EXAMINING FUNDAMENTAL MOVEMENT COMPETENCY

AND CLOSED-CHAIN UPPER-EXTREMITY DYNAMIC

BALANCE IN SWIMMERS
GARRETT S. BULLOCK,1 NATE BROOKRESON,2 AMY M. KNAB,3 AND ROBERT J. BUTLER4
1
Division of Physical Therapy, Duke University, Durham, North Carolina; 2Strength and Conditioning Program, North
Carolina State University, Raleigh, North Carolina; 3Kinesiology Department, Queens University of Charlotte, Charlotte,
North Carolina; and 4St. Louis Cardinals Baseball Club, St. Louis, Missouri

ABSTRACT dynamic balance differed between competition levels. These

Bullock, GS, Brookreson, N, Knab, AM, and Butler, RJ. data may be helpful in understanding injury and performance-
Examining fundamental movement competency and closed- based normative data for participation and return to swimming.
chain upper-extremity dynamic balance in swimmers. J KEY WORDS Y balance test upper quarter, Functional
Strength Cond Res 31(6): 1544–1551, 2017—Abnormal fun- Movement Screen, return to sport
damental movement patterns and upper-quarter dynamic bal-
ance are proposed mechanisms affecting athletic performance INTRODUCTION

S
and injury risk. There are few studies investigating functional
wimming injuries are prevalent throughout compe-
movement and closed-chain upper-extremity dynamic stability
tition levels (17,23,30). It has been observed that
in swimmers. The purpose of this study was to determine differ- swimming injury frequency can be as high as 1.48
ences in fundamental movement competency and closed-chain injuries per 1,000 athlete exposures (23), with the
upper-extremity dynamic balance, using the Functional Move- majority of these injuries being overuse in nature (23,30),
ment Screen (FMS) and Upper-Quarter Y Balance Test (YBT- stemming from repetitive forceful overhead stroke motions
UQ), of high school (HS; n = 70) and collegiate (COL; n = 70) (21). The majority of swimming injuries occur at the shoul-
swimmers. Variables included the individual movement tests on der (17,23,30), with 45–87% of swimmers experiencing
the FMS and the average normalized reach (percent limb shoulder pain in their careers (15,22,28,34). These injuries
length [%LL]) for each direction, with the YBT-UQ. Statistical and pain may be attributed to joint laxity, range of motion
analysis was completed using a chi square for the independent deficits, and competition level (17). Currently, there is a scar-
test scores on the FMS while independent samples t-test to city of normative data concerning identifying low fundamen-
examine performance on the YBT-UQ (p # 0.05). HS swim- tal movement pattern swimming performers, which can be
mers exhibited a statistically significant greater percentage of
accredited to a greater risk of injury. As a result, examiners
have focused on designing and implementing accessible on-
below average performance (score of 0 or 1) on the following
site tests to discern sport-specific competition-level norma-
FMS tests: lunge (HS: 22.9%, COL: 4.3%), hurdle step (HS:
tive data (6,8).
31.4%, COL: 7.1%), and push-up (HS: 61.4%, COL: 31.4%).
The swimming stroke is an open-chain overhead move-
Furthermore, COL males performed worse in the lunge (male: ment, with the majority of propulsion originating in the
9%, female: 0%), whereas COL females had poorer efficiency upper extremity and trunk (22,25). Although swimming is an
in the push-up (male: 17.6%, female: 44%). Significant effects open-chain activity, previous authors have concluded that
of competition level and sex were observed in YBT-UQ medial open-chain testing only partially examines the full role of
reach (HS: female 92.06, male 101.63; COL: female 101.3, the upper extremity within the sport (29,37). To completely
male 101.5% LL). Individual fundamental movement patterns examine the performance ability of the upper extremity, pre-
that involved lumbopelvic neuromuscular control differed vious research (5,29) has shown the value of closed-chain
between HS and COL swimmers. General upper-extremity tests, specifically the closed kinetic chain upper-extremity
stability test (CKUEST) and the Upper-Quarter Y Balance
Test (YBT-UQ) in baseball and swimming athletes. Incorpo-
Address correspondence to Garrett S. Bullock, garrett.bullock@duke.edu. rating upper-extremity weight bearing through closed-chain
31(6)/1544–1551 testing may be able to help identify dynamic stability (18,29).
Journal of Strength and Conditioning Research One evaluation that examines upper-extremity performance
Ó 2016 National Strength and Conditioning Association through closed kinetic chain testing is the YBT-UQ. The
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Functional Movement Screen

