FUNCTIONAL MOVEMENT SCREEN NORMATIVE VALUES AND VALIDITY IN HIGH SCHOOL ATHLETES: CAN THE FMS? BE USED AS A PREDICTOR OF INJURY?

Background

Limited information exists regarding injury risk factors for high school athletes. The Functional Movement Screen (FMS™) has been used to identify functional movement impairments and asymmetries, making it a potential predictor of injury.

Hypothesis/Purpose

To determine if the FMS™ is a valid predictor of injury in high school athletes and to identify a potential new FMS™ cutoff score for this population.

Study Design

Prospective Cohort

Methods

167 high school athletes among several sports were scored using the FMS™ and were monitored for injury during a single season. Likelihood ratios were calculated to determine how much a subject''s total FMS™ score influenced the post‐test probability of becoming injured.

Results

Of the 167 participants, 39 sustained a musculoskeletal injury. Of all component scores, the in‐line lunge scores were significantly higher for injured players. For shoulder mobility, scores were significantly lower for injured players. No statistically significant associations were found between total FMS™ scores and injury status.

Conclusion

The FMS™ may be useful for recognizing deficiency in certain movements, however this data suggests that the FMS™ should not be used for overall prediction of injury in high school athletes throughout the course of a season. Normative data from a large sample size is now available in the high school athlete demographic.

Level of Evidence

3     

RELATIONSHIP BETWEEN FUNCTIONAL MOVEMENT SCREENING SCORE AND HISTORY OF INJURY

Background and Aim:

The Functional Movement Screen (FMS™) is a screening instrument that evaluates selective fundamental movement patterns. The main aim of this study was to investigate the relationship between the FMS™ score and history of injury, and attempt to determine which active students are prone to injury.

Methods:

One hundred physically active (50 females and 50 males) students, between 18 and 25 years of age, with no recent (<6 weeks) history of musculoskeletal injury were recruited. All participants performed the FMS™ and were scored using the previously established standardized FMS™ criteria. The chi square, independent t‐test, one‐way analysis of variance, and POSTHOC Bonferroni tests were used for data analysis with a preset alpha value of p < 0.05.

Results:

Of the 100 subjects, 35 suffered an acute lower extremity (ankle = 20, knee = 15) injury in practice or competition. An odds ratio was calculated at 4.70, meaning that an athlete had an approximately 4.7 times greater chance of suffering a lower extremity injury during a regular competitive season if they scored less than 17 on the FMS™. There were statistical differences between the pre‐season FMS™ scores of the injured and non‐injured groups, the ankle injury, knee injury, and non‐injured groups, and also between contact injury, non‐contact injury, and non‐injured groups.

Discussion and Conclusion:

This cross‐sectional study provides FMS™ reference values for physically active students, which will assist in the interpretation of individual scores when screening athletes for musculoskeletal injury and performance factors. More research is still necessary before implementing the FMS™ into a pre‐participation physical examination (PPE) for athletics, but due to the low cost and its simplicity to implement, it should be considered by clinicians and researchers in the future.

Level of Evidence:

2B     

OVERHEAD DEEP SQUAT PERFORMANCE PREDICTS FUNCTIONAL MOVEMENT SCREEN? SCORE

Background

The Functional Movement Screen (FMS™) has been suggested for use in predicting injury risk in active populations, but time constraints may limit use of the screening test battery. Identifying one component of the FMS™ that can predict which individuals may perform poorly on the entire test, and therefore should undergo the full group of screening maneuvers, may reduce time constraints and increase pre‐participation screening utilization.

Purpose

The purpose of this study was to determine if performance on the FMS™ overhead deep squat test (DS) could predict performance on the entire FMS™.

Study Design

Cohort study.

Methods

One hundred and three collegiate athletes underwent offseason FMS™ testing. The DS and adjusted FMS™ composite scores were dichotomized into low performance and high performance groups with athletes scoring below 2 on the DS categorized as low performance, and athletes with adjusted FMS™ composite scores below 12 categorized as low performance. Scores of 2 or above and 12 or above were considered high performances for the DS test and adjusted FMS™ composite score respectively, and therefore low risk for movement dysfunction and potentially, injury.

