Association with injury of a Football-specific movement screen

Abstract

INTRODUCTION: Movement screening is widely used within football to quantify players’ movement quality. An established definition of movement quality does not exist; however, it encompasses aspects typically associated with safe exercise technique such as maintenance of neutral posture, balance and coordination. The underlying theory behind movement screening is that ‘poor’ movement quality increases the risk of injury whereas ‘good’ movement quality reduces the risk. Indeed, current convention advocates for the risk stratification of individuals based on movement screening scores with intervention targeted only to the high-risk group. The appeal of such practice is clear: potentially more efficient allocation of resources. However, very little evidence to support this approach exists within football. Consequently, the aims of this thesis were as follows: i) to determine what movement screens currently exist within the scientific literature, how reliable they are and their potential association with injury, ii) investigate the predictive ability of the most widely used and researched movement screen within a football population, iii) develop a new football-specific movement screen and test its reliability, and iv) establish the association with injury of the newly created footballspecific movement screen. METHODS: i) A structured literature review was conducted to identify the movement screens with supporting evidence regarding their reliability and association with injury. ii) The Functional Movement Screen (FMS™) was identified as the most widely used and researched movement screen; however, a paucity of research involving football players was observed. In order to investigate the predictive ability of the FMS™ within football 84 elite youth players from a professional club academy performed the screen during the pre-season period and were subsequently observed during the in-season period and injury incidence recorded. iii) The Soccer Injury Movement Screen (SIMS) was developed as a footballspecific movement screen. The constituent movements making up the SIMS were selected based on the most common injury locations (lower-body) and types (muscle strains and ligament sprains). To assess the intra- and inter-rater reliability of the SIMS, 25 recreational athletes performed the assessment and were scored by three raters on three separate occasions. iv) The final investigation established the association with injury of the SIMS within a football population. Utilising a prospective cohort study design, 306 semiprofessional football players performed the SIMS during the pre-season period and were subsequently observed during the in-season period with injury incidence and exposure time recorded. RESULTS: i) A total of 10 movement screens were identified by the structured literature search. The majority of the identified screens demonstrated acceptable reliability for use in applied practice and future research. However, only two of the 10 identified screens had any supporting evidence regarding their association with injury. Furthermore, the limited available evidence related to association with injury was equivocal and not sufficient to justify any movement screen as ‘predictive’. ii) No association with injury was observed for the FMS™ within a cohort of elite youth football players. iii) The SIMS demonstrated good to excellent intra- and inter-rater reliability. iv) However, no association with injury was observed for the SIMS composite score in relation to any of the categories investigated. DISCUSSION: While many reliable movement screens exist none have compelling evidence supporting a strong association with injury. Despite its widespread use within football the FMS™ was not associated with injury among a cohort of elite youth players questioning its value in terms of injury prediction. The SIMS demonstrated good to excellent reliability indicating its suitability for use in applied practice and future research; however, no association with injury was observed for the composite score. The present results challenge current convention that advocates risk stratification and targeted intervention based on screening score. Implementing universal injury prevention programmes albeit with content informed by prospective studies such as the ones conducted within this body of work are recommended ahead of attempting to identify specific ‘at-risk’ individuals.