Is There an Association Between Injury History and Lower Extremity Joint Injury During Canada Games Competition?

Background: Injuries during elite level competition like the Canada Games, occur frequently and injury history is one of the strongest predictors of future injury; however, this association is unknown in the Canada Games. Purpose: To determine the association between injury history and incidence of lower extremity joint injury during Canada Games competition. Methods: Data from the 2009 - 2019 Canada Games (8710 male and 8391 female athletes) competitions were de-identified by the Canada Games Council for analysis. Injury data were cleaned and categorized for previous injury and injury type and location. Injury history was self-reported and included concussion, major surgical procedure, neck and back, trauma to joint or bone, and trauma to ligament or tendon. Injury from the Canada Games competitions were categorized to include ankle, knee, hip, and patellofemoral joint injuries. Chi-Square (χ2 ) test of independence determined association between injury history and incidence of lower extremity joint injury during Canada Games competition. IBM SPSS (Version 26) was used for statistical analysis (p-value < 0.05). Results: Four hundred and seventy-five ankle, 503 knee, 253 hip, and 106 patellofemoral joint injuries were reported during 10 years of Canada Games competitions. There were significant associations between history of neck and back injuries with ankle injuries and knee injuries, history of trauma and overuse of ligament or tendon with hip injuries and history of trauma or overuse of joint or bone with patellofemoral joint injuries. Conclusion: These findings support previous literature suggesting that injury history is associated with future injury. Level of Evidence: 3.

Injuries and Illnesses Across 10 Years of Canada Games Competitions: 2009 - 2019.

Background: The Canada Games are a national level competition held every two years alternating between Summer and Winter Games. Participation in elite level athletics, like the Canada Games, have an inherent risk of injury and illness. Purpose: To analyze the incidence and characteristics of injuries and illnesses during Canada Games competitions from 2009-2019 (primarily) and to understand sex differences in odds of musculoskeletal injury for Summer and Winter Canada Games athletes (secondarily). Study Design: Descriptive Epidemiology Study. Methods: Using a retrospective cohort, data were abstracted from medical incident reports generated during Canada Games from 2009 - 2019. Data were coded for body part injured and injury type or illness system; injuries were also categorized as acute or chronic. Results: Across all 10 years of competition, 3160 injuries reported in 8710 male athletes and 3272 injuries reported in 8391 female athletes. Injury incidence was 362.8 and 389.9 and illness incidence was 47.8 and 64.5 per 1000 male and female athletes, respectively. Female athletes had a 1.12 (95% CI: 1.06; 1.19) greater odds of injury and 1.37 (95% CI: 1.20; 1.57) greater odds of illness compared to male athletes. Overall, injury (399.31 vs. 360.31; p < 0.001) and illness (68.67 vs. 47.30; p < 0.001) incidences were higher in Winter Games, compared to Summer Games, per 1000 athletes. When comparing male and female athletes participating in similar sports, sex specific differences exist in odds of both injury and illness. Conclusions: Male and female athletes competing in Canada Games competitions demonstrate differences in injury and illness incidence and odds of injury. This suggests a need to examine if additional modifiable risk factors may exist, which could contribute to prevention strategies to reduce injury and illness during Canada Games competition. Level of Evidence: 3.

Anthropometrics and electromyography as predictors for maximal voluntary isometric wrist torque: Considerations for ergonomists.

The purpose of this study was to evaluate anthropometry and forearm muscle activity as predictors of maximal isometric wrist torque. Thirteen anthropometric measures, forearm electromyography from flexor carpi radialis (FCR) and extensor carpi radialis (ECR), and maximal isometric wrist flexion/extension torque were obtained from 25 male participants. Pearson correlation coefficients assessed relationships between peak isometric torque and: (1) anthropometrics, (2) FCR and ECR activation, (3) FCR/ECR antagonist/agonist coactivation ratios. Based on significant correlations, linear regression equations were developed (SPSS v.25; p < 0.05). Hand thickness, forearm circumference and ECR activation or hand thickness, elbow circumference, FCR activation and body weight were most highly correlated with extension or flexion torque, respectively. Hand thickness, forearm circumference, and ECR activation (R2 = 54.5%; p = 0.001) and hand thickness, elbow circumference, FCR activation (R2 = 68.3%; p < 0.001) explained similar variance in torque regressions as did the addition of body weight to extension (R2 = 58.0%; p = 0.001) and flexion (R2 = 69.9%; p < 0.001) torque regression equations, respectively. Circumference measurements, a pseudo for muscle size, and activation amplitude influenced wrist force output more than limb length or coactivation.

