Little associations exist between the three commonly used functional screening tests in collegiate athletes

Although an abundant number of studies have investigated the predictability of the commonly used functional screening tests and despite their popularity and applicability, the relationships between these tests have rarely been studied and have not been well established. This study aimed to examine the potential association between the Functional Movement Screen (FMS), Y Balance Test (YBT), and Landing Error Scoring System (LESS). Six hundred twenty-seven Iranian collegiate athletes (347 males, age = 22.63 ± 4.07, weight = 75.98 ± 13.79, height = 181.99 ± 10.15, BMI = 22.84 ± 3.16; and 280 females, age = 22.22 ± 3.37, weight = 60.63 ± 9.58, height = 166.55 ± 6.49, BMI = 21.81 ± 2.84) participated in this study. Following a 5-min warm-up, each participant underwent a standardized screening battery including the FMS, YBT, and LESS, and the scores were recorded and live coded for the statistical analysis, except for the LESS. The LESS tests were video recorded and scored by one expert examiner using an open-source 2D video analysis software (Kinovea- version 0.9.5), afterwards. The Spearman correlation was utilized as a measure for the correlation, and the Mann‒Whitney U test with a significance level of 0.05 was used to check the differences between male and female athletes. The statistical analysis was performed with RStudio 2023.03.0 using R 4.3.1. A small correlation (0.364) was observed between the FMS composite score and the YBT in male athletes. All other pairwise correlations were negligible among male and female athletes, ranging from - 0.096 to 0.294. Reducing the FMS to the component scores targeting the lower extremities did not alter the correlation to the other screening scores. The median FMS composite score in female athletes was significantly higher than that in males (p < 0.001). Negligible correlations exist between the FMS, LESS, and YBT; they do not measure the same values and therefore are irreplaceable with one another. A combination of these tests as a standardized screening battery may potentially better identify injury-predisposed athletes than the application of each test as a stand-alone screening test. Females outperformed males in the FMS test significantly, so sex must be considered a key variable in the FMS studies. Males had slightly higher LESS scores (median difference = 0.5) than females, but this difference is not clinically meaningful. Future research should continue to explore the relationships between various functional screening tests and identify the most effective combinations for comprehensive assessment in different populations and sports disciplines.

Lower Quarter Y-Balance Test Anterior Reach Asymmetry and Noncontact Lower Limb Injury in Subelite Young Male Soccer Players With Different Training Experiences

Poor single-leg balance performance is associated with an increased risk of sustaining lower limb injuries in team sports. However, it is unclear whether this relationship is modified by the level of training experience (years of training experience). The objective of the present study was to evaluate whether soccer players’ single-leg balance performance is related to lower limb injuries in noncontact situations with different levels of training experience. Subelite young male soccer players performed the Lower Quarter Y-Balance Test with the dominant and the nondominant leg at the beginning of the preseason. Due to COVID-19 rules, the occurrence of lower limb injuries during the second half of the competitive season was documented. The odds of injury were calculated based on a previously reported Lower Quarter Y-Balance Test cut-off score for side-to-side anterior reach difference (≥4 cm). Twelve soccer players sustained a lower leg injury in noncontact situations. Only four of them had an anterior reach difference equal to or above the cut-off score. Soccer training experience has no significant influence on the association between Lower Quarter Y-Balance Test anterior reach asymmetry and noncontact lower limb injury in young male players.

Correlations Between Preseason Functional Test Scores and Game Performance in Female Collegiate Volleyball Players

Background

Functional tests (FT) are assessment tools that attempt to evaluate balance, flexibility, strength, power, speed, or agility through performance of gross motor skills. FT are frequently administered by coaches or sports medicine professionals to evaluate athletic ability, to predict performance, to identify athletes at risk for injury, or to evaluate an athlete's ability to return to sport after injury. Functional tests which can provide accurate or predictive information regarding athletic ability would be advantageous to coaching staffs or medical professionals.

