I would like to express my sincere gratitude to Dr. Helm for her assistance and guidance. The author is indebted to Dr. Helm for the invaluable suggestions and encouragement she graciously provided. Special thanks to the Valparaiso University Women’s Soccer team and coaches for all of the assistance they gave to allow this study to be conducted.
Twelve NCAA D1 female soccer players were assessed using their performance on the Soccer Injury Movement Screen. The five component movements of the SIMS were performed in sequential order starting with the Anterior Reach followed by the Single Leg Romanian Dead Lift, In-Line Lunge, Single Leg Hop for Distance and Tuck Jump. The Anterior Reach and Single Leg Hop for Distance were scored in real time, while the In-Line Lunge, Single Leg Romanian Dead Lift and Tuck Jump were scored retroactively via video by the researcher. Researchers were able to find that the average composite score for the screen was a 7.5 out of 50 with 0 being the best possible score and 50 being the worst. Single Leg Hop for Distance (SLHD) showed wide range (33 centimeters) in the difference scores of all the participants. During the Tuck Jump (TJ) test, all 12 of the participants showed the “Were landings in the same footprint” flaw. No limb asymmetries were able to be assessed due to the flaw identification currently being nonspecific. Currently, SIMS would not be an accurate indicator of limb asymmetries.
McGunn, Aus Der Funten, Whalan, Sampson, and Meyer (2018) suggested that the development of a soccer specific movement quality assessment has the possibility of benefiting performance by identifying athlete limb asymmetries along with strength and flexibility weaknesses. The Soccer Injury Movement Screen (SIMS) looks to fill this void in the soccer performance industry. The screen is comprised of five movements: Anterior Reach (AR), Single Leg Romanian Dead Lift (SLRDL), In Line Lunge (ILL), Single Leg Hop for Distance (SLHD) and Tuck Jump (TJ) (McGunn, 2018).
McGunn et al (2018) found that SIMS does not currently seem to have a correlation to injury risk, thus a new purpose for SIMS should be developed and researched to effectively benefit athletes. Faude, Junge and Kindermann (2006) identified various risk factors for injuries in elite female soccer players. A few of these risk factors were limb asymmetries, ankle strength, previous injuries and certain anthropometric and body mass characteristics. The dynamic nature of playing soccer creates problems for strength and conditioning professionals. Faude, Junge and Kindermann (2006) also suggested that these problems were due to the plethora of training requirements for performance enhancement and injury prevention in soccer players. The athlete’s lower extremity muscles are required to generate and absorb high amounts of force during the various soccer actions throughout a match and athletes must replicate these actions effectively for over the span of 90 minutes or more. Therefore, to be prepared for competition, soccer athletes must train to have the physical capacity to perform during competition and elite athletes should train to reach the highest capacity possible (Faude, 2006). Movement quality assessments could be used more effectively to identify weaknesses and limb asymmetries in athletes in order to create training programs that are more personalized, effective and efficient at maximizing athletic potential.
Maly, Zahálka and Malá (2014) stated that leg dominance is common in soccer. While athletes train to be proficient using both feet, most will have a preferred side. The muscular compensation to leg dominance is an increase in muscle mass and strength in the dominant leg, as well as flexibility differences between legs. Researchers suggested that more than 50% of soccer players have a lower limb strength asymmetry. For example, the knee extensors and flexors showed significant bilateral deficits in knee flexion strength compared to knee extensor strength. These findings support the common notion that soccer players are “Quad Dominant” athletes and thus are deficient in posterior muscle strength. The increased extensor activation during deceleration and explosive movements within the sport increases the anterior leg muscles’ strength and overall mass. These bilateral and anterior-posterior (AP) strength asymmetries have the possibility of leading to imbalances and injuries (Maly, Zahálka and Malá, 2014).
One of the common movement quality assessments used in the sport performance industry today is the Functional Movement Screen™ (FMS). This screen was developed by Gray Cook in 1995 and is intended to be a pre-participation screening tool (Beardsley 2014). FMS™ has been shown to have both inter- and intra-rater reliability as well as have some correlation to injury risk in distance runners (Agresta, 2014) and American football players (Arneson, 2004). FMS™ studies have also been conducted on elite youth soccer players (Marques, 2017). While FMS™ has been widely researched and accepted, FMS™ is not sport specific.
Statement of the Problem
The aim of this research was to assess the movement quality and limb symmetries of a group of female soccer players using the Soccer Injury Movement Screen (SIMS).
