUnited
States
Clinical tests have been used to measure static flexibil-
ity (hereafter termed “flexibility”) in intact humans since
the early 1900s [11, 51]. In 1941, Cureton summarized
research on flexibility [52]. He discussed ways flexibility
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... The American College of Sports Medicine (ACSM) defines flexibility as the ability to move through full range of motion (ROM) [66]. Despite popular beliefs, the role of flexibility in injury risk is not clear, and the importance attributed to flexibility has been questioned in recent years [67]. Indeed, a recent systematic review assessing 78 studies with 71,324 athletes showed no relationship between assessments of flexibility, mobility, and ROM with hamstring injury risk [68]. ...
... Moreover, the development of flexibility is usually equated with stretching [66,67,70,71], despite strength training also being effective for improving ROM [67,[71][72][73][74]. Regarding the relationship between stretching and injury risk, a systematic review showed that stretching before or after exercise did not reduce injury risk [75]. In the last 20 years, several other systematic reviews have shown no effect of stretching on injury risk [45,[76][77][78][79][80][81][82]. ...
... Moreover, the development of flexibility is usually equated with stretching [66,67,70,71], despite strength training also being effective for improving ROM [67,[71][72][73][74]. Regarding the relationship between stretching and injury risk, a systematic review showed that stretching before or after exercise did not reduce injury risk [75]. ...
Prevention Strategies of Lower Limb Muscle Injuries
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Lower limbs muscle injuries (LLMI) are the most common sports-related injuries during practice and/or competition. The most affected muscle groups are the adductors, hamstrings, quadriceps, and calf muscles. These injuries generate a considerable competitive and economic burden, justifying a comprehensive investment in strategies focused on reducing injury risk. This chapter delivers an overview of potential risk reduction strategies of LLMI. Although the focus will be on exercise-based strategies, it should be recognized that strategies may be equally relevant (e.g., rules changes, proper equipment). Exercise-based strategies for reducing LLMI risk should consider two interacting features: modality and dose. The evidence surrounding different exercise modalities (e.g., strength training, balance training), dose-response relationships, timing of implementation (e.g., warm-up, postexercise), and mediator factors (e.g., adherence to interventions, interindividual variability in response) is explored. Potential trade-offs (e.g., reduction of injury risk versus performance impairment), the often-misunderstood role of asymmetry, and the value of screening tools are also debated. Currently, most of what is known derives from associative studies and causal relationships are largely unknown, while the focus on average data may be detracting from more personalized approaches to injury risk reduction. Therefore, although a conceptual model for reducing the risk of LLMI is provided, it should be considered tentative.
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... 5 It encompasses components such as speed, power, coordination, reaction time, agility and balance. 6 These components affect performance in health-related physical fitness, yet they have attracted less research interest. This is important also from the perspective of current fitness level of children and adolescents, since globally, nowadays generations are less fit 7 and more inclined to health risks associated with poor fitness. ...
... For more comprehensive picture, flexibility was included in this study despite its controversy. 6 The information gained from our research can guide interventions, inform curricular development, and contribute to injury prevention and performance enhancement efforts in physical education and sports settings. ...
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... In addition to a stable state of health, physical training can give you a fresher physical sensation. Therefore, the more you move, the less you get tired, and you can increase your endurance through physical training [11]. ...
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... Restricting analyses to data from cohorts 2016 until 2022 allowed us to include an indicator of a sixth physical fitness component, that is static balance. This test has been available only since 2016, replacing a flexibility test used between 2011 and 2015 [38]. Finally, as the focus is on the Covid pandemic effect and as there were particularly pronounced cohort effects relating to the 2011 to 2015 cohorts, the selection used here gives more weight to recent secular trends. ...
