Acta Medica Mediterranea, 2017, 33: 651

ANGULAR KINEMATICS OF THE DEEP SQUAT TEST IN FUNCTIONAL MOVEMENT SCREENTM

ACCORDING TO THE SCORING SYSTEM

CIGDEM BULGAN
Halic University, School of Physical Education and Sports- Istanbul, Turkey

ABSTRACT

The aim of this study was to determine to angular kinematic differences of the Functional Movement Screen (FMS)TM deep
squat test according to the classifications. 23 university students (age 22.43±1.53yrs; height 177.26±6.09cm and weight
70.21±12.40kg) participated to this study voluntarily. Participants performed a deep squat test three times according to Cook’s gui-
delines for Functional Movement Screening. They get scored by a clinician as 1, 2 or 3. During the test performance, 3D angular
kinematic data was collected by 8 high speed Oqus 7+ cameras which were connected directly to the computer. Left and right knee,
hip and shoulder angles; trunk flexion angle; hip, calf segmental angles, dowel angle in frontal axis; and also thigh segmental angle
in horizontal axis were assessed to examine differences between the three scoring groups by using Qualisys Track Manager (QTM)
Version 2.12.
SPSS 18.0 (SPSS Inc., Chicago, IL, USA) program was used for the differences by Kruskal Wallis test. As a result of the study,
the significant difference were found at right and left knee angle between groups (p<0.05). Also in horizontal plane, right and left
thigh were significantly difference between groups (p<0.05) too. There were no significant differences found in other parameters.
(p>0.05). As a conclusion, in squat movement, as the limitation of motion increases, the hip and knee angles were getting higher and
because there was a knee excursion in the horizantal plane, the mechanics of movement distorted.

Keywords: Angular Kinematics, Deep Squat, FMS, Screening.

DOI: 10.19193/0393-6384_2017_4_097

Received November 30, 2016; Accepted March 20, 2017

Introduction general population(26). Physically active people may

face the risk of long or short term injuries and these
Functional movement is the ability to produce injuries are commonly as lower extremity especially
and maintain a balance between mobility and stabili- in sportive activities/ games and may occur after an
ty along the kinetic chain while performing funda- intensive exercises or/and neuromuscular fatigue(4, 8).
mental patterns with accuracy and efficiency(25, 27). Preventing injuries, it should be determined
Muscular flexibility, strength, coordination, balance, whether the athletes are in the risk group(4). One of
endurance, and movement efficiency are components the popular screening tool for this, is the Functional
necessary to achieve functional movement, which is Movement ScreenTM (FMS)(12). FMSTM has demon-
integral to performance and sport-related skills(18) and strated some efficacy in the prediction of injuries and
also in health promotion environments, like gyms for is thus used by many practitioners to make recom-
652 Cigdem Bulgan

mendations for exercise(3, 10, 22). As the fundamental of have not experienced any lower extremity injuries
functional training system and the classic test of before. The study was conducted consistent with the
body functional movement, FMSTM is widely applied recommendations of the Declaration of Helsinki.
in physical therapy and strength and conditioning Before participating to the study, the subjects
area, and has good reliability and validity(28). It con- were informed about the research, including
sists of 7 fundamental movements which are scored potential the risks and benefits of the study. Written
on a 0-3 ordinal scale; involving locomotor, manipu- consent was obtained from all the students.
lative, and stabilizing actions that assess balance,
mobility, and stability(12, 17, 20, 21). Procedures
It also has developed a series of corrective exer- The data collection was done in Halic
cises that are prescribed based on the level and type University, Department of Physical Education and
of faulty movement patterns achieved. So together Sport’s Laboratory, Istanbul and asked all partici-
with these corrective exercises, the FMSTM is promot- pants to refrain from alcohol, caffeine and ergogenic
ed to reduce the risk of sport-related musculoskeletal aids the day before the test. According to the proce-
injury(20). Chorba et al 2010 indicated that the risk of dure, there was no given warming time for the partic-
injury in female collegiate athletes could be identi- ipants. Since there is no additional weight added to
fied by using a functional movement screening the athlete and the screens are designed to uncover
tool(29). However McCunn et al 2016 mentioned that limitations to movement, extensive warm-up is not
in their review, none of the movement screens that required(5).
appear within the scientific literature currently had The reflector markers which 3 cm diameter
enough evidence to justify the tag of ‘injury predic- were attached to their selected joints of right and left
tion tool’(30). acromion, olecranon, medial styloid, great
The scoring of the screening is made according trochanter, proximal patella, lateral malleolus and the
to the criteria given by the guidelines provided by dowel. These markers were applied to the partici-
Cook et al., (2010). However, within this criterion, pants with double-sided tape (Figure 1).
no angular evaluation of the subjects were found and
the angular differences of the individuals who score
1- 2 and 3 are not specified. One of the potential con-
founders is the issue of whether a knowledge of a
task’s scoring criteria can change how individuals
perform. If someone can influence their score based
on their knowledge or understanding of the test, the
outcomes of any strategy to prevent injury and
improve performance, be it coaching or exercise
related, could be compromised(10). The main purpose
of this study was to determine to the angular differ-
ences of related joints according to the FMSTM scor-
ing criteria and its classifications. It was hypothe-
sized that segmental angles would change as individ- Figure 1: Marker Positions.
uals adapted their movement in an attempt to meet
the scoring criteria. Kinematic data were collected by using 8 high
speed (120 Hz) Oqus 7+ cameras (Dimensions:
Materials and methods 18.7×11×12.5cm; Weight: 1.9-2.1kg) which were
connected directly to the computer. The cameras
Participants were placed to each other about 3-4 meters distance
23 students (6 women, mean age and 4-6meters to the participants. For analyses of the
22,66±1,96yrs; mean height 172,50±1,97cm and 3D angular kinematics, Qualisys Track Manager
mean weight 56,83±3,71kg; 17 men, mean age (QTM) Version 2.12, which is proprietary tracking
22,25±1,41yrs; mean height 178,94±6,18cm and software, designed to work seamlessly with any
mean weight 56,83±3,71kg) from Halic University, model of Qualisys camera, ensuring fast and precise
School of Physical Education and Sport Department data collection (Qualisys AB, 2011), were used. A
participated in this study as voluntarily. The students dynamic calibration method which was a wand cali-
Angular kinematics of the deep squat test in functional movement screenTM according to the scoring system 653

