Movement Assessment in Athletes

Physical therapists develop better injury screening tools

With participation in athletics comes an inherent risk for injury. But when you look at the statistics, the rate of those injuries is truly alarming. According to the U.S. Centers for Disease Control (CDC), participation in organized sports is on the rise. Nearly 30 million children and adolescents participate in youth sports in the United States. This increase in play has led to some other startling statistics about injuries among America's young athletes:

  • High school athletes account for an estimated 2 million injuries and 500,000 doctor visits and 30,000 hospitalizations each year.1
  • More than 3.5 million kids under age 14 receive medical treatment for sports injuries each year. 1
  • Children ages 5 to 14 account for nearly 40 % of all sports-related injuries treated in hospitals. On average, the rate and severity of injury increases with a child's age.2
  • Overuse injuries are responsible for nearly half of all sports injuries to middle- and high-school students.3
  • According to the CDC, more than half of all sports injuries in children are preventable.
  • Among athletes ages 5 to 14, 28 % of % of football players, 25 % of baseball players, 22 % of soccer players, 15 % of basketball players, and 12 % of softball players were injured while playing their respective sports.2

 Astronomical Impact
One injury that is well publicized in athletics is anterior cruciate ligament (ACL) injury. Due to the pure volume of these injuries as well as the time and cost associated with them, it has understandably received a lot of press.

For example, in 2012 there were over 250,000 ACL injuries in the United States. At an annual cost of more than $5 billion, the financial impact to the athlete, organization, carrier and health care system is astronomical.

According to recent studies published in the American Journal of Sports Medicine, 20% of those who have an ACL reconstruction (ACLR) will have a 2nd ACLR within two years. Forty % of those will have more structures involved (meniscus, MCL, etc.), which will prolong rehabilitation and increase cost. Seventy-nine % of those who have an ACLR will develop osteoarthritis within 12 years. This means increased risk for total joint procedures and surgery later in life, and that initial $5 billion cost skyrockets.

Figure 1: Following graph shows percentage reduction of injuries in D1 soccer players over 3 years.

Studies are also finding that the impact to athletic performance both current and future is much greater than originally published. Recent published data for return to sport is much lower than previously thought.

In a 2012 study in the American Journal of Sports Medicine, investigators found that only 63% of high school athletes and 69% of college athletes return to sport following ACLR. Of those that do return, only 43% return at the same level. This puts not only future athletic careers at risk, but also jeopardizes potential scholarships for athletes that may not have other means for a higher education.

Despite all the research, the plethora of data and the hundreds of prevention programs out there, nationally we have only seen a 1.5% reduction in the last five years. If you simply look at the start of the 2013-2014 NFL season, over 8 players suffered ACL injuries prior to the season's first kickoff.

Despite access to some of the most sophisticated technology and knowledge, non-contact ACL injuries continue to plague the sport. And ACL injuries continue to plague all sports. Not only are the initial costs astronomical, but downstream health complications are high and the athlete's ability to return to the same level of play is greatly reduced.

As a practice owner and community provider, if you had a way to assess this risk, you'd be doing a community service while setting yourself apart clinically. How do you do that?

 A Look at Biomechanics
According to current research, over 45% of non-contact sport related injuries occur to the lower kinetic chain (defined in research as the knee, ankle and foot). If you include hip and low back injuries, over 50% of athletic injuries are non-contact injuries to the lower kinetic chain.

Studies are also showing that if you can prevent these pathokinematics (pathological movements) known to be associated with ACL injuries, then you also reduce all other non-contact lower extremity injuries.

Figures 2 and 3: Comparison of risk distribution for team in 2010 vs. current. >20 % reduction in those at high risk.

Accelerated Conditioning and Learning (A.C.L.), LLC has developed an athletic biomechanical analysis (Dynamic Movement Assessment ™ or DMA™) that uses advanced video technology to film, score, interpret and improve pathokinematics on 6 core movements known to be associated with lower kinetic chain injuries. In their current study, being performed in association with Andrews Sports Medicine, they have been using this advanced technology with women's D1 soccer for 3 years. Using the information gained, correctives are developed to aid the team in reducing the pathokinematics identified, reduce their risk for injury and improve their athletic performance.  Although this study is continuing, Figure 1 shows impact on non-contact injuries to the lower kinetic chain over the last 3 years. Figures 2 and 3 shows the change in risk distribution for the team after using the correctives for two consecutive seasons. Besides the human savings, over the last 2 years, this has resulted in a $200K health care savings for the university.

So, why is this different and what does this mean clinically? We wanted to develop a tool that could be used efficiently in a clinic and that captures and objectively quantifies the movements we know put athletes at risk -- movements that we know, if improved, would dramatically and significantly impact patient outcomes, reduce risk for injury, and improve performance.

The developers also wanted something that was physically challenging enough to put an athlete in athletic like conditions. Doing such would highlight the athlete's individual pathokinematics present at the time when it matters the most, when they are fatigued.

Figure 4: US Olympic Development player previously assessed with alternate movement screen.

This particular athlete is an Olympic Development player who was assessed using an alternative movement assessment. After several months of training, his initial orthopedic complaints continued and his performance, although improved, was still not at the level he would like or needed. Although having performed well on the alternative movement assessment, his pathokinematics became clear. Based on this assessment, a much more targeted training program would not only impact his orthopedic complaints but also have a dramatic impact on his performance.

 Movement Screenings Critical
As physical therapy is a movement profession, the ability to accurately assess and interpret human movement and develop appropriate interventions is critical to the future of our profession. Physical therapists are going to be evaluated on their outcomes, their cost per episode of care, and customer satisfaction.

Yet, the majority of patients with lower kinetic chain issues rarely undergo a movement assessment, and have a high cost per episode of care. Rarely are they assessed to see how they move in a closed kinetic chain.

Consider a mechanic filling a flat tire on a car. If the mechanic never looks at the tire and merely takes out the nail, he only treats the symptom without addressing the root cause. Like the above athlete, whether he is being treated for PF pain, IT band or ankle issues, if he is not put in athletic conditions, the root cause of his problem would never be identified.



1. JS Powell, KD Barber Foss, 1999. Injury patterns in selected high school sports: a review of the 1995-1997 seasons. J Athl Train. 34: 277-84.

2. Petty, D; Robinson, K; Nessler, T.  Functional Movement Screen, Star Excursion Balance Test or 12" Drop Test: Which screen is more effective for prevention of injuries in high school athletics? 2009

3. "We Work to Prevent Sports Injuries." Safe Kids Worldwide. Online. http://www.safekids.org/search?search_api_views_fulltext=overuse+injuries.  Accessibility verified March 31, 2014


Trent Nessler is a physical therapist and CEO/Founder of Accelerated Conditioning and Learning (A.C.L.), LLC. He is the researcher and developer the Dynamic Movement Assessment™, Fatigue Dynamic Movement Assessment™, author of the textbook Dynamic Movement Assessment™: Enhance Performance and Prevent Injury, associate editor for International Journal of Athletic Therapy & Training, Member of the USA Cheer Safety Council and active blogger on injury prevention. For more information or to access these blogs go to http://www.aclprogram.com/.






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