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