Examining the association of injury with the Functional Movement Screen and Landing Error Scoring System in military recruits undergoing 16 weeks of introductory fitness training

Objectives

To examine the association of injury with the Functional Movement Screen (FMS) and Landing Error Scoring System (LESS) in military recruits undergoing an intensive 16-week training block.

Psychosocial predictors and psychological prevention of soccer injuries: A systematic review and meta-analysis of the literature

ObjectivesTo examine (a) the relationships between the psychosocial risk factors and injury rates and (b) the effects of psychological-based prevention interventions on the injury risk of soccer players.DesignScholarly electronic databases (PubMed/MEDLINE, Google Scholar, Scopus) were searched on 1 January 2017, complemented by manual searches of bibliographies. Setting: Systematic review and meta-analysis.ParticipantsWe identified 13 eligible studies, including a total of 1149 injured soccer players aged between 14 and 36 years.Main outcome measuresPsychosocial risk factors, psychological-based prevention interventions and injury risk in soccer players.ResultsPersonality traits, such as trait anxiety and perceived mastery climate, along with a history of stressors, like negative-life-event stress or high level of life stress, daily hassle, and previous injury, are the main predictors of injury rates among soccer players. Also, from injury prevention studies, it has been shown that psychological-based interventions reduce injury rates (effect size = 0.96; 95% CI 0.34–1.58; p = 0.002) in senior soccer players.ConclusionsPractitioners need to ensure injured soccer players are psychologically and socially ready to play. They should also employ psychological-based interventions (i.e., mindfulness, imagery, self-talk, stress management, relaxation, goal setting) when designing injury prevention programs.     

The incidence of injury in male field hockey players: A systematic review and meta-analysis

ObjectiveFew studies have investigated injury incidence in field hockey. The aim of this systematic review was to determine the incidence and characteristics of injury in male field hockey athletes.DesignPrognosis systematic review with meta-analysis.Literature searchMEDLINE via PubMed; EMBASE via Ovid; CINAHL via EBSCO; SPORTDiscus; and Web of Science were searched.Study selection criteriaProspective studies and retrospective studies employing video analysis, written in English and published in peer-reviewed journals, expressing the incidence of injury in male field hockey athletes were included. Studies must have been of a duration of a minimum one season or one tournament. Studies were screened by two authors, assessing the eligibility of each record. Following selection of the studies, data were extracted by the two authors.Data synthesisLevels of heterogeneity were assessed in aggregate data using the I² statistic.ResultsIn total, 1722 records were identified. Twelve studies were included in the review. Injury incidence ranged from 4.5 to 57.9/1000h (I² = 98.5%). Nine studies were undertaken in tournament settings, with the remaining three conducted in club-based athletes in season-long settings. When a medical attention definition was used, there was a pooled incidence rate of 48.1/1000h, all in tournament studies. Contusions and muscle strains were the most frequently reported injury types, while the lower limb was the most common site of injury. Contact injuries were most common in tournament-based studies, while non-contact was more common in season-long studies.ConclusionProspective, season-long epidemiological studies investigating injury incidence in field hockey are lacking.     

Injuries during transition periods across the year in pre-professional and professional ballet and contemporary dancers: A systematic review and meta-analysis

ObjectiveTo consider the association of injuries with transition periods in the dance year, i.e., when dancers return at the start of the year, and when they transition from rehearsal to performance periods.MethodsSix electronic databases were searched to November 2019. All English language peer-reviewed studies, of any study design investigating ballet and contemporary pre-professional and professional dance populations were included. Only those studies reporting on the timing of injury were included.ResultsFifteen cohort and two case-series studies were included. A meta-analysis of seven studies revealed the rate of injuries to be significantly higher for the second and third months (1.52; 95% confidence interval [CI]:1.11–2.08; 1.26; 95%CI:1.07–1.48 respectively) after the return to dance. Two further studies report more injuries up to Week 13 of the year. One study showed an increase in injured dancers at three and four weeks after transition from rehearsals to a performance season. Four studies show an increase in injuries at performance times.ConclusionsMeta-analyses of seven studies shows the second and third months after returning to dance have a significantly higher rate of injuries. More research is needed to quantify training loads in dance. Practitioners should be cognisant of the higher injury rates during periods of transition and consider modifying load, as it is a potential contributing factor.     

