Context

Majority of research surrounding the predictive value of clinical measurements and assessments for future athletic injury does not differentiate between contact and non-contact injuries.

Objective

We assessed the association between clinical measures and questionnaire data collected prior to sport participation and the incidence of non-contact lower extremity (LE) injuries among Division III collegiate athletes.

Design

Prospective cohort study

Setting

University setting, NCAA Division III

Participants

488 Division III freshmen athletes were recruited to participate in the study during their preseason physical examinations.

Patients or Other Participants

10,983 public schools.

Main Outcome Measure

Prospective incidence of non-contact Lower extremity Injury

Methods

Athletes completed questionnaires to collect demographics and musculoskeletal pain history. Clinical tests, performed by trained examiners, included hip provocative tests, visual appraisal of a single leg squat to identify dynamic knee valgus, and hip range of motion (ROM). Injury surveillance for each athlete’s collegiate career was performed. The athletic training department documented each athlete-reported, new onset injury and documented the injury location, type, and outcome (days lost, surgery performed). Univariable Generalized Estimating Equations (GEE) models were used to analyze the relationship between each clinical measure and the first occurrence of non-contact LE injury. An exchangeable correlation structure was used to account for repeated measurements within athletes (right and left limbs).

Results

Of the 488 athletes, 369 athletes (75%) were included in the final analysis. 69 non-contact LE injuries were reported. Responding “Yes” to “Have you ever had pain or an injury to your low back“ was associated with an increased risk of non-contact LE, odds ratio = 1.59 (95%CI 1.03- 2.45, p=.04). No other clinical measures were associated with increased injury risk.

Conclusion

A history of prior low back pain or injury was associated with an increased risk of sustaining a non-contact LE injury while participating in NCAA Division III athletics.

Non-contact injury, Injury risk, Injury prediction, Low-back pain
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Author notes

This work was supported by the following grants: K12 HD055931 (Dr Harris-Hayes) from the National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Institute of Neurological Disorders and Stroke; and grant 1 UL1 RR 024992-01 from the National Center for Research Resources, components of the National Institutes of Health and NIH Roadmap for Medical Research. Additional funding was provided by Washington University’s Program in Physical Therapy.