Functional movement screen and Y balance tests in adolescent footballers with hip/groin symptoms

Core stability is associated with dynamic postural balance in soccer players experiencing groin pain without time-loss

Objectives

The study sought to evaluate possible relationships between dynamic postural balance and pain, core stability, and hip range of motion in soccer players who were experiencing groin pain (GP). Furthermore, the study aimed to compare these measurements in symptomatic and asymptomatic players.

Methods

The study included 42 male soccer players experiencing GP and an equal number of asymptomatic players. Dynamic postural balance, pain, hip range of motion and trunk endurance were measured.

Results

The GP group revealed reduced dynamic balance performance (p < 0.01-0.001) in injured and non-injured limbs compared to control group. Further, players experiencing GP demonstrated lower hip range of motion in internal (p < 0.05) and total rotations (p < 0.01) in the injured limb, and lower trunk endurance (p < 0.001) compared to their asymptomatic peers. In general, core stability was associated (r = 0.13-0.61, p < 0.05-0.001) with the poor dynamic balance performance in the GP group while standing on injured and non-injured limbs. No significant correlations between dynamic postural balance, pain and hip range of motion were observed.

Conclusion

Poor core endurance was found to be associated with dynamic balance disorders in soccer players experiencing GP. This information can aid in the development of targeted strategies to enhance dynamic postural balance in these players.

Pilot Study: The Relationship between Foot Posture and Movement Quality in Non-Professional Male Football Players

(1) Background: This study focusses on establishing the relationship between quality of movement (based on the functional movement screen, or FMS) and foot posture (based on the foot posture index, or FPI-6). We hypothesised that a poor FMS test score may be derived from the foot position in the space measured by FPI-6. (2) Methods: a quasi-experimental and cross-sectional study was designed to analyse foot posture in 30 healthy football players, using the foot posture index and the functional movement screen. (3) Results: No significant relationships were found between movement quality and foot posture. Poor movement quality is present in more than half of all foot positions, supination, pronation, and neutral. Good quality seems to be more associated with a neutral foot position (23.3%) and supinated (16.6%) than a pronated foot position (6.6%). (4) Conclusions: this study found no relationship between the two tests; therefore, we cannot demonstrate that foot posture is relevant in the quality of the movement of the football players studied.

Postural balance asymmetry and subsequent noncontact lower extremity musculoskeletal injuries among Tunisian soccer players with groin pain: A prospective case control study

BACKGROUND

Recent studies reported postural balance disorders in patients and soccer players with groin pain (GP) compared to controls. Since postural balance asymmetry identified after an initial injury contributes for subsequent injuries, identification of this asymmetry in soccer players with GP may highlight the risk of sustaining subsequent noncontact lower extremity musculoskeletal injuries in these players. Therefore, the aims of this study were to (i) examine static and dynamic unipedal postural balance asymmetry in soccer players with GP compared to healthy ones, and (ii) quantify the risk of subsequent noncontact lower extremity injuries in these players.

RESEARCH QUESTION

Do soccer players with GP exhibit higher static and dynamic unipedal postural balance asymmetry, and higher risk of sustaining subsequent injuries compared to controls?

METHODS

In this prospective case control study, 27 soccer players with non-time loss GP (GP group: GPG), and 27 healthy ones (control group: CG) were enrolled. Static and dynamic unipedal postural balance asymmetry were evaluated with a force platform using symmetry index (SI), and Y-balance test (Y-BT), respectively. Additionally, subsequent noncontact lower extremity musculoskeletal injuries were tracked for 10 months.

RESULTS

The GPG revealed higher (p < 0.01) SI in eyes closed condition, higher (p < 0.001) side-to-side asymmetry in anterior, posteromedial and posterolateral reach distances and in composite Y-BT score compared to CG. They showed lower (p < 0.001) composite score for injured limb and higher (p < 0.001) side-to-side asymmetry in posteromedial reach distance compared to the cut-off values of 89.6 % and 4 cm, respectively. Moreover, GPG exhibited higher odds (OR= 7.48; 95 % CI = 2.15, 26.00; p < 0.01) of sustaining subsequent injuries compared to CG.

SIGNIFICANCE

The Y-BT should be instituted into existing pre-participation physical examinations to screen for soccer players with non-time loss GP at an elevated risk of sustaining subsequent injuries. This could help coaches and clinicians make valid return to play decisions.

The relationship between the Functional Movement Screen and the Y Balance Test in youth footballers

Background

The Functional Movement Screen (FMS) and the Y Balance Test (Y-BT) are screening tools to detect movement deficits and to identify footballers at high risk of injury. If these tools are able to identify athletes with high risk of injury, they should measure the same construct and also be highly correlated.

