Development of clinical rating criteria for tests of lumbopelvic stability

Return to Play Assessment After Lateral Ankle Sprains - German Male Elite Youth Football (Soccer) Academy Baseline Data

Background

Lateral ankle sprain (LAS) is one of the most common types of injury in football (soccer). Normative baseline data of performance tests for Return to Play (RTP) decision are still lacking.

Purpose

The primary aim of this study was to generate baseline values for uninjured elite youth football players for a multifactorial RTP assessment and compare with previously published data. A secondary aim was to investigate the use of the Limb Symmetry Index (LSI) as a method to determine whether an athlete passes a performance test or not.

Study Design

Observational Cohort study.

Methods

Baseline data of performance tests (Y-Balance [YBT-LQ], Heel Rise [HRT]; Singe Leg Squat [SLST]; Single Leg Drop Jump [SLDJ]; Side Hop [SHT]; Figure of 8 Hop [F-8]; Modified Agility T-Test [MAT]) were assessed in 20 elite youth football players, aged 16-21 years. Additionally, the traditional LSI (dividing the result of the non-dominant leg by the result of the dominant leg and multiplying by 100) and directionally corrected LSI (the worst value is divided by the better value and multiplied by 100) were calculated. The test values were compared to previously reported study results. LSI and side-to-side comparisons between dominant and non-dominant leg sides were analyzed using the Wilcoxon test.

Results

Male elite youth football players achieved better results in the dynamic performance tests (SHT, F-8, and MAT) compared to reference values of the cohorts previously described in the literature: YBT-LQ total score (cm) dominant (dom) 99.3±8.3, non-dominant (ND) 99.5±10.4; HRT (average number) dom. 27.1±5.4, ND 25.2±5.1); SLDJ height (cm) dom 15±5, ND 15±5 and contact time (sec) dom 0.29±0.08, ND 0.29±0.07, Reactive Strength Index (RSI) dom 0.52±0.12, ND 0.50±0.13); SHT (sec) dom 7.12±0.73, ND 7.39±0.93; F-8 (sec) dom 10.52±1.02, ND 10.37±1.04; and MAT (sec) 5.82±0.22. Directionally corrected LSI differed significantly from the traditional calculated LSI (p<0.05).

Conclusion

The findings of this study highlight the need to determine specific baseline data for RTP testing in male elite youth football players after LAS. The traditional LSI should not be used as a "stand alone method" for determining RTP. LSI calculations should consider the direction of asymmetry to determine passing a performance test or not.

Level of evidence

3b.

Intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers in cricket: a systematic review

BACKGROUND

Lumbar spine injuries in fast bowlers account for the greatest missed playing time in cricket. A range of extrinsic and intrinsic variables are hypothesised to be associated with low back pain and lumbar spine injury in fast bowlers, and an improved understanding of intrinsic variables is necessary as these may alter load tolerance and injury risk associated with fast bowling. This review critically evaluated studies reporting intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers and identified areas for future investigation.

METHODS

OVID Medline, EMBASE, SPORTDiscus, CINAHL, Web of Science and SCOPUS databases were last searched on 3 June 2022 to identify studies investigating intrinsic variables associated with low back pain and lumbar spine injury in cricket fast bowlers. Terms relevant to cricket fast bowling, and intrinsic variables associated with lumbar spine injury and low back pain in fast bowlers were searched. 1,503 abstracts were screened, and 118 full-text articles were appraised to determine whether they met inclusion criteria. Two authors independently screened search results and assessed risk of bias using a modified version of the Quality in Prognostic Studies tool.

RESULTS

Twenty-five studies met the inclusion criteria. Overall, no included studies demonstrated a low risk of bias, two studies were identified as moderate risk, and twenty-three studies were identified as high risk. Conflicting results were reported amongst studies investigating associations of fast bowling kinematics and kinetics, trunk and lumbar anatomical features, anthropometric traits, age, and neuromuscular characteristics with low back pain and lumbar spine injury.

CONCLUSION

Inconsistencies in results may be related to differences in study design, injury definitions, participant characteristics, measurement parameters, and statistical analyses. Low back pain and lumbar spine injury occurrence in fast bowlers remain high, and this may be due to an absence of low bias studies that have informed recommendations for their prevention. Future research should employ clearly defined injury outcomes, analyse continuous datasets, utilise models that better represent lumbar kinematics and kinetics during fast bowling, and better quantify previous injury, lumbar anatomical features and lumbar maturation.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/ERKZ2 .

Movement Competency Screens Can Be Reliable In Clinical Practice By A Single Rater Using The Composite Score

Background

Movement competency screens (MCSs) are commonly used by coaches and clinicians to assess injury risk. However, there is conflicting evidence regarding MCS reliability.