Results

Individuals categorized as low performance as a result of the DS test had lower adjusted FMS™ composite scores (p < 0.001). DS scores were positively correlated with adjusted FMS™ composite scores (ρ = 0.50, p < 0.001). Binomial logistic regression identified an odds ratio of 3.56 (95% CI: 1.24, 10.23, p = 0.018) between DS and FMS™ performance categories.

Conclusions

Performance on the DS test may predict performance on the FMS™ and help identify individuals who require further musculoskeletal assessment. Further research is needed to determine if DS performance can predict asymmetries during the FMS™.

Level of Evidence

Level 3     

THE FUNCTIONAL MOVEMENT SCREENING (FMS)?: AN INTER‐RATER RELIABILITY STUDY BETWEEN RATERS OF VARIED EXPERIENCE

Background:

Previous researchers have reported on the reliability of the scoring of the FMS™ movement screens. Those authors have reported good to excellent inter‐rater reliability between paired raters of similar experience level (either novice or expert), but no comparisons of inter‐rater reliability exist between a novice and an expert.

Purpose:

The purpose of this investigation was to examine the inter‐rater reliability of the scoring of the FMS™ between trained novices and an expert rater using video records.

Methods:

Twenty healthy college students participated. Each participant performed the series of seven functional movement screens. Four raters (three novices and one expert) independently scored the seven FMS™ tests by watching video recordings of the movements..

Results:

The mean total FMS™ score for all subjects was 14.6 ± 1.9, and was not significantly different between raters (p = 0.136). For the individual tests, half of them had perfect agreement, while the other half ranged from slight to moderate agreement (33‐66%).

Conclusion:

Conclusion: Total FMS™ scores were similar among the raters, and the inter‐rater reliability for a majority of the individual tests had as strong agreement despite the various level of experience of the raters scoring the FMS™ tests.

Clinical Relevance:

Although there was mostly moderate to perfect agreement among raters, the level of experience of the rater scoring the FMS™ should be considered, as it appears that the expert rater was more critical than novice raters in the interpretation of the scoring criteria.

Level of Evidence:

Level 3     

BREATHING PATTERN DISORDERS AND FUNCTIONAL MOVEMENT

Study Design:

Experimental design

Background:

Normal breathing mechanics play a key role in posture and spinal stabilization. Breathing Pattern Disorders (BPD) have been shown to contribute to pain and motor control deficits, which can result in dysfunctional movement patterns. The Functional Movement Screen™ (FMS™) has been shown to accurately predict injury in individuals who demonstrate poor movement patterns. The role BPD play on functional movement is not well established. Furthermore, there is currently no single test to clinically diagnose BPD. A variety of methods are used, but correlations between them are poor.

Purpose:

To examine the relationship between BPD and functional movement and identify correlations between different measures of BPD.

Methods:

Breathing was assessed in 34 healthy individuals using a multi‐dimensional approach that included biomechanical, biochemical, breathing related symptoms, and breathing functionality measures. Movement was assessed using the FMS™. Analysis, involving independent t‐tests and Pearson correlation were performed to identify associations between measures.

Results:

Individuals who exhibited biochemical and biomechanical signs of BPD were significantly more likely to score poorly on the FMS™. These studied measures of BPD correlated highly with each other.

Conclusion:

These results demonstrate the importance of diaphragmatic breathing on functional movement. Inefficient breathing could result in muscular imbalance, motor control alterations, and physiological adaptations that are capable of modifying movement. These findings provide evidence for improved breathing evaluations by clinicians.

Level of Evidence:

2B     

MODIFIED FUNCTIONAL MOVEMENT SCREENING AS A PREDICTOR OF TACTICAL PERFORMANCE POTENTIAL IN RECREATIONALLY ACTIVE ADULTS

Background

Failure to meet minimum performance standards is a leading cause of attrition from basic combat training. A standardized assessment such as the Functional Movement Screen™ (FMS™) could help identify movement behaviors relevant to physical performance in tactical occupations. Previous work has demonstrated only marginal association between FMS™ tests and performance outcomes, but adding a load challenge to this movement assessment may help highlight performance‐limiting behaviors.

