Pain-Free ≠ Risk-Free: What Movement Screening Is Really Telling Us #musculoskeletal injury risk assessment

Musculoskeletal injury is one of the most common, costly, and persistent challenges across military, athletic, and clinical populations. And yet, we continue to rely on pain as the primary gatekeeper for progress, discharge, or readiness.

But here’s the uncomfortable truth: Pain-free movement doesn’t mean optimal function.

And it certainly doesn’t mean low injury risk.

🚨 The Research Speaks: Movement Matters

A growing body of research—spanning military soldiers, rehabilitation cohorts, and clinical populations—shows that movement-based assessments like the Selective Functional Movement Assessment (SFMA) are uncovering what pain-centric assessments miss.

Let’s look at five recent studies that paint a clear picture about musculoskeletal injury risk assessment:

1. Teyhen et al. (2020)

In a prospective cohort of active-duty soldiers, just one painful movement was associated with a significantly increased risk of musculoskeletal injury in the following year.📈 Each additional painful pattern increased the odds.

2. Emberton et al. (2024) – Prevalence of Pain With Movement

This large-scale screening found that 59% of uninjured, active-duty soldiers reported pain with at least one movement—even though they were deemed “healthy” by standard metrics.

Pain-free status didn’t match movement-based pain.

3. Emberton et al. (Military Med, 2024)

In another related study, 99% of soldiers discharged from rehab had at least one dysfunctional movement pattern. Nearly half still experienced pain during these functional screens.

This is critical: we’re releasing people to duty, sport, or life while underlying risk remains.

4. Kiesel et al. (2024) – Risk Factors Review

Identified 11+ modifiable risk factors for MSK dysfunction, most of which can be picked up in structured movement assessments like the SFMA.

The gap isn’t in knowing what the risks are—it's whether we screen for them at all.

5. Matsel et al. (2023) – Predictive Value of Movement Tests

Validated the ability of movement-based screens to forecast future non-contact injury in otherwise asymptomatic individuals.

🧠 What This Means for Clinicians

If you’re discharging clients based on pain resolution alone, you’re discharging them into risk.

Structured movement assessments like the SFMA provide a layer of clinical insight that bridges the gap between pain and performance. They reveal:

• Underlying motor control deficits

• Mobility restrictions masked by compensation

• Pain behaviors that emerge only under load or complexity

This is not just about athletes or soldiers. It applies to everyday people too—desk-bound office workers, post-op patients, weekend warriors. Movement reflects function, and function predicts durability.

🛠️ Time to shift your standard when it comes to musculoskeletal injury risk assessment

Pain-free is the starting line, not the finish.Functional, pain-free movement—evaluated within a system—is what readiness truly looks like.

The SFMA is not a replacement for clinical reasoning. It’s a framework to direct it, refine it, and make it more predictive.

🔍 Final Thought

If we want to reduce re-injury, improve return-to-sport rates, and finally get in front of MSK health, we need to stop asking:

“Does it hurt?”

And start asking:

“Can you move well, without pain, across fundamental patterns?”

Because the research is now clear: Movement tells the truth—even when pain is silent.

The next SFMA course in Australia is part of the regional roadshow, to get world-class evidence-based movement assessment to those who used to have to drive or fly a long way to study and learn. It's time to level up and go to where you are - SFMA Level 1 Maitland, August 23-24, 2025 - places very limited - register now.

References

• Emberton, J. S., Adams, B. G., Hotaling, B. R., Zosel, K. L., Grist, S. M., Henderson, N., Kardouni, J., & Westrick, R. B. (2024a). Prevalence of pain with movement in active duty US Army soldiers. Military Medicine, 189(7–8), e1523. https://doi.org/10.1093/milmed/usae048

• Emberton, J. S., Adams, B. G., Kardouni, J., Westrick, R. B., et al. (2024b). Recovery, rehabilitation, and return to full duty after musculoskeletal injury. Military Medicine. [Exact citation details to be inserted when available.]

• Kiesel, K., Matsel, K., Bullock, G. S., et al. (2024). Risk factors for musculoskeletal health: A review of the literature and clinical application. International Journal of Sports Physical Therapy, 19(10), 1234–1250. https://doi.org/10.26603/ijspt20240123485

• Matsel, K., Kirsch, J., Netelbeek, T., et al. (2023). Use of movement-based tests for the prediction of non-contact low back injuries in uninjured military personnel: A six-month prospective cohort study. International Journal of Sports Physical Therapy, 18(7), 1450–1461. https://doi.org/10.26603/001c.XXXXXX

• Teyhen, D. S., Rhon, D. I., Shaffer, S. W., Goffar, S. L., Kiesel, K., Butler, R. J., & Plisky, P. J. (2020). Identification of risk factors prospectively associated with musculoskeletal injury in a warrior athlete population. Sports Health, 12(6), 564–572. https://doi.org/10.1177/1941738120902991