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Athlete Screening

Discussion in 'Biomechanics, Sports and Foot orthoses' started by RobinP, Oct 14, 2010.

  1. RobinP

    RobinP Well-Known Member


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    Dear All,

    Having had a moderate amount of success treating some athletes at a local athletics club with foot ankle injuries, I have been asked to do some "screening" with some of the higher level runners with a view to injury prophylaxis. Does anyone have any experience of doing screening as opposed to treating injury?

    I'm not really sure about this type of work. On the one hand, I think that using various kinetic tests would allow me to build athlete profiles for potential injury "hotspots". I wouldn't necessarily start making biomechanical alteraltions using foot orthoses unless they became injured. If the injury fitted the profile that I gave the athlete, then I would be the first point of contact.

    On the other hand, I think that the majority of them will be looking for kinematic analysis and treatment based on what the video analysis shows, regardless of their lack of current injury or kinetic signs to warrant treatment.

    If anyone does do this, do they have any suggestions about valid tests and their predictors of injury.

    Thanks

    Robin
     
  2. "Screen 'em all you like, you won't predict injury without some very sophisticated multivariate models- which we don't have. You know the saying- "you could get run over by a bus tomorrow"- yeah, that'll be the one. Measure their kinematics, measure their kinetics, you still won't pick the ones who'll get injured from those who won't. Suggestions of "pissing in the wind", Sir? Er, Yes.
     
  3. RobinP

    RobinP Well-Known Member

    Fair enough. So not worth even looking at them until they are injured?

    But I can't make any money out of that!

    Robin
     
  4. Griff

    Griff Moderator

    Hi Robin,

    I do some work for a rugby club, and this usually involves a screening clinic for all of their squads, including the juniors.

    It's always a tricky one, as in your mind you keep wanting to drift back into the motion paradigm. "Surely those rearfoot kinematics will be pathological... oh right I remember the prospective studies said they might not be"... is the kind of internal monologue you have to battle with. Not to mention the fact that every single person you see (and their parents/coach/physio) will be telling you that their 'flat feet' are abnormal. If they are asymptomatic and you explain that you will not intervene they will look at you as if you are a rogue trader. The whole room thinks these feet are bad, but you, the foot specialist, don't seem to. You feel about as out of place as a penis in a box of chocolates.

    Personally when screening I keep things fairly simple, as most days I do it I am seeing 30-40 players in a morning. A brief subjective history, particulary regarding previous injuries. A quick non weightbearing examination looking at range and quality of motion at hip, knee, ankle, subtalar joint and 1st MTPJ. A cursory glance at relaxed calcaneal stance position to check they are not maximally pronated at the subtalar joint (esp with the kids). Ask them to perform a small single knee bend and see how they can control it (both proximally and distally). Then the 3 old faithfuls: Supination resistance test, Jacks test, and a weightbearing lunge test. Done.

    Once they are done in my room they move next door to the Physio who also does an incredibly brief screening of more proximal things (such as scapula control and all sorts of other things that I don't understand). We then liase and generate a full report for each player and that goes to the manager and strength and conditioning coach.

    Sounds fancy but often the Physio and I grab a bite to eat after and discuss which ones we think may be at risk of injury. A: Not an effin clue. Do I enjoy doing them? A: Not really.
     
  5. Griff

    Griff Moderator

    Just saw Spooner posted this whilst I was typing out my post.

    Nailed it.
     
  6. I thank you.:drinks P.S. in rugby, locks are more likely to get injured than any other position. So when the 6' 6" guys walk in, tell 'em they're going to get injured.
     
  7. Asher

    Asher Well-Known Member

  8. RobinP

    RobinP Well-Known Member

    What if it were a box of....chocolate penises?;)
     
  9. moe

    moe Active Member

    Look at the lunge test thread and the Gabbe et al (2004) re football injuries and correlation with the lunge test
     
  10. Griff

    Griff Moderator

    I agree:

    It's about as good as screening tests get.