Instrumented platforms for balance and proprioceptive assessment in patients with total knee replacement: A systematic review and meta-analysis

BackgroundThe functional outcome of total knee replacement (TKR) is usually satisfying. However, patients may show functional limitations for years after surgery, which have been ascribed to impairments in balance and proprioception, mainly during standing tasks. A number of instrumentations and parameters have been used, rising confusion for clinical decisions on the assessment of patients.Research questionWhich are the most widespread and consistent procedures to assess balance and proprioception following TKR?MethodsA literature review was conducted in Pubmed, PEDro, and Cochrane database. From a total sample of 112 articles, 23 original studies published between 2008 and 2019 met inclusion criteria. The primary outcomes selected were variables related to balance and proprioception assessment in static and dynamic tasks performed with instrumented platforms. Data from papers using the same instrumentation, on patients with unilateral TKA and at least 12 months postoperatively were synthesized quantitatively in a random effect meta-analysis.ResultsFourteen articles were appropriate for the review. A large variability was found both in the instrumentation and the parameters used. The Neurocom Balance Master System™ was the most used instrument (four articles). On a total population of 186 patients with unilateral TKR 12 months postoperatively, a low degree of heterogeneity was found adopting the random effect in the four tasks explored (Firm and Foam Surface both with Eyes Open and Eyes Closed).SignificanceThis review found a large variability in the instrumentation used to assess balance and proprioception in patients operated on TKR. The meta-analysis demonstrated that the Neurocom Balance Master System™ for static assessment of balance showed an acceptable consistency and can be considered as a reference for further studies. However, balance and proprioception impairments following TKR have not been widely quantified by means of instrumented platforms. Further research is needed to address this issue, and improve clinical practice.     

Gender differences in knee abduction during weight-bearing activities: A systematic review and meta-analysis

BackgroundIncreased knee abduction during weight-bearing activities is suggested to be a contributing factor for the high knee injury risk reported in women. However, studies investigating gender difference in knee abduction are inconclusive.ObjectiveTo systematically review gender-differences in knee abduction during weight-bearing activities in individuals with or without knee injury.MethodsA systematic review and meta-analysis were conducted according to the PRISMA guidelines. A search in the databases Medline, CINAHL and EMBASE was performed until September 2015. Inclusion criteria were studies that reported (1) gender differences, (2) healthy individuals and/or those with anterior cruciate ligament (ACL) deficiency or reconstruction or patellofemoral pain PFP, and (3) knee abduction assessed with either motion analysis or visual observation during weight-bearing activity.ResultsFifty-eight articles met the inclusion criteria. Women with PFP had greater peak knee abduction compared to men (Std diff in mean; −1.34, 95%CI; −1.83 to −0.84). In healthy individuals, women performed weight-bearing tasks with greater knee abduction throughout the movement (initial contact, peak abduction, excursion) (Std diff in mean; −0.68 to −0.79, 95%CI; −1.04 to −0.37). In subgroup analyses by task, differences in knee abduction between genders were present for most tasks, including running, jump landings and cutting movements. There were too few studies in individuals with ACL injury to perform meta-analysis.ConclusionThe gender difference in knee abduction during weight-bearing activities should be considered in training programs aimed at preventing or treating knee injury.     

Effectiveness of shoulder injury prevention programs in an overhead athletic population: A systematic review

ObjectiveTo analyze the effectiveness of shoulder injury prevention programs in overhead athletes.DesignSystematic Review.MethodsCINAHL, Embase, PubMed, and SPORTDiscus electronic databases were searched from database inception through December 2020 for randomized controlled or prospective cohort studies that implemented shoulder injury prevention programs in overhead athletes and reported shoulder injury incidence rates.ResultsSeven studies fulfilled the inclusion criteria. Two studies reported on odds ratios (OR) that resulted in a reduction of shoulder injuries in overhead athletes following shoulder strengthening and flexibility exercises (OR, 0.72; 95% CI; 0.52, 0.98; OR, 0.22; 95% CI; 0.06, 0.75). One study reported on hazard ratio (HR) that resulted in a reduction of shoulder injuries following stretching of the posterior capsule (HR, 0.36; 95% CI; 0.13, 0.95).ConclusionThere is limited research surrounding the effectiveness of shoulder injury prevention programs in overhead athletes specific to injury reduction. Only three studies reported a favorable effect in terms of injury prevention, with only one study at low risk of bias. At present, no conclusions can be made regarding the effectiveness of shoulder injury prevention programs in the overhead athlete.     