Question to be Answered. What are the results of the Soccer Injury Movement Screen (SIMS) for Collegiate Women’s Soccer Players?
Objectives. The objectives of this study were:
To assess female college soccer players with the SIMS
To identify bilateral and anterior-posterior limb asymmetries using SIMS
Definition of terms
The following terms will be used in this study.
Flaws. Errors in the movement as described by McGunn (2018).
Limb Asymmetries. Differences in unilateral extremity abilities and/or between extensor/flexor abilities (Maly, 2014)
Performance. Abilities of athletes on either the SIMS or one of the five sub-movements of the screen.
Movement Quality Assessment. The qualitative analysis of the efficiency and effectiveness of coordinated movements.
The following were delimitations of this study:
The selection of subjects were purposive and convenient.
The Human Performance Lab was chosen as the setting for it’s controlled environment and wood flooring.
The SIMS tool may have delimited the study
The Script of SIMS and warm up pre-testing was the same for every participant.
The following were limitations to this study:
The motivation of the participants may have limited the study.
The validity SIMS may have limited the study.
Participant muscle soreness due to prior exercise pre-testing may have limited the study.
Assumptions of this study were:
Subjects were motivated to perform during assessments.
Subjects gave maximal effort during the SIMS.
The technician was reliable and able to effectively retrospectively score the data.
The use of the Soccer Injury Movement Screen (SIMS) on female soccer players has never been tested before this study. Previous research has been with non-soccer players and semiprofessional male soccer players. Conflicting reports discuss the most effective use of the SIMS since it has not yet been shown to be effective in predicting injury. SIMS could possibly be used as a performance assessment tool or limb asymmetry assessment tool. A strength coach or athletic trainer could use SIMS as a pre-training assessment to identify weaknesses and asymmetries in order to create a more efficient and effective training program for the athlete. This study will add to existing literature and evaluation of the integrity of SIMS.
Review of Related Literature
The aim of this research was to assess the movement quality and limb symmetries of a group of female soccer players using the Soccer Injury Movement Screen (SIMS). The following chapter gives an in-depth analysis of past, related literature. The previous studies on SIMS will be discussed as well as a few of it’s component exercises. Research on lower extremity asymmetries and effects on hip and knee control will also be examined. The chapter will close with a summary of important findings related to the present study.
Soccer Injury Movement Screen
The Soccer Injury Movement Screen was first researched by McGunn et al. The Intra-and Inter-rater Reliability of The Soccer Injury Movement Screen (SIMS) was studied after initial development of the screen. It was concluded that present results indicated sufficient reliability for the SIMS to be considered useful for further research and applied practitioners. Due to the promise of this study, McGunn then used the SIMS in another study on 306 male semi-professional soccer players (age 22 ±4.0 years, height 179 ± 7 cm, body mass 75 ± 10 kgs) in Wales who agreed to participate. The purpose of this research was two-fold: First, to investigate the relationship between SIMS composite score and injury risk; second, to investigate the relationship between individual subtests comprising SIMS and injury risk. The question that this study worked to answer was: Is there a relationship between a soccer specific movement quality assessment and injury risk among semi-professional male soccer players. Researchers analyzed all noncontact, time-loss lower extremity injuries for the subjects and compared them to their initial SIMS composite score. They concluded that results indicated that SIMS composite score was not associated with any of the injury categories involved and that SIMS should not be used to categorize players into high and low risk groups. However, researchers suggest that SIMS could be used to help practitioners identify limb asymmetries or used for developments in performance enhancement.
The Tuck Jump assessment was chosen because it is a bilateral exercise that can be assessed for its unilateral properties. It was also chosen for its ability to assess movement quality when fatigued. Hoog, P, Warren, M, Smith, C, Chimera, N (2016) looked at the Tuck Jump assessment to determine if athletes from lower ACL injury risk sports (diving, cross country, and track and field) scored better than athletes from high risk sports (soccer, basketball and volleyball). Researchers concluded that the high-risk group showed a higher TJA score, indicating worse performance, and higher number of jumps than the low risk group. A higher occurrence of the “foot placement not shoulder width apart” flaw was shown in the high-risk group. The value and thorough previous research is why the TJ was chosen for the SIMS.
