{"id":6795,"date":"2020-01-03T06:30:00","date_gmt":"2020-01-03T12:30:00","guid":{"rendered":"http:\/\/thesportjournal.org\/?p=6795"},"modified":"2019-12-12T16:07:46","modified_gmt":"2019-12-12T22:07:46","slug":"performance-differences-in-division-iii-female-field-hockey-athletes-with-prior-lower-extremity-injuries-over-a-competitive-season","status":"publish","type":"post","link":"https:\/\/thesportjournal.org\/article\/performance-differences-in-division-iii-female-field-hockey-athletes-with-prior-lower-extremity-injuries-over-a-competitive-season\/","title":{"rendered":"Performance Differences in Division III Female Field Hockey Athletes with Prior Lower Extremity Injuries Over a Competitive Season"},"content":{"rendered":"\n

Authors:<\/strong> Jackie Feliciano BA1<\/sup>, Michael P McNally PhD2,3<\/sup>, Andrew M Busch EdD1<\/sup><\/p>\n\n\n\n

1<\/sup>Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH
2<\/sup>School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
3<\/sup>Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA<\/p>\n\n\n\n

Corresponding Author:<\/strong>
Andrew M. Busch, EdD
Ohio Wesleyan University
107C Edwards Gymnasium
61 S. Sandusky St
Delaware OH, 43220
ambusch@owu.edu<\/a>
614-783-6917<\/p>\n\n\n\n

Andrew Busch is an assistant professor at Ohio Wesleyan University and is also an alumni of the United States Sports Academy. <\/strong><\/p>\n\n\n\n

Performance Differences in Division III Female Field Hockey Athletes with Prior Lower Extremity Injuries Over a Competitive Season<\/h3>\n\n\n\n

ABSTRACT<\/strong><\/p>\n\n\n\n

Background:<\/strong> In the sport of field hockey, athletes encounter\nrepetitive unilateral movements due to the nature of the sport, possibly\nleading to detectable changes in performance variables or functional movements.\n<\/p>\n\n\n\n

Purpose: <\/strong>The purpose of this study was to first investigate\npre-season power output, functional movement, and single leg balance\ndifferences in participants with a history of prior lower extremity injuries,\nand second, to examine potential changes in such measures throughout a\ncompetitive field hockey season. <\/p>\n\n\n\n

Methods<\/strong>: Eighteen healthy collegiate female field hockey athletes\n(mean age = 19.3 \u00b1 1.2 years) were assessed in different functional movement\nand performance measures including the Functional Movement Screen (FMSTM<\/sup>)deep squat, Y-balance anterior reach test (YBT), lumbar-locked thoracic\nrotation test (LLR), vertical jump, and a single-leg eyes-closed balance test\npre- and post-competitive season.  <\/p>\n\n\n\n

Results:<\/strong>  Fourteen participants\ncompleted the study.  Preseason testing\nrevealed a significantly lower peak concentric rate of force development (RFD)\nin those reporting previous injuries of the lower extremities compared to those\nwith no prior injuries (p<\/em> = 0.017, d<\/em> = 1.37).  No differences were noted post-season in\npreviously injured participants.  Post-season\ntesting revealed a significant decrease in LLR (Left:  p<\/em> =\n0.004, d<\/em> = 0.35; Right: p<\/em> =\n0.007, d<\/em> = 0.33), a decrease in multiple single-leg balance measures (center\nof pressure excursion: Left: p <\/em><\n.0005, d<\/em> = -0.7; Right: p<\/em> <\n.0005, d<\/em> = -1.1; medial\/lateral velocity: Left: p <\/em>< .001, d<\/em> = -0.24; Right: p<\/em> < .0005, d<\/em> = -0.74; anterior\/posterior velocity: Left: p <\/em>< .0005, d<\/em> = -1.06; Right: p<\/em> < .0005, d<\/em> = -1.18) and a\ndecrease in peak concentric rate of force development (RFD) (p<\/em> = 0.03, d<\/em>\n= .33).  There were no significant\nchanges noted in post-season FMSTM<\/sup> deep squat scores, or YBT results\namong the participants. <\/p>\n\n\n\n