Purpose

The purposes of this investigation were to quantify the effect of load on FMS™ tests and determine the extent to which performance outcomes could be predicted using scores from both loaded and unloaded FMS™ conditions.

Study Design

Crossover Trial.

Methods

Thirteen female and six male recreationally active college students (21 ± 1.37 years, 168 ± 9.8 cm, 66 ± 12.25 kg) completed the FMS™ under (1) a control condition (FMS™_C), and (2) an 18.10kg weight vest condition (FMS™_W). Balance was assessed using a force plate in double‐legged stance and tactical physical performance was evaluated via completion times in a battery of field tests. For each condition, penalized regression was used to select models from the seven FMS™ component tests to predict balance and performance outcomes. Data were collected during a single session lasting approximately three hours per participant. Results: For balance, significant predictors were identified from both conditions but primarily predicted poorer balance with increasing FMS™ scores. For tactical performance, models were retained almost exclusively from FMS™_W and generally predicted better performance with higher item scores.

Conclusions

The current results suggest that FMS™ screening with an external load could help predict performance relevant to tactical occupations. Sports medicine and fitness professionals interested in performance outcomes may consider assessing movement behaviors under a load.

Level of Evidence

3     

EFFECTS OF POSTURAL CONTROL MANIPULATION ON VISUOMOTOR TRAINING PERFORMANCE: COMPARATIVE DATA IN HEALTHY ATHLETES

Purpose/Background:

Visuomotor ability is an important parameter for neurologic function and effective sport performance. Adding a balance challenge during a structured eye‐hand coordination task, such as hitting lights on a light board (Dynavision™), has not been previously reported. Using Division I football players, the aim of this study was to determine normative data on a dual‐task performance regimen combining a visuomotor light board task with a balance task. The intent is to use such normative data and baseline data as part of a concussion management program.

Methods:

Division I college football team members, n=105, were consented. Subjects first performed Dynavision™ D2™ Visuomotor Training Device (D2™) eye‐hand coordination tasks, the A* and the RT; they then performed the same tasks with an added balance challenge, standing on a BOSU® ball.

Results:

Ninety‐four athletes completed the full testing procedure on the D2™ system. The mean score of the A* test was 93 ± 11.0 hits per minute; and the mean on the A* test with the added BOSU® balance challenge was 83.7 ± 9.2 hits per minute. The mean RT time was 0.33 ± 0.036 seconds. Mean reaction time increased to 0.38 ± 0.063 while the subject stood on the BOSU® ball. Performance on the D2™ A* and RT were both statistically significantly different in the dual task condition (p<0.05).

Conclusions:

Results show an approximate 10% decline in D2™ performance when healthy individuals stand on a BOSU® ball. From the data presented here, the authors determined that there is a 10% decrement in performance when one''s balance is challenged on the BOSU® ball. A fall in performance of substantially greater than 10% may indicate abnormal vestibulocerebellar regulatory processing of balance and motion. Further research, using these normative data is needed to determine more specific parameters for definitions of impairment and return‐to‐play and if there is utility for such studies as part of a concussion management program.

Level of Evidence:

III     

EFFECTS OF WEARING ATHLETIC SHOES,FIVE‐TOED SHOES,AND STANDING BAREFOOT ON BALANCE PERFORMANCE IN YOUNG ADULTS

Background/Purpose

Almost all research using participants wearing barefoot‐style shoes study elite runners or have participants with a history of barefoot style shoe training run on a treadmill when shod or barefoot. Wearing barefoot‐style shoes is suggested as a method of transition between shod and barefoot running. Static and dynamic balance exercises also are recommended. However, little information is available on the effects five‐toed barefoot style shoes have on static balance. The purpose of this study was to examine balance of subjects barefoot, wearing Vibram FiveFingers™ barefoot‐style shoes, and regular athletic shoes with eyes closed when using the Biodex Balance System‐SD™.

