Jeffrey B. Taylor

Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis

BACKGROUND CONTEXT Great effort has been made toward limiting low back pain (LBP). Recent focus has included factors involved with secondary and tertiary prevention, with less attention given to primary prevention. PURPOSE This review provided a current estimate of the incidence of LBP and risk factors associated with either first-time LBP or transition to LBP from a baseline of a pain-free state. STUDY DESIGN A systematic review and meta-analyses were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT SAMPLE Studies included subjects aged 18 years or older, from longitudinal, observational, cohort designs that included baseline risk factors to an outcome of either first-time LBP or transition to LBP from a baseline of a pain-free state. OUTCOME MEASURES Risk factors and incidence rates were reported using descriptive analysis and the PRISMA guidelines. METHODS Electronic search strategies in PubMed, CINAHL/SPORTDiscus, and Cochrane Central Register of Controlled Trials were combined with a hand search to identify articles for inclusion. Studies were classified based on the population studied (community vs. occupational based) and type of LBP outcome (first ever vs. transition from a baseline pain-free state). RESULTS A total of 41 studies were included for review. Meta-analytical incidence rates for first-time LBP and transition to pain from a pain-free state were similar (∼25%), regardless of community or occupational populations. Risk factors for first-time LBP or transition to LBP from a baseline of a pain-free state were psychosocial and physically related. No consistent risk factor emerged as predictive of first-time LBP, although prior LBP was a consistent predictor of future incident LBP. Significant heterogeneity was found across studies in most models, which limits these findings. CONCLUSIONS The results of this study suggest that incidence of LBP is similar in community and occupational settings regardless of LBP definition. There were multiple diverse physical and psychosocial risk factors for first-time LBP. A history of LBP was the most consistent risk factor for transition to LBP from a baseline of a pain-free state.

Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis

Background Anterior cruciate ligament (ACL) injury prevention programmes have shown mixed results, which may be due to differing emphasis on training components. The purpose of this study was to (1) quantify the overall and relative duration of each training component encompassed within these programmes and (2) examine the effect of these durations on ACL injury rates. Methods A systematic review was completed and meta-analyses performed on eligible studies to produce a pooled OR estimate of the effectiveness of these programmes. Meta-regression was used to detect any relationship that programme duration and the duration of individual training components had on ACL injury rates. Results 13 studies were included for review. Results of the meta-analyses revealed a significant reduction of injuries after preventative training programmes for all ACL injuries (pooled OR estimate of 0.612, 95% CI 0.44 to 0.85; p=0.004) and for non-contact ACL injuries (OR 0.351, 95% CI 0.23 to 0.54; p<0.001). Results of meta-regression analysis revealed that a greater duration of balance training was associated with a higher injury risk for ACL injury (p=0.04), while greater durations of static stretching was associated with a lower injury risk for non-contact ACL injuries (p=0.04). Conclusions While ACL prevention programmes are successful in reducing the risk of ACL injury, the ideal combination and emphasis of training components within these programmes remains unclear. Evidence indicates that greater emphases on balance training and static stretching may be associated with an increase and decrease in injury risk, respectively.

Risk factors for first time incidence sciatica: a systematic review.

BACKGROUND AND PURPOSE Characteristically, sciatica involves radiating leg pain that follows a dermatomal pattern along the distribution of the sciatic nerve. To our knowledge, there are no studies that have investigated risk factors associated with first time incidence sciatica. The purpose of the systematic review was to identify the longitudinal risk factors associated with first time incidence sciatica and to report incidence rates for the condition. For the purposes of this review, first time incidence sciatica was defined as either of the following: 1) no prior history of sciatica or 2) transition from a pain-free state to sciatica. Studies included subjects of any age from longitudinal, observational, cohort designs. METHODS The study was a systematic review. Eight of the 239 articles identified by electronic search strategies met the inclusion criteria. RESULTS Risk factors and their respective effect estimates were reported using descriptive analysis and the preferred reporting items for systematic reviews and meta-analyses guidelines. Modifiable risk factors included smoking, obesity, occupational factors and health status. Non-modifiable factors included age, gender and social class. Incidence rates varied among the included studies, in part reflecting the variability in the operationalized definition of sciatica but ranged from <1% to 37%. DISCUSSION A majority of the identified risk factors associated with first time sciatica are modifiable, suggesting the potential benefits of primary prevention. In addition, those risk factors are also associated with unhealthy lifestyles, which may function concomitantly toward the development of sciatica. Sciatica as a diagnosis is inconsistently defined among studies.