Single Leg Hop for Distance
The SLHD is an explosive unilateral test that can be quantitatively scored. This assessment was researched by Goossens, L., Witvrouw, E., Vanden Bossche, L., De Clercq, D. (2015) to see what the modifiable risk factors for hamstring injuries for freshman PETE students are. Subject limb dominance was determined by survey Each student conducted the lower extremity tests and then the occurrence of hamstring injury was followed for one full academic year. The subjects were randomly assigned to dominant or non-dominant limb groups for testing. Maximal strength tests of the hip extensors, hamstrings and quadriceps of the specified limb were conducted using a handheld dynamometer. Sixty-nine of the participants also completed the single leg hop for distance (SLHD) test. Researchers found 16 hamstring injuries from 10 of the participants. Eight of those cases were factored into the risk analysis. Researchers concluded that a lower score on the SLHD, lower eccentric hamstring strength and a higher isometric/eccentric hamstring strength ratio were significant risk factors for hamstring injuries in PETE students.
Lower Extremity Asymmetries
An asymmetry of the lower extremities is the lack of equality in muscular ability of the two legs. The reliance on distance running and the using of a dominant leg in soccer players can sometimes develop muscular asymmetries in the femoral region of athletes. There are two types of asymmetries. Bilateral asymmetry is an imbalance between the right and left leg. An anterior/posterior asymmetry is a difference in overall ability between the hamstrings and quadriceps of the two legs. Maly, T., Zahálka, F. & Malá, L. (2014) looked into these two types of asymmetries with 52 professional male soccer players from the Czech first and second division league. The purpose of this research was to compare the strength parameters of elite and sub-elite professional soccer players and look to identify any bilateral or knee extensor/flexor asymmetries. This study worked to answer the question: Are there strength asymmetries in elite and sub-elite professional soccer players. Limb dominance was determined by which foot the athlete identifies as his preferred kicking foot. The max peak muscle torque of the knee flexors and extensors of the dominant and non-dominant leg during concentric contractions were measured using an isokinetic dynamometer at three angular velocities of movement. Testing protocol monitored three attempts of knee flexion and three attempts at knee extension. Researchers found that over 50% of all players test have at least one strength asymmetry. Maly also found that significant differences were found in the strength difference between the knee extensors and knee flexors. The deficiency being in the knee flexors. Researchers conclude that these limb asymmetries display a potential risk for future injury.
There has not been a direct correlation found between SIMS composite score and any type of lower body injury. However, each component group has a 10-flaw identification scoring system which could be used to identify more specific injury risks such as muscular deficiencies or limb asymmetries. Limb asymmetries display potential risks for future injuries and thus SIMS could be used as a screen to identify limb asymmetries.
The aim of this research was to assess the movement quality and limb symmetries of a group of female soccer players using the Soccer Injury Movement Screen (SIMS). The following chapter outlines the methods used in this study including the setting of the study, participants used, instrumentation used, procedure of the study and the methods of data analysis.
The assessments were performed indoors in the morning of July 31st, 2018 in the Human Performance Lab on the campus of a D1 Midwestern University. All assessments were performed on wood flooring.
Twelve healthy NCAA Division One female college soccer players participated in this study. Participants were recruited via personal invitation following approval by the head coach. Participation was voluntary, and no compensation was awarded. Participants were medically cleared for participation by University athletic trainers. Participants were instructed to wear tight fitting sports clothing and training shoes. The participants were asked not to participate in vigorous physical activity for 48 hours prior to testing. However, their current training program and exercise timing was out of the researcher’s control. No subject reported a perceived muscle soreness score higher than a three out of 10. The average age of the subjects was 19.83 years old. The average height and weight was 65.42 in and 141.08 lbs.
The subjects of this study have previous experience with FMS ™ because they are screened annually by their sport performance coach. The participants also conduct a lower extremity mobility and body weight strengthening program daily as per instruction by their coaches. At the time of SIMS data collection, the athletes had just completed their summer training program and were transitioning to their pre-season program.
Instruments used for this study included the Soccer Injury Movement Screen (SIMS), FMS™ kit, two 60-centimeter tape measures, athletic tape, stopwatch, two GoPro cameras, pen and data collection sheets.
The SIMS was used as a method of data collection. The FMS Kit was used to assess the In Line Lunge (ILL) for the SIMS. The 60-centemeter tape measures were used to measure the Anterior Reach (AR) and Single Leg Hop for Distance (SLHD). The athletic tape was used as markers on the ground. The stopwatch was used to time the Tuck Jump (TJ). The GoPro cameras were used to film the ILL, Single Leg Romanian Dead Lift (SLRDL) and TJ. The pen and data collection sheets were used for accurate scoring of data.