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Background In spring of 2020, the Sars-CoV-2 incidence rate increased rapidly in Germany and around the world. Throughout the next 2 years, schools were temporarily closed and social distancing measures were put in place to slow the spread of the Covid-19 virus. Did these social restrictions and temporary school lockdowns affect children’s physical fitness? The EMOTIKON project annually tests the physical fitness of all third-graders in the Federal State of Brandenburg, Germany. The tests assess cardiorespiratory endurance (6-min-run test), coordination (star-run test), speed (20-m sprint test), lower (powerLOW, standing long jump test), and upper (powerUP, ball-push test) limbs muscle power, and static balance (one-legged stance test with eyes closed). A total of 125,893 children were tested in the falls from 2016 to 2022. Primary analyses focused on 98,510 keyage third-graders (i.e., school enrollment according to the legal key date, aged 8 to 9 years) from 515 schools. Secondary analyses included 27,383 older-than-keyage third-graders (i.e., OTK, delayed school enrollment or repetition of a grade, aged 9 to 10 years), who have been shown to exhibit lower physical fitness than expected for their age. Linear mixed models fitted pre-pandemic quadratic secular trends, and took into account differences between children and schools. Results Third-graders exhibited lower cardiorespiratory endurance, coordination, speed and powerUP in the Covid pandemic cohorts (2020–2022) compared to the pre-pandemic cohorts (2016–2019). Children’s powerLOW and static balance were higher in the pandemic cohorts compared to the pre-pandemic cohorts. From 2020 to 2021, coordination, powerLOW and powerUP further declined. Evidence for some post-pandemic physical fitness catch-up was restricted to powerUP. Cohen’s |ds| for comparisons of the pandemic cohorts 2020–2022 with pre-pandemic cohorts 2016–2019 ranged from 0.02 for powerLOW to 0.15 for coordination. Within the pandemic cohorts, keyage children exhibited developmental losses ranging from approximately 1 month for speed to 5 months for cardiorespiratory endurance. For powerLOW and static balance, the positive pandemic effects translate to developmental gains of 1 and 7 months, respectively. Pre-pandemic secular trends may account for some of the observed differences between pandemic and pre-pandemic cohorts, especially in powerLOW, powerUP and static balance. The pandemic further increased developmental delays of OTK children in cardiorespiratory endurance, powerUP and balance. Conclusions The Covid-19 pandemic was associated with declines in several physical fitness components in German third-graders. Pandemic effects are still visible in 2022. Health-related interventions should specifically target those physical fitness components that were negatively affected by the pandemic (cardiorespiratory endurance, coordination, speed).
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... Restricting analyses to data from cohorts 2016 until 2022 allowed us to include an indicator of a sixth physical fitness component, that is static balance. This test has been available only since 2016, replacing a flexibility test used between 2011 and 2015 [38]. Finally, as the focus is on the Covid pandemic effect and as there were particularly pronounced cohort effects relating to the 2011 to 2015 cohorts, the selection used here gives more weight to recent secular trends. ...
Covid Pandemic Effects on the Physical Fitness of Primary School Children: Results of the German EMOTIKON Project
Article
Full-text available
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Background. In spring of 2020, the Sars-CoV-2 incidence rate increased rapidly in Germany and around the world. Throughout the next 2 years, schools were temporarily closed and social distancing measures were put in place to slow the spread of the Covid-19 virus. Did these social restrictions and temporary school lockdowns affect chil- dren’s physical fitness? The EMOTIKON project annually tests the physical fitness of all third-graders in the Federal State of Brandenburg, Germany. The tests assess cardiorespiratory endurance (6-min-run test), coordination (star-run test), speed (20-m sprint test), lower (powerLOW, standing long jump test), and upper (powerUP, ball-push test) limbs muscle power, and static balance (one-legged stance test with eyes closed). A total of 125,893 children were tested in the falls from 2016 to 2022. Primary analyses focused on 98,510 keyage third-graders (i.e., school enrollment accord- ing to the legal key date, aged 8 to 9 years) from 515 schools. Secondary analyses included 27,383 older-than-keyage third-graders (i.e., OTK, delayed school enrollment or repetition of a grade, aged 9 to 10 years), who have been shown to exhibit lower physical fitness than expected for their age. Linear mixed models fitted pre-pandemic quadratic secu- lar trends, and took into account differences between children and schools. Results. Third-graders exhibited lower cardiorespiratory endurance, coordination, speed and powerUP in the Covid pandemic cohorts (2020–2022) compared to the pre-pandemic cohorts (2016–2019). Children’s powerLOW and static balance were higher in the pandemic cohorts compared to the pre-pandemic cohorts. From 2020 to 2021, coor- dination, powerLOW and powerUP further declined. Evidence for some post-pandemic physical fitness catch-up was restricted to powerUP. Cohen’s |ds| for comparisons of the pandemic cohorts 2020–2022 with pre-pandemic cohorts 2016–2019 ranged from 0.02 for powerLOW to 0.15 for coordination. Within the pandemic cohorts, keyage children exhibited developmental losses ranging from approximately 1 month for speed to 5 months for cardiorespi- ratory endurance. For powerLOW and static balance, the positive pandemic effects translate to developmental gains of 1 and 7 months, respectively. Pre-pandemic secular trends may account for some of the observed differences between pandemic and pre-pandemic cohorts, especially in powerLOW, powerUP and static balance. The pandemic further increased developmental delays of OTK children in cardiorespiratory endurance, powerUP and balance. Conclusions. The Covid-19 pandemic was associated with declines in several physical fitness components in German third-graders. Pandemic effects are still visible in 2022. Health-related interventions should specifically target those physical fitness components that were negatively affected by the pandemic (cardiorespiratory endurance, coordina- tion, speed).
