Getting to the Core of Overuse Lower Extremity Injury Risk Factors

Core Stability as a Risk Factor for the Development of Lower Extremity Overuse
Injuries: A Prospective Cohort Study

Blaiser C, De Ridder R, Willems T, Vanden Bossche L, Danneels L, Roosen P. Am J
Sports Med. 2019 Apr 29:363546519837724. doi: 10.1177/0363546519837724. [Epub
ahead of print]
Home Message:
A college freshman with dynamic postural
control limb imbalances, decreased hip extension strength, or decreased core
muscle endurance during bridging exercises is more likely to develop a lower
extremity overuse injury.

stability is important for lower extremity alignment and control, and may
relate to lower extremity overuse injuries. However, we lack information on how
different tests of core performance are linked to injury risk among
recreationally active young adults. Therefore, the authors performed a
prospective 1.5-year study among 139 healthy freshmen students enrolled in
physical education courses, and evaluated if different measures of core
strength, endurance, or control related to future overuse lower extremity injury.
The different core measurement tests can be found in the Table. The authors
defined a lower extremity overuse injury as any lower limb injury that caused
limitations in physical activity without a defining injury event. The authors
also recorded injury exposure time based on the total time spent participating
in practice and sport classes, such as basketball and soccer. Thirty-four
individuals developed an overuse injury with an incidence rate of 1.2 injuries per
50 hours of sport participation. Students with greater differences between left
and right limb star excursion balance test performance, decreased hip extension
as compared to hip flexion strength, or poor performance on prone bridging
exercises were more likely to develop overuse lower extremity injuries than
other students. However, combinations of tests failed to accurately predict who
would get an injury (predictive accuracy was only 53%).

the tests of core stability failed to accurately predict who would develop an
overuse injury, the new findings suggest that poor core performance on common
clinical tests are associated with the risk of overuse injury due to decrease
strength and stability. Hence, this reinforces the idea that it is beneficial
to address core control, strength, and endurance in injury prevention programs
to reduce the burden of lower extremity overuse injuries among young and
recreationally active individuals. The authors acknowledged that there are
other factors that contribute to overuse injuries, such as aerobic fitness,
alignment measures, and strength of other muscles that could have been assessed
to help predict who would get injured. Since this sample was limited to a
smaller sample of recreational collegiate students, it would be interesting to
see how the injury risk factors may perform among a larger sample, or in a
sample of competitive athletes. Further, it would be interesting to determine
what combination of core measures and other suggested factors would be most
predictive of lower extremity overuse injury risk as a form of clinical
screening or intervention. In all, the findings suggest that star excursion
balance test bilateral performance, hip strength, and bridging performance are
important to consider for risk of overuse lower extremity injuries. Clinical
injury prevention programs should consider implementing exercises to improve
core function.
Dynamic postural control test for balance on a single limb while reaching as far as possible along a tape measure in 3 directions
Handheld Dynamometry for the Hip and Trunk Strength
Core strength measures using maximal isometric measurements for tri-planar hip motions, and for trunk flexion and extension
Abdominal endurance measurement holding a plank position
Measure of back muscle endurance holding a back plank position
Measure of lateral core muscle endurance holding a side plank position
Endurance measure consisting of repeated lumbopelvic movement assessed for quality of movement, control of adjacent areas, preferential movement to one side, breathing, and number of quality repetitions
Proprioception assessment of repositioning accuracy of the lumbopelvic region following a dynamic task
Functional movement assessment of 5 consecutive lateral stepping down off of a box, scored based on movement patterns of the lumbopelvic region
for Discussion:
What core neuromuscular control exercises have you
implemented into injury prevention protocols? What other intrinsic measures
besides core outcomes do you use to evaluate lower extremity overuse injury
Reviewed by:
Jeffrey Driban
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