Conclusion:<\/strong> Female field hockey athletes with a history of lower\nextremity injuries demonstrate significantly less concentric RFD during a\nvertical jump when compared to athletes with no prior injuries.  Thoracic ROM, single-leg balance performance,\nand concentric RFD all significantly decreased after a competitive Division III\ncollegiate season.  FMSTM<\/sup> deep\nsquat and YBT anterior reach scores did not change throughout the season.  <\/p>\n\n\n\n

Applications in Sport:<\/strong> Field hockey athletes with a history of\nprevious lower extremity injuries should continually focus on power\ndevelopment, while thoracic ROM exercises, single-leg balance training and lower\nbody explosive exercises should be a point of focus for female field hockey\nathletes to maintain preseason values throughout a competitive season.<\/strong><\/p>\n\n\n\n\n\n\n\n

Key words:<\/strong> Field Hockey, Balance, Power, Performance, Functional movement<\/p>\n\n\n\n

INTRODUCTION<\/strong><\/p>\n\n\n\n

Field hockey is\none of the world\u2019s most popular sports and is growing rapidly within the United\nStates, with the largest growth occurring among National Collegiate Athletic\nAssociation (NCAA) Division III programs nationwide (6).  From 2002-2003\nto 2015-2016, participation in NCAA women\u2019s field hockey has increased by 11%\nwith a total of 273 colleges now offering field hockey with 6,032 women\nparticipating in 2015-2016 (15). \nHowever, despite its growing popularity, there is very limited research\non athletes who participate in field hockey, and specifically those with a\nhistory of previous injuries.  There is also little information regarding\nthe overall effects a competitive season has on certain performance tests and\nfunctional movement in female collegiate field hockey athletes.  <\/p>\n\n\n\n

Lower\nExtremity Injuries<\/em><\/p>\n\n\n\n

Field hockey\ninjuries have demonstrated similar overall injury rates to basketball and\nsoccer (6).  The most frequently injured sites in field hockey players are\nthe lower extremities, particularly ankle sprains (1,13,14).  Ankle\ninjuries tend to occur at a rate of 0.9 injuries per 1000 days of exposure(1).  Field hockey seems to\ndemonstrate a greater risk of subsequent injuries; including hamstring strains\nand anterior cruciate ligament-reconstruction (ACLR) re-injuries compared to\nbasketball, soccer, and lacrosse (1).  An\nNCAA injury surveillance system reported that knee internal derangement\ninjuries such as ACL tears were the second most common reported injury between\nthe years of 2003 and 2004 in female field hockey athletes, with a three-fold\nincreased risk to experience internal derangement during a game compared to\npractice (6).   Several studies\ninvestigating ACLR injuries have noted residual deficits in neuromuscular\nfactors such as proprioception, peak torque, intra-muscular forces, altered\ngait mechanics, and functional movement patterns post-injury (3,7).  It has also been noted that ACLR may induce\nneurological adaptations in brain processing regarding sensory-motor control,\nand may alter the way an individual recruits muscles to perform tasks such as\nflexion and extension of both the injured and non-injured legs (8,9). <\/p>\n\n\n\n

Postural\nAdaptations<\/em><\/p>\n\n\n\n

Field hockey\nathletes play with short, right-handed sticks, forcing them to maintain balance\nin a bent-over position that may cause muscular imbalances due to repetitive\nmotions and overuse of specific muscles. \nWhen evaluating muscle length in professional field hockey players,\nKawalek and Garsztka (2013) noted many muscles present as hypertonic (11).  Midfielders often demonstrated the highest\noverall number of hypertonic muscles (47%), and in the lower extremities of all\nplayers, every muscle was noted as hypertonic. \nThe only observed asymmetrical hypertonic muscle was the quadratus\nlumborum (11).  The significant\ndifference in the quadratus lumborum muscle may likely be due to the cumulative\nstress a laterally-flexed position of the spine creates during competition.<\/p>\n\n\n\n