Objectives

The aim of the study was to determine the relationship between the FMS and Y-BT in youth footballers. The present study also aimed to assess the degree of association between the FMS and Y-BT considering high-injury-risk (FMS <= 14 points and Y-BT <= 89.6%) and low-injury-risk groups (FMS > 14 points and Y-BT > 89.6%).

Method

A sample of 226 healthy athletes (mean age: 14.0 ± 2.3 years) was selected from a football club. The FMS and Y-BT data were collected from all participants. The Y-BT raw data were normalised to the relative length of the lower limbs. Spearman's correlation was used in the analysis.

Results

For the whole group, there was a moderate correlation (R = 0.41; p < 0.001) between the composite FMS score and composite Y-BT score. The strength of relationships varied from weak to moderate between the FMS subtests and most Y-BT results for each direction. In the high-injury-risk group, there was no correlation (R = 0.11; p = 0.61) between the composite FMS score and composite Y-BT score. For the low-injury-risk group, there was a weak significant correlation (R = 0.27; p < 0.007) between the composite FMS score and composite Y-BT score. Additionally, 56 and 53 athletes were classified to the high-injury-risk group based on the FMS and Y-BT, respectively. Only 23 athletes were classified to the high-risk group by both tests.

Conclusions

Youth footballers showed only weak to moderate correlations between the FMS and the Y-BT. Footballers classified in the high-injury-risk group based on the FMS and Y-BT presented a different relationship between the FMS and Y-BT tasks compared to the low-injury-risk group. The results confirmed that the FMS and Y-BT should not be used interchangeably as they assess different movement deficits in the group of youth football players. The study results may partially suggest that using one of these screening tools cannot successfully predict injury risk in adolescent football players. This justifies the need to use these tests simultaneously to identify possible neuromuscular control deficits in youth footballers.

Relationships between Functional Movement Quality and Sprint and Jump Performance in Female Youth Soccer Athletes of Team China

This study aimed to determine the optimal functional movement screen (FMS) cut score for assessing the risk of sport injury, and to investigate the correlations between functional movement quality and sprint and jump performance. Twenty-four (N = 24) athletes performed all tests in one day at 10−30 min intervals, and the FMS test was performed first, without a warm-up session. After a standard warm-up, athletes then completed the Y-balance Test (YBT), sprint, counter-movement jump (CMJ), and standing long jump (SLJ), in turn. For each test, the best of three attempts was recorded for further analysis. A receiver operating characteristic (ROC) curve and area-under-the-curve (AUC) were used to determine the optimal FMS cut score for assessing the risk of sport injuries, and Spearman’s rank correlation analysis was used to quantify associations between functional movement scores and athletic performance. The average FMS score was 16.2 and the optimal FMS cut score for assessing the risk of sport injuries was 14.5. There were moderate relationships between total FMS score and 10−20 m sprint time (r = −0.46, p < 0.05), between In-line Lunge and 0−20 m sprint time (r = −0.47, p < 0.05), between Shoulder Mobility and 0−10 m sprint time (r = −0.48, p < 0.05), and between Trunk-stability Push-up and 10−20 m sprint time (r = −0.47, p < 0.05). Moreover, Hurdle Step score was largely correlated with 0−10 m time (r = −0.51, p < 0.05). For Y-balance, moderate correlations were observed between CMJ height and anterior asymmetry score (r = −0.47, p < 0.05) and posteromedial asymmetry score (r = −0.44, p < 0.05). However, there were no significant associations between YBT performance (asymmetric in three directions and composite score) and sprint performance (p > 0.05). Taken together, the results indicate that a FMS score of 14 is not a gold standard for assessing the risk of injury in all populations; we recommend that the FMS cut score of 14.5 should be the optimal score for assessing risk of injury in young female elite soccer players. Moreover, the FMS and YBT were introduced to assess the quality of functional movements, and they cannot be used to assess sprint and jump performance. Practitioners can use components of the FMS that have similar characteristics to specific sports to assess athletic performance.

Ultrasound Shear Modulus and Thickness of Lateral Abdominal Muscles in Different Contractile States in Relation to Self‐ Reported Hip/Groin Problems in Youth Soccer Players

