After reading research I take some time to think about the take home points, how I can apply it to my practice (either performance or in clinic), additional questions that pop into my head, concerns about the methodology, and random thoughts. I’ll provide references to back my thoughts when I can. The intent of “Thoughts After Reading Research” is to catalog my thoughts and to spark sharing. Hopefully, readers will find it valuable.

 

Disclaimer: I’m a fan of the FMS in principle, however there are areas that need improvement –

 

  • “FMS is a screen for injuries”, yet it is not validated against injuries because the scores and approach have no specificity,
  • 15 years of irrefutable research on the impact of dynamic valgus on ACL injury and PFP fails to become incorporated,
  • FMS tests at low load and load velocity cannot be extrapolated to movement strategies and control (high load and high velocity) during sport.
  • poor inter-rated reliability[1],

 

All this said, FMS played a huge impact in my development and it has had undeniable positive impact on the health care industry and strength and conditioning world – making it more focussed on movement and the concept of injury prevention and screening. To help evolve and take injury screening to the next level where we have sensitivity, specificity, reliability and prospective validity (the ability to predict future injury likelihood) I look to work that the Cincinnati Sports Medicine group is creating – in fact they have their annual meeting coming up May 25th – 28th – Advances on the Knee, Shoulder & Sports Medicine 2014.

 

What did I read[2, 3]

 

Myer, G.D., et al., High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? Br J Sports Med, 2014. (THIS ARTICLE IS AN ABSOLUTE GAME CHANGER)

 

Harrison, A.D., et al., Sex differences in force attenuation: a clinical assessment of single-leg hop performance on a portable force plate. Br J Sports Med, 2011. 45(3): p. 198-202.

Thoughts

 

  • Injury Thresholds and Predicative Abilities: Myer et al. demonstrated in a prospective study that knee abduction moments (KAM) landing above 15.4 Nm is associated with a 2.3x greater risk (6.8% vs. 2.9% risk) to develop PFP compared to those that landed with KAM below in girls aged 13.3. Likewise KAM above 25.4 Nm (established ACL risk threshold) was associated with a 17x greater risk for ACL injury (6.8% vs. .4%) in girls aged 16.1. The amazing point to consider is KAM is the metric that was used to predict future injury risk in two seemingly difference injuries. Having metrics and identifying key motor control drivers for injuries is very exciting. Utilizing the Drop Jump protocol[4] and derived injury thresholds add value to injury screens because there is predicative validity.

 

  • Different injuries can have the same etiology (cause). The authors raise the question, “Is PFP itself a predictor for subsequent ACL Injury”. I believe dynamic valus and trunk control have been shown to have strong predictive associations with injury[2, 4-7]. Connecting the dots it seems like common movement dysfunctions (such as dynamic valgus) can “manifest” as different injuries based on loading – exposure and magnitude. Data in this study, showed that there are age and threshold loads that help predict PFP and ACL injuries caused by KAM – AMAZING. One simple test, combine with age can help us predict what injuries will occur. This idea has been shared with the development of the Hockey Triad.

 

  • Injury prevention = motor control. There is irrefutable evidence that we can reduce the injury risk of PFP and ACL[8-18]. Neuromuscular control strategies are our best line of defense that target lowering KAM by:

 

  1. Increasing posterior chain strength
  2. Using a hip landing strategy vs. a knee landing strategy
  3. Technical cueing of proper landing mechanics, plyometrics, speed and COD abilities – particularly during the maturation years
  4. Foot and ankle control
  5. Improving trunk control

 

  • Use of metrics in practice and the potential role of the health care professional – prevention vs. reaction. Too often we see patients only when there is a problem. Resolving pain occurs only when you find the source. We have collected irrefutable evidence that motor control errors lead to injuries and correcting those motor control errors prevent injuries. The circle is complete. As health care professionals who know this literature, we can change the game. We can choose to prevent those injuries. How we evaluate the athlete and how we use metrics; becomes a new tool that I believe, will change the way we practice. FMS is a great start…but there is more

 

  • Rate of Force Absorption / Attenuation. A lot of strength and conditioning professional aim to improve RFD. Equally important, but often an after thought is rate of force absorption. As with all force profiles of jumping and landing, landing creates higher magnitude and rates of loading than jumping. No will argue that landing is important; and it is tied to strength, but we need to take a better look and appreciate the loads that are applied to the body during landing – when we lack control our KAM increases. As I discussed in the previous “Thoughts After Reading”, understanding the rate of knee of abduction would be a great metric.

 

  1. Frost, D.M., et al., Using the Functional Movement Screen™ to evaluate the effectiveness of training. J Strength Cond Res, 2012. 26(6): p. 1620-30.
  2. Myer, G.D., et al., High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? Br J Sports Med, 2014.
  3. Harrison, A.D., et al., Sex differences in force attenuation: a clinical assessment of single-leg hop performance on a portable force plate. Br J Sports Med, 2011. 45(3): p. 198-202.
  4. Noyes, F.R., et al., The drop-jump screening test: difference in lower limb control by gender and effect of neuromuscular training in female athletes. Am J Sports Med, 2005. 33(2): p. 197-207.
  5. Lee, A.S., et al., Comparison of trunk proprioception between patients with low back pain and healthy controls. Arch Phys Med Rehabil, 2010. 91(9): p. 1327-31.
  6. Zazulak, B.T., et al., Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. Am J Sports Med, 2007. 35(7): p. 1123-30.
  7. Fleisig, G.S., et al., Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med, 2011. 39(2): p. 253-7.
  8. Myer, G.D., et al., Augmented feedback supports skill transfer and reduces high-risk injury landing mechanics: a double-blind, randomized controlled laboratory study. Am J Sports Med, 2013. 41(3): p. 669-77.
  9. Stroube, B.W., et al., Effects of task-specific augmented feedback on deficit modification during performance of the tuck-jump exercise. J Sport Rehabil, 2013. 22(1): p. 7-18.
  10. Myer, G.D., et al., The Influence of Age on the Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes: A Meta-Analysis. Am J Sports Med, 2012.
  11. Reed, C.A., et al., The effects of isolated and integrated ‘core stability’ training on athletic performance measures: a systematic review. Sports Med, 2012. 42(8): p. 697-706.
  12. Cheung, R.T. and I.S. Davis, Landing pattern modification to improve patellofemoral pain in runners: a case series. J Orthop Sports Phys Ther, 2011. 41(12): p. 914-9.
  13. Crowell, H.P. and I.S. Davis, Gait retraining to reduce lower extremity loading in runners. Clin Biomech (Bristol, Avon), 2011. 26(1): p. 78-83.
  14. Noehren, B., J. Scholz, and I. Davis, The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. Br J Sports Med, 2011. 45(9): p. 691-6.
  15. Barrios, J.A., K.M. Crossley, and I.S. Davis, Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment. J Biomech, 2010. 43(11): p. 2208-13.
  16. Stearns, K.M. and C.M. Powers, Improvements in Hip Muscle Performance Result in Increased Use of the Hip Extensors and Abductors During a Landing Task. Am J Sports Med, 2014.
  17. Souza, R.B. and C.M. Powers, Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther, 2009. 39(1): p. 12-9.
  18. Souza, R.B. and C.M. Powers, Predictors of hip internal rotation during running: an evaluation of hip strength and femoral structure in women with and without patellofemoral pain. Am J Sports Med, 2009. 37(3): p. 579-87.