    But.... the research only tells us that increased ankle joint dorsiflexion stiffness may increase an individuals risk for lower extremity injury. Will everyone who 'fails' the lunge test definately get a lower extremity overuse injury? Probably not. Are we still pissing in the wind? Probably.
     
  11. "Despite the large number of potential risk factors studied and the high incidence of lower extremity injuries in the cohort, a definitive individual injury risk profile for all lower extremity injuries was not identified"
     
  12. Ian Linane

    Ian Linane Well-Known Member

    It is pickle. In my neck of the woods it tends to be the distance or marathon runner that comes, often carrying similar injuries and you think can't we at least look at doing something.
     
  13. Robin:

    If you have the equipment and time, it would be nice to do some slow motion video analysis of their running stride from both posterior and lateral along with in-shoe pressure analysis, pressure mat analysis and/or force plate analysis. By looking at the differences of the kinetics and kinematics of the different runners, you may be able to start to see some correlations of potential "hot spots" in the foot and lower extremity that may experience injury and suggest changes.

    However, if you don't have the equipment and time, then I would do a quick lower extremity evaluation and then watch them walk and run both barefoot and in their shoes to try and accomplish the same thing. This is a great opportunity for you to watch and analyze various athletes perform in a controlled setting...the experience will be invaluable, no matter how you do it.
     
  14. Isn’t athlete screening what a lot of our local specialists running shops do when they look at people on the treadmill and select a particular running shoe? The local shop near me has been known also to put heel raises and rearfoot wedges in peoples shoes. I have had several pt's attend clinic saying ' I have a leg length difference' or 'they watched me run on the treadmill and I pronate'. When I ask, what their problem is, the response is often 'I don't get any pain!’

    The point is that runners are a funny breed (I should know, I married one!!) and are often in pursuit of what will make them a faster runner, more efficient runner. These can be both the most interesting and /or frustrating pt's as they may wish to purchase the worlds best casted FFO even after you tell them that they are not required.

    Screening is difficult, because biomechanically if you go looking, then you will find something. You are unlikely to find perfect as what is perfect?

    If looking at asymptomatic runners you may wish to only go as far as a history as previous injuries may give an indication of possible injury prevention and you can then look at injury patterns and advise, treat etc.

    Regards

    Gareth
     
  15. RobinP

    RobinP Well-Known Member

    This is what concerned me initially about doing screening when asked.

    I have turned down doing paediatric screening clinics in the past as I have stated my feelings about a local practitioner who will treat any child with an RCSP of 4 degrees eversion.

    I'll give them the facts and they can decide if they still want to do it . However a brief conversation I had with one of the athletes indicated that the screening was of people who were carrying injuries which were not necessarily enough to completely stop training.

    Isn't that every athlete though?

    Robin
     
  16. Griff

    Griff Moderator

    Er... no.
     
  17. RobinP

    RobinP Well-Known Member

    Hi Kevin,

    I have some basic slow motion analysis software but no force plate and I do not have great amounts of time. I think if I was going to do something, what I had in my head was what Ian Griffiths suggested although i didn't have single knee bend test on my list.

    I receive a lot of referrals because I am known for not treating patients unnecessarily and I am keen to draw a line between offering advice and treating pathology. I suppose if I could do that successfully, I would welcome the opportunity to do as you have suggested

    Thanks

    Robin
     
  18. CraigT

    CraigT Well-Known Member

    Interesting little thread this one-
    A couple of points...
    One thing I like about doing screening is that you DO see people who have biomechanics which are difficult to fault- remember that most people who seek treatment do so because of a problem, so they are more likely to have some form of issue. It is easy to forget there are 'normals' out there, and it is a good experience.

    I think there can be sub-clinical signs which may suggest overload- medial tibial tenderness, plantar intrinsic tenderness etc... In addition to this, speaking to the individuals, going through their history and describing any abnormal biomechanics that you see may reveal problems which have not been noted before- you may be 'joining the dots' for them.
     
  19. Also Robin it´s a great promo for you - maybe the kids have problems or the parents. I bet you get more than the 1 My child has this or Ive got this pain - outcomes the business card book in a time so we can really assess the issues and find a solution.
     
