FUNCTIONAL MOVEMENT SCREEN SCORING SHEET

DATE: ______________ NAME: ___________________________________ AGE: _______ LEVEL: ____________________

TEAM/SCHOOL: ________________________________ HEIGHT: __________ HAND DOMINAANCE: R L

SPORT/POSITION: ______________________________ WEIGHT: __________ LEG DOMINANCE: R L

TEST SCORE DYSFUNCTION GRADING CRITERIA III GRADING CRITERIA II GRADING CRITERIA I
1. Deep Squat 3 2 1 0 >Upper torso is parallel with >Upper torso is parallel with >Tibia and upper torso are not
tibia or toward vertical tibia or toward vertical parallel
TOE TOUCH TEST: Able >Femur below horizontal >Femur below horizontal >Femur not below horizontal
Not able >Knees aligned over feet >Knees aligned over feet >Knees not aligned over feet
>Dowel aligned over feet >Dowel aligned over feet on a >Lumbar flexion noted
2X4
2. Hurdle Step 3 2 1 0 >The hips, knees & ankles >Alignment is lost between >Contact with foot & hurdle
remain aligned in the sagital hips, knees & ankles >Loss of balance at any time
Inches: ____________ plane >Movement in the lumbar
>Minimal Movement in the spine
Left Leg Up 3 2 1 0 lumbar spine >Dowel & hurdle do not remain
>Dowel & hurdle remain parallel
Right Leg Up 3 2 1 0 parallel
3. In-Line Lunge 3 2 1 0 >Minimal to no torso >Movement noted in torso >Loss of balance at any time
movement >Feet do not remain in sagital
Inches: ____________ >Feet remain in sagital plane plane on the 2X6
on the 2X6 >Knee does not touch 2X6
Left Leg Forward 3 2 1 0 >Knee touches 2X6 behind the behind the heel of front foot
heel of front foot
Right Leg Forward 3 2 1 0
4. Shoulder Mobility 3 2 1 0 >Fists should be within one >Fists should be within one >Fists fall greater than one and
Distance (tip of middle finger to L top: ____ hand length and a half hand lengths a half hand lengths
distal crease): ____________ R top: ____

IMPINGEMENT TESTS SCORE 6.5=9.75, 6.75=10.1, 7.0=10.5,

__________Left 3 2 1 0 7.25=10.86, 7.5=11.25, 7.75=11.63, 8=12,
__________Right 3 2 1 0 8.25=12.38, 8.5=12.75, 8.75=13.1, 9=13.5
5. Active Straight Leg Raise 3 2 1 0 >Malleoi resides between mid- >Malleoi resides between mid- >Malleoi resides below mid-
thigh and ASIS thigh and mid-patella patella
L: ______
R: ______
6. Trunk Stability Push Up 3 2 1 0 >Males perform 1 repetition >Males perform 1 repetition >Males unable to perform 1
with the thumbs above head with thumbs in line with the rep with hands in line with chin
PRONE PRESS UP TEST >Females perform 1 repetition chin >Females unable to perform 1
____________ with thumbs in line with the >Females perform 1 rep with rep with thumbs in line with
chin thumbs in line with the clavicle clavicle
7. Rotary Stability Quadruped 3 2 1 0 >Performs 1 unilateral rep >Performs 1 diagonal rep while >Unable to perform diagonal
while keeping torso parallel to keeping torso parallel to board repetitions
KNEELING LUMBAR board >Knee & elbow touch in line
FLEXION TEST >Knee & elbow touch in line with the board
________________ Left Up 3 2 1 0 with the board

Right Up 3 2 1 0

Total Score Tests 1-7: ____________/21 Initials of Tester: ___________________ Revised 4/15/11