Prevention of Lower Extremity Injuries in Basketball: A Systematic Review and Meta-Analysis

Context: Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. Objective: To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. Data Sources: PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015. Study Selection: Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture). Results: Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P < 0.001) and ankle sprains (OR, 0.45; 95% CI, 0.29-0.69; P < 0.001), yet not ACL ruptures (OR, 1.09; 95% CI, 0.36-3.29; P = 0.87) in basketball athletes. Conclusion: In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries.

An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus

Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.

Biomechanical Comparison of Single- and Double-Leg Jump Landings in the Sagittal and Frontal Plane

Background: Double-leg forward or drop-jump landing activities are typically used to screen for high-risk movement strategies and to determine the success of neuromuscular injury prevention programs. However, research suggests that these tasks that occur primarily in the sagittal plane may not adequately represent the lower extremity biomechanics that occur during unilateral foot contact or non–sagittal plane movements that are characteristic of many multidirectional sports. Purpose: To examine the extent to which lower extremity biomechanics measured during a jump landing on a double leg (DL) after a sagittal plane (SAG) movement is representative of biomechanics measured during single-leg (SL) or frontal plane (FRONT) jump landing tasks. Study Design: Controlled laboratory study. Methods: Lower extremity biomechanics were measured in 15 recreationally active females (mean age [±SD], 19.4 ± 2.1 years; mean height, 163.3 ± 5.9 cm; mean weight, 61.1 ± 7.1 kg) while performing SAGDL, SAGSL, FRONTDL, and FRONTSL jump landing tasks. Repeated-measures analyses of variance examined differences in lower extremity biomechanics between the 4 tasks, and linear regressions examined the extent to which an individual’s biomechanics during SAGDL were representative of their biomechanics during SAGSL, FRONTDL, and FRONTSL. Results: Lower extremity kinematics and kinetics differed by condition, with the SAGDL task generally eliciting greater hip and knee flexion angles and lower hip and knee forces than the other tasks (P < .05). Although biomechanics during the SAGDL task were strongly associated with those during the FRONTDL task (R 2, 0.41-0.82), weaker associations were observed between SAGDL and single-leg tasks for hip kinematics (R 2, 0.03-0.25) and kinetics (R 2, 0.05-0.20) and knee abduction moments (R 2, 0.06-0.18) (P < .05). Conclusion: Standard double-leg sagittal plane jump landing tasks used to screen for ACL injury risk and the effectiveness of ACL injury prevention programs may not adequately represent the lower extremity biomechanics that occur during single-leg activities. Clinical Relevance: These results support further investigation of single-leg multidirectional landings to identify high-risk movement strategies in female athletes playing multidirectional sports.

Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis

Background Stress fractures are common overuse injuries with up to 95% occurring in the lower extremities. Among runners, stress fractures account for 15–20% of all musculoskeletal injuries. Purpose We systematically reviewed and critiqued the evidence regarding risk factors associated with increased risk of lower extremity stress fractures in runners. Study design Systematic review. Methods A systematic, computerised literature search of Medline, Embase, PubMed, SPORTDiscus, and CINAHL databases (from database inception through 9 January 2014) using keywords related to risk factors and stress fractures. This systematic review with meta-analysis utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the search and reporting phases of the study. Inverse variance meta-analyses, using a random effects model were used to summarise ORs. Results 8 articles met the inclusion criteria; 7 were considered low risk. 4 articles qualified for meta-analysis. Results of the meta-analysis identified previous history of stress fracture and female sex as the primary risk factors for future stress fracture with a pooled OR of 4.99 (95% CI 2.91 to 8.56; p<0.001; I2=0%) and 2.31 (95% CI 1.24 to 4.29; p<0.01; I2=0%), respectively. Conclusions Currently, only previous history of stress fracture and female sex are risk factors for lower extremity stress fractures strongly supported by the data.