(FMS) (35). The FMS assesses
fundamental movement pat-
terns in 7 basic bodyweight
tasks, involving balance, pro-
prioception, mobility, and sta-
bility. These 7 tests are scored
on an ordinal scale of 0–3,
which can be totaled into
a composite score (9). Previous
authors (12,24) have examined
the injury predictive value of
the composite score, with
a normative cutoff score of
equal to or below 14. Garrison
et al. (12) found that division 1
Figure 1. Sex and competition-level differences in reach on the Upper-Quarter Y Balance Test scores across all and club swimming/diving,
reach directions. *Denotes statistically significant for high school (HS) and collegiate (COL) at p # 0.05. soccer, and rugby athletes were
#Denotes statistically significant between males and females at p # 0.05. 15 times more likely to suffer
an injury if they had a previous
injury and scored below a com-
YBT-UQ is a unilateral upper-quarter procedure, which uses posite score of 14. An injury was defined as modifying train-
3 reach directions: medial (M), inferolateral (IL), and supero- ing or competition for at least 24 hours or requiring bracing
lateral (SL) (13). This test assesses the strength, stability, and or taping. Although a composite score has been shown to be
mobility of the upper quarter (1,13,36). The YBT-UQ has beneficial in injury prediction (12,24), the efficacy of exam-
been determined to be reliable and valid (13,35). However, ining each individual test has been elucidated in previous
to the authors’ knowledge, there are few studies investigating research (19,33). Hotta et al. (19) concluded that although
the YBT-UQ in swimmers. Only one study was found in the FMS composite was not a reliable injury predictor, the
which Butler et al. (5) observed that male swimmers ex- deep squat (DS) and active straight leg raise (ASLR) were
hibited greater upper-extremity dynamic stability compared consistent in predicting injuries in competitive runners. To
with women, after values were normalized. date, there are limited data investigating individual FMS test
Another field-ready test that examines closed kinetic scores and how these individual tests deteriorate and/or are
chain upper-extremity function among other things is the predictive of specific injuries in different sports. As a result,
examining individual move-
ments and specific deficits
within different sports and
competition levels is needed
TABLE 1. Functional Movement Screen and competition level. to understand how to more
Competition level Score 0 Score 1 Score 2 Score 3 effectively train and treat
within different sports and
Deep squat HS 2 29 29 10 competition levels (19,33).
COL 2 17 43 8 As previously reported,
Hurdle step* HS 1 22 47 0
COL 1 4 64 1 competition level is a contribut-
Inline lunge* HS 0 16 50 4 ing factor in swimming injuries
COL 0 3 64 3 (17). Higher competition levels
Shoulder mobility HS 6 10 28 26 have been observed to have
COL 3 7 30 30 greater strength and proprio-
Active straight leg raise HS 0 16 29 25
COL 0 8 33 29 ceptive requirements (6,8,31).
Trunk stability* HS 6 37 23 4 In a study by Sell et al. (31),
Push-up COL 2 20 30 18 higher competition-level golf-
Rotary stability* HS 4 3 63 0 ers displayed greater postural
COL 1 16 52 1 ability during balance tasks.
*Denotes statistically significant at p # 0.05. Other investigations (6,8) have
observed that higher levels of
competition display greater

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 Examining Fundamental Movement Competency

