The Concept of Neuromuscular Repatterning in Dancers: A Systematic Review.

Repatterning is a term that can be used in different fields, including genetics, molecular biology, neurology, psychology, or rehabilitation. Our aim is to identify the key concept of neuromuscular repatterning in somatic training programmes for dancers. A systematic search of eight databases was conducted using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. The Quality Assessment Tool for Quantitative Studies and the Oxford Levels of Evidence scales were used. The search yielded 1218 results, of which 5 met the inclusion criteria. Five studies (n = 5) were related to psychosomatic health (n = 5), two studies highlighted integration and inter-articular connectivity in movement (n = 2), four studies investigated the neurological component of alignment and efficiency in dance practice (n = 4), and two studies investigated self-confidence (n = 2). Five studies (n = 5) used imagery based on the anatomical and physiological experience of body systems as the main analytical method. Four studies (n = 4) used developmental movement through Bartenieff fundamentals as the main technique for this methodology. Developmental movement and imagery are two methodologies strongly connected to the concept of neuromuscular repatterning in somatic training programmes for dancers. The acquisition of further quantitative experimental or quasi-experimental studies is warranted to better define the level of improvement or impact of neuromuscular repatterning in dancers.

Running shoes for preventing lower limb running injuries in adults.

BACKGROUND: Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury. OBJECTIVES: To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners. SEARCH METHODS: We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology. MAIN RESULTS: We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes. AUTHORS' CONCLUSIONS: Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners.  Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.

External Load of Flamenco Zap-3 Footwork Test: Use of PlayerLoad Concept with Triaxial Accelerometry.

The intense footwork required in flamenco dance may result in pain and injury. This study aimed to quantify the external load of the flamenco Zapateado-3 (Zap-3) footwork via triaxial accelerometry in the form of PlayerLoad (PL), comparing the difference in external loads at the fifth lumbar vertebra (L5), the seventh cervical vertebra (C7) and the dominant ankle (DA), and to explore whether the speed, position, axis and proficiency level of the flamenco dancer affected the external load. Twelve flamenco dancers, divided into professional and amateur groups, completed a 15-s Zap-3 footwork routine at different speeds. Triaxial accelerometry sensors were positioned at the DA, L5 and C7 and were utilized to calculate the total PlayerLoad (PLTOTAL), uniaxial PlayerLoad (PLUNI) and uniaxial contributions (PL%). For both PLTOTAL and PLUNI, this study identified significant effects of speed and position (p < 0.001), as well as the interaction between speed and position (p ≤ 0.001), and at the DA, values were significantly higher (p < 0.001) than those at C7 and L5. Significant single axis and group effects (p < 0.001) and effects of the interactions between the position and a single axis and the group and speed (p ≤ 0.001) were also identified for PLUNI. Medial-lateral PL% represented a larger contribution compared with anterior-posterior PL% and vertical PL% (p < 0.001). A significant interaction effect of position and PL% (p < 0.001) also existed. In conclusion, the Zap-3 footwork produced a significant external load at different positions, and it was affected by speed, axis and the proficiency level of the flamenco dancer. Although the ankle bears the most external load when dancing the flamenco, some external load caused by significant vibrations is also borne by the lumbar and cervical vertebrae.

Screening Tools as a Predictor of Injury in Gymnastics: Systematic Literature Review.