Detailed descriptions of each movement within the SIMS and scoring criteria are outlined in Appendices 1 and 2. The ILL is the same in its setup as part of the FMS™, while the tuck jump is performed and scored exactly as described by Myer et al.
Upon arrival at the facility, participants read and signed the informed consent after review with researcher. They also filled out a background information sheet. After paperwork was filled out, the participants were given an opportunity to ask questions about the study prior to beginning the warm up. A standardized five minute dynamic warm up was completed before the SIMS assessment was administered. The warm up consisted of squats, walking lunges, hamstring walkouts, diagonal hop and holds and jumping jacks.
The five component movements were performed in sequential order starting with the AR followed by the SLRDL, ILL, SLHD and TJ. The instructions were read aloud to the participants (Appendix 1) verbatim. Participants were allowed three practice attempts for each sub-test where any obvious miscommunication or misunderstandings relating to execution of the movements were clarified. The researcher was transparent with the flaws in movement and every participant was offered the opportunity to view the scoring criteria. Time to complete the entire assessment per participant was approximately 15-20 minutes per participant.
Each component movement was scored out of 10 points resulting in a theoretical maximum composite score of 50. A higher score indicated poorer performance; hence, zero was the theoretical ‘best’ score while 50 was the ‘worst’. The AR and SLHD scoring criteria were objective in nature and were based on reach and jump distance respectively. In contrast, the SLDL, ILL and TJ were filmed and relied on subjective assessment of movement quality. The researcher watched the video of the movements in both real-time speed and slow motion as many times as necessary to make an accurate judgment when scoring. All scoring was conducted by the lead researcher both during the data collection and retrospectively from video review.
Analysis of Data
The aim of this research was to assess the movement quality and limb symmetries of a group of female soccer players using the Soccer Injury Movement Screen (SIMS). The following tables display the data collected in this study. The question to be answered was: What are the results of the Soccer Injury Movement Screen (SIMS) for Collegiate Women’s Soccer Players?
Table 1. represents the demographics of the participants.
Table 1. Demographic of Female Soccer Players
|Participant||Age (yrs)||Height (in)||Weight (lbs)||Year||Leg Dom.|
The question “What are the results of the SIMS” is reported in Table 2. The table represents the scores of each of the five subtests as well as a composite score (all five scores totaled).
Table 2. Results of SIMS
Key. AR= Anterior Reach
SLRDL= Single Leg Romanian Dead Lift
ILL= In Line Lunge
SLHD= Single Leg Hop for Distance
TJ= Tuck Jump
Table 3 is the scores of the Anterior Reach (AR) test. The average difference between the left and right legs was 0.92 cm.
Table 3. AR Scores
|Participant||Left (cm)||Right (cm)||Dif.|
Table 4 is the results of the Single Leg Romanian Dead Lift (SLRDL) test. Each of the 10 flaws are outlined and the participants that exhibited a flaw are highlighted. Participant’s SLRDL scores are represented on the bottom row and the number of times each flaw was shown is represented on the far right column and highlighted.
Table 4. SLRDL Flaws
|Is external hip rotation visible?||Y||N||N||N||Y||N||N||Y||N||N||Y||N||4|
|Does lumbar spine remin neutral?||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||0|
|Does thoracic spine remain neutral?||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||0|
|Does knee of raised leg remain extended?||Y||Y||N||Y||Y||Y||N||Y||Y||Y||Y||N||3|
|Is upper and lower body synchronized?||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||0|
|Is footprint maintained?||N||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||1|
|Is hip abduction present?||Y||Y||Y||Y||N||Y||N||N||N||N||N||N||5|
|Does the standing leg knee remain extended?||Y||N||Y||N||Y||Y||Y||Y||N||Y||N||N||5|
|Parallel to floor position achieved?||90||90||90||89-45||90||90||90||90||90||90||90||89-45||2|
Table 5 displays the results of the In Line Lunge (ILL) test. Each of the 10 flaws are outlined and the participants that exhibited a flaw are highlighted.