Purpose

This study aimed to: (i) determine the inter- and intra-rater reliability of a sport specific field-based MCS in novice and expert raters using different viewing methods (single and multiple views); and (ii) ascertain whether there were familiarization effects from repeated exposure for either raters or participants.

Study Design

Descriptive laboratory study.

Methods

Pre-elite youth athletes (n=51) were recruited and videotaped while performing a MCS comprising nine dynamic movements in three separate trials. Performances were rated three times with a minimal four-week wash out between testing sessions, each in randomized order by 12 raters (3 expert, 9 novice), using a three-point scale. Kappa score, percentage agreement and intra-class correlation were calculated for each movement individually and for the composite score.

Results

Fifty-one pre-elite youth athletes (15.0±1.6 years; n=33 athletics, n=10 BMX and n=8 surfing) were included in the study. Based on kappa score and percentage agreement, both inter- and intra-rater reliability were highly variable for individual movements but consistently high (>0.70) for the MCS composite score. The composite score did not increase with task familiarization by the athletes. Experts detected more movement errors than novices and both rating groups improved their detection of errors with repeated viewings of the same movement.

Conclusions

Irrespective of experience, raters demonstrated high variability in rating single movements, yet preliminary evidence suggests the MCS composite score could reliably assess movement competency. While athletes did not display a familiarization effect after performing the novel tasks within the MCS for the first time, raters showed improved error detection on repeated viewing of the same movement.

Level of Evidence

Cohort study.

Validity and inter-rater reliability of ankle motion observed during a single leg squat

BACKGROUND

The single leg squat (SLS) test is a clinical functional test commonly used to evaluate clinically aberrant movement patterns of the knee. The SLS could be an interesting option to analyze ankle control in the frontal plane during dynamic load analysis. However, to date, there are no studies that have analyzed the associations between the increased subtalar joint pronation by navicular drop (ND) test and ankle control with single leg squat (SLS_ankle) using a three-point scale. The purpose of this study was to evaluate the reliability of a clinical observation method to assess and determine the relationship between navicular drop (ND) and ankle control on the SLS_ankle score.

METHODS

A total of fifty-five healthy, physically active (31 females and 24 males) volunteers participated in this study. The degree of subtalar pronation was assessed through the ND test, and the ankle control was defined as the ankle displacement in the frontal plane during the SLS.

RESULTS

We found good intra-rater and inter-rater agreement during SLS_ankle, with Kappa values from 0.731 to 0.750. The relationship between the SLS_ankle and ND was significant ; the Spearman's rank correlation coefficient was 0.504 (p < 0.05).

CONCLUSIONS

The SLS_ankle score supplied the clinical practice with a reliable and valid alternative for quantifying foot mobility in comparison to the ND test.

Effect of cycling exercise on lumbopelvic control performance in elite female cyclists

OBJECTIVES

The purpose of the present study is to assess the effects of an intense cycling training session on the stability of the lumbopelvic-hip complex through two dynamic exercise tests - the single-leg-deadlift (SLD) and a variation of the bird-modified dog (BD), via the OCTOcore application.

METHODS

Thirty-one elite female road cyclists were self-evaluated with their own smartphones, before and immediately after finishing their training sessions. Right, left and composite were measured for each exercise test.

RESULTS

There was a significant time effect on performance for both the SLB and BD tests (p<0.05; η2=0.137), and the SLD and BD tests were increased with respect to the pre-test at 15% and 17%, respectively.

CONCLUSION

An intense cycling training session produced significant alterations in lumbopelvic behavior in the elite female cyclists. The OCTOcore application demonstrated that it was a sensitive tool in detecting these changes and it could easily be used by the cyclists themselves.

Accuracy of movement quality screening to document effects of neuromuscular control retraining exercises in a young ex-footballer with hip and groin symptoms: A proof of concept case study

Hip and groin pain is common in footballers and altering movement patterns can reduce symptoms. Observational tests of movement control are thought to identify abnormal movement patterns, but their accuracy needs yet to be confirmed by comparison with an objective measure. To assess the accuracy, using 3D motion analysis, of observational movement control tests and their ability to detect changes, and document changes in symptoms following a neuromuscular control exercise programme in an ex-footballer with hip and groin pain. A 25-year-old male with chronic bilateral hip and groin pain had their movement control ability rated and kinematic data collected using 3D motion analysis while performing Small Knee Bend (SKB) and SKB with Rotation (SKB Rot) tests pre-and post-neuromuscular control exercise training. Movement control was rated as at fault if they were unable to control specific trunk and pelvic movements during the tests. The Copenhagen Hip and Groin Outcome Score (HAGOS) was used to assess symptoms. Following the intervention, observational rating during the SKB test improved from fault to no fault for anterior pelvic tilt, which decreased by 17° and 16° during right and left leg SKB tests respectively. The HAGOS symptoms subsection improved from 36% to 61%. Observational movement screening ratings were supported by 3-D motion analysis. These findings indicate that the screening tool was accurate for detecting improvements in trunk and pelvic movement control following an exercise programme in an ex-footballer who had presented with hip and groin pain.