was propositioned because of

previous work associating
TABLE 2. Functional Movement Screen scores based on sex at the high school
competition level. greater strength, balance, and
movement competency of
Sex Score 0 Score 1 Score 2 Score 3 higher level athletes (4,6,8,31).
Deep squat Male 0 18 18 7 METHODS
Female 2 11 11 3
Hurdle step Male 1 13 29 0 Experimental Approach to
Female 0 9 18 0 the Problem
Inline lunge Male 0 9 32 2 A cross-sectional design was
Female 0 7 18 2
used to comprehend upper-
Shoulder mobility Male 4 5 20 14
Female 2 5 8 12 extremity dynamic stability and
Active straight leg raise Male 0 12 21 10 fundamental movement compe-
Female 0 4 8 15 tency, as evaluated by the YBT-
Trunk stability* Male 4 23 14 2 UQ and FMS, at the HS club
Push-up Female 2 14 9 2
swim level and National Colle-
Rotary stability Male 3 0 40 0
Female 1 3 23 1 giate Athletic Association divi-
sion 1 and 2 competition levels.
*Denotes statistically significant at p # 0.05. Competition level was based
solely on participation of the
athletes’ respective swimming
organizations. The YBT-UQ
performance on the Lower-Quarter Y Balance Test. To and FMS were administered through standardized protocols
the authors’ knowledge, there is a paucity of literature (13,24). Data were documented into a centralized database for
investigating competition level–specific YBT-UQ and retrospective analysis through a posttesting review process (8).
FMS performance studies. Furthermore, there is a lack
of literature examining YBT-UQ and FMS normative Subjects
values in swimmers. A total of 70 HS (male: n = 43, age = 17.0 6 1.1 years, limb
The purpose of this study was to research performance length [LL] = 92.6 6 3.5 cm; female: n = 27, age = 16.7 6 0.7
differences on the YBT-UQ and FMS in 2 distinct swimming years, LL = 87.6 6 4.0 cm) and 70 COL (male: n = 34, age =
competition levels, high school (HS) and college (COL). It 20.8 6 1.2 years, LL = 94.6 6 4.4 cm; females: n = 36, age =
was suggested that COL swimmers would exhibit greater 20.5 6 1.2 years, LL = 85.9 6 3.2 cm) male and female
performance on the YBT-UQ and the FMS. This hypothesis swimmers were recruited for this study. Exclusion criteria con-
sisted of current injury, pain
while performing the YBT-LQ
or FMS, or not participating in
TABLE 3. Functional Movement Screen scores based on sex at the college practice or competitions within
competition level. the last month. Subjects were
Sex Score 0 Score 1 Score 2 Score 3 included if they did not report
pain with the assessments and
Deep squat Male 1 6 23 4
were participating in all practi-
Female 1 11 20 4
Hurdle step Male 1 2 30 1 ces, training, and meets within
Female 0 2 34 0 their respective organizations.
Inline lunge* Male 0 3 31 0 After screening, the data were
Female 0 0 33 3
Shoulder mobility Male 2 2 18 12 de-identified. Explanation of
Female 1 5 12 18 the risks and benefits of the
Active straight leg raise Male 0 5 19 10 study was provided, and a writ-
Female 0 3 14 19 ten consent form was obtained
Trunk stability* Male 2 4 17 11
Push-up Female 0 16 13 7 from each high school athlete.
Rotary stability Male 1 7 25 1 Written parental or guardian
Female 0 9 27 0 consent was obtained for sub-
*Denotes statistically significant at p # 0.05. jects under 18 years old. The
institutional review board
approved this investigation.
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Before YBT-UQ assessment,

the examiner instructed the
athletes on proper testing pro-
tocol. Subjects were to main-
tain both feet-shoulder width
apart, in a plank position, with
one hand on the centralized
platform and with the thumb
on the stabilizing hand behind
the red line. Patients were
advised to maintain the follow-
ing criteria during each trial (a)
a 3-point contact (2 feet and
stance hand) was to be main-
tained throughout each test,
(b) momentum was not to be
used (i.e., push) to advance the
Figure 2. Frequency of Functional Movement Screen scores for competition level. *Denotes statistically indicator, (c) to advance the
significant at p # 005.
indicator only on the desig-
nated area, (d) to not gain
stability through pushing on
Procedures the top of the box, reach pole, or the ground with the reach
Upper-Quarter Y Balance Test. Examiners trained in the Y hand during testing, and (e) to maintain control and return
Balance home study course, in the YBT-UQ protocol, back to the starting position after the trial was completed.
completed all upper-quarter dynamic stability testing. All The athlete was informed if these criteria were not met, the
subjects completed the YBT-UQ testing (Functional Move- trial would be deemed unsuccessful and the subject would
ment Systems, Inc., Chatham, VA, USA) without shoes to have to repeat the test. To standardize the protocol, the right
standardize protocol. Each athlete was measured for upper- arm was used first as the stance limb. While maintaining 3-
quarter LL, standing with feet together, with shoulders point plank position, each subject used the most distal
abducted to 908, elbows extended, and wrists in anatomic portion of the opposite hand to advance the reach indicator
neutral position to standardize data collection. A cloth tape in the M, IL, and SL positions (all directions are referenced
was used to measure from the seventh cervical vertebrae to the stance limbs). Each subject completed all 3 reaches
spinous process to the right middle finger. Each subject’s per trial. A total of 2 practice trials and 3 data collection tests
upper-quarter LL was measured twice (5). were accomplished for both limbs (5). Each athlete volition-
ally executed self-determined
rest breaks between trials, as
the test administrator recorded
the data and returned each
indicator to their original posi-
tions (6). The maximum score
for each reach direction was
recorded during a successful
trial where all the aforemen-
tioned criteria were met.