Table 5. ILL Flaws
|Does dowel remain vertical? (Frontal Plane)||Y||Y||Y||Y||Y||N||Y||Y||N||Y||Y||Y||2|
|Does torso rotation occur?||N||N||N||N||N||N||N||N||N||N||N||N||0|
|Does dowel remain vertical? (Saggital Plane)||N||Y||Y||Y||Y||Y||Y||Y||Y||N||Y||Y||2|
|Does back knee touch the floor?||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||N||1|
|Does heel of front foot lift off the floor?||N||N||N||N||N||N||N||N||N||N||N||N||0|
|Is footprint maintained throughout?||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||0|
|Are three points of contact maintained?||Y||Y||Y||Y||Y||Y||N||Y||Y||N||N||Y||3|
|Does knee valgus occur during the movement?||N||N||N||N||N||N||N||N||N||N||Y||N||1|
Table 6 represents the results of the Single Leg Hop for Distance (SLHD) test. The average sum of the hop from each leg was 355.5 cm and the average difference between legs was 9 cm.
Table 6. SLHD Scores
|Participant||Right (cm)||Left (cm)||Sum||Difference|
Table 7 shows the results of the Tuck Jump (TJ) test. Each of the 10 flaws are outlined and the participants that exhibited a flaw are highlighted.
Table 7. TJ Flaws
|Was there knee valgus at landing?||Y||N||N||Y||N||N||N||N||Y||N||Y||N||4|
|Do thighs reach parallel?||Y||Y||Y||Y||Y||N||N||Y||Y||Y||Y||N||3|
|Were thighs equal side-to-side?||Y||Y||Y||N||Y||Y||N||Y||Y||N||N||Y||4|
|Was foot placement shoulder width apart?||N||Y||Y||N||Y||Y||Y||N||Y||Y||Y||N||4|
|Was foot placement parallel (front to back)?||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||N||Y||1|
|Was foot contact timing equal?||Y||Y||Y||N||Y||Y||Y||Y||Y||Y||Y||Y||1|
|Was there excessive contact landing noise?||N||N||N||N||N||N||N||N||N||N||N||N||0|
|Was there a pause between jumps?||N||N||N||N||N||N||Y||N||N||N||Y||N||2|
|Did technique decline prior to 10 seconds?||N||N||N||N||N||N||N||N||N||Y||Y||N||2|
|Were landings in the same footprint?||N||N||N||N||N||N||N||N||N||N||N||N||12|
Summary of Findings
There were three main findings when the SIMS scores of our participants were analyzed. In the Anterior Reach (AR) test, there was no significant bilateral asymmetry in any of the athletes. The largest difference score between right and left leg score was three centimeters. During the Tuck Jump (TJ) test, 100% of the participants showed a flaw in the “Were landings in the same footprint”. No other flaws in the Tuck jump test showed in more than 50% of participants. There was a wide range (33 centimeters) in the difference scores of all the participants for the Single Leg Hop for Distance (SLHD).
Discussion, Conclusions, and Recommendations
This chapter presents the purpose of the study, a summary of procedures, a discussion of major findings, conclusions and recommendations.
Purpose of the Study
The aim of this research was to assess the movement quality and limb symmetries of a group of female soccer players using the Soccer Injury Movement Screen (SIMS). The questions to be answered were:
What are the results of the Soccer Injury Movement Screen (SIMS) for Collegiate Women’s Soccer Players?
Can SIMS identify bilateral and anterior-posterior limb asymmetries?
Summary of Procedures
After paperwork was completed, the participants performed a standardized five-minute dynamic warm up before the SIMS assessment was administered. The warm up consisted of squats, walking lunges, hamstring walkouts, diagonal hop and holds and jumping jacks. The five component movements were performed in sequential order starting with the Anterior Reach followed by the Single Leg Romanian Dead Lift, In-Line Lunge, Single Leg Hop for Distance and Tuck Jump. The instructions were read aloud to the participants (Appendix 1) verbatim. Participants were allowed three practice attempts for each sub-test where any obvious miscommunication or misunderstandings relating to execution of the movements were clarified. The researcher was transparent with the flaws in movement and every participant was offered the opportunity to view the scoring criteria. The Anterior Reach and Single Leg Hop for Distance were scored in real time, while the In-Line Lunge, Single Leg Romanian Dead Lift and Tuck Jump were scored retroactively via video by the researcher.
Summary of Major Findings
Question one asked “What are the results of the Soccer Injury Movement Screen (SIMS) for Collegiate Women’s Soccer Players?” By conducting the SIMS on twelve Division One women’s soccer players, researchers were able to find that the average composite score for the screen was a 7.5 out of 50 with 0 being the best possible score and 50 being the worst.
