Do dancers score differently than other athletes on the Y Balance Test Lower Quarter?

Researchers found that Y Balance Test Lower Quarter performance in collegiate dancers was superior to other athletes, with dancers demonstrating a mean composite reach score of 105%. “This research supports the findings of previous studies by demonstrating dancers’ superior dynamic balance ability compared to other athletes, thus indicating the need for YBT-LQ normative values to be established for dancers.” (Cole et al)

Do modifiable risk factors for injury still remain at return to sport in those with ACL reconstructions?

Another group of researchers (see previous CSM research post for the other research) found that  deficits are present in athletes who return to sport post-ACLR. In particular, the star excursion balance test anterior reach asymmetry and prone heel height difference (a method to identify decreased knee extension ROM) were present at return to sport and clinicians “should consider using the SEBT to identify post-ACLR athletes who may be at increased risk for injury and decreased joint health.” (Stanley et al)

Does pain with clearing or movement tests predict injury in healthy active duty soldiers?

You bet it does!

In a cohort of 1455, “pain was present on 207 (14.2%) FMS movement tests, 176 (13.5%) FMS clearing tests, 56 (3.8%) YBT-LQ, 96 (6.6%) YBT-UQ, 93 (6.4%) 6-m hop tests, 80 (5.5%) triple crossover hop tests, and 13 (0.9%) ankle dorsiflexion. Pain at baseline movement testing was associated (P =.001) with future injury. The odds ratio of being injured in the upcoming year based on pain on movement tests was 2.0 (95% confidence interval: 1.6, 2.5). The odds ratio of being injured in the upcoming year based on prior history of injury was 2.1 (95% confidence interval: 1.7, 2.6).” (Teyhen et al)

 

Teyhen D, Shaffer SW, Butler R, Goffar SL, Kiesel KB, Rhon DJ, Plisky P. Pain and prior injury as risk factors for musculoskeletal injury in Service Members: A prospective cohort study. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A39.

Stanley LE, Shanley E, Thigpen C, Padua D. Star Excursion Balance Test and Heel-Height Difference as Screening Tools in Athletes Who Have Returned to Sport Following Primary Anterior Cruciate Ligament. Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A65.

Cole HT, McGivern JM, Morejon A, Sudol-Horowitz T, Pivko S, Brooks G, Lusk MM. The Performance of Dancers on the Lower Quadrant Y-Balance Test (YBT-LQ).Platform Presentation. J Orthop Sports Phys Ther. 2014;44(1): A67.

 

CSM 2014

So you have decided to take the plunge — you are going to try some injury prevention with a large group or team. You have already talked with the coach and have some “buy in” (if you don’t, start here). Here are 5 things that will help make your injury prevention successful:

teamwork - ants

1. Start Small – Just like dieting, small incremental steps are key to permanent success. People hear that we test 150 athletes in 2-3 hours and give real time reports of performance, risk categories, and 3 corrective exercises for each athlete. However, this didn’t happen overnight. Just like water eroding rock over time, we gradually changed our injury prevention culture over several YEARS. If you start by simply setting a goal of making your injury prevention better than it was last year, you will gradually get there. Here are a few suggestions:

      • Start with a coach you have a good relationship with and one team
      • Select one or two tests to do (see below)
      • Ask injury history questions
      • Work with the individuals who had pain with testing
      • Be sure to retest those individuals to ensure the risk factors have normalized.

2. Categorize to maximize your resources – Particularly when testing large groups, it can be a daunting task to try addressing the risk factors you find. If you categorize individuals by their degree of risk (Lehr 2013), you can make the process more manageable.  Check out how a Division III college did it with their Body Armor Program.

3. It’s gonna take a village – I frequently feel like I am on an “injury prevention island”. With some discussion, I do find many like-minded individuals. Some have tried injury prevention strategies before  only to stop because they didn’t have good buy in. Others (particularly coaches) want to implement injury prevention, but don’t know how. Still others have misconceptions about how long it is going to take or how difficult it is. Just like other behavioral change, Start with Why to get people on board. When talking with a coach, discuss performance and durability benefits. For medical personnel, discuss keeping our athletes healthy and on the field.  Also, think outside of the box when assembling your team of testers.  Elicit the help of students (of any type: exercise physiology, PT, ATC, etc can help with the simpler testing), coaches (corralling the athletes), parents (ensuring forms are completed), and front desk personnel (data entry). They can all do something to help.

4. Use reliable, evidenced-based, predictive tests that can be completed quickly – Most frequently, I use injury history, Y Balance Test and Functional Movement Screen (I clearly acknowledge my bias here — I would love to hear what you use).

5. Start with Return to Sport Testing – Remember, previous injury is the most consistently reported risk factor for future injury so be sure you are using predictive, evidence based tests in your discharge protocol. Over the next several posts, I will take research based look at discharge testing and answer some commonly asked questions like:

    • What should the limb symmetry be for hop testing? (hint: it is NOT 90%)
    • What percent of athletes return to sport after ACL reconstruction?
    • Do strength and range of motion testing matter?
    • What does research tell us about basic movement testing?

So, if you are currently doing injury prevention, write down your goals for making your injury reduction strategies better than next year. If you haven’t started, utilize a few of the strategies to get started on a small scale. For those of you who have implemented injury prevention programs, please share your strategies with the group by commenting below.

When it comes to injury prevention, we are all excited, passionate and ready to get started only to hit road blocks: No one seems to want to give it the attention that it deserves. Coaches don’t want to give up valuable practice time, parents can’t fit it into jam packed schedules, and athletes, well, they are athletes!

Over the past 15 years, I have made many failed attempts at implementing injury prevention programs, so I would like to share with you what I have learned. After a great Twitter Chat with #solvePT, I decided to focus this blog post on talking with coaches and parents.

Fallen Tree Blocking Road

Some of the best injury prevention researchers in the world looked back at their injury prevention efforts with a huge cohort of female handball teams over a 10 year period (Mykelbust et al 2013). One of their key findings is that for injury prevention to be successful you “must have the coach as a “partner” in the process”. But how exactly do you do that?

Frequently, because of our passion, we provide too much information and end up sounding like a pushy salesperson. When talking with coaches and parents I suggest breaking it down into several steps:

  • Step #1: Ask, “Can I test your team/athlete to see how they are doing?”  Don’t promise too much. Just mention that there is some good research about the ability to identify athletes at more risk of injury and improve their performance. (Remember: researchers have found that the message should focus on both performance and prevention — also remember that if you are on the bench with an injury, you can’t perform!)
  • Step #2 After testing, don’t say anything. Wait for coach/parent to say: “How did they do?” Now you have some buy in because they are asking the question — you are not pushing information
  • Step #3 Tell them how they did: “I found these risk factors and research indicates that puts them at risk for injury.” Then be quiet. This is THE hardest part!
  • Step #4 Parent/Coach says “Well, what are YOU going to do about it?” I say smiling, “I’m glad you asked.” — Total buy in
  • Step #5 Present your evidence-based injury prevention strategy by changing the modifiable risk factors you tested

While these steps are the best way I have found to have the conversation, it is by no means 100% effective. I think the other key ingredient is persistence. Mykelbust et al said it best:

“persistent effort to promote injury prevention over several years, using every opportunity available”

It can take years to change the culture of any organization. In future posts, I will talk about specific implementation strategies. Sign up for this blog to be sure you get notified when it comes out.

I really want to hear from you. What strategies have you found to be successful to get people on board with your passion?


About Phil

Phil Plisky

I want to change peoples lives through dialogue about injury prevention research and return to activity testing.

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