Identifying risk factors for musculoskeletal (MSK) injury is critical to maintain the health and safety of athletes. While current tests consider isolated assessments of function or subjective ratings, objective tests of reactive postural responses, especially when in cognitively demanding scenarios, may better identify risk of MSK injury than traditional tests alone.

Objectives To examine if objective assessments of reactive postural responses, quantified using wearable inertial measurement units, are associated with the risk for acute lower extremity MSK injuries in collegiate athletes.

Design Prospective survival analysis

Methods 191 Division I NCAA athletes completed an instrumented version of a modified Push and Release (I-mP&R) test at the beginning of their competitive season. The I-mP&R was performed with eyes closed under single- and dual-task (concurrent cognitive task) conditions. Inertial measurement units recorded acceleration and angular velocity data that was used to calculate time to stability (TTS). Acute lower extremity MSK injuries were tracked from first team activity for six months. Cox proportional hazard models were used to determine if longer times to stability were associated with faster time to injury.

Results Longer TTS was associated with increased risk of injury; every 250 ms increase in dual-task median TTS was associated with a 37% increased risk of acute, lower-extremity MSK injury.

Conclusion Tests of reactive balance, particularly under dual-task conditions, may be able to identify athletes at risk of acute lower extremity MSK injury. Clinically-feasible, instrumented tests of reactive should be considered in assessments for prediction and prevention of MSK injury in collegiate athletes.

The authors have declared no competing interest.

This project was supported by from the Pac-12 Conference Student-Athlete Health and Well-Being Initiative (PI: Fino, Dibble). Additional funding support was provided by the Eunice Kennedy Shiver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number K12HD073945 and the University of Utah Study Design and Biostatistics Center with funding, in part, from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002538 (formerly 5UL1TR001067-05, 8UL1TR000105, and UL1RR025764). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the Pac-12 Conference, or its members, or of the National Institute of Health.

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Approval was granted by the Institutional Review Board of the University of Utah (Date: 2/28/2019/No: IRB_00116431)

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Data produced in the present study are available upon reasonable request to the authors