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Guest LectureRecurrence of Injury and Pain in Sport – What’s MissingMark Comerford, Kinetic Control (UK), Performance-Rehab (Australia)Screening of athletes for musculo-skeletal factors is commonplace in elite, professional and competitive sport. This screening is promoted as part of an injury risk management strategy to prevent recurrence of pain or re-injury. To date, musculo-skeletal screening has focused on testing joint range, muscle strength (both power and endurance) and testing muscle extensibility (Bennell et at 1998 1999, Garrick 2004, Leetun et al 2004, Gabbe et al 2005, Kibler et al 2006). Assessing these parameters invariably tends to isolate the individual joints or muscles in non-functional ‘standard’ situations. All have been relatively unsuccessful at predicting risk of re-injury or recurrence of pain. There is almost no reliable evidence base to support the use of screening for these physical factors to either predict risk of injury to prevent re-injury in the systematic review or meta-analysis databases (Chalmers 2002, Wingfield et al 2004). Currently, the research and review evidence points to a history of previous injury being the single most consistent and reliable predictor of high risk of re-injury (Van Mechelen et al 1992 1996, Watson 2001, Locke 2003, Reed 2004, Joy et al 2004, Fuller & Drawer 2004). If this is the case, then clearly there is a problem in the way that we are managing the original or previous injury. It seems that the acceptable outcomes of asymptomatic function, normal range of joint motion (isolated testing) and normal muscle strength (isolated testing) are not adequate rehabilitation end points to prevent recurrence. The process of assessing the control of ‘real’ function, that is, the influence of the multiple muscle interactions acting on multiple joints in functionally orientated tasks has not be promoted because it has universally been put in the ‘too hard basket’. This is the missing piece of the screening puzzle. |
