Functional Movement Assessments Are Not Associated with Risk of Injury During Military Basic Training

Abstract

Introduction Musculoskeletal injuries (MSK-I) in the U.S. military accounted for more than four million medical encounters in 2017. The Military Entrance Processing Screen to Assess Risk of Training (MEPSTART) was created to identify MSK-I risk during the first 180 days of military service. Methods Active duty applicants to the United States Army, Navy, Air Force, and Marine Corps between February 2013 and December 2014 who consented completed a behavioral and injury history questionnaire and the MEPSTART screen [Functional Movement Screen (FMS), Y-Balance Test (YBT), Landing Error Scoring System (LESS), and Overhead Squat assessment (OHS)] the day they shipped to basic training. Male (n = 1,433) and Female (n = 281) applicants were enrolled and MSK-I were tracked for 180 days. Binomial logistic regression and multivariate Cox proportional hazards modeling were used to assess relationships among MEPSTART screens and MSK-I independent of age, BMI, sex, Service, injury history, and smoking status. Analyses were finalized and performed in 2017. Results The only functional screen related to injury was the LESS score. Compared to those with good LESS scores, applicants with poor LESS scores had lower odds of MSK-I (OR = 0.54, 95% CI = 0.30–0.97, p = 0.04), and a lower instantaneous risk of MSK-I during the first 180 d (HR = 0.58, 95%CI = 0.34–0.96, p = 0.04). However, secondary receiver operator characteristic (ROC) analyses revealed poor discriminative value (AUC = 0.49, 95%CI = 0.43–0.54). Conclusions Functional performance did not predict future injury risk during the first 180 days of service. Poor LESS scores were associated with lower injury risk, but ROC analyses revealed little predictive value and limited clinical usefulness. Comprehensive risk reduction strategies may be preferable for mitigating MSK-I in military training populations.

Prediction and injury risk based on movement patterns and flexibility in a 6-month prospective study among physically active adults

“…Some authors indicate lack of accuracy prediction based on the FMS assessment. De la Motte et al (2019a) ; De la Motte et al (2019b) used several functional tests, including FMS, but did not indicate the possibility of predicting injury in a large group of over 1,600 soldiers during the 180-day observation period. Sodownik, Ogonowska-Sodownik & Morgulec-Adamowicz (2018) examined injuries among handball players retrospectively (12 months) with the FMS assessment and 6 months after (observation period), and did not show simple relationships between the quality of movement patterns and injuries.…”

“…Many studies confirm the prevalence of injuries that occur during physical activity among ordinary people around the world ( Zotkowska et al, 2015 ; Marar et al, 2012 ; Cai et al, 2018 ). Injuries may be caused by incorrect warm-up, excessive physical load ( Ristolainen et al, 2014 ), previous injuries ( Giroto et al, 2017 ), poor quality movement patterns ( Kiesel, Plisky & Voight, 2007 ; Garrison et al, 2015 ), and a low level of motor fitness, especially flexibility ( De la Motte et al, 2019a ; De la Motte et al, 2019b ). Injuries may be predicted by identifying the determinants of injuries and preventive measures may reduce the risk of injury ( Emery & Pasanen, 2019 ).…”

“…Kiesel, PJ & Voight (2007) and Duke, Martin & Gaul (2017) indicated that it is possible to accurately predict injuries when assessing the quality of movement patterns in studies spanning 4.5 months and 8 months, respectively. However, studies conducted by Sodownik, Ogonowska-Sodownik & Morgulec-Adamowicz (2018) and De la Motte et al (2019a) ; De la Motte et al (2019b) suggest that it is not possible to predict an injury within 6 months of taking an FMS test. Most studies were conducted in groups of athletes and soldiers.…”

“…Existing discrepancies indicate the need to consider other comorbid factors associated with injuries. They include the level of motor skills, especially flexibility ( De la Motte et al, 2019a ; De la Motte et al, 2019b ). Appropriate flexibility of soft tissues allows for better absorption of forces acting on them during physical activity ( Safran, Seaber & Garrett, 1989 ).…”

“…There are no studies on the determinants of injuries that have simultaneously captured the quality of the movement patterns and flexibility, although it has been suggested that higher quality movement patterns are associated with a higher level of flexibility ( Chimera et al, 2017 ; Yildiz, Pinar & Gelen, 2019 ). However, both, movement patterns and flixibility are factors predispose to injury ( Kiesel, PJ & Voight, 2007 ; Garrison et al, 2015 ; De la Motte et al, 2019a ; De la Motte et al, 2019b ). Further study of simultaneous use movement patterns quality and flexibility should allow for a more accurate prediction of injury.…”