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? 

---