Emergency Medical Technicians with Impaired Functional Movement Patterns have Poorer Dynamic Balance and Muscle Flexibility: A Cross-Sectional Study

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Methods This cross-sectional study recruited 91 EMTs from the Bureau of Fire in Tainan, Taiwan. Functional movement patterns were assessed using the Functional Movement Screen (FMS™). Muscle strength and flexibility of the upper and lower extremities and core stability were assessed using a hand-held dynamometer and clinical tests. The dynamic balance ability of each leg was assessed using the Y balance test, and agility was assessed using the agility T-test. Results The average FMS™ score for all EMTs was 14.1, and 44 participants (48%) were classified as the higher-scoring group (FMS™ score higher than 14), and 47 (52%) were the lower-scoring group (FMS™ score 14 or less). The lower-scoring group exhibited significantly poorer fundamental movement patterns, reduced lower body flexibility, and impaired dynamic balance compared to the higher-scoring group. No differences were observed in muscle strength for the upper and lower extremities, core stability, shoulder mobility, and agility. Conclusion The current results indicate that EMTs present with impaired functional movement patterns, with lower FMS™ performance associated with limited lower body mobility and reduced dynamic balance ability. These findings support the need for intervention strategies targeting movement quality to preserve occupational health in those EMTs. Postural Balance Movement Physical Fitness Occupational Injuries Paramedics Introduction Emergency medical technicians (EMTs) play a critical role in life-saving care under intense pressure and limited resources. Their work often involves high-speed transport, emergency care, and shift-based schedules in unpredictable and hazardous conditions 4 . Over half report significant mental and physical fatigue during shifts, increasing their risk for both fatal and nonfatal injuries and resulting in lost workdays and reduced quality of life 19 , 39 . EMTs experience injury rates nearly three times the national average 2 , 53 . A systematic review of 12 studies found annual injury rates for paramedics ranging from 29.7 to 345.6 injuries per 1,000 workers, and EMTs have the highest rate of workers' compensation claims among healthcare professionals 16 . Common injuries include sprains and strains, particularly in the lower back and upper limbs, often caused by repetitive motions, poor posture, excessive physical effort, or lifting and transferring patients and equipment 16 , 34 . These injuries frequently lead to pain, reduced quality of life, and impacts on daily activities, social interactions, and career longevity 49 . Therefore, early risk identification and targeted, evidence-based interventions are crucial to protecting EMTs’ long-term health. The Functional Movement Screen (FMS™) assesses seven fundamental movement patterns to identify dysfunctions or performance limitations and screen for musculoskeletal injury risk 7 , 8 . These tests evaluate basic locomotor, manipulative, and stabilizing movements by placing individuals in challenging positions to reveal weaknesses and imbalances. Corrective exercises are prescribed accordingly 23 , 48 . Although extensively studied in athletes, firefighters, and soldiers 5 , 6 , 17 , 33 , its application among EMTs remains underexplored. A 2017 systematic review of nine studies found that individuals with an FMS™ score ≤ 14 were 2.74 times more likely to sustain musculoskeletal injuries 3 . Despite the high musculoskeletal injury rate in EMTs, research on their physical evaluation and prevention strategies is limited. Existing studies focus mainly on ergonomic assessments related to repetitive tasks such as lifting and bending 18 , 30 , 51 . Unlike firefighters, whose fitness has been well documented 41 , 42 , EMTs have received little attention, with limited studies noting issues like excess body weight, poor back strength, and reduced hamstring flexibility 1 , 13 . To date, only one study reported a median FMS™ score of approximately 14 in emergency medical service professionals 50 . Further research is needed to explore FMS™ performance and its relationship to physical functions such as strength, flexibility, core stability, balance, and agility. Therefore, the main purposes of this study were (1) to examine the functional movement patterns of EMTs using the FMS™ and evaluate their physical functions, including strength, flexibility, core stability, balance, and agility, and (2) to investigate the associations between functional movement patterns and physical functions. It was hypothesized that EMTs with lower FMS™ scores would perform worse in physical function tests, while those with higher scores would perform better. Materials and Methods Study Design This cross-sectional study investigated the quality of functional movement patterns and physical functions in EMTs. Testing was conducted in a laboratory at the Department of Physical Therapy of a local university. Ethical approval for this study was obtained from the Institutional Review Board of National Cheng Kung University Hospital (A-ER-105-335). Participants Ninety-one EMTs were recruited from the Tainan City Bureau of Fire in Taiwan. All had at least 10 years of EMT training and held the highest national EMT qualification, EMTs-paramedic (EMT-P). Those with current pain or acute injuries affecting their duties or participation were excluded. Procedures Anthropometric measurements, including height, weight, leg length, waist and hip circumferences, and waist-to-hip ratio, were recorded. Participants completed questionnaires on demographics, health, work experience, exercise habits, and musculoskeletal injury history. Musculoskeletal injuries were assessed using the Nordic Musculoskeletal Questionnaire (NMQ), which evaluates symptoms across nine body regions, including neck, shoulders, upper back, lower back, elbows, wrists/hands, hips/thighs, knees, and ankles/feet, using a diagram for localization 14 , 27 . Participants then underwent standardized evaluations of functional movement patterns and physical functions. Functional movement patterns were assessed using the FMS™, while physical function assessments included measurements of muscle strength and flexibility (upper and lower limbs), core stability, agility, and dynamic balance. A 5-minute warm-up consisting of general joint mobility exercises and light jogging was performed before all tests, and the order of physical assessments was randomized for each participant to minimize fatigue. Quality of functional movement patterns: FMS™ The quality of functional movement patterns was assessed using the FMS™, which consists of seven fundamental movement tests: deep squat, hurdle step, in-line lunge, shoulder mobility, active straight-leg raise, trunk stability push-up, and rotary stability. These movements are fundamental for jumping, running, and agility 9 , 10 . Each is scored from 0 to 3, with a maximum total of 21. A score of 3 indicates balanced, symmetrical, and stable functional movement; 2 indicates that the movement is not optimal; 1 means the movement cannot be performed; and 0 indicates that attempting the movement causes pain. The scores below 14 indicate an increased risk of future injury 3 . A systematic review has demonstrated that the intra-rater and inter-rater reliability of the FMS™ is excellent 3 . Physical functions Muscle strength Maximum isometric strength for the major upper and lower extremity muscles on the dominant side was assessed using a hand-held dynamometer (MicroFit3, Hoggn Health Industries Inc., Salt Lake City, UT, USA), including the shoulder flexors, shoulder abductors, elbow flexors, elbow extensors, hip flexors, hip extensors, hip abductors, knee flexors, and knee extensors. Maximal grip strength was measured using the JAMAR dynamometer. The dominant hand was identified as the one used to pick up an object, and the dominant leg was determined by which leg was used to kick a ball. All testing positions and methods followed standardized techniques for manual examination and performance 21 . Two trials were averaged and normalized to body weight. Muscle flexibility Flexibility was assessed using the shoulder circumduction, sit-and-reach, and straight-leg raise tests. The shoulder circumduction test assessed the mobility of the upper extremities and upper trunk, particularly the shoulder joints and thoracic spine. Participants raised a stick overhead with arms extended and progressively reduced their grip width while moving it behind their body. The minimum hand distance was measured. 