Use of clinical movement screening tests to predict injury in sport

Altered inter-segmental coordination in athletes with a history of concussion

Concussion-recovered athletes have a higher risk of injury following return to sport. This study investigated the effect of history of concussion on the pattern and variability of inter-segmental coordination in athletes during squat jumps and timed squat and hinge tasks. A human pose estimation algorithm was applied to videos of 111 athletes (72 with no history of concussion (NOHX), 9 within 1 year of concussion (CONC1), 30 more than one-year post-concussion (CONC2) performing a series of movement tasks. Continuous relative phase metrics, calculated from phase angles of two contiguous segments, were used to evaluate inter-segmental coordination. Linear models were used to evaluate the causal effect of concussion group on hip, knee, and ankle coordination and repetition duration for each task. CONC1 affected repetition duration and knee and hip coordination and variability, while CONC2 influenced knee coordination. The findings suggest that concussion may have long-term persisting effects on lower-limb inter-segmental coordination in athletes.

Relationship Between the Results of the Landing Error Scoring System and Trunk Muscle Thickness

Background

A landing error scoring system (LESS) is widely used to evaluate landing maneuvers. Poor landing maneuvers, such as lateral bending of the trunk, are thought to be associated with a risk of lower-extremity injury. However, no studies have examined the association between landing and trunk muscle function, which is associated with a high risk of lower-extremity injury.

Hypothesis/Purpose

This study examined whether an association exists between landing movements and a high risk of lower-extremity injury and trunk muscle function. It was hypothesized that athletes with poor activation of deep trunk muscle (transversus abdominis and internal oblique) would have lower LESS scores.

Study Design

Cross-sectional study.

Methods

The trunk muscle thickness at rest and during the plank was measured using ultrasonography. The percent of change in muscle thickness (during plank/at rest) was calculated. The LESS was measured using the Physimax. Based on the LESS scores, patients were divided into high- (LESS > 6) and low-risk (5 > LESS) groups for lower extremity injury. The relationship between the high-risk group and trunk muscle thickness was examined using a stepwise regression analysis.

Results

The high-risk group had significantly lower muscle thicknesses of the transversus abdominis (p=0.02) and transversus abdominis plus internal oblique abdominis (p=0.03) muscles during the plank. Additionally, the high-risk group showed significantly lower percent of change in muscle thickness of the internal oblique (p=0.02) and transversus abdominis plus internal oblique (p=0.01) muscles. Only the percentage of change in the thickness of the internal oblique and transverse abdominal muscles was extracted from the regression as a factor.

Conclusion

The findings indicated that athletes with landing movements and a high risk of injury, as determined based on the LESS results, had low trunk muscle function, and a relationship was observed between the change in thickness of transversus abdominis and internal oblique abdominis muscles.

Level of Evidence

3B.

Changes in Dynamic Balance Ability Among Firefighter Recruits: A Longitudinal Cohort Study

ABSTRACT

Cornell, DJ, Gnacinski, SL, and Ebersole, KT. Changes in dynamic balance ability among firefighter recruits: A longitudinal cohort study. J Strength Cond Res 38(4): 734-741, 2024-It has been suggested that enhanced balance ability may mitigate the high musculoskeletal injury (MSKI) rate among firefighters, but the longitudinal changes in dynamic balance ability within this tactical athlete population have yet to be characterized. The purpose of this study was to examine the changes in dynamic balance ability of a cohort population of firefighter recruits completing a training academy and their probationary period as active-duty firefighters. Twenty-seven male firefighter recruits completed the modified Star Excursion Balance Test (mSEBT) at the beginning (W1) and at the end of their training academy (W14) and after completing their probationary period as active-duty firefighters (W38). After controlling for age and changes in body fat (BF) over time, significant changes in mSEBTANT ( p < 0.001), mSEBTPL ( p = 0.015), mSEBTPM ( p < 0.001), and mSEBTCOMP ( p = 0.003) were observed across time. Although mSEBTPL performance significantly increased ( p = 0.033) in from W1 to W14, significant decreases in all mSEBT reach directions were observed from W14 to W38 ( p < 0.05), with mSEBTANT ( p < 0.001) and mSEBTCOMP ( p = 0.002) also significantly decreasing from W1 to W38. However, the frequency of right vs. left asymmetries (>4 cm) did not significantly change over time in any mSEBT reach direction ( p > 0.05). Irrespective of age or changes in BF, minimal changes in the dynamic balance ability of firefighter recruits were observed during their training academy, but significant decreases in balance ability were noted by the end of their probationary period.

Test-retest, intra- and inter-rater reliability of the reactive balance test in patients with chronic ankle instability

Introduction

The Reactive Balance Test (RBT) could be a valuable addition to research on chronic ankle instability (CAI) and clinical practice, but before it can be used in clinical practice it needs to be reliable. It has already been proven reliable in healthy recreational athletes, but not yet in patients with CAI who have shown persistent deficits in dynamic balance. The study aimed to determine the test-retest, intra-, and inter-rater reliability of the RBT in patients with CAI, and the test-retest and inter-rater reliability of the newly developed RBT score sheet.

Methods

We used a repeated-measures, single-group design to administer the RBT to CAI patients on three occasions, scored by multiple raters. We included 27 participants with CAI. The study used multiple reliability measures, including Pearson r, intra-class correlations (ICC), standard error of measurement (SEM), standard error of prediction (SEP), minimal detectable change (MDC), and Bland-Altman plots, to evaluate the reliability of the RBT's outcome measures (visuomotor response time and accuracy). It also assessed the test-retest and inter-rater reliability of the RBT score sheet using the same measures.

Results

The ICC measures for test-retest reliability were similar for accuracy (0.609) and VMRT (0.594). Intra-rater reliability had high correlations and ICCs for accuracy (r = 0.816, ICC = 0.815) and VMRT (r = 0.802, ICC = 0.800). Inter-rater reliability had a higher ICC for VMRT (0.868) than for accuracy (0.690).

Conclusion

Test-retest reliability was moderate, intra-rater reliability was good, and inter-rater reliability showed moderate reliability for accuracy and good reliability for VMRT. Additionally, the RBT shows robust SEM and mean difference measures. The score sheet method also demonstrated moderate test-retest reliability, while inter-rater reliability was good to excellent. This suggests that the RBT can be a valuable tool in assessing and monitoring balance in patients with CAI.

