Does Cycling Training Reduce Quality of Functional Movement Motor Patterns and Dynamic Postural Control in Adolescent Cyclists? A Pilot Study

im of this study was to assess whether cycling training may in uence quality of functional movement patterns and dynamic postural control. We also sought to determine if the Functional Movement Screen and Lower Quarter Y-balance tests could be predictive of injury risk among adolescent road cyclists. Twenty-three male road cyclists, aged 15–18 years, were involved in the study. Quality of functional movement patterns was assessed using the Functional Movement Screen test (FMS). Dynamic postural control was evaluated using the Lower Quarter Y-balance test (YBT-LQ). Information on injury occurrence was collected through a retrospective survey. The results showed the highest percentage of scores equalling 0 and 1 (>30% in total) in two FMS component tests: the hurdle step and trunk stability push-up. The results also demonstrated a low injury predictive value of the Functional Movement Screen (cut-off <14/21 composite score)

Lower Quarter Y-balance test (YBT-LQ). Information on injury occurrence was collected through a retrospective survey. The results showed the highest percentage of scores equalling 0 and 1 (>30% in total) in two FMS component tests: the hurdle step and trunk stability push-up. The results also demonstrated a low injury predictive value of the Functional Movement Screen (cut-off <14/21 composite score) and the Lower Quarter Y-balance test (cut-off <94% composite score and >4 cm reach distance asymmetry) in adolescent road cyclists. The most important information obtained from this study is that youth road cyclists may have functional de cits within the lumbo-pelvic-hip complex and the trunk, while neither the FMS nor the YBT-LQ test are not recommended for injury risk screening in cyclists. Keywords:FMS test; Y-balance test; cycling training; overuse injury 1. Introduction Non-traumatic (overuse) injuries are a real problem among professional and amateur road cyclists [1]. Clarsen et al. [2] showed that 94% of world class cyclists experience injuries during a 1-year period, where symptoms of both lower back pain and anterior knee pain were common, with an annual prevalence of 58% and 36%, respectively. Barrios et al. [3], in professional road cyclists, reported about ve non-traumatic injuries per 100,000 covered km (mainly tendinitis of the patellar and Achilles tendon). Furthermore, during the year prior to the survey, a high level of pain and overuse injuries were observed in amateur cyclists, reaching 85 [4] and 88% [5]. What is of great signi cance is that each injury resulted in a loss of training time and socio-economic costs, and impeded competitive success [6–9]. Therefore, detection of speci c risk factors for cyclists is crucial in decreasing the rate of sport-related musculoskeletal injuries [10,11]. Road cycling is one of the most demanding endurance sports for the body. World-class road cyclists typically train a mean of 20 h per week and cover 600 km per week [12]. During this time, they assume a characteristic cycling position to reduce aerodynamic drag[13–15] , which requires extreme horizontal trunk attening and hip exion, achieved, in part, through anterior pelvic tilt [16]. In some studies, it has

endurance sports for the body. World-class road cyclists typically train a mean of 20 h per week and cover 600 km per week [12]. During this time, they assume a characteristic cycling position to reduce aerodynamic drag[13–15] , which requires extreme horizontal trunk attening and hip exion, achieved, in part, through anterior pelvic tilt [16]. In some studies, it has been shown that cyclists sitting on a bicycle modi ed the lumbar lordosis curve to kyphosis [17,18]. This situation may cause Int. J. Environ. Res. Public Health2022,19, 12109.