bration was used. T stick was simply moved around movements, there is also an additional clearing test
in the volume while a stationary reference object in that the client performs. If there is pain on the clear-
the volume defines the coordinate system for the ing test, 0 is scored for that movement. A sum com-
motion capture. Calibration time was set for 45sec posite score for the 7 components ranges from 0 to
(Figure 2). Marker trajectories were low pass filtered 21(13, 17, 12).
at 5Hz using Butterworth filter.
The Deep Squat Test
The deep squat is a test that challenges total
body mechanics when performed properly. It is used
to assess bilateral, symmetrical, functional mobility
of the hips, knees, and ankles. The dowel held over-
head assesses bilateral, symmetrical mobility of the
shoulders, as well as the thoracic spine(5).

Figure 2: Calibration Cube.

All participants performed a deep squat three

times, permitting the observer to vary their view of
the athlete’s movement through different planes of
motion (i.e., sagittal and frontal), respectively. It was
scored according to Cook’s guidelines. The best trial
was used for kinematic data analysis. 3D data for the
lower extremity during the deep squat trials were
analyzed to examine differences between the three
scores of the FMSTM. Left and right joint angles Figure 3: The Deep Squat Scoring System according to
Groups 1, 2 and 3(3, 24).
(knee, hip and shoulder); trunk flexion angles; hip,
calf segmental angle, dowel angle in frontal axis; and The individual assumes the starting position by
also thigh segmental angle in horizontal axis were placing his/her feet approximately shoulder width
assessed to examine differences between the three apart with the feet aligned in the sagittal plane. Then
groups. adjusts their hands on the dowel to assume a
90degree angle of the elbows with the dowel over-
Functional Movement ScreenTM head. Next, the dowel is pressed overhead with the
The full system of the FMSTM included 7 tests; shoulders flexed and abducted, and the elbows
deep squat, hurdle step (right then left), inline lunge extended. The individual is then instructed to
(right then left), shoulder mobility (right then left), descend slowly into a squat position. The squat posi-
active straight leg raise (right then left), trunk stabili- tion should be assumed with the heels on the floor,
ty push-up, and rotary stability (right then left)(21, 13, 23). head and chest facing forward and the dowel maxi-
The equipment consisted of a 121.9*5.1*15.3 cm mally pressed overhead. The individual may repeat
PVC measurement board with removable dowel the movement up to three times. If the criteria for a
(76.2 cm) inserts, a 121.9cm PVC dowel, and elastic score of III is not achieved, the athlete is then asked
band for the hurdle step movement(21). Clinicians cer- to perform the test with a 2 x 6 board under their
tified to perform FMSTM are taught to demonstrate heels (Figure 3)(5, 12). Scoring criteria has shown in
and evaluate each of the 7 movements. Evaluators Figure 3 according to the classifications(5, 10, 12).
assign 0 if there is any pain during the movement, 1
if the movement cannot be performed, 2 if there is Statistical Analysis
any compensation, and 3 if the movement is per- The data of angular kinematic variables from
formed without pain or compensation. For 3 of the FMSTM deep squat trials were statistically analysed
654 Cigdem Bulgan

