The functional movement test 9+ is a poor screening test for lower extremity injuries in professional male football players: a 2-year prospective cohort study

Predictive models of injury risk in male professional football players: a systematic review

BACKGROUND

One of the challenges for professional football players is injuries. Due to their influence on their teams, injuries greatly impact the sports business. This research aims to assess predictive models of injury risk in male professional football players.

METHODS

A systematic literature review was performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in the PubMed, Web of Science and Scopus databases. Two independent reviewers screened articles, assessed eligibility and extracted data. Methodological quality was determined by the Newcastle-Ottawa Scale.

RESULTS

26 studies met the inclusion criteria.

DISCUSSION

Various statistical techniques were used in research on injury prediction in professional football, with logistic regression being the most used. The assessment predictors, especially the area under the receiver operating characteristic Curve, showed significant variation, which indicates the prediction models' efficacy. The focus was frequently on lower limb injuries, where several risk predictors, including muscular strength, flexibility and global positioning system-derived data, were found to substantially impact the occurrence of injuries. Prominent predictors included age, position, physiological parameters, injury history and genetic polymorphisms.

CONCLUSIONS

This comprehensive analysis highlights the complexity of injury prediction and reinforces the necessity for football injury research to adopt a multivariate approach with accuracy and comprehensiveness.

PROSPERO REGISTRATION NUMBER

CRD42023465524.

Developing a data-driven multimodal injury and illness prevention programme in male professional football based on a risk management model: the IP2 NetWork

Background

Current injury prevention programmes in football are limited by a one-size-fits-all approach, which predominantly focuses on preventive exercise programmes while ignoring differences in risk profiles between individuals and teams.

Objective

To address this gap, we developed a new data-driven, customisable approach based on the principles of risk management. We collaborated with key stakeholders to identify focus areas for injury and illness prevention and determine their priorities.

Setting

The team medical and coaching staff included members from 17 professional football clubs, the national team and a youth football academy in Qatar.

Methods

In 2015, we launched a series of annual workshops under the Aspetar Sports Injury and Illness Prevention Programme. The workshops included club medical personnel and fitness coaches in a process to develop team-specific programmes for injury and illness prevention based on the principle of risk management. Over 2 years, workshops refined focus areas through discussions, surveys and small-group presentations, culminating in the creation a novel programme for football injury prevention.

Results

Out of 44 focus areas first identified, 23 were selected as priorities for inclusion in multimodal injury and illness prevention programmes. The identified focus areas represent a variety of aspects, including social/behavioural/lifestyle, exercise programmes/training, load management, recovery and equipment. The top priorities included communication, the Nordic hamstring exercise, training load, recovery strategies, nutrition, sleep, warm-up, the Copenhagen adduction exercise and core and dynamic stability.

Conclusion

We have developed a comprehensive framework for preventing injuries and illnesses in football grounded in the general principles of risk management. This framework has proven feasible and led to the creation of a new multicomponent programme, The Aspetar IP2 (Injury and Illness Prevention for Performance) NetWork, focusing on a range of areas beyond preventive exercise programmes only.

Independent association of the Meckel's cave with trigeminal neuralgia and development of a screening tool

PURPOSE

To 1) investigate the association of the properties of the Meckel's cave (MC) with TN occurrence (i.e., affected vs. unaffected nerves) and whether such association was independent of neurovascular contact (NVC); and 2) develop an objective screening tool for TN.

MATERIALS AND METHODS

Two hundred and nineteen trigeminal nerves were included. (The severity of) NVC was identified for individual nerve, and a set of 107 radiomic features were extracted to characterize various properties of each MC. Both procedures were primarily based on magnetic resonance imaging sequences. A radiomic score (Rad-score) was constructed for each MC to integrate the features associated with TN occurrence. Independent t-test and logistic regression were conducted to assess the association and develop the screening tool mentioned above.

RESULTS

Twelve features were selected to build the Rad-score, with the Inverse Difference Moment Normalized (IDMN) having the greatest weight. The Rad-score was significantly (p ≤ 0.05) higher in the affected compared to the unaffected nerves, irrespective of NVC. The Rad-score and NVC were incorporated in the regression model/screening tool, which demonstrated an acceptable discriminating ability (C-statistic = 0.84).