Effects of a proprioceptive focal stimulation (Equistasi®) on reducing the biomechanical risk factors associated with ACL injury in female footballers

Introduction

Football presents a high rate of lower limb injuries and high incidence of Anterior Cruciate Ligament (ACL) rupture, especially in women. Due to this there is the need to optimize current prevention programs. This study aims to verify the possibility to reduce the biomechanical risk factors associated with ACL injury, through the application of proprioceptive stimulation by means of the Equistasi® device.

Methods

Ten elite female footballers were enrolled and received the device for 4 weeks (5 days/week, 1h/day). Athletes were assessed directly on-field at four time points: T0 and T1 (evaluation without and with the device), T2 (after 2 weeks), T4 (after 4 weeks) while performing two different tasks: Romberg Test, and four sidestep cutting maneuvers bilaterally. Seven video cameras synchronized with a plantar pressure system were used, thirty double colored tapes were applied on anatomical landmarks, and three dimensional coordinates reconstructed. Vertical ground reaction forces and center of pressure data were extracted from the plantar pressure insoles. Hip, knee, and ankle flexion-extension angles and moments were computed as well as abd-adduction joint torques. From the Romberg Test both center of pressure descriptive variables and frequency analysis parameters were extracted. Each variable was compared among the different time frames, T1, T2 and T4, through Friedman Test for non-parametric repeated measures (p<0.05); Wilcoxon Signed Rank Test was used for comparing variables between T0 and T1 (p<0.05) and across the different time frames as follows: T1-T2, T2-T4 and T1-T4.

Results

Statistically significant differences in both posturographic and biomechanical variables between the assessment at T0 and T1 were detected. Reduced hip and knee abduction torques were revealed in association with reduced both ground reaction forces and ankle dorsiflexion torque from T1 up to T4.

Discussion

The proprioceptive stimuli showed to have the potential to improve cutting biomechanics mainly with respect to the ligament and quadriceps dominance theories. Results of the present study, even if preliminary and on a small sample size, could be considered promising towards the inclusion of proprioceptive training in injury prevention programs.

The ecological validity of traditional standing and novel bicycle balance and agility tests for predicting performance in mountain bikers

Falls are a common mechanism of injury in mountain biking and may be related to a loss of control of the bicycle. Traditionally, the components of bicycle control (balance and agility) are measured in standing and running, which may not reflect the skills required in mountain biking. In this paper, we present the validity of both traditional standing and novel bicycle-specific balance tests in mountain bikers. Twenty-nine male and female participants completed indoor laboratory tests and an outdoor downhill trail. Participants completed single-leg stance balance, Y-balance test, one static and four dynamic bicycle-specific balance tests, a bicycle agility test, and an outdoor downhill trail. Single-leg stance balance and Y-balance tests with eyes open had poor validity when associated with bicycle control. The static (r ​= ​-0.57, p = 0.001) and four dynamic bicycle balance tests (r ​= ​-0.51 to -0.78, p = 0.005 to 0.0001), and the bicycle agility test (r ​= ​0.87, p < 0.0001) had moderate to strong relationships with the outdoor downhill run. Single-leg stance balance and Y-balance tests with eyes open are not valid measures of performance on a mountain bike, and should not be used to assess these populations. Our novel bicycle balance tests have adequate validity to be used as measures of performance in mountain bikers.

The Effectiveness of Trunk and Balance Warm-up Exercises in Prevention, Severity, and Length of Limitation From Overuse and Acute Lower Limb Injuries in Male Volleyball Players

Background

Injuries in volleyball players are most common in the ankles and knees. Many volleyball players suffer from overuse injuries because of the strain placed on the lower extremities from repeated jumping. A characteristic of players who are most at risk for lower extremity injuries is the tendency to display trunk instability during landing, such as lateral flexion and rotation. Research has shown the effectiveness of exercise-based warm-up interventions for acute volleyball injuries. However, comprehensive analyses on the use of lower extremity, trunk, and balance programs to prevent overuse injuries are lacking.

Purpose

To examine the effects of trunk and balance warm-up exercises on the prevention, severity, and length of limitation of overuse and acute lower limb injuries in male volleyball players.

Study Design

Prospective, single-cohort study.

Methods

This study involved the 2019 (control group) and 2021 (intervention group) male volleyball teams. The control and intervention groups were on the same team; however, seven players joined in 2021 through a sports referral program through which different players are recruited. Measurements included injury incidence rate, injury severity, and injury burden. The intervention involved the addition of trunk and balance exercises during the 2021 season.

Results

There was no significant difference in injury incidence rates between groups. Injury severity decreased by 3.7 days for overuse injuries (p=0.04). Injury burden decreased by 11.8 (days/1000 player hours) overall and by 7.1 (days/1000 player hours) for overuse injuries.

Conclusion

The results show that an exercise-based warm-up aimed at improving trunk posture during landing did not reduce the incidence rate of injury in men's volleyball. However, the addition of this warm-up did significantly reduce the severity of overuse injury.

Level of Evidence

Level 3B.

Which Functional Tests and Self-Reported Questionnaires Can Help Clinicians Make Valid Return to Sport Decisions in Patients With Chronic Ankle Instability? A Narrative Review and Expert Opinion

Lateral ankle sprain is the most common injury in sports, with up to 40% of patients developing chronic ankle instability (CAI). One possible cause underlying this high rate of recurrence or feeling of giving way may be a premature return to sport (RTS). Indeed, except for time-based parameters, there are no specific criteria to guide clinicians in their RTS decisions in patients with CAI. A recent international consensus highlighted the relevance and importance of including patient-reported ankle function questionnaires combined with functional tests targeting ankle impairments in this population. Thus, the aim of this narrative review and expert opinion was to identify the most relevant functional performance tests and self-reported questionnaires to help clinicians in their RTS decision-making process following recurrent ankle sprains or surgical ankle stabilization. The PubMed (MEDLINE), PEDro, Cochrane Library and ScienceDirect databases were searched to identify published articles. Results showed that the single leg stance test on firm surfaces, the modified version of the star excursion balance test, the side hop test and the figure-of-8 test appeared to be the most relevant functional performance tests to target ankle impairments in patients with CAI. A combination of the Foot and Ankle Ability Measure (FAAM) and the Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) questionnaires were the most relevant self-reported questionnaires to assess patient function in the context of CAI. Although these functional tests and questionnaires provide a solid foundation for clinicians to validate their RTS decisions in patient with CAI, objective scientific criteria with cut-off scores are still lacking. In addition to the proposed test cluster, an analysis of the context, in particular characteristics related to sports (e.g., fatigue, cognitive constraints), to obtain more information about the patient's risk of recurrent injury could be of added value when making a RTS decision in patients with CAI. In order to evaluate the strength of evertors under ecological conditions, it would also be interesting to assess the ability to control weight-bearing ankle inversion in a unipodal stance. Further studies are needed to assess the relevance of this proposed test cluster in RTS decision-making following lateral ankle sprain injury and CAI.