Purpose

The primary purpose of this study was to identify correlations between preseason FT scores and in-season game statistics in a cohort of female collegiate level volleyball (VB) players. A secondary purpose was to present FT descriptive data for this cohort based on level of competition, player position, and starter status.

Study Design

prospective cohort; correlational.

Methods

One hundred and thirty-one female collegiate VB players representing three levels of competition completed four FT [standing long jump (SLJ), single-leg hop (SLH), lower extremity functional test (LEFT), and the Y-Balance Test - Lower Quarter (YBT-LQ)] at the start of the preseason. Player statistics were collected from team records at the completion of the season.

Results

Starters performed significantly better on all tests. There were moderate negative correlations between LEFT scores and game statistics for liberos, defensive specialists, and outside hitters. There were moderate positive correlations between YBT-LQ composite scores and game statistics for liberos, defensive specialists, hitters, and middle blockers. There were also low to moderate level positive correlations between SLJ and SLH scores and game performance for outside hitters. There were low to moderate level positive correlations between SLH scores and game performance for middle blockers and opposite side hitters.

Conclusions

The results of this study indicate that there are low to moderate correlations between some preseason functional test scores and some game statistics. The SLJ, SLH, LEFT, and YBT-LQ tests may help coaches with talent identification and/or may influence training strategies.

Level of Evidence

3.

Intra-rater Reliability of a Qualitative Landing Scale for the Single-Hop Test: A Pilot Study

Background

The test battery classically used for return-to-sport (RTS) decision-making after anterior cruciate ligament (ACL) reconstruction (ACLR) may not be sufficient, as it does not include a qualitative analysis of movement. Therefore, the Landing Error Scoring System (LESS) scale was adapted to a primary functional test in the typical RTS test battery: the single leg hop for distance (SHD).

Hypothesis/ Purpose

The aim of this study was to determine the intra-rater reliability of the LESS scale adapted to the SHD (SHD-LESS scale) in healthy young athletes.

Study Design

Reliability analysis.

Methods

Nineteen healthy individuals (14 men, 5 women; mean age: 22.4 years) participated in the study. Participants performed the SHD tasks on both limbs (dominant and non-dominant) using a standardized protocol in two sessions that were one week apart (single reviewer; 2-dimensional video). Intra-class correlation coefficients (ICC2,1) were used to measure the reproducibility of the scale in the dominant (dom) and non-dominant (nondom) limbs. Additionally, limb data (dom and nondom) were pooled and evaluated collectively with intra-class correlation coefficients. The Kappa coefficient was used to assess the reproducibility of each individual item of SHD-LESS scale.

Results

The intra-rater reliability was good (ICCdom = 0.77; ICCnondom = 0.87; ICCpooled = 0.87) for the overall SHD-LESS scale scores. Agreement of SHD-LESS individual items ranged from 62% to 100%. Dorsiflexion at initial contact (97% agreement; kappa value=0.79) and knee valgus after landing (88% agreement; kappa value=0.65) had excellent agreement and kappa values.

Conclusion

The newly-adapted SHD-LESS scale showed good intra-rater reliability overall. Further studies should evaluate the impact of using the SHD-LESS scale within the RTS test battery on outcomes in patients after ACLR.

Level of Evidence

3.

Current and Future Trends in Strength and Conditioning for Female Athletes

Participation by female athletes in competitive sport has increased dramatically since the inception of Title IX, although female athletes are represented significantly less than their male counterparts in strength and conditioning (S&C) literature. This is apparent when examining current identified trends in the field, such as implementation of blood flow restriction (BFR) training, functional assessments to predict injuries, or the ever-increasing use of technology in sports. The aim of this review is to examine three prevalent trends in contemporary S&C literature as they relate to female athletes in order to expose areas lacking in research. We conducted journal and database searches to progressively deepen our examination of available research, starting first with broad emerging themes within S&C, followed next by an inquiry into literature concerning S&C practices in females, ending finally with a review of emerging topics concerning female athletes. To this end, 534 articles were reviewed from PubMed, Academic Search Complete, Google Scholar, CINAHL, MEDLINE, and Web of Science. Results demonstrate the utility of implementing BFR, functional movement assessments, and various technologies among this population to expand representation of female athletes in S&C literature, improve athletic capabilities and performance, and decrease potential for injury over time.