CONCLUSION

This study has identified a potential association of the properties/features of the MC with TN occurrence, probably involving the demyelination and axonal injury of the trigeminal ganglion within the MC as suggested by the IDMN. Such association may be independent of NVC. This finding may provide new insight into the etiology and/or pathophysiology of TN. The screening tool, which demonstrated an acceptable discriminating ability, may contribute to an improvement in its diagnosis.

In Professional Male Soccer Players, Time-Loss Groin Injury Is More Associated With the Team Played for Than With Training/Match-Play Duration

OBJECTIVE

To investigate the relationship between training/match-play duration and time-loss groin injury in professional male soccer players, and to determine whether previously identified intrinsic risk factors influenced this relationship.

DESIGN

Prospective cohort study.

METHODS

A total of 579 professional male soccer players were prospectively followed from July 2013 to June 2015. Time-loss groin injuries and individual training and match-play duration were recorded using standardized surveillance methods. Acute training/match-play duration and chronic training/match-play duration were considered as interacting variables. Nonlinear Cox regression analysis (modeled using restricted cubic splines), clustered by player identification number, examined the relationship between training/match-play duration and groin injury. Previously identified intrinsic risk factors of previous groin injury and eccentric adduction strength were included in the multivariable regression analysis.

RESULTS

There was no clinically meaningful relationship between training/match-play duration and groin injury risk. Team played for had the strongest influence on groin injury risk (relative log hazard ratio -2.28 to 0.97). Groin injury risk was highest when accumulated chronic and acute training duration was also highest, but large confidence intervals indicate considerable uncertainty around this finding. Previous groin injury and eccentric adduction strength were not associated with groin injury risk when training/match-play duration and team were included in the model.

CONCLUSION

In professional male soccer players, there was no clinically meaningful relationship between groin injury risk and training/match-play duration. Team played for either protected against or increased groin injury risk, indicating that team-related factors not measured in this study had greater effect on groin injury risk than training/match-play duration. J Orthop Sports Phys Ther 2022;52(4):217-223. Epub 5 Feb 2022. doi:10.2519/jospt.2022.10845.

Long-standing pubic-related groin pain in professional academy soccer players: a prospective cohort study on possible risk factors, rehabilitation and return to play

Background

Despite being a common overuse entity in youth soccer, scientific data on risk factors, rehabilitation and return to play for long-standing pubic-related groin pain is still rare. The current prospective cohort study aims to evaluate potential risk-factors, propose a criteria-based conservative rehabilitation protocol and assess return-to-play outcomes among professional youth soccer players suffering from long-standing pubic-related groin pain.

Methods

Male soccer players with long-standing (> 6 weeks) pubic-related groin pain from a professional soccer club’s youth academy were analyzed for possible risk factors such as age, team (U12 - U23), younger/older age group within the team, position and preinjury Functional movement score. All injured players received a conservative, standardized, supervised, criteria-based, 6-level rehabilitation program. Outcome measures included time to return to play, recurrent groin pain in the follow-up period and clinical results at final follow-up two years after their return to play.

Results

A total of 14 out of 189 players developed long-standing pubic-related groin pain in the 2017/2018 season (incidence 7.4%). The average age of the players at the time of the injury was 16.1 ± 1.9 years. Risk factor analysis revealed a significant influence of the age group within the team (p = .007). Only players in the younger age group were affected by long-standing pubic-related groin pain, mainly in the first part of the season. Injured players successfully returned to play after an average period of 135.3 ± 83.9 days. Only one player experienced a recurrence of nonspecific symptoms (7.1%) within the follow-up period. The outcome at the 24-month follow-up was excellent for all 14 players.

Conclusions

Long-standing pubic-related groin pain is an overuse entity with a markedly high prevalence in youth soccer players, resulting in a relevant loss of time in training and match play. In particular, the youngest players in each team are at an elevated risk. Applying a criteria-based rehabilitation protocol resulted in an excellent return-to-play rate, with a very low probability of recurrence.

Trial registration

The trial was retrospectively registered under DRKS00016510 in the German Clinical Trials Register on 19.04.2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04837-x.

Poor Validity of Functional Performance Tests to Predict Knee Injury in Female Soccer Players With or Without Anterior Cruciate Ligament Reconstruction

BACKGROUND

Various tests have been developed to evaluate athletes' functional performance and for use as screening tools for injury prediction. Further validation of their accuracy to predict injury is needed.

