The Coach Wants a Starting Lineup Ranked by FMS
A high school soccer coach asks you to screen 22 varsity players during the first week of preseason and rank them by FMS score to help select the starting XI. You agree to screen but explain the limits of the tool. One player, a 17-year-old central midfielder, scores 15/21. His lowest item is left shoulder mobility, recorded 0 because the shoulder-clearing test reproduced sharp anterior shoulder pain at end range; the right side scores 3. He has no current complaint and played 90 minutes in the previous match. The screen is performed before any team training. The coach sees the 15 and says, 'He's in the top half, so he's fine; ignore that shoulder thing.' There is no physician on site, and the athlete's parents are present.
1. How should you answer the coach's request to rank and select players using the FMS total score?
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FMS is a screening tool, not a performance test or a ranking system. The total score was never designed to select a starting lineup, predict performance, or predict injury in an individual. The appropriate response is to decline the ranking use while offering a legitimate alternative: screen each athlete to identify painful or asymmetrical patterns, then use the results for individualized movement preparation and referral. Explain that a higher total does not mean an athlete is 'safer' or more ready, and a lower total does not bench an athlete. If the coach needs selection information, use sport-specific performance data and medical clearance, not the FMS total. Document that the screen was not used for selection.
2. Explain how the 15/21 total and the left shoulder score of 0 should be interpreted.
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The 15/21 is a sum of seven test scores, but the left shoulder score of 0 dominates the interpretation. A score of 0 is recorded whenever the clearing test reproduces pain, regardless of the distance measured. The 15 therefore does not mean 'top half and fine'; it contains a pain flag that requires follow-up. The shoulder-clearing test is a provocation test, and sharp anterior pain at end range is not a normal finding to ignore. The correct interpretation is: left shoulder mobility = 0 due to pain; right = 3; total = 15 with a pain flag. Do not reinterpret the 0 as a mobility score or average it away.
3. State your immediate actions and what you would document and communicate.
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Stop the shoulder mobility testing on that side, do not attempt to stretch or 'test through' the pain, and refer the athlete for appropriate medical assessment. Inform the parents and coach in plain language: the screen found pain, not a diagnosis, and the athlete should be evaluated before being loaded overhead or cleared for full participation. Document the exact test, side, pain location, and response; note that no diagnosis was made. Re-screen only after the athlete is pain-free and medically cleared. Do not tell the coach the athlete is 'fine' because of the total score, and do not give a return-to-play timeline.