Musculoskeletal Screening

The runners we send to the Olympics are not necessarily our top runners, but they are very good runners who have avoided injury at critical times” (Daniels, J. 2005 ix)  This quote is equally applicable to all sports.

Studies have estimated that between 47% – 75% of triathletes sustain overuse injuries during each season (Burns et al 2005).  The risk factors that contribute to athletic injury are extrinsic (independent of the athlete) and intrinsic (inherent to the athlete) in nature.  Extrinsic factors are difficult to avoid, however, the intrinsic factors can be reduced to a minimum.

Physiotherapy musculoskeletal screening falls within the continuum of athlete testing procedures, with injury prevention at one extreme (where, arguably, the science of medical screening by a doctor and full scientific testing would come) and pure performance enhancement at the other (screening by a strength and conditioning specialist). In this continuum, musculoskeletal screening comes somewhere midway.  Given that there is a direct relationship between the ability to train and the competitive performance, and that failure to achieve optimal training loads is primarily due to injury, the screening process plays a secondary role in optimising competition performance by keeping the athlete injury free (McLean, B).  Therefore if you manage to prevent even one injury during the season by correcting a biomechanical problem highlighted during screening, that athlete will have performed better.

At a more technical level, musculoskeletal screening is invaluable for revealing deficits in muscle/ joint flexibility and in muscular stability/control, any biomechanical faults, or asymmetry between the left and right sides that might lead to overuse injuries.  Although these relationships between deficits and injuries are difficult to prove, the popularity of musculoskeletal screening among professionals over the last few decades lends a heavy weight of anecdotal and clinical evidence to support its efficacy.

A second core aim of screening is to record the details of significant past injuries, and to assess for any ongoing effects on the mechanics of the injured and non-injured parts of the body.  Recording of injury rates and areas of injury across the whole of a season, or several seasons, can enable us to identify and correct any patterns of injury which may arise from any number of external factors, such intensity of training or competition, etc.  Thus aiding the coaching staff in the delivery of the long term athlete development programme, and enhancing the athletes’ willingness to adhere to their training regimes.

Screening is best carried out during the out of competition phase, or off season.  This is a time when training loads are reduced and athletes are injury free, allowing them to focus on any specific injury preventative measures.

Once the findings have been collated into a report for the athlete and their coach, detailing strengths, weaknesses and recommendations, a follow up session is then required.  This allows the coach and athlete (and parent if dealing with young athletes) to fully understand what is the recommend action.  If any relevant factors are detected, the athlete will be prescribed an individualised training programme to rectify the fault and reduce the risk of future injury.  What I have found to be most beneficial is to identify 3 action points, and 3 monitor points.  The action points are the specific exercises or stretches to be done, and the monitor points are any potential issues which the coach should keep a close eye on.

Ideally, this screening would be done at the end of the competitive season prior to the winter training, and then 4-6 weeks before the competitive season a follow up to ensure there have been no new problems arising over the winter, and that the previously identified issues have been addressed by the athlete and their coach.

So in summary, the purpose and benefits of the screening are thus:

Highlight any predisposing factors that may lead to injury

Reveal risk factors to injury so that personalised interventions can be used to rectify any musculoskeletal problem areas and hence reduce the likelihood of future injury

Prescreen athletes before events to ensure they are fit and injury free for competion

Assess any current injuries

Assess any deficit resulting from previous injuries

Assess any musculoskeletal factors that may impact on performance

Provide individual injury prevention programmes based on results.

Tim Pigott

Sports Physiotherapist

References:

Burns, J., Keenan, A-M., Redmond, A. (2005) Foot type and overuse injury in Triathletes.  Journal of the American Podiatric Medical Association 95:3  235-241

Daniels, J. (2005)  Daniels’ Running Formula 2nd Edition Human Kinetics p. ix

McLean, B.  Optimising Olympic Distance Triathlon Performance – A biomechanist’s Perspective.  Biomechanics Laboratory, Australian Institute of Sport

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