Kinematic risk factors for lower limb tendinopathy in distance runners: A systematic review and meta-analysis

IntroductionAbnormal kinematics have been implicated as one of the major risk factors for lower limb tendinopathy (LLT).ObjectiveTo systematically review evidence for kinematic risk factors for LLT in runners.MethodsIndividual electronic searches in PubMed, EMBASE and Web of Science were conducted. Two reviewers screened studies to identify observational studies reporting kinematic risk factors in runners with LLT compared to healthy controls. The Down and Black appraisal scale was applied to assess quality. A meta-analysis was performed provided that at least two studies with similar methodology reported the same factor.ResultsTwenty-eight studies were included: Achilles tendinopathy (AT) (9), iliotibial band syndrome (ITBS) (17), plantar fasciopathy (PF) (2), patellar tendinopathy (PT) (1), posterior tibial tendon dysfunction (PTTD) (1). Eighteen studies were rated high-quality and ten medium-quality. The meta-analyses revealed strong evidence of higher peak knee internal rotation, moderate evidence of lower peak rearfoot eversion and knee flexion at heel strike and greater peak hip adduction in runners with ITBS. Very limited evidence revealed higher peak ankle eversion in runners with PF and PTTD or higher peak hip adduction in PT.SignificancePeak rearfoot eversion was the only factor reported in all included LLTs; it is a significant factor in ITBS, PT and PTTD but not in AT and PF. More prospective studies are needed to accurately evaluate the role of kinematic risk factors as a cause of LLT. Taken together, addressing rearfoot kinematic and kinematic chain movements accompanied by peak eversion should be considered in the prevention and management of LLT.     

Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: A systematic review with meta-analysis

ObjectiveTo summarise and evaluate research on the diagnostic accuracy of clinical tests for ligamentous injury of the ankle syndesmosis.MethodsCINAHL, Embase, and MEDLINE were searched from inception to February 12, 2021. Studies comparing clinical examination to arthroscopy, magnetic resonance imaging, or ultrasound were considered eligible. Meta-analysis was based on random effect modelling and limited to studies fulfilling all QUADAS-2 criteria. Sensitivity (SN), specificity (SP) and likelihood ratios determined diagnostic accuracy, all with 95% confidence intervals (CI).ResultsSix studies were included (512 participants; 13 clinical tests; 29% median prevalence). No individual test was associated with both high sensitivity and high specificity. Tests with the highest sensitivity were: palpation [SN 92% (95%CI 79–98)] and dorsiflexion lunge [SN 75% (95% CI 64–84%); n = 2 studies]. Tests with the highest specificity were: squeeze test [SP 85% (95% CI 81–89%); n = 4 studies] and external rotation [SP 78% (95% CI 73–82%); n = 4 studies].ConclusionsClinical examination should involve initial clustering of tests with high sensitivity (palpation; dorsiflexion lunge), followed by a test with high specificity (squeeze). However, as these tests cannot definitively stratify syndesmotic injuries into stable vs unstable, decisions on optimal management (conservative vs surgery) require additional imaging or arthroscopy.     

Evidence of sensorimotor deficits in functional ankle instability: A systematic review with meta-analysis