Study Design

This was a repeated measures study.

Methods

Forty nine participants aged 18‐30 years without lower extremity injury or experience wearing barefoot‐style shoes were tested for static balance on the Biodex Stability System™ with their eyes closed while wearing Vibram FiveFingers™, athletic shoes, or barefoot. Three trials of 10 seconds for each footwear type were completed. Repeated measures analysis of variance with Bonferroni''s correction was used to analyze the degrees of sway in the anterior‐posterior and medial lateral directions. An overall stability index was also calculated by the Biodex.

Results

For anterior‐posterior and overall indices, differences were found between all conditions. Participants wearing athletic shoes demonstrated the smallest anterior‐posterior stability index (least sway) and spent the most time in the innermost concentric circular zone. Medial‐lateral indices were not different for any condition.

Conclusions

Wearing Vibram FiveFingers™ provided better overall and anterior‐posterior static balance than going barefoot. While differences between Vibram FiveFingers™ and barefoot are significant, results may reflect statistical significance rather than any clinical difference in young, uninjured individuals.

Clinical relevance

It would appear that Vibram FiveFingers™ mimic going barefoot and may be a bridge for exercising in preparation for barefoot exercise.

Level of Evidence

3B     

ASSOCIATIONS BETWEEN THE FEMALE ATHLETE TRIAD AND INJURY AMONG HIGH SCHOOL RUNNERS

Purpose/Background:

During the 2013‐14 school year, over 763,000 female athletes participated in interscholastic running sports in the United States. Recent studies have indicated associations between the female athlete triad (Triad) and stress fracture or other musculoskeletal injuries in elite or collegiate female running populations. Little is known about these relationships in an adolescent interscholastic running population. The purpose of this study was to determine the associations between Triad and risk of lower extremity musculoskeletal injury among adolescent runners.

Methods:

Eighty‐nine female athletes competing in interscholastic cross‐country and track in southern California were followed, prospectively. The runners were monitored throughout their respective sport season for lower extremity musculoskeletal injuries. Data collected included daily injury reports, Eating Disorder Examination Questionnaire (EDE‐Q) that assessed disordered eating attitudes/behaviors, a questionnaire on menstrual history and demographic characteristics, a dual‐energy x‐ray absorptiometry scan that measured whole‐body bone mineral density (BMD) and body composition (lean tissue and fat mass), and anthropometric measurements.

Results:

Thirty‐eight runners (42.7%) incurred at least one lower extremity musculoskeletal injury. In the BMD Z‐score ≤ ‐1 standard deviation (SD) adjusted model, low BMD relative to age (BMD Z‐score of ≤ ‐1SD) was significantly associated (Odds Ratio [OR]=4.6, 95% confidence interval [CI]: 1.5‐13.3) with an increased occurrence of musculoskeletal injury during the interscholastic sport season. In the BMD Z‐score ≤ ‐2 SDs adjusted model, a history of oligo/amenorrhea was significantly associated (OR=4.1, 95% CI: 1.2‐13.5) with increased musculoskeletal injury occurrence.

Conclusion:

Oligo/amenorrhea and low BMD were associated with musculoskeletal injuries among the female interscholastic cross‐country and track runners.

Clinical Relevance:

Regular, close monitoring of adolescent female runners during seasonal and off‐season training may be warranted, so that potential problems can be recognized and addressed promptly in order to minimize the risk of running injury.

Level Of Evidence:

2     

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     

ASSOCIATION OF ISOMETRIC STRENGTH OF HIP AND KNEE MUSCLES WITH INJURY RISK IN HIGH SCHOOL CROSS COUNTRY RUNNERS

Background

High school cross country runners have a high incidence of overuse injuries, particularly to the knee and shin. As lower extremity strength is modifiable, identification of strength attributes that contribute to anterior knee pain (AKP) and shin injuries may influence prevention and management of these injuries.

Purpose

To determine if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of AKP and shin injury in high school cross country runners.