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.

Reliability and Repeatability of ACL Quick Check®: A Methodology for on Field Lower Limb Joint Kinematics and Kinetics Assessment in Sport Applications

Anterior cruciate ligament (ACL) lesion represents one of the most dramatic sport injuries. Even though clinical screenings aiming at identifying subjects at risk of injuries are gaining popularity, the use of sophisticated equipment still represents a barrier towards their widespread use. This study aimed to test both reliability and repeatability of a new methodology to assess lower limb joints kinematics and kinetics directly on field with the aid of video cameras and plantar pressure insoles. Ten athletes and one case study (post ACL surgery) were assessed in a gait laboratory, while performing double leg squats, through the simultaneous acquisition of stereophotogrammetry, force plates, commercial video cameras and plantar pressure insoles. Different sources of errors were investigated and both reliability and repeatability analysis performed. Minimum and maximum RMSE values of 0.74% (right knee joint center trajectory) and 64.51%, respectively (ankle dorsi-plantarflexion moment), were detected. Excellent to good correlation was found for the majority of the measures, even though very poor and inverse between-trials correlation was found on a restricted number of trials especially for the ankle dorsi-plantarflexion moment. These findings could be used in combination with already available screening tools in order to provide more repeatable results.

Machine Learning-Based Estimation of Ground Reaction Forces and Knee Joint Kinetics from Inertial Sensors While Performing a Vertical Drop Jump

Nowadays, the use of wearable inertial-based systems together with machine learning methods opens new pathways to assess athletes' performance. In this paper, we developed a neural network-based approach for the estimation of the Ground Reaction Forces (GRFs) and the three-dimensional knee joint moments during the first landing phase of the Vertical Drop Jump. Data were simultaneously recorded from three commercial inertial units and an optoelectronic system during the execution of 112 jumps performed by 11 healthy participants. Data were processed and sorted to obtain a time-matched dataset, and a non-linear autoregressive with external input neural network was implemented in Matlab. The network was trained through a train-test split technique, and performance was evaluated in terms of Root Mean Square Error (RMSE). The network was able to estimate the time course of GRFs and joint moments with a mean RMSE of 0.02 N/kg and 0.04 N·m/kg, respectively. Despite the comparatively restricted data set and slight boundary errors, the results supported the use of the developed method to estimate joint kinetics, opening a new perspective for the development of an in-field analysis method.

The effect of fatigue on jump height and the risk of knee injury after a volleyball training game: A pilot study

Study aim: To investigate the effect of fatigue, induced by a volleyball training game on the risk of Anterior Cruciate Ligament (ACL) injury.

Material and methods: Thirteen female volleyball college athletes, ages 18 to 21 years old, completed jump landings from a box 30 cm height, prior and post a 60-minute volleyball training game. The clinical tool Landing Error Scoring System (LESS) was employed in order to evaluate the technique of landing prior and post the game. The level of fatigue induced by the volleyball game was assessed by vertical jump test and Borg Rating of Perceived Exertion (RPE) Scale pre and post-game. In order to compare measurements pre and post-game t-tests for dependent samples were used.

Results: Participants performed lower vertical jumps post-game with a Confidence Interval of 26.2 ± 2.3 cm (pre-game) and 24.9 ± 2.2 cm (post game). The difference between pre and post-game was found to be statistically significant with a t12 = 2.55 and a p-value of 0.026. In the case of assessing fatigue, the Borg RPE scale scores were found to be statistically significant (t12 = 14.05, p < 0.001) higher post-game (10.2 ± 0.6), as compared to pre-game (6.5 ± 0.4). Similarly, LESS scores increased significantly (t12 = 2.21, p = 0.047), post-game (6.3 ± 1.1) compared to pre-game (5.8 ± 1.0) that prove poorer landing ability.

Conclusion: It seems that a short duration volleyball training game induces fatigue and negatively affects the jumping and landing ability.

The Impact of Dance-Specific Neuromuscular Conditioning and Injury Prevention Training on Motor Control, Stability, Balance, Function and Injury in Professional Ballet Dancers: A Mixed-Methods Quasi-Experimental Study

BACKGROUND

Professional ballet dancers suffer high injury rates and are less likely than other athletes to specifically train to improve muscular strength, coordination, agility, speed and motor control because of heavy training demands, aesthetic appearances and financial barriers.

HYPOTHESIS/PURPOSE

The purpose of this study was to examine the effects of a supplemental conditioning program on professional and pre-professional contemporary ballet dancers. The authors hypothesized that those participating in a training program would reduce injury rate by improving their motor control, stability, balance and physical function. The authors aimed to observe the feasibility and qualitative phenomena related to a conditioning program from the dancer's perspective.

STUDY DESIGN

A mixed-methods study; within subject quasi-experimental design and qualitative interviews.

METHODS

Six professional classical and contemporary ballet dancers completed the five-week conditioning and injury prevention training program. Non-parametric analysis of baseline, posttest and four-month follow-up physical performance measures, subjective outcomes, and qualitative follow-up interviews, were reported.

RESULTS

Significant post-test improvements included: The Dance Functional Outcome Survey (Z= -2.2, p= 0.04), composite Modified Star Excursion Balance Test (Z= -2.2, p= 0.03 bilaterally), Single Leg Hop for Distance (Z= -2.02, p= 0.04), and Upper Extremity Closed Kinetic Chain Test (Z=-2.03, p= 0.04). Significant changes from baseline to the four-month follow up remained for: (1) Dance Functional Outcome Survey (Z= -2.2, p= 0.03), (2) Single Leg Hop for Distance (Z= -2.2, p= 0.03), and (3) Modified Star Excursion Balance Test composite maximum reach for the left lower extremity (Z= -2.2, p= 0.03).