Functional Movement Screen.

Test administrators, trained in
the FMS, conducted the test-
ing protocol. The FMS has
been examined to have good
to excellent interrater reliability
concerning the composite
Figure 3. Frequency of Functional Movement Screen scores for high school swimmers based on sex. *Denotes score (35). A standard FMS
statistically significant at p # 0.05. kit (Functional Movement Sys-
tems, Inc.) was used for this

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 Examining Fundamental Movement Competency

score and each individual FMS

test score. Each athlete was
rated on each individual move-
ment, which was then compiled
to form a composite score, from
0 to 21 (12). Five of the 7 tests
(HS, ILL, SM, ASLR, and RS)
were scored for asymmetries. If
a left-right asymmetry was
observed, the lower score was
calculated for the composite
and overall individual scores
(9). Each individual test score
(0–3) was analyzed separately
and then dichotomized into
low- (a score of 0 or 1) or
high-performance (a score of 2
Figure 4. Frequency of Functional Movement Screen scores of college swimmers based on sex. *Denotes or 3) categories. All variables of
statistically significant at p # 0.05.
interest were then compared
with each competition level (6,8).

procedure. The FMS assesses foundational movement ability Statistical Analyses

and employs 7 tests (9). The 7 standard movement tests A multivariate analysis of variance (gender 3 level) was used
include the DS, hurdle step, inline lunge (ILL), shoulder to analyze the different scores for the YBT-UQ (version 22;
mobility (SM), ASLR, trunk stability push-up (TSPU), and IBM Corp., Raleigh, NC, USA). Three different chi-square
rotary stability (RS). Each movement test is scored on an analyses were run: (a) All FMS individual tests (gender 3
ordinal scale from 0 to 3, with a score of 3 being awarded for level); (b) All FMS tests in HS swimmers (gender 3 score);
movement meeting all testing requirements and does not and (c) All COL swimmers (gender 3 score). All statistical
provoke pain. A score of 2 is given for movement that meets significances were identified at p # 0.05.
the standard but some compensation is observed, with no
RESULTS
pain. A score of 1 is rated for movement that does not meet
testing criteria and does not provoke pain. A score of zero is Upper-Quarter Y Balance Test
given if pain is reported while doing the movement (9,12,33). Significant effects of age and sex were found for upper-
Three clearing tests, scored as positive or negative, are also quarter dynamic stability performance across reach direc-
employed within testing. The 3 clearing tests are associated tions. In the M reach, there was a statistically significant
with the SM, TSPU, and RS (9,26). If pain is provoked difference between groups (HS: 97.95 6 9.02; COL:
during the clearing tests, the tests are deemed positive and 103.17 6 7.73; p # 0.05) (Figure 1). Significant effects of
an automatic score of 0 is given for the SM, TSPU, or RS, gender and competition level were observed for M dynamic
respectively (12). stability (HS: male 101.63 6 7.45, female 92.06 6 8.23; COL:
male 105.15 6 7.89, female 101.30 6 7.19). In contrast, only
Primary Variables for Upper-Quarter Y Balance Test. The competition level showed significant differences in dynamic
primary variables of interest for the YBT-UQ were the stability IL reach (HS: 97.76 6 13.72; COL: 99.46 6 13.97;
maximum normalized reach scores in all 3 reach directions: p # 0.05). A sex (male: 78.86 6 9.73; female: 75.46 6 9.24;
YBT-UQ asymmetry and YBT-UQ composite score. Each p # 0.05) and competition-level effect (HS: 75.28 6 1.16;
subject’s maximum reach score was normalized to each ath- COL: 78.95 6 1.13) was found for the SL reach direction.
lete’s LL. The left and right arm normalized scores were There was no statistical difference in reach asymmetries
then calculated for each direction. An YBT-UQ composite between gender or competition levels.
score was determined by averaging the normalized maxi- Functional Movement Screen
mum reach directions across all 3 reaches and then multi- HS and COL swimmers presented with varying perfor-
plied by 100. The absolute values for the left and right mance during fundamental movement patterns. There were
maximum reaches, for each direction, were also computed no differences found between COL and HS swimmers for
for reach asymmetry (5). FMS composite score (COL: 13.9 6 1.9; HS: 12.6 6 2.6).
COL swimmers displayed greater fundamental movement
Primary Variables for Functional Movement Screen. Primary proficiency during the hurdle step (p , 0.01), ILL (p ,
variables of interest for the FMS included total composite 0.01), and TSPU (p , 0.01). HS athletes presented with
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more proficient movement competence in RS (p , 0.01) school counterparts (6,8,31). The YBT-UQ protocol pro-
(Table 1). There were no differences in the SM, ASLR, or vides insight into the strength and neuromuscular require-
DS. Pain was elicited in certain FMS tests, with SM display- ments of the 3 reach directions. The athlete advances about
ing the highest frequency of pain (HS: 8.6%; COL: 4.3%; the closed-chain stance limb while the contralateral arm
total: 6.4%), followed by TSPU (HS: 8.6%; COL: 2.9%; total: reaches (36). As a result, each of the 3 reach directions