  20. was ment as irronic!!



    yes very much so...if i didn't run every time something, somewhere hurt then i would never run.

    regards

    Gareth
     
  21. mr2pod

    mr2pod Active Member

    I have had some experience in this with football clubs (australian rules). It provides a great promotion and point of contact for anyone associated with the club whether it be the athlete, trainers or family and friends.
    I have previously kept it very simple. A history of problems is always the 1st thing I would do, and range of motion and gait anaylisis tests and assessment of footwear. Bare in mind you normally have very limited time! If you see anything that might be considered "abnormal" I note it down, with a suggested referral to podiatrist, physio or other health professional you think is required. This was all recorded on a screening form that the coaches were provided with after I had photocpied them for my own records so if someone came to my clinic i could refer to it.
    You will find that even if they have no problems at all, they will appreciate your time and reassurance that there are no issues.
     
  22. Griff

    Griff Moderator

    I guess this is the key point of the debate though - when assessing asymptomatic athletes what is an 'abnormal' finding??
     
  23. Moreover, how do you predict those who will get injured? Yes you can go and sell yourself, but how do you segregate those who will get injured from those who won't? How many of you who do these "screenings" actually say to an individual: "You're going to get injured in the next X number of weeks" and actually get it right 95% of the time? None of you. My contention, it's a marketing tool, nothing more.
     
  24. mr2pod

    mr2pod Active Member

    Agreed. You can't predict injury. It is a marketing tool, but whenever I've gone to these screening sessions for so called asymptomatic people I have always found that a few of the athletes have actually complained of something - given the mentatility that if the coach knows they may be rested....
    So I have never predicted injuries only dealt with what was present.
     
  25. Sammo

    Sammo Active Member

    Greetings all,

    Been a little while.. Just thought I'd pitch in before my afternoon coffee..

    In my experience, sports people often tend to sit on an injury for a while, or try and train through it, before doing anything about it.. Especially if it is something insidious and chronic like plantar fasciitis and "shin splints" etc...

    So with regular screening and questioning you may pick up injuries earlier than the patient would go to seek treatmentm thus fixing them earlier and getting a brownie points for that.. And even if you've fixed them for free it's all good exposure and will keep you in the forefront of the athletes mind, should they need to think about lower limb injury..

    Regards,

    Sam
     
  26. RobinP

    RobinP Well-Known Member

    Hi Sam,

    As it happens, this was the case for the athletes who I saw and treated successfully, hence being offered the screening. They had niggling injuries which, whilst not stopping them from training, meant that they were unable to put in the training time they felt was necessary for the level at which they were competing.

    I'm still not happy with the idea of injury predictor screening for all the reasons mentioned. And it looks like building up some sort of injury "profile" is moot based on the research.

    Undeniably good as a marketing tool. I suppose one can only be honest with the people who are making the request.

    On the other hand, would I rather they went to someone else who told everyone with "abnormal" kinematics(or kinetics for that matter - assuming they understood the difference) that they needed treatment! Moreover, if I told everyone that they didn't need treatment until they were injured, I would probably look like a complete moron to them!

    I presume the research for kinematic/kinetic force alterations is the same for performance improvement? Anyone tend to see any patterns though?

    Robin
     
  27. Robin you will not look like a moron if you explain to them what your doing. Explain tissue stress and the use of mechancis to treat stressed tissues explain that there are no true relations between position and injury. Explain how things have changed. ie in the ealry 90´s it was this way now we know that is was wrong and this is how we do things. If they look at you funny use the red wine example and medicial research. One day aglass of wine will keep you alive and stop heart problems the next it will kill you - they will understand that is its in the papers so often.

    If they don´t like what they here and want orthotics for every player who ´overpronates´ tell thats not what it´s about and say no thanks and sleep well at night.

    ps the other paper is related to performance and leg stiffness.
     
  28. RobinP

    RobinP Well-Known Member

    Thanks for the papers Michael. I intend to do as you suggest. they can make up their minds after that.

    Cheers

    Robin
     
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