Abstract

Ankle injuries are highly prevalent in elite youth footballers and increase the mechanosensitivity of the local neural tissue, which may predispose athletes to re-injury and prolong rehabilitation periods. Increased neural mechanosensitivity presents clinically as altered pain pressure thresholds (PPTs) which are measured with pressure algometry. The purpose of this study was to determine the intra-rater and inter-rater reliability of PPTs of the ankle neural tissue in asymptomatic elite youth football players. Three raters utilised a digital algometer to evaluate the PPTs of the Sural and Tibial nervous tissue at the ankle of elite youth male footballers. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CI) were calculated to assess intra-rater and inter-rater reliability and Bland–Altman figures were plotted to enable visual evaluation of measurement error with a significance level of p < 0.05. Thirty-four players (16–18 years old) were assessed. Excellent intra-rater (Tibial ICC 0.88 (0.76–0.94); Sural ICC 0.89 (0.79–0.95)) and good inter-rater reliability (Tibial ICC 0.66 (0.40–0.82); Sural 0.71 (0.50–0.85)) was demonstrated. Bland–Altman plots demonstrated low levels of measurement error. Pressure algometry can be utilised clinically to accurately evaluate the PPTs of the Tibial and Sural nervous tissue at the ankle in asymptomatic elite male youth footballers.

Highlights

  • Football is the world’s most popular sport [1] with over 12,000 elite youth players playing in the professional leagues in England [2]

  • Mean pain pressure thresholds (PPTs) values ranged from 34.00–47.47 kPa at the Tibial and 31.59–50.23 kPa in the Sural nervous tissue respectively across three raters

  • The results demonstrated excellent intra-rater reliability (Sural Intraclass correlation coefficients (ICCs): 0.88 [95% confidence intervals (CI) 0.76–0.94]; Tibial ICC: 0.88 [0.79–0.95]) and good inter-rater reliability (Sural ICC: 0.72 [0.50–0.85]; Tibial ICC: 0.66 [0.40–0.82]) for both anatomical locations

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Summary

Introduction

Football is the world’s most popular sport [1] with over 12,000 elite youth players playing in the professional leagues in England [2]. Musculoskeletal injuries are highly prevalent in elite youth football [3], where the incidence is reported to be between 2.4 [4] and 4.8 [5] injuries per 1000 training hours, and may result in physical pain, reduced function, and psychological distress for players. In elite youth football, prolonged musculoskeletal injuries are particular problematic, as they reduce opportunities for career development and may impact on future professional contracts [7]. The assessment of the mechanosensitivity of neural structures local to the ankle should be included in a routine clinical assessment of elite youth footballing players by the club medical staff

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