Importance of Single
Limb Testing – Cont.
Last week we started to discuss the importance of single limb
testing. This week, we will continue
this discussion. We will start off with
a further examine of this concept of single limb testing versus bilateral, by
looking at Myers work in 2012. Myer et al published
a paper in 2012 in the American Journal
of Sports Medicine looked at asymmetries in single limb performance in
vertical jump and associated force attenuation in athletes that were released
to return to sport following ACL reconstruction. What they found was that these asymmetries
continue to be present and concluded that if they do persist, then this may
increase the risk of either contralateral (opposite side) or ipsilateral (same
side) injury. So clearly, we have to be
able to measure these deficits in a single limb fashion to even know they
exist.

What is sensitivity? The sensitivity of the test in this case is
the ability of the test to demonstrate minor improvements or decreases in
performance with a high degree of reliability.
Although some tests use the eyeball to quantify, some of the more
sophisticated used 2D technology to quantify.
But, even if we use 2D technology to quantify performance on single limb
testing, the ability to do it with any high degree of sensitivity is
limited. For example, with most tests,
if you do one rep, three reps or 10 reps, the score is based off the worst rep observed
during the sequence. This makes sense using
this methodology since it is the largest magnitude of the deviation that puts
you at highest risk. We also know that
if you scored every rep, then this would not be a very efficient test and
impractical for adopting as a standard of practice for mass physicals.
But is scoring off one rep really
sensitive? What if you compared two
athletes, one that did 10 reps and with each rep he/she had a large degree of
adduction in the frontal plane versus an athlete that did 10 reps and only had one
rep with a large degree of adduction in the frontal plane. Which one of the athletes would you say is at
greater risk? Obviously, we would all say the one in the first scenario since
it is the same degree but occurs multiple times. But if you were scoring only the worst rep,
then on paper they would appear to be at the same level of risk. So, how truly helpful is that
information? How can we account for
that? There is a couple of different
ways to accomplish this. One is to
perform multiple single limb tests and to score every rep. In this example, the three single limb tests
consists of 10 reps per limb on each of the tests or a total of 30 reps. With a recently introduced 3D technology, we
are now able to score every repetition performed during each for the tests based
on the degree of adduction in the frontal plane present. Previously, performance on these three tests
would give you a cumulative score of 9 points on the right and 9 points on the left. But, by performing in
this fashion with this technology, you now have a score of 90 points for the
right and 90 points for the left. By
doing it in this fashion, this allows you to see minor improvements in movement
on as little as one rep.

As much as we have talked in this SL testing
portion, several key things for everyone to understand. First is that if we can prevent injuries, we
preserve the future joint health and opportunities for our athletes. For many young athletes, their only
opportunity for a higher education and life opportunities is a college
scholarship. If we can prevent injuries,
we give them a better opportunity to do that.
The additional benefit of this approach is the impact that it has on
performance as well. It does not take a
biomechanist to look at the athlete pictured above to see potential
opportunities for improvement in performance.
Movement like this that is noted above results in loss of kinetic energy
and decreased power output. This means
decreased sprint speed and decreased vertical jump. If we have the opportunity to improve their
future opportunities and their future performance, why would we not?
We hope that you found this blog insightful
and useful. Next week we wrapping up
this series with a discussion on gradients of gluteus medius weakness and how
do we indentify. As we stated
previously, stay tuned and if you like what you see, SHARE THE PASSION! It is the biggest compliment you can
give. Follow us on Twitter @ACL_prevention and tweet about it. #ACLPlayItSafe and help us spread the passion.
Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment. He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject and has performed >5000 athletic movement assessments. He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.
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