BACKGROUND: Gymnastics requires a high level of physical ability and technical skill which utilises short sets of athleticism and artistry to perform complex and intense movements which can overload musculoskeletal tissues and result in acute injuries which can develop into chronic injuries. The aim of this systematic literature review was to investigate which screening tools predict injury in gymnasts and encompasses all genres, levels and ages. METHODS: An electronic search of seven databases from their inception until March 2021 was conducted. The databases were the Allied and Complementary Medicine Database, CINAHL, eBook Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro (the Physiotherapy Evidence Base). A combination of the following search terms was used: (1) Gymnastics AND injury AND Screening, (2) Screening AND Gymnastics and (3) Musculoskeletal AND Screening AND Gymnastics. These terms were searched in all text, abstract, title and subject terms. Studies were assessed using a 20-point scoring tool. RESULTS: The mean methodological quality score was 13.1 points (range 10-17 points). Range of motion, anthropometric and postural measurements, hypermobility, clinical diagnostic tests, movement screening tools, muscle strength, power and endurance were reported in the included studies. Some evidence existed for screening measurement of height and mass as taller and heavier gymnasts might be more susceptible to injury; however, the different methodologies utilised and lack of acknowledgment of confounding variables limit the clinical relevance of these findings. CONCLUSIONS: Height and mass should be recorded during the screening process. A lack of heterogeneity in study methodology prevented a meta-analysis. Studies were limited by a lack of prospective injury design, poor injury definition, self-reporting of injury and only 2 studies reported reliability of screening tools. Further research is required to determine the role of injury screening in gymnastics. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42020218339.

Effect of Kinesiology Tape on Tri-Axial Accelerometry During the Dance Aerobic Fitness Test.

OBJECTIVES: Kinesiology tape (KT) is thought to provide greater mechanical support during physical activity, however, there is a paucity of research investigating its application in dance. The study aimed to determine whether KT reduces PlayerLoad (PL) during the Dance Aerobic Fitness Test (DAFT) in addition to examining the relative sensitivity of accelerometer site locations.
Methods: University-level dancers (N = 11; age 18 ± 0.45 years, height 168.17 ± 12.25 cm, body mass 57.50 ± 9.91 kg) participated in two trials of the DAFT protocol in two conditions: no tape (NT) and kinesiology tape (KT). Global positioning systems (GPS) and accelerometer units were attached onto the seventh vertebra (C7) at the mid-scapula region and lower limb (LL) located at the midgastrocnemius of the dominant leg calculating measurements of triaxial (PLTotal) and uniaxial measures (anteroposterior [PLAP], mediolateral [PLML], and vertical [PLV]) measures of PlayerLoad during the DAFT.
Results: No significant main effect was observed for the taping condition in all measures of PlayerLoad (P > 0.10). A significant main effect (p < 0.01) was observed for unit location and time, with greater loading at the LL compared to C7 and during each consequent stage of the DAFT. No significant (p > 0.52) location*taping, nor location*taping*time (p > 0.36) interactions were observed for all variables measured.
Conclusions: Kinesiology tape does not reduce loading patterns in healthy dancers during a fatigue protocol. However, triaxial accelerometers provide adequate sensitivity when detecting changes in loading, suggesting the LL may be deemed as a more relevant method of monitoring training load in dancers.

The Relationship Between the Golf-Specific Movement Screen and Golf Performance.

CONTEXT: Golf requires effective movement patterns to produce an effective swing and performance. OBJECTIVE: To determine the relationship between the Titleist Performance Institute golf-specific functional movement screening (GSFMS) composite and individual element scores and golf performance by assessing a player's handicap, clubhead speed, side accuracy, ball speed, peak pelvis rotation speed, swing sequence, and common swing faults. DESIGN: Cohort study, clinical measurement. SETTING: English golf club. PARTICIPANTS: A total of 11 amateur golfers: 5 males (age: 37.2 [18.7] y, height: 184.4 [9.6] cm, body mass: 89.5 [13.4] kg, and handicap: 9 [6.6]) and 6 females (age: 53.7 [15.0] y, height: 166.8 [5.5] cm, body mass: 67.9 [16.6] kg, and handicap: 13 [6.1]). MAIN OUTCOME MEASURES: GSFMS composite and individual element scores and golf performance variables. RESULTS: Significant relationships existed between GSFMS composite scores and handicap (r = -.779, P = .01); clubhead speed (r = .701, P = .02); ball speed (r = .674, P = .02); and peak pelvis rotation speed (r = .687, P = .02). Significant relationships existed between 90°/90° golf position and clubhead speed (r = .716, P = .01); ball speed (r = .777, P = .01); seated trunk rotation and peak pelvis rotation speed (r = .606, P = .048); single-leg balance and handicap (r = -.722, P = .01); torso rotation and handicap (r = -.637,P = .04); and torso rotation and peak pelvis rotation speed (r = .741, P = .01). Single-leg balance, overhead deep squat, and pelvic tilt were the GSFMS tests which participants had most difficulty in performing. The most common swing faults identified included loss of posture, slide, chicken winging, and early hip extension. CONCLUSIONS: The GSFMS may be used to identify movement limitations that relate to golfing performance. These findings may potentially allow intervention to correct movement patterns and potentially improve golf performance.