31 . The sit-and-reach test assessed overall lower body mobility 37 . In a seated position with legs extended and heels 30 cm apart, participants reached forward with overlapped hands for two seconds. The maximum reach distance, measured from a 25-cm baseline aligned to the fingertips, was recorded. The straight-leg raise test assessed hamstring muscle flexibility 37 . Participants lay supine on the ground, and the dominant leg, with the knee straight, was passively raised until pelvic rotation began. The maximum hip flexion angle was recorded. Two trials were averaged for analysis. Core stability Core stability was assessed using the Sorensen and double straight-leg raise tests. The Sorensen test evaluated the endurance of the back extensors. Participants lay prone with the hips, knees, and feet secured by straps. The upper trunk was unsupported at the level of the anterior superior iliac spine, and arms were crossed over the chest. Time was recorded until the participant could no longer maintain the horizontal position 28 . The double straight-leg raise test assessed abdominal muscle endurance 36 . Participants lay supine with knees straight and hips flexed at 30 degrees. Time was recorded until they could no longer maintain the position. Only one trial was performed to prevent fatigue. Agility Agility, defined as the ability to change body position quickly while maintaining control, was assessed using the agility T-test. 43 . Participants sprinted forward, moved laterally, and backpedaled around four cones in a standardized pattern. Two trials were conducted, and the fastest time was recorded. Dynamic balance Dynamic balance was assessed using the YBT (Y-Balance Test Kit™, Perform Better, West Warwick, Rhode Island, USA). Participants balanced on one leg while reaching as far as possible with the other leg in three directions: anterior, posterolateral, and posteromedial, before returning to the starting position 40 . Trials were discarded if the balance was lost. Three valid attempts were averaged and normalized by leg length, measured from the anterior superior iliac spine to the medial malleolus. A composite score was calculated as the sum of reach distances divided by three times the leg length, multiplied by 100. Higher scores indicated better balance. Statistical Analysis Descriptive statistics for anthropometric, demographic, and outcome measures were reported for all participants to provide an overview of functional movement patterns and physical functions among EMTs. Based on their FMS™ scores, participants were categorized into the lower-scoring (LS, ≤ 14) and higher-scoring (HS, > 14) groups. Differences in functional movement patterns, physical functions, and participant characteristics were analyzed between the two groups using independent t-tests for continuous variables and Chi-square tests for categorical variables. Data were reported as means ± standard deviations, and significance was set at p < 0.05. Statistical analyses were performed using SPSS 17.0 software (SPSS 17.0 program, IBM). Results Participants A total of 91 EMTs (89 males and 2 females) aged from 25 to 53 years were included (Table 1 ). The average FMS™ score across all participants was 14.01, ranging from 7 to 19. According to the NMQ questionnaire, 81 of the 91 participants (89%) reported musculoskeletal symptoms in the past year, most commonly in the lower back (65%), followed by shoulder (52%), neck (40%), knee (36%), hand/wrist (27%), hip/thigh (22%), foot/ankle (21%), upper back (21%), and elbow (10%). Table 1 Demographic and anthropometric data of all EMTs Mean (SD) All EMTs (N = 91) Higher-scoring (n = 44) Lower-scoring (n = 47) p value Age (years) 36.12 (4.79) 37.18 (5.47) 35.17 (3.89) 0.048* Height (cm) 173.97 (4.46) 173.50 (4.46) 174.40 (4.47) 0.337 Weight (kg) 77.71 (10.40) 75.66 (10.73) 79.63 (9.79) 0.069 Waist circumference (cm) 85.71 (9.36) 83.29 (9.42) 87.93 (9.38) 0.021* Hip circumference (cm) 99.01 (5.93) 97.78 (6.11) 100.13 (5.59) 0.060 W/H ratio 0.86 (0.06) 0.85 (0.06) 0.88 (0.57) 0.037* FMS™ score (/21) 14.01 (2.82) 16.36 (1.28) 11.81 (1.94) < 0.001* NMQ injured sites 2.96 (2.47) 2.80 (2.55) 3.11 (2.42) 0.552 *p value 14), and 47 (52%) as lower-scoring (LS, ≤ 14). Each group included one female participant, and no gender differences were found between groups ( p = 0.962). The basic characteristics of the two groups are presented in Table 1 . The LS group was significantly younger and had greater waist circumference and waist-to-hip ratio than the HS group (all p < 0.05). As expected, the LS group had a significantly lower total FMS™ score than the HS group, with a mean difference of 4.55 ( p < 0.001). However, the number of injured sites reported did not differ between the groups ( p = 0.552). Functional movement patterns The LS group scored significantly lower on the total FMS™ score and six of the seven subtests: deep squat, in-line lunge, shoulder mobility, active straight-leg raise, push-up, and rotary stability compared to the HS group (Table 2 , all p < 0.05). There was also a trend of poorer performance in the hurdle step for the LS group ( p = 0.050), though it did not reach statistical significance. Table 2 Results of FMS™ of all participants, and between the higher-scoring and lower-scoring groups Number of participants All EMTs (N = 91) Higher-scoring (n = 44) Lower-scoring (n = 47) p value 0 1 2 3 0 1 2 3 0 1 2 3 Deep Squat 4 4 48 35 1 0 15 28 3 4 33 7 < 0.001* Hurdle Step 0 3 79 9 0 0 37 7 0 3 42 2 0.050 In-line Lunge 0 1 52 38 0 0 18 26 0 1 34 12 0.004* Shoulder Mobility 18 2 17 54 1 0 8 35 17 2 9 19 < 0.001* Active Straight-leg Raise 1 29 50 11 0 5 29 10 1 24 21 1 < 0.001* Push-up 20 29 17 25 1 13 8 22 19 16 9 3 < 0.001* Rotary Stability 6 7 76 2 0 1 42 1 6 6 34 1 0.016* *p value < 0.05 as significant Physical functions There were no significant differences between the groups in maximal muscle strength or core stability (Table 3 ). The LS group performed significantly worse on the sit-and-reach test ( p = 0.001) and had reduced straight-leg raise range of the left leg ( p = 0.020) compared to the HS group. Right hamstrings flexibility was also lower, though not statistically significant ( p = 0.117). No group difference was observed in shoulder mobility and agility performance. Table 3 Results of strength, flexibility, core stability, and agility between the higher-scoring and lower-scoring groups Mean (SD) Higher-scoring (n = 44) Lower-scoring (n = 47) Mean difference (95% CI) p value Muscle strength (%Body weight) Shoulder flexors 0.61 (0.17) 0.57 (0.14) 0.03 (-0.03, 0.10) 0.326 Shoulder abductors 0.55 (0.14) 0.51 (0.10) 0.04 (-0.01, 0.09) 0.154 Elbow flexors 0.77 (0.24) 0.81 (0.23) -0.03 (-0.14, 0.61) 0.452 Elbow extensors 0.50 (0.12) 0.49 (0.09) 0.01 (-0.30, 0.06) 0.563 Hip flexors 0.65 (0.18) 0.68 (0.16) 0.01 (-0.06, 0.07) 0.870 Hip extensors 0.74 (0.21) 0.68 (0.16) 0.06 (-0.01, 0.14) 0.104 Hip abductors 0.71 (0.21) 0.69 (0.16) 0.01 (-0.06, 0.09) 0.708 Knee flexors 0.56 (0.15) 0.55(0.13) 0.01 (-0.05, 0.07) 0.726 Knee extensors 0.77 (0.22) 0.78 (0.21) -0.01 (-0.10, 0.08) 0.826 Grip strength 0.65 (0.13) 0.63 (0.12) 0.02 (-0.03, 0.07) 0.449 Core stability (sec) Back extensors 105.43 (43.93) 96.81 (46.14) 8.62 (-10.29, 27.54) 0.368 Abdominal muscles 76.69 (43.43) 69.81 (50.72) 6.89 (-12.93, 26.76) 0.493 Flexibility Shoulder circumduction (cm) 53.74 (16.93) 57.09 (14.62) -3.35 (-10.01, 3.30) 0.319 Sit and reach test (cm) 29.74 (8.92) 23.36 (8.51) 6.39 (2.71, 10.06) 0.001* SLR of right leg (degree) 68.48 (20.07) 63.06 (11.79) 5.41 (-1.39, 12.22) 0.117 SLR of left leg (degree) 68.72 (20.26) 60.28 (13.11) 8.44 (1.36, 15.53) 0.020* Agility T test (sec) 14.50 (1.68) 14.68 (2.03) -0.18 (0.010, 0.61) 0.650 *p value < 0.05 as significant SD = Standard deviation, SLR = straight leg raises The results of dynamic balance, assessed using the YBT, are presented in Table 4 . The LS group demonstrated significantly shorter reach distances than the HS group for both legs in nearly all directions and for the composite score (all p < 0.05), except for the posterolateral direction of the right leg ( p = 0.082). Table 4 Results of dynamic balance between the higher-scoring and lower-scoring groups Mean (SD) Higher-scoring (n = 44) Lower-scoring (n = 47) Mean difference (95% CI) p value Right leg Anterior 0.75 (0.08) 0.70 (0.08) 0.05 (0.01, 0.08) 0.009* Postomedial 1.16 (0.09) 1.10 (0.12) 0.05 (0.01, 0.10) 0.015* Postolateral 1.17 (0.09) 1.13 (0.10) 0.04 (-0.00, 0.08) 0.082 Composite score 1.02 (0.07) 0.98 (0.09) 0.05 (0.01, 0.09) 0.008* Left leg Anterior 0.75 (0.08) 0.70 (0.08) 0.05 (0.02, 0.09) 0.001* Postomedial 1.17 (0.10) 1.12 (0.12) 0.05 (0.00, 0.10) 0.032* Postolateral 1.20 (0.08) 1.14 (0.09) 0.07 (0.03, 0.10) 0.001* Composite score 1.03 (0.08) 0.98 (0.08) 0.06 (0.02, 0.09) 0.001* Discussion Functional Movement Screen is a valuable and widely used tool to assess dysfunctional movement patterns, and it has been used in various populations to screen for musculoskeletal injury risk. This study assessed the functional movement patterns in the EMTs using the FMS™, and is the first to investigate its associations with different physical functions. The current results demonstrated that the average FMS™ score was 