Utility of FMS to understand injury incidence in sports: current perspectives

Deep squat test - Functional movement Screen: Convergent validity and ability to discriminate subjects with different levels of joint mobility

BACKGROUND

Functional Movement Screen (FMS) is an important tool in the assessment of exercise practice. Assuming FMS lacks precise validity for assessing postural deficits, further research is needed to assess whether it is a sufficiently precise tool for analysing joint mobility. Research aims were to evaluate: convergent validity of Deep Squat (DS) - one of FMS tests - regarding joint mobility, using data from a three-dimensional motion analysis as a comparable method; DS's ability to discriminate between subjects with different joint mobility levels.

METHODS

Sixty subjects were selected (23.6 ± 3.8 years). DS was performed according to FMS guidelines. Subjects' performance in frontal and sagittal planes was recorded by two video cameras and subsequently scored by two FMS-certified evaluators. Three-dimensional motion analyses of DS were acquired by a Vicon Motion Capture System (200 Hz). Ten trials were acquired for each subject. Ankle, knee, hip, and shoulder angular positions in sagittal plane were determined from the FullBody PlugInGait model. Spearman's coefficient examined the correlation between angular positions and DS score. Kruskal-Wallis test was used to assess the DS ability to discriminate between subjects with different joint mobility levels by comparing different scores.

RESULTS

Negligible to moderate correlations were found between DS score and angular positions (-0.5 < r < 0.5). Only shoulder angular positions showed differences between score "1" and "2" (p < 0.05). Shoulder and hip angular positions showed no differences between score "2" and "3" (p < 0.05).

CONCLUSIONS

DS yielded low convergent validity regarding joint mobility and did not show the ability to discriminate between subjects with different joint mobility levels.

Influence of Body Composition on Functional Movement Among Police Officers

Research indicates that the Functional Movement Screen (FMS) can be used to measure functional movement quality and characterize musculoskeletal injury risk in tactical populations. Although body composition has been linked to chronic disease in police officers, the link between body composition and functional movement quality has not been explored in this population. As such, the purposes of the study were to examine: (a) the effect of body mass index (BMI) on functional movement, and (b) determine the significance of fat mass (FM) and fat free mass (FFM) in predicting functional movement among active-duty police officers. Thirty-five active- duty police officers (31 male, 4 female; mean ±SD, age: 33.4 ±9.4 years, height: 177.4 ± 8.0 cm, weight: 88.4 ± 15.3 kg) were recruited to participate in this study, as part of a larger study on police fitness. All demographic data, BMI, FM, FFM, and FMS composite score (FMS CS) were obtained over two data collection sessions. With age held as a significant covariate, the results of the one-way ANCOVA revealed no significant effect of BMI category on FMS CS (p = 0.077). The linear regression analysis results suggest that FM and FFM contributed 36.9% variance in FMS CS while controlling for age (p < 0.001). FM was a significant individual predictor of FMS CS (p < 0.001), while FFM was not a significant individual predictor of FMS CS (p = 0.111). The current results reinforce the importance of police officers body composition management for health and functional movement quality across a career.

Markerless vision-based functional movement screening movements evaluation with deep neural networks

The functional movement screen (FMS) test is a seven-test battery used to assess fundamental movement abilities of individuals. It is commonly used to predict sports injuries but relies on clinical expertise and is not suitable for self-examination. This study presents an automatic FMS movement assessment framework using a multi-view deep neural network called MVDNN. The framework combines automatic skeleton extraction with manual feature selection to extract 3D trajectory features of human skeleton joints from two different directions. Three mainstream methods of time-series modeling are then used to learn high-level feature representation from skeleton sequences, and motion features from two views are fused to provide complementary information. Results of public FMS movements dataset demonstrate that our MVDNN outperforms current state-of-the-art methods with an average miF1 score of 0.857, maF1 score of 0.768, and Kappa score of 0.640 over ten runs.