Predicting Lower Quarter Y-Balance Test Performance From Foot Characteristics.

CONTEXT: The lower quarter Y-Balance Test (YBT-LQ) is associated with injury risk; however, ankle range of motion impacts YBT-LQ. Arch height and foot sensation impact static balance, but these characteristics have not yet been evaluated relative to YBT-LQ. OBJECTIVE: Determine if arch height index (AHI), forefoot sensation (SEN), and ankle dorsiflexion predict YBT-LQ composite score (CS). DESIGN: Descriptive cohort. SETTING: Athletic training laboratory. PARTICIPANTS: Twenty general population (14 females and 6 males; mean [SD]: age 35 [18] y, weight 70.02 [16.76] kg, height 1.68 [0.12] m) participated in this study. INTERVENTIONS: AHI measurement system assessed arch height in 10% (AHI10) and 90% (AHI90) weight-bearing. Two-point discrim-a-gon discs assessed sensation (SEN) at the plantar great toe, third and fifth metatarsal heads. Biplane goniometer and weight-bearing lunge tests were used to measure static and weight-bearing dorsiflexion, respectively. The YBT-LQ assessed dynamic single-leg balance. RESULTS: For right-limb dynamic single-leg balance, AHI90 and SEN were included in the final sequential prediction equation; however, neither model significantly (P = .052 and .074) predicted variance in YBT-LQ CS. For left-limb dynamic single-leg balance, both SEN and weight-bearing lunge test were included in the final sequential prediction equation. The regression model (SEN and weight-bearing lunge test) significantly (P = .047) predicted 22% of the variance in YBT-LQ CS. CONCLUSIONS: This study demonstrates that foot characteristics may play a role in YBT-LQ CS. The authors did not assess limb dominance in this study; therefore, the authors are unable to determine which limb would be the stance versus kicking limb. However, altered SEN and weight-bearing dorsiflexion appear to be contributing factors to YBT-LQ CS.

Association of Functional Screening Tests and Noncontact Injuries in Division I Women Student-Athletes.

Warren, M, Lininger, M, Smith, CA, Copp, A, and Chimera, NJ. Association of functional screening tests and noncontact injuries in Division I women student-athletes. J Strength Cond Res 34(8): 2302-2311, 2020-To determine the association between functional screening tests and lower-body, noncontact injuries in Division I women basketball, soccer, and volleyball student-athletes (SA). Sixty-eight injury-free women SA (age: 19.1 ± 1.1 years, height: 171.3 ± 8.7 cm, and mass: 68.4 ± 9.5 kg) were tested preseason with single hop (SH), triple hop (TH), and crossover hop (XH) for distance, and isometric hip strength (abduction, extension, and external rotation) in randomized order. The first lower-body (spine and lower extremity), noncontact injury requiring intervention by the athletic trainer was abstracted from the electronic medical record. Receiver operating characteristic and area under the curve (AUC) were calculated to determine cut-points for each hopping test from the absolute value of between-limb difference. Body mass-adjusted strength was categorized into tertiles. Logistic regression determined the odds of injury with each functional screening test using the hopping tests cut-points and strength categories, adjusting for previous injury. Fifty-two SA were injured during the sport season. The cut-point for SH was 4 cm (sensitivity = 0.77, specificity = 0.43, and AUC = 0.53), and for TH and XH was 12 cm (sensitivity = 0.75 and 0.67, specificity = 0.71 and 0.57, AUC = 0.59 and 0.41, respectively). A statistically significant association with TH and injuries (adjusted odds ratio = 6.50 [95% confidence interval: 1.69-25.04]) was found. No significant overall association was found with SH or XH, nor with the strength tests. Using a clinically relevant injury definition, the TH showed the strongest predictive ability for noncontact injuries. This hopping test may be a clinically useful tool to help identify increased risk of injury in women SA participating in high-risk sports.