Question two asked if SIMS can identify bilateral and anterior-posterior limb asymmetries. None of the unilateral movements showed a significant difference between the performance in right and left legs overall. There was a large range of scores on the Single Leg hop for Distance between our sample of 12 subjects. The Tuck Jump test showed one flaw that was shown in all 12 subjects.
Question one asked “What are the results of the Soccer Injury Movement Screen (SIMS) for Collegiate Women’s Soccer Players?” An average score of 7.5 out of 50 is a good score. This is likely due to the amount of time spent on hip, knee and ankle mobility and strengthening that our subjects perform on a daily basis. The college program that the subjects play for places a large emphasis on injury prevention and efficient periodization of training and conditioning programs in order to optimize the athlete’s performances and prevent fatigue.
Single Leg Hop for Distance (SLHD) showed wide range (33 centimeters) in the difference scores of all the participants. There are two main factors that effect this finding. The first contributing factor is that there were two participants that were recently returning from a major knee injury. Subjects were cleared for both the screen and competition; however, they had not yet regained full, bilaterally equal strength. This increased the difference score during the SLHD due to the injury-induced limb asymmetry. Conversely, the other factor were the subjects coming back at full strength that both hopped a far distance and differences scores as low as zero centimeters.
During the Tuck Jump (TJ) test, all 12 of the participants showed the “Were landings in the same footprint” flaw. No other flaws in the Tuck jump test showed in more than 50% of participants. Two possible reasons may describe this unanimous flaw. The first explanation was a lack of clarity in the script. The script reads “Stand on the middle of the cross taped on the floor with feet shoulder width apart. Upon signal from the tester, perform continuous vertical jumps on the spot for 10 seconds making sure to lift your knees towards your chest so that your upper thighs are parallel with the floor each time. Try to perform as many jumps as possible.” In this script, the only indicators that the jumps must land in the same footprint are “Stand on the middle of the cross” and “perform continuous vertical jumps on the spot”. The script could be made clearer that feet must stay straddling the cross at all times. The other possible explanation would be a possible lower extremity asymmetry favoring the dominant leg. The dominant leg could be generating more force during the jump, thus causing movement away from the center.
The scoring system of each component of SIMS is not specific to right or left limb. Due to this, when a flaw is identified during the movement, scorers are not able to address if it was the right leg or left leg that displayed the flaw. This does not allow the scoring to be specific to a limb. This decreases the ability for the SIMS to be able to identify asymmetries because the flaw identification is nonspecific.
This descriptive study simply worked to try and uncover the results of female collegiate soccer players on the SIMS. It was concluded that the average composite score was a 7.5 and that no limb asymmetries were present. Currently, SIMS would not be an accurate indicator of limb asymmetries.
In the future, it may be beneficial to conduct SIMS on a larger group of female soccer players to have a better sample. SIMS may show value as a pre-participation assessment for resistance training in order to design training programs that can target bilateral or anterior-posterior deficiencies.
In terms of improving the instrumentation, the SIMS scoring system could be adjusted to allow more accurate identification of bilateral and anterior-posterior limb asymmetries. None of the movements have a scoring system that differentiates which leg the flaw occurred on, only that it occurred. For example, on the Single Leg Romanian Dead Lift, a system of scoring each leg and identifying which hip showed external rotation or which knee did not remain extended through the movement should be developed. This would allow tangible identification of limb asymmetry.
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Appendix A: Description of the Soccer Injury Movement Screen (SIMS)
|Movement Name||Rationale/Perceived Usefulness||Instructions|
|Pre-Assessment||N/A||“For each exercise you have three practice attempts and three scored attempts on each leg. In the case of the tuck jump you have three practice jumps followed by the scored 10 second effort.”|
-Provides an indication of ankle mobility (dorsiflexion)
-Highlights limb asymmetry (ankle mobility and/or leg strength)
-Provides an indication of single-leg control (e.g. motor control and balance)
“Remove your shoes. Place the big toe of your standing leg so it is touching the back of the taped line. Place hands on your hips. Reach the toes of the other leg as far along the measuring tape as possible – hovering around 5 centimeters off the ground. You must keep your standing foot in contact with the floor throughout, e.g. you cannot rise up on to your toes. Try to hover at the point of maximal reach for a couple of seconds to allow scoring. You must return to the start position for the attempt to be counted. Likewise, you must maintain balance throughout each attempt for the score to be recorded.”
