Pre- and postmatch hop test outcomes in soccer players returning to performance after lower extremity injury.

BACKGROUND: Most soccer injuries concern the lower extremity with a higher injury rate during the second half of matches. In advising safe return to sport, hop tests are usually assessed at the point of return to sport under non-fatigued conditions. No studies exist investigating hop test outcomes before and after a match in soccer players returning to performance after lower extremity injury and non-injured teammates. The objective is to assess differences in hop test outcomes before and after a match in and between soccer players returning to performance after lower extremity injury and their non-injured teammates. METHODS: A repeated-measures design was used to measure outcomes on five hop tests before and after a soccer match. For analyzing differences in hop tests before and after a match, paired sample t-tests were used. Independent t-tests were used to analyze differences between soccer players after injury and non-injured teammates. Effect sizes were calculated using Cohen's d. RESULTS: Hop tests were completed by 61 amateur soccer players after injury and 121 non-injured teammates. Differences in hop tests before and after the match within both groups had negligible to small effect sizes (d=0.00-0.49), except for the figure of 8- and 30-seconds side hop in the injured leg of RTPf soccer players (d=0.56 and d=0.71 respectively). Differences between both groups were negligible to small (d=0.00-0.36). CONCLUSIONS: Soccer players returning to performance after a lower extremity injury showed similar scores on hop tests than their non-injured teammates. More demanding sport-specific performance test and measurement of quality of movement are additionally recommended for safe return to sport decision-making.

The Non-injured Leg Can Be Used as a Reference for the Injured Leg in Single-legged Hop Tests.

BACKGROUND: Single-legged hop tests are frequently used in substantiating return to sport decisions following lower extremity injury. Evidence for using the non-injured leg as a reference for the injured leg in the return to sport decision-making at the criterion-based point of return to sport following lower extremity injury is lacking. PURPOSE: To compare absolute values in single-legged hop tests between the non-injured leg of athletes returning to high-impact sports after lower extremity injury and the matched leg of healthy athletes. STUDY DESIGN: Cross-sectional study. METHODS: One hundred and sixty-nine athletes returning to high-impact sports after lower extremity injury and 169 matched healthy athletes executed five single-legged hop tests. Differences between athletes returning to high-impact sports after lower extremity injury and matched healthy athletes on five single-legged hop tests were analyzed using paired t-tests. RESULTS: There were no statistically significant differences between the non-injured leg of athletes returning to sport and the matched leg of healthy athletes. Effect sizes ranged from 0.05 to 0.14 indicating negligible effects. CONCLUSION: Clinicians can use the non-injured leg as a reference for the injured leg in single-legged hop tests for deciding on return to high-impact sports after lower extremity injuries. LEVEL OF EVIDENCE: 3b.

Association between Functional Performance and Return to Performance in High-Impact Sports after Lower Extremity Injury: A Systematic Review.

After lower extremity injury, only half of the injured athletes return to their pre-injury sports level. Even though functional performance tests are often used to make return to sport decisions, it is unknown whether functional performance is associated with return to performance after such injuries. The aim of this systematic review was to identify, critically appraise, and analyze studies that investigated the association of functional performance tests with return to performance after lower extremity injuries in athletes participating in high-impact sports. MEDLINE, Embase, Web of Science, and CINAHL were systematically searched for relevant studies. Articles were independently screened by two authors and data were obtained from each included study using a data extraction form. Two authors independently scored methodological quality using the Quality In Prognosis Studies tool. A qualitative best evidence synthesis was conducted. Eight studies reported the association of functional performance with return to performance after lower extremity injuries, involving 1,246 athletes after anterior or posterior cruciate ligament reconstruction. No studies were found on the association of functional performance with return to performance for lower extremity injuries other than after anterior or posterior cruciate ligament reconstruction. All included studies had a high risk of bias. Two studies found significant but small associations for selected hop tests after anterior cruciate ligament reconstruction. Low evidence of association between functional performance and return to performance was present after anterior cruciate ligament reconstruction for the triple hop for distance, the 6-meter timed hop, the side hop in female athletes, and for the combination of the single and crossover hop for distance. In athletes after posterior cruciate ligament reconstruction, the vertical jump showed a significant but small association with return to performance. There is no high-quality evidence that functional performance is associated with return to performance after lower extremity injuries in athletes practicing high-impact sports. Low quality evidence suggests small associations after anterior and posterior cruciate ligament reconstruction. No evidence exists for lower extremity injuries other than after anterior or posterior cruciate ligament reconstruction. Therefore, research on functional performance associated with return to performance is recommended in high-quality prospective cohort studies including athletes with any type of lower extremity injury.

TRANSLATION AND VALIDATION OF THE DUTCH INJURY PSYCHOLOGICAL READINESS TO RETURN TO SPORT SCALE (I-PRRS).

BACKGROUND: In facilitating and predicting successful return to sport (RTS), not only are physical factors important, but also the athlete's psychological status. No questionnaire in the Dutch language exists for measuring psychological readiness for RTS after injuries in general. PURPOSE: To translate and validate the Injury-Psychological Readiness to Return to Sport scale into the Dutch language. STUDY DESIGN: Cross-sectional, validation study. METHODS: One hundred and sixty-eight athletes, returning to high impact sports after lower extremity injuries, completed the Dutch I-PRRS twice. Another 162 athletes who visited their physical therapist for initial intake also completed the questionnaire. Floor and ceiling effects, internal consistency, reproducibility, construct validity, and divergent validity were analyzed. RESULTS: The I-PRRS was successfully translated into Dutch and showed no floor or ceiling effects. It had good internal consistency (0.85) and good test-retest reproducibility (ICC 0.74, 95% CI 0.43-0.86) where the lower bound of 95% CI indicates at least fair reproducibility. The SEM was 2.02 and the MDC 5.58 points. There was a significant fair correlation between total scores on the I-PRRS and TSK (rs = 0.41, p<0.001). Athletes who RTS and those who initially visited their physical therapist differed significantly on all items and on total scores (p<0.001). CONCLUSIONS: The I-PRRS was successfully translated into Dutch and can be administered to athletes with lower extremity injuries who have clearance to RTS. The MDC of 5.58 on the total score indicated that with a score below six, there is no noticeable change outside the measurement error. For measuring and monitoring psychological readiness for RTS, the use of the Dutch I-PRRS is recommended for Dutch physical therapists. LEVEL OF EVIDENCE: 3b.