PURPOSE

To investigate the validity of predetermined cutoffs used to differentiate between high- and low-risk players in different functional performance tests to predict (1) anterior cruciate ligament (ACL) injury or (2) severe traumatic knee injury in a cohort of female soccer players with a primary unilateral ACL reconstruction and a cohort of knee-healthy players.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 117 active female soccer players (mean age ± SD, 20 ± 2 years) an average of 19 ± 9 months after ACL reconstruction and 119 knee-healthy players (age, 19 ± 3 years) were prospectively followed up for 2 years for new knee injuries. At baseline, all players underwent tests to assess postural control (Star Excursion Balance Test), hop performance (single-leg hop for distance, side hop), and movement asymmetries in the lower limbs and trunk (drop vertical jump [DVJ], tuck jump). The predictive validity of the test cutoffs to identify players who would sustain an ACL injury or a severe traumatic knee injury (absence from soccer play, >28 days) was assessed. The risk ratio (RR), area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated.

RESULTS

A total of 46 players (39%) with ACL reconstruction sustained 48 severe knee injuries, including 28 ACL ruptures. Of the knee-healthy players, 13 (11%) sustained 14 severe knee injuries, including 8 ACL ruptures. No association was found between the predetermined functional performance test cutoffs and the risk of a new ACL injury or severe knee injury in players with ACL reconstruction. In knee-healthy players, the only variable associated with future ACL injury was ≥6.5 cm knee valgus in the frontal plane (any knee) in the DVJ (RR, 4.93; 95% CI, 1.04-23.40; P = .045), but with only fair predictive validity (AUC, 0.7; sensitivity, 0.75; specificity, 0.65).

CONCLUSION

In our cohorts of female soccer players, the validity of commonly used functional performance tests to predict new knee injuries was poor. Only knee valgus during the DVJ was associated with new ACL injuries in knee-healthy players, but with only fair predictive validity.

The 9+ screening test score does not predict injuries in elite floorball players

We aimed to examine whether the 9+ screening test score could predict injuries in elite floorball players. Eighty-four elite floorball players participated in the study. At baseline, two physiotherapists assessed the participants using the 9+ screening test. The test score reflects strength, stability, mobility, and functional movement pattern with an emphasis on the lower body and core. Injuries that occurred the following season (2013/2014) were recorded by medical staff, coaches, and/or self-reported by the players. Overall, there was no relationship between the 9+ screening test score and injury risk (OR = 0.96 per SD lower test score, P = .84). We, therefore, conclude that the 9+ screening test is not suited for overall injury risk prediction in elite floorball players. Whether the test may be used to predict risk of certain injury types more strongly related to inadequate mobility and strength (eg, muscle ruptures or strains) warrants further investigation.

Handball and movement screening - can non-contact injuries be predicted in adolescent elite handball players? A 1-year prospective cohort study

Introduction: The nine-test screening battery (9SB) consists of 11 tests used to assess injury risk in sports populations.Objectives: To evaluate the predictive value of the composite score and underlying factors of the 9SB for sustaining non-contact injury in adolescent elite handball players.Methods: Forty-five (23 females) adolescent elite handball players, median age 17 (range 16-18), pre-seasonally performed the 9SB, followed by weekly recordings of injuries for 52 weeks using a web-based questionnaire.Results: The median value for seasonal substantial injury prevalence was 22% (25-75^th percentiles 6-41). An exploratory factor analysis extracted three factors, complex movements, mobility, and lower extremity control, that explained a cumulative variance of 56%, where each factor contributed with 13-26% of the total variance. Based on the identified cutoff values, none of the factors or the complete 9SB could predict the risk of a non-contact new injury as well as the risk of reporting a substantial injury. Area under the curve values were ranged 0.50 to 0.59, with the corresponding 95% CI including 0.50 for all factors.Conclusion: Based on the limited predictive ability of the 9SB, it is not recommended that clinicians use the 9SB to predict injury in adolescent elite handball players.