Preseason functional tests discriminate injury risk in female collegiate volleyball players

OBJECTIVE

Preseason functional tests have been previously associated with noncontact time-loss lower extremity injuries in a variety of athletic populations. This study aimed to determine the effectiveness of one or more functional tests to discriminate injury risk in a cohort of female collegiate volleyball players in the United States.

DESIGN

Prospective cohort study.

SETTING

National Collegiate Athletic Association Division II & III, National Association of Intercollegiate Athletics female volleyball players; PARTICIPANTS: 130 female volleyball players (mean age: 19.31 ± 1.1 years).

MAIN OUTCOME MEASURE

Lower extremity functional test, single limb hop for distance, standing long jump, previous injury history, lower quarter Y-balance test, and limb symmetry index were measured prior to the season beginning. Noncontact time-loss lower quarter injuries were tracked during the season.

RESULTS

Athletes with suboptimal scores on the single limb hop test (<70% of height) and standing long jump (<80% of height), combined with a previous history of injury, were three times more likely to sustain an injury during the season (OR = 3.0; 95% CI: 1.09 to 8.30). Individual functional tests did not discriminate injury risk.

CONCLUSIONS

A battery of preseason functional tests and injury history discriminates injury risk in female collegiate volleyball players.

The Test Re-Test Reliability of A Novel Single Leg Hop Test (T-Drill Hop Test)

BACKGROUND

Functional training and testing are an important part of a comprehensive rehabilitation program stressing the neuromuscular system in ways that simulate athletic performance to help determine criteria for return to sport. There are numerous single leg hop tests that have been used for these purposes, however, the validity and clinical relevance has been questioned. Many of the functional performance tests assess only the sagittal plane or forward direction and may only partially assess a person's athletic abilities. There is a need for reliable and valid functional tests to assess in a multi-directional manner.

PURPOSE/HYPOTHESIS

The purpose of this study is to determine the test re-test reliability of a novel multi-directional timed single leg hop test (T-Drill Hop Test) for use in rehabilitation and performance assessments.

STUDY DESIGN

Cross-sectional reliability study.

METHODS

Fifty healthy recreationally active college age subjects, (23 males and 27 females) between the ages of 18 and 35, (mean age 23.48 with SD 3.82) consented to perform the test. The subjects hopped along a 10ft. x 10ft. "T" shaped course. Subjects performed two timed maximum effort trials of the T-Drill Hop Test on each leg with an interval of 3-7 days between the two testing days. Intraclass Correlation Coefficients (ICC) were calculated to determine intersession reliability.

RESULTS

The inter-rater reliability (ICC's) for the entire group of 50 subjects ranged between .98 and 1.00 suggesting excellent reliability. The bilateral comparison, utilizing paired t-tests, of the T-Drill Hop Test demonstrated no significant differences between the time scores for the dominant and non-dominant legs for either males or females (p>.05).

CONCLUSION

This study demonstrates the T-Drill Hop Test has excellent test re-test reliability. These results are important prior to validation and utilization as a clinical functional performance test.

LEVELS OF EVIDENCE

Level 2.

