Preseason Functional Test Scores Are Associated With Future Sports Injury in Female Collegiate Athletes.

Brumitt, J, Heiderscheit, B, Manske, R, Niemuth, PE, Mattocks, A, and Rauh, MJ. Preseason functional test scores are associated with future sports injury in female collegiate athletes. J Strength Cond Res 32(6): 1692-1701, 2018-Recent prospective cohort studies have reported preseason functional performance test (FPT) measures and associations with future risk of injury; however, the findings associated with these studies have been equivocal. The purpose of this study was to determine the ability of a battery of FPTs as a preseason screening tool to identify female Division III (D III) collegiate athletes who may be at risk for a noncontact time-loss injury to the lower quadrant (LQ = low back and lower extremities). One hundred six female D III athletes were recruited for this study. Athletes performed 3 FPTs: standing long jump (SLJ), single-leg hop (SLH) for distance, and the lower extremity functional test (LEFT). Time-loss sport-related injuries were tracked during the season. Thirty-two (24 initial and 8 subsequent) time-loss LQ injuries were sustained during the study. Ten of the 24 initial injuries occurred at the thigh and knee. At-risk athletes with suboptimal FPT measures (SLJ ≤79% ht; (B) SLH ≤64% ht; LEFT ≥118 seconds) had significantly greater rates of initial (7.2 per 1,000 athletic exposures [AEs]) and total (7.6 per 1,000 AEs) time-loss thigh or knee injuries than the referent group (0.9 per 1,000 AEs; 1.0 per 1,000 AEs, respectively). At-risk athletes were 9 times more likely to experience a thigh or knee injury (odds ratio [OR] = 9.7, confidence interval [CI]: 2.3-39.9; p = 0.002) than athletes in the referent group. At-risk athletes with a history of LQ sports injury and lower off-season training habits had an 18-fold increased risk of a time-loss thigh or knee injury during the season (adjusted OR = 18.7, CI: 3.0-118.1; p = 0.002). This battery of FPTs appears useful as a tool for identifying female D III athletes at risk of an LQ injury, especially to the thigh or knee region.

The Lower-Extremity Functional Test and Lower-Quadrant Injury in NCAA Division III Athletes: A Descriptive and Epidemiologic Report.

CONTEXT: The Lower-Extremity Functional Test (LEFT) has been used to assess readiness to return to sport after a lower-extremity injury. Current recommendations suggest that women should complete the LEFT in 135 s (average; range 120-150 s) and men should complete the test in 100 s (average; range 90-125 s). However, these estimates are based on limited data and may not be reflective of college athletes. Thus, additional assessment, including normative data, of the LEFT in sport populations is warranted. OBJECTIVE: To examine LEFT times based on descriptive information and off-season training habits in NCAA Division III (DIII) athletes. In addition, this study prospectively examined the LEFT's ability to discriminate sport-related injury occurrence. DESIGN: Descriptive epidemiology. SETTING: DIII university. SUBJECTS: 189 DIII college athletes (106 women, 83 men) from 15 teams. MAIN OUTCOME MEASURES: LEFT times, preseason questionnaire, and time-loss injuries during the sport season. RESULTS: Men completed the LEFT (105 ± 9 s) significantly faster than their female counterparts (117 ± 10 s) (P < .0001). Female athletes who reported >3-5 h/wk of plyometric training during the off-season had significantly slower LEFT scores than those who performed ≤3 h/wk of plyometric training (P = .03). The overall incidence of a lower-quadrant (LQ) time-loss injury for female athletes was 4.5/1000 athletic exposures (AEs) and 3.7/1000 AEs for male athletes. Female athletes with slower LEFT scores (≥118 s) experienced a higher rate of LQ time-loss injuries than those with faster LEFT scores (≤117 s) (P = .03). CONCLUSION: Only off-season plyometric training practices seem to affect LEFT score times among female athletes. Women with slower LEFT scores are more likely to be injured than those with faster LEFT scores. Injury rates in men were not influenced by performance on the LEFT.

Off-season training habits and preseason functional test measures of division iii collegiate athletes: a descriptive report.

PURPOSE/BACKGROUND: Division III (D III) collegiate coaches are challenged to assess athletic readiness and condition their athletes during the preseason. However, there are few reports on off-season training habits and normative data of functional assessment tests among D III athletes. The purpose of this study was to examine off-season training habits of D III athletes and their relationships to the standing long jump (SLJ) and single-leg hop (SLH) tests. METHODS: One-hundred and ninety-three athletes (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to the start of their sports seasons. Athletes reported their off-season training habits (weightlifting, cardiovascular exercise, plyometric exercise, and scrimmage) during the six weeks prior to the preseason. Athletes also performed three maximal effort SLJs and three SLHs. RESULTS: Male athletes reported training more hours per exercise category than their female counterparts. Mean SLJ distances (normalized to height) were 0.79 ± 0.10 for females and 0.94 ± 0.12 for males. Mean SLH distances for female athletes' right and left limbs were 0.66 (± 0.10) and 0.65 (± 0.10), respectively. Mean SLH distances for male athletes' right and left limbs were 0.75 (± 0.13) and 0.75 (± 0.12), respectively. Several significant differences between off-season training habits and functional test measures were found for both sexes: males [SLJ and weightlifting (p = 0.04); SLH and weightlifting (p = 0.04), plyometrics (p = 0.05)]; females [SLJ and plyometrics (p = 0.04); SLH and scrimmage (p = 0.02)]. CONCLUSION: This study provides normative data for off-season training habits and preseason functional test measures in a D III athlete population. Greater SLJ and SLH measures were associated with increased time during off-season training. CLINICAL RELEVANCE: The findings between functional tests and off-season training activities may be useful for sports medicine professionals and strength coaches when designing their preseason training programs. LEVEL OF EVIDENCE: 4.

