To Screen or Not to Screen? That is the Question.

In the last blog we pressed pause and reviewed the work we conduct at Millfield Institute of Sport and Wellbeing and its impact on our understanding of our student population and the wider context of youth sport. The start of the new academic year provides a platform to reflect on best practice within this context. This process allows us to constantly check and challenge our practice. It is in this vein that we visit a well trodden path, screening.

Screening, for injury risk identification and risk reduction has see a substantial rise and fall over recent years. Evidence has been able to substantially disprove the initial theories that we would be able to identify and effectively predict those who may be at increased risk of a certain injury by assessing them while healthy. Some tests described in the literature demonstrate a high level of statistical significance in identifying the targeted risk factor, however they still provide little value in being able to predict if an injury will occur. Furthermore, the test in question must be applicable to the groups being tested. If the studies demonstrating statistical significance to the risk factor in question have only been in conducted in adults, then their extrapolation to youth populations only diminishes their statistical value.

A more critical piece of the puzzle was muted by Bahr (2016). The outcome of an injury prevention screen is an injury risk reduction programme. This is an exercise-based intervention designed to address the identified risk factors from the screen, thus reducing the impact of that risk factor and therefore reducing the risk of injury occurring. As pointed out there has been no study to date which has compared or shown, that a targeted injury risk reduction programme (based upon an injury prevention screen) is more effective than the same programme given to all athletes.

Considering the significant practical limitations to screening, a more valuable use of practitioner and student time would be to implement, on mass, proven injury risk reduction programmes. Programmes such as the FIFA 11+ and RFU Activate have been able to show up to a 75% reduction in injury in youth populations following relatively modest exposure. These benefits were seen in both healthy individuals and those with injury history, and presumably existing risk factors.

Physiotherapists are often seen as a those who have knowledge or understanding of humans that transcend others within the medical field. Screening may have been seen as a magic bullet to rid athletic populations of injury. As we have seen there are many flaws in the ability of screening to predict injury risk. In contrast mass exposure to injury risk reduction strategies appear to be effective at reducing risk in both those with and without injury risk factors making them a much more efficient option at attempting to rid athletes of the often-inevitable risk of injury. Injury risk reduction strategies are inexpensive to run, time efficient, evidenced, effective and should be included in all youth sports programmes.

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