Inter-Rater and Test-Retest Reliability of an Innovative Evaluation Tool: CrossFit Functional Assessment Battery of Tests for the Shoulder Joint

Background and objectives This study aims to introduce an innovative functional assessment tool designed for CrossFit athletes, to identify a high risk of injury at the shoulder joint. Additionally, the study seeks to examine both inter-rater reliability, which was tested in 40 CrossFit participants, and test-retest reliability, which was assessed in twenty subjects. Methodology CrossFit Functional Assessment Battery for the Shoulder Joint (CrossFit FABS) is a newly created instrument presented for the first time. The evaluation of the performance of its six items aimed to reveal deficits that could contribute to incidents of shoulder injuries. For this purpose, 40 healthy CrossFit participants were concurrently but independently examined by two raters, and twenty healthy adults active in sports were assessed by the main investigator at two different time points. Cohen's kappa coefficient was used to analyze categorical data with an ordinal structure. Results Inter-rater reliability ranged from 0.824 to 1 (P = 0.000) and test-retest reliability was 0.661 to 0.906 (P < 0.001) for each test of CrossFit FABS. A strong to almost perfect correlation was demonstrated for all the variables between the two examiners. Moderate to almost perfect correlation was shown through test-retest procedures. Conclusions The proposed test battery was established as a reliable tool for evaluating performance routines that represent high injury-risk elements for the shoulder joint in CrossFit athletes.

Well-being as a performance pillar: a holistic approach for monitoring tennis players

This perspective article aims to discuss the usefulness of tools that can assist tennis professionals effectively manage the well-being of their players. This includes identifying and monitoring meaningful metrics (i.e., training load, training intensity, heart rate variability), as well as careful planning of training and competition schedules with appropriate recovery periods. The use of innovative training methods (i.e., repeated-sprint training in hypoxia and heat training), and proper dietary practices, along with biometric assessment for young players, represents should be considered. Adopting a holistic approach to decision-making about training and competition, balancing both health and performance considerations, is crucial for tennis players and their support teams. More research is needed to refine best practices for enhancing tennis performance while prioritizing the well-being of players.

Recreational windsurfing-related acute injuries: a narrative review. Part 2: injury prevention and a proposal for a set of potential prevention strategies with a holistic approach

Objective

The purpose of this review was to identify existing prevention strategies for recreational windsurfing-related acute injuries and provide clinicians with a practical overview of current evidence supporting proposed potential prevention strategies.

Methods

A literature search was conducted through March 8, 2023, using relevant keywords with Boolean operators, such as "windsurfing" AND "injury prevention" and "windsurfing" AND "exercise interventions," from the PubMed and Google Scholar databases. Only peer-reviewed English-articles were included.

Results

Existing prevention strategies, right-of-way rules, a new proposed set of eight potential primary to tertiary prevention strategies for windsurfing-related acute injuries, and proposed definitions of injury prevention levels equivalent to Haddon's matrix were identified and tabled.

Conclusions

The proposed potential prevention strategies may facilitate clinicians in preventing recreational windsurfing-related acute injuries. Injury prevention for recreational windsurfing is under-researched. Future studies should focus on large prospective clinical trials evaluating the efficacy of prevention strategies for recreational windsurfing-related injuries.

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.

The Functional Movement Screen: Exploring Interrater Reliability between Raters in the Updated Version

Background

The Functional Movement Screen™ (FMS™) was updated by adding the ankle clearing test and modifying the rotary stability movement pattern and scoring criteria. This updated FMS™ may be used to support clinical decisions for the well-being of athletes and active adults.

Purpose

The purpose of this study was to determine if the updated FMS™ has acceptable interrater reliability, so that various practitioners can utilize it with their patients.

Study Design

Observational Laboratory Study.

Methods

Two licensed Physical Therapists (PTs) conducted the testing for the study. No warmup was allowed for the participants. Each participant underwent one FMS™ session while being recorded on video lasting approximately 15 minutes. Participants were allowed three attempts to complete each movement pattern with the best score recorded. The participants, 45 healthy active PT students, were taken through the FMS™ by a licensed PT and videotaped. The raters were four second-year PT students that observed and scored the FMS independently after videotaping was completed. SPSS was used for the interrater reliability analysis. ICC was calculated using a 2-way mixed model looking for absolute agreement.