|Single Leg Romanian Dead Lift (SLRDL)||- Provides an indication of ability to simultaneously flex and extend at the hip with extended knees while maintaining neutral spinal alignment - Provides an indication of hamstring flexibility - Provides an indication of single-leg control (e.g. motor control and balance)||“Put your shoes back on. Tuck your t-shirt into your shorts. Stand on the middle of the cross, taped on the floor, and cross arms over your chest. Imagine a straight line between your head and your right heel. Try to hinge at the hip while keeping that line straight until parallel to the floor. Try to keep your standing leg (left) extended. Return to the start position with both feet touching the floor between each repetition.” Switch the words ‘right’ and ‘left’ when instructing the participant when testing the other side.|
|In-Line Lunge||- Provides an indication of ability to simultaneously flex and extend at the hip with flexed knees while maintaining neutral spinal alignment - Provides an indication of lower limb motor control and balance||As per instructions from Functional Movement Screen (Cook et al. 2006a) (see reference list for full article details). “Place your left toes so they are touching the back of the taped line. Place the heel of your right foot xx centimeters (as marked by instructor)** directly in front of your left foot. Hold the dowel behind your back gripping it with your left hand at your neck and your right hand at your lower back. Make sure the dowel is touching your head, upper back and buttocks. While maintaining an upright posture, descend into a lunge touching your left knee to the floor. Maintain contact with the dowel at the head, upper back and bum throughout. Return to the start position with knees fully extended between each repetition.” Switch the words ‘right’ and ‘left’ when instructing the participant when testing the other side.|
|Single-leg hop for distance||- Provides an indication of lower-limb unilateral power - Highlights limb asymmetry (lower-limb power and/or ankle stability and/or lower-limb eccentric strength) - Provides an indication of single-leg control||“Place the toes of the jumping leg so they are touching the back of the taped line. Jump as far as you can while still able to stick the landing on the same leg and hold your position to allow measurement. You must record three successful scored jumps on each leg and you will receive as many attempts as necessary to achieve this.”|
|Tuck Jump||- Allows quick assessment of bilateral knee control during plyometric activity - Highlights limb asymmetry (lower-limb power and/or hip mobility)||As per instructions from Myer et al. (2008) (see reference list for full article details). “Stand on the middle of the cross taped on the floor with feet shoulder width apart. Upon signal from the tester, perform continuous vertical jumps on the spot for 10 seconds making sure to lift your knees towards your chest so that your upper thighs are parallel with the floor each time. Try to perform as many jumps as possible.”|
Appendix B: Scoring Criteria
General rater instructions:
Record each participant’s background information. If a participant cannot physically perform any test due to pain then they should be considered injured, this should be reported to the relevant athletic training staff members and the test should be postponed.
Scoring guidelines for the anterior reach and single-leg hop for distance are objective assessments.
Scoring guidelines for the single-leg deadlift, in-line lunge and tuck jump are subjective assessments.
If an error occurs once and the rater judges it to be egregious then it should be scored as an error.
If an error (but only to a minor extent) is observed once then it should not be scored.
If the same error (but only to a minor extent) is observed twice then it should be scored as an error.
Defining specifically what constitutes “minor extent” or “egregious” is not possible. These judgments are left to the discretion of each individual rater. An important consideration is that raters are consistent in their judgments within themselves.
Measure the distance (in centimeters) from the start line to the most distal part of the foot of the reaching leg. Round to the nearest centimeter. Three repetitions are performed on each leg and reach distance should be recorded for each attempt. The maximum reach distances achieved by each leg should be used to calculate the difference between left and right. The maximum theoretical score achievable is 10 and this would represent a ‘poor’ score. In contrast, the theoretical minimum score is zero and this would represent a ‘good’ score.
|Difference in reach distance (cm)||Test score between legs|
The score for this test is based on the ‘movement quality’ criteria outlined below. Three repetitions are performed on each leg. The maximum theoretical score achievable is 10 and t his would indicate ‘poor’ movement quality. In contrast, the theoretical minimum score is zero and this would indicate ‘good’ movement quality. Both legs are scored and the average of both right and left scores is assigned to the individual.