Int. J. Environ. Res. Public Health2022,19, 12109 2 of 12 posture abnormalities such as increased standing thoracic kyphosis [19] or greater anterior pelvic tilt in a seated position [16] compared to sedentary individuals. Furthermore, San Emeterio et al. [20] found that in elite female cyclists, intense cycling training induced signi cant alterations in lumbopelvic movement. The speci city of training also includes mainly endurance exercise and general strengthening exercise, usually not focused on lumbo-pelvic stability and on hip mobility [21–23]. However, there are not many studies in which the impact of road cycling training on neuromuscular control and movement quality is addressed using movement-competency base tests such as the Functional Movement Screen (FMS) and/or the Lower Quarter Y-balance test (YBT-LQ). Moreover, the sensitivity and speci city of the FMS and YBT-LQ as tools for injury prediction in the population of cyclists has not been reported. FMS is a screening test that was developed with the goal of identifying de cits in movements that may predispose an otherwise healthy person to injuries during physical activity [24,25]. FMS allows the assessment of stability and mobility within the kinetic chain of full body movement, the identi cation of painful patterns and body asymmetries, and the recognition of overall poor-quality movement patterns [21,24,25]. The Functional Movement Screen is inexpensive, easy to use, and shows acceptable intra- and inter-rater reliability [26,27]. However, like any tools, the FMS has limitations, i.e., task-speci c evalu- ation criteria and high intra- and inter-individual variability in movement coordination and control [28], as well as equivocal injury predictive value of the composite score [29–36]. YBT-LQ is extensively used for injury risk identi cation [37], return to sport testing [38], and pre–post intervention measurement [39–41]. YBT-LQ aids the assessment of dynamic neuromuscular control and lower-extremity functional exibility. The Lower Quarter Y- balance test, like FMS, is inexpensive, easy to use, and shows good intra- and inter-rater reliability [42]. However, the relationship between composite score, reach distance (raw and normalized), reach distance asymmetry, and injury risk remains unclear [43–49]. We have hypothesized that because of long-time exposure to speci c cycling positions,

neuromuscular control and lower-extremity functional exibility. The Lower Quarter Y- balance test, like FMS, is inexpensive, easy to use, and shows good intra- and inter-rater reliability [42]. However, the relationship between composite score, reach distance (raw and normalized), reach distance asymmetry, and injury risk remains unclear [43–49]. We have hypothesized that because of long-time exposure to speci c cycling positions, in combination with a high level of physical effort, road cyclists may be prone to speci c neuromuscular alternations. Therefore, the aim of this study was to assess whether cycling training in uences quality of functional movement patterns and dynamic postural control. We also sought to determine if the Functional Movement Screen and Lower Quarter Y- balance tests may be predictive in injury risk assessment among adolescent road cyclists. 2. Materials and Methods 2.1. Participants The study involved 23 male road cyclists, aged 15–18 years, recruited from students of the Sport Championship School in´Swidnica, Poland. The inclusion criteria were: (i) minimum1-year training experience; (ii) obtaining a sports result at the level of at least the second sports class (according to the standards established by the Polish Cycling Federation) in the 12 months preceding the study; (iii) average training volume above8 h per week in the last 3 weeks before the study, registered with a sport-tester; (iv) having a current certi cate from a sports medicine doctor regarding the ability to practice road cycling. The exclusion criteria were acute injuries that made it impossible to perform the tests. The characteristics of the study population are presented in Table. 2.2. Experimental Design All measurements were performed by an experienced researcher during one visit at the beginning of the preparatory period. The Functional Movement Screen (FMS) and Lower Quarter Y-balance test (YBT-LQ) were performed with a 5 min break in between and in a random order. Additionally, at baseline, anthropometric measurements and information about training experience were collected. All measurements were performed between8:00 a.m. and 4:00 p.m. in a sports hall at an ambient temperature of 20 + 1 C. The participants were asked by e-mail not to perform intensive training sessions within

performed with a 5 min break in between and in a random order. Additionally, at baseline, anthropometric measurements and information about training experience were collected. All measurements were performed between8:00 a.m. and 4:00 p.m. in a sports hall at an ambient temperature of 20 + 1 C. The participants were asked by e-mail not to perform intensive training sessions within 48 hprior to testing. Eighteen weeks after measurements, participants were asked to ll