CONCLUSION

Completing a conditioning and prevention program for professional ballet dancers was related to improved function, balance, hop distance/stability and upper extremity stability. Dancers found the program beneficial, identified barriers to participation, and elucidated factors making the program feasible and successful. More research is necessary to determine the effect of such programs on injury incidence.

LEVEL OF EVIDENCE

3b.

Systematic review of screening tools for common soccer injuries and their risk factors

Background

Several screening tools are available for use in a clinical setting to predict injury. However, there is a lack of evidence regarding the accuracy of these tools to predict soccer-specific injuries.

Objectives

The purpose of this systematic literature review was to determine the psychometric properties or accuracy of screening tools for common soccer injuries.

Methods

A systematic review of diagnostic test accuracy was undertaken based on the Joanna Briggs Institute (JBI) procedure for conducting systematic reviews. Databases such as SPORT Discus, Cinahl, Medline, Science Direct, PubMed and grey literature were searched in order to access suitable studies.

Results

A total of 10 studies were included for the analysis – three were analysed quantitatively whilst the remaining seven were analysed qualitatively. The screening tools were of high reliability, sensitivity and specificity (calculated as intraclass correlation coefficient [ICC] (0.68 95% confidence interval [CI]: 0.52–0.84 and 0.64 95% CI: 0.61–0.66, respectively).

Conclusion

The screening tools assessed for the prediction of common soccer injuries that emerged from this systematic review include the Functional Movement Screening (FMS™), the Landing Error Scoring System (LESS), the Tuck Jump Assessment, the Soccer Injury Movement Screening (SIMS) and the conventional hamstrings to quadriceps ratio; all with good evidence of predicting common soccer injuries. These tools were of high sensitivity and specificity thus reliable for soccer screening.

Clinical implications

The validity of these tools is acceptable and therefore the authors recommend that these tools be included in an injury prevention programme for soccer players.

Factors associated with musculoskeletal injuries in an infantry commanders course

OBJECTIVES

To evaluate the prevalence of injuries among young combat soldiers as assessed and reported by the military physicians, and to investigate whether parameters such as anthropometric measures, postural balance, proprioceptive ability, and chronic ankle instability are related to injuries during and following an infantry commanders course.

METHODS

In this cross-sectional study, 165 soldiers were tested for anthropometric measurements, proprioceptive ability, and dynamic postural balance (DPB), as well as for their responses to an ankle stability questionnaire (CAIT), on three occasions: pre-course, middle-course, and end-course testing. All musculoskeletal injuries were assessed and recorded in the digital medical file of each participant by specialist military physicians before and during/following the course.

RESULTS

Ninety-eight soldiers (59.4%) were injured before the course. Forty soldiers (24.2%) incurred an injury during/following the course (with 33 out of the 40 [82.5%] soldiers that were injured during/following the course having also been injured before the course). Sixty soldiers had no injury before/during/following the course. A survival curve showed that half of the soldiers who were injured during/following the course (20 soldiers) were recorded as injured in the first half of the course (during the first 46 days of the 92-day course). Logistic regression showed that the pre-course parameters that were significant among injured soldiers compared with the non-injured soldiers were: low CAIT results (OR = 2.736, 95% CI = 1.178-6.354), high BMI (OR = 1.234, 95% CI = 1.082-1.406) and reduced proprioceptive ability (OR =.858, 95% CI =.797-.924).

CONCLUSION

With a high prevalence of soldiers injured during and following a commanders course, a somatosensory intervention program should be generalized into the practical daily preparation and training routines of the soldiers for improving somatosensory abilities, optimizing military physical readiness, and for preventing future musculoskeletal injuries.

FUNCTIONAL MOVEMENT SCREEN™ (FMS™) SCORES DO NOT PREDICT OVERALL OR LOWER EXTREMITY INJURY RISK IN COLLEGIATE DANCERS

Purpose

Dance is a physically demanding activity, with 50-85% of dancers suffering injury during a single performance season. The majority of dancers' injuries are in the lower extremity (LE) and chronic in nature. These injuries often arise when causal factors are not identified early and addressed before they ultimately result in an injury. Practitioners often use movement screens such as the Functional Movement Screen™ (FMS™) to detect and quantify kinetic chain dysfunction. Prior researchers have suggested that these screens can stratify at-risk individuals and allow practitioners to devise targeted interventions to reduce their injury risk. However, whether the FMS™ can identify at-risk dancers remains unclear. Thus, the purpose of this study was to examine whether FMS™ scores predicted injury risk in collegiate dancers.

Methods

In this prospective study, 43 collegiate dance majors (34 female, 9 male; 18.3 ± 0.7yrs; 163.9 ± 7.3cm; 60.8 ± 8.1kg) in a program which emphasizes modern dance were scored on the seven FMS™ movements (scale 0-3, total maximum score=21) where 3=movement completed without compensation, 2=movement completed, but with compensation(s), 1=unable to complete movement, 0=pain during movement or during clearing tests as described in prior literature at the start of the academic year. An in-house certified athletic trainer documented dancer's overall and LE injuries over an academic year (40 weeks). Separate Receiver Operator Characteristic (ROC) curve analyses examined whether composite FMS™ score predicted (1) Overall or (2) LE injury status.

Results

The subjects FMS™ scores were 16.2 + 1.7 (range=11-19). Twenty dancers were injured, whereas 23 remained injury-free. Injured dancers had 55 overall (1.28 injuries/dancer) and 44 LE injuries (1.02 LE injuries/dancer). FMS™ score did not predict overall (AUC=.28, SE=.08, p=.02, 95%CI=.13-.43) or LE injury risk (AUC=.38, SE=.1, p=.21, 95% CI=.21-.56).