To date, no studies have assessed lateral abdominal muscles’ (LAM) elasticity and thickness in relation to hip and groin symptoms in any population. The objectives were to a) assess the relationship between LAM ultrasound measurements (elasticity and thickness) and self-reported subscales of the Copenhagen Hip and Groin Outcome Score (HAGOS) and b) compare LAM elasticity and thickness between asymptomatic and symptomatic sides. Shear modulus and thickness of the oblique external (OE), internal (OI) and transversus abdominis (TrA) muscles in 25 young soccer players were assessed at rest and during isometric contraction using ultrasound shear wave elastography. HAGOS subscales were used to assess self-reported hip/groin problems. There was a significant (p < 0.05) moderate correlation between allometric-scaled OI resting thickness (mean of right and left) and the Activities of Daily Living (r = 0.40), Sport (r = 0.57) and Quality of Life (QOL) (r = 0.41) HAGOS subscales. Also, a moderate significant correlation was found between allometric-scaled TrA resting thickness and the QOL subscale (r = 0.47). Moderate correlations were found between resting OI shear modulus and the QOL (r = 0.44), between right TrA shear modulus during contraction and Symptoms (r = 0.57), and between the left TrA shear modulus during contraction and Physical Activity (r = 0.41) subscales. No differences were found between the symptomatic and asymptomatic side in thickness and elasticity measurements among soccer players with unilateral symptoms (p > 0.05). The relationships found between LAM and hip/groin problems in youth male soccer players indicate that muscles are thinner and more elastic (less stiff) in more symptomatic athletes.

Assessment of Dysfunctional Movements and Asymmetries in Children and Adolescents Using the Functional Movement Screen-A Narrative Review

The Functional Movement Screen (FMS) is a screening tool that identifies dysfunctional movements in seven test items requiring an interplay of cognitive, perceptual, proprioceptive, and motor functions that involve muscular strength/endurance, flexibility, mobility, coordination, and balance. The results of the FMS include an overall composite score, scores on the individual test items, and identification of compensatory movement patterns and left-right asymmetries on 5 bilateral test items. Although there is a plethora of literature on the use of the FMS in adults, there is a growing body of evidence indicating its use in children. The available research in children involves school children and young athletes in at least 20 different sports in over 20 countries and comparisons between pre- and post-pubescent children, and normal weight, overweight, and obese children. Studies that include measures of adiposity and physical activity levels, or report prevalence of asymmetries and dysfunctional movement patterns are not well represented in the children’s literature. The purpose of this paper is to synthesize the currently available literature in children and suggest potential uses of the FMS by coaches, physical educators, and other health/fitness professionals, appropriate interpretation of results, and future research in children.

Long-standing pubic-related groin pain in professional academy soccer players: a prospective cohort study on possible risk factors, rehabilitation and return to play

Background

Despite being a common overuse entity in youth soccer, scientific data on risk factors, rehabilitation and return to play for long-standing pubic-related groin pain is still rare. The current prospective cohort study aims to evaluate potential risk-factors, propose a criteria-based conservative rehabilitation protocol and assess return-to-play outcomes among professional youth soccer players suffering from long-standing pubic-related groin pain.

Methods

Male soccer players with long-standing (> 6 weeks) pubic-related groin pain from a professional soccer club’s youth academy were analyzed for possible risk factors such as age, team (U12 - U23), younger/older age group within the team, position and preinjury Functional movement score. All injured players received a conservative, standardized, supervised, criteria-based, 6-level rehabilitation program. Outcome measures included time to return to play, recurrent groin pain in the follow-up period and clinical results at final follow-up two years after their return to play.

Results

A total of 14 out of 189 players developed long-standing pubic-related groin pain in the 2017/2018 season (incidence 7.4%). The average age of the players at the time of the injury was 16.1 ± 1.9 years. Risk factor analysis revealed a significant influence of the age group within the team (p = .007). Only players in the younger age group were affected by long-standing pubic-related groin pain, mainly in the first part of the season. Injured players successfully returned to play after an average period of 135.3 ± 83.9 days. Only one player experienced a recurrence of nonspecific symptoms (7.1%) within the follow-up period. The outcome at the 24-month follow-up was excellent for all 14 players.

Conclusions

Long-standing pubic-related groin pain is an overuse entity with a markedly high prevalence in youth soccer players, resulting in a relevant loss of time in training and match play. In particular, the youngest players in each team are at an elevated risk. Applying a criteria-based rehabilitation protocol resulted in an excellent return-to-play rate, with a very low probability of recurrence.

Trial registration

The trial was retrospectively registered under DRKS00016510 in the German Clinical Trials Register on 19.04.2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04837-x.

Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity

BACKGROUND

Deficits in dynamic neuromuscular control have been associated with post-injury sequelae and increased injury risk. The Y-Balance Test Lower Quarter (YBT-LQ) has emerged as a tool to identify these deficits.

PURPOSE

To review the reliability of the YBT-LQ, determine if performance on the YBT-LQ varies among populations (i.e., sex, sport/activity, and competition level), and to determine the injury risk identification validity of the YBT-LQ based on asymmetry, individual reach direction performance, or composite score.

STUDY DESIGN

Systematic Review.