Noncontact Knee Ligament Injury Prevention Screening in Netball: A Clinical Commentary with Clinical Practice Suggestions for Community-Level Players

Netball is a predominantly female team court-sport which is played worldwide. Netball is becoming more popular in the United States following its countrywide introduction to schools and community centers. A unique characteristic of netball is the footwork rule which restricts players to a one-step landing after catching the ball. Most netball landings are single-leg landings resulting in high vertical ground reaction forces and high skeletal tissue forces. Thus, high-risk landing events that have the biomechanical potential for injury occur frequently. Noncontact knee ligament injuries are common following a knee abduction collapse when landing. Because the consequences of noncontact knee ligament injury are profound, strategies are needed to mitigate the burden of such injury for players, teams, and society. The purpose of this clinical commentary is to demonstrate how theoretical principles, different types of research, and different levels of evidence underpin a rational clinical reasoning process for developing noncontact knee ligament injury prevention screening procedures in netball. The theoretical principles that are discussed in this commentary include injury control, the sequence of prevention, principles of screening in injury prevention, the multifactorial model of injury etiology, complex systems theory, and systems science. The different types of research that are reviewed include descriptive and analytic-observational studies. The different levels of evidence that are discussed include prospective studies, cross-sectional studies, and clinicians' own kinesiological modelling. Subsequently, an integrated approach to the evidence-informed development of noncontact knee ligament injury prevention screening procedures is presented. Clinical practice suggestions include a selection of evidence-informed screening tests that are quickly and easily implemented with netball players in local communities. The need for repeated screening at strategic timepoints across a season/year is explained. Sports physical therapists will find this commentary useful as an example for how to undertake clinical reasoning processes that justify the content of screening procedures contributing to noncontact knee ligament injury prevention in community-level netball.

LEVEL OF EVIDENCE

5.

Single-leg hop distance normalized to body height is associated with the return to sports after anterior cruciate ligament reconstruction

Purpose

To investigate the relationship between single-leg hop distance (SLHD), normalized body height, and return-to-sports (RTS) status after anterior cruciate ligament reconstruction (ACLR) and to identify the cut-off value for SLHD on the operated side.

Methods

Seventy-three patients after primary ACLR (median 13.5 months) participated in this cross-sectional study. Participants were divided into ‘‘Yes-RTS’’ (YRTS) or ‘‘No-RTS’’ (NRTS) groups based on a self-reported questionnaire. SLHD was measured, and the limb symmetry index (LSI) and SLHD (%body height) were calculated. A minimum p-value approach was used to calculate the SLHD cut-off points (%body height) on the operated side that were strongly associated with the RTS status. Logistic regression analysis was used to analyse the association between RTS status and SLHD cut-off point (%body height). Isokinetic strength and Tampa scale for kinesiophobia (TSK) were measured as covariates.

Results

Among 73 patients, 43 (59%) were assigned to the YRTS and 30 (41%) to the NRTS group. The 70% body height cut-off point for SLHD on the operated side was most strongly associated with RTS status. In a logistic regression analysis including other covariates, SLHD (%body height) < 70% and TSK were negatively associated with RTS status. Except for two participants, the LSI of the SLHD exceeded 90% and there was no significant association between the LSI of the SLHD and RTS status.

Conclusion

Even after improvement in the LSI of the SLHD, planning rehabilitation with the goal of achieving SLHD over 70% body height may be important for supporting RTS after ACLR.

Level of evidence

Cross-sectional study, Level IV

Relationship Between 3 Single-Leg Functional Performance Tests for Netball Noncontact Knee Injury Prevention Screening in Uninjured Female Adult Players

CONTEXT

Single- versus double-leg landing events occur the majority of the time in a netball match. Landings are involved in large proportions of netball noncontact knee injury events. Of all landing-induced anterior cruciate ligament injuries, most occur during single-leg landings. Knowledge of whether different single-leg functional performance tests capture the same or different aspects of lower-limb motor performance will therefore inform clinicians' reasoning processes and assist in netball noncontact knee injury prevention screening.

OBJECTIVE

To determine the correlation between the triple hop for distance (THD), single hop for distance (SHD), and vertical hop (VH) for the right and left lower limbs in adult female netball players.

DESIGN

Cross-sectional.