5.7%). Rotary stability (HS: 5.7%; COL: 1.7%; total: 4.3%), offers a specific neuromuscular requirement. The M reach
DS (HS: 2.9%; COL: 2.9%; total: 2.9%), and hurdle step (HS: may represent a challenge to general upper-quarter stabil-
1.4%; COL: 1.4%; total: 1.4%) tests also produced pain. No ity; the IL tests scapular upward rotation, and the SL re-
other FMS tests provoked pain. quires eccentric external rotation control and scapular
Fundamental movement competency differences were depression. COL swimmers have a greater propensity for
also observed between genders. No composite score differ- sport-specific adaptation (6,8,10) because of increased total
ences were found between COL males and females (males: swimming volume (16) and shoulder adduction being the
13.8 6 2; females: 14.0 6 1.8), nor between HS males and primary movement responsible for propulsion (2). These
females (males: 12.5 6 2.5; females: 12.9 6 2.9). HS fe- adaptations may cause a muscle imbalance between the
males exhibited higher FMS scores in the ASLR compared anterior and posterior shoulder musculature to develop
with HS males (p # 0.05). COL females demonstrated (16), with swimmers exhibiting decreased external rotation
better performance on the ILL (p # 0.05) in contrast to strength. In our study, the M and IL reaches may have been
COL males. However, COL males performed better in the able to stratify high-level performers because of the
TSPU in comparison with COL females (p # 0.05) (Tables enhanced neuromuscular control in general stability and
2 and 3). The frequencies of FMS scores (competition level scapular upward rotation required. Whereas the SL reach
and by sex) are depicted in Figures 2–4. There was no is able to illuminate different shoulder-specific performance
effect of gender on all other fundamental movement com- standards not seen in the M or IL conditions because of the
petency tests. SL’s decreased core contribution.
COL athletes displayed statistically significant aptitude
DISCUSSION in the hurdle step, ILL, and TSPU assessments compared
Closed-chain upper-extremity performance and fundamen- with HS swimmers. The ILL and HS are considered
tal movement component testing are integral to identify functional movement patterns that require higher level
optimal training practices for individual athletes (35,36). qualities of mobility and stability within the lumbopelvic-
The purpose of this study was to investigate upper- hip complex and lower extremities, whereas the TSPU
quarter dynamic stability and fundamental movement com- requires high-threshold stabilization and is considered
petency in swimmers of various competitive levels. It was a transitional movement pattern (9). In previous studies
anticipated that COL swimmers would display greater nor- (3,27), the COL athletes displayed greater fundamental
mative scores over HS swimmers on the YBT-UQ and movement proficiency in the hurdle step and the TSPU
FMS. This hypothesis was propositioned because of pre- compared with HS athletes. COL swimmers may possess
vious work associating greater strength, balance, and move- greater inter- and intramuscular coordination, core
ment competency with higher level athletes (4,6,8,31). strength, and stability compared with the HS cohort
Supporting the hypothesis, COL swimmers displayed (4,6,8,31). However, perhaps because of poorly managed
greater aptitude in the M and IL reach in the YBT-UQ stress from increased training demands at the collegiate
and the hurdle step, ILL, and TSPU in the FMS. Addition- level (32) or inefficient stabilization patterning (proximal
ally, male swimmers demonstrated superior performance in to distal) (14), the COL group displayed inferior stability
the M and SL reach over their female counterparts. Con- as manifested in the RS assessment. The RS screen is an
trary to the hypothesis, inferior performance was noted on assessment of submaximal stabilization, which is consid-
the SL reach for COL swimmers compared with HS and ered a transitional movement pattern (9). The HS cohort
for the RS assessment in the FMS. displayed superior performance in this portion of the FMS
COL swimmers exhibited greater proficiency in the screen, which perhaps suggests the need for the COL
YBT-UQ in the M and IL conditions compared with HS group to prioritize the pursuit of fundamental stability in
athletes, whereas COL athletes demonstrated decreased SL the training regimen (9). However, this is simply an
reach values. This is in contrast to a study by Garrigues assumption because actual training data for the groups
et al. (11), which observed that HS and COL baseball play- were not collected for this study.
ers displayed similar upper-extremity dynamic balance. Male swimmers, compared with females, demonstrated
The YBT-UQ challenges the core and upper-quarter greater upper-quarter dynamic stability in all directions but
strength, stability, and mobility required to be successful the IL reach, similar to previous studies (5,35). However, in
in swimming (1,36). Therefore, it can be inferred that the a study by Gorman et al. (13), there was no statistical differ-
more advanced COL population possesses these dynamic ence between genders in testing upper-quarter dynamic sta-
balance characteristics at a greater degree than their high bility in active adults. Research by Westrick et al. (36) found