Discussion

While nearly half of the dancers in this group suffered from injury over the year, composite FMS™ scores did not predict overall or LE injury risk in collegiate dancers. Dancers face unique and challenging physical demands that distinguish them from traditional sport-athletes including greater ranges of movement during performance. Thus, the FMS™ may not be sensitive enough to distinguish 'appropriate' from 'excessive' mobility and adequately identify injury risk in dancers. Overall, it is suggested that practitioners should use caution before using the FMS™ as a primary screening mechanism to identify collegiate dancers at overall or LE injury risk.

Level of Evidence

2.

The Effects of a Novel Quadrupedal Movement Training Program on Functional Movement, Range of Motion, Muscular Strength, and Endurance

Buxton, JD, Prins, PJ, Miller, MG, Moreno, A, Welton, GL, Atwell, AD, Talampas, TR, and Elsey, GE. The effects of a novel quadrupedal movement training program on functional movement, range of motion, muscular strength, and endurance. J Strength Cond Res XX(X): 000-000, 2020-Quadrupedal movement training (QMT) is a form of bodyweight training incorporating animal poses, transitions, and crawling patterns to reportedly improve fitness. This type of training may improve multiple facets of fitness, unfortunately, little evidence exists to support commercial claims and guide practitioners in the best use of QMT. Therefore, the purpose of this study was to assess the impact of a commercially available QMT program on functional movement, dynamic balance, range of motion, and upper body strength and endurance. Forty-two active college-age (19.76 ± 2.10 years) subjects (males = 19, females = 23) were randomly assigned to a QMT (n = 21) or control (CON) (n = 21) group for 8 weeks. Quadrupedal movement training consisted of 60-minute classes performed 2×·wk in addition to regular physical activity. Active range of motion, Functional Movement Screen (FMS), Y-Balance Test (YBT), handgrip strength, and push-up endurance were assessed before and after the intervention. The QMT group showed significantly greater improvements than the CON group in FMS composite score (1.62 ± 1.53 vs. 0.33 ± 1.15, p = 0.004) and FMS advanced movements (0.81 ± 0.87 vs. 0.01 ± 0.71, p = 0.002) and fundamental stability (0.57 ± 0.75 vs. 0.05 ± 0.50, p = 0.011), along with hip flexion, hip lateral rotation, and shoulder extension (p < 0.05). No significant differences between groups were observed for dynamic balance or upper body strength and endurance. Our results indicate that QMT can improve FMS scores and various active joint ranges of motion. Quadrupedal movement training is a viable alternative form of training to improve whole-body stabilization and flexibility.

FUNCTIONAL MOVEMENT AND DYNAMIC BALANCE IN ENTRY LEVEL UNIVERSITY DANCERS

BACKGROUND

Dance requires integration and synergy between movement, postural stability, and body alignment to effectively execute the technical and aesthetic requirements of the performance. Evaluation of movement competency and dynamic balance provides opportunity to identify dysfunctional movement which may negatively impact both artistic and technical aspects of dance performance. Investigation of the relationships between movement competency and postural control may aid in technical development, performance improvement, and ultimately injury reduction. Although the Functional Movement Screen™ (FMS™) and Y-Balance Test (YBT) have assessed movement competency in athletes, they have not been used extensively in the performing arts.

PURPOSE

The purposes of this investigation were to examine movement competency in university dancers using the FMS™ and YBT and to determine the relationship between functional movement and dynamic balance.

STUDY DESIGN

Cross sectional.

METHODS

Fifteen, injury-free, female members (19.1 ± 1.18 years old) of an introductory university ballet class volunteered to participate. Pearson product correlations were used to determine relationships between variables.

RESULTS

The mean composite FMS™ score was 15.32 ± 2.30. Shoulder mobility (SM) (r = 0.63, p  =  0.01), In-line lunge (ILL) (r = 0.64, p  =  0.01), and Deep Squat (DS) (r = 0.62, p  =  0.01) were correlated with composite FMS™ score. Overall composite YBT score was 86.62% ± 8.17%. Reach asymmetry was 3.25 cm ± 3.53 cm (anterior), 4.06 cm ± 3.59cm (posteromedial (PM)), and 3.28cm ± 2.61cm (posterolateral (PL)). Composite FMS™ score was not correlated with composite YBT composite score (r = 0.44, p = 0.10). A moderate to good correlation was found between the ILL and YBT composite score (r = 0.64, p  =  0.01).

CONCLUSION

Collectively the results indicate the FMS™ and YBT do not measure the same constructs. However, the associations between individual components of the FMS™ and YBT indicate a relationship between certain movements and dynamic balance, supporting their combined use in a dancer injury risk management program.

LEVEL OF EVIDENCE

2b.

The ‘DEEP’ Landing Error Scoring System

The Landing Error Scoring System (LESS) is an injury-risk screening tool used in sports; but scoring is time consuming, clinician-dependent, and generally inaccessible outside of elite sports. Our aim is to evidence that LESS scores can be automated using deep-learning-based computer vision combined with machine learning and compare the accuracy of LESS predictions using different video cropping and machine learning methods. Two-dimensional videos from 320 double-leg drop-jump landings with known LESS scores were analysed in OpenPose. Videos were cropped to key frames manually (clinician) and automatically (computer vision), and 42 kinematic features were extracted. A series of 10 × 10-fold cross-validation experiments were applied on full and balanced datasets to predict LESS scores. Random forest for regression outperformed linear and dummy regression models, yielding the lowest mean absolute error (1.23) and highest correlation (r = 0.63) between manual and automated scores. Sensitivity (0.82) and specificity (0.77) were reasonable for risk categorization (high-risk LESS ≥ 5 errors). Experiments using either a balanced (versus unbalanced) dataset or manual (versus automated) cropping method did not improve predictions. Further research on the automation would enhance the strength of the agreement between clinical and automated scores beyond its current levels, enabling quasi real-time scoring.

Twelve-week sensorimotor training as a factor influencing movement patterns of canoe slalom athletes, assessed by the Functional Movement Screen

Introduction: The aim of the study was to evaluate whether our own twelve-week Sensorimotor Exercise Programme (SEP) affected FMS results in canoe slalom athletes. The Functional Movement Screen (FMS) is a tool for detecting asymmetries and movement range limitations in order to prevent sport injuries. The screen evaluates mobility and stability in seven fundamental movement patterns.

