Movement quality and neuromuscular exercise training for optimal musculoskeletal health

Overview:

While it is clear that physical activity is important for good health, some types of activity can cause injuries that can become long-term conditions.  One such condition is osteoarthritis, which has a high rate in very active people. It has been suggested that people with some musculoskeletal conditions (with or without pain) have abnormal movement that put abnormal loads on joints and lead to damage and osteoarthritis.  Our research therefore includes efforts to prevent abnormal movements.   There have been a number of warm-up exercise programs to help prevent abnormal movements from developing. These have been shown to reduce injuries.  

Evidence suggests that there is a connection between how people move and joint injuries. Therefore, it is possible that by improving the way that people move and control their joints, i.e. the quality of how they move, injuries (from trauma and overuse) can be reduced and prevented.  

The Hip and Lower limb Movement Screen, which was developed at the University of Southampton, is being used to assess movement quality in different sports (e.g. footballers, golfers) and occupational groups (e.g. military recruits). This screening tool is helping to develop warm-up exercises specifically to protect the hips and lower limb joints. The effect of these warm-up exercises is being studied to see if movement quality can be improved to reduce injuries and improve performance. The research involves both males and females, filling a particular gap in understanding how females move. Several studies are in progress involving students looking into different aspects of this research.  Part of this work involves ensuring that the exercises will be suitable for the particular sport/occupation to keep using them as part of their routine in the long-term.  

Although warm-up exercises are known to be effective, they will only be effective if people actually do them regularly. A review of the literature on improving adherence to these exercise programmes forms part of this research.  If shorter warm-up sessions were available, then that may improve adherence, so different lengths of warm-up sessions are being investigated.

Aims and Objectives:

• Examine the effects of a neuromuscular warm-up exercise programme in military recruits to improve movement quality and reduce injuries during training.
• Does the performance of a single neuromuscular exercise session have an immediate and more beneficial effect on lower extremity biomechanics than that of a usual warm-up session?  
• Do neuromuscular warm-up sessions of different length have different effects?
• Can movement screening be conducted reliability using remote observations via teleconference?

Outputs:

Developmental within the Centre underpinning present studies

• Whittaker JL, Booysen N, de la Motte S, Dennett L, Lewis CL, Wilson D, McKay C, Warner M, Padua D, Emery CA, Stokes M. Predicting sport and occupation lower extremity injury risk through movement quality screening: A systematic review. British Journal of Sports Medicine 2017; 51(7):580-585. 
• Wilson DA, Booysen N, Dainese P, Markus O. Heller MO, Stokes M, Warner MB. Accuracy of movement quality screening to document effects of neuromuscular control retraining exercises in a young ex-footballer with hip and groin symptoms: A proof of concept case study. Medical Hypothesis 2018; 120:116–120
• Linek, P., Booysen, N., Sikora, D., Stokes, M., Functional movement screen and Y balance tests in adolescent footballers with hip/groin symptoms. Phys Ther Sport 2019; 39:99-106.  doi: https://doi.org/10.1016/j.ptsp.2019.07.002
• Booysen N,  Wilson DA,  Lewis CL, Warner MB, Gimpel M, Mottram S, Comerford M, Stokes M. Assessing movement quality using the hip and lower limb movement screen: development, reliability and potential applications. Journal of Musculoskeletal Research 2019; 22(3 & 4): 1950008 (21 pages)  
• Linek P, Muckelt PE, Sikora D, Booysen N, Stokes M. Assessing Movement Quality in Youth Footballers: Relationship between Hip and Lower Limb Movement Screen, and Functional Movement Screen. Applied Sciences 2021; 11, 9298. https://doi.org/10.3390/app11199298

Work Package	Stratified Care and Personalised Medicine: Care
Objective	1.1
Lead	Paul Muckelt
Investigators	Maria Stokes, Martin Warner, Nadine Booysen, Conor Power, Jo Fallowfield. Overseas collaborators/advisors: Pavel Linek (Poland), Carolyn Emery (Canada), Jackie Whittaker (Canada) and Duncan Reid (New Zealand)
Institution	University of Southampton