Functional ankle instability (FAI) has been associated with impaired sensorimotor function; however individual studies have produced conflicting results. In an attempt to reduce this ambiguity, a systematic review with meta-analysis was undertaken to determine which sensorimotor deficits exist with FAI. Fifty-three studies assessing sensorimotor factors in subjects with FAI were included from 465 identified articles. Studies were rated for methodological quality and data were pooled for peroneal reaction time, joint position sense, and postural sway during single-leg stance and time to stabilisation from a single-leg jump. Data on joint movement sense were unable to be pooled. When subjects with unstable ankles were compared to healthy controls, sensorimotor impairments were demonstrated for passive joint position sense (mean difference (MD) = 0.7°, 95% confidence interval (CI): 0.2–1.2°, p = 0.004), active joint position sense (MD = 0.6°, 95% CI: 0.2–1.0°, p = 0.002), postural sway in single-leg stance (standardised MD (SMD) = 0.6, 95% CI: 0.2–1.0, p = 0.002), the star excursion balance test (SMD = 0.4, 95% CI: 0.1–0.7, p = 0.009), and time to stabilisation from a single-leg jump in a medio-lateral (MD = 0.6 ms, 95% CI: 0.4–0.8, p < 0.0001) and an antero-posterior direction (MD = 0.7 ms, 95% CI: 0.4–1.0, p < 0.0001). Peroneal reaction time was not affected. Sensorimotor deficits occur for joint position sense and postural control in subjects with FAI. Deficits in peroneal muscle reaction time following perturbation are not evident.     

Injuries and associated risk factors of the shoulder and elbow among adolescent baseball pitchers: A systematic review and meta-analysis

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis of the current literature surrounding risk factors associated with shoulder and elbow injuries among adolescent baseball pitchers.MethodsRelevant studies were assessed for inclusion and retained from PubMed, EMBASE, SportDiscus, and CINAHL databases. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis.ResultsThe search resulted in 1238 studies identified with 10 ultimately retained for systematic review. Five studies including one case-control, two prospective cohort, and two cross-sectional studies met inclusion criteria for meta-analysis. This meta-analysis revealed that playing with arm fatigue was a significant risk factor (pooled odds ratio = 13.32, 95% confidence interval: 3.22–55.09). The other three risk factors (long competitive season, pitching for more than one team or league, and playing catcher as a secondary position) were not statistically significant.ConclusionPitching with arm fatigue is a significant risk factor for shoulder and elbow injuries among adolescent baseball pitchers. Future efforts in assessment and mitigation of pitching with arm fatigue among this population may help to reduce the risk of arm injuries. Furthermore, investigations of additional risk factors in a more homogeneous population of adolescent pitchers may be warranted.     

Physical fitness and academic performance in youth: A systematic review

Physical fitness (PF) is a construct of health‐ and skill‐related attributes which have been associated with academic performance (AP) in youth. This study aimed to review the scientific evidence on the association among components of PF and AP in children and adolescents. A systematic review of articles using databases PubMed/Medline, ERIC, LILACS, SciELO, and Web of Science was undertaken. Cross‐sectional and longitudinal studies examining the association between at least one component of PF and AP in children and adolescents, published between 1990 and June 2016, were included. Independent extraction of articles was carried out by the two authors using predefined data fields. From a total of 45 studies included, 25 report a positive association between components of PF with AP and 20 describe a single association between cardiorespiratory fitness (CRF) and AP. According to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines: 12 were classified as low, 32 as medium risk, and 1 as high risk of bias. Thirty‐one studies reported a positive association between AP and CRF, six studies with muscular strength, three studies with flexibility, and seven studies reported a positive association between clustered of PF components and AP. The magnitude of the associations is weak to moderate (β = 0.10–0.42 and odds = 1.01–4.14). There is strong evidence for a positive association between CRF and cluster of PF with AP in cross‐sectional studies; and evidence from longitudinal studies for a positive association between cluster of PF and AP; the relationship between muscular strength and flexibility with AP remains uncertain.     

A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review

Objectives: The clinical examination of the shoulder joint is an undervalued diagnostic tool for evaluating acromioclavicular (AC) joint pathology. Applying evidence-based clinical tests enables providers to make an accurate diagnosis and minimize costly imaging procedures and potential delays in care. The purpose of this study was to create a decision tree analysis enabling simple and accurate diagnosis of AC joint pathology.

Methods: A systematic review of the Medline, Ovid and Cochrane Review databases was performed to identify level one and two diagnostic studies evaluating clinical tests for AC joint pathology. Individual test characteristics were combined in series and in parallel to improve sensitivities and specificities. A secondary analysis utilized subjective pre-test probabilities to create a clinical decision tree algorithm with post-test probabilities.

Results: The optimal special test combination to screen and confirm AC joint pathology combined Paxinos sign and O’Brien’s Test, with a specificity of 95.8% when performed in series; whereas, Paxinos sign and Hawkins-Kennedy Test demonstrated a sensitivity of 93.7% when performed in parallel. Paxinos sign and O’Brien’s Test demonstrated the greatest positive likelihood ratio (2.71); whereas, Paxinos sign and Hawkins-Kennedy Test reported the lowest negative likelihood ratio (0.35).

