Sports Medicine Research: In the Lab & In the Field: A Call for High Quality Evidence Linking Movement Screenings to Injury Risk (Sports Med Res)


Wednesday, January 11, 2017

A Call for High Quality Evidence Linking Movement Screenings to Injury Risk

Predicting sport and occupational lower extremity injury risk through movement quality screening: A systematic review

Whittaker JL, Booysen N, de la Motte S, Dennet L, Lewis CL, Wilson D, McKay C, Warner M, Padua D, Emery CA, Stokes M. Br J Sports Med. December 2016; [Epub ahead of print]

Take Home Message: There is limited evidence that poor movement quality is associated with a greater risk of lower extremity injury in athletic and military/first-responder populations.

Prevention strategies to reduce short- and long-term effects of lower extremity musculoskeletal (MSK) conditions must include purposeful selection of risk factors and evaluation of interventions to ensure effectiveness. While movement quality screenings offer several advantages (e.g., mass administration, cost-effectiveness, adaptability) it is unclear whether poor movement quality is associated with greater risk of lower extremity injury. The authors executed a systematic review to identify whether screening movement quality can predict lower extremity MSK injury in athletic and military/first-responder populations. Following PRISMA guidelines, the authors performed targeted keyword search in 5 databases: MEDLINE, EMBASE, CINAHL, Sport Discus, and SCOPUS. Inclusion criteria included prospective study design to identify a relationship between a movement quality outcome (rating of functional compensation, asymmetry, or impairment of movement) and lower extremity MSK injury (hip and below). The authors identified 17 articles that met the inclusion criteria. Based on the CEBM scale, most studies were classified as low-quality (level 4). Common risk factors reported included age, Functional Movement Screen (FMS) scores (total, ≤14, ≤ 12, hurdle step, in-line lunge, deep squat), and Landing Error Scoring System (LESS) scores (total, ≤5). The authors concluded that evidence supporting poor movement quality as a predictor of lower extremity MSK risk in athletic and military/first-responder populations is low-level with inconsistent methodological quality. These findings limit the use of movement quality outcomes.

Successful prevention strategies may reduce healthcare costs and time loss from activity due to injury, particularly in young athletes. While movement screening tools are tempting to utilize to drive prevention program implementation, particularly from a cost- and time-efficiency perspective, the authors are clear that higher quality evidence must be established in future work to ensure selection of appropriate movement screening tools and to establish relationships with lower extremity MSK risk. These screens can be effective for identifying those in need of specific improvements to range of motion, strength, balance, etc. However, clinicians should exercise caution when basing the decision to implement a prevention program to reduce lower extremity MSK risk on information gathered via mass administration of a movement screening tool in athletes and military/first-responder personnel. Finally, prevention programs must be prospectively evaluated for their ability to reduce injury risk in specific populations in which they are implemented, effectively closing the evidence-based feedback loop for the clinician.

Questions for Discussion: How are you generating prevention programs in your setting? Are you incorporating movement quality, in addition to other risk factors, to target individuals vulnerable to lower extremity injury?

Written By:  Laura McDonald
Reviewed by: Jeffrey Driban

Related Posts:
Minding the Gap: Connecting Pre-season Screenings with Prospective Injury Data

Whittaker JL, Booysen N, de la Motte S, Dennett L, Lewis CL, Wilson D, McKay C, Warner M, Padua D, Emery CA, & Stokes M (2016). Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review. British journal of sports medicine PMID: 27935483


Alexandra DeJong said...

I think this systematic review raises many important points about screening tools from an Athletic Training standpoint. The battery of tests explored in the articles of this meta-analysis were not found to be particularly sensitive to injury, however it is hard to extrapolate this information to clinical practice. Although the article stated that studies were summarized in an appendix, this was not readily available in the PDF on PubMed. It is hard to appreciate what kind of athletes were included, and break down how sensitive the tests were for respective sports and gender. I think as clinicians it is important to consider what the movement screens are assessing and if the movements are even necessarily performed in the given sports. I think individualizing functional movement screens for sport would be an interesting concept for increased sensitivity to injury risk, though more difficult to perform as a mass screening option.

Jeffrey Driban said...

Hi Alexandra: The appendices are available on the journal's website. The sports included pro basketball, high school sports, military soldiers, firefighter trainees, NCAA D2 sports, junior hocket, NCAA D1 sports, track and field, pro American Football, coast guard cadets, marine corps officer trainees, elite youth soccer, and university athletes (incl rec).
Great points about individualized screening. Thanks!

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