14.01, with 52% of the participants scoring ≤ 14, indicating a higher risk of musculoskeletal injury. Those EMTs identified with higher injury risk had significantly poorer functional movement patterns, lower trunk flexibility, and dynamic balance than those with lower injury risk but no differences in muscle strength, core stability, or agility. EMTs face a significantly higher risk of occupational injury and fatality compared to other occupations 35 . Studies indicate that an FMS™ score ≤ 14 is associated with an increased risk of musculoskeletal injuries in various groups, including athletes, firefighters, and military personnel 3 . In this study, the average FMS™ score for EMTs was 14.01, aligning with a prior study of emergency medical service professionals with a median score of about 14 50 . A 2019 meta-analysis found that FMS™ scores in tactical occupations ranged from 14.5 to 16.6 24 , while two recent studies reported average scores of 12 in Chinese police officers and firefighters 12 , 22 . These differences may result from variations in age, gender, work experience, workload, physical activity, and previous injuries 22 , 38 . Over half of the participants (52%) in this study had an FMS™ score ≤ 14, consistent with previous findings in EMTs and firefighters that roughly half had FMS™ scores at or below this threshold 47 , 50 . These findings highlight the need for screening and early intervention in tactical populations, necessitating urgent attention to safeguard their occupational health. EMTs with a lower FMS™ score in this study showed significantly poorer dynamic balance and lower trunk flexibility than those at lower risk of injury, while muscle strength, core stability, and agility were similar between groups. These results support previous studies linking decreased hamstring flexibility to low back pain, which was the most commonly reported injury (65%) in this study 13 , 46 . Overexertion during patient handling and hazardous biomechanical tasks such as lifting or pulling heavy loads from low heights further emphasize the need for adequate flexibility in EMTs 29 . This study is the first to assess balance in EMTs, showing significantly poorer dynamic balance among individuals with a higher risk of injury. Loss of balance is a critical factor in injury events among emergency medical service workers, who frequently operate on uneven surfaces, navigate stairs, and work in confined or dimly lit environments 44 . The results are consistent with studies showing poorer balance in athletes and firefighter trainees with FMS™ scores ≤ 14 11,32 . These findings highlight the importance of dynamic balance and movement pattern evaluations for EMTs to mitigate their high risk of musculoskeletal injuries. This study revealed that EMTs in the LS group were younger and had higher body weight and waist-to-hip ratio than those in the HS group. while previous studies have linked lower FMS™ scores to higher body mass index or fat mass 20 , our finding that younger EMTs had greater injury risk contrasts with studies associating lower FMS™ scores with older age 45 . This inconsistency may reflect differences in sample characteristics or experience levels, as shown by Krysak et al., who found older professional golfers performed better in movement and balance than younger golfers at various levels 26 . No significant differences in muscle strength, core stability, or agility were found between groups in this study, suggesting these factors may not directly relate to injury risk as measured by FMS™. Similar results have been reported in collegiate athletes, showing no correlations between the FMS™ scores and strength or athletic performance 32 , 52 . Conversely, some studies reported associations with strength, plank endurance, agility, or running speed in firefighter trainees and youth populations 15 , 25 . These inconclusive findings highlight the need for cautious interpretation, especially where factors such as biological maturation and skill levels are unaccounted for. Functional movement training and corrective exercises have been shown to improve functional movement patterns and potentially reduce injury risk 23 . Unlike traditional strength training, which targets maximal strength and power through single-joint loading, functional movement training emphasizes multi-joint coordination, balance between joint mobility and stability, and proper motor control across various postures under unstable conditions. This approach is often lacking in current EMTs training programs, where resistance training with progressive loading aimed at muscle strength predominates. Future research is needed to evaluate the effects of functional movement training on FMS™ scores, physical functions like balance and flexibility, and injury prevention in EMTs. This study identified functional movement impairments in Taiwanese EMTs but has several limitations. The ability of FMS™ scores to reliably predict future injuries remains uncertain, as some studies, including Supples et al., found limited or no predictability for injuries in EMTs over one to two years 50 . The commonly used cutoff score of ≤ 14 requires further validation. The predominantly male participant group (only two females) limits the generalizability. Only muscle strength, flexibility, balance, and agility were assessed, leaving other important physical functions, such as aerobic fitness and muscle power, unexplored. The cross-sectional design further limits conclusions on causality between functional movement patterns and physical function. Future research should involve randomized controlled trials and use larger and more diverse samples, as well as longitudinal designs to better assess injury risk and intervention effects in EMTs. Conclusion Despite the high prevalence of musculoskeletal injuries reported among EMTs, studies focusing on the evaluation, management, and prevention of these injuries are limited. This study demonstrated that EMTs exhibited deficits in functional movement patterns, as assessed by the FMS™, with those scoring lower (indicating higher injury risk) showing poorer dynamic balance and reduced trunk flexibility compared to those with higher scores. These findings suggest that establishing a protocol for early detection of potential occupational injury during regular training or continuing education, incorporating comprehensive assessments of functional movement patterns and balance, and implementing effective intervention or training programs should be prioritized to enhance the occupational health of EMTs. Abbreviations EMTs Emergency medical technicians FMS™ Functional Movement Screen NMQ Nordic Musculoskeletal Questionnaire YBT Y-Balance Test LS Lower-scoring HS Higher-scoring Declarations Ethics approval and consent to participate: Ethical approval was obtained from the Institutional Review Board of National Cheng Kung University Hospital (A-ER-105-335). The requirement for informed consent was waived by the ethics committee because the study involved secondary analysis of de-identified data. This study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript. Funding This work was supported by National Cheng Kung University Hospital and the Ministry of Science and Technology, Taiwan (grants NCKUH-10603002 and NSTC 113-2410-H-006-098-MY2) Author Contribution All authors contributed to the conception and design of the study. KCC was responsible for data collection. YJT and KCC were responsible for analysis and interpretation of the data. YJT was responsible for drafting the manuscript. YJT, HIS, KCC and HCH made important intellectual contributions to the content of the manuscript. 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Lemmink KA, Han K, de Greef MH, Rispens P, Stevens M. Reliability of the Groningen fitness test for the elderly. J Aging Phys Act. 2001;9(2):194–212. Liang Y-P, Kuo Y-L, Hsu H-C, Hsia Y-Y, Hsu Y-W, Tsai Y-J. Collegiate baseball players with more optimal functional movement patterns demonstrate better athletic performance in speed and agility. J Sports Sci. 2019;37(5):544–52. Lisman P, O’CONNOR FG, Deuster PA, Knapik JJ. Functional movement screen and aerobic fitness predict injuries in military training. Med Sci Sports Exerc. 2013;45(4):636–43. Möckel L, Gerhard A, Mohr M, Armbrust CI, Möckel C. Prevalence of pain, analgesic self-medication and mental health in German pre-hospital emergency medical service personnel: a nationwide survey pilot-study. Int Arch Occup Environ Health. 2021;94(8):1975–82. Maguire BJ, Hunting KL, Guidotti TL, Smith GS. Occupational injuries among emergency medical services personnel. Prehosp Emerg Care Oct-Dec. 2005;9(4):405–11. 10.1080/10903120500255065 . Massoud Arab A, Salavati M, Ebrahimi I, Ebrahim Mousavi M. Sensitivity, specificity and predictive value of the clinical trunk muscle endurance tests in low back pain. Clin Rehabil. 