A Refined Prediction Model for Core and Lower Extremity Sprains and Strains Among Collegiate Football Players
Wilkerson GB, and Colston MA. Journal of Athletic Training. 2015; E pub ahead of print. April 6, 2015.
Take Home Message: A college football player was 5.3 times more likely to have an injury during a season if he was a starter, had poor core endurance, and reported more low back disability. Assessing for these things during your preseason screening can help identify at-risk individuals who may benefit from injury prevention programs.
Many football players experience a lower extremity injury that results in significant time lost. Injury prevention programs that are designed to address modifiable risk factors that predict injury in football and targeted to individuals that may be at a higher risk within the population have the potential to make a significant impact. The purpose of this study was to refine a clinical prediction model over the course of 3 seasons in efforts to better determine at-risk collegiate football individuals. Preseason evaluations were conducted at the beginning of 3 separate seasons among 152 NCAA Division I football athletes. Preseason evaluations consisted of core endurance tests (i.e., wall-sit hold, trunk-flexion hold, back-extension hold), surveys (i.e., Oswestry Disability Index, International Knee Documentation Committee Subjective Knee Form, sports component of Foot and Ankle Ability Measure), and body mass index. Core endurance tests were slightly modified over the course of the 3 preseason evaluations. Game/practice exposure information and injury incidence rates were collected throughout the ensuing season. An injury was defined as any acute core or lower extremity sprain/strain that was treated by an athletic trainer and required limited football participation for at least 1 day. Over the 17,208 player-exposures 82 athletes suffered 132 core or lower extremity sprains or strains. The authors found that a player was 5.3 times more likely to have an injury in a season if they had 2 of the 3 predictor risk factors: starter in 1 or more games, Oswestry Disability Index (low back disability) score ≥ 4, and poor wall-sit hold performance. Having 2 or more risk factors resulted in a 56% sensitivity and an 80% specificity.
The prediction model in this study identified 2 modifiable risk factors that are easy to assess and show relatively good screening capabilities at preseason; particularly if you know the player will start in at least one game that season. It may be helpful to determine if these findings are generalizable to other teams (college/university or high school) since most teams follow slightly different strength and conditioning training programs. It makes sense that injury rates may be higher among game starters because they may be put at risk more than nonstarters but we cannot control this as clinicians. Knowing that these individuals are already at an increased risk is something that we should be aware of. Intervention efforts targeted towards improving or addressing the low back disability that exists at preseason as well as the poor performance on a wall-sit hold may prove to be instrumental in our overall prevention efforts. If you identify that an athlete has 2 of these 3 risk factors, it may be important to immediately institute a program to try to intervene. Preseason screenings are relatively common; however, they rarely include a core endurance challenge or patient-reported outcome instruments. With minimal resource and time commitment, preseason screenings can become more informative in the athletic populations if they incorporate patient-reported and functional assessments. Once a clinician identifies high-risk athletes it may be helpful to develop a preventive treatment plan.
Questions for Discussion: Are there other things that you include in your preseason screenings? Do you think that prevention programs would be effective if introduced at preseason?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban