Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System

There is a growing concern around concussions in rugby union, at all levels of the game. These concerns highlight the need to better manage and care for players. However, consistency around concussion-related responsibilities of stakeholders across the community rugby system remains challenging. Taking a systems thinking approach, this pragmatic, qualitative descriptive study explored key stakeholder groups within New Zealand's community rugby system's perceptions of their own and others' concussion-related responsibilities. Participants included players from schools and clubs, coaches, parents, team leads and representatives from four provincial unions. A total of 155 participants (67 females and 88 males) were included in the study. Focus groups and individual interviews were conducted. Thematic content analysis was used to analyse data. Thirty concussion-related responsibilities were identified. These responsibilities were contained within four themes: (1) policies and support (responsibilities which influence policy, infrastructure, human or financial resources); (2) rugby culture and general management (responsibilities impacting players' welfare and safety, attitudes and behaviour, including education, injury reporting and communication); (3) individual capabilities (responsibilities demonstrating knowledge and confidence managing concussion, leadership or role/task shifting) and (4) intervention following a suspected concussion (immediate responsibilities as a consequence of a suspected concussion). The need for role clarity was a prominent finding across themes. Additionally, injury management initiatives should prioritise communication between stakeholders and consider task-shifting opportunities for stakeholders with multiple responsibilities. How concussions will realistically be managed in a real-world sports setting and by whom needs to be clearly defined and accepted by each stakeholder group. A 'framework of responsibilities' may act as a starting point for discussion within different individual community rugby contexts on how these responsibilities translate to their context and how these responsibilities can be approached and assigned among available stakeholders.

High Sport Specialization Is Associated With More Musculoskeletal Injuries in Canadian High School Students

OBJECTIVE

To describe levels of sport specialization in Canadian high school students and investigate whether sport specialization and/or sport participation volume is associated with the history of musculoskeletal injury and/or concussion.

DESIGN

Cross-sectional study.

SETTING

High schools, Alberta, Canada.

PARTICIPANTS

High school students (14-19 years) participating in various sports.

INDEPENDENT VARIABLES

Level of sport specialization (high, moderate, low) and sport participation volume (hours per week and months per year).

MAIN OUTCOME MEASURES

Twelve-month injury history (musculoskeletal and concussion).

RESULTS

Of the 1504 students who completed the survey, 31% were categorized as highly specialized (7.5% before the age of 12 years). Using multivariable, negative, binomial regression (adjusted for sex, age, total yearly training hours, and clustering by school), highly specialized students had a significantly higher musculoskeletal injury rate [incidence rate ratio (IRR) = 1.36, 95% confidence interval (CI), 1.07-1.73] but not lower extremity injury or concussion rate, compared with low specialization students. Participating in one sport for more than 8 months of the year significantly increased the musculoskeletal injury rate (IRR = 1.27, 95% CI, 1.02-1.58). Increased training hours significantly increased the musculoskeletal injury rate (IRR = 1.18, 95% CI, 1.13-1.25), lower extremity injury rate (IRR = 1.16, 95% CI, 1.09-1.24), and concussion rate (IRR = 1.31, 95% CI, 1.24-1.39).

CONCLUSIONS

Approximately one-third of Canadian high school students playing sports were categorized as highly specialized. The musculoskeletal injury rate was higher for high sport specialization students compared with low sport specialization students. Musculoskeletal injuries and concussion were also more common in students who train more and spend greater than 8 months per year in one sport.

Time to expand the circle of care - General practitioners' experiences of managing concussion in the community

New Zealand Rugby (NZR) implemented a concussion management pathway (CMP), aimed at improving management at community level. General Practitioners (GPs) played a large role in the design of this process. The objective of this study was to explore GPs' perceptions of barriers and facilitators of the CMP and rugby-related concussion management in the community. A descriptive qualitative approach using interviews and focus groups was employed. Four themes were derived: i) GPs' existing knowledge and confidence around concussion management; ii) Operational resources: time, remuneration and pathway guidance; iii) Standardising concussion care and iv) Expanding the circle of care - the need for multi-disciplinary healthcare team. These themes described how GP's concussion knowledge, and the efficiency and availability of operational resources affected their experience and ability to fulfil their tasks within the CMP. GPs found NZR's CMP especially valuable, as it provided guidance and structure. Expanding the role of other healthcare providers was seen as critical to reduce the burden on GPs, while also delivering a more holistic experience to improve clinical outcomes. Addressing the identified barriers and expanding the network of care will help to improve the ongoing development of NZR's CMP, while supporting continued engagement with all stakeholders.