Materials/Methods

Sixty‐eight high school cross country runners (47 girls, 21 boys) participated in the study. Isometric strength tests of hip abductors, knee extensors and flexors were performed with a handheld dynamometer. Runners were prospectively followed during the 2014 interscholastic cross country season for occurrences of AKP and shin injury. Bivariate logistic regression was used to examine risk relationships between strength values and occurrence of AKP and shin injury.

Results

During the season, three (4.4%) runners experienced AKP and 13 (19.1%) runners incurred a shin injury. Runners in the tertiles indicating weakest hip abductor (chi‐square = 6.140; p=0.046), knee extensor (chi‐square = 6.562; p=0.038), and knee flexor (chi‐square = 6.140; p=0.046) muscle strength had a significantly higher incidence of AKP. Hip and knee muscle strength was not significantly associated with shin injury.

Conclusions

High school cross country runners with weaker hip abductor, knee extensor and flexor muscle strength had a higher incidence of AKP. Increasing hip and knee muscle strength may reduce the likelihood of AKP in high school cross country runners.

Level of Evidence

2b     

AN ELASTIC EXERCISE BAND MOUNTED WITH A BANDCIZER? CAN DIFFERENTIATE BETWEEN COMMONLY PRESCRIBED HOME EXERCISES FOR THE SHOULDER

Background

Home‐exercise is commonly prescribed for rehabilitation of the shoulder following injury. There is a lack of technology available to monitor if the patient performs the exercises as prescribed.

Purpose

The purpose of this study was to investigate the validity of using three dimensional (3D) gyroscope data recorded with the Bandcizer™ sensor to differentiate between three elastic band exercises performed in the shoulder joint: abduction, flexion, and external rotation.

Design

Concurrent validity study.

Methods

This study was performed over two phases. In the first phase, 20 subjects performed three sets of 10 of shoulder abduction, external rotation and flexion exercises with a Thera‐Band mounted with a Bandcizer, while supervised by a physical therapist. The Bandcizer has an inbuilt three‐dimensional gyroscope, capable of measuring angular rotation. Gyroscope data were analyzed in Matlab, and a one‐way ANOVA was used to test for significant differences between each of the three exercises. An algorithm was then created in Matlab based on the exercise‐data from the gyroscope, to enable differentiation between the three shoulder exercises. Twenty new subjects were then recruited to cross‐validate the algorithm and investigate if the algorithm could differentiate between the three different shoulder exercises.

Results

A blinded assessor using the Matlab algorithm could correctly identify 56 out of 60 exercise sets. The kappa agreement for the three exercises ranged between 0.86‐0.91.

Conclusion

The ability to differentiate between the home exercises performed by patients after shoulder injury has great implications for future clinical practice and research. When home exercises are the treatments‐of‐choice, clinicians will be able to quantify if the patient performed the exercise as intended. Further research should be aimed at investigating the feasibility of using the Bandcizer™ in a home‐based environment.

Word count

2429

Level of Evidence

2     

A TOTAL MOTION RELEASE WARM‐UP IMPROVES DOMINANT ARM SHOULDER INTERNAL AND EXTERNAL ROTATION IN BASEBALL PLAYERS

Context:

Current literature indicates a correlation between decreased total shoulder range of motion (ROM) and internal rotation (IR) of the dominant arm and increased injury risk in throwers. The optimal method for increasing shoulder ROM, improving performance, and preventing injury is unknown. It is also unknown if treating the non‐dominant arm may affect ROM on the dominant side.

Purpose:

To explore the effect of the Total Motion Release (TMR®) Trunk Twist (TT) and Arm Raise (AR) on IR and external rotation (ER) of the dominant shoulder in baseball players compared to a traditional dynamic warm‐up.

Design:

Cohort study.

Setting:

University athletic training clinic and baseball field.

Participants:

Pitchers (males, n = 10; age, 18.6 ± 1.3) recruited from local baseball teams were randomly assigned two one of two groups: TMR® treatment group (TMRG; n = 5) or traditional warm‐up group (TWG; n = 5).