2007;21(7):640–7. Mayorga-Vega D, Merino-Marban R, Viciana J. Criterion-related validity of sit-and-reach tests for estimating hamstring and lumbar extensibility: a meta-analysis. J sports Sci Med. 2014;13(1):1. Moore E, Chalmers S, Milanese S, Fuller JT. Factors influencing the relationship between the functional movement screen and injury risk in sporting populations: a systematic review and meta-analysis. Sports Med. 2019;49:1449–63. Patterson PD, Weaver MD, Frank RC, et al. Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehospital Emerg Care. 2012;16(1):86–97. Plisky P, Schwartkopf-Phifer K, Huebner B, Garner MB, Bullock G. Systematic review and meta-analysis of the Y-balance test lower quarter: reliability, discriminant validity, and predictive validity. Int J sports Phys therapy. 2021;16(5):1190. Poplin GS, Roe DJ, Burgess JL, Peate WF, Harris RB. Fire fit: assessing comprehensive fitness and injury risk in the fire service. Int Arch Occup Environ Health. 2016;89:251–9. Ras J, Smith DL, Kengne AP, Soteriades EE, Leach L. Cardiovascular disease risk factors, musculoskeletal health, physical fitness, and occupational performance in firefighters: A narrative review. J Environ public health. 2022;2022(1):7346408. Raya MA, Gailey RS, Gaunaurd IA et al. Comparison of three agility tests with male servicemembers: Edgren Side Step Test, T-Test, and Illinois Agility Test. J Rehabilitation Res Dev. 2013;50(7). Reichard AA, Marsh SM, Tonozzi TR, Konda S, Gormley MA. Occupational Injuries and Exposures among Emergency Medical Services Workers. Prehosp Emerg Care . Jul-Aug. 2017;21(4):420–31. 10.1080/10903127.2016.1274350 . Renner MN, Gnacinski SL, Porter FJ, Cornell DJ. The influence of age and dynamic balance on functional movement among active-duty police officers. J sport rehabilitation. 2022;32(3):242–7. Sadler SG, Spink MJ, Ho A, De Jonge XJ, Chuter VH. Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskelet Disord. 2017;18:1–15. Shore E, Dally M, Brooks S, Ostendorf D, Newman M, Newman L. Functional movement screen as a predictor of occupational injury among Denver firefighters. Saf health work. 2020;11(3):301–6. Stanek JM, Dodd DJ, Kelly AR, Wolfe AM, Swenson RA. Active duty firefighters can improve Functional Movement Screen (FMS) scores following an 8-week individualized client workout program. Work. 2017;56(2):213–20. Sterud T, Ekeberg Ø, Hem E. Health status in the ambulance services: a systematic review. BMC Health Serv Res. 2006;6:1–10. Supples MW, Brichler KP, Glober NK, Lardaro TA, O’Donnell DP. Functional movement screen did not predict musculoskeletal injury among emergency medical services professionals. Work. 2022;71(3):795–802. Weiler MR, Lavender SA, Crawford JM, Reichelt PA, Conrad KM, Browne MW. Identification of factors that affect the adoption of an ergonomic intervention among Emergency Medical Service workers. Ergonomics. 2012;55(11):1362–72. Willigenburg N, Hewett TE. Performance on the Functional Movement Screen is related to hop performance but not to hip and knee strength in collegiate football players. Clin J Sport Med. 2017;27(2):119–26. Yilmaz A, Serinken M, Dal O, Yaylacı S, Karcioglu O. Work-related injuries among emergency medical technicians in western Turkey. Prehosp Disaster Med. 2016;31(5):505–8. Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Hsin-I","middleName":"","lastName":"Shih","suffix":""},{"id":572720236,"identity":"33a37281-c86e-4b7f-9755-0e9c7cde754f","order_by":2,"name":"Kai-Chia Cheng","email":"","orcid":"","institution":"National Cheng Kung University","correspondingAuthor":false,"prefix":"","firstName":"Kai-Chia","middleName":"","lastName":"Cheng","suffix":""},{"id":572720237,"identity":"703b693d-8644-40c3-b85d-dcf08153c07b","order_by":3,"name":"Hsiang-Chin 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10:37:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":984611,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8371191/v1/4bf9876f-4e0b-4c5d-9dc0-ab3b33275f19.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Emergency Medical Technicians with Impaired Functional Movement Patterns have Poorer Dynamic Balance and Muscle Flexibility: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEmergency medical technicians (EMTs) play a critical role in life-saving care under intense pressure and limited resources. Their work often involves high-speed transport, emergency care, and shift-based schedules in unpredictable and hazardous conditions \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Over half report significant mental and physical fatigue during shifts, increasing their risk for both fatal and nonfatal injuries and resulting in lost workdays and reduced quality of life \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEMTs experience injury rates nearly three times the national average \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e. A systematic review of 12 studies found annual injury rates for paramedics ranging from 29.7 to 345.6 injuries per 1,000 workers, and EMTs have the highest rate of workers' compensation claims among healthcare professionals \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Common injuries include sprains and strains, particularly in the lower back and upper limbs, often caused by repetitive motions, poor posture, excessive physical effort, or lifting and transferring patients and equipment \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. These injuries frequently lead to pain, reduced quality of life, and impacts on daily activities, social interactions, and career longevity \u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. Therefore, early risk identification and targeted, evidence-based interventions are crucial to protecting EMTs\u0026rsquo; long-term health.\u003c/p\u003e \u003cp\u003eThe Functional Movement Screen (FMS\u0026trade;) assesses seven fundamental movement patterns to identify dysfunctions or performance limitations and screen for musculoskeletal injury risk \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. These tests evaluate basic locomotor, manipulative, and stabilizing movements by placing individuals in challenging positions to reveal weaknesses and imbalances. Corrective exercises are prescribed accordingly \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. Although extensively studied in athletes, firefighters, and soldiers \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, its application among EMTs remains underexplored. A 2017 systematic review of nine studies found that individuals with an FMS\u0026trade; score\u0026thinsp;\u0026le;\u0026thinsp;14 were 2.74 times more likely to sustain musculoskeletal injuries \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite the high musculoskeletal injury rate in EMTs, research on their physical evaluation and prevention strategies is limited. Existing studies focus mainly on ergonomic assessments related to repetitive tasks such as lifting and bending \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. Unlike firefighters, whose fitness has been well documented \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e, EMTs have received little attention, with limited studies noting issues like excess body weight, poor back strength, and reduced hamstring flexibility \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. To date, only one study reported a median FMS\u0026trade; score of approximately 14 in emergency medical service professionals \u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. Further research is needed to explore FMS\u0026trade; performance and its relationship to physical functions such as strength, flexibility, core stability, balance, and agility. Therefore, the main purposes of this study were (1) to examine the functional movement patterns of EMTs using the FMS\u0026trade; and evaluate their physical functions, including strength, flexibility, core stability, balance, and agility, and (2) to investigate the associations between functional movement patterns and physical functions. It was hypothesized that EMTs with lower FMS\u0026trade; scores would perform worse in physical function tests, while those with higher scores would perform better.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis cross-sectional study investigated the quality of functional movement patterns and physical functions in EMTs. Testing was conducted in a laboratory at the Department of Physical Therapy of a local university. Ethical approval for this study was obtained from the Institutional Review Board of National Cheng Kung University Hospital (A-ER-105-335).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eNinety-one EMTs were recruited from the Tainan City Bureau of Fire in Taiwan. All had at least 10 years of EMT training and held the highest national EMT qualification, EMTs-paramedic (EMT-P). Those with current pain or acute injuries affecting their duties or participation were excluded.