The Beighton Score and Injury in Dancers: A Prospective Cohort Study.

CONTEXT: Joint hypermobility has a high prevalence in dancers and may be associated with injury and performance. OBJECTIVES: To investigate whether total Beighton score can predict injury and to determine the relationship between joint hypermobility and injury, and to report injury demographics. DESIGN: A prospective cohort injury study. SETTING: Edge Hill University dance injury clinic. PARTICIPANTS: Eighty-two dancers (62 females, 20 males). MAIN OUTCOME MEASURES: Joint hypermobility via the Beighton score ≥4 with lumbar flexion included and removed. RESULTS: A total of 61 dancers were classified as hypermobile, which was reduced to 50 dancers with lumbar flexion removed. A significant difference existed between pooled total days injured in hypermobile dancers and nonhypermobile dancers with lumbar flexion included (P = .02) and removed (P = .03). No significant differences existed for total Beighton score between injured and noninjured groups with lumbar flexion included (P = .11) and removed (P = .13). Total Beighton score was a weak predictor of total days injured (r2 = .06, P = .51). In total, 47 injuries occurred in 34 dancers, and pooled injury rate was 1.03 injuries/1000 hours. Receiver operating characteristic curve analysis demonstrated an area under the curve of 0.83 for male dancers with lumbar flexion removed, which was considered diagnostic for injury. CONCLUSIONS: The Beighton score can be utilized to identify dancers who may develop injury. Clinicians should consider the role of lumbar flexion in total Beighton score when identifying those dancers at risk of injury. Different injury thresholds in female and male dancers may aid injury management.

The relationship between the functional movement screen, star excursion balance test and the Beighton score in dancers.

Objectives: To determine the association between the Functional Movement Screen (FMS), Star Excursion Balance Test (SEBT) and the Beighton Score (BS) in dancers with implications for performance and injury.Methods: The study was of cross-sectional design and included 47 female university dancers (age: 20.4 ± 0.7 years, height: 160.5 ± 5.8 cm; mass: 55.6 ± 4.8 kg). Participants completed the FMS and the anterior, posteromedial and posterolateral reach components of the SEBT and hypermobility was assessed via the BS.Results: A fair significant correlation existed between FMS composite and total BS (r = 0.37, p = 0.01). For individual elements of the screening tools, there were 24 significant correlations between the FMS and the BS, 11 significant correlations between the FMS and SEBT and 4 significant correlations between the SEBT and BS.Conclusion: The FMS and the BS correlations highlighted the importance of the deep squat in functional movement and the relationship between FMS mobility elements and the BS. The significant correlation between the FMS and the BS may suggest that they capture similar information. The active straight leg raise and shoulder mobility measurements should be considered key elements to measure during screening.

Joint Hypermobility as a Predictor of Mechanical Loading in Dancers.

