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Single Leg Step-Down Test is Associated with Lower Extremity Injury Risk in High School Football Athletes

This study assessed the ability of a common functional test, the Single Leg Step-Down Test (SLSD) to predict athletes who might be at greater risk for lower extremity injuries and ACL injuries during the football season.

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Single Leg Step-Down Test is Associated with Lower Extremity Injury Risk in High School Football Athletes

  1. 1. Performance on the Single Leg Step Down Test is Associated with Lower Extremity Injury Risk in High School Football Athletes Matthew Choice MS, Olivia Wishman MS, Luke Bunch, DPT, Patrick Cook PT, Cale A. Jacobs PhD, Mary Lloyd Ireland MD, Julie Neumann MD, Jeremy M. Burnham MD Jeremy M. Burnham, MD Medical Director of Sports Medicine Ochsner Health – Baton Rouge
  2. 2. I have nothing to disclose. Disclosures 2
  3. 3. • Lower extremity injuries in adolescent athletes are increasing at a staggering rate • Implications of sports injuries are significant • 20% of children in the United States with sports related injuries miss one or more days of school • Pediatric patients undergoing knee ligament surgery are at risk of decreased academic performance Background & Epidemiology 3
  4. 4. • ACL Injuries numbered 95,000 in 1991 • Currently 200,000-250,000 in 2006 (Boden, Griffin et al. 2000, Mohammadi, Salavati et al. 2013) • ACL Reconstruction (ACL-R) performed 50,000 times in 1995, 100,000 in 2006, 170,000+ annually 2014 • Estimated annual cost for ACL-R is over $1.5 billion (Boden, Griffin et al. 2000) • Long term complications of OA 10-100x greater in ACL injured patients (Hewett and Myer 2011) Background & Epidemiology 4
  5. 5. Mechanism – How Does It Happen? • 70% are Noncontact • Athlete’s body position is a critical, and potentially modifiable, risk factor… (Burnham et al. 2017) • Ireland described the mechanism of non-contact ACL injuries in 1999 • “Position of No Return” • “Proximal Link to a Distal Problem” (Reiman et al. 2009)
  6. 6. Ireland, M. L. (1999). Anterior cruciate ligament injury in female athletes: epidemiology. J Athl Train, 34(2).
  7. 7. Literature – Hip/Core Strength and Injuries • Weak Abduction and ER strength, as well as increased hip adduction during gait, are associated with PFP (Ireland, Willson et al. 2003, and Noehren, Hamill et al. 2013) • Increased hip strength can decrease dynamic valgus knee loads (Myer, Brent et al. 2008) • Weak ER/Abd predictive of LE injury (Leetun, Ireland et al. 2004; Khayambashi et al. 2016)
  8. 8. Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Jr., Colosimo, A. J., McLean, S. G., . . . Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med, 33(4), 492-501. doi: 10.1177/0363546504269591
  9. 9. Core Stability & Trunk Strength • High risk knee loads are likely the result of poor control of body posture and trunk accelerations (Hewett and Myer 2011) • In non-contact ACL injury, lateral trunk motion with the body shifted over one leg, was associated with high knee abduction or medial knee collapse (Hewett and Myer 2011) • Excessive lateral trunk sway is associated with increased ACL injury risk (Zazulak, Hewett et al. 2007)
  10. 10. Hewett, T. E. and G. D. Myer (2011). "The mechanistic connection between the trunk, hip, knee, and anterior cruciate ligament injury." Exerc Sport Sci Rev 39(4): 161-166.
  11. 11. Football Non-contact ACL Injury
  12. 12. How do we measure hip & core strength?
  13. 13. Functional Tests: Single Leg Step-Down
  14. 14. Hop Tests 16
  15. 15. Return to Play
  16. 16. Hypothesis • Lower performance on the Single Leg Step Down Test and Hop Tests would correlate with higher incidence of lower extremity injuries in high school athletes • Goal: Early detection of at-risk athletes
  17. 17. Methods • SLSD and SLH tests were administered to 83 high school male American football athletes • age range 14-19, mean 16 +/- 1.24 • Participants were monitored throughout the subsequent football season for lower extremity injury • Spearman’s rank correlation was used to assess the relationship between test performance and lower extremity injury • Participants were also stratified into quartiles for each of the tests based on performance. The chi-square test was used to examine the relationship between quartiles and injury risk
  18. 18. Single Leg Step-Down Test20
  19. 19. Results • For the left leg, Lower performance on the SLSD test for the was correlated with increased LE injury risk (p=0.02) • Scoring in the lowest quartile for SLSD on the left LE was also significantly correlated with left LE injury (p=0.04, OR=4.0) • No significant relationship existed between SLH performance and LE injury, or right LE SLSD performance and right LE injury.
  20. 20. Results:
  21. 21. Results:
  22. 22. Discussion: Strengths • Prospective • Possible early identification of at risk athletes • Low cost, minimal time for a test
  23. 23. Discussion: Weaknesses • Left leg results only • Leg dominance? • Low sample size • How many of these injuries were non– contact • Application to other sports • Interventions
  24. 24. Neuromuscular Training Program • 12 week NMT program (Mandelbaum et al. 2005) • 3000 female soccer players • Education, strengthening, stretching, plyometrics, sports specific agility drills replaced traditional warm up • 74-88% reduction in non-contact ACL tears
  25. 25. Conclusion • Poor preseason performance on for the left leg on the SLSD test was associated with increased lower extremity injury risk for that leg in high school American football athletes • This test could be utilized in the future to help identify athletes at risk of lower extremity injury
  26. 26. Thank You 28