Monday, July 1, 2013

Using The Dynamic Movement Assessment ™ to Prevent Injuries and Improve Performance With Division 1 Soccer - A Business Case

The following 2 blogs will highlight a current business case being conducted using the Dynamic Movement Assessment ™ in a D1 College setting. 

Injury Rates in Athletics, Health Care Costs & Impact on Performance

Participation in athletics presents an inherent risk for injury. In high school athletics, football has the highest severe injury rate per 1000 athlete exposures, followed by wrestling, girls’ basketball, and girls’ soccer.  Among comparable sports, females sustain a higher severe injury rate than boys do, with the knee and ankle accounting for over 41% of them most common severely injured body sites.  Decades of research has been devoted to identification of intrinsic and extrinsic factors that predispose athletes to injury. Intrinsic factors include lower extremity malalignment, ligament laxity, lower extremity muscle strength/endurance, neuromuscular control, hormonal influences, intercondylar notch width, and biomechanical technique of sport-specific performance.  Published return to play percentages following an Anterior Cruciate Ligament Reconstruction (ACLR) has traditionally thought to be favorable but recent studies indicate those numbers are much lower than previously thought.  The MOON (Multicenter Orthopedic Outcome Network) group recently published results of a multi-site study indicating that 20% of females who have an ACLR will have a second one within 3 years.  In a 12 year follow up study published in 2012, investigators found that 79% of those who had an ACLR had osteoarthritis on the involved side.  Besides the human toll, there is a huge health care cost associated with.   Annually, over 250,000 to 300,000 suffer an ACL injury. With the average cost of $20,000 to $50,000 per injury, the health care cost is well over $5-10B for the initial injury only.  This does account for the downstream cost of re-injury (which 27% have) or complications from OA (which 79% develop in 12 years).  Although there are some intrinsic factors that cannot be changed, there are many that can be positively influenced with training.  Specifically identifying those athletes with pathokinematics (pathological movement patterns or poor mechanics) and implementing a training regime that targets their specific deficits can and will reduce injury rates.  Over the last decade, there has been a plethora of studies showing that implementing targeted training programs can result in over 80% reduction in non-contact injuries.  If implemented correctly and simply decreasing the incidence by 10% would result in a $500M to $1B health care savings.  So prevention and post-operative rehabilitation are essential to restoration of function and ability to return to sport. 
Although the association of pathokinematics to injuries has been well established, until recently, the association to poor athletic performance has not.  Studies are now indicating that the same pathokinematics that add to increased risk for injury also add to decrease in athletic performance.  Studies indicate that simply improving these pathokinematics results in improved efficiency in the system which has the net result of increased power output and maximal force production.  Improving individual performance and keeping key players off the DL would suggest this could lead to improved team performance.  Knowing there are multiple factors that feed into the complexity of the issue, we must find ways to thoroughly assess all the contributing factors that can be influenced with training and have a reliable method to do such.  We also need to be able to use this not only to assess athletes but also to re-assess the effectiveness of our interventions. 
Hence, this is the reason for development of the Dynamic Movement Assessment™ or DMA™ and the following business case for use in college and professional athletics. 
 
What Tools Are Currently Available
There are numerous movement screens and tools available to assess movement.  The major drawback with the majority of these falls into three categories:
·         Subjectivity of the scoring methodology. 
·         Inability to assess the “true athletic profile” of how the athlete looks during the game or later in the game post fatigue.
·         Lack of Single Leg Testing – in 2013, several studies showed that single leg testing gives a much more reliable and valid measure of pathokinematics related to lower extremity injuries than bilateral testing.

Current movement systems out there include (but are not limited to):
·         Functional Movement Screen (FMS)
·         SportsMetrics
·         Star Excursion Balance Test (SEBT)
·         Dynamic Movement Assessment™ (DMA™)
As we know, endurance plays a major role on movement and yet all of the movement screens (with exception of the DMA™) fail to tap into to the athlete’s true athletic profile following exertion or mid-game or end of the game pathokinematics where we know most injuries occur. 
With this business case, the DMA™ was chosen for the intervention for the following reasons.
The DMA™ proposes to:
  • Capture the mechanics we “know” are related to injury and performance issues
  • Be challenging enough that it taxes the system in a way that mimics sport (80 reps and 3 min of planks) vs. 3 reps of an isolated movement
  • Improve interrater reliability – use of Dartfish technology has been shown to improve interrater reliability with movement and gait assessments.
  • The intensity of this movement system taxes systems in the way that is similar to sport
  • Use movements that are sport specific, FWB and incorporates single leg.
  • 50% of the test is performed on one leg and therefore more accurately accesses pathokinematics associated with injury
Although these are ‘major differentiators” from the other system, it also:
  • Considers the magnitude of the deviation (amount of lateral shift and adduction to mid-line or past) in the score
  • Considers the # of deviations in the scoring
  • Provides visual feedback which is essential for motor learning, mental rehearsal and changes in motor patterns
  • When used with the fatigue protocol, it puts the athlete in competitive sport like condition with similar endurance and strength demands – average D1 college athlete rating of exertion was 8/10 on over 150 subjects
  • Provides flexibility for integration into the existing university’s strength and conditioning program
The next article will highlight the methods, results and conclusion.
References
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2.       Beckett M, Massie D, Bowers K, Stoll D. Incident of hyperpronation in the ACL injured knee: a clinical perspective. J Athl Train. 1992;27:5862.
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