CONTEXT: Dance requires the performance of complex movements that may exceed normal anatomical range. However, in hypermobile individuals, this may have implications for injury and performance. OBJECTIVES: The aim of the study was to investigate the efficacy of the Beighton score (BS) in predicting mechanical loading in dancers in hypermobile and nonhypermobile dancers with consideration of accelerometer placement and lumbar flexion hypermobility. DESIGN: Cohort study, clinical measurement. SETTING: University. PARTICIPANTS: A total of 34 dancers had their joint hypermobility assessed by the BS. Participants completed the Dance Aerobic Fitness Test with a global positioning device incorporating a triaxial accelerometer located at the cervico-thoracic junction (C7) and one at the midbelly of the gastrocnemius. MAIN OUTCOME MEASURES: Accelerometry data were used to calculate PlayerLoad total, PlayerLoad medial-lateral, PlayerLoad anterior-posterior, and PlayerLoad vertical. Physiological response was measured via heart rate and fatigue response by rate of perceived exertion. RESULTS: The total BS was a poor predictor of all mechanical loading directions with PlayerLoad anterior-posterior C7 (r = .15) and PlayerLoad total lower limb (r = .20) the highest values. Multiple linear regression was a better predictor with values of C7 (r = .43) and lower limb (r = .37). No significant difference existed between hypermobile and nonhypermobile subjects for mechanical loading values for all stages of the Dance Aerobic Fitness Test and for heart rate and fatigue responses. CONCLUSIONS: The BS is not a good predictor of mechanical loading which is similar in hypermobile and nonhypermobile dancers for all levels of the Dance Aerobic Fitness Test. Mechanical loading and fatigue responses are similar between hypermobile and nonhypermobile dancers.

Functional Movement Screening as a Predictor of Mechanical Loading and Performance in Dancers.

Dance requires effective functional movement for the prevention of injury, with implications for the biomechanical response to performance. This study investigated the efficacy of the Functional Movement Screening (FMS) in predicting mechanical loading during the Dance Aerobic Fitness Test (DAFT). Twenty-five university dancers (19 females; age: 20.3 ± 0.94 years; height: 162.55 ± 0.05 cm; mass: 58.73 ± 6.3 kg; and 6 males; age: 21.08 ± 2.01 years; height: 175 ± 6.54 cm; mass: 68.16 ± 4.97 kg) were screened using the FMS. Subjects then completed the DAFT with a GPS-mounted triaxial accelerometer located at the cervico-thoracic junction. Accelerometry data were sampled at 100 Hz and used to calculate total accumulated PlayerLoad, Playerload medial-lateral (PLML), PlayerLoad anterior-posterior (PLAP), and PlayerLoad vertical (PLV) over the duration of the DAFT. Linear regression analysis was used to determine the strength of correlation between FMS and PlayerLoad, PLML, PLAP, and PLV, and forward stepwise hierarchical modelling was performed to establish which FMS components were the primary predictors of mechanical loading. The Deep Squat (DS) demonstrated statistical significance for PLVTotal and PLTotal. The non-dominant Hurdle Step (HS) was a statistically significant predictor of PLMLTotal. The FMS composite score was a statistically significant predictor for PLVTotal. Forward stepwise regression analysis demonstrated that DS was the sole predictor for PLTotal and the primary predictor for PLVTotal. Non-dominant HS was identified as the primary predictor of PLMLTotal. It is concluded that the DS, non-dominant HS, and the FMS composite score can be used to predict mechanical loading in performance of the DAFT, which may have implications for dance performance and injury prevention.

Effect of Fatigue on Functional Movement Screening Performance in Dancers.

OBJECTIVE: Dance is associated with a high risk of injury, with fatigue identified as a contributing factor. Functional movement screening (FMS) has been used to identify alterations in normal movement which may contribute to injury risk, though this test is not normally performed in a fatigued state. The aim of this study was to determine whether fatigue induced by the dance aerobic fitness test (DAFT) results in changes in FMS scores with implications for performance and injury risk. METHODS: Forty-one university dancers completed the FMS before and immediately after completion of the DAFT. Rate of perceived exertion and heart rate were quantified as measures of fatigue. RESULTS: Post-DAFT, the mean FMS composite score (15.39±1.86) was significantly less (p≤0.01) than the pre-exercise score (16.83±1.83). Element-specific analysis revealed that the deep squat, non-dominant lunge, and dominant inline lunge scores were all significantly impaired post-DAFT (all p≤0.01). CONCLUSION: The identification of changes in quality of movement in a fatigued state suggests that movement screening should also be performed post-exercise to enhance screening for injury risk. The influence of dance-specific fatigue was FMS element-specific. Specifically, the deep squat and inline lunge were most susceptible to fatigue, with implications for injury risk and performance and reflective of the high level of neuromuscular control required.

