Kyle Kiesel

Functional movement test scores improve following a standardized off-season intervention program in professional football players

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 players score improves beyond the established cut‐off of 14 and/or asymmetry is resolved.

Modifiable risk factors predict injuries in firefighters during training academies

OBJECTIVE To examine whether measures of physiologic function and fundamental movement are predictive of injury in firefighters during a training academy. PARTICIPANTS 108 firefighter trainees enrolled in the training academy. METHODS Baseline measures of physical performance and fundamental movement patterns were obtained in firefighters entering a training academy to determine predictors of injury. The physical performance measures were standardized tests of individual maximum performance on a set of four different total body tests and one firefighter specific performance test, the tower test. Measurements of fundamental movement patterns consisted of the seven tests of the Functional Movement Screen (FMS) along with the composite score.Performance on each of the individual tests was examined to determine if any of the variables were predictive of injury. RESULTS ROC curve analysis established that a FMS cut score of ≤ 14 was able to discriminate between those at a greater risk for injury. In addition, the deep squat and push up component of the FMS were statistically significant predictors of injury status along with the sit and reach test. CONCLUSIONS Injury in firefighters during academy can be predicted by baseline measures of musculoskeletal movement and physiology.

Biomechanical analysis of the different classifications of the Functional Movement Screen deep squat test

The purpose of this study is to examine the peak sagittal plane joint angles and joint moments of the lower extremity during the deep squat (DS) movement of the Functional Movement Screen (FMS) to assess differences between the classifications (1,2,3). Twenty-eight participants volunteered for the study and were screened to assess their FMS score on the DS task. All participants underwent a quantitative movement analysis performing the FMS DS movement at a self-selected speed. The participants in Group 3 exhibited greater dorsiflexion excursion compared to those in Group 1. Participants in Group 3 had greater peak knee flexion and knee flexion excursion than those in Group 2 who exhibited more than the participants in Group 1. Group 3 also exhibited a greater peak knee extension moment compared to Group 1. At the hip, Groups 3 and 2 exhibited greater peak hip flexion, hip flexion excursion and peak hip extension moment compared to Group 1. Thus, it appears that individuals who score differently on the deep squat as determined by the FMS exhibit differences in mechanics that may be beneficial in assessing strategies for interventions. Future research should assess how fundamental changes in mobility and stability independently affect DS performance.

Dynamic balance performance and noncontact lower extremity injury in college football players: an initial study.

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.

Field‐expedient screening and injury risk algorithm categories as predictors of noncontact lower extremity injury

In athletics, efficient screening tools are sought to curb the rising number of noncontact injuries and associated health care costs. The authors hypothesized that an injury prediction algorithm that incorporates movement screening performance, demographic information, and injury history can accurately categorize risk of noncontact lower extremity (LE) injury. One hundred eighty‐three collegiate athletes were screened during the preseason. The test scores and demographic information were entered into an injury prediction algorithm that weighted the evidence‐based risk factors. Athletes were then prospectively followed for noncontact LE injury. Subsequent analysis collapsed the groupings into two risk categories: Low (normal and slight) and High (moderate and substantial). Using these groups and noncontact LE injuries, relative risk (RR), sensitivity, specificity, and likelihood ratios were calculated. Forty‐two subjects sustained a noncontact LE injury over the course of the study. Athletes identified as High Risk (n = 63) were at a greater risk of noncontact LE injury (27/63) during the season [RR: 3.4 95% confidence interval 2.0 to 6.0]. These results suggest that an injury prediction algorithm composed of performance on efficient, low‐cost, field‐ready tests can help identify individuals at elevated risk of noncontact LE injury.