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 Examining Fundamental Movement Competency

that there was a statistically significant relationship between PRACTICAL APPLICATIONS

performance in the YBT-UQ and dynamic tests involving Upper-extremity closed-chain performance is vital for the
core stability and upper-extremity performance. Teyhen success of a swimming athlete (5). Additionally, functional
et al. (35) observed that males displayed better performance movement screening has been shown to be a reliable
on the YBT-UQ and trunk stability tests compared with method to determine injury risk (24,35). Previous studies
females. To further explore gender differences in trunk sta- have suggested that different competition levels warrant
bility, the FMS TSPU test was also used. The FMS TSPU altered dynamic balance movement strategies (4,5,8,11)
test is more associated with lumbopelvic stability and neu- and fundamental movement proficiency (3,27). The results
romuscular control (9). The female athletes’ poorer TSPU of this study support previous research (4,7,8) that demon-
scores in our study may explain the gender differences strates how increased competition level can lead to greater
observed within the upper-extremity dynamic stability proficiency in upper-quarter dynamic stability. However, the
scores. The FMS TSPU test is more associated with lumbo- SL reach condition was inferior for COL swimmers com-
pelvic stability and neuromuscular control (9). Future inves- pared with HS because of its sensitivity to more shoulder-
tigators should examine gender differences in the YBT-UQ specific performance (4). Furthermore, the HS group
and whether they are associated with increased injury risk or displayed superior performance in the RS assessments of
weakness between genders. the FMS compared with COL swimmers. Based on these
As with all studies, there are limitations. The primary findings, all swimmers are not average and there is a benefit
limitations within this investigation involved the lack of to screening and individualizing training programs. As
heterogeneity in the cohorts. Participants from a few small a result, swimmers of all competition levels need to be pro-
clubs and programs were recruited for this study. Although vided high-level strength and conditioning services that
we believe that this cohort is representative of the larger include movement assessments such as the YBT Upper-
swimming populations, future inquiries should involve and Lower-Quarter protocols and the FMS. Following these
a greater variability and range of subjects to further screens, intervention processes are planned to strengthen the
illuminate normative data. Furthermore, we did not detail perceived weaknesses through a targeted training process,
height and weight of the athletes. Although arm length can including corrective exercises specifically for the identified
be used as proximity for height (20), without the exact limitations (9).
height and weight data, the full subject population descrip-
tion is absent. This study also did not investigate swimming ACKNOWLEDGMENTS
event performance or stroke preference in subject selection. The authors would like to thank the Duke Doctor of
Understanding swimming skill, beyond competition level, Physical Therapy students, Jason Shutt, Freddie Nordhoff
may have allowed for further deciphering the effect swim- and Dr. Scott Greenapple for assisting in the data collection.
ming skill played on fundamental movement and upper-
quarter dynamic stability performance. Finally, because this
was a retrospective study, participants’ past injury and REFERENCES
training strategies may have affected the data. Disparities 1. Aspenes, ST and Karlsen, T. Exercise-training intervention studies in
in subject history may clarify some of the differences in competitive swimming. Sports Med 42: 527–543, 2012.
fundamental movement pattern proficiency and upper- 2. Bak, K and Magnusson, SP. Shoulder strength and range of motion
quarter dynamic stability (5,24). in symptomatic and pain-free elite swimmers. Am J Sports Med 25:
454–459, 1997.
In summary, COL swimmers displayed altered neuromus-
3. Bardenett, SM, Micca, JJ, Denoyelles, JT, Miller, SD, Jenk, DT, and
cular strategies in the M and IL conditions of the YBT-UQ Brfooks, GS. Functional movement screen normative values and
and more efficient functional movement strategies in the validity in high school athletes: Can the FMS be used as a predictor
ILL, HS, and TSPU assessments of the FMS. Intriguingly, on injury? Int J Sports Phys Ther 10: 303–308, 2015.
HS swimmers performed better in the SL reach in the YBT- 4. Bullock, GS, Arnold, TW, Plisky, PJ, and Butler, RJ. Basketball
players’ dynamic performance across competition levels. J Strength
UQ, which may reveal more shoulder-specific compensa- Cond Res 2016. [Epub ahead of print.]
tion, and on the RS, perhaps because of the increased 5. Butler, R, Arms, J, Reiman, M, Plisky, P, Kiesel, K, Taylor, D, and
submaximal stabilization qualities. Creating normative values Queen, R. Sex differences in dynamic closed kinetic chain upper
between different levels of swimmers in the YBT-UQ and quarter function in collegiate swimmers. J Athl Train 49: 442–
446, 2014.
FMS allows clinicians to identify below standard performers
who could benefit from additional and specific training. As 6. Butler, RJ, Bullock, GS, Arnold, T, Plisky, PJ, and Queen, R.
Competition level differences on the lower quarter Y balance test in
the athlete progressed from HS to COL, it could provide baseball players. ACSM’s 62nd Annual Meeting, 6th World
normative data to track and assess progress in closed-chain Congress on Exercise is Medicine and World Congress on the Basic
upper-extremity function and functional movement pro- Science of Exercise Fatigue. May 29, 2015. San Diego, CA.
ficiency. Future research is necessary to see if there is 7. Butler, RJ, Myers, HS, Black, D, Kiesel, KB, Plisky, PJ, Moorman, CT
III, and Queen, RM. Bilateral differences in the upper quarter
a relationship between the differences in HS and COL function of high school aged baseball and softball players. Int J Sports
cohorts in YBT-UQ and FMS performance and injury risk. Phys Ther 9: 518–524, 2014.
the TM