Interventions:

Baseline IR and ER goniometry range of motion (ROM) measurements were recorded. The TMRG then completed the TMR® exercises and post‐intervention measurements. The TWG completed a traditional static and dynamic warm‐up (e.g., lunges, power skips, sprints, sleeper stretch) and then completed post‐intervention measurements. Following the completion of those measurements, the TWG completed the TMR® Trunk Twist and Arm Raise protocol and had post‐intervention measurements recorded once more.

Main Outcome Measures:

ROM measures for IR and ER of the dominant shoulder. Alpha level was set at p ≤ 0.05.

Results

Significant differences were present for IR (p = 0.025) and ER (p = 0.014) between the TMRG and the TWG after initial intervention. Significant differences for IR were present in the TWG between baseline and TMR® intervention and traditional warm‐up and TMR® intervention. For the TWG, changes in ER were not statistically significant at baseline, post‐warm‐up, or post‐ TMR® intervention. Significant differences were not present for IR (p = 0.44) or ER (p = 0.23) between groups once TMR® had been completed by both groups.

Conclusions:

TMR® produced larger increases in IR and ER of the throwing shoulder when compared to the TWG. Generalizability is limited, however, by the low number of participants in each group and a potential ceiling effect of attainable ROM gains. Future studies should examine if using a full TMR® treatment process is more beneficial. Additionally, future research should compare TMR® intervention to other warm‐up activities or stretching protocols (e.g. resistance tubing, weighted balls) and examine its effect across other variables (e.g., injury rates, throwing velocity).

Level of Evidence:

Clinical Evidence Based Level 2b     

THE RELATIONSHIP BETWEEN GLENOHUMERAL JOINT TOTAL ROTATIONAL RANGE OF MOTION AND THE FUNCTIONAL MOVEMENT SCREEN? SHOULDER MOBILITY TEST

Purpose/Background:

Side to side asymmetry in glenohumeral joint rotation correlates with injury risk in overhead athletes. The purpose of the current study was to identify the relationship between side‐to‐side asymmetries in glenohumeral joint total rotational range of motion and shoulder mobility test scores from the Functional Movement Screen™ in collegiate overhead athletes. The authors hypothesized that asymmetries of > 10° in glenohumeral total rotation would not be associated with asymmetrical findings in the Functional Movement Screen™ (FMS) shoulder mobility test.

Methods:

Passive glenohumeral total rotational range of motion and the shoulder mobility test of the FMS were measured during pre‐participation examinations in 121 NCAA male and female Division II collegiate overhead athletes from varied sports. Passive shoulder range of motion was measured in supine at 90° of abduction, with the humerus in the scapular plane using two measurers and a bubble goniometer. A Pearson Chi‐square analysis, p<.05 was used to associate the presence of asymmetries in glenohumeral joint rotation and in the FMS shoulder mobility test in each subject.

Results:

40/114 (35.1%) athletes demonstrated asymmetries in total glenohumeral rotation. 45/114 (39.5%) athletes demonstrated asymmetries in the shoulder mobility test. Only 17 of the 45 subjects who demonstrated asymmetry on the shoulder mobility test also demonstrated glenohumeral joint rotation differences of > 10°. Athletes with asymmetries in rotation of > 10° were not any more likely to have asymmetries identified in the shoulder mobility test (95% CI=.555‐2.658, P=.627).

Conclusions

Glenohumeral joint range of motion is one of multiple contributors to performance on the FMS shoulder mobility test, and alone, did not appear to influence results. The FMS shoulder mobility test should not be used alone as a means of identifying clinically meaningful differences of shoulder mobility in the overhead athlete. Clinicians working with overhead athletes may consider using both assessments as a complete screening tool for injury prevention measures.

Level of Evidence:

Level 3     

COMPARING THE EFFECTS OF SELF‐MYOFASCIAL RELEASE WITH STATIC STRETCHING ON ANKLE RANGE‐OF‐MOTION IN ADOLESCENT ATHLETES

Background:

Increased flexibility is often desirable immediately prior to sports performance. Static stretching (SS) has historically been the main method for increasing joint range‐of‐motion (ROM) acutely. However, SS is associated with acute reductions in performance. Foam rolling (FR) is a form of self‐myofascial release (SMR) that also increases joint ROM acutely but does not seem to reduce force production. However, FR has never previously been studied in resistance‐trained athletes, in adolescents, or in individuals accustomed to SMR.

