PRE-PARTICIPATION SCREENING

considering the whole athlete, due to time and resource con- straints.

Issues such as the potential effects of neuromuscular decondition- ing from the rehabilitation process, the specific demands of the sport/game and the influence of player style and position will all affect the capacity of the injured athlete to return to sport. A screening programme should incorporate functional testing, as well as clinical test procedures, in an attempt to deal with these issues.

Clinical testing Standard orthopaedic testing of the injured body part and associ- ated joints should form the first stage of assessing an injured ath- lete’s potential for return to sport. Orthopaedic testing of struc- tural integrity needs to be refined towards the end of the reha- bilitation process as the findings are often more subtle than in the earlier stages of rehabilitation. During these tests the practition- er should be on the lookout for any deformities, any abnormal ranges of movement (either hyper- or hypo-mobility), and any signs or symptoms through range of movements, including active, passive, accessory and physiological movements. Orthopaedic testing should include not just the involved structure but also clearing tests of proximal and distal joints.

Functional testing Before we can screen an athlete wanting to return to a particular sport, we first need to determine the key physical demands of the sport that the athletes would be expected to cope with to safely participate in the sport. Every sport, game and player position incurs different demands. The more we are able to quantify the demands the more objective our decisions on a player’s ability to return to sport will be. Obviously, it is impossible to quantify all the demands a player will be subject to, all we can hope to do is

to identify the most likely maximum expected (key) physical demands. A Sports Key Task Analysis (SKTA) should be developed for each sport, which focuses on the key demands of the sport, and incorporates some consideration of player position. The use of a SKTA to plan a screening programme should not replace stan- dard orthopaedic testing, but rather enhance it.

I recommend that when developing a SKTA the physical demands be divided into a range of categories: a) muscular strength b) power c) muscle endurance d) flexibility e) cardiovascular f) coordination g) balance h) reaction times.

In clinical practice I use a basic SKTA for each of the main sports I encounter in my patient population with some room for vari- ability based on player position. Some positions have key physi- cal demands that are significantly different to those of other posi- tions in the same team. Compare the key physical demands of a goalkeeper to a midfield player in football. Sports such as tennis have less obvious differences in SKTA’s, however player style (baseline hitter, compared to net player) may affect the key demands on the athlete.

Development of a SKTA should be done in consultation with the team trainer, coach and/or athlete. Once a SKTA is developed the functional pre-participation screening programme follows auto- matically as we attempt to match the athlete’s capacity with the identified physical demands.

TABLE 2. FINDINGS FROM GENERAL SCREENING PROGRAMMES (ADAPTED FROM TAYLOR 1999 (1)) Reference

DuRant et al 1992 (13)

Study design Survey

Subjects Measurements physical exam Results

674 males Questionnaire and • Knee injuries associated with previous knee injury, knee surgery and history of injuries requiring medical treatment • Ankle injuries related to previous ankle injury and history of injuries requiring medical treatment • Athletes with abnormal knee or ankle findings more likely to injure the knee/ankle, but sensitivity and specificity is low

Knapik et al 1991 (19)

Cohort 138 females Isokinetic knee • Increased incidence of lower extremity injury if; right knee flexor 15% stronger than left knee flexor, right hip extensor 15% more flexible than left hip extensor, knee flexion/extension ratio of less than 0.75 at 180 degrees per second

strength and general flexibility

Abdenour and Survey 42 gender Weir 1986 (4) Gomez et

unknown Survey al 1993 (11) and exam

History questionnaire • High correlation between injuries detected by the questionnaire and the physical exam

and females screening exam, full orthopaedic exam

Meeuwisse and Cohort 712 males Fowler 1988 (5)

Laure 1996 (6) Survey and females exam

259 males 2 minute orthopaedic • Sensitivity of screening 50.8% • Specificity of screening 97.5%

History and general • Medial tibial stress syndrome in female runners predicted by pain on palpation of the posterior tibia • All other factors not significant in predicting injury

150 males Questionnaire on • 36% of athletes reported having had bad quality pre-participa- tion sports examinations • No significant difference between age and gender.

and females impression of pre- participation sports

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