\u003c/p\u003e\n\u003ch3\u003eProcedures\u003c/h3\u003e\n\u003cp\u003eAnthropometric measurements, including height, weight, leg length, waist and hip circumferences, and waist-to-hip ratio, were recorded. Participants completed questionnaires on demographics, health, work experience, exercise habits, and musculoskeletal injury history. Musculoskeletal injuries were assessed using the Nordic Musculoskeletal Questionnaire (NMQ), which evaluates symptoms across nine body regions, including neck, shoulders, upper back, lower back, elbows, wrists/hands, hips/thighs, knees, and ankles/feet, using a diagram for localization \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eParticipants then underwent standardized evaluations of functional movement patterns and physical functions. Functional movement patterns were assessed using the FMS\u0026trade;, while physical function assessments included measurements of muscle strength and flexibility (upper and lower limbs), core stability, agility, and dynamic balance. A 5-minute warm-up consisting of general joint mobility exercises and light jogging was performed before all tests, and the order of physical assessments was randomized for each participant to minimize fatigue.\u003c/p\u003e\n\u003ch3\u003eQuality of functional movement patterns: FMS™\u003c/h3\u003e\n\u003cp\u003eThe quality of functional movement patterns was assessed using the FMS\u0026trade;, which consists of seven fundamental movement tests: deep squat, hurdle step, in-line lunge, shoulder mobility, active straight-leg raise, trunk stability push-up, and rotary stability. These movements are fundamental for jumping, running, and agility \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Each is scored from 0 to 3, with a maximum total of 21. A score of 3 indicates balanced, symmetrical, and stable functional movement; 2 indicates that the movement is not optimal; 1 means the movement cannot be performed; and 0 indicates that attempting the movement causes pain. The scores below 14 indicate an increased risk of future injury \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. A systematic review has demonstrated that the intra-rater and inter-rater reliability of the FMS\u0026trade; is excellent \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003ePhysical functions\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMuscle strength\u003c/h2\u003e \u003cp\u003eMaximum isometric strength for the major upper and lower extremity muscles on the dominant side was assessed using a hand-held dynamometer (MicroFit3, Hoggn Health Industries Inc., Salt Lake City, UT, USA), including the shoulder flexors, shoulder abductors, elbow flexors, elbow extensors, hip flexors, hip extensors, hip abductors, knee flexors, and knee extensors. Maximal grip strength was measured using the JAMAR dynamometer. The dominant hand was identified as the one used to pick up an object, and the dominant leg was determined by which leg was used to kick a ball. All testing positions and methods followed standardized techniques for manual examination and performance \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Two trials were averaged and normalized to body weight.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMuscle flexibility\u003c/h3\u003e\n\u003cp\u003eFlexibility was assessed using the shoulder circumduction, sit-and-reach, and straight-leg raise tests. The shoulder circumduction test assessed the mobility of the upper extremities and upper trunk, particularly the shoulder joints and thoracic spine. Participants raised a stick overhead with arms extended and progressively reduced their grip width while moving it behind their body. The minimum hand distance was measured. \u003csup\u003e31\u003c/sup\u003e. The sit-and-reach test assessed overall lower body mobility \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. In a seated position with legs extended and heels 30 cm apart, participants reached forward with overlapped hands for two seconds. The maximum reach distance, measured from a 25-cm baseline aligned to the fingertips, was recorded. The straight-leg raise test assessed hamstring muscle flexibility \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Participants lay supine on the ground, and the dominant leg, with the knee straight, was passively raised until pelvic rotation began. The maximum hip flexion angle was recorded. Two trials were averaged for analysis.\u003c/p\u003e\n\u003ch3\u003eCore stability\u003c/h3\u003e\n\u003cp\u003eCore stability was assessed using the Sorensen and double straight-leg raise tests. The Sorensen test evaluated the endurance of the back extensors. Participants lay prone with the hips, knees, and feet secured by straps. The upper trunk was unsupported at the level of the anterior superior iliac spine, and arms were crossed over the chest. Time was recorded until the participant could no longer maintain the horizontal position \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. The double straight-leg raise test assessed abdominal muscle endurance \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Participants lay supine with knees straight and hips flexed at 30 degrees. Time was recorded until they could no longer maintain the position. Only one trial was performed to prevent fatigue.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAgility\u003c/h2\u003e \u003cp\u003eAgility, defined as the ability to change body position quickly while maintaining control, was assessed using the agility T-test. \u003csup\u003e43\u003c/sup\u003e. Participants sprinted forward, moved laterally, and backpedaled around four cones in a standardized pattern. Two trials were conducted, and the fastest time was recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDynamic balance\u003c/h2\u003e \u003cp\u003eDynamic balance was assessed using the YBT (Y-Balance Test Kit\u0026trade;, Perform Better, West Warwick, Rhode Island, USA). Participants balanced on one leg while reaching as far as possible with the other leg in three directions: anterior, posterolateral, and posteromedial, before returning to the starting position \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Trials were discarded if the balance was lost. Three valid attempts were averaged and normalized by leg length, measured from the anterior superior iliac spine to the medial malleolus. A composite score was calculated as the sum of reach distances divided by three times the leg length, multiplied by 100. Higher scores indicated better balance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics for anthropometric, demographic, and outcome measures were reported for all participants to provide an overview of functional movement patterns and physical functions among EMTs. Based on their FMS\u0026trade; scores, participants were categorized into the lower-scoring (LS, \u0026le;\u0026thinsp;14) and higher-scoring (HS, \u0026gt;\u0026thinsp;14) groups. Differences in functional movement patterns, physical functions, and participant characteristics were analyzed between the two groups using independent t-tests for continuous variables and Chi-square tests for categorical variables. Data were reported as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, and significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Statistical analyses were performed using SPSS 17.0 software (SPSS 17.0 program, IBM).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA total of 91 EMTs (89 males and 2 females) aged from 25 to 53 years were included (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The average FMS\u0026trade; score across all participants was 14.01, ranging from 7 to 19. According to the NMQ questionnaire, 81 of the 91 participants (89%) reported musculoskeletal symptoms in the past year, most commonly in the lower back (65%), followed by shoulder (52%), neck (40%), knee (36%), hand/wrist (27%), hip/thigh (22%), foot/ankle (21%), upper back (21%), and elbow (10%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and anthropometric data of all EMTs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll EMTs\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigher-scoring\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLower-scoring\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003evalue\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.12 (4.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.18 (5.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.17 (3.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.048*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173.97 (4.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173.50 (4.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e174.40 (4.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77.71 (10.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.66 (10.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79.63 (9.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85.71 (9.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.29 (9.