Use of Triaxial Accelerometry During the Dance Aerobic Fitness Test: Considerations for Unit Positioning and Implications for Injury Risk and Performance.

Injury incidence in dance is high, in large part due to the frequency of repetitive and complex movements that require the lower limb to absorb and utilize extreme forces. The aim of this study was to quantify the biomechanical demands of the Dance Aerobic Fitness Test (DAFT) via triaxial accelerometry and utilize it to compare loading at the cervical spine and distal aspect of the lower limb. University dancers (N = 26; age: 20.0 ± 1.5 years; height: 1.61 ± 0.08 m; body mass: 58.40 ± 6.20 kg) completed two trials (one familiarization and one experimental) of the DAFT, consisting of five incremental levels of dance performance. Micromechanical electrical systems (MEMS) accelerometry was used to calculate total accumulated PlayerLoad (PLTotal) and it's uniaxial (anteroposterior [PLAP], mediolateral [PLML], and vertical [PLV]) components for each level. MEMS units were positioned at cervical vertebra 7 (C7) and the center of gastrocnemius (LL). There was a significant main effect for each level, with loading increasing in relation to exercise duration. There was also a significant main effect for anatomical placement, with higher PLTotal (C7 = 41.05 ± 7.31 au; LL = 132.58 ± 35.70), PLAP (C7 = 12.96 ± 2.89 au; LL = 47.16 ± 13.18 au), and PLML (C7 = 10.68 ± 2.15; LL = 46.29 ± 12.62 au) at LL when compared to C7, with the converse relationship for PLV (LL = 20.05 ± 3.41 au; C7 = 44.89 ± 11.22 au). Significant interactions were displayed for all PL metrics. It is concluded that triaxial PlayerLoad was sensitive enough to detect increased loading associated with increases in exercise intensity, while lower limb accelerometer placement detected higher loading in all planes. The specificity in anatomical placement has practical implications, with lower limb accelerometry recommended to assess movement strategies in that location.

The Influence of Fatigue on Star Excursion Balance Test Performance in Dancers.

Dance is associated with a high risk of injury and fatigue is often a contributing factor. The Star Excursion Balance Test (SEBT) has been used to identify alterations in normal movement that may contribute to injury risk; however, there has been limited investigation of the potential effects of fatigue. The aim of this study was to explore the influence of dance-specific fatigue on SEBT performance, with implications for injury and performance in dance. Thirty-five university dancers completed the modified SEBT in anterior, posterolateral, and posteromedial directions prior to and immediately following the Dance Aerobic Fitness Test (DAFT). The SEBT was completed for dominant and non-dominant legs. Heart rate and rate of perceived exertion were quantified as measures of fatigue. Post-DAFT, the mean SEBT percentage maximized reach distances for dominant and nondominant legs were non-significant compared to pre-DAFT scores. Lack of a main effect for exercise was observed in each of the anterior dominant and non-dominant, posterolateral dominant and non-dominant, and posteromedial dominant and non-dominant scores. It is concluded that the limited changes in the ability of dancers to perform the SEBT suggest that they were able to maintain SEBT performance in both dominant and non-dominant legs following exercise. This resistance to fatigue may demonstrate a dance-specific performance adaptation so that potential alterations in movement performance that may increase injury risk were not observed.

INJURY IDENTIFICATION: THE EFFICACY OF THE FUNCTIONAL MOVEMENT SCREEN™ IN FEMALE AND MALE RUGBY UNION PLAYERS.