Results

The interrater reliability was highest for the rotary stability test (ICC 0.96) while the deep squat was the least reliable (ICC 0.78). The total scores showed excellent reliability among the four student raters with an ICC of 0.95. The updated FMS™ produced good to excellent interrater reliability.

Conclusion

The updated FMS™ has acceptable interrater reliability between minimally, but adequately trained individuals. The updated FMS™ may be reliably used to assess risk for future injury.

Level of Evidence

3.

Using the Y-balance Test as a Predictor Tool for Evaluating Non-contact Injuries in University League Football Players: A Prospective Longitudinal Study

Background Football is a highly competitive sport, and participants can experience various contact and non-contact sports injuries in the sporting process. In any elite sport, screening players using different scientific tools is an important injury prevention strategy. The Y- Balance test (YBT) was found to be a predictive tool for non-contact injury. However, the use of criteria from these tests to predict injuries has not been substantiated and should be further investigated. Purpose The aim of this study was to determine the predictors for injury among athletes using baseline YBT, number of matches, and minutes of physical activity; the cutoff scores for predictors of injury, including baseline YBT, number of matches, and minutes of physical activity; and the clinical prediction rules for predicting injury in this population. Methods A total of 39 young student football players were included in this study. The mean age was 20.28 years, and the mean body mass index (BMI) was 23.83 kg/m². A baseline assessment of the participant's characteristics was taken and each participant performed the YBT once before starting the league. After the university league football players had finished their tournament, we asked them questions related to non-contact injuries. Results The results showed that the prevalence of injury was 17.95% among this population. An increase in the YBT score was significantly associated with a decrease in the odds of having an injury [odds ratio (OR) 95% confidence interval (CI): 0.94 (0.88, 0.99), p = 0.047). In addition, the number of matches was significantly associated with an increase in the odds of having an injury p = 0.012. However, the minutes of physical activity were not statistically significant p = 0.065. The highest Youden index was ≤97.89, with a sensitivity of 87.50% and specificity of 71.43%, for the posterior medial reach and ≤92.88, with a sensitivity of 90.62% and specificity of 57.14%, for the posterior lateral reach. The clinical prediction rule was an area under the curve (AUC) of 0.88. Conclusions The results of the study provide evidence for the potential utility of the YBT as a predictor tool for evaluating non-contact injuries in university league football players. By identifying players with lower YBT scores who were at higher risk for injury, targeted interventions could be implemented to address functional movement deficits and potentially reduce injury risk.

Dynamic valgus knee revealed with single leg jump tests in soccer players

BACKGROUND

Dynamic valgus knee occurs in sports that involve jumps and landing such as soccer and pose an increased risk for anterior cruciate ligament injury. Visual estimation is biased by the athlete's body type, the experience of the evaluator and the movement phase at which the valgus is assessed - thus the result is highly variable. The aim of our study was to accurately assess dynamic knee positions during single and double leg tests through a video-based movement analysis system.

METHODS

Young soccer players (U15, N.=22) performed single leg squat, single leg jump, and double leg jump tests while the knee medio-lateral movement was monitored with a Kinect Azure camera. Jumping and landing phases of the movement were determined within the continuous recording of the knee medio-lateral position over the ankle and the hip vertical position. Kinect measurements were validated by Optojump (Microgate, Bolzano, Italy).

RESULTS

Soccer players retained their predominantly varus knee positions in all phases of double-leg jumps, which was far less prominent in single leg tests. Interestingly, a marked dynamic valgus was observed in athletes who participated in traditional strengthening exercises, while this valgus shift was mostly prevented in those who participated in antivalgus training regimes. All these differences were only revealed during single leg tests, while the double leg jump tests masked all valgus tendencies.