When specifically\nlooking at performance differences between left and right sides, field hockey\nathletes often have significantly greater trunk sway when cutting to the left\nside (4).  These findings may also likely result from the bent-over stick\nposition, as it is more advantageous and common for athletes to cut right.  It has also been suggested that players can\nshoot with greater accuracy and power when flexing the trunk, and special\ntraining programs have been implemented for players to perform maximal flexion\nof the spine to teach this pattern (16). \nThis repetitive strain on the spine poses long-term implications for\nsuch athletes.  Computed tomography (CT)\nscans of the lumbar spine have demonstrated a number of functional and\nstructural pathological changes that strongly correlate to years of training\n(mean = 18.5 years) in professional field hockey athletes (16).  Excessive lumbar lordosis, alterations in\nlumbar mobility, decreases in disc height, and changes in the shape of\nvertebral bodies were noted in these athletes compared to controls, suggesting\nthe intervertebral discs were improperly absorbing vertical forces, directly\ntransferring such forces to the vertebral bodies (16,17).     <\/p>\n\n\n\n

Therefore, the\nstress of playing can create overuse imbalances and changes in spinal movements\nworsened by greater years of playing (16,17). \nWith such evidence demonstrating the impact residual deficits could have\non motor control, and with the sport-specific stress field hockey creates\nwithin the body, a greater understanding is needed for the role previous\ninjuries play in measures such as a vertical jump, thoracic ROM, functional\nmovement, and single leg balance.  It is\nalso unknown how such measures may change throughout a collegiate season.  Such information could assist strength\ncoaches and rehab professionals in the development of safe, biomechanically\nbased training programs to improve durability, explosiveness, and balance\nacross a season.  The purpose of this\nstudy was to investigate whether lower body explosiveness (assessed by a\ncountermovement vertical jump), functional movements, and single leg balance measures\ndiffer among field hockey athletes who previously sustained a lower extremity\ninjury, and if such measures undergo deleterious effects after a collegiate season.  It was hypothesized that previous injuries\nwould negatively affect pre-season testing measures, and greater decreases in power,\nfunctional movement, and balance, would be noticed after the season in\npreviously injured participants, with greater differences in those who played\nmore cumulative minutes throughout the season.<\/p>\n\n\n\n

Study\nDesign<\/em><\/em><\/p>\n\n\n\n

This study used an\nobservational design in a controlled laboratory setting to evaluate the effect\nprevious lower extremity injuries have on power output, functional movement,\nand balance.  Ground reaction forces during\na countermovement vertical jump and single leg balance was measured using a\nforce plate.  The Functional Movement\nScreen (FMSTM<\/sup>) deep squat, single-leg Y-balance test (YBT) anterior\nreach scores, and a lumbar-locked rotation (LLR) test to measure thoracic-spine\nrange of motion (ROM) were recorded.  Due\nto the low mean number of years playing field hockey in the current collegiate\nsample (7.2 years), compared to the 18.5 year mean in professional players\nsuffering from structural and pathological lumbar changes (16), the authors\nfelt any changes that might possibly occur in the lumbar spine may be too small\nto detect over the course of eight weeks. \nTherefore, it was decided changes may be more detectable in thoracic\nROM, which has much greater ROM compared to the lumbar region, and may also\nfunction as a proxy for overall stress on spinal ROM.    <\/p>\n\n\n\n

METHODS <\/strong><\/p>\n\n\n\n

Participants<\/em><\/p>\n\n\n\n

An institutional\nreview board approval and informed consent were obtained prior to any data\ncollection.  Eighteen healthy female NCAA\nfield hockey athletes from a single university were recruited to participate\n(age = 19.3 \u00b1 1.2 years, height = 1.66 \u00b1 0.075 m, mass = 66.84 \u00b1 8.99 kg,\nplaying experience = 7.8 \u00b1 2.3 years). \nEach participant received an email describing the study, and completed\nan athletic injury history questionnaire. \nPrevious injuries in the lower extremity were defined as: any prior\nsurgery or injury in the lower extremity requiring a minimum time-loss of two\nweeks within the past four years.  The\nprimary positions of the 18 participants originally enrolled in this study\nwere: goalkeepers (n<\/em> = 2), defenders\n(n<\/em> = 5), midfielders (n<\/em> = 7), and forwards (n<\/em> = 4). \nParticipants were included if they were listed on the active roster at\nthe time of testing pre- and post-season, and were free of current injuries at\nthe time of testing.  They were excluded\nif they did not complete the season with the team, or were injured at the time\nof testing, therefore altering their ability to perform the testing\nprotocol.  A total of four athletes were\nexcluded from the post-season testing because three encountered season-ending\ninjuries, and one quit the team during the season.  Fourteen participants completed both pre- and\npost-season testing.<\/p>\n\n\n\n