A Critically Appraised Topic on the Tuck Jump Assessment: Does the Tuck Jump Assessment Demonstrate Interrater and Intrarater Reliability in Healthy Individuals?

Clinical Scenario: Lower-extremity injuries in the United States costs millions of dollars each year. Athletes should be screened for neuromuscular deficits and trained to correct them. The tuck jump assessment (TJA) is a plyometric tool that can be used with athletes. Clinical Question: Does the TJA demonstrate both interrater and intrarater reliability in healthy individuals? Summary of Key Findings: Four of the 5 articles included in this critically appraised topic showed good to excellent reliability; however, caution should be taken in interpreting these results. Although composite scores of the TJA were found to be reliable, individual flaws do not demonstrate reliability on their own, with the exception of knee valgus at landing. Aspects of the TJA itself, including rater training, scoring system, playback speed, volume, and number of views allotted, need to be standardized before the reliability of this clinical assessment can be further researched. Clinical Bottom Line: The TJA has shown varying levels of reliability, from poor to excellent, for both interrater and intrarater reliability, given current research. Strength of Recommendation: According to the Centre for Evidence Based Medicine levels of evidence, there is level 2b evidence for research into the reliability of the TJA. This evidence has been demonstrated in elite, adolescent, and college-level athletics in the United Kingdom, Spain, and the United States. The recommendation of level 2b was chosen because these studies utilized cohort design for interrater and intrarater reliability across populations. An overall grade of B was recommended because there were consistent level 2 studies.

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

The Functional Movement Screen (FMS) is a popular movement screen used by rehabilitation, as well as strength and conditioning, professionals. The FMS, like other movement screens, identifies movement dysfunction in those at risk of, but not currently experiencing, signs or symptoms of a musculoskeletal injury. Seven movement patterns comprise the FMS, which was designed to screen fundamental movement requiring a balance between stability and mobility. The 7 movement patterns are summed to a composite FMS score. For an instrument to have wide applicability and acceptability, there must be high levels of reliability, validity, and accuracy. The FMS is certainly a reliable tool, and can be consistently scored within and between raters. Although the FMS has high face and content validity, the criterion validity (discriminant and convergent) is low. Additionally, the FMS does not appear to be studying a single construct, challenging the use of the summed composite FMS score. The accuracy of the FMS in screening for injury is also suspect, with low sensitivity in almost all studies, although specificity is higher. Finally, within the FMS literature, the concepts of prediction and association are conflated, combined with flawed cohort studies, leading to questions about the efficacy of the FMS to screen for injury. Future research on the use of the FMS, either the composite score or the individual movement patterns, to screen for injury or injury risk in adequately powered, well-designed studies are required to determine if the FMS is appropriate for use as a movement screen.

PREDICTION OF FUNCTIONAL MOVEMENT SCREEN™ PERFORMANCE FROM LOWER EXTREMITY RANGE OF MOTION AND CORE TESTS.

BACKGROUND: There are varied reports in the literature regarding the association of the Functional Movement Screen™ (FMS™) with injury. The FMS™ has been correlated with hamstring range of motion and plank hold times; however, limited research is available on the predictability of lower extremity range of motion (ROM) and core function on FMS™ performance. PURPOSE/HYPOTHESES: The purpose of this study was to examine whether active lower extremity ROM measurements and core functional tests predict FMS™ performance. The authors hypothesized that lower extremity ROM and core functional tests would predict FMS™ composite score (CS) and performance on individual FMS™ fundamental movement patterns. STUDY DESIGN: Descriptive cohort study. METHODS: Forty recreationally active participants had active lower extremity ROM measured, performed two core functional tests, the single leg wall sit hold (SLWS) and the repetitive single leg squat (RSLS), and performed the FMS™. Independent t tests were used to assess differences between right and left limb ROM measures and outcomes of core functional tests. Linear and ordinal logistic regressions were used to determine the best predictors of FMS™ CS and fundamental movement patterns, respectively. RESULTS: On the left side, reduced DF and SLWS significantly predicted lower FMS™ CS. On the right side only reduced DF significantly predicted lower FMS™ CS. Ordinal logistic regression models for the fundamental movement patterns demonstrated that reduced DF ROM was significantly associated with lower performance on deep squat. Reduced left knee extension was significantly associated with better performance in left straight leg raise; while reduced right hip flexion was significantly associated with reduced right straight leg raise. Lower SLWS was associated with reduced trunk stability performance. CONCLUSIONS: FMS™ movement patterns were affected by lower extremity ROM and core function. Researchers should consider lower FMS™ performance as indicative of underlying issues in ROM and core function. Clinicians may consider ROM interventions and core training strategies to improve FMS™ CS. LEVEL OF EVIDENCE: Level 2B.

