Sports Medicine Research: In the Lab & In the Field: Retention of Movement Pattern Changes After a Lower Extremity Injury Prevention Program Is Affected by Program Duration (Sports Med Res)
Monday, February 13, 2012

Retention of Movement Pattern Changes After a Lower Extremity Injury Prevention Program Is Affected by Program Duration

Retention of Movement Pattern Changes After a Lower Extremity Injury Prevention Program Is Affected by Program Duration

Padua DA, Distefano LJ, Marshall SW, Beutler AI, de la Motte SJ, Distefano MJ . Am J Sports Med. 2012; 40(2):300-306.

Over the past few years, we’ve seen a growing body of evidence that lower extremity injury prevention programs can alter movement patterns and reduce the risk of knee injuries. Unfortunately, it remains unknown how long the altered movement patterns are maintained after discontinuing training? Therefore, Padua et al compared the retention of altered movement patterns between a short-duration (3 months) and extended-duration injury prevention program completed by youth soccer athletes (aged 11 to 17 years). Initially, a total of 140 athletes completed a generalized (one-size-fits-all) or a customized injury prevention program that was incorporated into a team’s warm-up routine. This study focused on the 84 (60%) athletes that showed improved movement patterns, based on Landing Error Scoring System (LESS) scores, immediately after completing the injury prevention program. The 84 athletes included: 33 out of 56 athletes in the generalized program (11 athletes in generalized short-duration, 22 athletes in generalized long-duration programs) and 51 out of 84 athletes in the customized program (22 athletes in customized short-duration, 29 in customized long-duration programs). Movement patterns were assessed with LESS by blinded investigators (they didn’t know what program the athlete performed) at baseline (pre-training), immediately after the injury prevention program, and 3 months after the program was completed (during off season). While athletes in the short-duration and extend-duration had improved LESS scores (movement patterns) immediately after the injury prevention program only the extended-duration group maintained their improved LESS scores 3 months after stopping the program. In contrast, the short-duration group had similar values at 3 months after stopping the program and pre-training.

This study is important because it demonstrates that training duration may be an important factor that needs to be considered when designing, implementing, and assessing an injury prevention program. It will be interesting to see similar research among different age groups (e.g., college athletes) and to get a better sense of how long does retention of altered movement patterns last after short-duration or long-duration injury prevention programs. Studies in this area will help us determine if injury prevention programs need to be incorporated into team warm-ups every year or if an extended-duration program alone will result in permanent changes in the athletes’ movement patterns. This study may also raise an important question about how we rehabilitate our injuries: If short-term training (3 months or less) only have transient influences on movement patterns, and if this hold true for other joints or injuries, then is our 4 to 12 week rehab program for scapular dyskinesis or patellofemoral pain sufficient to prevent recurrence of symptoms/reinjury? Many of our rehab programs focus on neuromuscular retraining but are the outcomes we’re generating only transient? If so, we’ll need to rethink how we manage our patients when they return to play or are discharged from the clinic. This study begins to answer an important question regarding injury prevention but may also open another series of questions about injury rehabilitation. Have you noticed patients that come back later and don’t have the movement patterns you’ve taught them?

Written by: Jeffrey Driban
Reviewed by: Stephen Thomas

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Padua DA, Distefano LJ, Marshall SW, Beutler AI, de la Motte SJ, & Distefano MJ (2012). Retention of movement pattern changes after a lower extremity injury prevention program is affected by program duration. The American Journal of Sports Medicine, 40 (2), 300-6 PMID: 22064608

2 comments:

Anonymous said...

I thank Padua et al for opening the door to research in this area, it is much needed and this is a fantastic starting point. The authors bring up a good point in referencing injuries such as patellofemoral pain syndrome and scapular dyskinesis and the typical duration of rehab for these injuries. In my experience working in a physical therapy clinic and on the field as an ATC, I have seen many cases of chronic recurrent patellofemoral pain syndrome. I do believe that these patients have this chronic recurrent condition because the effects of their short rehab stint are so transient and many of these patients believe that since their pain is gone, they no longer have to perform the exercises we have taught them. I think that as more research becomes available on the duration of rehabilitation or preventative programs and how long their training effects last post completion, we can provide better care for our patients in the long term.

Jeffrey Driban said...

I think the previous comment brings up some interesting points. Firstly, "because the effects of their short rehab stint are so transient": It seems to be true but we need more evidence to support the idea that more rehab sessions are needed, particularly for clinicians that are working with insurance companies. We need to provide evidence to the insurance companies that more rehab sessions today could save them money down the road (injury prevention) and that the extra sessions are not a waste of time, money, or resources. Secondly, "many of these patients believe that since their pain is gone, they no longer have to perform the exercises we have taught them": This can be helped by providing more supervised sessions but we also need to find better ways to educate the patient about the importance of performing their exercises even when pain free. To some degree you must wonder if we need to shift to a behavior modification approach where we work with patients to understand that from here on out they are going to need to keep up with their exercises to reduce the risk of reinjury or joint degeneration in the long-term.

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