FREE Functional Movement Questionnaire Report

Free Functional Movement Questionnaire (FMQ) Report

HOW TO COMPLETE THE QUESTIONAIRE: Please read the question and then check the answer that BEST represents your ability to perform each movement.

IMPORTANT WARNING: If you have any question as to your ability to complete these movements safely or feel they are risky DO NOT perform the movement. Just score yourself appropriately. If you feel you need support, as in the use of a wall, chair, cane or other support device for balance feel free to use them and score yourself appropriately.

IMPORTANT UNDERSTANDING: Your answers are being used to create your personalized exercise prescription. For your safety it is important to be honest. Be sure you that you either FULLY meet the criteria for your answers or score yourself lower. It is important to score yourself "strictly" and give yourself a lower score rather than higher if you are not sure you fully meet the functionality of the higher score. For your own safety it is better to score lower and receive exercises that you are fully capable of then to score high and find out the exercises prescribed are difficult or not possible for you to do.

PAIN WITH MOVEMENT: You should NOT feel pain with movement. You might feel tightness, pulling, or dull ache, but do not use any of these feelings a marker of pain - you should be looking for the OUCH. If you feel pain with any of these motions score yourself appropriately and consult your primary care provider or physical therapist.

Remember to chose the answer that BEST matches your movement ability and it is better to error on the side of scoring lower rather than scoring higher. Be tough with your scoring.

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0 - I have PAIN doing this movement1 - I need to heavily assist myself with my arms and/or lean far forward to do this or I am not confident attempting this movement2 - I need to lean slightly and/or use my arms slightly to complete this movement3 - I can complete this movement without leaning forward or using assistance

0- I have PAIN doing this movement1 - I must support myself using the wall, cane, chair, table etc. or I am not confident attempting this movement2- I don’t need to support myself, but I wobble or lean in one direction3 - I can stay upright, tall and steady and could keep my balance for over 30 seconds

0 - I have PAIN doing this movement1 - I must support myself using the wall, cane, chair, table etc. or I am not confident attempting this movement2- I don’t need to support myself, but I wobble or lean in one direction3 - I can stay upright, tall and steady and could keep my balance for over 30 seconds

0 - I have pain getting into this position and doing this movement1 - I’m not able to get all the way down onto one knee without assistance, I do not keep my chest upright, or I am not confident attempting this movement2 - I can get onto one knee with my chest upright if I used something to keep balanced3 - I can get down on one knee with chest upright and can stand back up

0 -I have pain getting into this position and doing this movement1 - I’m not able to get all the way down onto one knee without assistance, I do not keep my chest upright, or I am not confident attempting this movement2 - I can get onto one knee with my chest upright if I used something to keep balanced3 - I can get down on one knee with chest upright and can stand back up

0 - I have PAIN with this movement1 - I cannot reach between my shoulder blades2 - I am able to reach between my shoulder blades and come within 3-5 inches of touching my hands together3 - I am able to or I can come within 1-2 inches of touching my hands together

0 - I have PAIN with this movement1 - I cannot reach between my shoulder blades2 - I am able to reach between my shoulder blades and come within 3-5 inches of touching my hands together3 - I am able to or I can come within 1-2 inches of touching my hands together

0 - I have PAIN with this movement1 - I cannot lift my leg more than a foot or so off the ground without bending my knee or I am not confident in attempting this movement2 - I can lift my leg almost vertical or almost vertical before my knee bends3 - I can keep my leg straight and achieve a vertical position with it above my hip

0 - I have PAIN with this movement1 - I cannot lift my leg more than a foot or so off the ground without bending my knee or I am not confident in attempting this movement2 - I can lift my leg almost vertical or almost vertical before my knee bends3 - I can keep my leg straight and achieve a vertical position with it above my hip

0 - I have PAIN with this movement1 - I am not able to lift my body off the ground or I am not confident attempting this movement2 - I can only push myself off the ground if I allow my upper body to come off the ground before my lower body or vis versa. I can push up but NOT in a strict, tight plank position3 - I can push my whole body off the floor using one strict, tight plank position

Put your LEFT hand on your RIGHT shoulder. Keep your hand there and slowly raise your elbow as high as possible. Was there any PAIN with this movement?

Put your RIGHT hand on your LEFT shoulder. Keep your hand there and slowly raise your elbow as high as possible. Was there any PAIN with this movement?

Assume what is referred to as Child's Pose. Sit on your shins and curl your upper body forward bringing you head to the ground. Was there any PAIN with this movement?

Assume what is referred to as Cobra Pose. Lie on the ground face down and then while keeping your legs and hips on the ground press your upper body upward. Was there any PAIN with this movement?