Data\nCollection<\/em>. <\/p>\n\n\n\n

Pre-season testing\nbegan one week prior to any official competition.  The season consisted of 18 games spanning eight\nweeks in duration, and post-season testing was performed the week immediately\nafter the last game.  Each testing period\nwas divided into two days.  On day one,\nparticipants performed a five-minute warm-up jog at a self-selected pace,\nfollowed by a series of moderate-intensity dynamic stretches used in previous\nresearch that are commonplace in athletic settings (18).  Participants performed three maximal effort\ncountermovement vertical jumps on a portable force plate measuring takeoff\nground reaction forces (Bertec- 4060-05, Columbus, OH).  A VerTec jump-measuring device was used to\nrecord jump height, and was placed 35 centimeters in front of the force plate,\nresulting in athletes jumping slightly forward to avoid landing on the\nrestricted surface size of the force plate (Figure 1).  The takeoff ground reaction forces (GRF) were\nused to calculate peak vertical GRF, eccentric and concentric rate of force\ndevelopment (RFD), peak vertical power, and energy generation as the integral\nof vertical power during takeoff.  Each\nparticipant then performed a single leg balance test on the same force\nplatform, randomizing the starting leg between participants.  They were instructed to stand on one leg in\nthe center of the force plate, closing their eyes once balance was sustained,\nand remain in this position for 30 seconds (Figure 2).  The first and last five seconds of each trial\nwere eliminated to ensure steady-state balance, and from this, average velocity\nin the medial-lateral (ML) and anterior-posterior (AP) directions were\ncalculated, along with total center of pressure (COP) excursion (Figures 3\n& 4).<\/p>\n\n\n\n

On the second day\nof testing, all participants were individually screened in random order in the\nFunctional Movement Screen (FMSTM<\/sup>) deep squat, the Y-balance\nanterior reach test (YBT), and a lumbar-locked thoracic rotation (LLR) test,\nwhich have all been shown to have excellent to good reliability in\nappropriately trained individuals (10,19,20).  The examiner for all participants\nwas a certified FMSTM<\/sup>, and YBT practitioner, with over 6 years of\nexperience screening individuals.  Pilot\ntesting data demonstrated high intra-rater reliability for each test: FMSTM\n<\/sup>:100%, YBT: ICC = .847 (95% CI =.569-.945, p <\/em>< .0001), LLR: ICC = .820 (95% CI = .518-.933, p <\/em>< .001).  <\/p>\n\n\n\n

The LLR scores\nwere obtained with the athletes kneeling on an\nexamination table, with hips sitting back on their heels. One elbow was placed\nbetween the knees, with the forearm outstretched flat on the table. The\nopposite hand was placed on the lower back. \nA handheld digital inclinometer (Acumar- ACU001, Lafayette, IN)\nwas placed perpendicular to the spine between the inferior angles of the\nscapula.  Participants\nwere instructed to rotate their torso as far as possible toward the sky while\nmaintaining contact of the forearm with the table.  Once maximum rotation was achieved, their\nangle of rotation was recorded.  This was\nperformed two times for each side, recording the best angle (Figure 5).<\/p>\n\n\n\n