using SPSS 18.0 (SPSS Inc., Chicago, IL, USA) pro- although most researchers have investigated to deter-
gram. The results were presented as Means± SD. mine either reliability of the FMSTM testing system(13,
Kruskal-Wallis test were utilized to identify any dif- 19, 20, 21)
or relationships between other performance
ferences between specific groups (group 1, 2 and 3) and health parameters(1, 2, 4, 6, 9, 15).
and MannWhitney-U test was used as a Post Hoc. The ability to perform the deep squat requires
The statistical significance level was set at 0.05. closed-kinetic chain dorsiflexion of the ankles, flex-
ion of the knees and hips, and extension of the tho-
Group 1 (n=4) Group 2 (n=6) Group 3 (n=13)
racic spine, as well as flexion and abduction of the
Mean±Std.D Mean±Std. D Mean±Std. D shoulders(5). Results showed that squat performances
Hip Flexion Angle (Right)
83,46±16,63 62,42±10,10 60,29±8,62 were differed. The significance differences were
(º)
Knee Extension Angle found between group 1 and 2, 3, especially in knee
81,75±20,51 49,32±12,53 49,38±8,81*
(Right) (º)
angles and thigh segments (p<0.05). Findings sug-
Shoulder Angle (Right) (º) 111,26±3,09 112,14±6,88 112,29±6,64
gest that the knee angles create different positions
Hip Flexion Angle (Left) (º) 73,59±20,35 60,69±10,06 60,05±9,14 during examination. The knee joint is the primary
Knee Extension Angle
(Left) (º)
80,71±21,78 50,52±12,49 48,85±9,30* modulator of lower extremity motion during the deep
Shoulder Angle (Left) (º) 117,07±1,61 115,13±8,65 112,94±8,22 squat and has to resolve large joint moments proxi-
Trunk Flexion Angle (º) 32,35±9,98 25,74±7,67 24,54±5,43
mally from the hip and distally from the ankle(3).
Right Calf Angle (Frontal
Since the FMSTM deep squat test is commonly used
30,28±13,31 32,77±7,96 30,14±6,82
Plane) (º) to identify mobility or stability impairments of the
Left Calf Angle (Frontal
29,54±10,79 29,66±6,04 31,25±5,42
Plane) (º) entire kinetic chain(12), the participants who have a
Right Thigh Angle
(Horizantal Plane) (º)
-23,25±11,95 6,02±11,93 8,75±7,97* lower scores, cannot completed proper movements.
Left Thigh Angle
(Horizantal Plane) (º)
-20,74±14,19 7,56±12,08 9,44±8,29* In present study, right knee extension angle was
Hip Segment Angle
0,73±2,27 1,36±1,37 -0,22±2,99
81,75±20,51° for 1; 49,32±12,53° for group 2;
(Frontal Plane) (º)
Dowel Angle (Frontal 49,38±8,81° for group 3 and left knee extension
-1,34±2,72 -1,07±1,46 -0,70±2,48
Plane) (º)
angle was 80,71±21,78° for group 1; 50,52±12,49°
Table1: The Mean and Std.Deviation of Angular for group 2; 48,85±9,30° for group 3. These exten-
Parameters for Deep Squat Test according to sion angles were similar with literature(3, 14). Butler et
Classifications. al., 2010, found peak knee flexion as 84.7±4.3° for
*p<0.05 group 1; 111.0±4.9° for group 2 and 130.7±3.8°.
Krause et al., (2015) was found knee flexion angle as
Results 109,9° after a 3d motion analysis. There were no any
differences found between group 2 and 3 angular
Deep squat angular kinematics for some select- kinematics for all parameters (p>0.05). It is thought
ed joints and segments differed between the classifi- that this was caused by the fact that a platform was
cations. The angles for all evaluated parameters were placed under the feet of the participants. The plat-
shown in Table 1. Hip and knee angle were greater in form may have affected the squat mechanism
score 1 compared to score 2 and 3 for both right and because it would change the dorsiflexion angle of the
left side (Table 1). According to the results the signif- participants. Butler at al., (2010), found significant
icant difference were found at right and left knee difference of the three variables of interest at the
angle between group 1 and 2 (p<0,03; p<0,05 ankle joint was that the peak dorsiflexion excursion
respectively); between group 1 and 3 (p<0,06). Also was greater in group 3 compared to group 1 (p<0.03)
in horizontal plane, right and left thigh were signifi- and they emphasized that there was a large effect
cantly difference between group 1 and 2 (p<0,01); 1 size difference (p<0.04) between group 1 and group
and 3 (p<0,001). There were no significant differ- 3 along with a moderate effect size difference
ences found in other parameters. (p>0,05). (p<0.27) between group 2 and group 3 for peak dor-
siflexion (p<0.10) (3). In this study dorsiflexion
Discussion angle was not examined.
In the present study, there were no any signifi-
This study examined the differences of angular cant differences in hip angular changes (p>0.05).
kinematics of FMSTM deep squat test according to the Similar results found in different studies especially
scoring classifications. Similar to present study there between group 2 and 3(3, 7, 11). In group 1, a greater
were some researches done for deep squat testing(3, 16), range of motions was observed in the lower limb
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