Association of pre-season musculoskeletal screening and functional testing with sports injuries in elite female basketball players

Basketball is one of the most popular sports in Lithuania, and participation in women’s basketball is on the rise. Pre-participation examinations, including musculoskeletal screening and functional performance testing, is an essential part of a multidisciplinary approach to prevent future injuries. Because the lower extremities are the most commonly-injured body area in basketball players. Assessing fundamental movement qualities is of utmost importance. The aim of our study was to determine if functional tests can predict sports injuries in elite female basketball players. A total of 351 records for professional female basketball players were screened during 2013–2016 season. We analysed functional characteristics before the season and used functional performance tests for injury risk assessment: the Functional Movement Screen (FMS), the lower quarter Y Balance test (YBT-LQ) and the Landing Error Scoring System (LESS). Data from 169 players’ records were analysed: 77 of them made it to the end of season without injury, making up the non-injured group, while 92 of them suffered lower limb sport injuries during the sport season (injury group). Student’s t-test and the Mann-Whitney U-test were used to determine differences between groups. The most commonly encountered sports injuries in our population were those of knee 40.2% and ankle 38%. The injury group had a lower total FMS score (p = 0.0001) and higher total LESS score (p = 0.028) than non-injury group. The dynamic balance of lower limbs was similar in both groups. Imperfect functional movement patterns and poor jump-landing biomechanics during pre-season screening were associated with lower extremity injuries in elite female basketball players. Impairments of dynamic stability in the lower extremities were not associated with injury rates in our population. A combination of functional tests can be used for injury risk evaluation in female basketball players.

Characteristics of functional movement screening testing in elite handball players: Indicative data from the 9

OBJECTIVES

To test 9 + screening batterie's intra-rater reliability, to provide indicative data of elite handball players, and to analyze difference between age, playing positions and level of play.

DESIGN

Descriptive study.

SETTING

Icelandic elite male handball players.

PARTICIPANTS

182 elite male handball players.

MAIN OUTCOME MEASURES

Nine + screening battery.

RESULTS

Reliability test: Intra-class correlation for the total score was 0.95. The correlation of each of the test factors varied from 0.63 to 0.91. The mean total score was 22.3 ± 2.9 (95%CI 16.7-28.1), with no difference in total score comparing players age or level of play. Goalkeepers displayed a higher total score than other players (F_3,151 = 5.75, p = 0.001). Junior players had a lower score than senior players in tests measuring abdominal strength and core stability; Test 5; │²(3, 182) = 41.5, p < 0.0001, Test 6; │²(3, 182) = 55.7, p < 0.0001, Test 7; │²(3, 182) = 11.8, p < 0.005, but higher scores in tests measuring trunk and shoulder mobility Test 8; │²(3, 182) = 18.2, p < 0.0001, Test 9; │²(3, 182) = 22.2, p = 0.006.

CONCLUSIONS

The 9+ intra-rater reliability was acceptable for the total score and individual tests. Age-related differences were provided in many individual tests.

Can movement tests predict injury in elite orienteerers? An 1-year prospective cohort study

The purpose of this study was to determine the predictive value of the movement test, the nine test screening battery (9TSB) and an orienteering-modified version of the 9TSB (M9TSB), for lower extremity injury in adolescent elite orienteerers. Design Prospective cohort study. Participants Forty adolescent (15-19 years), male and female orienteerers from two Swedish orienteering high schools performed the 9TSB, M9TSB, and recorded injuries based on a web-based questionnaire for 52 weeks. Results The results showed no difference in composite scores between injured and non-injured orienteerers for either 9TSB (p = 0.75) or M9TSB (p = 0.83). The optimal cut-off score was calculated at 25 for the 9TSB, with sensitivity and specificity of 74% and 41% respectively, and 17 for the M9TSB, with sensitivity and specificity of 47% and 61%, respectively. There was no association between 9TSB or M9TSB and injury (OR1.38, 95% CI: 0.39-4.92). Including athletes with a history of injury did not result in improved prediction of injury for the 9TSB or M9TSB (OR 2.84, 95% CI: 0.50-16.10). Conclusion Low sensitivity and specificity were obtained for both the M9TSB and the 9TSB. Thus, it is not recommended that physiotherapists use the nine test screening battery to predict lower extremity injury in orienteerers.

Preseason intrinsic risk factors-associated odds estimate the exposure to proximal lower limb injury throughout the season among professional football players

Background/aim

Football players frequently face the occurrence of non-contact musculoskeletal injuries. The purpose of the study was to verify whether the evaluation of combined risk factors could produce a score system to determine the probability of injury in football players during the Brazilian football season.

Methods

Sixty-two male professional soccer players recruited from the first and second division soccer teams, with ages between 18 and 36 years. Functional performance evaluations were carried out at the beginning of the preseason which included strength and jumping tests, history of injuries and characteristics of athletes.

Results and conclusions

The results were grouped and a score/monogram was constructed.