CONCLUSIONS

We propose to use single-leg tests and movement analysis systems for evaluating dynamic valgus knee in athletes. These methods can reveal valgus tendencies even in soccer players who have a characteristic varus knee while standing.

The Influence of Age and Dynamic Balance on Functional Movement Among Active-Duty Police Officers

CONTEXT

Although occupational injuries for police officers cannot be prevented, factors that contribute to musculoskeletal injury risk could be better identified to inform preventative interventions. Previous research has supported screening tools such as the functional movement screen (FMS) and Y-Balance Test (YBT) as possible indicators of musculoskeletal injury risk. The purposes of this study are to (1) examine the relationships between age, dynamic balance, and functional movement in police officers and (2) determine how much variance in functional movement is predicted by age and dynamic balance.

METHODS

This study was conducted in a university research laboratory as part of an ongoing collaboration with a local police department. All data for the current study were collected across 2 separate laboratory visits within a 14-day period.

PARTICIPANTS

Thirty-five active-duty police officers (31 men and 4 women; mean [SD], age 33.4 [9.4] y, height 177.4 [8.0] cm, body mass 88.4 [15.3] kg) volunteered to participate in this study.

MAIN OUTCOME MEASURES

Functional movement was assessed using the FMS, and FMS overall scores were calculated. Dynamic balance was assessed via the YBT, and lower quarter Y-Balance Test scores (LQYBT%) were calculated.

RESULTS

There was a significant negative correlation between FMS overall score and age (r = -.641, P < .001). Correlations between FMS overall score and LQYBT% and between LQYBT% and age were not statistically significant. Age and LQYBT% scores significantly predicted FMS overall scores (F2,32 = 11.162, P < .001), accounting for 41.1% of the variance in FMS overall scores (R2 = .411) with age being the only significant predictor.

CONCLUSIONS

This study confirms that age and FMS overall score have a strong, negative relationship, suggesting that age may be a contributing factor to movement quality and may lead to an increased risk of musculoskeletal injury within this unique population.

Feasibility and reliability of the Functional Movement Screen battery in adults with intellectual disability

BACKGROUND

The feasibility and reliability of the Functional Movement Screen (FMS) battery for predicting injury risk have been widely studied in athletic, military, public service and healthy populations. However, scant research has been carried out in people with disabilities. This study aimed at identifying the feasibility and reliability of the FMS battery when administered to adults with intellectual disability (ID).

METHODS

Adults from a residential and day care centre over 18 years of age, diagnosed with ID and able to follow simple instructions, were included in the study. All participants with behavioural or health problems that prevented the completion of the FMS battery were excluded. All exercises were video recorded to assure proper scoring. Three assessors (one trained and two novices) scored each of the FMS subtests performed separately from the videos. Feasibility was based on completion rates. Reliability of the composite test scores was analysed using intraclass correlation coefficients (ICCs).

RESULTS

A total of 30 people with ID (mean age: 35.5 ± 7.12 years; 33.3% women) completed all assessments. The battery showed to be feasible, although difficulties when performing two of the subtests were observed among those with moderate and severe ID. Mean total scores from the three assessors ranged from 7.83 to 8.90. An inverse trend was observed indicating that the higher the ID level, the lower the total FMS score. Test-retest reliability was good for the trained assessor (ICC = 0.89) and mostly moderate for both novice assessors (ICC range: 0.60 to 0.76). Moderate to good inter-rater reliability was observed (ICC range: 0.65 to 0.80).

CONCLUSION

The FMS battery is a reliable tool that can be performed by people with ID, albeit with certain difficulties, especially in those with moderate to severe impairment. The battery does not seem to be useful for identifying people with ID at risk of suffering a sport injury. Adequately powered, well-designed studies are required to determine if the FMS battery is appropriate for identifying changes in functional performance in this population.

Sex-related Anthropometrics in a Lower-Body Mobility Assessment Among Professional Soccer Athletes

Background

The functional movement screen (FMS™) and Y-balance test (YBT) are commonly used to evaluate mobility in athletes.