Statistical\nAnalysis<\/em><\/p>\n\n\n\n

Statistical\nanalyses were conducted with theStatistical Package for the Social\nSciences version 23.0 (SPSS, Inc., Chicago, IL)<\/strong>.  Statistical\nsignificance was determined using a two-tailed priori<\/em> at p<\/em> <\n0.05.  Descriptive statistics were\nutilized.  Left and right side performance were compared for bilateral\nassessments.  Chi-square analyses were performed\nto assess FMSTM <\/sup>deep squat differences between participants with or\nwithout previously reported injuries.  Independent\nt-tests were used to compare preseason right and left sides, ground reaction\nforces, YBT, LLR, and all single leg balance measures between participants with\nor without previously reported injuries. \nPaired t-tests were used to compare pre- and post FMSTM <\/sup>deep\nsquat, YBT, LLR, ground reaction forces and single leg balance measures.  To determine the effect playing time had on\nperformance changes, the total number of minutes played during the season was\ntabulated and compared to the performance measures.  Effect sizes were interpreted as very small\n(<0.2), small, (0.2-0.5), medium (0.5-0.8), or large (>0.8).  <\/p>\n\n\n\n

RESULTS<\/strong><\/p>\n\n\n\n

Fourteen of the\neighteen participants completed the study. \nThree were injured during the season and did not regain medical\nclearance, and one quit the team.  Upon\ninitial demographic and injury questionnaire data, nine participants reported\nexperiencing an injury in the last four years in the lower extremities, yet all\nwere medically cleared and listed on the active roster at the time of\ntesting.  The most reported previous injury\nwas an ACL tear (4), followed by ankle sprains (2), turf toe (2), and metatarsal\nfracture (1).  For the preseason data\nanalysis, all eighteen initial participants were included.  Independent samples t <\/em>tests of preseason data revealed significantly lower peak\nconcentric rate of force development (RFD) in participants with prior reported lower\nextremity injuries (10830.8 \u00b1 8250.9 N\/s) than those with no prior injuries (40978\n\u00b1 29921.4 N\/s) a statistically significant difference of 30147.2 N\/s (95% CI,\n6823.7 to 53470.7), (t<\/em>(16) = 2.914, p<\/em> = 0.017, d<\/em> = 1.37).  No differences were noted in FMSTM<\/sup>\ndeep squat, YBT, LLR, or balance measures between participants with or without\nprevious injuries.  <\/p>\n\n\n\n

