The Evolution of Functional Testing

Sep 1, 2016 | by Gray Institute

By: Dr. David Tiberio, Gray Institute

Functional movement is not a new concept, but the organization and objective measurement of functional movement began in the early 1990s.

As a result of two Team Reaction seminars sponsored by the Gray Institute, a structured system for measuring movement in all three planes was created. Gary Gray invited physical therapists and movement specialists from a variety of practice environments to work together based on the belief that functional movements, in contrast to isolated joint and muscle testing, better represented the abilities of individuals.  These seminars resulted in the publication of the Lower Extremity Functional Profile (LEFP) in 1951.

The movements, which served as both tests and exercises, gained traction in the practical world of rehabilitation, training, and injury prevention.  However, integrated movements ran counter to the “establishment perspective” of isolation.  The movements were criticized as lacking reliability (repeatability) and a number of research studies were completed to determine both their reliability and validity.

In 1998 Kinzey and Armstrong found that the tests were reliable and that performing up to 6 practice repetitions resulted in good reliability.  This was followed in 2000 by the first of many research studies by a group of colleagues.  Hertel et al found acceptable intra- and inter-tester reliability using 8 directions of balance reach tests using the opposite foot for the reach.  They called the battery of 8 tests the Star Excursion Balance Tests (SEBT) with the source being the LEFP. Olmstead et al then found that the SEBT had validity in detecting deficits in a group of subjects with recurrent ankle sprains.

In 2006, two studies enhanced the value for functional testing. 

The study by Plisky et al5 demonstrated that for certain reaches, difference between sides of greater than 4cm was a predictor of lower extremity injury.  This fostered a number of subsequent studies regarding the utility of balance reach tests to predict injuries beyond the limited scope of ankle sprains.  Also in 2006 Hertel et al6 performed factor analysis in an attempt to reduce the number of tests required to identify functional deficits in subjects with ankle sprains.  They came up with three that would give the examiner “more bang for the buck” in cases of ankle sprains.  Similar studies led to the development of the “Y balance test” using only 3 directions.  Unfortunately the three from Hertel’s study are not the three used in the Y-test.  So efficiency with fewer tests is likely deficit specific.  Without knowing the exact deficit that is to be measured, utilizing tests that do not assess movement in both directions in each of the three planes, as well as combined planes, may result in failure to identify both the deficit and the cause(s) of dysfunction.

In the last ten years, a few of the functional movements contained in the LEFP, have been used in hundreds of research studies. 

This begs the question: What enhancements to functional testing have been developed at the Gray Institute since 1995?  It must be pointed out that the LEFP was much more than balance reach tests.  Many different movements/exercises were part of that initial publication. The LEFP morphed into the Total Body Functional Profile.  In utilizing functional tests, Gary Gray realized different body parts could be used to drive functional movements and that these were all measurable.

Without going into too much detail on the continuous efforts of the Gray Institute to make functional testing more efficient and at the same time more effective, let’s fast forward 20 years to 2015.  That is when the 3-Dimensional Movement Analysis and Performance System (3DMAPS) was launched. 3DMAPS is the culmination of 40 years striving to be better, acknowledging errors, and searching for the “truths” of human movement.

  • 3DMAPS answers the need to assess both the motion available (mobility) and the ability to control that motion (stability) during integrated global movements.
  • 3DMAPS leverages the AFS Principle of “3D” by testing and training in three planes of motion.
  • 3DMAPS utilizes both the legs and the arms to create a more global movement.  The two “drivers” make it more difficult for the subject to compensate/cheat, while at the same time making it easier for the movement specialist to determine the degree of success.
  • Finally 3DMAPS leverages the maxim “the test is the exercise and the exercise is the test”.  The Performance component of 3DMAPS takes the six primary examination movements and creates 14 different training strategies and sequences based on the subject’s existing success.

From comprehensive yet simple analysis movements to unlimited training, rehabilitation, and injury prevention programs: that is the power of 3DMAPS.

  1. Lower Body Functional Profile 1995 Wynn Marketing
  2. Kinzey SJ, Armstrong CW The reliability of the star-excursion test in assessing dynamic balance. J Orthop Sports Phys Ther. 1998 May;27(5):356-60.
  3. Hertel J, Miller SJ, Denegar CR. Intratester and intertester reliability during the Star Excursion Balance Tests. J Sport Rehabil. 2000, 9:104–116.
  4. Olmsted LC, Carcia CR, Hertel J, Shultz SJ.  Efficacy of the Star Excursion Balance Tests in Detecting Reach Deficits in Subjects with Chronic Ankle Instability.   J Ath Training 2002, 37:501-506.
  5. Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006, 36: 911-9.
  6. Hertel J1, Braham RA, Hale SA, Olmsted-Kramer LC. Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability. J Orthop Sports Phys Ther. 2006, 36: 131-7.