Conclusion: No combination of special tests performed in series or in parallel creates more than a small impact on post-test probabilities to screen or confirm AC joint pathology. Paxinos sign and O’Brien’s Test is the only special test combination that has a small and sometimes important impact when used both in series and in parallel. Physical examination testing is not beneficial for diagnosis of AC joint pathology when pretest probability is unequivocal. In these instances, it is of benefit to proceed with procedural tests to evaluate AC joint pathology. Ultrasound-guided corticosteroid injections are diagnostic and therapeutic. An ultrasound-guided AC joint corticosteroid injection may be an appropriate new standard for treatment and surgical decision-making.

Level of Evidence: II – Systematic Review.     

The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis

Objective  

To determine the discriminative validity and reliability of the evidence base using meta-analysis.     

Pain severity during functional activities in individuals with patellofemoral pain: A systematic review with meta-analysis

ObjectivesPatellofemoral pain (PFP) is a common lower extremity condition that results in pain during functional tasks. Currently, it is unknown the extent to which differences in pain levels exist in individuals with PFP compared to asymptomatic controls during functional task and if pain differ across various functional tasks. The purpose of this systematic review and meta-analysis is to evaluate pain levels between individuals with PFP and asymptomatic controls and compare pain severity across various functional tasks.DesignSystematic review.MethodsOVID, SPORTSDiscus, CINAHL, Web of Science and Embase were searched for studies that included PFP and asymptomatic controls with pain assessed during a functional task. Pooled pain scores mean with 95% confidence intervals were calculated between groups across 11 functional tasks. Standardized mean differences (SMD) were calculated based on Hedge's g effect sizes. Tasks whose SMD 95% confidence intervals were non-overlapping were considered significantly different.Results28 articles were included for data analysis. Pain was greater across 10 tasks (SMD = 1.52–6.08) in individuals with PFP compared to the asymptomatic controls with an average SMD of 2.45. Running and star excursion balance testing resulted in greater pain than walking. Limited evidence showed greater pain in sitting than seven other tasks.ConclusionsModerate evidence exists for greater pain levels in individuals with PFP compared to asymptomatic controls in functional tasks. Pain was greater during running and star excursion balance compared to walking. Clinicians should assess knee pain before and after functional tasks to improve our understanding of patient specific pain experiences.     

The effect of ankle supports on lower limb biomechanics during functional tasks: A systematic review with meta-analysis

ObjectivesTo systematically review the literature on the effects of ankle supports on lower extremity biomechanics during functional tasks.DesignSystematic review with meta-analysis.MethodsEight electronic databases were searched from inception to July 2019. Studies of biomechanical outcomes during functional tasks that used a within-participant (repeated measures) design were included. Two independent reviewers screened studies, extracted data, assessed the methodological quality of the included studies and rated the quality of evidence. Meta-analysis was performed and reported as standardised mean differences and 95% confidence intervals.ResultsA total of 8350 studies were identified in the electronic search and 42 studies involving a total of 761 participants were included in the review (21 studies included for qualitative reporting and 21 studies in the meta-analysis). Most individual studies and the meta-analyses demonstrated no effect of ankle supports on ground reaction force or ankle inversion angle. However, there was high quality evidence that ankle taping decreased plantarflexion angle at initial contact during landing from a height (P = 0.0009, standerdised mean differences = 0.72, 95% confidence intervals = 1.15, 0.03, I ² = 3%). The effect of ankle supports on transverse plane ankle biomechanics has not been adequately investigated.ConclusionsAnkle taping only decreased plantarflexion angle at initial contact during landing from a jump. Ankle supports did not affect inversion angle or forces in linear and multiplanar tasks. There was insufficient evidence on the effect of ankle supports on ankle transverse plane biomechanics.     