Post-season data\nanalysis only included fourteen participants who completed the study, with\nsignificant findings presented in Table 1. \nThere were no differences to report in any performance measure between\npreviously injured and non-injured participants.  Paired samples t<\/em> tests revealed significant decreases in the LLR assessment, as\nROM decreased significantly on both the left (p<\/em> = 0.004) and right (p<\/em> =\n0.007) sides, with no differences to note between sides.  Significant increases were noted in all\nsingle-leg balance measures recorded for both legs: Left COP excursion (p <<\/em> 0.005), ML velocity (p = <\/em>0.001), AP velocity (p <\/em>< 0.005), and Right COP excursion (p <<\/em> 0.005), ML velocity (p < <\/em>0.005), AP velocity (p <\/em>< 0.005).  Additionally, there was a significant\ndecrease in peak concentric RFD (p <\/em>=\n0.03).  There were no significant changes\nto report in FMSTM <\/sup>deep squat, or YBT scores, or in players with\ngreater playing time throughout the competitive season.<\/p>\n\n\n\nTable 1.<\/strong> Comparison of Preseason and Postseason Test Performance\n\n \n \n \n \n \n \n \n \n \n \n \n \n
Measure<\/strong><\/td>\n Direction\/Limb<\/strong><\/td>\n Preseason mean (SD)<\/strong><\/td>\n Postseason mean (SD)<\/strong><\/td>\n Mean Difference (SD)<\/strong><\/td>\n 95% CI of Difference <\/strong><\/td>\n Effect Size<\/strong><\/td>\n P <\/em><\/strong>Value<\/strong><\/td>\n <\/tr>\n
Lumbar-Locked Rotation (LLR)a<\/td>\n Left Rotation<\/td>\n 69.92 (14.27)<\/td>\n 57.67 (10.11)<\/td>\n 12.25 (11.77)<\/td>\n (4.77, 19.73)<\/td>\n 0.35<\/td>\n 0.004<\/td>\n <\/tr>\n
Right Rotation<\/td>\n 68.25 (11.54)<\/td>\n 55.83 (14.89)<\/td>\n 12.42 (13.11)<\/td>\n (4.09, 20.75)<\/td>\n 0.33<\/td>\n 0.007<\/td>\n <\/tr>\n
Balance (Center of Pressure Excursion)b<\/td>\n Left<\/td>\n 2.31 (1.01)<\/td>\n 4.07 (0.49)<\/td>\n -1.76 (.916)<\/td>\n (-2.29, -1.23)<\/td>\n -0.7<\/td>\n <.0005<\/td>\n <\/tr>\n
Right<\/td>\n 2.25 (0.65)<\/td>\n 4.06 (0.5)<\/td>\n -182 (.865)<\/td>\n (-2.32, -1.32)<\/td>\n -1.1<\/td>\n <.0005<\/td>\n <\/tr>\n
Balance (Medial\/Lateral Velocity)c<\/td>\n Left<\/td>\n .071 (.041)<\/td>\n .115 (.014)<\/td>\n -0.044 (.037)<\/td>\n (-.065, -.023)<\/td>\n -0.24<\/td>\n .001<\/td>\n <\/tr>\n
Right<\/td>\n .074 (.023)<\/td>\n .116 (.016)<\/td>\n -.0421 (.025)<\/td>\n (-.056, -.028)<\/td>\n -0.74<\/td>\n <.0005<\/td>\n <\/tr>\n
Balance (Anterior\/Posterior Velocity)c<\/td>\n Left<\/td>\n .076 (.027)<\/td>\n .146 (.018)<\/td>\n -.070 (.027)<\/td>\n (-.085, -.055)<\/td>\n -1.06<\/td>\n <.0005<\/td>\n <\/tr>\n
Right<\/td>\n .073 (.018)<\/td>\n .143 (.017)<\/td>\n -.0693 (.024)<\/td>\n (-.083, -.056)<\/td>\n -1.18<\/td>\n <.0005<\/td>\n <\/tr>\n
Peak Concentric Rate of Force Development (RFD)d<\/td>\n Bilateral Vertical Jump<\/td>\n 21430.3 (23631.9)<\/td>\n 5833.8 (2746.5)<\/td>\n 15596.5 (23976.8)<\/td>\n (1752.7, 29440.3)<\/td>\n 0.33<\/td>\n .030<\/td>\n <\/tr>\n

Significance observed (p <\/em>< .05)
\n aValues are degrees of passive ROM
\n bValues are meters (m)
\n cValues are m\/s
\n dValues are N\/s
\n Note: Effect size = Cohen’s d <\/td>\n <\/tr>\n <\/tbody>\n<\/table>\n\n\n\n

DISCUSSION<\/strong><\/p>\n\n\n\n

There were several\nprimary findings of this research.  Initial data collection revealed a\nrelationship between previous lower extremity injuries and RFD.  Participants who experienced lower extremity\ninjuries in the previous four years had significantly lower RFD compared to\nthose with no history of injury.  This\nmay be due in part from residual deficits existing after those athletes were\ncleared to play.  <\/p>\n\n\n\n

Significant increases\nin single leg balance measures were observed among all participants in each\nmeasure of balance after the season, suggesting overall balance decreased, as greater\nexcursion distances and ML\/AP velocities are interpreted as more \u2018sway\u2019 in the\nfoot.  The Cohen\u2019s effect size values\nsuggest a high practical significance for all three balance measures.\n This suggests the decrease in postural stability could be from the\ndemands of the season.  Previous research\nhas demonstrated that decreases in postural stability are due to weakness or\nfatigue in the surrounding muscle groups of the lower extremities, along with\nfatigue of the neuromuscular system (2,5)  <\/p>\n\n\n\n

