An investigation of the Landing Error Scoring System and clinically assessable sport-related injury risk factors

Background: Preventing sport-related lower-extremity injuries relies on identifying individuals at risk. The Landing Error Scoring System (LESS) is a clinical injury risk screening tool suitable for large-scale screening without expensive equipment. However, psychometric properties, influencing factors, and differences in methodological procedures reported between studies need further exploration to justify its use. Furthermore, it is debatable whether the double-leg jump-landing (DLJL) task used in the LESS is ecologically valid and reflects sport and injury-specific situations. Moreover, generalised hypermobility, the Movement-Specific Reinvestment Scale (MSRS), and dorsiflexion range of motion (ROM) have all been used to assess injury risk factors, although their influence on dynamic movements remains relatively unexplored. Aim: To explore the LESS and other clinically assessable sport-related injury risk factors. Methods: Two systematic reviews were undertaken: one on the psychometric properties of the LESS, and another on factors potentially influencing LESS scores. LESS outcomes between different final LESS score calculation methods, self-selected landing distance and landing distance set to 50% of body height, and Pre and Post information sessions on LESS scoring criteria and prior performance were compared using Generalised Estimating Equations, odds ratios, t-tests, McNemar’s, and Wilcoxon signed ranks tests. To determine which jump-landing task best represented the kinematics of a sport-specific and high injury risk task (i.e., unanticipated cutting), the degree of association based on intraclass correlation coefficients (ICC) of three-dimensional whole-body kinematics and ratings of subjective difficulty between unanticipated cutting and four jump-landings were compared using Friedman tests with post-hoc Wilcoxon signed-rank tests. Spearman rank correlation coefficients were calculated to investigate the relationship between LESS, Beighton hypermobility, and MSRS scores. Furthermore, multiple regression models were used to compare three-dimensional whole-body cutting kinematics between asymptomatic hypermobile and non-hypermobile participants, and between cutting kinematics and participants’ dorsiflexion ROM. Results: The overall LESS score demonstrated good-to-excellent reliability (ICC 0.81 to 0.99) and most LESS items had moderate-to-excellent validity against three-dimensional motion analysis measurements. However, the predictive value of the LESS for non-contact lower-extremity injuries remains uncertain. Therefore, the LESS is suitable to evaluate jump-landing kinematics in a clinical setting, but more work is required to ascertain and support its use as a tool to screen for risk of injury. Sex, previous Anterior Cruciate Ligament (ACL) injury, and neuromuscular training programme significantly influenced LESS scores (p ≤ 0.042). The final LESS score calculation method, landing distance, and knowledge of scoring criteria and prior performance altered LESS outcomes. The kinematics of the DLJL were the least associated with those of cutting (ICC 0.00 to 0.81), and rotated DLJL (ICC 0.34 to 0.81) and rotated single-leg jump-landing (SLJLᵣₒₜ) kinematics (ICC 0.31 to 0.80) were the most strongly associated with cutting. Participants rated the SLJLᵣₒₜ as the most difficult task. Asymptomatic hypermobile participants and participants with greater MSRS scores did not present more high-risk movement patterns that could predispose them to ACL injury during jump-landing or cutting. However, dorsiflexion ROM may influence cutting kinematics and contribute to ACL injury risk. Conclusion: Overall, the evidence supports using the LESS for screening of risky movement patterns linked with non-contact lower-extremity injuries. However, incorporating SLJLᵣₒₜ into the LESS may improve its predictive value for sport-related injuries. The use of clinical measures of dorsiflexion ROM may be useful in cutting sports for screening purposes, but not necessarily MSRS or asymptomatic hypermobility

Kreativním a kritickým myšlením k rozvoji akademického psaní

Příspěvek se zabývá impulzy kreativního a kritického myšlení a možnosti jejich využití pro rozvoj akademického psaní v cizím jazyce na vysokých školách s důrazem na samotný proces psaní. Text příspěvku analyzuje typické nedostatky studentských esejí a diskutuje možnosti, které nabízejí techniky kreativního psaní a kritického myšlení, vedoucí k žádoucímu osvojování fází procesu psaní a zlepšení výsledků studentského akademického psaní jak po stránce obsahové, tak formální, tj. stylistické.

Landing Error Scoring System

Introduction: The Landing Error Scoring System (LESS) is a 17-item clinical tool which identifies athletes at high risk of non-contact lower-extremity injuries. This work systematically reviews the literature using the LESS as main outcome to address the psychometric properties and influencing factors of LESS scores. Methods: Three electronic databases were searched in March 2018 using “Landing Error Scoring System”. All peer-reviewed English language articles using the LESS as main outcome were included (n = 38). Results: Overall LESS scores demonstrate good-to-excellent reliability, but concurrent validity of individual items against 3D motion capture is item dependent. The association between LESS scores and other screening tools is poor. The value of the LESS for predicting anterior cruciate ligament (ACL) injury incidence is unclear. Sex, previous ACL injury, and training program influence LESS scores. Discussion: Literature supports that the LESS is a reliable and generally valid screening tool for assessing movement patterns linked with injury risk with low financial, spatial, and temporal costs. However, further work is needed to improve its concurrent and predictive validity for non-contact lower-extremity injuries. Take home message: The LESS can be recommended to medical staff and coaches for monitoring movement abilities of athletes

