FAI is associated with impaired balance. Due to the relatively large effect sizes and simplicity of use of time in balance and foot lifts, we recommend that further research should establish their clinical validity and clinical cutoff scores.

Musculoskeletal injuries during military and sport-related training are common, costly and potentially debilitating. Thus, there is a great need to develop and implement evidence-based injury prevention strategies to reduce the burden of musculoskeletal injury. The lack of attention to implementation issues is a major factor limiting the ability to successfully reduce musculoskeletal injury rates using evidence-based injury prevention programs. We propose 7 steps that can be used to facilitate successful design and implementation of evidence-based injury prevention programs within the logical constraints of a real-world setting by identifying implementation barriers and associated solutions. Incorporating these 7 steps along with other models for behavioral health interventions may improve the overall efficacy of military and sport-related injury prevention programs.

Background Identification of risk factors for lower extremity (LE) injury in sport and military/first-responder occupations is required to inform injury prevention strategies. Objective To determine if poor movement quality is associated with LE injury in sport and military/first-responder occupations. Material and methods Five electronic databases were systematically searched. Studies selected included: original data; analytic design; movement quality outcome (qualitative rating of functional compensation, asymmetry, impairment or efficiency of movement control); LE injury sustained with sport or military/first-responder occupation. The PRISMA guidelines were followed. Two independent authors assessed the quality [Downs and Black (DB) criteria] and level of evidence (Oxford Centre of Evidence-Based Medicine model). Results Of 4361 potential studies, 17 were included. The majority were low quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3–15). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen was the most common outcome investigated (15/17 studies). Four studies considered interrelationships between risk factors, seven reported diagnostic accuracy and none tested an intervention program targeting individuals identified as high-risk. There is inconsistent evidence that poor movement quality is associated with increased risk of LE injury in sport and military/first-responder occupations. Conclusions Future research should focus on high quality cohort studies to identify the most relevant movement quality outcomes for predicting injury risk followed by developing and evaluating pre-participation screening and LE injury prevention programs through high quality randomized controlled trials targeting individuals at greater risk of injury based upon screening tests with validated test properties.

Objectives:Lower-extremity stress fracture injuries are a major cause of morbidity in physically active populations. The ability to efficiently screen for modifiable risk factors associated with injury is critical in developing and implementing effective injury prevention programs. The purpose of this study was to determine if baseline Landing Error Scoring System (LESS) scores were associated with the incidence rate of lower-extremity stress fracture during four years of follow-up.Methods:To accomplish this objective we conducted a prospective cohort study at a US Service Academy. A total of 1772 eligible subjects with complete baseline data and no history of lower-extremity stress fracture were included in this study. At baseline we conducted motion analysis during a jump landing task using the LESS. Incident lower-extremity stress fracture cases were identified during the four year follow-up period using the injury surveillance systems at our institution. The primary outcome of interest was the incidence rate of lower-extremity stress fracture during follow-up. The electronic medical records of each potential incident case were reviewed and case status was determined by an adjudication committee consisting of two sports medicine fellowship-trained orthopaedic surgeons who were blinded to baseline LESS data. The association between baseline LESS scores and the incidence rate of lower-extremity stress fracture was examined for total LESS score and for each individual LESS item. Univariate and multivariable Poisson regression models were used to estimate the association between baseline LESS scores and the incidence rate of lower-extremity stress fracture during follow-up.Results:During the follow-up period, 94 incident lower-extremity stress fractures were documented in the study cohort and the cumulative incidence of stress fracture was 5.3% (95%CI: 4.3%, 6.5%). In univariate analyses total LESS score at baseline was associated with the incidence rate of lower-extremity stress fracture during follow-up. For every additional movement error documented at baseline there was a 15% increase in the incidence rate of lower-extremity stress fracture during follow-up (IRR=1.15; 95%CI: 1.02, 1.31, p=0.025). Based on univariate analyses, several individual LESS items at baseline were also associated with the incidence rate of stress fracture during follow-up. Ankle flexion at initial contact (p=0.055), stance width at initial contact (p=0.026), asymmetrical landing at initial contact (p=0.003), trunk flexion at initial contact (p=0.036), and overall impression (p=0.021) were significantly associated with the incidence rate of stress fracture. In multivariable analyses controlling for sex and year of entry into the cohort, subjects who consistently landed flat-footed or heel-to-toe were 2.33 times (IRR=2.33; 95%CI: 1.36, 3.97, p=0.002) more likely to sustain a lower-extremity stress fracture during follow-up. Similarly, subjects who consistently demonstrated asymmetric landing at initial contact were 2.53 times (IRR=2.53; ...

