Should we still be doing screening for risk of injuries?

Pre-season and periodic in season screening for risk for injuries in athletes is commonly used in most sporting environments. A common one is the Functional Motor Screening tool (FMS) developed by G. Cook in 2001, which aims to identify deficits or imbalances in movement patterns which may cause an increased risk for injury. A critical review of injury screening tools highlighted that screening tools may not be able to predict injury as we currently think they do. I have been through the process of pre-season screening from my days as a rugby player. During my time at the WPRI in Stellenbosch I was put into a stratified rehab group, where I spent time working on reducing imbalances identified in my movement patterns. This was done with individual sessions on an isokinetic machine, as well as in group preventative rehab (‘prehab’) sessions. Ironically I still got the same injury throughout that particular season. Working now in the sports physiotherapy industry, and having done research for my masters degree on injury prevalence in endurance sports, and I am asking the question more- can we predict injuries, and if so what tests should we use.

A review by Bahr (2016) talks about the need for injury screening tools to follow a three-step process in their development: 1) identify strong relationship between screening test markers and risk for injury (i.e. epidemiology studies); 2) validate the test and cut-off values in relevant populations; and 3) intervention programs should be beneficial for athletes identified as being high risk. The biggest issue it seems is the question as to whether the tests used are beneficial to the athletes? Injury screening tools place athletes in a continuous spectrum of risk for injury (low to high), whereas the goal should be to identify risk as yes or no. Changing the risk from low to high does not necessarily remove the risk of injury. What these tests do give us is an understanding of causation for getting the injury, but they cannot predict future injuries sufficiently. This may not be a benefit to athletes as the potential for injury is still there. I don’t believe it is possible, though, to remove the risk for injury completely as the risk factors are multi-faceted. Both internal and external factors play a big role in getting an injury; and currently injury prevention involves lowering these risks as much as possible rather than removing them all together.

My opinion on the use of screening tools, particularly in team sports, is that there is definitely benefit from using them. The IOC developed a consensus statement on periodic health evaluation of elite athletes, with building rapport between the athlete and the medical team a noted benefit. From my own experience as an athlete, you definitely do build a good relationship with the physio and other medical staff during these screening processes. As an athlete you feel like you are becoming part of the system, part of a process to improvement of your sporting performance. Being placed into the ‘prehab’ group I believe has a positive effect on the mentality of an athlete, as it puts you into a space of self-improvement. That mentality builds good trust with the medical team for future injuries and issues that may arise.

From the other perspective now as a sports physio, it is evident that the findings of these screening tools do not predict injuries. They do give insight into understanding causation of getting the injury, which I believe adds weight to injury prevention? We know that the six-stage model of injury prevention (Finch, 2006) indicates that in order to prevent an injury, we need to be able to measure the effectiveness of the intervention. Improving the score on a FMS, for example, has not shown to remove the risk for injury, only it improves the quality of movement and control. This may lower the risk for getting a particular injury during a season (not remove the risk), and give both coach and player a better chance at success throughout the season. The question though remains- is this injury prevention? The science is not there to back this up. From personal experience in this field as a player and as a physio is that addressing imbalances can definitely improve your movement patterning and perhaps sporting performance. Mentally this makes a big difference for athletes, even if it may not be remove the risk of injury.

Practically there are two things I believe we should be doing as part of the medical team:

  1. a blanket injury prevention program for all athletes in the team setup (based on the needs of the sport) should be implemented. This should aim to address known causative factors for injury in that particular sport.
  2. screening should still be done individually as it provides a platform for building rapport and identifying any other musculoskeletal conditions/previous injuries that require medical attention throughout the sporting season.

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