Effect of Footwear Versus Barefoot on Double-Leg Jump-Landing and Jump Height Measures: A Randomized Cross-Over Study

# Background Assessing individuals in their own athletic footwear in clinics is common, but can affect movement, performance, and clinical measures. # Purpose The aim was to compare overall Landing Error Scoring System (LESS) scores, injury risk categorization, specific LESS errors, and jump heights between habitual athletic footwear and barefoot conditions. # Study design Randomized cross-over laboratory study. # Methods Eighty healthy individuals (55% male) completed the LESS following standard procedures (i.e., land from a 30-cm box to a distance of 50% of body height and then jump upwards maximally). Participants performed the LESS three times in two randomized conditions: footwear and barefoot. LESS data were extracted from 2D videos to compare group-level mean LESS scores, group-level and individual-level injury risk categorization (5-error threshold), specific landing errors, and jump heights between conditions. # Results LESS scores were significantly greater (0.3 errors, *p*=0.022) and jump heights were significantly lower (0.6 cm, *p*=0.029) in footwear than barefoot, but differences were *trivial* (*d* = 0.18 and -0.07, respectively) and not clinically meaningful. Although the number of high injury-risk participants was not statistically different at a group level (*p*=1.000); 27 individuals (33.8%) exhibited a clinically meaningful difference between conditions of one error or more in LESS score, categorization was inconsistent for 16.3% of individuals, and four of the 17 landing errors significantly differed between conditions. # Conclusion At a group level, habitual athletic footwear does not meaningfully influence LESS scores, risk categorization, or jump height. At an individual level, footwear can meaningfully affect LESS scores, risk categorization, and alter landing strategies. Use of consistent protocol and footwear is advised for assessing movement patterns and injury risk from the LESS given the unknown predictive value of this test barefoot. # Level of Evidence Level 3. ©The Author(s

The Impact of a Novel Neuromuscular Training Program on Leg Stiffness, Reactive Strength, and Landing Biomechanics in Amateur Female Rugby Players

This randomized control study aimed to assess 12 weeks of a novel neuromuscular training program (KneeRugbyWomen) on jump-related biomechanical variables in amateur female rugby players. Twenty-four participants were randomly allocated to either an experimental group (EG; n = 12, age: 20.05 ± 4.43 yrs., height: 166.54 ± 4.46 cm, weight: 64.65 ± 6.44 kg) or a control group (CG; n = 12, age: 20.04 ± 4.88 yrs., height: 166.83 ± 7.30 cm, weight: 69.83 ± 12.84 kg). Participants were tested before and after a 12-week intervention for jump-related biomechanical variables (leg stiffness, Reactive Strength Index (RSI), and landing mechanics using the Landing Error Scoring System (LESS)). A significant increase in RSI was found in EG (p = 0.012, r = 0.70, large effect). At post-testing, players in EG had significantly greater RSI scores compared to CG at post-intervention (p = 0.007, r = 0.55, large effect). LESS scores of CG were significantly greater compared to EG at pre-intervention (p = 0.008, r = 0.55, large effect) and post-intervention (p = 0.003, r = 0.60, large effect). Results of this study demonstrate a positive effect of the KneeRugbyWomen training program on RSI, which has been previously associated with increased ACL injury risk in female players

The Influence of Asymptomatic Hypermobility on Unanticipated Cutting Biomechanics

Background: Generalized joint hypermobility is an important risk factor for knee injuries, including to the anterior cruciate ligament (ACL). Examining movement patterns specific to hypermobile individuals during sport-specific movements could facilitate development of targeted recommendations and injury prevention programs for this population. Hypothesis: Asymptomatic hypermobile participants will present kinematics measures suggestive of a greater risk of noncontact knee or ACL injuries. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Forty-two (15 asymptomatic hypermobile and 27 nonhypermobile) individuals performed unanticipated side-step cutting on their dominant and nondominant legs. Ankle, knee, hip, pelvis, and trunk angles in all planes of motion were collected during the first 100 ms after initial contact using a 3-dimensional infrared system. Precontact foot-ground angles were also extracted. Data from hypermobile and nonhypermobile groups were compared using multiple regression models with sex as a confounder. When nonsignificant, the confounder was removed from the model. Effect sizes (Hedge g) were calculated in the presence of significant between-group differences. Results: Hypermobile individuals presented with lower minimum knee valgus angles with a mean difference of 3.5° (P = 0.03, Hedge g = 0.69) and greater peak knee external rotation angles with a mean difference of −4.5° (P = 0.04, Hedge g = 0.70) during dominant leg cutting, and lower peak ankle plantarflexion angles with a mean difference of 4.5° (P = 0.03, Hedge g = 0.73) during nondominant leg cutting compared with nonhypermobile individuals. Conclusions: Based on current scientific evidence, however, the identified differences are not crucial biomechanical injury risk factors that could predispose asymptomatic hypermobile individuals to noncontact knee or ACL injuries. Clinical Relevance: Further research is needed to highlight differences between hypermobility groups. Knowledge of the differences between these groups may change the physical activity recommendations, prevention of injury, and rehabilitation approaches