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e87.93 (9.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99.01 (5.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.78 (6.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.13 (5.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eW/H ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.86 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.85 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.88 (0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.037*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFMS\u0026trade; score (/21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.01 (2.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.36 (1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.81 (1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNMQ injured sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.96 (2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.80 (2.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.11 (2.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e*p\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as significant\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD\u0026thinsp;=\u0026thinsp;Standard deviation, W/H ratio\u0026thinsp;=\u0026thinsp;waist\u0026ndash;hip ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on the total FMS\u0026trade; score, 44 participants (48%) were categorized as higher-scoring (HS, \u0026gt;\u0026thinsp;14), and 47 (52%) as lower-scoring (LS, \u0026le;\u0026thinsp;14). Each group included one female participant, and no gender differences were found between groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.962). The basic characteristics of the two groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The LS group was significantly younger and had greater waist circumference and waist-to-hip ratio than the HS group (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As expected, the LS group had a significantly lower total FMS\u0026trade; score than the HS group, with a mean difference of 4.55 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the number of injured sites reported did not differ between the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.552).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFunctional movement patterns\u003c/h2\u003e \u003cp\u003eThe LS group scored significantly lower on the total FMS\u0026trade; score and six of the seven subtests: deep squat, in-line lunge, shoulder mobility, active straight-leg raise, push-up, and rotary stability compared to the HS group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was also a trend of poorer performance in the hurdle step for the LS group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.050), though it did not reach statistical significance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of FMS\u0026trade; of all participants, and between the higher-scoring and lower-scoring groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eAll EMTs\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eHigher-scoring\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e \u003cp\u003eLower-scoring\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep Squat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHurdle Step\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-line Lunge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder Mobility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive Straight-leg Raise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePush-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRotary Stability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003e\u003cem\u003e*p\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePhysical functions\u003c/h2\u003e \u003cp\u003eThere were no significant differences between the groups in maximal muscle strength or core stability (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The LS group performed significantly worse on the sit-and-reach test (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) and had reduced straight-leg raise range of the left leg (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020) compared to the HS group. Right hamstrings flexibility was also lower, though not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.117). No group difference was observed in shoulder mobility and agility performance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of strength, flexibility, core stability, and agility between the higher-scoring and lower-scoring groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher-scoring\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower-scoring\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean difference (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eMuscle strength (%Body weight)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder flexors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.61 (0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.57 (0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03 (-0.03, 0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder abductors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.55 (0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.51 (0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04 (-0.01, 0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow flexors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.77 (0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81 (0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.03 (-0.14, 0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.49 (0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01 (-0.30, 0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip flexors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.65 (0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68 (0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01 (-0.06, 0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.74 (0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68 (0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06 (-0.01, 0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip abductors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.71 (0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69 (0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01 (-0.06, 0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnee flexors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.56 (0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55(0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01 (-0.05, 0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnee extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.77 (0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78 (0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.01 (-0.10, 0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrip strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.65 (0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02 (-0.03, 0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCore stability (sec)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBack extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105.43 (43.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.81 (46.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.62 (-10.29, 27.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal muscles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.69 (43.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.81 (50.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.89 (-12.93, 26.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFlexibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder circumduction (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.74 (16.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.09 (14.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.35 (-10.01, 3.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSit and reach test\u003c/p\u003e \u003cp\u003e(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.74 (8.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.36 (8.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.39 (2.71, 10.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSLR of right leg (degree)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.48 (20.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.06 (11.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.41 (-1.39, 12.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSLR of left leg\u003c/p\u003e \u003cp\u003e(degree)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.72 (20.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.28 (13.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.44 (1.36, 15.