METHODS

A comprehensive search was performed of 10 online databases from inception to October 30, 2019. Only studies that tested dynamic single leg balance using the YBT-LQ were included. Studies were excluded if the Y-Balance Test kit was not utilized during testing or if there was a major deviation from the Y-Balance test procedure. For methodological quality assessment, the modified Downs and Black scale and the Newcastle-Ottawa Scale were used.

RESULTS

Fifty-seven studies (four in multiple categories) were included with nine studies assessing reliability, 36 assessing population differences, and 16 assessing injury prediction were included. Intra-rater reliability ranged from 0.85-0.91. Sex differences were observed in the posteromedial direction (males: 109.6 [95%CI 107.4-111.8]; females: 102.3 [95%CI 97.2-107.4; p = 0.01]) and posterolateral direction (males: 107.0 [95%CI 105.0-109.1]; females: 102.0 [95%CI 97.8-106.2]). However, no difference was observed between sexes in the anterior reach direction (males: 71.9 [95%CI 69.5-74.5]; females: 70.8 [95%CI 65.7-75.9]; p=0.708). Differences in composite score were noted between soccer (97.6; 95%CI 95.9-99.3) and basketball (92.8; 95%CI 90.4-95.3; p <0.01), and baseball (97.4; 95%CI 94.6-100.2) and basketball (92.8; 95%CI 90.4-95.3; p=0.02). Given the heterogeneity of injury prediction studies, a meta-analysis of these data was not possible. Three of the 13 studies reported a relationship between anterior reach asymmetry reach and injury risk, three of 10 studies for posteromedial and posterolateral reach asymmetry, and one of 13 studies reported relationship with composite reach asymmetry.

CONCLUSIONS

There was moderate to high quality evidence demonstrating that the YBT-LQ is a reliable dynamic neuromuscular control test. Significant differences in sex and sport were observed. If general cut points (i.e., not population specific) are used, the YBT-LQ may not be predictive of injury. Clinical population specific requirements (e.g., age, sex, sport/activity) should be considered when interpreting YBT-LQ performance, particularly when used to identify risk factors for injury.

LEVEL OF EVIDENCE

1b.

Postural balance impairment in Tunisian second division soccer players with groin pain: A case-control study

OBJECTIVE

To compare postural balance outcomes between soccer players with and without groin pain (GP).

DESIGN

Case-control study.

SETTING

Laboratory.

PARTICIPANTS

Fifty-four soccer players, 27 with GP (GP group: GPG) and 27 healthy ones (control group: CG).

MAIN OUTCOME MEASURES

Static and dynamic postural balance were assessed with a force platform and Y-balance test (Y-BT), respectively. Hip abduction, internal rotation (IR), external rotation (ER) and total rotation (TR) of both limbs were evaluated.

RESULTS

The GPG exhibited significant higher centre of pressure values in the bipedal posture only on the foam surface in eyes opened and closed compared to controls. Besides, they had lower anterior, posteromedial and posterolateral reach distances and composite Y-BT score on the injured limb (IL) compared to non-injured limb (NIL) and dominant-limb (DL) of the CG. Moreover, they showed lower abduction, IR, ER, and TR on the IL compared to NIL and DL.

CONCLUSIONS

Dynamic unipedal postural balance disorder could be one of the limiting factors of performance in soccer players with non-time loss GP. Hence, postural balance data in these players could enable sport coaches and physical therapists to better understand the mechanisms contributing for performance decrease.

Assessment of the Relationship between Y-Balance Test and Stabilometric Parameters in Youth Footballers

Objectives

The purpose of the study was to evaluate the correlation between dynamic test results obtained on a stabilometric platform and the results achieved on the Y-balance test (Y-BT).

Method

The study group consisted of 52 adolescent athletes, aged 14 to 17 years. Each participant was evaluated in the scope of their ability to maintain dynamic balance using the Y-BT as well as via dynamic tests on the ‘Alfa' stabilometric platform. The following parameters were analysed: (a) from the Y-BT—relative reach of the right and left lower limbs in the anterior, posterolateral, and posteromedial directions, as well as the side-to side difference in relative reach for each direction and (b) from the ‘Alfa' platform—path length and time to reach the target using right and left lower limbs in the anterior and posterior directions.

Results

A correlation between the results obtained on the stabilometric platform and the Y-BT was found only for the posteromedial direction. Statistical analysis demonstrated that the increased difference between the right and left lower limbs in the posteromedial test is related to an increase in time taken to reach the points located forward and to the left, and backwards and to the right, as well as an increase in the overall time required to complete the task on the stabilometric platform.

Conclusions

The results from the Y-BT and stabilometric platform are weakly related in adolescents. These findings indicate that the Y-BT and stabilometric platform analyse different kinds of dynamic balance in adolescents. Thus, these tools should not be used interchangeably in clinical practice or scientific research.