Objective:

To compare the effects of SS and FR and a combination of both (FR+SS) of the plantarflexors on passive ankle dorsiflexion ROM in resistance‐trained, adolescent athletes with at least six months of FR experience.

Methods:

Eleven resistance‐trained, adolescent athletes with at least six months of both resistance‐training and FR experience were tested on three separate occasions in a randomized cross‐over design. The subjects were assessed for passive ankle dorsiflexion ROM after a period of passive rest pre‐intervention, immediately post‐intervention and after 10, 15, and 20 minutes of passive rest. Following the pre‐intervention test, the subjects randomly performed either SS, FR or FR+SS. SS and FR each comprised 3 sets of 30 seconds of the intervention with 10 seconds of inter‐set rest. FR+SS comprised the protocol from the FR condition followed by the protocol from the SS condition in sequence.

Results:

A significant effect of time was found for SS, FR and FR+SS. Post hoc testing revealed increases in ROM between baseline and post‐intervention by 6.2% for SS (p < 0.05) and 9.1% for FR+SS (p < 0.05) but not for FR alone. Post hoc testing did not reveal any other significant differences between baseline and any other time point for any condition. A significant effect of condition was observed immediately post‐intervention. Post hoc testing revealed that FR+SS was superior to FR (p < 0.05) for increasing ROM.

Conclusions:

FR, SS and FR+SS all lead to acute increases in flexibility and FR+SS appears to have an additive effect in comparison with FR alone. All three interventions (FR, SS and FR+SS) have time courses that lasted less than 10 minutes.

Level of evidence:

2c     

INJURY RISK IS ALTERED BY PREVIOUS INJURY: A SYSTEMATIC REVIEW OF THE LITERATURE AND PRESENTATION OF CAUSATIVE NEUROMUSCULAR FACTORS

Background:

Active adults commonly present with lower extremity (LE) injuries from a variety of professional and amateur sports activities. Decreased LE function significantly alters daily life and subsequent injuries increase this impact. The purpose of this systematic review was to examine the association between previous injury and the risk of re‐injury, and to describe the changes in kinematics and motor programming that may contribute to this relationship.

Methods:

A preliminary search was conducted to determine the four most common LE injuries on PubMed, CINAHL and Web of Science. These injuries, in a healthy active adult population, were hamstring strain (HS), anterior cruciate ligament injury (ACL), achilles tendon pathology, and ankle sprain. After these injuries were established, the search for this systematic review found evidence relating these injuries to re‐injury. Articles related to degenerative changes were excluded. Twenty‐six articles were included in the systematic review detailing the risk of re‐injury from a previous injury and were graded for quality.

Results:

ACL injury was linked to a successive injury of the same ACL, and other injuries in the LE. HS was associated with subsequent ipsilateral HS and knee injuries. Previous achilles tendon rupture increased the risk of an analogous injury on the contralateral side. An ankle sprain was associated with a re‐injury of either the ipsilateral or the contralateral ankle. Post‐injury changes were present in strength, proprioception, and kinematics, which may have led to overall changes in motor control and function.

Conclusion:

This review provides insight into the changes occurring following common LE injuries, how these changes potentially affect risk for future injury, and address the needs of the active adult population in rehabilitation.

Clinical Relevance:

Current research on previous injury and re‐injury is of high quality, but scarce quantity. Deficits following an injury are known, but how these deficits correlate or lead to re‐injury requires further exploration.

Level of Evidence:

1     

REGIONAL INTERDEPENDENCE OF THE HIP AND LUMBO‐PELVIC REGION IN DIVISON II COLLEGIATE LEVEL BASEBALL PITCHERS: A PRELIMINARY STUDY

Background

Pitchers may be at greater risk of injury in comparison to other overhead throwing athletes due to the repetition of the pitching motion. It has been reported that approximately 30% of all baseball injuries occur in the lower body. This may be related to limited hip mobility, which can compromise pitching biomechanics while placing excessive stress on the trunk and upper quarter. Hip motion and strength measurements have been reported in professional baseball pitchers but have not been reported in collegiate pitchers.