SETTING

Local community netball club.

PARTICIPANTS

A total of 23 players (age 28.7 [6.2] y; height 171.6 [7.0] cm; mass 68.2 [9.8] kg).

INTERVENTIONS

There were 3 measured trials (right and left) for THD, SHD, and VH, respectively.

MAIN OUTCOME MEASURES

Mean hop distance (percentage of leg length [%LL]), Pearson intertest correlation (r), and coefficient of determination (r2).

RESULTS

Values (right and left; mean [SD]) were as follows: THD, 508.5 (71.8) %LL and 510.9 (56.7) %LL; SHD, 183.4 (24.6) %LL and 183.0 (21.5) %LL; and VH, 21.3 (5.2) %LL and 20.6 (5.0) %LL. All correlations were significant (P ≤ .05), r/r2 values (right and left) were THD-SHD, .91/.83 and .87/.76; THD-VH, .59/.35 and .51/.26; and SHD-VH, .50/.25 and .37/.17. A very large proportion of variance (76%-83%) was shared between the THD and SHD. A small proportion of variance was shared between the THD and VH (25%-35%) and SHD and VH (17%-25%).

CONCLUSION

The THD and SHD capture highly similar aspects of lower-limb motor performance. In contrast, the VH captures aspects of lower-limb motor performance different to the THD or SHD. Either the THD or the SHD can be chosen for use within netball knee injury prevention screening protocols according to which is reasoned as most appropriate at a specific point in time. The VH, however, should be employed consistently alongside rather than in place of the THD or SHD.

Does Mental Fatigue Negatively Affect Outcomes of Functional Performance Tests?

PURPOSE

Mental fatigue impairs psychomotor skill performance by affecting visuomotor reaction time, accuracy, and decision-making. Recently, neurocognitive functional performance tests (FPT) that integrate these outcomes have been developed. The aim of this study was to assess the effect of mental fatigue on traditional and neurocognitive FPT in healthy adults.

METHODS

Fourteen volunteers (four women; mean ± SD age, 22 ± 1 yr; height, 176.9 ± 8.4 cm; weight, 69.7 ± 10.4 kg) participated in a randomized counterbalanced crossover design. A 100% incongruent Stroop color word test of 90 min was used to induce mental fatigue and the control task encompassed watching a 90-min documentary. Traditional FPT comprised a single-leg hop for distance, countermovement jump, and Y-balance test, whereas the neurocognitive FPT encompassed the reactive balance test (RBT). All FPTs were evaluated pre-post the 90-min task. Mental fatigue was assessed using the Stroop task, visual analog scale for mental fatigue, and the Eriksen-Flanker task.

RESULTS

Mental fatigue was successfully induced, as shown by a significant increase in visual analog scale for mental fatigue (P < 0.001), with no decrease in performance on the Stroop and Eriksen-Flanker task. No interaction effect of mental fatigue was found for the Y-balance test, single-leg hop, and countermovement jump. For the RBT accuracy, a significant interaction effect of mental fatigue and time was observed (P = 0.024), with participants performing significantly worse when mentally fatigued. No interaction effect or main effect of condition and time was observed when considering the effect of mental fatigue on visuomotor reaction time in the RBT.

CONCLUSIONS

Mental fatigue negatively affects a neurocognitive FPT, indicated by a decreased accuracy in response to visual stimuli in the RBT. Traditional FPT remained unaffected by mental fatigue.

Practicability of lower extremity functional performance tests and their measurement properties in elite athletes: protocol for a systematic review

INTRODUCTION

Lower extremity injury (LEI) is highly prevalent and its occurrence increases the risk of future injury in athletic populations. Identifying athletes at risk of injury is the key to target injury-prevention programmes. Functional performance tests (FPT) assess an athlete's ability to produce and accept forces during movement tasks reflective of those experienced in sport, and are used to identify deficits in physical qualities or neuromuscular control. This review aims to identify FPT which have potential to predict LEI and assess their measurement properties associated with reliability, validity, responsiveness and practicability (interpretability and feasibility).