Material and methods: The study population consisted of 16 athletes from the Canoe Slalom National Team of Poland who competed in three sports categories: kayak single, canoe single, canoe double. The athletes, 13 men and 3 women, undertook the FMS screen twice before the starting season. Between the first and the second screen the athletes undertook a twelve-week long sensorimotor training programme.

Results: The result analysis showed a statistically significant difference in FMS results. The mean FMS screen result after twelve weeks of training increased from 16.6 points to 19.6 points.

Conclusions: An adequately designed SEP can lead to an improvement in athlete movement patterns. The FMS screen allows for assessment of changes in athlete movement patterns after twelve weeks of SEP training.

Is the Landing Error Scoring System Reliable and Valid? A Systematic Review

CONTEXT

The Landing Error Scoring System (LESS) is a clinical tool often used in research and practice to identify athletes presenting high injury-risk biomechanical patterns during a jump-landing task.

OBJECTIVE

To systematically review the literature addressing the psychometric properties of the LESS.

DATA SOURCES

Three electronic databases (PubMed, Web of Science, and Scopus) were searched on March 28, 2018, using the term "Landing Error Scoring System."

STUDY SELECTION

All studies using the LESS as main outcome measure and addressing its reliability, validity against motion capture system, and predictive validity were included. Original English-language studies published in peer-reviewed journals were reviewed. Studies using modified versions of the LESS were excluded.

STUDY DESIGN

Systematic literature review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Study design, population, LESS testing procedures, LESS scores, statistical analysis, and main results were extracted from studies using a standardized template.

RESULTS

Ten studies met inclusion criteria and were appraised using Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. The overall LESS score demonstrated good-to-excellent intrarater (intraclass correlation coefficient [ICC], 0.82-0.99), interrater (ICC, 0.83-0.92), and intersession reliability (ICC, 0.81). The validity of the overall LESS score against 3-dimensional jump-landing biomechanics was good when individuals were divided into 4 quartiles based on LESS scores. The validity of individual LESS items versus 3-dimensional motion capture data was moderate-to-excellent for most of the items addressing key risk factors for anterior cruciate ligament (ACL) injury. The predictive value of the LESS for ACL and other noncontact lower-extremity injuries remains uncertain based on the current scientific evidence.

CONCLUSION

The LESS is a reliable screening tool. However, further work is needed to improve the LESS validity against motion capture system and confirm its predictive validity for ACL and other noncontact lower-extremity injuries.

LOWER QUARTER- AND UPPER QUARTER Y BALANCE TESTS AS PREDICTORS OF RUNNING-RELATED INJURIES IN HIGH SCHOOL CROSS-COUNTRY RUNNERS

BACKGROUND

While cross-country running is a popular interscholastic sport, it also has a high incidence of running-related injuries (RRIs). Recent literature suggests that functional tests may identify athletes at increased risk of injury. The Y-Balance Test (YBT) is an objective measure used to assess functional muscle strength, balance, and expose asymmetries between tested limbs.

PURPOSE/HYPOTHESIS

The purpose of this study was to determine if the YBT could predict RRI in high school cross-country runners. It was hypothesized that an asymmetric right (R)/left (L) YBT reach distance for the lower or upper extremities would be associated with an increased risk of RRI.

STUDY DESIGN

Prospective observational cohort.

METHODS

One hundred forty-eight athletes (80 girls, 68 boys) who competed in interscholastic cross-country in Southern California during the 2015 season participated in the study. Prior to the cross-country season, the runners completed Lower-Quarter YBT (LQ-YBT) and Upper-Quarter YBT (UQ-YBT) testing to assess lower and upper extremity asymmetry, respectively. The runners were prospectively monitored for RRI occurrence throughout the season using the Daily Injury Report form.

RESULTS

Forty-nine runners (33.1%) incurred a RRI during the 2015 season, with the lower leg (shin/calf) and knee the most common RRI sites. Girls had a higher RRI occurrence (38.8%) than boys (26.5%) (p = 0.12). Boys had greater raw scores for LQ-YBT R and L anterior (ANT), posteromedial (PM), posterolateral (PM) and composite reach distances than girls (p<0.05). With the exception of normalized superolateral reach distance, boys had significantly greater scores for raw and normalized R and L UQ-YBT reach distances and raw composite scores than girls (p<0.05). After adjusting for prior RRI, while boy runners with a LQ-YBT PM reach difference ≥4.0 cm were five times more likely to incur a RRI (Adjusted odds ratio [AOR] = 5.05, 95% CI: 1.3-19.8; p = 0.02), girl runners with a UQ-YBT inferolateral (IL) reach difference ≥ 4.0 cm were 75% less likely to incur a RRI (AOR = 0.25, 95% CI: 0.1-0.7; p = 0.005). By lower extremity body region, boy runners with a UQ-YBT superolateral (SL) reach difference ≥ 4.0 cm were seven times more likely to incur a hip/thigh/knee RRI [AOR] = 7.20, 95% CI: 1.1-45.6; p = 0.002).

CONCLUSION

Greater lower extremity (PM) or upper extremity (SL) reach distance asymmetry, as measured by the LQ-YBT or UQ-YBT, respectively, were associated with RRI in boy high school cross-country runners.

LEVEL OF EVIDENCE

2b.

Bringing context to balance: development of a reactive balance test within the injury prevention and return to sport domain

Background

Balance tests are commonly used in clinical practice with applicability in injury prevention and return to sport decisions. While most sports injuries occur in a changing environment where reacting to a non-planned stimulus is of great importance, these balance tests only evaluate pre-planned movements without taking these dynamics environmental aspects into account. Therefore, the goal of this paper was to develop a clinician-friendly test that respects these contextual interactions and to describe the test protocol of an adapted Y-balance test that includes environmental perception and decision-making.

Methods

Within the theoretical construct of balance and adaptability, balance errors were selected as outcome measures for balance ability and, visuomotor reaction time and accuracy are selected as outcome measures for adaptability. A reactive balance task was developed and described using the Y-balance test for the balance component, while the FitLight training system^TM was chosen for the environmental perception and decision-making component of the test.

Results

This paper describes the test protocol of a reactive balance test as an adapted Y-balance test. The LED-lights of the FitLight training systemTM are placed at 80% of the maximal reach distance for each axis along the Y-Balance test kitTM. To induce cognitive load within the visuomotor task, colours were fixed to a corresponding axis, and both the order of the visual stimuli as the interstimulus time were randomised to integrate environmental perception and decision-making.