Purpose

The purpose of this study was to report preliminary findings for passive hip motion and isometric hip muscle strength in collegiate pitchers and compare them to previously published values for professional level pitchers.

Study Design

Cross sectional study

Methods

Twenty‐nine collegiate baseball pitchers (age = 20.0 + 1.4 years, height = 1.88 + 0.06 m; weight = 89.3 + 10.7 kg; body mass index = 25.3 + 2.5 kg/m2) were recruited. Subjects were assessed for hip internal rotation (IR) and external rotation (ER) passive motion, hip anteversion or retroversion, gluteus maximus, gluteus medius, hip internal rotator, hip external rotator strength, and lumbo‐pelvic control with the prone active hip rotation test as described by Sahrmann. Statistical analysis included calculation of subject demographics (means and SD) and use of a two‐tailed t‐test (p >0.05).

Results

Fifty‐two percent of the right‐handed and 50% of the left‐handed pitchers demonstrated poor lumbo‐pelvic motor control with an inability to stabilize during active hip IR and ER even though isolated strength deficits were not detected at a significant level. There were no significant differences in hip passive motion or gluteus medius strength between right and left‐handed pitchers. Differences did exist between collegiate data and previously published values for professional pitchers for IR motion measured in prone and gluteus maximus strength. Hip retroversion was present in 55% of the pitchers primarily in both limbs with four of the pitchers presenting with retroversion singularly in either the stride or trail limb where the ER rotation motion was greater than the IR.

Conclusion

Assessing mobility and muscle strength of the lower quarter in isolation can be misleading and may not be adequate to ensure the potential for optimal pitching performance. These findings suggest that lumbo‐pelvic control in relation to the lower extremities should be assessed as one functional unit. This is the first study to explore hip motion, strength, and lumbo‐pelvic control during active hip rotation in collegiate baseball pitchers.

Evidence Level

2     

BILATERAL DIFFERENCES IN THE UPPER QUARTER FUNCTION OF HIGH SCHOOL AGED BASEBALL AND SOFTBALL PLAYERS

Purpose/Background:

The Upper Quarter Y Balance Test (YBT‐UQ) was developed as a way to identify upper extremity and trunk mobility in the open kinetic chain in the reaching limb as well as midrange limitations and asymmetries of upper extremity and core stability in the closed kinetic chain on the stabilizing limb. Performance on the YBT‐UQ is similar between genders and between limbs; however, this has not been examined in athletes who participate in sports that result in upper extremity asymmetries. The primary purpose of this study is to determine if differences exist between the throwing vs. non‐throwing sides in high‐school baseball and softball athletes on the YBT‐UQ.

Methods:

In order to complete this forty‐eight male high school baseball players and seventeen female high school softball players were tested on the YBT‐UQ. Reach distances were normalized to arm length (% AL). Comparisons were made between the throwing (T) and non‐throwing (NT) arm for each direction as well as the composite score.

Results:

No significant differences were observed between the T and NT arm for the medial (NT: 98.4 ± 8.6 %AL, T: 99.1 ± 8.6 %AL, p=0.42), inferolateral (NT: 90.8 ± 11.8 %AL, T: 90.3 ± 11.5 %AL, p =0.61), superolateral (NT: 70.6 ± 10.9 %AL, T: 70.4 ± 11.1 % AL, p=0.91) reaches, or the composite score (NT: 87.2 ± 8.9 % AL, T: 86.6 ± 8.1 %AL, p=0.72). Similarly, no differences were observed between the male baseball and female softball players (p=0.30‐0.90).

Conclusions:

Based on these findings, it was concluded that there was no difference in performance on the YBT‐UQ between throwing and non‐throwing limbs in high school baseball and softball players.

Level of Evidence:

3