BACKGROUND: Rugby union is a collision sport which is associated with a high injury rate and therefore the development of effective injury prevention strategies is required. PURPOSE: This study aimed to determine whether the Functional Movement Screen™ (FMS™) components can predict injury in female and male rugby union players and whether differences exist in the FMS™ scores of injured and non-injured players. STUDY DESIGN: Prospective cohort study. METHODS: Sixty-four female university rugby union players (age: 20.39 ± 1.91 years) and 55 male university rugby union players (age: 21.05 ± 1.35 years) completed the FMS™ which assesses seven functional movements on a scale of 0 to 3 and provides a total or composite score out of 21. Players were subsequently monitored for injury during the season and injury rates calculated. RESULTS: The training injury rates for females were 5.80 injuries/1000 hours and males 5.34 injuries/1000 hours while the match injury rates for females was 55.56 injuries/1000 hours and males 46.30 injuries/1000 hours. FMS™ composite score demonstrated a significant difference between injured females and non-injured males (p = 0.01) and a combined sample comparison of injured and non-injured subjects was significant (p = 0.01). FMS™ composite score was not a good predictor of injury however as FMS™ individual components predicted 37.4% of the variance in total days injured in females. ROC curve analysis revealed an injury cut off score of 11.5 for females and males and provided a sensitivity and specificity of 0.90 and 0.86 and 0.88 and 1.00 respectively. The combined sample FMS™ composite score of 'multiple injuries' participants demonstrated no significant difference between non-injured (p = 0.31) and single injury subjects (p = 0.76). CONCLUSION: Injury rates between female rugby and male rugby were similar with match injury rates higher in females. The FMS™ can be used to identify those players with the potential to develop injury and the FMS™ injury cut off point was 11.5 for both female rugby and male rugby players. Individual components of the FMS™ are a better predictor of injury than FMS™ composite score. LEVELS OF EVIDENCE: 2b.

RELATIVE JOINT CONTRIBUTION TO JOINT HYPERMOBILITY IN RUGBY PLAYERS, NETBALLERS AND DANCERS: THE NEED FOR CAREFUL CONSIDERATION OF LUMBAR FLEXION.

BACKGROUND: Generalized joint hypermobility is commonly measured using the Beighton and Horan Joint Mobility Index which provides a Beighton score of 0-9. Generally, scores of > 4 are classified as hypermobile however joint hypermobility classification lacks consistency across the literature. PURPOSE: The aim of the study was to compare the relative contribution of five joints to joint hypermobility scores in female and male rugby players, female netball players, female dancers and male and female age matched controls. STUDY DESIGN: Individual cohort study. METHODS: Joint hypermobility was assessed in 286 subjects using the Beighton and Horan Joint Mobility Index. Subjects were assigned a Beighton score of 0-9. These scores were then categorized using three different joint hypermobility classification systems and results were analyzed using a Pearsons Chi Square (x2) to report the relative contributions of each joint to hypermobility scores. RESULTS: Significant differences existed for group and gender analysis at the left and right 5th metacarpophalangeal joints, left and right thumb, left and right elbow and lumbar spine (p < 0.001). Lumbar flexion demonstrated significant x2 values and large effect sizes for all groups. This effect size was reduced to a moderate effect size when male against female analysis was performed and joint hypermobility was greater in females in comparison to males. The knee joint demonstrated the lowest hypermobility across all populations and ranged from 3% in male rugby players to 24% in female dancers. Seven hypermobile knees existed in males and 53 in females. Female dancers had the highest prevalence (93%) of hypermobile lumbar flexion and all female groups had a higher prevalence of hypermobile lumbar flexion than males. The removal of lumbar flexion from the total Beighton score had no effect on joint hypermobility prevalence in males in contrast to females where changes were demonstrated. CONCLUSION: Joint hypermobility classification of female dancers should consider the high prevalence of hypermobility of lumbar flexion in interpretation. The consideration of separate classification systems for males and females, and between athletes of different sports and dancers may aid future understanding. LEVELS OF EVIDENCE: 2b.

Screening Tools as a Predictor of Injury in Dance: Systematic Literature Review and Meta-analysis.