Normative Data and the Influence of Age and Gender on Power, Balance, Flexibility, and Functional Movement in Healthy Service Members

OBJECTIVES Determine the influence of age and sex and describe normative data on field expedient tests associated with power, balance, trunk stability, mobility, and functional movement in a military population. METHODS Participants (n = 247) completed a series of clinical and functional tests, including closed-chain ankle dorsiflexion (DF), Functional Movement Screen (FMS), Y-Balance Test Lower Quarter (YBT-LQ), Y-Balance Test Upper Quarter (YBT-UQ), single leg vertical jump (SLVJ), 6-m timed hop (6-m timed), and triple hop. Descriptive statistics were calculated. Analysis of variance tests were performed to compare the results based on sex and age (<30 years, >30 years). RESULTS Service members demonstrated DF of 34.2 ± 6.1°, FMS composite score of 16.2 ± 2.2, YBT-LQ normalized composite score of 96.9 ± 8.6%, YBT-UQ normalized composite score of 87.6 ± 9.6%, SLVJ of 26.9 ± 8.6 cm, 6-m hop of 2.4 ± 0.5 seconds, and a triple hop of 390.9 ± 110.8 cm. Men performed greater than women (p < 0.05) on the YBT-LQ, YBT-UQ, SLVJ, 6-m timed, and triple hop. Those <30 years of age performed better than older participants (p < 0.05) on the DF, FMS, YBT-LQ, SLVJ, 6-m hop, and triple hop. CONCLUSIONS Findings provide normative data on military members. Men performed better on power, balance, and trunk stability tests, whereas younger individuals performed better on power, balance, mobility, and functional movement.

Automation to improve efficiency of field expedient injury prediction screening.

Abstract Teyhen, DS, Shaffer, SW, Umlauf, JA, Akerman, RJ, Canada, JB, Butler, RJ, Goffar, SL, Walker, MJ, Kiesel, KB, Plisky, PJ. Automation to improve efficiency of field expedient injury prediction screening. J Strength Cond Res 26(7): S61–S72, 2012—Musculoskeletal injuries are a primary source of disability in the U.S. Military. Physical training and sports-related activities account for up to 90% of all injuries, and 80% of these injuries are considered overuse in nature. As a result, there is a need to develop an evidence-based musculoskeletal screen that can assist with injury prevention. The purpose of this study was to assess the capability of an automated system to improve the efficiency of field expedient tests that may help predict injury risk and provide corrective strategies for deficits identified. The field expedient tests include survey questions and measures of movement quality, balance, trunk stability, power, mobility, and foot structure and mobility. Data entry for these tests was automated using handheld computers, barcode scanning, and netbook computers. An automated algorithm for injury risk stratification and mitigation techniques was run on a server computer. Without automation support, subjects were assessed in 84.5 ± 9.1 minutes per subject compared with 66.8 ± 6.1 minutes per subject with automation and 47.1 ± 5.2 minutes per subject with automation and process improvement measures (p < 0.001). The average time to manually enter the data was 22.2 ± 7.4 minutes per subject. An additional 11.5 ± 2.5 minutes per subject was required to manually assign an intervention strategy. Automation of this injury prevention screening protocol using handheld devices and netbook computers allowed for real-time data entry and enhanced the efficiency of injury screening, risk stratification, and prescription of a risk mitigation strategy.

Sex differences in dynamic closed kinetic chain upper quarter function in collegiate swimmers.

CONTEXT Upper quarter injuries have a higher incidence in female swimmers; however, to date, there are few ways to assess the basic functional ability of this region. The upper quarter Y balance test (YBT-UQ) may assist in this process because it was developed to provide a fundamental assessment of dynamic upper quarter ability at the limit of stability. OBJECTIVE To examine how sex affects performance on the YBT-UQ in swimmers. DESIGN Cohort study. PATIENTS OR OTHER PARTICIPANTS Forty-three male and 54 female National Collegiate Athletic Association Division I college swimmers were recruited preseason. MAIN OUTCOME MEASURE(S) We measured YBT-UQ performance for the left and right limbs in the medial, inferolateral, and superolateral directions. The maximum score for each direction was normalized to upper extremity length. The average of the greatest normalized reach scores in each reach direction was used to develop a composite score (average distance in 3 directions/limb length [LL] × 100). To examine reach symmetry between sexes, the difference in centimeters between the left and right sides was calculated for each reach direction prior to normalization. Statistical analysis was conducted using an independent-samples t test (P < .05). RESULTS Average scores in the medial (women: 92.5 ± 7.4%LL, men: 100.0 ± 8.7%LL; P < .01) and inferolateral (women: 85.6 ± 10.3%LL, men: 89.8 ± 10.8%LL; P = .05) directions and composite score (women: 83.4 ± 8.3%LL, men: 88.3 ± 8.9%LL; P < .01) were higher in men than in women. No differences were observed for reach symmetry in any direction. CONCLUSIONS Performance on several YBT-UQ indices was worse for female than male collegiate swimmers. These results may have implications for the use of preseason and return-to-sport testing in swimmers as a measurement of upper quarter function and symmetry.