View
... Flexibility is an important factor in both sports performance and the rehabilitation process [1,2]. Several stretching techniques are effective in increasing range of motion (ROM), with static stretching being the most commonly used [3]. ...
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... Flexibility, in general, is considered one of the important aspects of physical fitness related to health. However, in recent years, whether flexibility can be considered as important as muscular strength, muscular endurance, or cardiopulmonary fitness has been called into question because, among other reasons, unlike the other related factors, no evidence exists that it has a significant predictive value of mortality [65]. Flexibility has uncertain predictive value for the appearance of back pain or injuries in adults. ...
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... Науковець J.L. Nuzzo досліджує роль гнучкості у фізичній підготовці та спорті [5]. Автор розглядає експерименти, які вказують на те, що гнучкість може мати обмежену важливість у фізичній підготовці, і пропонує зняти гнучкість зі списку основних компонентів фізичної підготовки. ...
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... Therefore, reduction of flexibility could be found in athletes. The American College of Sports Medicine has classified flexibility as a major component of physical fitness because it determines the maximum ROM of joints without causing injury (Nuzzo, 2020). Research evidence suggest that flexibility is a key factor in sports for performing, such as sprinting, jumping, agility and balance. ...
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... Physical fitness is the foundation of the people and the key to the development of scientific, cultural and moral qualities. 5 Only by improving the physical quality of college students can their overall qualification level be improved. Therefore, this paper discusses the effect of aerobics training on improving the body, heart and lung functions of universities. ...
EFFECT OF AEROBIC TRAINING ON PHYSICAL FITNESS AND CARDIOPULMONARY RESISTANCE OF UNIVERSITY STUDENTS
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Background: Ballet dancers have a high prevalence of injuries to the lower extremity. Many studies have investigated the relationship between dance injury and risk factors. However, risk factors for lower-extremity injury comparing recreational- and elite-level ballet dancers are scarce. Objective: To systematically review available original studies to assess risk factors for lower-extremity injury in female ballet dancers between recreational and elite ballet dancers. Data sources: Five online databases [Web of Science, PubMed, OVID (Medline), EBSCO, and ProQuest] were searched systematically. Study selection: Included studies had an analytic study design published in the past 11 years and investigated an association between potential risk factors and lower-extremity injury in female ballet dancers. Study appraisal: Assessed independently by 2 reviewers using the Downs and Black (DB) criteria and Oxford Centre of Evidence-Based Medicine. Results: Seventeen studies were included. Alignment was a risk factor for lower-extremity injury in both recreational and elite ballet dancers. In elite ballet dancers, poor lumbopelvic movement control, inappropriate transversus abdominis contraction, decreased lower-extremity strength, and poor aerobic fitness were risk factors for lower-extremity injury. In recreational ballet dancers, hypermobility of the hip and ankle and longer training hours were risk factors for lower-extremity injury. Mean DB score was 15.94 (SD 1.57). The majority of studies were retrospective cohort studies or had poor follow-up, with 7 level 2b studies, 6 level 3b studies (cross-sectional), and 4 level 1b studies (prospective cohort with good follow-up). Conclusions: Alignment was identified as a common risk factor for recreational and elite ballet dancers. Other risk factors differed between recreational ballet dancers and elite ballet dancers. Future studies are warranted to use a prospective study design, identify dance level-specific risk factors, and implement evidence-based prevention strategies.