Context: Functional reach on the Star Excursion BalanceTest is decreased in participants with chronic ankle instability (CAI). However, comprehensive 3-dimensional kinematics associated with these deficits have not been reported.Objective: To determine if lower extremity kinematics differed in CAI participants during anteromedial, medial, and posteromedial reach on the Star Excursion Balance Test.Design: Case-control study. Setting: Sports medicine research laboratory.Patients or Other Participants: Twenty CAI participants (age ¼ 24.15 6 3.84 years, height ¼ 168.95 6 11.57 cm, mass ¼ 68.95 6 16.29 kg) and 20 uninjured participants (age ¼ 25.65 6 5.58 years, height ¼ 170.14 6 8.75 cm, mass ¼ 69.89 6 10.51 kg) with no history of ankle sprain. We operationally defined CAI as repeated episodes of ankle ''giving way'' or ''rolling over'' or both, regardless of neuromuscular deficits or pathologic laxity. All CAI participants scored 26 on the Cumberland Ankle Instability Tool.Intervention(s): Star Excursion Balance Test reaches in the anteromedial, medial, and posteromedial directions. The CAI participants used the unstable side as the stance leg. Control participants were sex, height, mass, and side matched to the CAI group. The 3-dimensional kinematics were assessed with a motion-capture system.Main Outcome Measure(s): Group differences on normalized reach distance, trunk, pelvis, and hip-, knee-, and anklejoint angles at maximum Star Excursion Balance Test reach.Results: No reach-distance differences were detected between CAI and uninjured participants in any of the 3 reach directions. With anteromedial reach, trunk rotation (t 1,38 ¼ 3.06, P ¼ .004), pelvic rotation (t 1,38 ¼ 3.17, P ¼ .003), and hip flexion (t 1,38 ¼ 2.40, P ¼ .002) were greater in CAI participants. With medial reach, trunk flexion (t 1,38 ¼ 6.39, P ¼ .05) was greater than for uninjured participants. No differences were seen with posteromedial reach.Conclusions: We did not detect reach-distance differences in any direction. However, participants with CAI rotated the trunk and pelvis more toward the stance leg than did stable-ankle participants during anteromedial and medial reach, possibly to help maintain a proximal stable posture and compensate for distal instability. These joint-angle differences with Star Excursion Balance Test performance may represent unique compensatory patterns for those with CAI.

Few studies have investigated differences in functional movement assessment performance across scholastic levels of competition. This study examined Functional Movement Screen (FMS) performance in middle school (MS), high school (HS) and collegiate (COL) American football players and Y-Balance test (YBT) scores in MS and HS players. Functional movement measurements were collected for MS (N = 29; age = 12.8 ± 0.7 years), HS (N =52; age = 15.7 ± 1.2 years), and COL (N =77; age = 19.9 ± 1.4 years) football players prior to each group’s competitive season. Differences in composite FMS and YBT measurements were examined using Welch’s ANOVA and Mann-Whitney U-tests, respectively. Chi-square analyses examined normality of score distributions for individual FMS tests. The MS group displayed a lower composite FMS (12.9 ± 1.9) than both HS (14.0 ± 1.7) and COL (14.1 ± 2.1) groups (p = 0.019). COL players scored significantly lower on the Shoulder Mobility (SM) but higher on the Deep Squat (DS), In-line Lunge (ILL), Active Straight-Leg Raise (ASLR) and Push-Up (PU) than both HS and MS groups. No differences were found between MS and HS groups for any YBT normalized reach distances and side-to-side reach distance differences. FMS performance varied with football competition level whereas YBT performance did not. The results suggest that football competition levels normative data and injury-risk thresholds should be established when using FMS scores to guide performance and injury prevention programming.

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