Effectiveness and cost-effectiveness of double reading in digital mammography screening: A systematic review and meta-analysis

PurposeDouble reading is the strategy of choice for mammogram interpretation in screening programmes. It remains, however, unknown whether double reading is still the strategy of choice in the context of digital mammography. Our aim was to determine the effectiveness and cost-effectiveness of double reading versus single reading of digital mammograms in screening programmes.MethodsWe performed a systematic review by searching the PubMed, Embase, and Cochrane Library databases up to April 2017. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist to assess the methodological quality of the diagnostic studies and economic evaluations, respectively. A proportion’s meta-analysis approach, 95% Confidence Intervals (95% CI) and test of heterogeneity (P values) were used for pooled results. Costs are expressed US$ PPP (United States Dollar purchasing power parities). The PROSPERO ID of this Systematic Review’s protocol is CRD42014013804.ResultsOf 1473 potentially relevant hits, four high-quality studies were included. The pooled cancer detection rate of double reading was 6.01 per 1000 screens (CI: 4.47‰–7.77‰), and it was 5.65 per 1000 screens (CI: 3.95‰–7.65‰) for single reading (P = 0.76). The pooled proportion of false-positives of double reading was 47.03 per 1000 screens (CI: 39.13‰–55.62‰) and it was 40.60 per 1000 screens (CI: 38.58‰–42.67‰) for single reading (P = 0.12). One study reported, for double reading, an ICER (Incremental Cost-Effectiveness Ratio) of 16,684 Euros (24,717 US$ PPP; 2015 value) per detected cancer. Single reading + CAD (computer-aided-detection) was cost-effective in Japan.ConclusionThe evidence of benefit for double reading compared to single reading for digital mammography interpretation is scarce. Double reading seems to increase operational costs, have a not significantly higher false-positive rate, and a similar cancer detection rate.     

Neuromechanical response to passive cyclic loading of the ACL in non-professional soccer players: A pilot study

ObjectiveTo investigate the effects of passive cyclic loading (CYC) on anterior tibial translation (ATT), knee extensor and flexor muscle strength and activation in soccer players.DesignCross-sectional study.Setting: Functional Assessment Laboratory; Participants: Eight healthy competitive soccer players.Interventions: The knee of the dominant limb was subjected to 10 min of CYC at 200 N force.Main outcomes measuresATT was measured before and after CYC. Percentage of variation was used to estimate ACL creep. Knee extension and flexion maximal voluntary contractions (MVCs) were assessed both before and after CYC. EMG amplitudes of both Biceps Femoris (BF) and Vastus Lateralis (VL) were recorded during both MVCs and CYC.ResultsThere was a 20.7% increase in ATT after CYC application (p<0.001). Post-CYC agonist and antagonist BF activations were 37.7% and 18.4% lower than pre-CYC ones during MVCs (p<0.05). BF EMG activity in the last 30s of CYC was 19.9% higher than in the first 30s (p<0.05).ConclusionThe increased ATT and the variations in neuromuscular activation of the BF in response to loading may expose the knee at higher injury risk by increasing joint instability. Further studies are required to thoroughly investigate these aspects in both laboratory and real-field settings.     

The concurrent validity and intrarater reliability of a hand-held dynamometer for the assessment of neck strength in semi-professional rugby union players

ObjectivesThe main objective of this study was to determine the concurrent validity between a hand-held (HHD) and mounted hand-held dynamometer (MHHD) for assessing isometric neck strength.DesignObservational design.SettingSemiprofessional rugby club.ParticipantsNineteen semi-professional rugby players (age = 26 ± 5 years, stature = 186.5 ± 6.5 cm, body mass = 98.7 ± 12.8 kg).Main outcome measuresConcurrent validity (limits of agreement, correlation) between HHD and MHHD, the intrarater reliability (intra-class correlation, ICC) and comparison between playing positions.ResultsAbsolute peak and mean peak force were systematically lower when using the HHD compared to MHHD, with the mean bias ranging from −1.8 to −3.8 kgf (P < 0.05). Differences were not evident for flexion when applying the correction equations (−0.5 to 2.1 kgf, P > 0.05) but remained for extension. Correlations between methods were large-to-very large; the ICCs for both methods were good (ICC = 0.72–0.89), with no difference between positions (P < 0.05).ConclusionThe concurrent validity of HHD was considered acceptable when compared to the MHHD and the correction equation applied. Both methods are reliable and useful for assessing neck strength in rugby players, though, caution is needed when determining strength during neck extension.