The Value of Sport: Wellbeing Benefits of Sport Participation during Adolescence

Insight into the unique benefits of sport participation above and beyond those associated with participation in other physical activities among adolescents is limited in Aotearoa New Zealand (NZ). The purpose of this study was to examine the association between wellbeing and organised sport participation among adolescents whilst accounting for demographic characteristics and other recreational physical activity. Demographic characteristics (age, gender, ethnicity, deprivation, (dis)ability status), organized sport, recreational physical activity, and wellbeing were assessed in cohorts of NZ adolescents (11–17 years) between 2017 and 2019. After adjusting for demographics, better wellbeing was associated with participation in any recreational physical activity (OR = 2.49, 95%CI = 1.97–3.13), meeting physical activity recommendations (OR = 1.63, 95%CI = 1.47–1.81), and each additional hour of recreational physical activity (OR = 1.03, 95%CI = 1.02–1.04). After adjusting for demographics and overall recreational physical activity participation, better wellbeing was also associated with participation in any organized sport (OR = 1.66, 95%CI = 1.49–1.86), and each additional hour of organized sport (OR = 1.09, 95%CI = 1.07–1.11). Although participation in recreational physical activity appears to be beneficial for wellbeing, organized sport appears to offer unique additional wellbeing benefits. Positive experiences of organized sport participation may offer additional wellbeing value above and beyond other recreational physical activity types in young people who are active.

Sport concussion assessment in New Zealand high school rugby players: a collaborative approach to the challenges faced in primary care

PRIMARY OBJECTIVE

To describe the collaborative development of a New Zealand Rugby Concussion Assessment (NZRCA) for primary care and to provide normative baseline data from a representative group of high school rugby players.

METHODS

This study, conducted over the 2018 and 2019 community rugby season where players were baseline tested during the pre- or start of season period.

RESULTS

Data were collected from 1428 players (males n = 1121, females n = 307) with a mean age of 15.9 ± 1.4 years. The mean ± SD symptom severity score was 11.3 ± 8.6, the mean number of endorsed symptoms was 8.5 ± 5.3 and the percentage feeling "normal" was 80.2 ± 15.3%. Only 5.3% of players reported no symptoms at baseline. The most common reported were: 'distracted easily' (72.5%), 'forgetful' (68.5%), and 'often tired' (62.6%). None of the participants achieved a perfect score for the SAC50. The majority of participants (89.7%) passed the tandem gait test with a time of 12.2 ± 1.7 seconds. Age, gender, and ethnicity were associated with NZRCA performance; albeit weakly.

CONCLUSION

This study provides normative reference values for high-school rugby players. These data will aid healthcare providers in their identification of suspected concussion in the absence of individualized baselines.

A systematic video analysis of 21 anterior cruciate ligament injuries in elite netball players during games

This systematic video analysis of 21 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games, describes the situation, movement pattern and player behaviour, providing insight regarding the injury mechanism. Seventeen of the ACL injuries occurred from jump-landing actions and only two from cutting manoeuvres. A common scenario was identified for 11 players. In this scenario, players were decelerating rapidly after jumping to receive a high pass, utilising a double-footed landing with a wide base of support (WBOS). Deceleration appeared to be applied predominantly via the injured leg with the knee extended and foot planted. Often the players appeared unbalanced on landing leaning too far back. ACL injury risk was possibly exacerbated by the players head turning away from the injured side. A further compressive knee moment may have been placed on the lateral aspect of the knee by bringing the ball from a high position to a low position at the estimated time of injury. Players may benefit from landing technique training programmes that encourage shoulder-width foot landings, with ≥30° knee flexion, a small amount of plantar-flexion and good balance. Incorporating challenges to players balance and ability to cope with perturbations may also be beneficial. Training programmes should include instruction on securing the ball in a stable above pelvis-level position after receiving a pass and bringing their whole body around during landing into the direction of their next pass, rather than simply turning their head to look.

