REHABILITATION

ticipation screening is poor. The link between risk factors and injury is often well established in the literature (2). However, our ability to predict whether the presence of a risk factor will lead to an injury (predictability) is not supported by the evidence in the literature. A measure of predictability is vital for the clinician per- forming pre-participation screening of the injured athlete.

This paucity of literature reflects: a) The multitude of factors that may lead to a sports injury occurring, many of which are not included in the research. External risk factors such as weather, equipment used, playing surface and standard of competition will influence the risk of injury (2). All of the studies appear to aim at the physical capacity side of the return to sport equation without attempt- ing to quantify the physical demands side. Only two general screening studies attempted to quantify the demands of the sport, via contact risk (9) and cardiovascular demands and body parts at risk of injury (17). b) The lack of a validated screening protocol. Researchers need to collaborate with clinicians to design a standardised screening

protocol, which is reproducible and repeatable in the clinic. This standard protocol could then be used in risk analysis and in the analysis of predictive values. The Australian Institute of Sport have recently brought out a book titled “Screening Test Protocols” which addresses some of these issues. If there was a standardised protocol for screening, then databases could be used to pool results from clinicians. Statistical analysis could then be performed which could provide strong evidence, based on the number of subjects involved, and the standardised nature of the examination. Development of such programmes and vali- dation through the collection of data in practice will allow the profession to provide evidence for the efficacy of the pre-partic- ipation screening process.

DEVELOPING A STANDARDISED PROGRAMME Traditional pre-participation screening assessments have general- ly focused on standardised orthopaedic assessment of structural integrity, musculoskeletal alignment, neuromuscular testing and measurement of cardiovascular function (18). In clinical practice there is a tendency to focus on the clinical presentation without

Results • Ankle dorsiflexion range significant predictor of injury • Abnormal stabilometry values ran a significantly higher risk of ankle injuries • No relationship between previous ankle injury and risk of further injury • Eversion:inversion strength ratio significantly greater for injured group • Plantar flexion strength and dorsiflexion:plantarflexion ratio significantly different for the injured ankle compared to the contralateral ankle

• Limbs with medial tibial stress syndrome had significantly less standing foot angle than controls • Heavy subjects and increased Q angle more likely to have patellofemoral stress syndrome

• Significant relationship between foot type and knee pain • No relationship between foot type and ankle sprain • Knee recurvatum, excessive navicular drop and excessive subtalar joint pronation significant discriminators between ACL injured and non-injured groups

• Unequal strength ratio for hamstrings : quadriceps significant to hamstring injury • No statistical difference between injured and non injured • No difference in hamstring flexibility between injured and non-injured

• Not able to accurately predict plantar fasciitis in runners

• Ankle sprains related to; increased height, lower body mass index, higher incidence of posture defects of the ankle and knee, more clinical defects, higher incidence of lower limb proprioceptive deficits

• Bilateral weight difference and abnormal right Q angle variables can predict injury status in 91% of players

• Player position and previous injury was not significant • High playing time was associated with increased injuries • Low vigor and high fatigue predicted injuries

• Nine variables represented significant difference between low and high risk athletes; weight, height, age, mesomorphy, quetelet index, shoulder flexion, lumbar extension, standing lumbar curve and total peripheral flexibility

• Ankle injuries related to lower score of ankle mechanics • Knee injury related to lumbar lordosis and sway back • Strains related to lumbar lordosis, sway back and abnormal knee interspace • Back injuries related to poor shoulder symmetry, scapulae abduction, back asymmetry, kyphosis, lordosis and scoliosis • Two or more injuries were related to a lower overall body mechanics score.

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