Walk into any physical therapy clinic complaining about your shoulder, and the first thing they’ll ask is: “On a scale of 1-10, how much does it hurt?” But here’s what I’ve learned after thousands of movement assessments: pain and limitation aren’t the same thing, and confusing them leads to completely different treatment paths.
The Functional Movement Screen (FMS) cuts through this confusion with a simple but profound distinction: Are you limited by pain, or are you limited by movement quality? The answer determines whether you need medical intervention or movement education—and getting this wrong keeps people stuck in cycles of temporary fixes instead of lasting solutions.
The Pain vs. Movement Quality Plot Twist
Picture this: Two people walk into my clinic, both complaining they can’t reach overhead without discomfort. Person A winces and stops halfway up due to sharp pain. Person B can reach all the way up but their shoulder blade wings out, their back arches excessively, and their opposite hip shifts.
Traditional assessment focuses on Person A—the one in obvious pain. But Person B’s compensation patterns are setting them up for future injury, reduced performance, and chronic issues that won’t show up for months or years.
The FMS reveals this difference immediately. Person A has a pain problem that needs medical attention. Person B has a movement problem that needs corrective exercise. Same complaint, completely different solutions.
What the FMS Actually Tests (And Why It's Brilliant)
The Functional Movement Screen isn’t about testing your flexibility or strength—it’s about testing your movement software. Seven simple movements reveal whether your body’s movement patterns are clean or corrupted:
- Deep Squat – Can you sit down without falling over or compensating?
- Hurdle Step – Can you step over an obstacle without your whole body shifting?
- In-Line Lunge – Can you lunge without wobbling or tilting?
- Shoulder Mobility – Can you reach behind your back from both directions?
- Active Straight Leg Raise – Can you lift your leg without your back arching?
- Trunk Stability Push-Up – Can you maintain a plank while moving?
- Rotary Stability – Can you crawl without your hips swaying?
Each movement gets scored 0-3, but here’s the key: if any movement causes pain, it automatically gets a zero and a red flag. Pain trumps everything because pain changes how you move, and moving differently creates new problems.
The Red Flag vs. Movement Flag Distinction
Red Flag (Pain Present):**
- Sharp, shooting, or burning sensations
- Pain that increases with movement
- Pain that doesn’t improve with position changes
- Asymmetrical pain patterns
This needs medical evaluation before any exercise prescription.
Movement Flag (No Pain, Poor Quality):
- Compensations and workarounds
- Asymmetrical movement patterns
- Loss of stability or control
- Limited range without pain
This needs movement re-education, not medical intervention.
Why This Distinction Changes Everything
When you confuse movement limitations with pain problems, you end up with:
Over-medicalization of movement issues: Getting X-rays, MRIs, and injections for problems that need movement practice, not medical treatment.
Under-addressing of pain issues: Trying to “stretch through” or “strengthen around” actual tissue problems that need healing.
Chronic compensation cycles: Treating symptoms (tight hip flexors) instead of causes (poor core stability).
Frustrating plateaus: Wondering why your flexibility isn’t improving when your real limitation is motor control, not tissue length.
The Assessment That Changed My Practice
I used to spend sessions trying to stretch people’s tight muscles and strengthen their weak ones. But the FMS taught me to ask a different question: “Is this limitation coming from the tissues, or from the nervous system’s control of those tissues?”
A tight hamstring that won’t stretch might not be a tight hamstring—it might be a nervous system that won’t let that hamstring relax because something else isn’t doing its job. A “weak” glute might not be weak—it might be neurologically inhibited by an overactive hip flexor.
The FMS reveals these patterns in minutes, not months.
What Your Score Actually Means
Score of 3: Clean movement pattern, no compensation, full range of motion. Keep doing what you’re doing.
Score of 2: Movement accomplished but with compensation patterns. You can do it, but you’re working around limitations that will eventually become problems.
Score of 1: Movement barely accomplished with major compensations. You’re one stress away from an injury.
Score of 0: Pain present or unable to perform the movement. Medical evaluation recommended before exercise.
The magic number is 14 out of 21. Below that, you’re at higher injury risk and should prioritize movement quality over performance.
The Real-World Application
Here’s how this plays out practically:
If you score 0 on any movement: Address the pain first. See a healthcare provider, reduce inflammation, allow healing. Movement quality work comes after pain resolution.
If you score 1s and 2s without pain: This is your goldmine. These are the movement patterns that need attention before they become pain patterns. A few weeks of targeted corrective exercise can prevent months of injury and rehabilitation.
If you score mostly 3s: You have good movement competency. Focus on strength, power, and skill development.
Beyond the Numbers
The real value of the FMS isn’t the score—it’s the conversation it starts about movement quality. It shifts focus from “What hurts?” to “How do you move?” and from “What exercises should I do?” to “What movement patterns need attention?”
Most importantly, it distinguishes between problems that need medical intervention and problems that need movement education. This alone can save you months of ineffective treatment and thousands of dollars in unnecessary procedures.
Your body is constantly sending you feedback through movement quality. The FMS just gives you a way to listen.
Stay Nimble and Stress Less Action
This week, assess your own movement quality with this simple self-screen:
- Overhead reach test: Can you reach both arms straight up without arching your back?
- Single leg balance: Can you stand on one foot for 30 seconds without wobbling?
- Deep squat hold: Can you sit in a squat for 30 seconds without lifting your heels or falling backward?
If any movement causes pain—stop and consider professional evaluation. If movements feel difficult but don’t hurt, you’ve identified areas for improvement.
Note: Difficulty without pain = movement opportunity. Pain = red flag for professional assessment.
The goal isn’t perfection—it’s awareness of your movement patterns before they become pain patterns.