Sport Specialization, Physical Performance and Injury History in Canadian Junior High School Students

BACKGROUND

Youth sports participation is encouraged for proposed physical and psychological benefits. However early sport specialization and the potentially negative consequences may be a cause for concern.

PURPOSE

To describe sport specialization in Canadian youth and investigate associations with previous injury and physical performance.

STUDY DESIGN

Cross-sectional study.

METHODS

Junior high school students (grades 7-9, ages 11-16) were invited to participate. All participants completed a questionnaire capturing specialization level (low, moderate, high; based on year-round training, exclusion of other sports, and single-sport training) and injury history in the previous 12-months. Additionally, all participants completed physical performance measures including vertical jump (cm), predicted VO2max (mL/kg/min), single-leg balance (secs) and Y-Balance composite score (%). Logistic regression examined the association between school grade, school size, sex and sport specialization (Objective 1) and the association between sport specialization and injury history (Objective 2). Multivariable linear regression analyses (4) assessed associations between sport specialization category and physical performance measures (Objective 3).

RESULTS

Two hundred and thirty-eight students participated in the study. Eighteen percent of participants reported high specialization, with no significant associations between sex, grade or school size and specialization category. There was no significant difference in the odds of sustaining previous injury between participants reporting moderate (odds ratio [OR]=1.94, 95% CI 0.86-4.35) or high (OR=2.21, 95% CI 0.43-11.37) compared to low specialization. There were no significant differences in vertical jump height (mean diff [MD] = -0.4 to 2.1cm), predicted VO2max (MD = 2.2 to 3.1mL/kg/min), single leg balance (MD = 0.5 to 1.9sec) or Y-balance (MD = 0.6 to 7.0%) between sport specialization categories.

CONCLUSIONS

Sport specialization exists in Canadian junior high schools but may be less common than previously reported and it was not associated with sex, grade, or school size. Level of specialization was not associated with history of injury nor a range of physical performance measures.

LEVEL OF EVIDENCE

Level 3.

Baseline concussion assessment performance of community-based senior rugby players: a cross-sectional study

OBJECTIVE

To report pre-season baseline concussion assessment performance among senior rugby players and explore associations between assessment performance and player demographics.

DESIGN

A cross-sectional study using the New Zealand Rugby Concussion Assessments (NZRCA), comprising symptom, cognitive and dynamic coordination assessments was conducted in the 2018-2019 season.

METHODS

Players' baseline assessments were characterised using descriptive statistics; effect sizes (ES) and t-tests were used to explore associations between player demographic characteristics and NZRCA performance.

RESULTS

A total of 733 players (11.4% female) aged between 16 and 52 years completed the NZRCA. The median (range) value for symptom severity, endorsed symptoms and "percentage normal" was respectively, 5 (0-40), 5 (0-21) and 90% (30-100%). A perfect standardised assessment of concussion score was achieved by one participant; seven achieved ≥27/30 for immediate recall, and 22 achieved a perfect delayed recall score. Most participants (n = 674, 92%) passed the tandem gait test. Associations between NZRCA performance and gender, concussion history, and Pasifika ethnicity were observed with effect sizes ranging from small (0.18) to large (0.70). Six hundred and twenty-three (85%) participants reported at least one symptom.

CONCLUSIONS

The results from this study could help support decision-making by clinicians, improving the management of concussions in the community setting.

Short and long versions of a 12-week netball specific neuromuscular warm-up improves landing technique in youth netballers

OBJECTIVE

To investigate the efficacy of two 'NetballSmart', netball specific warm-ups in improving landing technique measures in New Zealand secondary school netball players.

DESIGN

Multi-site cluster experimental trial.