METHODS/ANALYSIS

This protocol will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol and the COnsensus-based Standards for the selection of health Measurement INstruments Methodology. The search strategy has two stages: stage 1 will identify lower limb FPT used in athletic populations; and stage 2 will assess the measurement properties of the identified FPT. A sensitive search strategy will use MEDLINE, EMBASE, CINHAL and SPORTdiscus databases; from inception to June 2020. Hand searching reference lists, key journals and grey literature will be completed. One reviewer will complete search 1 and data extraction. Two reviewers will complete the search, data extraction and risk-of-bias assessment for search 2. Evidence will be pooled or summarised by individual measurement property by each individual study and grouped by FPT. Meta-analysis using a random effects model with subgroup analysis will be performed where possible. Pooled or summarised results for each FPT in relation to each measurement property will be rated against the criteria for good measurement properties. Two reviewers will assess the overall body of evidence per measurement property per FPT using the modified Grading of Recommendations, Assessment, Development and Evaluation guidelines. This review will enable clinicians to make an informed choice when selecting FPT.

ETHICS AND DISSEMINATION

No ethical approval is required for this review and the results will be disseminated through peer-reviewed publications and submitted for conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42020188932.

Utility of Kinetic and Kinematic Jumping and Landing Variables as Predictors of Injury Risk: A Systematic Review

Purpose

Jump-landing assessments provide a means to quantify an individual’s ability to attenuate ground reaction forces, generate lower limb explosive power and maintain joint alignment. In order to identify risk factors that can be targeted through appropriate training interventions, it is necessary to establish which (scalar) objective kinetic, kinematic, and performance measures are most associated with lower-extremity injury.

Methods

Online searches of MEDLINE, SCOPUS, EBSCOHost, SPORTDiscus and PubMed databases were completed for all articles published before March 2020 in accordance with PRISMA guidelines.

Results

40 articles investigating nine jump-landing assessments were included in this review. The 79% of studies using drop jump (n = 14) observed an association with future injury, while only 8% of countermovement jump studies (n = 13) observed an association with injury risk. The 57% of studies using unilateral assessments found associations with risk of injury (n = 14). Studies using performance measures (jump height/distance) as outcome measure were only associated with injury risk in 30% of cases. However, those using kinetic and/or kinematic analyses (knee abduction moment, knee valgus angle, knee separation distance, peak ground reaction force) found associations with injury in 89% of studies.

Conclusion

The landing element of jump-landing assessments appears to be superior for identifying individuals at greater risk of injury; likely due to a closer representation of the injury mechanism. Consequently, jump-landing assessments that involve attenuation of impact forces such as the drop jump appear most suited for this purpose but should involve assessment of frontal plane knee motion and ground reaction forces.

The Association Between the Single Leg Hop Test and Lower-Extremity Injuries in Female Athletes: A Critically Appraised Topic

Clinical Scenario: Female college student-athletes (SA) often experience time loss from musculoskeletal injuries to the lower extremities. This can lead to lengthy rehabilitation, expensive medical bills, and declines in health-related quality of life. Identifying at-risk athletes prior to the start of an athletic season may allow coaches or athletic trainers to prescribe an injury prevention program. Clinical Question: In female college SA, are preseason single leg hop (SLH) scores associated with identifying those at risk for lower-extremity musculoskeletal injuries? Summary of Key Findings: Five prospective cohort studies in female SA scored athletes on the SLH prior to the start of the athletic sport season. One of 5 studies found an association of SLH with injury risk. An additional 2 studies found that the SLH as part of a battery of functional performance tests was associated with injury risk in some anatomic locations (eg, thigh/knee), but not overall injury risk. Clinical Bottom Line: Methodological limitations of the reviewed studies limits a final conclusion, and there is insufficient evidence to determine if the SLH should be used as a sole functional performance test to identify at-risk female SA; it may be useful as part of a battery of functional performance tests for female college SA. Strength of Recommendation: All studies were prospective cohort studies (level 3).