Lower extremity functional tests and risk of injury in division iii collegiate athletes.

PURPOSE/BACKGROUND: Functional tests have been used primarily to assess an athlete's fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single-leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time-loss sports-related low back or lower extremity injury. METHODS: A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to their sports seasons. Athletes performed the functional tests in the following sequence: SLJ, SLH, LEFT. The athletes were then prospectively followed during their sports season for occurrence of low back or LE injury. RESULTS: Female athletes who completed the LEFT in $118 s were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in #100 s were more likely to experience a time-loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 s or more. Female athletes with a greater than 10% side-to-side asymmetry between SLH distances had a 4-fold increase in foot or ankle injury (cut point: >10%; OR=4.4, 95% CI: 1.2, 15.4). Male athletes with SLH distances (either leg) at least 75% of their height had at least a 3-fold increase (OR=3.6, 95% CI: 1.2, 11.2 for the right LE; OR=3.6, 95% CI: 1.2, 11.2 for left LE) in low back or LE injury. CONCLUSIONS: The LEFT and the SLH tests appear useful in identifying Division III athletes at risk for a low back or lower extremity sports injury. Thus, these tests warrant further consideration as preparticipatory screening examination tools for sport injury in this population. CLINICAL RELEVANCE: The single-leg hop for distance and the lower extremity functional test, when administered to Division III athletes during the preseason, may help identify those at risk for a time-loss low back or lower extremity injury. LEVEL OF EVIDENCE: 2.

Hip strength in collegiate female athletes with patellofemoral pain.

PURPOSE: Decreased hip strength has been theorized to contribute to the development of patellofemoral pain. The purpose of this study was to test for strength differences of six hip muscle groups in collegiate female athletes diagnosed with unilateral patellofemoral pain compared with the unaffected leg and noninjured sport-matched controls. METHODS: At four Division III schools, all collegiate female athletes experiencing unilateral patellofemoral pain were recruited during the 2004-2005 academic school year. The athletes were diagnosed with patellofemoral pain by sports medicine-trained family physicians or orthopedic surgeons. Hip strength of six different muscle groups was tested using a handheld dynamometer. The highest value of two trials was used, and strength values were normalized to body weight. The measurements from the injured leg were compared with the uninvolved leg and also with uninjured control subjects matched for sport. RESULTS: Thirteen athletes were diagnosed with unilateral patellofemoral pain. The injured-side hip abductor (P = 0.003) and external rotator muscle groups (P = 0.049) were significantly weaker than the noninjured sides. There were no significant differences in the other hip muscles tested. In addition, the injured legs were significantly weaker in five of the six hip muscle groups compared with the control group. CONCLUSIONS: The results of this study show that hip abductors and external rotators were significantly weaker between the injured and unaffected legs of the injured athletes. In addition, injured collegiate female athletes exhibited global hip weakness compared with age- and sport-matched asymptomatic controls. Screening for hip muscle weakness and adding strengthening exercises to the affected hip muscles may be important factors in managing female athletes with patellofemoral pain.

Hip muscle weakness and overuse injuries in recreational runners.

OBJECTIVE: To test for differences in strength of 6 muscle groups of the hip on the involved leg in recreational runners with injuries compared with the uninvolved leg and a control group of noninjured runners. DESIGN: Descriptive analysis. SETTING: : Three outpatient physical therapy clinics in the Minneapolis/St. Paul metropolitan area. PARTICIPANTS: Thirty recreational runners (17 female, 13 male) experiencing a single leg overuse injury that presented for treatment between June and September 2002. Thirty noninjured runners (16 female, 14 male) randomly selected from a pool of 46 volunteers from a distance running club served as controls. MAIN OUTCOME MEASURES: Self-report demographic information on running habits, leg dominance demonstrated by preferred kicking leg, and injury information. Muscle strength of the 6 major muscle groups of the hip was recorded using a hand-held dynamometer. The highest value of 2 trials was used, and strength values were normalized to body mass(2/3). RESULTS: Results comparing the injured and noninjured groups showed that leg dominance did not influence the leg of injury (chi(2)(1) = 0.134; P = 0.71). Correlations for internal reliability of muscle measurements between trials 1 and 2 with the hand-held dynamometer ranged from 0.80 to 0.90 for the 6 muscle groups measured, and all P values were less than 0.0001. No significant side-to-side differences in hip group muscle strength were found in the noninjured runners (P = 0.62-0.93). Among the injured runners, the injured side hip abductor (P = 0.0003) and flexor muscle groups (P = 0.026) were significantly weaker than the noninjured side. In addition, the injured side hip adductor muscle group was significantly stronger (P = 0.010) than the noninjured side. Duration of symptoms was not a contributing factor to the extent of injury as measured by muscle strength imbalance between injured and uninjured sides. CONCLUSIONS: Although no cause-and-effect relationship has been established, this is the first study to show an association between hip abductor, adductor, and flexor muscle group strength imbalance and lower extremity overuse injuries in runners. Because most running injuries are multifaceted in nature, areas secondary to the site of pain, such as hip muscle groups exhibiting strength imbalances, must also be considered to gain favorable outcomes for injured runners. The addition of strengthening exercises to specifically identified weak hip muscles may offer better treatment results in patients with running injuries.