Conclusion

The reactive balance test is a functional test that allows clinicians to score balance ability and athlete adaptability easily.

Construct validation of lower limb segmental excursion as a measure of potential risk for lower limb injury in Division I women's basketball players

The region of limb stability (ROLS) is an inertial sensor-based measure of static knee joint stability, defined by thigh and shank movements of the supporting limb during single limb stance. Changes in thigh and shank movements and/or symmetry differences between limbs may predict risk of injury to the less stable limb or the need for rehabilitation. In this study, construct validity of the ROLS metrics was examined in twelve Division I women's basketball players during pre-season in preparation for their exercise training program. The subjects were categorized based on their injury history during the season: (Group 1) No reported injuries throughout the season, (Group 2) lower limb injury that did not result in missing any games, and (Group 3) lower limb injury that resulted in missing both practice and the remainder of their season. Significant differences were found in ROLS metrics at pre-season between Group 3 and other groups in a prospective cohort study (p < 0.05). Study findings provided pilot data for supporting ROLS as a measure of postural stability impairment and potential risk for lower limb injury in athletes.

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.

Functional movement screen comparison between the preparative period and competitive period in high school baseball players

BACKGROUND/OBJECTIVE

Although the functional movement screen (FMS) has been widely applied for screening athletes, no previous study has used FMS scores to examine the association between distinct training seasons in high school baseball players. The aims of this study were to ascertain the functional movement screen (FMS) scores differences between the preparative period (PPP) and the competitive period (CPP) among high school baseball players and further determine whether FMS can be used as a tool to predict injuries during two major periods.

METHODS

Fifty-five male high school baseball players (age 15.3 ± 1.7 years; height 1.7 ± 0.8 m; weight 64.6 ± 11.5 kg) volunteered. Athletic injuries were reported through a self-report questionnaire. Players performed the FMS during the PPP and the CPP. A receiver operator characteristic (ROC) curve to calculate a cutoff total composite score ≤ 14 for the relationship between the FMS score and injury. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and an area under the curve (AUC) were calculated.

RESULTS

FMS individual task score and total composite score were significantly lower in the CPP than in the PPP. However, a cutoff total composite score ≤14 for risk of injury, determined through a ROC curve, represented a low sensitivity of 58%, NPV of 66%, an AUC of 69%, specificity of 79%, and PPV of 71%.

CONCLUSION

Although the low sensitivity and NPV and AUC scores indicated that the FMS does not accurately predict the risk of injury, the FMS individual task and total composite scores differed significantly between the PPP and CPP. Therefore, FMS could be used as a tool to identify physical deficiencies between distinct training seasons; however, utilizing the FMS as a screening tool for injury prediction in particular during the CPP in this population would not be recommended.

INTRA-RATER TEST-RETEST RELIABILITY AND RESPONSE STABILITY OF THE FUSIONETICS™ MOVEMENT EFFICIENCY TEST

BACKGROUND

A new functional movement assessment, known as the Fusionetics- Movement Efficiency (ME) Test, has recently been introduced in the literature. Before the potential clinical utility of the ME Test can be examined, the reliability of this assessment must be established.

PURPOSE

To examine the intra-rater test-retest reliability of the Fusionetics- ME Test.

STUDY DESIGN

Cross-sectional.

METHODS

ME Test data were collected among 23 (6 males, 17 females) university students (mean ± SD, age = 25.96 ± 3.16 yrs; height = 170.70 ± 9.96 cm; weight = 66.89 ± 12.67 kg) during sessions separated by 48 hours (Day 1, Day 2). All participants completed the seven sub-tests of the ME Test: 2-Leg Squat, 2-Leg Squat with Heel Lift, 1-Leg Squat, Push-Up, Shoulder Movements, Trunk Movements, and Cervical Movements. Overall ME Test scores and ME Test scores for each individual sub-test were calculated on a scale of 0 - 100 (worst - best) based on commonly observed movement compensations associated with each sub-test.

RESULTS

Intraclass correlation coefficients (ICC_3,1) statistics indicated that the intra-rater test-retest reliability of the Overall ME Test and individual sub-tests ranged from fair-to-excellent (ICC_3,1 range = 0.55 - 0.84). Statistically significant differences in ME Test scores were identified between Day 1 and Day 2 among the 2-Leg Squat with Heel Lift (p = 0.015) and Cervical Movements (p = 0.005) sub-tests. In addition, a large range in the standard error of the measure (SEM) and minimal detectable change values (MDC_90% & MDC_95%) were identified within individual sub-tests of the ME Test (SEM range = 7.05 - 13.44; MDC_90% range = 16.40 - 31.27; MDC_95% range = 19.53 - 37.25), suggesting that the response stability varies among these individual sub-tests. Prevalence-adjusted bias-adjusted kappa statistics (κ_PABA) suggest that 55 of the 60 (92%) individual movement compensations hold moderate-to-almost perfect intra-rater test-retest reliability (κ_PABA range = 0.30 - 1.00).

CONCLUSIONS

Excellent intra-rater test-retest reliability of the Overall ME Test score was identified, and thus, clinicians can reliably utilize the Fusionetics- ME Test to assess change in functional movement quality across time. However, caution should be taken if utilizing an individual sub-test to assess functional movement quality over time.

LEVEL OF EVIDENCE

2b.

Functional Movement Screening and Injury Rates in High School and Collegiate Runners: A Retrospective Analysis of 3 Prospective Observational Studies

OBJECTIVE

Determine if the Functional Movement Screening (FMS) can be used to predict injury in high school and collegiate cross-country and track runners.

DESIGN

Prospective Observational, Cohort Study, Level of Evidence, 2.

SETTING

High schools and colleges in the Central Ohio area.

PATIENTS

Inclusion: (1) cross-country or track runners at participating schools; (2) full participation without restrictions; and (3) signed informed assent or consent. Exclusion: (1) Any injury or lower extremity surgery within 30 days; (2) planned limited participation in the upcoming season; or (3) other participation restrictions.

INTERVENTIONS

Functional Movement Screening was completed before the start of each season. Injuries were tracked during the regular season. No interventions were made based on FMS score.