Tuck Jump Assessment: An Exploratory Factor Analysis in a College Age Population.

Lininger, MR, Smith, CA, Chimera, NJ, Hoog, P, and Warren, M. Tuck Jump Assessment: An exploratory factor analysis in a college age population. J Strength Cond Res 31(3): 653-659, 2017-Due to the high rate of noncontact lower extremity injuries that occur in the collegiate setting, medical personnel are implementing screening mechanisms to identify those athletes that may be at risk for certain injuries before starting a sports season. The tuck jump assessment (TJA) was created as a "clinician friendly" tool to identify lower extremity landing technique flaws during a plyometric activity. There are 10 technique flaws that are assessed as either having the apparent deficit or not during the TJA. Technique flaws are then summed up for an overall score. Through expert consensus, these 10 technique flaws have been grouped into 5 modifiable risk factors: ligament dominance, quadriceps dominance, leg dominance or residual injury deficits, trunk dominance ("core" dysfunction), and technique perfection. Research has not investigated the psychometric properties of the TJA technique flaws or the modifiable risk factors. The present study is a psychometric analysis of the TJA technique flaws to measure the internal structure using an exploratory factor analysis (EFA) using data from collegiate athletes (n = 90) and a general college cohort (n = 99). The EFA suggested a 3 factor model accounting for 46% of the variance. The 3 factors were defined as fatigue, distal landing pattern, and proximal control. The results differ from the 5 modifiable risk categories as previously suggested. These results may question the use of a single score, a unidimensional construct, of the TJA for injury screening.

Comparison of Female Collegiate Athletes and College Age Cohort in Tuck Jump Assessment.

Smith, CA, Olson, BK, Olson, LA, Chimera, NJ, and Warren, M. Comparison of female collegiate athletes and college age cohort in tuck jump assessment. J Strength Cond Res 31(4): 1048-1054, 2017-The tuck jump assessment (TJA) is a plyometric jumping assessment with 10 flaw criteria against which technique is assessed over a 10-second interval. The TJA has been reported as a tool for identifying neuromuscular deficits that increase risk for anterior cruciate ligament injury, but group specific data on female TJA scores are limited. No cut point has been developed for groups with different activity levels or participation in athletics. This study investigated the association between TJA score and athletic participation in college-aged females. One hundred twenty-one females (53 collegiate athletes and 68 college students) completed the TJA. TJA score was the sum of flaws for the 10 criteria observed, and the number of jumps was recorded. Poisson regression was used to assess the association between TJA score and number of jumps. The association between each of the 10 flaws between groups was assessed with the chi-square test. No significant association was found between groups for TJA score (mean ± SD: 4.66 ± 1.07 athletes; 5.45 ± 1.05 college cohort; p = 0.06; ß = 0.82). Athletes jumped significantly more times (12.23 ± 1.04 athletes; 9.35 ± 1.04 college cohort). Athletes had a lower proportion of 2 flaws: "thighs do not reach parallel" and "pause between jumps." Lower statistical power may limit interpretation of the remaining flaws. The lack of control of the number of jumps may impact TJA score. To improve the TJA usefulness on the field and clinic, the protocol may need to standardize the number of jumps.

FUNCTIONAL HOP TESTS AND TUCK JUMP ASSESSMENT SCORES BETWEEN FEMALE DIVISION I COLLEGIATE ATHLETES PARTICIPATING IN HIGH VERSUS LOW ACL INJURY PRONE SPORTS: A CROSS SECTIONAL ANALYSIS.