Purpose

The primary aim of this investigation was to determine the relationship between demographic and anthropometric factors such as sex, body composition, and skeletal dimension and scoring on YBT and FMS™ in male and female professional soccer athletes.

Study Design

Cross Sectional.

Methods

During pre-season assessments, athletes from two professional soccer clubs were recruited and underwent body composition and skeletal dimension analysis via dual-energy X-ray absorptiometry (DEXA) scans. Balance and mobility were assessed using the YBT and FMS™. A two-tailed t-test was used to compare YBT between sexes. Chi-square was used for sex comparisons of FMS™ scores. Correlation analysis was used to determine if body composition and/or skeletal dimensions correlated with YBT or FMS™ measures. Type-I error; α=0.05.

Results

40 Participants were successfully recruited: (24 males: 27±5yr, 79±9kg; |16 females: 25±3yr, 63±4kg). YBT: Correlations were found between anterior reach and height (r=-0.36), total lean mass (LM)(r=-0.39), and trunk LM(r=-0.39) as well as between posterolateral reach and pelvic width (PW)(r=0.42), femur length (r=0.44), and tibia length (r=0.51)(all p<0.05). FMS™: The deep squat score was correlated with height(r=-0.40), PW(r=0.40), LM(r=-0.43), and trunk LM (r =-0.40)(p<0.05). Inline lunge scores were correlated with height(r=-0.63), PW(r=0.60), LM(r=-0.77), trunk LM(r=-0.73), and leg LM(r=0.70)(all p<0.05). Straight leg raise scores were correlated with PW (r=0.45, p<0.05). Females scored higher for the three lower body FMS™ measures where correlations were observed (p<0.05).

Conclusions

Lower body FMS™ scores differ between male and female professional soccer athletes and are related to anthropometric factors that may influence screening and outcomes for the FMS™ and YBT, respectively. Thus, these anatomical factors likely need to be taken into account when assessing baseline performance and risk of injury to improve screening efficacy.

Level of Evidence

Level 3b.

Can Injuries Be Predicted by Functional Movement Screen in Adolescents? The Application of Machine Learning

ABSTRACT

Karuc, J, Mišigoj-Duraković, M, Šarlija, M, Marković, G, Hadžić, V, Trošt-Bobić, T, and Sorić, M. Can injuries be predicted by functional movement screen in adolescents? The application of machine learning. J Strength Cond Res 35(4): 910-919, 2021-This study used machine learning (ML) to predict injuries among adolescents by functional movement testing. This research is a part of the CRO-PALS study conducted in a representative sample of adolescents and analyses for this study are based on nonathletic (n = 364) and athletic (n = 192) subgroups of the cohort (16-17 years). Sex, age, body mass index (BMI), body fatness, moderate-to-vigorous physical activity (MVPA), training hours per week, Functional Movement Screen (FMS), and socioeconomic status were assessed at baseline. A year later, data on injury occurrence were collected. The optimal cut-point of the total FMS score for predicting injury was calculated using receiver operating characteristic curve. These predictors were included in ML analyses with calculated metrics: area under the curve (AUC), sensitivity, specificity, and odds ratio (95% confidence interval [CI]). Receiver operating characteristic curve analyses with associated criterium of total FMS score >12 showed AUC of 0.54 (95% CI: 0.48-0.59) and 0.56 (95% CI: 0.47-0.63), for the nonathletic and athletic youth, respectively. However, in the nonathletic subgroup, ML showed that the Naïve Bayes exhibited highest AUC (0.58), whereas in the athletic group, logistic regression was demonstrated as the model with the best predictive accuracy (AUC: 0.62). In both subgroups, with given predictors: sex, age, BMI, body fat percentage, MVPA, training hours per week, socioeconomic status, and total FMS score, ML can give a more accurate prediction then FMS alone. Results indicate that nonathletic boys who have lower-body fat could be more prone to suffer from injury incidence, whereas among athletic subjects, boys who spend more time training are at a higher risk of being injured. Conclusively, total FMS cut-off scores for each subgroup did not successfully discriminate those who suffered from those who did not suffer from injury, and, therefore, our research does not support FMS as an injury prediction tool.