Development of Concise Physical Performance Test Batteries in Young Athletes

PURPOSE

This study aimed 1) to define the principal components of physical function assessed by 10 common lower extremity physical performance tests and 2) to derive a reduced-item set of physical performance tests that efficiently and accurately measures raw performance and limb symmetry on each underlying component in pediatric and adolescent athletes.

METHODS

This study included healthy, uninjured volunteers (n = 100) between the ages 6 and 18 yr (mean age = 11.7 ± 3.6 yr; 52 females). Subjects performed the stork balance, stork balance on BOSU® Balance Trainer, single leg squat (SLS), SLS on BOSU, clockwise and counterclockwise quadrant single leg hop (SLH), forward SLH, timed SLH, triple crossover SLH, and lower quarter Y-Balance Test™. Item reduction was performed using principal components analysis (PCA). We developed separate principal components analysis for average raw performance and side-to-side limb symmetry, with secondary analyses to evaluate consistency of results by age and sex.

RESULTS

We identified two components for average raw performance (accounting for 65.2% of the variance in total test battery) with a reduced-item set composed of five tests, and four components for limb symmetry (accounting for 62.9% of the variance in total test battery) with a reduced-item set of seven tests. The most parsimonious test suitable for screening both average raw performance and limb symmetry would consist of five tests (stork balance on BOSU, SLS on BOSU, forward SLH, timed SLH, and lower quarter Y-Balance Test™). Age- and sex-specific test batteries may be warranted.

CONCLUSION

Comprehensive screening for lower extremity average raw performance and limb symmetry is possible with short physical performance test batteries.

Off-Season Training Habits and BMI, Not Preseason Jump Measures, Are Associated with Time-Loss Injury in Female Collegiate Soccer Players

The primary purpose of this study was to determine the effectiveness of the standing long jump (SLJ) and the single-leg hop (SLH) tests to discriminate lower quadrant (low back and lower extremities) injury occurrence in female collegiate soccer players. The secondary purpose of this study was to determine associations between injury and off-season training habits or anthropometric measures. SLJ, SLH, and anthropometric measures were collected during a preseason screening clinic. Each subject completed a questionnaire providing demographic information and off-season training habits. Each athlete performed three SLJ and three SLH per leg. SLJ and SLH scores were not associated with an increased risk of a noncontact time-loss lower quadrant (LQ) injury. Athletes with a higher BMI or who reported less time training during the off-season were two times more likely to sustain an injury. Athletes who had both a higher body mass index (BMI) and lower off-season training habits were three times (relative risk = 3.1 (95% CI: 1.7, 5.5) p-value = 0.0001) more likely to sustain a noncontact time-loss lower quadrant injury. Preseason SLJ and SLH scores do not discriminate injury risk in female collegiate soccer players. Higher BMI and lower off-season training habits are associated with an increased risk of LQ injury.

Preseason Functional Performance Test Measures Are Associated With Injury in Female College Volleyball Players