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.020*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgility T test (sec)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.50 (1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.68 (2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.18 (0.010, 0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003e*p\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as significant\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eSD\u0026thinsp;=\u0026thinsp;Standard deviation, SLR\u0026thinsp;=\u0026thinsp;straight leg raises\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of dynamic balance, assessed using the YBT, are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The LS group demonstrated significantly shorter reach distances than the HS group for both legs in nearly all directions and for the composite score (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), except for the posterolateral direction of the right leg (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.082).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of dynamic balance between the higher-scoring and lower-scoring groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher-scoring\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower-scoring\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean difference (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003cp\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight leg\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.70 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05 (0.01, 0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostomedial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16 (0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05 (0.01, 0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostolateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17 (0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13 (0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04 (-0.00, 0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98 (0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05 (0.01, 0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeft leg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.70 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05 (0.02, 0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostomedial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17 (0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.12 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05 (0.00, 0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.032*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostolateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.14 (0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07 (0.03, 0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.03 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06 (0.02, 0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eFunctional Movement Screen is a valuable and widely used tool to assess dysfunctional movement patterns, and it has been used in various populations to screen for musculoskeletal injury risk. This study assessed the functional movement patterns in the EMTs using the FMS\u0026trade;, and is the first to investigate its associations with different physical functions. The current results demonstrated that the average FMS\u0026trade; score was 14.01, with 52% of the participants scoring\u0026thinsp;\u0026le;\u0026thinsp;14, indicating a higher risk of musculoskeletal injury. Those EMTs identified with higher injury risk had significantly poorer functional movement patterns, lower trunk flexibility, and dynamic balance than those with lower injury risk but no differences in muscle strength, core stability, or agility.\u003c/p\u003e \u003cp\u003eEMTs face a significantly higher risk of occupational injury and fatality compared to other occupations \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Studies indicate that an FMS\u0026trade; score\u0026thinsp;\u0026le;\u0026thinsp;14 is associated with an increased risk of musculoskeletal injuries in various groups, including athletes, firefighters, and military personnel \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In this study, the average FMS\u0026trade; score for EMTs was 14.01, aligning with a prior study of emergency medical service professionals with a median score of about 14 \u003csup\u003e50\u003c/sup\u003e. A 2019 meta-analysis found that FMS\u0026trade; scores in tactical occupations ranged from 14.5 to 16.6 \u003csup\u003e24\u003c/sup\u003e, while two recent studies reported average scores of 12 in Chinese police officers and firefighters \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. These differences may result from variations in age, gender, work experience, workload, physical activity, and previous injuries \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Over half of the participants (52%) in this study had an FMS\u0026trade; score\u0026thinsp;\u0026le;\u0026thinsp;14, consistent with previous findings in EMTs and firefighters that roughly half had FMS\u0026trade; scores at or below this threshold \u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. These findings highlight the need for screening and early intervention in tactical populations, necessitating urgent attention to safeguard their occupational health.\u003c/p\u003e \u003cp\u003eEMTs with a lower FMS\u0026trade; score in this study showed significantly poorer dynamic balance and lower trunk flexibility than those at lower risk of injury, while muscle strength, core stability, and agility were similar between groups. These results support previous studies linking decreased hamstring flexibility to low back pain, which was the most commonly reported injury (65%) in this study \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Overexertion during patient handling and hazardous biomechanical tasks such as lifting or pulling heavy loads from low heights further emphasize the need for adequate flexibility in EMTs \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study is the first to assess balance in EMTs, showing significantly poorer dynamic balance among individuals with a higher risk of injury. Loss of balance is a critical factor in injury events among emergency medical service workers, who frequently operate on uneven surfaces, navigate stairs, and work in confined or dimly lit environments \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. The results are consistent with studies showing poorer balance in athletes and firefighter trainees with FMS\u0026trade; scores\u0026thinsp;\u0026le;\u0026thinsp;14 \u003csup\u003e11,32\u003c/sup\u003e. These findings highlight the importance of dynamic balance and movement pattern evaluations for EMTs to mitigate their high risk of musculoskeletal injuries.\u003c/p\u003e \u003cp\u003eThis study revealed that EMTs in the LS group were younger and had higher body weight and waist-to-hip ratio than those in the HS group. while previous studies have linked lower FMS\u0026trade; scores to higher body mass index or fat mass \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, our finding that younger EMTs had greater injury risk contrasts with studies associating lower FMS\u0026trade; scores with older age \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. This inconsistency may reflect differences in sample characteristics or experience levels, as shown by Krysak et al., who found older professional golfers performed better in movement and balance than younger golfers at various levels \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNo significant differences in muscle strength, core stability, or agility were found between groups in this study, suggesting these factors may not directly relate to injury risk as measured by FMS\u0026trade;. Similar results have been reported in collegiate athletes, showing no correlations between the FMS\u0026trade; scores and strength or athletic performance \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e. Conversely, some studies reported associations with strength, plank endurance, agility, or running speed in firefighter trainees and youth populations \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. These inconclusive findings highlight the need for cautious interpretation, especially where factors such as biological maturation and skill levels are unaccounted for.\u003c/p\u003e \u003cp\u003eFunctional movement training and corrective exercises have been shown to improve functional movement patterns and potentially reduce injury risk \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Unlike traditional strength training, which targets maximal strength and power through single-joint loading, functional movement training emphasizes multi-joint coordination, balance between joint mobility and stability, and proper motor control across various postures under unstable conditions. This approach is often lacking in current EMTs training programs, where resistance training with progressive loading aimed at muscle strength predominates. Future research is needed to evaluate the effects of functional movement training on FMS\u0026trade; scores, physical functions like balance and flexibility, and injury prevention in EMTs.