EVIDENCE-BASED PROCEDURES FOR PERFORMING THE SINGLE LEG SQUAT AND STEP-DOWN TESTS IN EVALUATION OF NON-ARTHRITIC HIP PAIN: A LITERATURE REVIEW

BACKGROUND

Functional performance tests are commonly utilized in screening for injury prevention, evaluating for athletic injuries, and making return-to-play decisions. Two frequently performed functional performance tests are the single leg squat and step-down tests.

PURPOSE

The purpose of this study was to systematically review the available psychometric evidence for use of the single leg squat and step-down tests for evaluating non-arthritic hip conditions and construct an evidence-based protocol for test administration.

STUDY DESIGN

Review of the Literature.

MATERIALS/METHODS

A search of the PubMed and SPORTSDiscus databases was performed. Psychometric evidence of reliability, validity, and responsiveness to support the use of the both tests were collected. The protocols used for administering these tests were extracted, summarized, and combined.

RESULTS

Of the 3,406 articles that were reviewed, 56 total articles met the inclusion criteria and were included in the review. Evidence for reliability and validity was available to support the use of the single leg squat and step-down tests. Both tests assess for neuromuscular control of the hip and surrounding muscular structures. Evaluation of these functional movement patterns enable the clinician to assess for limitations that may cause an increase in hip pain and dysfunction.

CONCLUSIONS

The single leg squat and step-down tests can assess for kinematic and biomechanical deficiencies and may be useful in the evaluation process for individuals with non-arthritic hip pain. The authors of this review present a comprehensive evidence-based protocol for standardized performance of these tests.

LEVEL OF EVIDENCE

2b.

Hamstring Muscle Injuries, a Rehabilitation Protocol Purpose

Context:

Hamstring acute muscle injuries are prevalent in several sports including AFL football (Australian Football League), sprinting and soccer, and are often associated with prolonged time away from sport.

Evidence Acquisition:

In response to this, research into prevention and management of hamstring injury has increased, but epidemiological data shows no decline in injury and re-injury rates, suggesting that rehabilitation programs and return to play (RTP) criteria have to be improved. There continues to be a lack of consensus regarding how to assess performance, recovery and readiness to RTP, following hamstring strain injury.

Results:

The aim of this paper was to propose rehabilitation protocol for hamstring muscle injuries based on current basic science and research knowledge regarding injury demographics and management options.

Conclusions:

Criteria-based (subjective and objective) progression through the rehabilitation program will be outlined along with exercises for each phase, from initial injury to RTP.

Foot orthoses for the prevention of lower limb overuse injuries in naval recruits: study protocol for a randomised controlled trial

Background

Foot orthoses are frequently used for the prevention of lower limb overuse injuries but evidence for their effectiveness is limited. The primary aim of this study is to determine if prefabricated foot orthoses reduce the incidence of lower limb overuse injuries in naval recruits undertaking 11 weeks of basic training.

Methods

This study is a participant and assessor blinded, parallel-group, randomised controlled trial. The trial will recruit participants undertaking 11 weeks of basic training at the Royal Australian Navy Recruit School, Cerberus, Victoria, Australia. Participants will be randomised to a control group (flat insole) or an intervention group (prefabricated foot orthosis). Over the 11 weeks of basic training, participants will document the presence and location of pain in weekly self-report diaries. The end-point for each participant will be the completion of 11 weeks of basic training. The primary outcome measure will be the combined incidence of four lower limb injuries (medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy, and plantar fasciitis/plantar heel pain) which are common among defence members. Secondary outcome measures include: (i) overall incidence of lower limb pain, (ii) severity of lower limb pain, (iii) time to injury, (iv) time to drop-out due to injury, (v) adverse events, (vi) number of lost training days, (vii) shoe comfort, and (viii) general health status. Data will be analysed using the intention-to-treat principle.

Discussion

This randomised controlled trial will evaluate the effectiveness of prefabricated foot orthoses for the prevention of common lower limb overuse injuries in naval recruits.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12615000024549.