Active straight leg raising (ASLR) competence improves with reverse-ASLR exercises and not repeating ASLR exercises

In the Functional Movement Screen (FMS), a subgroup of those with a score of 1 due to limitations in the active straight leg raising (ASLR) but not in the passive straight leg raising is considered to have a stability or motor control dysfunction (SMCD). The FMS proposes the use of the movements in a reverse pattern to improve FMS scores. The aim of this study was to investigate whether the reverse pattern of the ASLR (reverse-ASLR) was more effective than repeating the ASLR to improve the FMS score in participants with the FMS ASLR score of 1 due to the SMCD (ASLR-1-SMCD). A two-armed randomized controlled trial was conducted in individuals with the ASLR-1-SMCD. The intervention was either the reverse-ASLR or the ASLR exercise on both sides at home for a month followed by a 1-month wait-and-see interval, wherein the primary outcome measure was the right FMS ASLR score. Forty participants were randomized to the ASLR exercise group (n=20) or the reverse-ASLR exercise group (n=20). The Fisher exact test demonstrated a statistically significant difference (P=0.020) in the proportion of those with FMS ASLR score improvement to a score of 2 (ASLR exercise group, one; reverse-ASLR exercise group, eight) at follow-up 1, but no significance (P=0.106) at follow-up 2 (ASLR exercise group, none; reverse-ASLR exercise group, four). This study indicated that the reverse-ASLR exercise was more effective than repeating the ASLR exercise in order to improve the ASLR score among individuals with the ASLR-1-SMCD.

Can the Functional Movement Screen Method Identify Previously Injured Wushu Athletes?

The functional movement screen (FMS) is commonly used to evaluate sports injury risks, but no study has been reported for Wushu athletes. The aim of this study was to identify optimal FMS cut-off points for previously injured Wushu athletes and to examine the associations with other possible factors. In this study, a total of 84 Chinese Wushu athletes (15.1 ± 4.5 years old, 51% male) with a minimum of two years of professional training background in either Taiji, Changquan, or Nanquan were assessed by the FMS. Video recordings were used to confirm the scoring criteria, and previous injuries were assessed based on face-to-face interviews. An optimal cut-off of the FMS score was investigated by receiver operating characteristic curves with sensitivity and specificity. We found that FMS score of less than 16 (sensitivity = 80%, specificity = 56%) was related to an increased occurrence of injuries (odds ratio = 5.096, 95%CI: 1.679-15.465) for the current study sample. The training type and training levels were related with FMS scores. More than half of the athletes (58%) had FMS asymmetry and 21% of athletes reported pain while performing the FMS protocol. Future prospective studies are recommended to use FMS with cut-off of 16 points in Wushu athletes.

Influence of Prolonged Running and Training on Tibial Acceleration and Movement Quality in Novice Runners

CONTEXT

Changes in lower limb loading and movement quality after prolonged running and training periods might influence injury risks in runners.

OBJECTIVES

To assess (1) the effects of a single prolonged run and a 3-week running training program on peak tibial acceleration (PTA) during running and Functional Movement Screen (FMS) criterion tests, and (2) the relationship between running volume during the 3-week training program and changes in PTA and FMS scores after training.

DESIGN

Case series.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Ten novice runners (age = 27 ± 7 years) with 15 ± 14 months of running experience, who ran on average 19.6 ± 4.8 km per week at a preferred pace of 7:05 ± 1:30 minutes per km.

MAIN OUTCOME MEASURE(S)

Participants completed a 30-minute submaximal prolonged treadmill run and 3-week training program with 25% increases in weekly running volume. Peak tibial acceleration and the deep-squat and active straight-leg-raise criterion FMS test scores were assessed before and after the prolonged run at enrollment and after the training program (ie, 3 testing sessions).

