Pilates, the Functional Movement Screen and Runners

The Functional Movement Screen is something I have commented on a couple of times (here and here), so when a new study on using it in runners turned up I went to look. Initially, I was not going to write about it as writing time is very limited these days and probably should spend that time writing about stuff that is more important. I have had the study open in the browser for most of the day while I do other work. In the end, I thought the study does give an opportunity for a ‘teachable moment’.

Here is the study:

The Effect of Clinical Pilates on Functional Movement in Recreational Runners
Anna Laws, Shaun Williams, Cassie Wilson
Int J Sports Med; in press
Biomechanical imbalances and inefficient functional movements are considered contributing factors to running-related injuries. Clinical Pilates uses a series of exercises focused on retraining normal movement patterns. This study investigated whether a 6-week course of Clinical Pilates improves functional movement and thereby, potentially, reduces the risk of running-related injuries associated with movement dysfunction. A modified functional movement screen was used to analyze the functional movement ability of forty runners. Forty participants completed a 6-week course of Clinical Pilates delivered by a Clinical Pilates instructor. The movement screen was carried out 3 times for each runner: 6 weeks pre-intervention (baseline), within one week pre-intervention (pre) and within one week post-intervention (post). Repeated-measures analysis of variance and post-hoc tests found significant increases in scores between baseline and post (mean±SD; 13.4±2.4 vs. 17.0±1.7, p<0.01) and pre and post (mean±SD; 13.5±2.5 vs. 17.0±1.7, p<0.01), but no significant difference between baseline and pre (p=0.3). A 6-week course of Clinical Pilates significantly improves functional movement in recreational runners, and this may lead to a reduction in the risk of running-related injuries.

I won’t relitigate the issues with the Functional Movement screen, as been there done that: see some of the links to critiques I posted here.

I will start with the conclusion made by the authors:

The purpose of this study was to examine the effects of Clinical Pilates on functional movement in uninjured recreational runners. Results show that a 6-week course of Clinical Pilates significantly improves functional movement in recreational runners and potentially reduces the risk of RRI associated with movement dysfunction

The question then is, did they actually show that and can the results be extrapolated to reduce the risk for a running injury? The answer is ‘no’ and ‘no’:

  • Firstly, there was no control group, which is something that the authors did not even reiterate in their discussion of the study. This is a major limitation to the strength of the results they reported. The editor and peer reviewers should have picked up on that. Without a proper control group, we have no idea if the ‘Clinical Pilates’ was the reason for the improvement in the Functional Movement Screen version that they used. I can think of any number of reasons as to why they improved in that score that may be totally unrelated to pilates. It is likely that it was the Pilates that led to the improvement, but without the control group to rule out the other reasons, the strength of the claims made by the authors that the Pilates was the reason is not very well supported. There is nothing wrong with studies without control groups, it is just you can not rule out other reasons for changes, so their usefulness or strength of the results is always going to be limited.
  • Secondly, the authors did comment on several studies that have shown how the Functional Movement Screen is predictive of injury, but none of the studies they reviewed were actually on runners; they were on “athletes” (though there would probably be some runners mixed in with the other athletes). Oddly, they failed to mention the study by Hotta et al which found that the overall Functional Movement Screen was not associated with injury in runners. Given the nature of the study and the findings the above authors got and the claims that they made re ‘potentially reduces the risk of RRI“, don’t you think it might have been important that the authors include this paper to include a study on the Functional Movement Screen and running injury in their literature review and discussion? The peer reviewers should have picked up on that and required some acknowledgment of that study.
  • Thirdly (really an expanded ‘Secondly’), is the unpublished study (a PhD thesis) by Padilla which appeared to show that while a higher score in the Functional Movement Screen is, in general, associated with less injuries in athletes, a higher score in runners was actually predictive of getting an injury. The contradicts the claims of the above authors of ‘potentially reduces the risk of RRI associated with movement dysfunction‘. Sadly the work by Padilla is only available in abstract form (so can’t review all their methodology) and has not (yet) been published in a peer reviewed journal, so we have to attribute not a lot of weight to it, but given the lack of the control group above, it does provide some impetus to not give the claims in the above study much weight (also bearing in mind that the above study was not on injuries).

Please do not get me wrong; Pilates may be useful for runners. The problem is the lack of the control group weakens the strengths of the claims and the two studies that I mentioned on actual injuries do not support the authors claims that the increase in their version of the Functional Movement Screen has the potential to reduce running injury risk.

As always, I go where the evidence takes me until convinced otherwise …. and this study is a good teachable moment about the strengths of claims that get made when you have no control group and miss key references in the discussion.

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