Another important\nfinding in this study was the overall decrease in the LLR test that measures thoracic\nROM and the Cohen\u2019s effect size value suggests a high practical significance.\n Field hockey requires athletes to repeatedly run in a bent-over position\nwhere the spine is flexed and\/or laterally flexed while often forcefully\nrotating their spine in to the left when passing or shooting.  This data\nsuggests the strain of this repetitive motion throughout the season can lead to\nsignificant decreases in overall thoracic ROM. \nPrevious research has shown ROM at specific joints may or may not cause\nchanges in movement due to compensation for that deficit (12), however,\ncompensation can lead to asymmetries which can eventually lead to disruptions\nin the kinetic chain during athletic performance.  The vertebral joints of the spine are very\nimportant when performing full-range symmetrical movements (12).  Even though every stick is right-handed in\nfield hockey, thoracic ROM decreased in both directions.  While this finding opposes the logic of the\nimbalanced sport movement, the decreased ROM may have simply resulted from the\noverall demands of the sport.  It is\nunknown whether such decreases influence other areas of muscle imbalance or\nasymmetry because the YBT and balance measures did not result in significant\nbetween-limb asymmetries.   <\/p>\n\n\n\n

The knowledge\ngained from this study is helpful for coaches and athletes to understand the\neffects prior lower extremity injuries have on the RFD, and the effects a\ncompetitive season has on thoracic ROM, single-leg balance, and RFD.  These findings provide support for regularly\nincorporating power development in previously injured athletes, along with\nfocusing on balance, stability, and thoracic ROM exercises within strength and conditioning programs for field hockey\nathletes to continually target proprioceptive awareness and mobility of the\nspine.  Although this study did not track\nlower back injuries or pain symptoms, it seems plausible that continual\ndecreases in balance performance and thoracic spine ROM could increase the risk\nof lower extremity or lower back injuries.<\/p>\n\n\n\n

This study does have some limitations when interpreting the\ndata.  The sample was a convenience\nsample from a single university, which could impact results due to their\nspecific training regimen.  Only 14 participants\nwere on the roster at the end of the season to therefore complete the\nstudy.  This may have underpowered the\nprospective analysis of comparing performance measures post-season.  Practice time, warm-up routines, and strength\nand conditioning practices were not investigated, which could also play an\nimportant role in the outcomes measured. \n<\/p>\n\n\n\n

Clinical\nRelevance<\/em><\/p>\n\n\n\n

Based on these results, coaches and trainers who work with\nfield hockey athletes should continually emphasize safe power development in\nathletes with a history of previous lower extremity injuries.  Additionally, balance training with a focus\non single-leg exercises that challenge athletes\u2019 proprioceptive awareness\nshould be regularly implemented. \nFinally, incorporating a variety of thoracic ROM exercises into a warm-up\nroutine are recommended to maintain baseline levels of spinal rotation through\na season in which much of the stress is unilateral due to posture when playing\nfield hockey. <\/p>\n\n\n\n

CONCLUSIONS<\/strong><\/p>\n\n\n\n

This study determined that Division III female field hockey\nathletes with a history of lower extremity injuries demonstrate significantly\nless concentric RFD during a vertical jump when compared to athletes with no\nprior injuries.  Balance performance and\nthoracic ROM significantly decreased in all athletes after the season.  Overall power performance, FMSTM<\/sup>\ndeep squat and YBT anterior reach scores did not change throughout the season.\n This data extends the knowledge of the effects prior injuries have on\nlower extremity performance measures, and how a competitive season effects functional\nmovement, balance and power performance in collegiate female field hockey\nathletes. <\/p>\n\n\n\n

APPLICATIONS IN SPORT<\/strong><\/p>\n\n\n\n

Coaches and trainers who work with field hockey athletes\nshould continually emphasize safe power development in athletes with a history\nof previous lower extremity injuries. \nAdditionally, balance training with a focus on single-leg exercises that\nchallenge athletes\u2019 proprioceptive awareness should be regularly\nimplemented.  Finally, incorporating a\nvariety of thoracic ROM exercises into a warm-up routine are recommended to\nmaintain baseline levels of spinal rotation through a season in which much of\nthe stress is unilateral due to posture when playing field hockey. <\/p>\n\n\n\n

ACKNOWLEDGMENTS<\/strong><\/p>\n\n\n\n

The authors would\nlike to thank The Ohio State University for help in equipment usage during the\ndata collection process.  None of the\nauthors of this article have any conflicts of interest or financial conflicts\nto report.  There are no conflicts of\ninterest to report and no funding was received for this study.
\n<\/strong><\/p>\n\n\n\n

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