PARTICIPANTS

77 youth participants, mean ± SD age = 15.8 ± 0.9 were recruited from secondary school netball teams.

SETTING

12 teams from 6 schools performed either the NetballSmart Dynamic Warm-up (NSDW) (n = 37); or Power warm-up (PWU) (n = 40), three times a week for 12 weeks. All players within a school (2 teams) were assigned the same warm-up, avoiding treatment contamination.

MAIN OUTCOME MEASURES

A series of unilateral and bilateral drop vertical jumps on to a portable force plate were completed by all participants. Measures included peak vertical ground reaction force (GRF) for single-leg and bilateral landings; frontal plane projection angle (FPPA) for right and left single-leg landings and Landing error scoring system (LESS) for bilateral landings. Paired t-tests were used to assess mean differences pre and post the warm-up. Generalised linear mixed effects models were developed to evaluate the effects between the NSDW and PWU groups.

RESULTS

Significant improvements were found in all the landing technique outcome measures for both warm-up groups (ES Range- GRF = -0.6 to -1.1; FPPA = 0.8 to 1.2; LESS = -1.6 to-3.2; p < 0.05). Results of mixed effects models revealed that there was only a significantly greater improvement in LESS for the PWU group (β = -0.30, p = 0.001).

CONCLUSION

Results show both warm-ups can improve landing technique measures in youth secondary school netball players. It is recommended that coaches should consider implementing one of the two warm-ups in their netball programmes. Their choice of warm-up will likely be dependent on their environment and time demands.

Performance Profiling of Female Youth Netball Players

McKenzie, CR, Whatman, C, and Brughelli, M. Performance profiling of female youth netball players. J Strength Cond Res 34(11): 3275-3283, 2020-The purpose of this study was to investigate the physical performance characteristics of New Zealand secondary school netball players to provide a physical performance profile and determine whether there are differences between playing grade and playing positions for this group. A total of 102 female netball players (mean ± SD: age 13.3 ± 0.50 years, height 166.95 ± 5.72 cm, and body mass 60.94 ± 12.80 kg) participated in this study. Measurements included anthropometry, horizontal and vertical jump performance, balance, core strength, change-of-direction speed, and split sprint times. Magnitude-based inferences were used to determine differences in all measures. Grade 1 players jumped further and higher (effect size [ES] = 0.41-1.37) and ran faster with small to moderate differences. They demonstrated faster change-of-direction speed (ES = -0.73 to -1.31), greater core strength (ES = 0.28-1.17), and a faster time-to-stabilization (ES = -0.69). Grade 2 circle players jumped further (ES = -0.29), compared with noncircle players who jumped higher (ES = 0.35). Noncircle players had faster sprint and change-of-direction speed (ES = -0.33 to -0.55) and measures of balance (ES = -0.47 to 0.55). Grade 1 circle players were found to be faster over 20 m (ES = 0.75). The results of this study showed differences in the physical performance capabilities between youth netball players competing in different grades, as well as differences between playing positions. These findings have provided a physical performance profile of female youth netball players in New Zealand, suggesting that physical performance measures could be used for position-specific training and talent identification and selection.

Ten-year nationwide review of netball ankle and knee injuries in New Zealand

OBJECTIVES

To review netball ankle and knee injuries between 2008 and 2017.

DESIGN

Audit of insurance injury claims.

METHODS

Data were divided into 5 equal year groups (2008/9, 2010/11, 2012/13, 2014/15, 2016/17), and 3 age groups (10 to 14 years, 15 to 19 years, 20 to 24 years old). Raw injury counts and injury rates per 1000 affiliated players were reported. Changes in injury rates over the 10-year period and differences between age groups were expressed as Incident rate ratios (IRRs). A Shewhart control chart was created to identify monthly injury patterns.

