July 2014

Screening gets specific: Functional testing studies sharpen focus

In the moment: Sports medicine

7ITMsports-shutterstock_750455-v2By Jordana Bieze Foster

As evidence accumulates in support of functional movement testing for predicting injury risk, researchers are taking a closer look at how functional screening can be applied to specific athlete populations.

Studies presented in June at the annual meeting of the National Athletic Trainers Association (NATA) held in Indianapolis focused on the use of functional testing in high school versus college football players, male versus female collegiate athletes, and infantry Marines awaiting deployment.

“We really need population-specific studies, and we need to look at whether test score does predict injury in different patient populations,” said Sarah de la Motte, PhD, MPH, ATC, a research assistant professor at the Uniformed Services University of the Health Sciences in Bethesda, MD.

Physical maturity and level of competition appears to affect football players’ performance on the star excursion balance test (SEBT) of dynamic postural control, according to findings from the University of Toledo in Ohio, suggesting that clinical use of the test to predict lower extremity injury should be adjusted accordingly.

SEBT performance in 318 male high school football players differed significantly from 180 male college football players for the posterolateral, posteromedial, and composite scores; anterior reach distance was not significantly different between groups.

“Despite participating in the same sport, these athletes differ in terms of postural control,” said Ryan McCann, MSEd, ATC, a graduate student in the Department of Kinesiology, who presented the findings at the NATA meeting. “We can find some of these differences in postural control using the SEBT, which is accessible to all clinicians regardless of budget controls.”

Ideally, McCann said, researchers will be able to identify SEBT cutoff scores that are predictive of injury risk in each population. In the meantime, clinicians should be aware of the variation.

“Younger athletes may be expected to have lower scores than older athletes, so younger and older athletes may be expected to have different definitions of ‘normal,’” McCann said.

Meanwhile, researchers from Indiana University in Bloomington found that, although total score on the Functional Movement Screen (FMS) did not differ significantly between 157 male and 162 female college athletes, specific components of the seven-part screen did differ significantly between genders.

Male athletes had higher scores (indicating better performance) than their female counterparts on the push-up test, while female athletes outscored male athletes on the in-line lunge, shoulder mobility, and straight-leg raise tests. No gender differences were observed for the deep squat, hurdle step, or rotary stability tests.

“You just have to be cognizant of the fact that male athletes will be better than female athletes on the strength tests, and female athletes will be better on the range-of-motion tests,” said Ashley Allen, MS, ATC, LAT, an athletic trainer at the university who presented the findings at the NATA meeting. “We also might want to look at gender-specific cutoff scores for the different tests.”

In infantry Marines awaiting deployment, de la Motte and colleagues found that a history of musculoskeletal injury was significantly associated with FMS scores of 14 (the cutoff for injury risk in many published studies) or lower. However, the mean FMS score for the 358 Marines in the study was 13.1, suggesting significant movement deficits in the population as a whole.

Unfortunately, the investigators also found that the busy predeployment period is not ideal for implementing interventions to reduce injury risk, de la Motte said, adding that they are now looking into the possibility of screening and intervention during basic training.


McCann RS, Kosik K, Quinlevan M, et al. Differences in Star-Excursion Balance Test performance between high school and collegiate football players. J Athl Train 2014;49(3 Suppl):S-81.

Allen AE, Forbing M, Simon J, et al. Differences in performance of the Functional Movement Screen between men and women Division 1 athletes. J Athl Train 2014;49(3 Suppl):S-82.

de la Motte SJ, Lisman P, Beutler A, et al. Previous musculoskeletal injury history is related to Functional Movement Screen performance. J Athl Train 2014;49(3 Suppl):S-79.

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