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Return to Sport: Running Injuries in Student-Athletes: Summary
Risk Assessment Tools TABLE 2: TRIAD CUMULATIVE RISK ASSESSMENT (TRIAD CRA) Six risk factors stratified into low (0), moderate (1), or high risk (2): • Low energy availability • Low BMI • Delayed menarche • Amenorrhea/oligomenorrhea • Low bone mineral density • Bone stress injury Total score : 0–1: Low risk 2–5: Moderate risk 6+ High risk
For females, asking about menstrual cycles can be very beneficial in determining overall energy availability to maintain the endocrine system. Questions should include date of first period, last period, and how often they have occurred over the last 2 years. For males, screening for signs of low testosterone is important, including loss of facial hair, sexual dysfunction, or loss of morning erections. Similarly, discussing proper sleep hygiene is important in youth athletes. Poor sleep affects every system of your body, including the ability to perceive pain. In youth athletes, specifically, sleeping <8 hours per night was associated with 1.7 times higher chance of injury.
TABLE 3: RELATIVE ENERGY DEFICIENCY IN SPORT CLINICAL ASSESSMENT TOOL (RED-S CAT) High Risk Moderate Risk Low Risk • Eating disorder
• Substantial or prolonged weight loss • Menstrual dysfunction • Prolonged relative energy deficiency • Abnormal lab values (white blood count [WBC], ferritin, testosterone, T3)
• Healthy eating habits • Functioning endocrine system • Healthy bone mineral density • Healthy musculoskeletal system
• Other serious medical disorder • Extreme weight loss techniques • Abnormal electrocardiogram (ECG)
EXAMINATION
The athlete’s footwear should be examined, looking for uneven wear patterns. It can also be important to note the drop of the shoe, use of inserts, and age of shoes. Functional Testing After strength testing, functional testing should be examined. Some functional tests should replicate running mechanics without impact. These include single leg balance (eyes open/eyes closed), single leg heel raises, lateral/forward step downs, single leg squats, and lunges. Next, plyometric strength should be examined if able. This might include a broad jump for distance or hop testing. It is important to note not only the distance with hop testing but also the body control. The running readiness scale was created to help determine risk of injury in athletes, looking at a combination of five movements that mimic the demands of running. (See Table 4). Although results did not correlate with injury in collegiate cross-country runners, it can be a good tool to utilize in an exam to assess mechanics with functional movements.
Basic Examination Basic examination should start with looking at vital signs to determine if further medical help is necessary (e.g., tachycardia, postural hypotension). BMI measurements can be helpful to take to examine due to growth spurts in young athletes to help determine need for nutritional interventions. Other basic examinations should include range of motion of the lower quarter, including flexibility of hamstrings, quadriceps, hip flexors, and gastrocnemius. Furthermore, screening for systemic hypermobility via the Beighton Scale (score >/= 4). For strength testing, manual muscle testing may not be sufficient in the lower body as the therapist’s strength is typically the limiting factor. It can be more beneficial to utilize tools such as a handheld dynamometer or a 1-rep max testing for a greater comparison of differences between sides, as well as comparing to age related norms.
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