RESULTS

10-14-year-olds showed the biggest increase in injury counts (ankle 84% increase and knee 133% increase). 20-24-year-olds had the highest mean injury rate over the ten-years (ankle = 77.8, knee = 71.6 injuries/1000 players). 10-14-year-olds had the biggest increase in risk of injury between 2008/09 to 2016/17, (ankle IRR = 2.0; knee IRR = 2.5), 15-19-year-olds (ankle IRR = 1.4; knee IRR = 1.5), 20-24 year olds (ankle IRR = 0.5; knee IRR = 1.9). The older two groups had a significantly higher mean risk of ankle and knee injury (IRR = 1.9 to 2.2; p < 0.001). Higher than expected yearly injury incidence was repeatedly seen in 10-19-year-olds.

CONCLUSION

Ankle and Knee injuries have increased with the biggest increase in 10-19-year-olds. Injuries in 20-24-year-olds still represent the highest cost and continue at a higher rate than in younger players. Spikes in injury are likely associated with intense periods of trialling and tournament play.

What they know and who they are telling: Concussion knowledge and disclosure behaviour in New Zealand adolescent rugby union players

The purpose of this study was to survey high school rugby players from a range of ethnic, geographic and socioeconomic backgrounds in New Zealand (NZ) to gain an understanding of concussion knowledge, awareness of NZ Rugby's (NZR) guidelines and attitudes towards reporting behaviours. Male and female high school rugby players (n= 416) from across NZ were surveyed. The findings indicated that 69% of players had sustained a suspected concussion, and 31% had received a medical diagnosis of concussion. 63% of players indicated they were aware of NZR's guidelines. Māori and Pasifika players were less likely to be aware of the guidelines compared to NZ European, Adjusted OR 0.5, p = 0.03. Guideline awareness was significantly higher for those from high decile schools when compared to low (Unadjusted OR 1.63, p = 0.04); however, when ethnicity and school locations were controlled for this became non-significant (Adjusted OR= 1.3, p=0.37). The coach was the key individual for the provision of concussion information and disclosure of symptoms for players. The findings of this study will inform the development and delivery of NZR's community concussion initiative and how these examined factors influence a high school player's concussion knowledge and reporting behaviour.

Visual rating of movement quality in individuals with and without a history of intra-articular knee injury

Objective: To investigate the use of visually rated movement quality in a group including those with a history of intra-articular knee injury.Design: Historical cohort study.Setting: Laboratory.Participants: A total of 115 youth and young adults (62 previously injured).Main outcome measures: Inter-rater agreement for ratings of movement quality during single limb squat and vertical drop jump (VDJ) were assessed. Odds ratios were calculated to determine if the history of knee injury was associated with greater odds of poor movement quality. The difference in knee:ankle separation ratio between the injured and uninjured groups was compared.Results: Rater agreement was moderate to excellent (κ = 0.55 to 0.93). Comparing the injured and uninjured limb in previously injured participants or injured participants to matched uninjured controls, there was no significant difference in the proportion of good versus poor movement ratings (diff = 0% to 10%; p ≥ 0.23). Prior history of knee injury did not increase the odds of poor movement quality during the VDJ (OR 0.91; 95% CI 0.41 to 2.03) or single leg squat (OR 1.04; 95% CI 0.38 to 2.85) and there was no significant difference in the knee:ankle separation ratios (mean diff -0.03; p = 0.30).Conclusion: Visual rating of movement in individuals with and without a history of knee injury is reliable. A history of knee injury does not increase the likelihood of poor visually rated movement quality.

The effect of the NetballSmart Dynamic Warm-up on physical performance in youth netball players

OBJECTIVES

To investigate the efficacy of the NetballSmart Dynamic Warm-up in improving physical performance measures in New Zealand secondary school netball players.

DESIGN

Cluster randomised controlled trial.

SETTING

A seven-week intervention study in secondary school netball.

PARTICIPANTS

81 youth netball players (Intervention group, n = 45; Control group, n = 36).

MAIN OUTCOME MEASURES

Performance measures included prone hold, change of direction, sprint, vertical and horizontal jump, Y-balance and time-to-stabilisation. Mixed effects models and t-tests were used to determine significant differences of pre and post measures between groups.