The effect of a 3-month prevention program on the jump-landing technique in basketball: a randomized controlled trial.

CONTEXT: In jump-landing sports, the injury mechanism that most frequently results in an injury is the jump-landing movement. Influencing the movement patterns and biomechanical predisposing factors are supposed to decrease injury occurrence. OBJECTIVES: To evaluate the influence of a 3-mo coach-supervised jump-landing prevention program on jump-landing technique using the jump-landing scoring (JLS) system. DESIGN: Randomized controlled trial. SETTING: On-field. PARTICIPANTS: 116 athletes age 15-41 y, with 63 athletes in the control group and 53 athletes in the intervention group. INTERVENTION: The intervention program in this randomized control trial was administered at the start of the basketball season 2010-11. The jump-landing training program, supervised by the athletic trainers, was performed for a period of 3 mo. MAIN OUTCOME MEASURES: The jump-landing technique was determined by registering the jump-landing technique of all athletes with the JLS system, pre- and postintervention. RESULTS: After the prevention program, the athletes of the male and female intervention groups landed with a significantly less erect position than those in the control groups (P < .05). This was presented by a significant improvement in maximal hip flexion, maximal knee flexion, hip active range of motion, and knee active range of motion. Another important finding was that postintervention, knee valgus during landing diminished significantly (P < .05) in the female intervention group compared with their control group. Furthermore, the male intervention group significantly improved (P < .05) the scores of the JLS system from pre- to postintervention. CONCLUSION: Malalignments such as valgus position and insufficient knee flexion and hip flexion, previously identified as possible risk factors for lower-extremity injuries, improved significantly after the completion of the prevention program. The JLS system can help in identifying these malalignments. LEVEL OF EVIDENCE: Therapy, prevention, level 1b.

A 3-month jump-landing training program: a feasibility study using the RE-AIM framework.

CONTEXT: Evaluating the translatability and feasibility of an intervention program has become as important as determining the effectiveness of the intervention. OBJECTIVE: To evaluate the applicability of a 3-month jump-landing training program in basketball players, using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. DESIGN: Randomized controlled trial. SETTING: National and regional basketball teams. PATIENTS OR OTHER PARTICIPANTS: Twenty-four teams of the second highest national division and regional basketball divisions in Flanders, Belgium, were randomly assigned (1:1) to a control group and intervention group. A total of 243 athletes (control group = 129, intervention group = 114), ages 15 to 41 years, volunteered. INTERVENTION(S): All exercises in the intervention program followed a progressive development, emphasizing lower extremity alignment during jump-landing activities. MAIN OUTCOME MEASURE(S): The results of the process evaluation of the intervention program were based on the 5 dimensions of the RE-AIM framework. The injury incidence density, hazard ratios, and 95% confidence intervals were determined. RESULTS: The participation rate of the total sample was 100% (reach). The hazard ratio was different between the intervention group and the control group (0.40 [95% confidence interval = 0.16, 0.99]; effectiveness). Of the 12 teams in the intervention group, 8 teams (66.7%) agreed to participate in the study (adoption). Eight of the participating coaches (66.7%) felt positively about the intervention program and stated that they had implemented the training sessions of the program as intended (implementation). All coaches except 1 (87.5%) intended to continue the intervention program the next season (maintenance). CONCLUSIONS: Compliance of the coaches in this coach-supervised jump-landing training program was high. In addition, the program was effective in preventing lower extremity injuries.

Efficacy of a 3 month training program on the jump-landing technique in jump-landing sports. Design of a cluster randomized controlled trial.

BACKGROUND: With the relatively high rate of injuries to the lower extremity due to jump-landing movement patterns and the accompanied high costs, there is need for determining potential preventive programs. A program on the intervention of jump-landing technique is possibly an important preventative measure since it appeared to reduce the incidence of lower extremity injuries. In real life situations, amateur sports lack the infrastructure and funds to have a sports physician or therapist permanently supervising such a program. Therefore the current prevention program is designed so that it could be implemented by coaches alone. OBJECTIVE: The objective of this randomized controlled trial is to evaluate the effect of a coach supervised intervention program targeting jump-landing technique on the incidence of lower extremity injuries. METHODS: Of the 110 Flemish teams of the elite division, 24 teams are included and equally randomized to two study groups. An equal selection of female and male teams with allocation to intervention and control group is obtained. The program is a modification of other prevention programs previously proven to be effective. All exercises in the current program are adjusted so that a more progressive development in the exercise is presented. Both the control and intervention group continue with their normal training routine, while the intervention group carries out the program on jump-landing technique. The full intervention program has a duration of three months and is performed 2 times a week during warm-up (5-10 min). Injuries are registered during the entire season. DISCUSSION: The results of this study can give valuable information on the effect of a coach supervised intervention program on jump-landing technique and injury occurrence. Results will become available in 2011. TRIAL REGISTRATION NUMBER: NTR2560.