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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1. Squat - Rate your ability to get in and out of a seat that is quite low (slightly lower than height of your knee) without using your arms, leaning far forward or rocking.

2. Single Leg Stance on LEFT leg - Rate your ability to stand “straight, tall and steady” on one leg while lifting the opposite foot off the floor at least one foot for 20 sec – Stand on LEFT leg, right knee lifted to hip height.

3. Single Leg Stance on RIGHT leg - Rate your ability to stand “straight, tall and steady” on one leg while lifting the opposite foot off the floor at least one foot for 20 sec – Stand on RIGHT leg, left knee lifted to hip height.

4. Lunge (RIGHT leg forward) - Rate your ability to “take a knee” onto the floor from a standing position (keep your chest and head upright and kneel on left knee while keeping right knee up).

5. Lunge (LEFT leg forward) - Rate your ability to “take a knee” onto the floor from a standing position (keep your chest and head upright and kneel on right knee while keeping left knee up).

6. Shoulder Mobility (LEFT) - Rate your ability to scratch your back between your shoulder blades with both arms at the same time when lifting your Left hand up and over your head and your right hand under your shoulder.

7. Shoulder Mobility (RIGHT) - Rate your ability to scratch your back between your shoulder blades with both arms at the same time when lifting your Right hand up and over your head and your Left hand under your shoulder.

8. Active Straight Leg Raise (LEFT) - While lying on your back on the floor with both legs stretched straight and toes pointing toward the ceiling, rate your ability to lift your straightened LEFT leg up while keeping your RIGHT leg fully straightened with toes pointing up and on the floor.

9. Active Straight Leg Raise (RIGHT) - While lying on your back on the floor with both legs stretched straight and toes pointing toward the ceiling, rate your ability to lift your straightened RIGHT leg up while keeping your LEFT leg fully straightened with toes pointing up and on the floor.

10. Trunk Stability Push-Up: While lying on your stomach on the floor in a push up position with your hands atcollar bone height and hands slightly wider than your shoulders, rate your ability topush your body off the ground while keeping your body in a strict and 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?