RESULTS

Significant improvements in prone hold (β = 20.46 s; p = 0.01) and vertical jump (β = 6.73 cm; p = 0.01) were found in the intervention group compared to the control group, while horizontal jump was found to significantly decrease (β = -9.86 cm; p = 0.03) in comparison to the control group.

CONCLUSIONS

The results of this study show the NetballSmart Dynamic Warm-up can improve some physical performance measures in youth netball players. It is recommended that coaches should consider implementing the warm-up in their netball programmes.

The Proportion of Lower Limb Running Injuries by Gender, Anatomical Location and Specific Pathology: A Systematic Review

Running is associated with a higher risk of overuse injury than other forms of aerobic exercise such as walking, swimming and cycling. An accurate description of the proportion of running injuries per anatomical location and where possible, per specific pathology, for both genders is required. The aim of this review was to determine the proportion of lower limb running injuries by anatomical location and by specific pathology in male and female runners (≥800m - ≤ marathon). The preferred reporting items for systematic reviews and meta-analyses guidelines were followed for this review. A literature search was performed with no restriction on publication year in Web of Science, Scopus, Sport-Discus, PubMed, and CINAHL up to July 2017. Retrospective, cross-sectional, prospective and randomised-controlled studies which surveyed injury data in runners were included. 36 studies were included to report the overall proportion of injury per anatomical location. The overall proportion of injury by specific pathology was reported from 11 studies. The knee (28%), ankle-foot (26%) and shank (16%) accounted for the highest proportion of injury in male and female runners, although the proportion of knee injury was greater in women (40% vs. 31%). Relative to women, men had a greater proportion of ankle-foot (26% vs. 19%) and shank (21% vs. 16%) injuries. Patellofemoral pain syndrome (PFPS; 17%), Achilles tendinopathy (AT; 10%) and medial tibial stress syndrome (MTS; 8%) accounted for the highest proportion of specific pathologies recorded overall. There was insufficient data to sub-divide specific pathology between genders. The predominate injury in female runners is to the knee. Male runners have a more even distribution of injury between the knee, shank and ankle-foot complex. There are several methodological issues, which limit the interpretation of epidemiological data in running injury.

A review of the risk factors for lower extremity overuse injuries in young elite female ballet dancers

The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.

The Influence of Optimal Handheld Load on the Technical Ability to Apply Ground Reaction Forces during Horizontal Jumping in Female Netball Players

Handheld load has been reported to enhance horizontal jump performance, however little is known about its influence on ground reaction forces (GRF), especially in female athletes. This study investigated the effects of individualized optimal handheld loading on the technical and physical ability to apply GRF during horizontal jumping in female netball players. Maximal effort, single standing, horizontal jumps were performed by 13 female netballers. Participants performed the jumps under 2 conditions: 1) unloaded, and 2) loaded. Eccentric mean horizontal GRF significantly increased with loading (p<0.05; Effect Size [ES]= 0.74). The ratio of horizontal-to-total GRF significantly increased (p<0.05; ES=0.57), however resultant GRF did not, suggesting that the technical ability to apply force in the direction of intended movement may be of greater importance than the magnitude of force applied. Jump distance also increased from 188.2±16.1 cm to 196.4±13.6 cm (p<0.01; ES=0.55) with handheld load. In conclusion, individualized optimal handheld loading improved single horizontal jump performance in this population of athletes; most likely through various mechanisms that allowed for increased eccentric horizontal GRFs and the technical ability of force application. Findings could have practical implications for the strength and conditioning coach, trainer and athlete.

The effect of ankle bracing on lower extremity biomechanics during landing: A systematic review

OBJECTIVES

To examine the evidence for effect of ankle bracing on lower-extremity landing biomechanics.

DESIGN

Literature review.

METHODS

Systematic search of the literature on EBSCO health databases. Articles critiqued by two reviewers.

RESULTS

Ten studies were identified which investigated the effect of ankle bracing on landing biomechanics. Overall results suggest that landing biomechanics are altered with some brace types but studies disagree as to the particular variables affected.