BACKGROUND: Although functional tests including the single leg hop (SLH), triple hop (TH), cross over hop (COH) for distance, and the tuck jump assessment (TJA) are used for return to play (RTP) criteria for post anterior cruciate ligament (ACL) injury, sport-specific baseline measurements are limited. PURPOSE: The purpose of this study was to examine differences in SLH, TH, and COH distance and limb symmetry index (LSI), as well as total scores, number of jumps, and individual flaws of the TJA in 97 injury-free Division I (DI) collegiate female student athletes participating in ACL injury prone vs. non ACL injury prone sports. The hypothesis was that significant mean differences and asymmetries (LSI) would exist between the two groups in SLH, TH, COH and TJA. STUDY DESIGN: Cross sectional. METHODS: Due to research suggesting inherent ACL injury risk associated with specific sport involvement, participants were grouped into high (HR, n=57) and low (LR, n=40) ACL injury risk based on participating in a sport with high or low ACL injury rates. The HR group was composed of athletes participating in soccer, basketball, and volleyball, while the LR group athletes participated in diving, cross country, and track and field. Participants performed all standard functional tests (SFT) and side-to-side differences for each participant as well as between group differences were assessed for the hop tests. The LSI, a ratio frequently used to gauge athletes' readiness for RTP post injury, was also assessed for between group differences. The TJA was compared between the groups on individual flaws, overall scores, and number of jumps performed. RESULTS: No between group differences for hop distances were found, with medium to large effect sizes for SLH, TH, and COH. The HR group had a higher TJA score, number of jumps, and higher proportion of the flaw of 'foot placement not shoulder width apart'. CONCLUSION: Although most SFT's showed no significant differences between athlete groups, some differences were seen in the TJA; the HR group showed an increase in 'foot placement not shoulder width apart' flaw, higher overall flaw scores, and overall jumped more times compared to the LR group. These results may warrant caution in relying solely on SFT for RTP decisions, due to potential asymmetries seen in an uninjured population with baseline testing. LEVEL OF EVIDENCE: 4.

The Effects of a 4-Layer Compression Bandaging System on Skin Perfusion Pressure in Healthy Adults.

OBJECTIVE: Current practice precludes compression in patients with wounds and reduced arterial flow; however, this treatment may reduce edema and vascular resistance, thus improving distal circulation. The objective of this study was to determine the effects of compression on skin perfusion pressure (SPP), edema, and ankle range of motion. DESIGN: This was a quasi-experimental time series. SETTING: The study was conducted at The Center for Skin Integrity in Cheektowaga, New York. PARTICIPANTS: The study participants were 20 healthy adults, 10 in a younger age bracket (22.10 [SD, 2.77] years, 23.14 [SD, 5.03] kg/m) and 10 in an older age bracket (55.90 [SD, 4.48] years, 28.84 [SD, 4.83] kg/m). INTERVENTIONS: Sixty minutes of Profore Multi-layer Compression was performed. MAIN OUTCOME MEASURES: Precompression and postcompression measurements: SPP, Ankle Brachial Index, calf circumference (15 cm proximal to lateral malleolus), and static and dynamic ankle dorsiflexion range of motion (DF ROM) compared between young and older adults. MAIN RESULTS: There was a significant main effect for time for SPP (P = .049) and static (P = .02) and dynamic (P = .03) DF ROM. Skin perfusion pressure significantly increased at 40, 50, and 60 minutes of compression compared with precompression. Static and dynamic DF ROM significantly increased from precompression to postcompression. Although not statistically significant, calf circumference decreased by 6 cm in the older-adult group postcompression. CONCLUSION: A 4-layer compression dressing system improved SPP; this may be secondary to the decongestion of a proximal confined space. The 4-layer compression dressing also improves DF ROM postcompression and may reduce lower-extremity edema. Seeing these results in healthy participants suggests the need for future research in a patient population to determine if compression can be used to offload arterial structures and thus promote wound healing in patients.

Use of clinical movement screening tests to predict injury in sport.