Association of Physical Inactivity, Weight, Smoking, and Prior Injury on Physical Performance in a Military Setting

CONTEXT  Although inactivity, being overweight, smoking, and a history of injury are identified as risk factors for poor health and injury, few authors have examined their association on physical performance. Young adults may be more likely to adopt healthier lifestyles if they understand the effect of health behaviors on performance. OBJECTIVE  To determine the association of being overweight, smoking, inactivity, and a history of injury with physical performance. DESIGN  Cross-sectional study. SETTING  Military population. PATIENTS OR OTHER PARTICIPANTS  Active-duty service members (N = 1466; 1380 men, 86 women; age = 24.7 ± 5.0 years; body mass index = 26.7 ± 3.4 kg/m2). MAIN OUTCOME MEASURE(S)  Participants performed 8 measures (the triple-crossover hop for distance, the 6-m timed-hop test, the Functional Movement Screen, the Lower Quarter Y-Balance Test, the Upper Quarter Y-Balance Test, and the 3-event Army Physical Fitness Test) for evaluation of endurance, strength, muscular endurance, power, agility, balance, and motor control. Participants were categorized based on the number of health risk factors present. Using an analysis of covariance, we assessed the relationship between risk factors and physical performance with age and sex as covariates. RESULTS  Compared with those who had no risk factors (27.9% of men, 34.9% of women), physical performance was worse in those who had 1, 2, or 3 to 4 risk factors present by 4.3%, 6.7%, and 10.3%, respectively. Decrements in performance for those with 3 to 4 risk factors ranged from 3.3% to 14.4%. CONCLUSIONS  An unhealthy lifestyle habit or a history of injury was negatively associated with physical performance. Physical performance decrements were associated with the number of risk factors present. Understanding how risk factors contribute to decreased physical performance may enable clinicians to improve compliance with injury-prevention programs in occupational settings in which a young and relatively healthy workforce may be more concerned about performance than health.

Developing predictive models for return to work using the Military Power, Performance and Prevention (MP3) musculoskeletal injury risk algorithm: a study protocol for an injury risk assessment programme

Background Musculoskeletal injuries are a primary source of disability in the US Military, and low back pain and lower extremity injuries account for over 44% of limited work days annually. History of prior musculoskeletal injury increases the risk for future injury. This study aims to determine the risk of injury after returning to work from a previous injury. The objective is to identify criteria that can help predict likelihood for future injury or re-injury. Methods There will be 480 active duty soldiers recruited from across four medical centres. These will be patients who have sustained a musculoskeletal injury in the lower extremity or lumbar/thoracic spine, and have now been cleared to return back to work without any limitations. Subjects will undergo a battery of physical performance tests and fill out sociodemographic surveys. They will be followed for a year to identify any musculoskeletal injuries that occur. Prediction algorithms will be derived using regression analysis from performance and sociodemographic variables found to be significantly different between injured and non-injured subjects. Discussion Due to the high rates of injuries, injury prevention and prediction initiatives are growing. This is the first study looking at predicting re-injury rates after an initial musculoskeletal injury. In addition, multivariate prediction models appear to have move value than models based on only one variable. This approach aims to validate a multivariate model used in healthy non-injured individuals to help improve variables that best predict the ability to return to work with lower risk of injury, after a recent musculoskeletal injury. Trial registration number NCT02776930.