Most of our patients come to see us after they have suffered an injury, and we are happy to help them; but in the world of professional sports, one of Physiotherapists responsibility is to prevent injuries from actually occurring in the first place. This occurs through pre-season screening and injury prevention or “prehab”.
Screening is designed to identify intrinsic or individual factors that may predispose a player to both acute or overuse injury. Identifying musculoskeletal deficits or abnormalities and instituting appropriate intervention is in turn designed to reduce injury. There have been numerous studies in local and overseas football leagues that have shown great results.
So what does the physio assess and measure and can it be used to prevent injuries in the normal population?
A typical screening includes:
- Strength
- Joint and Muscle range of motion
- Functional Movement
- Age
- Hyper/hypomobility
- Functional-specific testing related to the individuals sport
Strength:Strength is relatively easy to measure and a lack of strength is a good indicator of future injury. A neat trick for objectively measuring strength is to use a sphygmomanometer to measure the force generated by an isometric muscle contraction. In football we measure commonly injured muscles (hamstrings, groins, hip flexors), but shoulder strength and lower back endurance can also be accurately assessed using these methods. If weakness or imbalance is found exercises are given to strengthen that area.
Normal Range of movement: We measure joint and muscle range of movement using standard orthopaedic tests and a goniometer or tape measure. Where possible we aim to improve range of movement with flexibility programs or manual therapy. While it is not always possible to improve range of movement at a joint, deterioration in range of movement during the season from baseline is a good indicator of when treatment or rest is needed.
Functional Movement: We assess functional movements such as squats, walking and running to see if there are problems with normal movement patterns. These can be addressed through stability and functional exercises in many cases. The most common problems we see here are usually related to weakness in the core and glute med muscle groups in the lower limb and scapula dyskinesia in the upper limbs.
Age, Hyper/Hypomobility, Foot Posture: These are examples of factors that we measure even though we cannot directly influence them. However it is important to be very aware of them for reasons such as training load, footwear and prehab exercises. For example we can’t change age, but for older athletes we are aware they will have a greater need for recovery whereas a younger athlete may be at risk for certain injuries such as groin injuries in adolescent soccer players. Athletes who are hypermobile need less stretching and more stability and the reverse is true for hypomobile athletes.
These tests are crucial for professional athletes however they can also be very helpful for the average population. In particular for individuals who are about to commence an exercise or weight loss program, or for people who have had a recurrent injury or injuries. The value of screening like this is in providing objective measures of factors that are known to increase the chance of injury so that they can be addressed in a straight forward and systematic injury prevention plan.