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Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review
  1. Jackie L Whittaker1,2,3,
  2. Nadine Booysen4,5,
  3. Sarah de la Motte6,
  4. Liz Dennett7,
  5. Cara L Lewis8,
  6. Dave Wilson4,5,
  7. Carly McKay5,9,
  8. Martin Warner4,5,
  9. Darin Padua10,
  10. Carolyn A Emery3,11,12,
  11. Maria Stokes3,4
  1. 1Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
  2. 2Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
  3. 3Faculty of Kinesiology, Sport Injury Prevention Research Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  4. 4Faculty of Health Sciences, University of Southampton, Southampton, UK
  5. 5Arthritis Research UK Centre for Exercise, Sport and Osteoarthritis, Nottingham, UK
  6. 6Constortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  7. 7John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
  8. 8Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, Massachusetts, USA
  9. 9Department for Health, Bath University, Bath, UK
  10. 10Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
  11. 11Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  12. 12Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Jackie L Whittaker, Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, 8205-114 Street, Edmonton, Alberta, Canada T6G 2G4; jwhittak{at}


Background Identification of risk factors for lower extremity (LE) injury in sport and military/first-responder occupations is required to inform injury prevention strategies.

Objective To determine if poor movement quality is associated with LE injury in sport and military/first-responder occupations.

Materials and methods 5 electronic databases were systematically searched. Studies selected included original data; analytic design; movement quality outcome (qualitative rating of functional compensation, asymmetry, impairment or efficiency of movement control); LE injury sustained with sport or military/first-responder occupation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. 2 independent authors assessed the quality (Downs and Black (DB) criteria) and level of evidence (Oxford Centre of Evidence-Based Medicine model).

Results Of 4361 potential studies, 17 were included. The majority were low-quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3–15). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen was the most common outcome investigated (15/17 studies). 4 studies considered inter-relationships between risk factors, 7 reported diagnostic accuracy and none tested an intervention programme targeting individuals identified as high risk. There is inconsistent evidence that poor movement quality is associated with increased risk of LE injury in sport and military/first-responder occupations.

Conclusions Future research should focus on high-quality cohort studies to identify the most relevant movement quality outcomes for predicting injury risk followed by developing and evaluating preparticipation screening and LE injury prevention programmes through high-quality randomised controlled trials targeting individuals at greater risk of injury based on screening tests with validated test properties.

  • Injuries
  • Lower extremity
  • Functional movement screen
  • Risk factor

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  • Twitter Follow Jackie Whittaker @jwhittak_physio, Carly McKay @Dr_CMcKay, Carolyn Emery @CarolynAEmery, Darin Padua @DarinPadua, Sarah de la Motte @sarahdlm

  • Contributors JLW, CAE, NB and DW were responsible for the conception of the study while all authors were involved in study design. LD designed and executed the extensive search strategy. All authors (except LD) independently reviewed the literature, participated in rating the literature and extracted data. JLW was the primary author in preparing the manuscript; however, all authors contributed to the interpretation of the findings, critical revision of the manuscript and reviewed the document prior to submission.

  • Funding NB is funded by the National Institute for Health Research (grant number: CDRF-2014-05-021); DW and MW are funded by Arthritis Research UK (grant number: 20194); CLL is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award number K23 AR063235). CAE is funded through a Chair in Pediatric Rehabilitation (Alberta Children's Hospital Foundation).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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