MAIN OUTCOME MEASURES

Functional Movement Screening scores, including overall, lower extremity, and specific exercises were compared between runners who did and did not sustain an injury using 2 sample t tests. A cutoff FMS score of ≤14 (most common in previous studies), and ≤15 (determined by a receiver operating characteristic curve), were compared using χ tests.

RESULTS

One hundred eighty-three runners were enrolled in the study. Overall, 32 (17.5%) runners sustained an injury. Functional Movement Screening score was not accurate in predicting injury for ≤14 (sensitivity: 65.6%; specificity: 39.7%; and area under the curve = 0.501) or ≤15 (sensitivity: 84.4% and specificity: 23.8%). There was no difference in risk of injury for runners with a FMS score of ≤14 (15.5%) and >14 (18.8%) (P = 0.572) or with a FMS score of ≤15 (17.5%) and >15 (17.4%) (P = 0.988).

CONCLUSIONS

Functional Movement Screening composite score may not be useful for injury prediction in populations of high school and collegiate runners.

PRESEASON LOWER EXTREMITY FUNCTIONAL TEST SCORES ARE NOT ASSOCIATED WITH LOWER QUADRANT INJURY - A VALIDATION STUDY WITH NORMATIVE DATA ON 395 DIVISION III ATHLETES

BACKGROUND

Preseason performance on the lower extremity functional test (LEFT), a timed series of agility drills, has been previously reported to be associated with future risk of lower quadrant (LQ = low back and lower extremities) injury in Division III (D III) athletes. Validation studies are warranted to confirm or refute initial findings.

HYPOTHESIS/PURPOSE

The primary purpose of this study was to examine the ability of the LEFT to discriminate injury occurrence in D III athletes, in order to validate or refute prior findings. It was hypothesized that female and male D III athletes slower at completion of the LEFT would be at a greater risk for a non-contact time-loss injury during sport. Secondary purposes of this study are to report other potential risk factors based on athlete demographics and to present normative LEFT data based on sport participation.

METHODS

Two hundred and six (females = 104; males = 102) D III collegiate athletes formed a validation sample. Athletes in the validation sample completed a demographic questionnaire and performed the LEFT at the start of their sports preseason. Athletic trainers tracked non-contact time-loss LQ injuries during the season. A secondary analysis of risk based on preseason LEFT performance was conducted for a sample (n = 395) that consisted of subjects in the validation sample (n = 206) as well as athletes from a prior LEFT related study (n = 189).

STUDY DESIGN

Prospective cohort.

RESULTS

Male athletes in the validation sample completed the LEFT [98.6 ( ± 8.1) seconds] significantly faster than female athletes [113.1 ( ± 10.4) seconds]. Male athletes, by sport, also completed the LEFT significantly faster than their female counterparts who participated in the same sport. There was no association between preseason LEFT performance and subsequent injury, by sex, in either the validation sample or the combined sample. Females who reported starting primary sport participation by age 10 were two times (OR = 2.4, 95% CI: 1.2, 4.9; p = 0.01) more likely to experience a non-contact time-loss LQ injury than female athletes who started their primary sport at age 11 or older. Males who reported greater than three hours per week of plyometric training during the six-week period prior to the start of the preseason were four times more likely (OR = 4.0, 95% CI: 1.1, 14.0; p = 0.03) to experience a foot or ankle injury than male athletes who performed three or less hours per week.

CONCLUSIONS

The LEFT could not be validated as a preseason performance measure to predict future sports injury risk. The data presented in this study may aid rehabilitation professionals when evaluating an injured athlete's ability to return to sport by comparing their LEFT score to population norms.

LEVEL OF EVIDENCE

2.

[Biomechanical screening for injury prevention : The importance of 3D-motion analysis in high performance sports]

Standardized clinical diagnostic procedures cannot assess the functionality of the anatomical structures in sport-specific movement. Biomechanical screening is able to detect deficits but is not sufficiently and objectively precise with the current clinical examination tools including conventional imaging techniques. The fields of use of functional testing methods are versatile and range from injury prevention analysis, screening during rehabilitation phases up to the return-to-play decision. Using simple musculoskeletal function analysis it is difficult to assess the risk of injuries. The main advantage of instrumented 3D-motion analysis is its potential to generate objective, reliable and reproducible data with exact joint angles, muscle activity, as well as loading inside the joints during movement. These marker-based motion analysis procedures are more time-consuming and more cost intensive and necessitate in particular biomechanical and medical knowledge to assess the analytical data in terms of clinical relevance. In the absence of scientific studies on biomechanical analyses in professional sports, this study shows preliminary approaches to this topic.

Lower Quarter Y-Balance Test Scores and Lower Extremity Injury in NCAA Division I Athletes

Background:

Functional movement tests that are predictive of injury risk in National Collegiate Athletic Association (NCAA) athletes are useful tools for sports medicine professionals. The Lower Quarter Y-Balance Test (YBT-LQ) measures single-leg balance and reach distances in 3 directions.

Purpose:

To assess whether the YBT-LQ predicts the laterality and risk of sports-related lower extremity (LE) injury in NCAA athletes.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

The YBT-LQ was administered to 294 NCAA Division I athletes from 21 sports during preparticipation physical examinations at a single institution. Athletes were followed prospectively over the course of the corresponding season. Correlation analysis was performed between the laterality of reach asymmetry and composite scores (CS) versus the laterality of injury. Receiver operating characteristic (ROC) analysis was used to determine the optimal asymmetry cutoff score for YBT-LQ. A multivariate regression analysis adjusting for sex, sport type, body mass index, and history of prior LE surgery was performed to assess predictors of earlier and higher rates of injury.

Results:

Neither the laterality of reach asymmetry nor the CS correlated with the laterality of injury. ROC analysis found optimal cutoff scores of 2, 9, and 3 cm for anterior, posteromedial, and posterolateral reach, respectively. All of these potential cutoff scores, along with a cutoff score of 4 cm used in the majority of prior studies, were associated with poor sensitivity and specificity. Furthermore, none of the asymmetric cutoff scores were associated with earlier or increased rate of injury in the multivariate analyses.

Conclusion:

YBT-LQ scores alone do not predict LE injury in this collegiate athlete population. Sports medicine professionals should be cautioned against using the YBT-LQ alone to screen for injury risk in collegiate athletes.