Clinical movement screening tests are gaining popularity as a means to determine injury risk and to implement training programs to prevent sport injury. While these screens are being used readily in the clinical field, it is only recently that some of these have started to gain attention from a research perspective. This limits applicability and poses questions to the validity, and in some cases the reliability, of the clinical movement tests as they relate to injury prediction, intervention, and prevention. This editorial will review the following clinical movement screening tests: Functional Movement Screen™, Star Excursion Balance Test, Y Balance Test, Drop Jump Screening Test, Landing Error Scoring System, and the Tuck Jump Analysis in regards to test administration, reliability, validity, factors that affect test performance, intervention programs, and usefulness for injury prediction. It is important to review the aforementioned factors for each of these clinical screening tests as this may help clinicians interpret the current body of literature. While each of these screening tests were developed by clinicians based on what appears to be clinical practice, this paper brings to light that this is a need for collaboration between clinicians and researchers to ensure validity of clinically meaningful tests so that they are used appropriately in future clinical practice. Further, this editorial may help to identify where the research is lacking and, thus, drive future research questions in regards to applicability and appropriateness of clinical movement screening tools.

SPORTSMETRICS™ TRAINING IMPROVES POWER AND LANDING IN HIGH SCHOOL ROWERS.

BACKGROUND: Successful rowing participation requires leg power, back strength, cardiovascular endurance, and balance. SportsMetrics™ training improves lower limb alignment, hamstring peak torque, and vertical jump height; however, this training has not been used in athletes who row and may have different outcomes based on experience level. PURPOSE/HYPOTHESES: The purpose of this study was to compare the effects of a six-week SportsMetrics™ training program on vertical jump height (VJH), Y Balance Test (YBT), and Drop Jump Screening Test (DJST) between novice and varsity high school rowers. The authors hypothesized that following Sportsmetrics™ training; novice rowers would not be different from varsity rowers in VJH and YBT. All rowers will have improved normalized knee joint separation distance in DJST following training. STUDY DESIGN: Cross sectional. METHODS: 52 (31 varsity: 16.4 ± 0.8 years, 62.0 ± 9.0 kg, 1.7 ± 0.1m [mean ± SD], 21 novice: 14.5 ± 0.7years, 58.6 ± 5.4 kg, 1.7 ± 0.1m [mean ± SD]) high school rowers completed the Sportsmetrics™ training and participated in the study. Varsity rowers were defined as a returner; any new rower was considered novice. Differences in age, weight, and height were examined using independent t-tests. Repeated measures ANOVA assessed pre- to post-training differences between groups in VJH, YBT composite score (CS) and reach asymmetry (ASY), and normalized knee joint separation distance (DJST). RESULTS: VJH significantly improved for all athletes from pre- to post-training (mean ± SD: 29.0 ± 7.0 vs. 31.9 ± 5.1cm; p=0.001) and normalized knee separation distance significantly increased for all athletes pre to post training at the pre-landing (mean ± SD: 58.2 ± 12.5 vs. 68.7 ± 7.4%; p<0.001), landing (mean ± SD: 49.4 ± 18.2 vs. 66.3 ± 14.2%; p<0.001), and take off (mean ± SD: 47.8 ± 18.4 vs. 64.8 ± 13.8%; p<0.001) phases of the jump; there was no effect for group. There was no difference in varsity and novice pre to post training in YBT CS (99.3 ± 7.5 vs. 99.7 ± 7.1%; p=0.53) or ANT ASY (mean ± SD: 3.4 ± 4.6 vs. 2.7 ± 2.3; p=0.36). CONCLUSIONS: SportsMetrics™ training improved VJH regardless of experience level; which suggests that rowers may have more leg power following training. Normalized knee joint separation distance increased to greater than 60% of hip joint separation distance following training, indicating that training reduced serious knee injury risk. LEVEL OF EVIDENCE: Level 3.

Performance Comparison of Student-Athletes and General College Students on the Functional Movement Screen and the Y Balance Test.

Although various studies have assessed performance of athletes on the Functional Movement Screen (FMS) and the Y Balance Test (YBT), no study to date has directly evaluated a comparison of performance between athletes and members of the general population. Thus, to better understand the application of the FMS and the YBT to general college students, this study examined whether or not general college students performed similarly to student-athletes on the FMS (composite and movement pattern scores) and the YBT (composite and reach directions). This study evaluated 167 Division I student-athletes and 103 general college students from the same university on the FMS and the YBT. No difference was found in FMS composite scores between student-athletes and general college students. For FMS movement patterns, female student-athletes scored higher than general college students in the deep squat. No difference was found for men in any FMS movement pattern. Female student-athletes scored higher than female general college students in YBT composite scores; no difference was found for men in YBT composite scores. In analysis of YBT reach directions, female student-athletes scored higher than female general college students in all reach directions, whereas no difference was found in men. Existing research on the FMS composite score in athletic populations may apply to a general college population for the purposes of preparticipation screening, injury prediction, etc. Existing research on the YBT in male athletic populations is expected to apply equally to general college males for the purposes of preparticipation screening, injury prediction, etc.