CONCLUSIONS

There is evidence that ankle bracing may alter lower-extremity landing biomechanics in a manner which predisposes athletes to injury. The focus of studies on specific biomechanical variables rather than biomechanical patterns, analysis of pooled data means in the presence of differing landing styles between participants, variation in landing-tasks investigated in different studies, and lack of studies investigating goal-directed sport-specific landing tasks creates difficulty in interpreting results. These areas require further research.

The effect of reduced ankle dorsiflexion on lower extremity mechanics during landing: A systematic review

OBJECTIVES

To examine the evidence for effect of restricted ankle dorsiflexion range of motion on lower-extremity landing mechanics.

DESIGN

Literature review.

METHODS

Systematic search of the literature. Articles critiqued by two reviewers.

RESULTS

Six studies were identified that investigated the effect of restricted DF ROM on landing mechanics. Overall, results suggest that landing mechanics are altered with restricted DF ROM, but studies disagree as to the particular mechanical variables affected.

CONCLUSIONS

There is evidence that restricted dorsiflexion range of motion may alter lower-extremity landing mechanics in a manner, which predisposes athletes to injury. Interpretation of results was made difficult by the variation in landing tasks investigated and the lack studies investigating sport-specific landing tasks. The focus of studies on specific mechanical variables rather than mechanical patterns and the analysis of pooled data in the presence of different compensation strategies between participants also made interpretation difficult. These areas require further research.

Effects of a lower limb functional exercise programme aimed at minimising knee valgus angle on running kinematics in youth athletes

OBJECTIVES

To investigate the effectiveness of 8-weeks of lower limb functional exercises on frontal plane hip and knee angles during running in youth athletes.

DESIGN

Pre- and post-intervention quantitative experimental.

METHODS

Nineteen athletes (11 male, 8 female, 11.54 ± 1.34 years) from a long-term athletic development programme had 3-dimensional running gait measured pre and post an 8-week exercise intervention. Youth athletes randomised to control (upper limb strengthening exercises) or experimental (lower limb functional exercises aimed at minimising knee valgus angle) interventions completed the exercises during the first 10 min of training, three mornings a week. Pre- and post-parallel groups' analysis provided estimates of intervention effects for control and experimental groups.

RESULTS

Differences in pre- to post-intervention changes in mean frontal plane angles between control and experimental groups were trivial for the left hip (0.1°) and right knee (-0.3°). There was a small beneficial decrease in right hip joint angle (0.4°) but a very large (ES = 0.77, CI 0.1-3.7) detrimental increase in left knee valgus angle (1.9°) between groups.

CONCLUSION

The 8-week lower limb functional exercises had little beneficial effects on lower limb hip and knee mechanics in youth athletes aged 9-14 years.

Physiotherapist agreement when visually rating movement quality during lower extremity functional screening tests

OBJECTIVES

To investigate physiotherapist agreement in rating movement quality during lower extremity functional tests using two visual rating methods and physiotherapists with differing clinical experience.

DESIGN

Clinical measurement.

PARTICIPANTS

Six healthy individuals were rated by 44 physiotherapists. These raters were in three groups (inexperienced, novice, experienced).

MAIN MEASURES

Video recordings of all six individuals performing four lower extremity functional tests were visually rated (dichotomous or ordinal scale) using two rating methods (overall or segment) on two occasions separated by 3-4 weeks. Intra and inter-rater agreement for physiotherapists was determined using overall percentage agreement (OPA) and the first order agreement coefficient (AC1).

RESULTS

Intra-rater agreement for overall and segment methods ranged from slight to almost perfect (OPA: 29-96%, AC1: 0.01 to 0.96). AC1 agreement was better in the experienced group (84-99% likelihood) and for dichotomous rating (97-100% likelihood). Inter-rater agreement ranged from fair to good (OPA: 45-79%; AC1: 0.22-0.71). AC1 agreement was not influenced by clinical experience but was again better using dichotomous rating.

CONCLUSIONS

Physiotherapists' visual rating of movement quality during lower extremity functional tests resulted in slight to almost perfect intra-rater agreement and fair to good inter-rater agreement. Agreement improved with increased level of clinical experience and use of dichotomous rating.