Context:Preseason functional performance test measures have been associated with noncontact time-loss injury in some athletic populations. However, findings have been equivocal with many studies consisting of heterogeneous populations.Objective:To determine if preseason standing long jump and/or single-leg hop test scores are associated with a noncontact time-loss injury to the lower quadrant (LQ = low back or lower-extremities) in female Division III college volleyball (VB) players.Design:Prospective cohort study.Setting:National Collegiate Athletic Association Division III female VB teams.Patients:A total of 82 female college VB players (age = 18.9 [1.0] y).Main Outcome Measures:Standing long jump and single-leg hop test measures were collected at the start of the official preseason. Athletic trainers tracked all time-loss injuries and their mechanisms. Athletes were categorized as at risk if their preseason standing long jump <80% height, bilateral single-leg hop <70% height, and had a SLH side-to-side asymmetry >10%.Results:The noncontact time-loss overall injury rate for the LQ region in at-risk athletes was 13.5 (95% confidence interval [CI], 4.3–31.5) per 1000 athletic exposures. At-risk athletes were significantly more likely to experience a noncontact time-loss injury than VB players in the referent group (rate ratio = 6.2; 95% CI, 1.9–17.2;P = .008). The relative risk of sustaining a noncontact time-loss injury to the LQ was 4 times greater in the at-risk group (relative risk = 4.6; 95% CI, 2.1–10.1;P = .01). At-risk athletes were 6 times more likely to experience a foot or ankle injury (relative risk = 6.3; 95% CI, 2.1–19.2;P = .008).Conclusion:Suboptimal performance on a battery of functional performance tests is associated with a significantly greater risk of noncontact time-loss injury to the LQ in female Division III college VB players.

Y-Balance Test Performance Does Not Determine Non-Contact Lower Quadrant Injury in Collegiate American Football Players

Collegiate American football has a high rate of injury. The Lower Quarter Y-Balance Test (YBT-LQ), a dynamic assessment of lower extremity strength, mobility, and balance, has been purported to identify athletes at risk for injury in different sports including football. Previous studies examining the association between YBT-LQ and injury have reported varied findings; therefore, the purpose of this study was to assess if preseason YBT-LQ performance predicted whether football players would sustain a non-contact lower extremity or low back (lower quarter (LQ)) injury during the season. Fifty-nine male collegiate American football players (age 20.8 ± 1.3 y, height 1.8 ± 0.1 m, body mass 94.6 ± 14.2 kg) completed a survey of training and injury history and had their YBT-LQ performance assessed at the start of the season. Athletic training staff tracked the occurrence of non-contact LQ injuries during the season. There were no significant relationships found between preseason YBT-LQ values and incidence of non-contact LQ injury in this population of collegiate American football players. This study is consistent with recent reports that have not found a significant association between preseason YBT-LQ values and LQ injury. These results suggest that, in isolation, the YBT-LQ may have limited utility as a screening test for non-contact injury in collegiate football players.

Prior history of anterior cruciate ligament (ACL) reconstruction is associated with a greater risk of subsequent ACL injury in female collegiate athletes

OBJECTIVES

The risk of a subsequent anterior cruciate ligament (ACL) sprain is greater in high school aged female athletes with prior history of ACL reconstruction (ACLR) than in age-matched controls. The risk of a subsequent ACL injury in female collegiate athletes with prior ACLR is unknown. The primary purpose of this study was to determine the relative risk of a subsequent ACL injury in female collegiate athletes with prior ACLR when compared to age-matched controls. The secondary purpose of this study was to evaluate the ability of jump and hop tests to discriminate ACL injury risk.

DESIGN

Prospective cohort.

METHODS

Three hundred and sixty female collegiate athletes (mean age 19.3 ± 1.4 years) representing the following sports: volleyball, soccer, and basketball were recruited. Subjects reported prior history of ACLR and standing long jump (SLJ) and single-leg hop (SLH) scores were collected during the preseason. Noncontact time-loss ACL and lower quadrant (i.e., low back and lower extremities) injuries were tracked by university athletic trainers.

RESULTS

Female collegiate athletes with a prior history of ACLR were 6 times (RR = 6.8 [95% CI: 1.4, 32.9] p-value = 0.007) more likely to experience an ACL injury than controls. Suboptimal performance on a battery of tests (SLJ ≤ 79% height, (B) SLH ≤ 69% height) was associated with a greater risk of lower quadrant injury (RR = 1.6 [95% CI: 1.1, 2.4] p-value = 0.028); however performance on these tests was not associated with ACL injury.

CONCLUSIONS

Female collegiate athletes should be screened for history of ACLR.