BACKGROUND: Dance involves movements of complexity and physical intensity which result in stress on the body. As a consequence, dancers are at risk of injury which can impact on their well-being. Screening tools are used for injury prevention to identify those dancers at risk of injury. The aim of this study was to investigate which screening tools can predict injury in dancers, encompassing all dance genres, levels and ages. METHODS: An electronic search of seven databases from their inception to December 2017 was conducted. The databases were the Allied and Complementary Medicine Database (AMED), CINAHL, eBOOK Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro: the Physiotherapy Evidence Base. The following search terms were used: (i) Dance AND injury AND Screening, (ii) Screening AND dance and (iii) Musculoskeletal AND Screening AND Dance. Studies were assessed using a 20-point scoring tool, and eligible studies were included in a meta-analysis. RESULTS: The mean methodological quality score was 12.2 points. Injured dancers had a significantly higher compensated turnout range of motion than non-injured dancers: pooled mean difference of compensated turnout (23.29°; 95% CI 14.85-31.73; P < 0.00001; I2 = 0%). Injured dancers had significantly greater functional turnout range of motion when compared to non-injured dancers: pooled mean difference of functional turnout (14.08°; 95% CI 7.09-21.07; P < 0.0001; I2 = 0%). There also some evidence for use of hip range of motion as a predictor of dance injury. CONCLUSIONS: Some evidence exists for the potential use of dance-specific positions as a predictor of injury. A number of studies were limited by a lack of prospective injury design, injury definition and self-reporting of injury.

Dual antibiotics for bronchiectasis.

BACKGROUND: Bronchiectasis is a chronic respiratory disease characterised by abnormal and irreversible dilatation of the smaller airways and associated with a mortality rate greater than twice that of the general population. Antibiotics serve as front-line therapy for managing bacterial load, but their use is weighed against the development of antibiotic resistance. Dual antibiotic therapy has the potential to suppress infection from multiple strains of bacteria, leading to more successful treatment of exacerbations, reduced symptoms, and improved quality of life. Further evidence is required on the efficacy of dual antibiotics in terms of management of exacerbations and extent of antibiotic resistance. OBJECTIVES: To evaluate the effects of dual antibiotics in the treatment of adults and children with bronchiectasis. SEARCH METHODS: We identified studies from the Cochrane Airways Group Specialised Register (CAGR), which includes the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine (AMED), and PsycINFO, as well as studies obtained by handsearching of journals/abstracts. We also searched the following trial registries: US National Institutes of Health Ongoing Trials Register, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. We imposed no restriction on language of publication. We conducted our search in October 2017. SELECTION CRITERIA: We searched for randomised controlled trials comparing dual antibiotics versus a single antibiotic for short-term (< 4 weeks) or long-term management of bronchiectasis diagnosed in adults and/or children by bronchography, plain film chest radiography, or high-resolution computed tomography. Primary outcomes included exacerbations, length of hospitalisation, and serious adverse events. Secondary outcomes were response rates, emergence of resistance to antibiotics, systemic markers of infection, sputum volume and purulence, measures of lung function, adverse events/effects, deaths, exercise capacity, and health-related quality of life. We did not apply outcome measures as selection criteria. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the titles and abstracts of 287 records, along with the full text of seven reports. Two studies met review inclusion criteria. Two review authors independently extracted outcome data and assessed risk of bias. We extracted data from only one study and conducted GRADE assessments for the following outcomes: successful treatment of exacerbation; response rates; and serious adverse events. MAIN RESULTS: Two randomised trials assessed the effectiveness of oral plus inhaled dual therapy versus oral monotherapy in a total of 118 adults with a mean age of 62.8 years. One multi-centre trial compared inhaled tobramycin plus oral ciprofloxacin versus ciprofloxacin alone, and one single-centre trial compared nebulised gentamicin plus systemic antibiotics versus a systemic antibiotic alone. Published papers did not report study funding sources.Effect estimates from one small study with 53 adults showed no evidence of treatment benefit with oral plus inhaled dual therapy for the following primary outcomes at the end of the study: successful management of exacerbation - cure at day 42 (odds ratio (OR) 0.66, 95% confidence interval (CI) 0.22 to 2.01; 53 participants; one study; very low-quality evidence); number of participants with Pseudomonas aeruginosa eradication at day 21 (OR 2.33, 95% CI 0.66 to 8.24; 53 participants; one study; very low-quality evidence); and serious adverse events (OR 0.48, 95% CI 0.08 to 2.87; 53 participants; one study; very low-quality evidence). Similarly, researchers provided no evidence of treatment benefit for the following secondary outcomes: clinical response rates - relapse at day 42 (OR 0.57, 95% CI 0.12 to 2.69; 53 participants; one study; very low-quality evidence); microbiological response rate at day 21 - eradicated (OR 2.40, 95% CI 0.67 to 8.65; 53 participants; one study; very low-quality evidence); and adverse events - incidence of wheeze (OR 5.75, 95% CI 1.55 to 21.33). Data show no evidence of benefit in terms of sputum volume, lung function, or antibiotic resistance. Outcomes from a second small study with 65 adults, available only as an abstract, were not included in the quantitative data synthesis. The included studies did not report our other primary outcomes: duration; frequency; and time to next exacerbation; nor our secondary outcomes: systemic markers of infection; exercise capacity; and quality of life. We did not identify any trials that included children. AUTHORS' CONCLUSIONS: A small number of studies in adults have generated high-quality evidence that is insufficient to inform robust conclusions, and studies in children have provided no evidence. We identified only one dual-therapy combination of oral and inhaled antibiotics. Results from this single trial of 53 adults that we were able to include in the quantitative synthesis showed no evidence of treatment benefit with oral plus inhaled dual therapy in terms of successful treatment of exacerbations, serious adverse events, sputum volume, lung function, and antibiotic resistance. Further high-quality research is required to determine the efficacy and safety of other combinations of dual antibiotics for both adults and children with bronchiectasis, particularly in terms of antibiotic resistance.