Non-operative management of femoroacetabular impingement: A prospective, randomized controlled clinical trial pilot study

OBJECTIVES To determine the efficacy of physical therapy on pain and physical function in patients with femoroacetabular impingement. DESIGN Randomized, participant- and assessor blinded controlled trial pilot study. METHODS This trial was registered at ClinicalTrials.gov (NCT01814124) and reported according to Consolidated Standards of Reporting Trials (CONSORT) requirements. Patients were randomly assigned to receive either a combination of manual therapy and supervised exercise (MTEX), plus advice and home exercise or advice and home exercise alone (Ad+HEP) over six weeks. Primary outcomes were average pain (Visual Analog Scale) and physical function (Hip Outcome Score) at week seven. RESULTS Fifteen patients, mean age 33.7 (SD 9.5, 73% female) satisfied the eligibility criteria and completed week seven measurements. The between group differences for changes in pain or physical function were not significant. Both groups showed statistically significant improvements in pain: the MTEX group improved a mean of 17.6mm and the Ad+HEP group, 18.0mm. CONCLUSIONS The results of this pilot study provide preliminary evidence that symptomatic femoroacetabular impingement may be amenable to conservative treatment strategies however further full-scale randomized controlled trials are required to demonstrate this. In this small pilot study, supervised manual therapy and exercise did not result in greater improvement in pain or function compared to advice and home exercise in patients with symptomatic femoroacetabular impingement.

Association of Lower Quarter Y-Balance Test with lower extremity injury in NCAA Division 1 athletes: an independent validation study ☆

OBJECTIVES To determine if the Lower Quarter Y-Balance Test (LQYBT) is predictive of lower extremity injury in NCAA Division 1 athletes. DESIGN Prospective cohort, therapy. PARTICIPANTS One hundred eighty-nine NCAA Division 1 athletes participated in the study and underwent a preparticipation screen that included the LQYBT. Maximal reach distances were recorded in each direction and normalized to leg length. A composite score was calculated by summing the three normalized reach distances and dividing by three times leg length. Side to side asymmetry was calculated as the lesser of the two composite scores, divided by the greater of the two composite scores, multiplied by 100. Injuries for the following season were tracked and recorded; LQYBT scores were compared between injured and non-injured athletes. RESULTS In our sample, 90 [59 female, 31 male] of the 189 athletes participating suffered a lower extremity injury. No significant differences were found between injured and non-injured athletes for reach distance, normalized reach distance, normalized composite reach distance, or normalized composite percent score (P>0.05). CONCLUSIONS The LQYBT does not appear to predict general lower extremity injury in a diverse population of NCAA D1 athletes. These results are in direct conflict with previous findings suggesting the LQYBT is predictive of injury suggesting its utility as an injury risk screening tool in a general collegiate athletic population should continue to be questioned.

Potential limitations of the functional movement screen: a clinical commentary

Athletic injury and its sequelae remain a primary concern of sports professionals globally. As a result, screening athletes to predict injury is of great interest, especially if the screening/testing procedure is non-invasive, effective, and efficient. One such procedure of increasing popularity is the functional movement screen (FMS), which, in 2007, was reported to predict injury in American football players in a single season.1 The FMS attempts to identify fundamental movement patterns that simultaneously measure range of motion, stability, and balance1 and shows moderate evidence for acceptable reliability when deriving a composite score.2 The FMS attempts to take a comprehensive approach to assess human movement and encourages clinicians to look beyond impairments and isolated single joint motion and explore more comprehensive movement patterns representative of those used in daily activities and sport. Considering the growing popularity of the FMS both clinically and in research literature, its merits warrant closer analysis. A composite score of ≤14 on the FMS is commonly …