You will know by now how important change of direction ability is for the return to sport for your team sports players whether they be recreation or professional in the later stages of rehabilitation (Nimphius et al., 2017). However, because this is not a core part of our training in musculoskeletal physiotherapy it can be hard to decide on how we should assess this important skill.
In clinic we often don’t have access to 3D motion analysis systems or expensive force plates ….
So how do you capture important information about a patients change of direction (COD) ability to inform your rehabilitation decisions? Well I think there are 3 important components that all physiotherapists should be able to assess to make meaningful and insightful decisions about our patients. So you will need the following:
1. A gold standard test of change of direction (COD) speed
This for me is the 505 test of change of direction speed. It is a validated test of change of direction speed and a very good acid test of a patient’s confidence to change direction at speed (Dos’Santos et al., 2020).
The test involves a 5metre sprint into a 180-degree turn follow by a 5 metre sprint out of the turn.
This can be recorded with your smart phone or tablet using the slow-motion app on your device frame by frame. This allows a qualatative assessment of the patients movement competency. It can also be timed using a stop watch. Although, using a stopwatch is crude because of the degree of measurement error, clinically it still provides you with vital quantatitive information about your patients COD qualities.
(** Although the 505 is one of the most validated tests it is not suitable early in a patients rehabilitation pathway because of the high muscular breaking forces and knee joint loading the patient is subjected too (Dos’Santos et al., 2021b)) Therefore a 45 degree or 90 degree cut / turn with a 5 metre entry and exit can be used because of its lower breaking and knee joint loading forces.
2. A test of deceleration
Change of direction tests involve acceleration and then rapid deceleration into the change of direction task and then rapid reacceleration on exit. To help you clinically differentiate if your patient has a deceleration or a change of directional problem, a deceleration test can be very useful (Harper & Kiely, n.d.).
A deceleration test is simple to conduct! You will need a standardized distance say 1-2 metres and a 5-10 metre run up before it. The aim of the test is to see if the patient is able to stop in the 1-2 metre box after the 5-10 metre run up. The patient should be sprinting towards the box or running as fast as they can. If the patient can stop in the box without over shooting this suggests they have good deceleration ability. The smaller the box, the higher the breaking forces and better technique is required by the patient. So, decreasing the size of the box can be used as a assessment of difficulity over time.
3. A test of muscle strength (Maximal force expression)
This is an important assessment tool and one in which there are several ways to gain an appreciation of your patient’s maximal muscle force. At the very least I would recommend using a hang held dynameter to assess quadriceps and posterior gluteal isometric muscle strength.
Alternatively, an assessment of single leg seated leg press or a quadriceps knee extension machine can provide an objective measure of isolated quadriceps function which is accessible in most clinical settings. However, if possible a functionally more quantitive measure such as a back squat can be very useful and rich in information because of its association with sprinting and change of direction ability(Watts, 2015). Of course, if you are lucky enough you may have access to an isokinetic dynameter which will allow you an easy method of comparison with a range of normative values for your population. However, what’s most important is that you have a method for assessing muscle strength which is more objective than the 0-5 isometric MRC scale.
So, I hope you can see change of direction assessment in a clinical setting does not have to be complicated to aid your decision-making process!
Further reading
Biomechanical Determinants of Knee Joint Loads Associated with Increased Anterior Cruciate Ligament Loading During Cutting: A Systematic Review and Technical Framework—PubMed. (n.d.). Retrieved 23 July 2021, from https://pubmed.ncbi.nlm.nih.gov/33136207/
Brughelli, M., Cronin, J., Levin, G., & Chaouachi, A. (2008). Understanding change of direction ability in sport: A review of resistance training studies. Sports Medicine (Auckland, N.Z.), 38(12), 1045–1063. https://doi.org/10.2165/00007256-200838120-00007
Dos’Santos, T., McBurnie, A., Thomas, C., Comfort, P., & Jones, P. A. (2020). Biomechanical Determinants of the Modified and Traditional 505 Change of Direction Speed Test. Journal of Strength and Conditioning Research, 34(5), 1285–1296. https://doi.org/10.1519/JSC.0000000000003439
Dos’Santos, T., Thomas, C., McBurnie, A., Comfort, P., & Jones, P. A. (2021a). Biomechanical Determinants of Performance and Injury Risk During Cutting: A Performance-Injury Conflict? Sports Medicine (Auckland, N.Z.). https://doi.org/10.1007/s40279-021-01448-3
Dos’Santos, T., Thomas, C., McBurnie, A., Comfort, P., & Jones, P. A. (2021b). Change of Direction Speed and Technique Modification Training Improves 180° Turning Performance, Kinetics, and Kinematics. Sports (Basel, Switzerland), 9(6), 73. https://doi.org/10.3390/sports9060073
Harper, D. J., & Kiely, J. (2018). Damaging nature of decelerations: Do we adequately prepare players? BMJ Open Sport & Exercise Medicine, 4(1), e000379. https://doi.org/10.1136/bmjsem-2018-000379
McBurnie, A. J., DosʼSantos, T., & Jones, P. A. (2019). Biomechanical Associates of Performance and Knee Joint Loads During A 70-90° Cutting Maneuver in Subelite Soccer Players. Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000003252
Nimphius, S., Callaghan, S., Bezodis, N., & Lockie, R. (2017). Change of Direction and Agility Tests: Challenging Our Current Measures of Performance. Strength and Conditioning Journal, 40, 1. https://doi.org/10.1519/SSC.0000000000000309
Nygaard Falch, H., Guldteig Rædergård, H., & van den Tillaar, R. (2019). Effect of Different Physical Training Forms on Change of Direction Ability: A Systematic Review and Meta-analysis. Sports Medicine - Open, 5(1), 53. https://doi.org/10.1186/s40798-019-0223-y
Peterson, M. D., Alvar, B. A., & Rhea, M. R. (2006). The contribution of maximal force production to explosive movement among young collegiate athletes. Journal of Strength and Conditioning Research, 20(4), 867–873. https://doi.org/10.1519/R-18695.1
Watts, D. (2015). A brief review on the role of maximal strength in change of direction speed. Journal of Australian Strength and Conditioning, 23, 100–108.
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