The Beighton score as a predictor of Brighton criteria in sport and dance.

OBJECTIVES: To determine the efficacy of using the Beighton joint hypermobility score as a predictor of Brighton criteria components, considering the influence of gender and sports participation. DESIGN: Cross sectional study design. SETTING: A University. PARTICIPANTS: Sixty-five female rugby players, 38 male rugby players, 61 netball players, 42 female dancers, 40 male controls and 40 female controls. MAIN OUTCOME MEASURES: The Beighton score was assessed using the Beighton and Horan Joint Mobility Index. The Brighton criteria was used to assess joint hypermobility syndrome. A binary logistic regression was performed for a pooled sample (n = 286), and subsequently for gender and sport to assess the Beighton score as a predictor of Brighton criteria. RESULTS: Beighton scores were found to be a predictor of arthralgia (P = 0.002), dislocation and subluxation (P = 0.048) in the pooled analysis; a predictor of dislocation and subluxation (P = 0.047) in males and arthralgia (P = 0.001) in females. Beighton scores were a predictor of arthralgia in female rugby (P = 0.003) and in female controls (P = 0.012). CONCLUSIONS: The potential of the Beighton score to predict joint arthralgia and dislocation/subluxation may allow clinicians to implement effective injury prevention strategies.

The Functional Movement Screen and modified Star Excursion Balance Test as predictors of T-test agility performance in university rugby union and netball players.

OBJECTIVES: Agility is a functional requirement of many sports, challenging stability, and commonly cited as a mechanism of injury. The Functional Movement Screen (FMS) and modified Star Excursion Balance Test (mSEBT) have equivocally been associated with agility performance. The aim of the current study was to establish a hierarchical ordering of FMS and mSEBT elements in predicting T-test agility performance. DESIGN: Cross-sectional study design. SETTING: University. PARTICIPANTS: Thirty-two female rugby players, 31 male rugby players and 39 female netballers MAIN OUTCOME MEASURES: FMS, mSEBT, T-test performance. RESULTS: The predictive potential of composite FMS and mSEBT scores were weaker than when discrete elements were considered. FMS elements were better predictors of T-test performance in rugby players, whilst mSEBT elements better predicted performance in netballers. Hierarchical modelling highlighted the in-line lunge (ILL) as the primary FMS predictor, whereas mSEBT ordering was limb and sport dependent. CONCLUSIONS: The relationship between musculoskeletal screening tools and agility performance was sport-specific. Discrete element scores are advocated over composite scores, and hierarchical ordering of tests might highlight redundancy in screening. The prominence of the ILL in hierarchical modelling might reflect the functional demands of the T-test. Sport-specificity and limb dominance influence hierarchical ordering of musculoskeletal screens.