In this article Brian Schiff explains some of the criteria he uses to test his athletes before releasing them back to the field following an ACL reconstruction. While he presents a unique school of thought, he uses research articles to back up why he implements specific tests. Included in this post is a video of the single leg broad jumps, triple hop, cross-over hop, and 6 M timed hop test. If you are interested in getting a different perspective on return to play criteria for ACL athletes, this article is a great read. What are some of the return to play criteria you use to determine if an athlete is ready?
How many of your clients have decreased flexibility in their lower extremities? Probably most of them! As astute practitioners, we all know that statically stretching a muscle is no longer the gold standard for increasing muscle flexibility. This post from The Sports Physiotherapist discusses the benefits of including eccentric based exercises to help increase muscle flexibility.
The study they conducted analyzed 6 articles on eccentric training of the quadriceps, hamstrings, and gastroc-soleus. Each of the 6 articles showed improvements in range of motion or muscle fascicle length. While these articles used healthy subjects, it is definately something think about when trying to increase muscle flexibility with your clients.
With the prevalence of concussion's occurring in sports right now we must keep up with the latest evidence on concussion management. Unfortunately, there is still no clear cut evidence on exact return to play criteria in concussions. Today's article focuses on the SCAT 2 assessment tool. This article aimed to find baseline scores for the SCAT 2 in high school athletes. Although the conclusion was not final, what we can take away from this article is that with a baseline score on the SCAT 2 before season, we can determine discrepancies when assessing an athlete during a game for concussion.
The SCAT 2 supersedes the original SCAT from 2005 and is used in athletes aged 10 and older. The test involves a symptom questionnaire, glascow coma scale, maddocks sideline assessment, coordination, balance, and cognition scores. The total score is out of 100 and again although no cut-off scores have been established yet, if a pre-season baseline is taken then it is a useful tool. The SCAT 2 is endorsed by the IOC, IRB, IIHF, and FIFA.
There is a download of the assessment tool online if you simply type in: SCAT 2 assessment tool. Additionally, there is a FREE I-phone app that you can use which is nice because it adds up the scores for you. Anyone performing sideline coverage will find this a useful app to have in their toolboxes, as many athletic trainers use it.
Which Screening Tools Can Predict Injury to the Lower Extremities in Team Sports? A Systematic Review
This systematic review helps explain some of the evidence behind lower extremity tools that can predict injuries in the athletic population. Injury prevention is a hot topic in sports. With tools like FMS becoming popular it is important for physical therapists to understand which tools provide the best evidence for future injury. This review broke down the lower extremity into multiple muscular and ligamentous injuries: ACL, knee injuries, hamstring strains, groin injuries, and ankle sprains.
The authors found that for ACL-injured athletes, there was a knee abduction moment 2.5x greater during the drop vertical jump. Furthermore, knee abduction moments predisposed the occurrence of an ACL injury with 73% specificity and 78% sensitivity. When predictive tools for knee injury were reviewed, the authors were unable to find any measured factors that could predict acute knee injuries.
Predictive tools for hamstring strains were less conclusive. The authors noted that while a decrease in flexibility of the hamstrings was predictive for football players older than age 23, flexibility of the hamstrings in soccer players was not significant. However, the hamstring to quadriceps ratio was a significant predictive factor for hamstring strains in football players.
Additionally, groin injuries were analyzed in soccer, football, and hockey players. It was found that hip adduction to hip abduction strength ratio was a significant predictive tool for a future adductor strain when hip adduction is less that 80% of hip abductor strength. Additionally, a decreased ROM of hip abduction for groin strains was found to be significant.
Ankle sprain predictive tools were conflicting and the authors described BMI, age, and postural sway as predictors for future ankle sprains in athletes.
What is important to consider from this systematic review is that these tools only scratch the surface of predicting lower extremity injuries in athletes. Considering the athlete's full history, specific sport, and current level of conditioning is necessary whenever assessing injury risk.
For those of you who have performed pre-participation screenings or have seen screenings done, which tools do you use and/or find beneficial? What are your thoughts on FMS in comparison?