RESULTS

No differences in PTA or FMS scores were observed among the 3 testing times. Although the changes in PTA (r = 0.57) and FMS aggregate score (r = 0.15) were not significantly correlated with training volume, training volume explained 32% of the variance in the PTA change from before to after training.

CONCLUSIONS

Our findings suggest that tibial acceleration and movement quality were not influenced by a single submaximal-effort prolonged run or a 3-week training period. However, novice runners who have a greater increase in running volume might be more susceptible to training-related changes in tibial acceleration than those whose running volume is less.

DEEP NECK FLEXORS IMPACT RECTUS ABDOMINIS MUSCLE ACTIVITY DURING ACTIVE STRAIGHT LEG RAISING

Background

Active straight leg raising (ASLR) is commonly performed to test fundamental movement competency. Head control or positioning can affect the abdominal muscle activity during movements.

Purpose

To investigate whether abdominal muscle activity differs when the head is extended or when deep neck flexor (DNF) muscles are selectively activated during the ASLR.

Study Design

Cross-sectional.

Methods

Participants were included based on the following criteria: 1) age>17 years; 2) no spinal or lower extremity pain in the prior month; 3) the vertical line of the malleolus in an elevated the lower limb resides below the knee joint line of a non-moving lower limb during ASLR and above during a passive straight leg raising in each lower limb; and 4) no history of diagnosed spinal deformities or central nervous system disorders. Participants with > 39% reference voluntary contraction in the sternocleidomastoid muscle during the craniocervical flexion test (CCFT) of 24 mmHg target were excluded from the analyses. Right ASLR was repeated in each of the following three head conditions in a random order: 1) neutral head position, 2) head extended by 25 °, and 3) CCFT maintained with a 24 mmHg target. Among the three head conditions, the relative latency for the onset of the right rectus femoris (RF) muscle during the right ASLR and the muscle activity amplitude for 50ms were compared after the onset of RF muscular activity in the following muscles: left rectus abdominis (RA), bilateral external obliques, bilateral internal obliques, and left gluteus maximus muscles.

Results

Data from 31 participants (21 women and 10 men, mean age=22.5 years) were analyzed. The relative latency of the left RA (Hedges' g = 0.39, p=.038) was higher in the CCFT condition (mean±SD=112.1ms±86.0ms) than that in the neutral head condition (82.9ms±58.6ms). However, no difference (all p>.05) was observed in other measures between the groups.

Conclusion

In people with impaired movement competency in ASLR, head extension did not alter the abdominal muscle activities in ASLR. However, selective activation of the DNF muscles delayed the onset of RA muscle activity during the ASLR.

Level of Evidence

4.

Relationship between movement dysfunctions and sports injuries according to gender of youth soccer player

The purpose of this study is to investigate relationship between movement dysfunctions and sports injuries according to gender of youth soccer player. Thirty-eight middle school soccer players participated in this study and they were divided into male (n=19) and female (n=19) groups. The Functional Movement Screen (FMS) and the Quadriceps-angle (Q-angle) during single-leg squat were analyzed for identifying imbalance and asymmetry of the body, and sports injury questionnaire was examined for 6 months after FMS test. The number of sports injuries did not show significant difference between youth male and female soccer athletes. In FMS results, the scores of overhead squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, and rotary stability and the total scores were no significant differences between gender, but the score for the trunk stability push-up was significantly higher in male group than female group. There was no significant difference of Q-angle values between the left and right legs, but Q-angle value between youth male and female groups significantly showed interaction. Therefore, the present data suggested that FMS and Q-angle during single-leg squat might be indicators to predict and/or prevent sports injury in youth male and female soccer players.