\u003c/p\u003e \u003cp\u003eThis study identified functional movement impairments in Taiwanese EMTs but has several limitations. The ability of FMS\u0026trade; scores to reliably predict future injuries remains uncertain, as some studies, including Supples et al., found limited or no predictability for injuries in EMTs over one to two years \u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. The commonly used cutoff score of \u0026le;\u0026thinsp;14 requires further validation. The predominantly male participant group (only two females) limits the generalizability. Only muscle strength, flexibility, balance, and agility were assessed, leaving other important physical functions, such as aerobic fitness and muscle power, unexplored. The cross-sectional design further limits conclusions on causality between functional movement patterns and physical function. Future research should involve randomized controlled trials and use larger and more diverse samples, as well as longitudinal designs to better assess injury risk and intervention effects in EMTs.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite the high prevalence of musculoskeletal injuries reported among EMTs, studies focusing on the evaluation, management, and prevention of these injuries are limited. This study demonstrated that EMTs exhibited deficits in functional movement patterns, as assessed by the FMS\u0026trade;, with those scoring lower (indicating higher injury risk) showing poorer dynamic balance and reduced trunk flexibility compared to those with higher scores. These findings suggest that establishing a protocol for early detection of potential occupational injury during regular training or continuing education, incorporating comprehensive assessments of functional movement patterns and balance, and implementing effective intervention or training programs should be prioritized to enhance the occupational health of EMTs.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003eEMTs Emergency medical technicians\u003c/p\u003e \u003cp\u003eFMS\u0026trade; Functional Movement Screen\u003c/p\u003e \u003cp\u003eNMQ Nordic Musculoskeletal Questionnaire\u003c/p\u003e \u003cp\u003eYBT Y-Balance Test\u003c/p\u003e \u003cp\u003eLS Lower-scoring\u003c/p\u003e \u003cp\u003eHS Higher-scoring\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e Ethical approval was obtained from the Institutional Review Board of National Cheng Kung University Hospital (A-ER-105-335). The requirement for informed consent was waived by the ethics committee because the study involved secondary analysis of de-identified data. This study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by National Cheng Kung University Hospital and the Ministry of Science and Technology, Taiwan (grants NCKUH-10603002 and NSTC 113-2410-H-006-098-MY2)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the conception and design of the study. KCC was responsible for data collection. YJT and KCC were responsible for analysis and interpretation of the data. YJT was responsible for drafting the manuscript. YJT, HIS, KCC and HCH made important intellectual contributions to the content of the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAl-Yousef HNM, Awada W, Michailidou E. Fitness characteristics of Jordanian emergency medical technicians. Adv J Emerg Med. 2019;3(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAwini AB, Opoku DA, Ayisi-Boateng NK, et al. Prevalence and determinants of occupational injuries among emergency medical technicians in Northern Ghana. PLoS ONE. 2023;18(4):e0284943.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonazza NA, Smuin D, Onks CA, Silvis ML, Dhawan A. Reliability, validity, and injury predictive value of the functional movement screen: a systematic review and meta-analysis. Am J Sports Med. 2017;45(3):725\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrice JH, Studnek JR, Bigham BL et al. EMS provider and patient safety during response and transport: proceedings of an ambulance safety conference. \u003cem\u003ePrehospital Emergency Care\u003c/em\u003e. 2012;16(1):3\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eButler RJ, Contreras M, Burton LC, Plisky PJ, Goode A, Kiesel K. Modifiable risk factors predict injuries in firefighters during training academies. Work. 2013;46(1):11\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChorba RS, Chorba DJ, Bouillon LE, Overmyer CA, Landis JA. Use of a functional movement screening tool to determine injury risk in female collegiate athletes. North Am J sports Phys therapy: NAJSPT. 2010;5(2):47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook G. Functional movement screening: the use of fundamental movements as an assessment of function\u0026ndash;part 1. Int J Sports Phys Therapy. 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook G. Functional movement screening: the use of fundamental movements as an assessment of function-part 2. Int J sports Phys therapy. 2014;9(4):549.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function\u0026ndash;part 1. 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Prehosp Disaster Med. 2016;31(5):505\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Postural Balance, Movement, Physical Fitness, Occupational Injuries, Paramedics","lastPublishedDoi":"10.21203/rs.3.rs-8371191/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8371191/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe purpose of this study was to examine functional movement patterns and physical functions, including strength, flexibility, balance, and agility in emergency medical technicians (EMTs), and to explore their associations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study recruited 91 EMTs from the Bureau of Fire in Tainan, Taiwan. Functional movement patterns were assessed using the Functional Movement Screen (FMS\u0026trade;). Muscle strength and flexibility of the upper and lower extremities and core stability were assessed using a hand-held dynamometer and clinical tests. The dynamic balance ability of each leg was assessed using the Y balance test, and agility was assessed using the agility T-test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe average FMS\u0026trade; score for all EMTs was 14.1, and 44 participants (48%) were classified as the higher-scoring group (FMS\u0026trade; score higher than 14), and 47 (52%) were the lower-scoring group (FMS\u0026trade; score 14 or less). The lower-scoring group exhibited significantly poorer fundamental movement patterns, reduced lower body flexibility, and impaired dynamic balance compared to the higher-scoring group. No differences were observed in muscle strength for the upper and lower extremities, core stability, shoulder mobility, and agility.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe current results indicate that EMTs present with impaired functional movement patterns, with lower FMS\u0026trade; performance associated with limited lower body mobility and reduced dynamic balance ability. These findings support the need for intervention strategies targeting movement quality to preserve occupational health in those EMTs.\u003c/p\u003e","manuscriptTitle":"Emergency Medical Technicians with Impaired Functional Movement Patterns have Poorer Dynamic Balance and Muscle Flexibility: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 07:14:00","doi":"10.21203/rs.3.rs-8371191/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-03T04:42:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-27T14:45:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-15T13:42:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-11T07:06:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125740378578324642721494771176740204069","date":"2026-01-11T06:56:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93676434953170349585429662195524549149","date":"2026-01-09T17:22:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319241178204238180629027888213775560839","date":"2026-01-08T23:47:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T12:07:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-19T08:56:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-17T09:50:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-17T09:49:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2025-12-16T02:56:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03eb6116-0d2a-43b5-8dc4-cd5af96bb7a1","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-26T07:55:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 07:14:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8371191","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8371191","identity":"rs-8371191","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}