1. Is external hip rotation (standing leg) visible? Yes=1 No=0
2. Does lumbar spine remain neutral? Yes=0 No=1
3. Does thoracic spine remain neutral? Yes=0 No=1
4. Does knee of raised leg remain extended throughout? Yes=0 No=1
5. Is upper and lower body movement synchronized? Yes=0 No=1
6. Is footprint maintained? Yes=0 No=1
7. Is hip abduction (standing leg) present? Yes=1 No=0
8. Does the standing leg knee remain extended throughout? Yes=0 No=1
9. Parallel to floor position achieved?
Parallel (90°)=0, 89°-45°=1, <45°=2 (all relative to the stance leg hip flexion angle)
The score for this test is based on the ‘movement quality’ criteria outlined below. Three repetitions are performed on each side. The maximum theoretical score achievable is eight and this would indicate ‘poor’ movement quality. In contrast, the theoretical minimum score is zero and this would indicate ‘good’ movement quality. Both legs are scored and the average of both right and left scores is assigned to the individual.
To generate a score out of 10 multiply the fractional score out of eight by 10 e.g. if an individual displays four out of eight possible errors then the score out of 10 is: (4/8)x10 = 5. The reason for generating a score out of 10 is to maintain the same weighting between the five sub-tests.
1. Does dowel remain vertical in frontal plane throughout? Yes=0 No=1
2. Does torso rotation (transverse plane) occur? Yes=1 No=0
3. Does dowel remain vertical in sagittal plane throughout? Yes=0 No=1
4. Does back knee touch the floor? Yes=0 No=1
5. Does heel of front foot lift off the floor? Yes=1 No=0
6. Is footprint maintained throughout? Yes=0 No=1
7. Are the three dowel contact points with body maintained? Yes=0 No=1
8. Does knee valgus occur during the movement? Yes=1 No=0
Single-leg hop for distance
Measure the distance (in centimeters) from the start line to the heel of the jumping/landing leg. Round to the nearest centimeter. Three repetitions are performed on each leg and jump distance should be recorded for each attempt. Both jump distance and limb symmetry are taken into account when assigning a test score. The maximum jump distance achieved on each leg should be summed and used to calculate the score. Combine the scores for jump distance and jump symmetry to produce the final score out of 10. The maximum theoretical score achievable is 10 and this would represent a ‘poor’ score. In contrast, the theoretical minimum score is zero and this would represent a ‘good’ score
|Sum of right and left best jump distances (cm)||Test Scores|
|Difference between best right and left jumps (cm)||Test Score|
Mark a cross on the floor using tape (two 60cm strips that intersect). The score for this test is based on the ‘movement quality’ criteria outlined below. The maximum theoretical score achievable is 10 and this would indicate ‘poor’ movement quality. In contrast, the theoretical minimum score is zero and this would indicate ‘good’ movement quality. Myer et al. (2008) created the tuck jump assessment and any further clarification on scoring procedures can be sought from their original article (see reference list for full article details).
1. Was there knee valgus at landing? Yes=1 No=0
2. Do thighs reach parallel (peak of jump)? Yes=0 No=1
3. Were thighs equal side-to-side (during flight)? Yes=0 No=1
4. Was foot placement shoulder width apart? Yes=0 No=1
5. Was foot placement parallel (front to back)? Yes=0 No=1
6. Was foot contact timing equal? Yes=0 No=1
7. Was there excessive contact landing noise? Yes=1 No=0
8. Was there a pause between jumps? Yes=1 No=0
9. Did technique decline prior to 10 seconds? Yes=1 No=0
10. Were landings in same footprint (within taped cross)? Yes=0 No=1
Appendix C: Background Information
SIMS Background Information
Name: ______________________________ Gender: M or F Age:______ DOB:__________________
Height (in): __________ Weight (lbs): __________ Approx. # of NCAA D1 games played: ________
Soccer Position: ____________________________ Eligibility Class: FR SO JR SR
Academic Class: FR SO JR SR
List all major injuries and surgeries.
Have you had any major lower extremity injuries in the last three (3) years? If yes, what injury?
When is the last time you conducted vigorous physical activity?
Do you have any joint or muscle with recurring injuries (major and minor)?
On a scale of 1-10 (1 being none and 10 being unbearable) what is your current perceived muscle soreness?
Have you ever performed an Anterior Reach, Single-Leg Romanian Dead Lift, In-Line Lunge, Single-Leg Hop for Distance or Tuck Jump test before? If so, which?
Subject # __________