Earlier onsets in internal oblique and gluteus maximus muscles during leg raising in Functional Movement Screen score 3 than score 1

Active straight leg raising (ASLR) is a fundamental test and used in the Functional Movement Screen (FMS). In the ASLR of the FMS, one subgroup performs the movement correctly without any compensation (ASLR-3), whereas another subgroup has limitations in ASLR but not the passive straight leg raising (ASLR-1-SMCD). We aimed to investigate whether abdominal muscle activities in ASLR are different between individuals with ASLR-1-SMCD and ASLR-3. The relative latency of the onset of the following muscles to the right rectus femoris muscle during the right ASLR and the amplitude of activity in the following muscles for 50 msec after the onset of rectus femoris muscle activity were compared: left rectus abdominal, bilateral external oblique, bilateral internal oblique, and left gluteus maximus muscles. Data of 17 participants with ASLR-3 and 34 participants with ASLR-1-SMCD, whose sex ratio was matched to the ASLR-3 group, were analyzed. Those with ASLR-1-SMCD had statistically significant delays in the relative latency of the right internal oblique muscle (46.32±70.83 msec) and left gluteus maximus muscle (100.36±75.40 msec) muscles compared with those with ASLR-3 (right internal oblique muscle=9.75±23.07 msec, left gluteus maximus muscle=57.50±36.89 msec). However, the difference in the amplitude of activity in any muscles was not significant. The ASLR-1-SMCD group had greater relative latency of the onset of right internal oblique muscle and left gluteus maximus muscle to the onset of the right rectus femoris muscle during the right ASLR compared with the ASLR-3 group.

Effects of dynamic neuromuscular stabilization (DNS) training on functional movements

Functional movements (FMs) dysfunction is a potential risk factor of injuries. A variety of training strategies is proposed to improve the performance of FMs. We investigated if a system of fundamental movement exercises called Dynamic Neuromuscular Stabilization (DNS) could improve FMs. Thirty-four female students were randomly assigned into two matched groups to receive DNS (the study protocol) versus physical fitness (PF) training. The groups practiced for six-weeks (three sessions of 50 min weekly). We used five FMs tests as pre and post measures of exercise effectiveness. Repeated Measures ANOVA showed a significant interaction in all five FMs tests in favour of DNS group (F_(1,32) ≥ 4.13, P ≤ .001 and ƞ² ≥ 0.29), meaning that DNS group had a higher progress rate compared to that of PF group. Based on Eta-square coefficients, the highest and lowest differences in the progression rate were observed in Y-Balance and Functional Movement Screening Tests, respectively. Our findings supported the hypothesis that fundamental movements of DNS could be used to improve FMs. However, the progression coefficient declined as FMs became more specific. Lower progression of "specific FMs" suggests that it might prove more effective to add "specific training" to "fundamental training" for them.

Supervised physiotherapy leads to a better return to physical activity after anterior cruciate ligament reconstruction

BACKGROUND

The main goal of rehabilitation after anterior cruciate ligament reconstruction (ACLR) is to return to functional and sports activity at a preinjury level. The aim of this study was to assess the influence of supervised (SU) versus non-supervised (NS) rehabilitation protocols after ACLR on the return to sports activity and quality of life of amateur athletes.

METHODS

The study included a total of 50 patients after ACLR, with 25 in the SU group and 25 in the NS group. No significant differences were observed between the two groups with regard to age, sex, or BMI. Two different ACLR techniques were used: hamstring graft and bone patellar tendon bone. The patients were examined preoperatively and 12 months postoperatively. Outcomes were evaluated utilizing the Kujala Scale, Tegner Scale, the Knee injury and Osteoarthritis Outcome Score (KOOS), the Functional Movement Screen (FMS), and range of motion. Patients from the SU group participated in rehabilitation sessions with a physiotherapist with an average of 48 meetings. Those in the NS attended six meetings with the physiotherapist.

RESULTS

At final follow-up, patients from both groups demonstrated a higher level of functional and sports activity and had a better quality of life 12 months after ACLR. Patients from the supervised group returned to a significantly higher level of sports activity (Tegner Scale: SU=6, NS=5, P=0.003) and reported significantly better quality of life 12 months after ACLR (KOOS QOL: SU=90, NS=74; P<0.001).

CONCLUSIONS

Supervised, controlled physiotherapy results in higher activity levels and better quality of life in amateur athletes 12 months after ACLR.