The 'DEEP' Landing Error Scoring System

The Landing Error Scoring System (LESS) is an injury-risk screening tool used in sports; but scoring is time consuming, clinician-dependent, and generally inaccessible outside of elite sports. Our aim is to evidence that LESS scores can be automated using deep-learning-based computer vision combined with machine learning and compare the accuracy of LESS predictions using different video cropping and machine learning methods. Two-dimensional videos from 320 double-leg drop-jump landings with known LESS scores were analysed in OpenPose. Videos were cropped to key frames manually (clinician) and automatically (computer vision), and 42 kinematic features were extracted. A series of 10 × 10-fold cross-validation experiments were applied on full and balanced datasets to predict LESS scores. Random forest for regression outperformed linear and dummy regression models, yielding the lowest mean absolute error (1.23) and highest correlation (r = 0.63) between manual and automated scores. Sensitivity (0.82) and specificity (0.77) were reasonable for risk categorization (high-risk LESS ≥ 5 errors). Experiments using either a balanced (versus unbalanced) dataset or manual (versus automated) cropping method did not improve predictions. Further research on the automation would enhance the strength of the agreement between clinical and automated scores beyond its current levels, enabling quasi real-time scoring

Preliminary Scoring Template of a Modified Landing Error Scoring System

Background: The Landing Error Scoring System (LESS) identifies participants displaying potentially high-risk movement patterns during a double-leg jump-landing (DLJL) task. However, the DLJL has been criticized for not reflecting injury-prone situations in sport. The biomechanics and perceived difficulty of a rotated single-leg jump-landing (SLJLrot) task have shown stronger associations with sport-specific cutting maneuvers than DLJL. Therefore, the SLJLrot may be a better suited task than the DLJL to assess landing “errors”. Objectives: Present a preliminary scoring template of a modified LESS applied to a SLJLrot task. Design: Cross-sectional study. Methods: Whole-body motion was recorded for 42 young active participants (25 males and 17 females) using a three-dimensional infrared camera system during DLJL and SLJLrot tasks. Ankle, knee, hip, and trunk angles corresponding to the original LESS items were extracted for dominant and non-dominant legs from both tasks. Based on the differences in kinematic values between tasks, original LESS thresholds, and current scientific evidence, the original LESS items from the DLJL were modified to suit the SLJLrot task. Results: A preliminary scoring template of a modified LESS applied to a SLJLrot task was developed, including operational definitions of errors and relevant thresholds. The preliminary template consists of 13 items. The minimum and maximum scores are 0 and 12 errors, respectively, with higher scores indicating poorer landing biomechanics. Conclusions: The modified LESS may be an appropriate clinical screening tool for assessing sport-related non-contact lower extremity injury risk in athletes. The proposed template and thresholds require further scientific validation

Factors influencing the Landing Error Scoring System: Systematic review with meta-analysis.

OBJECTIVES: Systematically review the literature addressing age, sex, previous injury, and intervention program as influencing factors of the Landing Error Scoring System. DESIGN: Systematic review with meta-analysis. METHODS: Three databases (PubMed, Web of Science®, and Scopus®) were searched on 1 April 2020. Original studies using the Landing Error Scoring System as primary outcome and exploring age, sex, previous injury, and intervention program were included, assessed for risk of bias, and critically appraised. Three meta-analyses were performed using one random and two mixed effect models with dependent variables: sex, previous injury and intervention program, respectively. Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the strength of the evidence. PROSPERO registration number CRD42018107210. RESULTS: Fifty-two studies were included. Pooled data indicated that females have higher Landing Error Scoring System scores than males (p<0.001, mean difference=0.6 error). Participants with previous anterior cruciate ligament injury have higher LESS scores than healthy controls (p=0.004, mean difference 1.2 error). Neuromuscular training programs lasting a minimum of six weeks and other intervention programs decrease Landing Error Scoring System scores (p<0.001, mean difference 1.2 error and p=0.042, mean difference 0.5 error, respectively). There is limited evidence suggesting that age may influence Landing Error Scoring System scores in clinically meaningful manner. Overall, Grading of Recommendations Assessment, Development and Evaluation ratings suggest very low strength of evidence. CONCLUSIONS: History of anterior cruciate ligament injury and undertaking neuromuscular training for a minimum of six weeks meaningfully altered Landing Error Scoring System scores. These findings, however, should be interpreted cautiously considering the very low Grading of Recommendations Assessment, Development and Evaluation rating of the evidence