Background:Field expedient screening tools that can identify individuals at an elevated risk for injury are needed to minimize time loss in American football players. Previous research has suggested that poor dynamic balance may be associated with an elevated risk for injury in athletes; however, this has yet to be examined in college football players.Hypothesis:To determine if dynamic balance deficits are associated with an elevated risk of injury in collegiate football players. It was hypothesized that football players with lower performance and increased asymmetry in dynamic balance would be at an elevated risk for sustaining a noncontact lower extremity injury.Study Design:Prospective cohort study.Methods:Fifty-nine collegiate American football players volunteered for this study. Demographic information, injury history, and dynamic balance testing performance were collected, and noncontact lower extremity injuries were recorded over the course of the season. Receiver operator characteristic curves were calculated based on performance on the Star Excursion Balance Test (SEBT), including composite score and asymmetry, to determine the population-specific risk cut-off point. Relative risk was then calculated based on these variables, as well as previous injury.Results:A cut-off point of 89.6% composite score on the SEBT optimized the sensitivity (100%) and specificity (71.7%). A college football player who scored below 89.6% was 3.5 times more likely to get injured.Conclusion:Poor performance on the SEBT may be related to an increased risk for sustaining a noncontact lower extremity injury over the course of a competitive American football season.Clinical Relevance:College football players should be screened preseason using the SEBT to identify those at an elevated risk for injury based upon dynamic balance performance to implement injury mitigation strategies to this specific subgroup of athletes.

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The purpose of this study was to determine if an off-season intervention program was effective in improving Functional Movement Screen(™) (FMS) scores in professional American football players. Pre- and post-intervention FMS scores were obtained on 62 subjects who completed a 7-week off-season intervention program. A repeated measures ANOVA was conducted to determine the effectiveness of the training program on FMS scores. A chi-square was performed to determine if there were a greater number of players who met the injury threshold and if asymmetries were reduced following intervention. Logistic regression was used to predict what factors were associated with failure (post-test score of <14). There was a positive main effect for time (P<0.01) and a greater number of individuals with a score >14 following the intervention. At post-test, 41 players were free of asymmetry as compared with 31 at the pre-test. The strongest predictor of program failure was a low squat score at pre-test. This study demonstrated that fundamental movement characteristics do change with a standardized intervention. Further research is required to determine if injury risk is reduced when a player's score improves beyond the established cut-off of 14 and/or asymmetry is resolved.

The Functional Movement Screen (FMS) is a series of 7 tests that categorize fundamental movement. Each test is scored on an ordinal scale with 4 categories. The purpose of this study was to determine the interrater reliability of the FMS. Forty healthy subjects were videotaped while performing the FMS. The videos were independently scored by 4 raters, including 2 experts who instruct FMS training courses and 2 novices who completed a standardized training course on the FMS. Interrater reliability was analyzed using the weighted kappa statistic. The novice raters demonstrated excellent or substantial agreement on 14 of the 17 tests, whereas the expert raters did the same on 13 of the 17 tests. When the novice raters were paired with the expert raters, all 17 components demonstrated excellent or substantial agreement. These data indicate that the FMS can confidently be applied by trained individuals. This would suggest that the FMS can be confidently used to assess the movement patterns of athletes and to make decisions related to interventions for performance enhancement, and the FMS may assist in identifying athletes at risk for injury.

The results of this study suggest that fundamental movement patterns and pattern asymmetry are identifiable risk factors for time-loss injury during the preseason in professional football players.

Dynamic balance performance varied with competition level. This may indicate that athletes' movement strategies may be different depending on the competition level and that normative values may need to be established for each competition level.

ObjectivesChronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non‐specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF).MethodsThis review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP.ResultsImaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition.ConclusionsTargeting MF control with restorative neurostimulation promises a new treatment option.

T he role of muscles in joint protection and stabilization has been of increasing interest to researchers and clinicians involved in spinal pain and rehabilitation. Evidence for the importance of deep posterior muscles of the spine in the management of people with low back pain (LBP) has been provided by biomechanical 7,60,80,82 and neurophysiological 46,48 investigations. Imaging studies have further allowed definition of both normal morphology and impairments in paraspinal muscles. 22,27,32,33 Rehabilitative ultrasound imaging (RUSI) is a potentially useful tool in physical therapy for the assessment and treatment of these muscles. The advantages of RUSI over other imaging techniques have been discussed in a recently published related cles can be incorporated into neuromusculoskeletal rehabilitation. The main applications of RUSI for measurement of morphological characteristics (morphometry) and visualization of muscle contraction for biofeedback are discussed. The lumbar multifidus is the most widely studied paraspinal muscle, in both healthy populations 68 and people with spinal pain and injury. 22,26,27 Studies of different cervical muscles are also emerging. 37,39,[61][62][63] In the thoracic region, the lower trapezius is the first muscle to be measured with ultrasound imaging. 53Quantitative evaluation of the posterior paraspinal musculature using static and dynamic imaging has been used to study muscle morphology and behavior during contraction. 34,39,64,74,76 In this context, behavior relates to level of contraction (change in thickness), changes in size over time and with respect to other muscles, as well as observation of contraction as a biofeedback tool for the patient or therapist. In this commentary we review what is known about RUSI as applied to the paraspinal musculature, propose guidelines for standardizing the imaging and measurement techniques in clinical and research applications, and propose future directions for research. SYNOPSIS:Interest in rehabilitative ultrasound imaging (RUSI) of the posterior paraspinal muscles is growing, along with the body of literature to support integration of this technique into routine physical therapy practice. This clinical commentary reviews how RUSI can be used as an evaluative and treatment tool and proposes guidelines for its use for the posterior muscles of the lumbar and cervical regions. Both quantitative and qualitative applications are described, as well as measurement reliability and validity. Measurement of morphological characteristics of the muscles (morphometry) in healthy populations and people with spinal pathology are described. Preliminary normal reference data exist for measurements of cross-sectional area (CSA), linear dimensions (muscle depth/thickness and width), and shape ratios. Compared to individuals without low back pain, changes in muscles' size at rest and during the contracted state have been observed using RUSI in people with spinal pathology. Visual observation of the image during contraction indicates that RUSI may be a va...