Injury history, sex, and performance on the functional movement screen and Y balance test.

CONTEXT: Research is limited regarding the effects of injury or surgery history and sex on the Functional Movement Screen (FMS) and Y Balance Test (YBT). OBJECTIVE: To determine if injury or surgery history or sex affected results on the FMS and YBT. DESIGN: Cross-sectional study. SETTING: Athletic training facilities. PATIENTS OR OTHER PARTICIPANTS: A total of 200 National Collegiate Athletic Association Division I female (n = 92; age = 20.0 ± 1.4 years, body mass index = 22.8 ± 3.1 kg/m(2)) and male (n = 108; age = 20.0 ± 1.5 years, body mass index = 27.0 ± 4.6 kg/m(2)) athletes were screened; 170 completed the FMS, and 190 completed the YBT. INTERVENTION(S): A self-reported questionnaire identified injury or surgery history and sex. The FMS assessed movement during the patterns of deep squat, hurdle step, in-line lunge, shoulder mobility, impingement-clearing test, straight-leg raise, trunk stability push-up, press-up clearing test, rotary stability, and posterior-rocking clearing test. The YBT assessed balance while participants reached in anterior, posteromedial, and posterolateral directions. MAIN OUTCOME MEASURE(S): The FMS composite score (CS; range, 0-21) and movement pattern score (range, 0-3), the YBT CS (% lower extremity length), and YBT anterior, posteromedial, and posterolateral asymmetry (difference between limbs in centimeters). Independent-samples t tests established differences in mean FMS CS, YBT CS, and YBT asymmetry. The Mann-Whitney U test identified differences in FMS movement patterns. RESULTS: We found lower overall FMS CSs for the following injuries or surgeries: hip (injured = 12.7 ± 3.1, uninjured = 14.4 ± 2.3; P = .005), elbow (injured = 12.1 ± 2.8, uninjured = 14.3 ± 2.4; P = .02), and hand (injured = 12.3 ± 2.9, uninjured = 14.3 ± 2.3; P = .006) injuries and shoulder surgery (surgery = 12.0 ± 1.0, no surgery = 14.3 ± 2.4; P < .001). We observed worse FMS movement pattern performance for knee surgery (rotary stability: P = .03), hip injury (deep squat and hurdle: P < .042 for both), hip surgery (hurdle and lunge: P < .01 for both), shoulder injury (shoulder and hand injury: P < .02 for both), and shoulder surgery (shoulder: P < .02). We found better FMS movement pattern performance for trunk/back injury (deep squat: P = .02) and ankle injury (lunge: P = .01). Female athletes performed worse in FMS movement patterns for trunk (P < .001) and rotary (P = .01) stability but better in the lunge (P = .008), shoulder mobility (P < .001), and straight-leg raise (P < .001). Anterior asymmetry was greater for male athletes (P = .02). CONCLUSIONS: Injury history and sex affected FMS and YBT performance. Researchers should consider adjusting for confounders.

Association of the Functional Movement Screen with injuries in division I athletes.