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Article
  • Sep 2019
Ferreira-Júnior, JB, Benine, RPC, Chaves, SFN, Borba, DA, Martins-Costa, HC, Freitas, EDS, Bemben, MG, Vieira, CA, and Bottaro, M. Effects of static and dynamic stretching performed before resistance training on muscle adaptations in untrained men. J Strength Cond Res XX(X): 000-000, 2019-This study evaluated the effects of dynamic and static stretching (SS) performed before resistance training on biceps femoris hypertrophy and knee flexor strength gains in untrained young men. Forty-five untrained young men (age, 21.2 ± 0.5 years; mass, 72.2 ± 5.6 kg; height, 178 ± 1 cm) were randomly assigned to 1 of the 3 groups: (a) 80 seconds of SS (n = 14); (b) 80 seconds of dynamic stretching (DS, n = 13); or (c) control group (CON, n = 18) in which subjects performed no stretching before exercise. Both SS and DS were performed before resistance exercise. Resistance training consisted of 4 sets of 8-12 repetition maximum of seated leg curl exercise 2 days per week for 8 weeks, with a period of at least 48 hours between sessions. Unilateral biceps femoris muscle thickness (MT) and maximal isometric strength (MIS) of the knee flexors were measured 1 week before training and 1 week after the last training session. There were significant increases in MIS (SS = 13.9 ± 10.3 kgf; DS = 10.2 ± 13.1 kgf; CON = 12.7 ± 7.6 kgf; p < 0.05) and MT (SS = 6.0 ± 3.5 mm; DS = 6.7 ± 4.1 mm; CON = 5.7 ± 3.0 mm; p < 0.05) with no significant differences across groups (p > 0.05). Additionally, all groups demonstrated moderate effect sizes for MIS (1.27-1.4), and DS was the only group that had a large effect size for MT increases (DS = 2.18; SS = 1.35; CON = 0.92). In conclusion, 80 seconds of SS and DS did not induce any additional muscular adaptations to resistance training in untrained young men.
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Flexibility exercise training for adults with fibromyalgia (Review)
Article
Flexibility exercise training for adults with fibromyalgia This review summarizes the effects of flexibility exercise for adults with fibromyalgia. What problems do fibromyalgia cause? People with fibromyalgia have persistent, widespread body pain. They may also have fatigue, anxiety, depression, and sleep difficulties. What is flexibility exercise training? Flexibility exercise training is a type of exercise that focuses on improving or maintaining the amount of motion available in muscles and joint structures by holding or stretching the body in specific positions. Study characteristics We searched the literature up to December 2017 and found 12 studies (743 individuals) that met our inclusion criteria. Flexibility interventions were compared with control (treatment as usual), aerobic training interventions (e.g. treadmill walking), resistance‐training interventions (e.g. using weight machines that provide resistance to movement), and other interventions (e.g. Pilates). The average age of participants was 48.6 years. Trials were conducted in seven countries, and most studies (58.3%) included only female participants. Exercise trials ranged from 4 to 20 weeks. The stretching exercise programs ranged from 40 to 60 minutes, 1 to 3 times a day. The intensity of the stretches (e.g. how far the stretch was taken in the available range of motion) was not reported in most cases. The time each stretch was held ranged from 6 to 60 seconds. The targeted muscles were usually of both the upper and lower extremities, neck, and back. The flexibility training was either supervised or done at home. Our main comparison was flexibility exercise versus land‐based aerobic training. Key results at the end of treatment for our main comparison Compared with land‐based aerobic exercise training, flexibility exercise resulted in little benefit at 8 to 20 weeks' follow‐up. Each measure below was measured on a scale from 0 to 100, with lower scores better. Health‐related quality of life: People who received flexibility exercise training were 4% worse (ranging from 6% better to 14% worse). • People who had flexibility training rated their quality of life as 46 points. • People who had aerobic training rated their quality of life as 42 points. Pain intensity: People who received flexibility exercise training were 5% worse (ranging from 1% better to 11% worse). • People who had flexibility training rated their pain as 57 points. • People who had aerobic training rated their pain as 52 points. Fatigue: People who received flexibility exercise training were 4% better (ranging from 13% better to 5% worse). • People who had flexibility training rated their fatigue as 67 points. • People who had aerobic training rated their fatigue as 71 points. Stiffness: People who received flexibility exercise training were 30% better (ranging from 8% better to 51% better). • People who had flexibility training rated their stiffness as 49 points. • People who had aerobic training rated their stiffness as 79 points. Physical function: People who received flexibility exercise training were 6% worse (ranging from 4% better to 16% worse). • People who had flexibility training rated their physical function as 23 points. • People who had aerobic training rated their physical function as 17 points. Withdrawal from treatment A total of 18 per 100 people dropped out of the flexibility exercise training group for any reason compared to 19 per 100 people from the aerobic training group. Harms We found no clear information on harms. One study reported that one participant had swelling (tendinitis) of an ankle tendon (Achilles), but it is unclear if this was related to participation in the flexibility exercise. Quality of evidence The evidence does not show that flexibility exercise significantly improves health‐related quality of life, pain, fatigue, or physical function. The number of people dropping out from each group was similar. Although the evidence suggests that flexibility exercise improves stiffness, caution is advised in interpretation of these results, as this improvement was seen in only one study with very few participants. We considered the overall certainty of the evidence to be low to very low due to study design issues, the small number of participants, and low certainty of results.
