Barbara J. Hoogenboom

This invited clinical commentary summarizes the current state of knowledge in the area of prevention of anterior cruciate ligament (ACL) injuries. ACL injuries occur with a four to six fold greater incidence in female compared to male athletes playing the same high risk sports. The combination of increased risk of ACL injury and a 10-fold increase in sports participation since the enactment of Title IX in 1972 has led to an almost epidemic rise in ACL injuries in female athletes. Examination of the mechanisms responsible for this sex disparity in ACL rupture accelerated in the last two decades. A summary of these findings and a synthesis and framework for understanding the results of the intense investigation of this research are detailed herein. This clinical commentary focuses on the current understanding, identification and interventional targeting of the primary neuromuscular and biomechanical risk factors associated with the ACL injury mechanism in high-risk individuals.

UNLABELLED: Part 1 of this two-part series (presented in the June issue of IJSPT) provided an introduction to functional movement screening, as well as the history, background, and a summary of the evidence regarding the reliability of the Functional Movement Screen (FMS™). Part 1 presented three of the seven fundamental movement patterns that comprise the FMS™, and the specific ordinal grading system from 0-3, used in the their scoring. Specifics for scoring each test are presented. Part 2 of this series provides a review of the concepts associated with the analysis of fundamental movement as a screening system for functional movement competency. In addition, the four remaining movements of the FMS™, which complement those described in Part 1, will be presented (to complete the total of seven fundamental movements): Shoulder Mobility, the Active Straight Leg Raise, the Trunk Stability Push-up, and Rotary Stability. The final four patterns are described in detail, and the specifics for scoring each test are presented, as well as the proposed clinical implications for receiving a grade less than a perfect "3". The intent of this two part series is to present the concepts associated with screening of fundamental movements, whether it is the FMS™ system or a different system devised by another clinician. Such a fundamental screen of the movement system should be incorporated into pre-participation screening and return to sport testing in order to determine whether an athlete has the essential movements needed to participate in sports activities at a level of minimum competency. Part 2 concludes with a discussion of the evidence related to functional movement screening, myths related to the FMS™, the future of functional movement screening, and the concept of movement as a system. LEVEL OF EVIDENCE: 5.

OBJECTIVE: To assess the nutritional knowledge and attitudes of the female collegiate cross-country runner. Awareness of the deficient areas of nutritional knowledge, important in performance and healing, may assist professionals in educating female runners. DESIGN AND SETTING: In this descriptive study, subjects completed a nutritional questionnaire with both quantitative and qualitative components. In a 9-day period, the nutritional questionnaire was administered at 6 colleges and universities in Illinois and Michigan. SUBJECTS: The convenience sample included female collegiate cross-country runners (N = 60). Overall compliance rate was 61% (60 out of 99). MEASUREMENTS: Our questionnaire included a demographics section, 76 Likert-scale true-false questions, and 7 open-ended questions. True-false questions were divided into subscales of 3 or more questions based on the topic. Statistical analyses focused on quantitative analysis. RESULTS: Runners who completed a nutrition course in college scored significantly higher overall. Runners scored significantly higher in the knowledge for the athlete component than in the general knowledge component. Several specific areas of deficient nutritional knowledge were identified. Overall, the mean of the runners' total positive responses for the attitudes component of the questionnaire was 90.6%. CONCLUSIONS: Our findings suggest that the female collegiate cross-country runner lacks nutritional knowledge critical to preventing nutrition-related health problems. Because most of the runners in our study exhibited positive attitudes toward nutrition, female collegiate cross-country runners may be receptive to nutritional education.

BACKGROUND: Previous researchers have reported on the reliability of the scoring of the FMS™ movement screens. Those authors have reported good to excellent inter-rater reliability between paired raters of similar experience level (either novice or expert), but no comparisons of inter-rater reliability exist between a novice and an expert. PURPOSE: The purpose of this investigation was to examine the inter-rater reliability of the scoring of the FMS™ between trained novices and an expert rater using video records. METHODS: Twenty healthy college students participated. Each participant performed the series of seven functional movement screens. Four raters (three novices and one expert) independently scored the seven FMS™ tests by watching video recordings of the movements.. RESULTS: The mean total FMS™ score for all subjects was 14.6 ± 1.9, and was not significantly different between raters (p = 0.136). For the individual tests, half of them had perfect agreement, while the other half ranged from slight to moderate agreement (33-66%). CONCLUSION: Total FMS™ scores were similar among the raters, and the inter-rater reliability for a majority of the individual tests had as strong agreement despite the various level of experience of the raters scoring the FMS™ tests. CLINICAL RELEVANCE: Although there was mostly moderate to perfect agreement among raters, the level of experience of the rater scoring the FMS™ should be considered, as it appears that the expert rater was more critical than novice raters in the interpretation of the scoring criteria. LEVEL OF EVIDENCE: Level 3.

BACKGROUND: Female athletes often have inadequate diets due to lack of nutritional knowledge and nutritional misconceptions. Poor nutrition may lead to an increased chance of developing the Female Athlete Triad, a trio of low energy availability, menstrual dysfunction, and low bone mass. Physical therapists, as part of a healthcare team, must be prepared to address nutritional issues, recognize signs and symptoms of the female athlete triad, and make the appropriate intervention or referral. OBJECTIVES: The purpose of this study was to determine the nutritional knowledge of female collegiate swimmers and how effectively they apply their nutritional knowledge to their everyday eating habits. METHODS: Eighty-five female collegiate swimmers from six Michigan universities completed a nutritional knowledge questionnaire and a 24-hour food recall survey. Demographic, nutritional, and statistical data were analyzed. RESULTS: The mean score on nutritional knowledge test was 54.53/76 (71.75% correct). Mean total caloric intake of swimmers was 3229.10 calories per day. Ninety-five point nine percent did not meet the recommended dietary allowance (RDA) for all three macronutrients. No difference in total mean survey score existed between the three collegiate divisions. CONCLUSION: This study suggests that athletes lack knowledge of nutrition, healthy food choices, components of a well-balanced diet, and the implications of nutrition on performance.