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8. Butler, RJ, Southers, C, Gorman, PP, Kiesel, KB, and Plisky, PJ. 23. Kerr, ZY, Baugh, CM, Hibberd, EE, Snook, EM, Hayden, R, and
Differences in soccer players’ dynamic balance across levels of Dompier, TP. Epidemiology of National Collegiate Athletic
competition. J Athl Train 47: 616–620, 2012. Association men’s and women’s swimming and diving injuries from
9. Cook, G, Burton, L, Hoogenboom, BJ, and Voight, M. Functional 2009/2010 to 2013/2014. Br J Sports Med 49: 465–471, 2015.
movement screening: The use of fundamental movements as an 24. Kiesel, K, Plisky, PJ, and Voight, ML. Can serious injury in
assessment of function—Part 1. Int J Sports Phys Ther 9: 396–409, 2014. professional football be predicted by a preseason functional
10. Feeley, BT, Agel, J, and LaPrade, RF. When is it too early for single movement screen? N Am J Sports Phys Ther 2: 147–158, 2007.
sport specialization? Am J Sports Med 44: 234–241, 2016. 25. McCabe, CB, Sanders, RH, and Psycharakis, SG. Upper limb
11. Garrigues, G, Gorman, PP, Plisky, PJ, Kiesel, Myers, KBH, Black, D, kinematic differences between breathing and non-breathing
Queen, RM, and Butler, RJ. Differences on the upper quarter Y conditions in frontcrawl sprint swimming. J Biomech 48: 3995–
balance test between high school and college baseball players. 4001, 2015.
American College of Sports Medicine Annual Meeting. San 26. Minick, KI, Kiesel, KB, Burton, L, Taylor, A, Plisky, P, and Butler, RJ.
Francisco, CA; May 29–June 2, 2012. Interrater reliability of the functional movement screen. J Strength
12. Garrison, M, Westrick, R, Johnson, MR, Benenson, J. Association Cond Res 24: 479–486, 2010.
between the functional movement screen and injury development in 27. Mokha, M, Sprague, PA, and Gatens, DR. Predicting musculoskeletal
college athletes. Int J Sports Phys Ther 10: 21–28, 2015. injury in national collegiate athletic association division II athletes
13. Gorman, PP, Butler, RJ, Plisky, PJ, Kiesel, KB. Upper Quarter Y from asymmetries and individual-test versus composite functional
Balance Test: Reliability, and performance comparison between movement screen scores. J Athl Train 51: 276–282, 2016.
gender in active adults. J Strength Cond Res 26: 3043–3048, 2012. 28. Pink, MM and Tibone, JE. The painful shoulder in the swimming
14. Gribble, PA, Robinson, RH, Hertel, J, and Denegar, CR. The effects athlete. Orthop Clin North Am 31: 247–261, 2000.
of gender and fatigue on dynamic postural control. J Sports Rehabil 29. Roush, JR, Kitamura, J, Waits, MC. Reference values for the closed
18: 240–257, 2009. kinetic chain upper extremity stability test (CKCUEST) for
15. Hibberd, EE and Myers, JB. Practice habits and attitudes and collegiate baseball players. N Am J Sports Phys Ther 2: 159–163, 2007.