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Effects of functional and traditional training in body composition and muscle strength components in older women: A randomized controlled trial
Article
Background: While traditional resistance exercises have been widely used to promote muscle strength and hypertrophy in the elderly, few studies have reported the use of a functional approach in which common patterns for daily activities are considered the primary stimulus. Objective: Investigate whether functional training has similar effects the traditional on body composition and muscle strength components in physically active older women. Methods: Forty-seven older women completed a randomized and crossover clinical trial, distributed in three groups: Functional or Traditional Training (FUNCT/TRAD: n=32; 65.28±4.96 years) and Stretching Group (STRETCH: n=15; 64.40±3.68 years). Maximal dynamic strength was verified with the 1 repetition maximum (RM) test in the leg press and rowing machines. Muscular power was analyzed using 50% of the maximum load, speed was determined using a linear encoder, and isometric strength was analyzed with hand and lumbar dynamometers. ANOVA for repeated measures was applied for comparisons. Results: The FUNCT showed a significant decrease in fat percentage (p=0.015, 3.51%) and the TRAD a significant increase in lean mass (p=0.008, 2.92%). Both FUNCT and TRAD generated significant increases in all components of muscle strength compared to baseline whereas STRETCH showed declines in these variables. No statistically significant differences were observed between the experimental groups in body composition. Conclusion: Functional and traditional training are equally efficient in improving strength components in physically active older women and, therefore, they may be complementary to combat some of the deleterious effects of senescence.
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Musculoskeletal Screening to Identify Female Collegiate Rowers at Risk for Low Back Pain
Article
  • Dec 2018
Context: Rowers are at risk for overuse injuries, including low back pain (LBP). Defining the utility of screening tests for identifying those at risk for LBP can aid in the development of guidelines for injury prevention. Objective: To determine if the Functional Movement Screen (FMS) and impairments can identify rowers at risk for developing LBP. Design: Prospective cohort study. Setting: Athletic training room. Patients or other participants: A total of 31 National Collegiate Athletic Association Division I, female, open-weight rowers (age = 19.9 ± 1.4 years, height = 163.6 ± 30.8 cm, mass = 84.1 ± 37.63 kg); coxswains were excluded. Main outcome measure(s): We assessed the FMS and 5 impairment measures of the Star Excursion Balance Test, closed kinetic chain dorsiflexion range of motion, and the plank, Sorensen, and sit-and-reach tests before the fall season. Low back pain injuries were tracked by the sports medicine staff. Impairment measures were compared between the injured and uninjured athletes. The FMS cutoff score that discriminated injured from uninjured rowers was determined using a receiver operating characteristic curve analysis. Impairments were compared between those at a higher versus lower risk of LBP. Results: Eighteen rowers sustained an LBP injury. No differences in FMS or impairments between groups were demonstrated. The FMS receiver operating characteristic curve analysis cutoff score was 16 points (area under the curve = 0.60, specificity = 0.67, risk ratio = 1.4 [95% confidence interval = 0.91, 2.11]). Rowers with an FMS score ≤16 had a shorter plank-test time (109.5 ± 60.2 seconds) than those with less risk (175.3 ± 98.6 seconds, mean difference = 65.9 seconds, 95% confidence interval = -129.4, -2.3; P = .043). Conclusions: Those with an FMS score ≤16 had a shorter plank-test hold time, indicating that a lack of core endurance may contribute to the increased risk of LBP in female rowers. An FMS score ≤16 indicated a small increased risk (1.4) of developing LBP compared with rowers who had scores >16; however, the FMS is not recommended for widespread screening of female rowers because the risk ratio was relatively small and had a wide 95% confidence interval.
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