CONTEXT: The Functional Movement Screen (FMS) evaluates performance in 7 fundamental movement patterns using a 4-point scale. Previous studies have reported increased injury risk with a composite score (CS) of 14/21 or less; these studies were limited to specific sports and injury definition. OBJECTIVE: To examine the association between FMS CS and movement pattern scores and acute noncontact and overuse musculoskeletal injuries in division I college athletes. An exploratory objective was to assess the association between injury and FMS movement pattern asymmetry. DESIGN: Prospective cohort. SETTING: College athletic facilities. PARTICIPANTS: 167 injury-free, college basketball, football, volleyball, cross country, track and field, swimming/ diving, soccer, golf, and tennis athletes (males = 89). INTERVENTION: The FMS was administered during pre-participation examination. MAIN OUTCOME MEASURE: Noncontact or overuse injuries that required intervention from the athletic trainer during the sport season. RESULTS: FMS CS was not different between those injured (n = 74; 14.3 ± 2.5) and those not (14.1 ± 2.4; P = .57). No point on the ROC curve maximized sensitivity and specificity; therefore previously published cut-point was used for analysis with injury (≤ 14 [n = 92]). After adjustment, no statistically significant association between FMS CS and injury (odds ratio [OR] = 1.01, 95% CI 0.53-1.91) existed. Lunge was the only movement pattern that was associated with injury; those scoring 2 were less likely to have an injury vs those who scored 3 (OR = 0.21, 95% CI 0.08-0.59). There was also no association between FMS movement pattern asymmetry and injury. CONCLUSION: FMS CS, movement patterns, and asymmetry were poor predictors of noncontact and overuse injury in this cohort of division I athletes.

Association of y balance test reach asymmetry and injury in division I athletes.

PURPOSE: The Y balance test (YBT) is a screen of dynamic balance requiring stance leg balance while the contralateral leg reaches in anterior (ANT), posteromedial (PM), and posterolateral (PL) directions. YBT has been proposed as a screen for injury risk; however, limited research has examined the association between YBT and injury. The purpose of this study was to examine the association between YBT (asymmetry and composite score (CS)) and noncontact injury in a sample of Division I (DI) college athletes from multiple sports. METHODS: DI college athletes were screened with the YBT during the preparticipation examination to determine asymmetry (absolute difference between legs in ANT, PL, and PM) and CS (summed average of right/left ANT, PL, and PM normalized to leg length). Participants were followed throughout the sport season, and noncontact injuries requiring athletic training staff intervention were recorded for analysis. Demographic variables between injured and uninjured athletes were assessed with independent t-tests. Receiver operating characteristic (ROC) curves determined optimal cut points for predicting injury on the basis of CS and asymmetry. CS was analyzed as a continuous variable, as ROC curves were unable to maximize sensitivity and specificity. Logistic regression models adjusted for sport and previous injury determined the odds of injury on the basis of asymmetry and CS. RESULTS: One hundred and eighty-four participants were included in analysis; 81 were injured. ROC curves determined asymmetry >4 cm (sensitivity, 59%; specificity, 72%) as the optimal cut point for predicting injury. Only ANT asymmetry was significantly associated with noncontact injury (odds ratio, 2.33; 95% confidence interval, 1.15-4.76). CONCLUSIONS: ANT asymmetry >4 cm was associated with increased risk of noncontact injury. CS in this sample of DI athletes was not associated with increased risk of injury.

Interrater and intrarater reliability of the functional movement screen.

The purpose of this study was to investigate interrater and intrarater reliability of the Functional Movement Screen (FMS) with real-time administration with raters of different educational background and experience. The FMS was assessed with real-time administration in healthy injury-free men and women and included a certified FMS rater for comparison with other raters. A relatively new tool, the FMS, was developed to screen 7 individual movement patterns to classify subjects' injury risk. Previous reliability studies have been published with only one investigating intrarater reliability. These studies had limitations in study design and clinical applicability such as the use of only video to rate or the use of raters without comparison to a certified FMS rater. Raters (n = 4) with varying degrees of FMS experience and educational levels underwent a 2-hour FMS training session. Subjects (n = 19) were rated during 2 sessions, 1 week apart, using standard FMS protocol and equipment. Interrater reliability was good for session 1 (intraclass correlation coefficient [ICC] = 0.89) and for session 2 (ICC = 0.87). The individual FMS movements showed hurdle step as the least reliable (ICC = 0.30 for session 1 and 0.35 for session 2), whereas the most reliable was shoulder mobility (ICC = 0.98 for session 1 and 0.96 for session 2). Intrarater reliability was good for all raters (ICC = 0.81-0.91), with similar ICC regardless of education or previous experience with FMS. The results showed that the FMS could be consistently scored by people with varying degrees of experience with the FMS after a 2-hour training session. Intrarater reliability was not increased with FMS certification.