behaviors concerning shoulder pain in high school competitive club 30. Schroeder, AN, Comstock, RD, Collins, CL, Everhart, J,
swimmers. Clinic J Sports Med 23: 450–455, 2013. FLanigan, D, and Best, TM. Epidemiology of overuse injuries
16. Hibberd, EE, Oyama, S, Spang, JT, Prentice, W, and Myers, JB. among high-school athletes in the United States. J Pediatr 166:
Effect of a 6-week strengthening program on shoulder and scapular- 600–606, 2015.
stabilizer strength and scapular kinematics in division I collegiate 31. Sell, TC, Tsai, YS, Smoliga, JM, Myers, JB, and Lephart, SM.
swimmers. J Sport Rehabil 21: 253–265, 2012. Strength, flexibility, and balance characteristics of highly proficient
17. Hill, L, Collins, M, and Posthumus, M. Risk factors for shoulder pain golfers. J Strength Cond Res 21: 1166–1171, 2007.
and injury in swimmers: A critical systematic review. Phys Sportsmed 32. Sheldon, KM and Watson, A. Coach’s autonomy support is
43: 412–420, 2015. especially important for varsity compared to club and recreational
18. Hirashima, M, Kadota, H, Sakurai, S, Kudo, K, and Ohtsuki, T. athletes. Int J Sports Sci Coach 6: 109–123, 2011.
Sequential muscle activity and its functional role in the upper 33. Sprague, PA, Mokha, GM, and Gatens, DR. Changes in functional
extremity and trunk during overarm throwing. J Sports Sci 20: 301– movement screen scores over a season in collegiate soccer and
310, 2002. volleyball athletes. J Strength Cond Res 28: 3155–3163, 2014.
19. Hotta, T, Nishiguchi, S, Fukutani, N, Tashiro, Y, Adachi, D, Morino, 34. Stocker, D, Pink, M, and Jobe, FW. Comparison of shoulder injury in
S, Shirooka, H, Nozaki, Y, Hirata, H, Yamaguchi, M, and Aoyama, collegiate- and master’s-level swimmers. Clin J Sport Med 5: 4–8, 1995.
T. Functional movement screen for predicting running injuries in 18- 35. Teyhen, DS, Shaffer, SW, Lorenson, CL, Greenberg, MD, Rogers,
to 24-year-old competitive male runners. J Strength Cond Res 29: SM, Koreerat, CM, VIllena, SL, Zosel, KL, Walker, MJ, and Childs,
2808–2815, 2015. JC. Clinical measures associated with dynamic balance and
20. Jarzem, PF and Gledhill, RB. Predicting height from arm functional movement. J Strength Cond Res 28: 1272–1283, 2014.
measurements. J Pediatr Orthop 13: 761–765, 1993. 36. Westrick, RB, Miller, JM, Carow, SD, Gerber, JP. Exploration of the
21. Jobe, FW, Kvitne, RS, and Giangarra, CE. Shoulder pain in the Y-Balance test for assessment of upper quarter closed kinetic chain
overhand or throwing athlete. The relationship of anterior instability performance. Int J Sports Phys Ther 7: 139–147, 2012.
and rotator cuff impingement. Orthop Rev 18: 963–975, 1989. 37. Wilk, KE, Arrigo, CA, and Andrews, JR. Closed and open kinetic
22. Johnson, D. In swimming, shoulder the burden. Sportcare Fitness 1: chain exercise for the upper extremity. J Sport Rehabil 5: 88–102,
24–30, 1988. 1996.

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