Sports Medicine Research: In the Lab & In the Field: 2 Out of 3 Is Bad: Starter, Disability, and Poor Core Endurance (Sports Med Res)
Wednesday, May 27, 2015

2 Out of 3 Is Bad: Starter, Disability, and Poor Core Endurance

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

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Wilkerson, G., & Colston, M. (2015). A Refined Prediction Model for Core and Lower Extremity Sprains and Strains Among Collegiate Football Players Journal of Athletic Training DOI: 10.4085/1062-6050-50.2.04

4 comments:

Candace Bernitt said...

I think it is often assumed that the primary consequence of a weak core is the development of low back pain. It seems to be frequently overlooked that a dysfunctional core can contribute to the incidence of extremity injuries as well. Therefore, the assessment of core function is essential when evaluating an injured athlete. Personally, when I manage a lower extremity injury, my first thought is probably not that the athlete lacks a functional core. I think it becomes important for us as athletic trainers to consider training the core in all rehabilitation and preventative programs, as it is clearly linked to an increased risk of injury. While we may not be able to control the amount of games that an athlete starts in, we can intervene by training the core. This can lead to stronger, more functional athletes, and ultimately a lesser incidence of injury.

Nicole Cattano said...

Candace - you make a really great point and one that we can implement very easily as clinicians. How do you personally assess an athlete's functional core?

Matt Kneece said...

I would be curious if injuries per game exposure were calculated, and if so if there were different results comparing the two groups of starters and those players who come off the bench. Game exposures are likely to be more intense and cause a higher level of sport anxiety in athletes. This is not a bad thing as long as the athlete is able to control their excitation. I completely agree with Candace as well, a functional core is critical to athletic performance and reduction of injury risk.

I find it's not always applicable to use static endurance tests as a measure for core function. Core function is a combination of coordinated movements and activation patterns. Core control could be evaluated in plyometric testing and select core exercises, however few have been shown in literature to be strongly relatable to competition. Diaphragmatic breathing and the ability to brace/hollow the abdomen is huge. Increasing core function after this is demonstrated by the ability to maintain spinal neutral with movement of the extremities in increasingly difficult movements that require the coordinated movements of many joints.

Nicole Cattano said...

Matt-I think that is a great question but the data does not provide that level of detail. To take your question a step further-it may be interesting to further investigate minutes played. I would anticipate that those who play more have a greater risk of injury.

I agree that static tests may not be the best option, but what tests do you utilize?

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