Int. J. Environ. Res. Public Health2022,19, 12109 3 of 12 in a retrospective survey on the prevalence of injuries occurring since the time of the baseline tests. Table 1.Characteristics of studied population. Median (Q1–Q3) Minimum Maximum CQV (%) Age [year] 16.0 (15.0–17.0) 15.0 17.0 6.3 TE [year] 5.0 (3.0–6.0) 1.0 8.0 30.0 Age in TE groups [year] 1–4 year,n= 9 15.0 (15.0–16.0) 15.0 17.0 3.2 5–8 year,n= 16 16.5 (16.0–17.0) 15.0 17.0 3.0 Body height [cm] 178.5 (174.0–180.5) 167.5 192.0 1.8 Body mass [kg] 63.2 (60.1–67.6) 52.6 82.2 5.9 Lean body mass [kg] 53.4 (51.0–57.3) 43.9 67.1 5.9 Fat mass [kg] 9.8 (8.7–12.2) 6.5 15.1 17.9 Fat [%] 15.5 (14.5–17.9) 11.1 19.7 11.0 Q1–Q3— rst and third quartiles, CQV—coef cient of quartile variation, TE—training experience. 2.3. Anthropometric Measurements Body height was measured via an anthropometer (Metrisis, Thessaloniki, Greece). The length of the lower limbs was measured in supine position (anterosuperior iliac spine to centre of the ipsilateral medial malleolus) via a measuring tape (TK Gruppe Timo Klingler, Shenzhen, China) [50]. Body mass and fat mass were determined with a body composition multi-frequency octopolar analyser (Tanita MC 780 MA, Tokyo, Japan) using the method of electrical bioimpedance in sport mode [51]. Before measurements, the feet and hands of the subject and the analyser were cleaned and degreased. 2.4. Functional Movement Screen Test (FMS) The purpose of the FMS test was to assess fundamental movement patterns. Partici- pants completed seven parts of the test (deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up, and quadruped rotary stability) using the FMS kit (Perform Better, Cranston, RI, USA) in accordance with the methodology described by Cook et al. [52,53]. Participants were given verbal instructions for task perfor- mance and were allowed three attempts for each task (maximal score was registered). Then, the scores of all seven test parts were summed, resulting in a composite score (0–21 points). Five of the seven test parts assessed asymmetry by bilateral measurements. If discrepancies existed between the left and right sides, the score for the worse side was registered. Each test component

and were allowed three attempts for each task (maximal score was registered). Then, the scores of all seven test parts were summed, resulting in a composite score (0–21 points). Five of the seven test parts assessed asymmetry by bilateral measurements. If discrepancies existed between the left and right sides, the score for the worse side was registered. Each test component was scored on an ordinal scale (0–3 points) based on quality of movement, with three being the maximum score. A score of 2 indicated that the participants required some type of compensation or were unable to complete the entire movement. A score of 1 was given if the individual was unable to remain in the movement position throughout the movement, lost balance during the test, or did not meet the minimum criteria to score a 2. Pain during any of the FMS component tests indicated a score of 0. In addition to the seven component tests, the FMS includes three clearing tests for pain detection (shoulder internal rotation and abduction with the hand placed on the opposite shoulder, lumbar extension performed in prone press-up position, and end-range lumbar exion in quadruped). Pain on a clearing test resulted in a score of 0 for the shoulder mobility, trunk stability push-up, or rotatory stability tests, respectively. Details on scoring for each of the component tests are provided in the works by Teyhen et al. [54] and Cook et al. [52,53]. FMS test reliability for the ICC inter-rater ranged from 0.87 to 0.89, and for the ICC intra-rater, the range was from 0.81 to 0.91 [55,56].

Int. J. Environ. Res. Public Health2022,19, 12109 4 of 12 2.5. Lower Quarter Y-Balance Test (YBT-LQ) The YBT-LQ test, which was applied to evaluate quality of dynamic postural con- trol, was performed using the YBT kit (Move2Perform, Evansville, IN, USA). The par- ticipants pushed the reach indicator blocks with one foot as far as possible in three directions—anterior(A), posteromedial (PM), and posterolateral (PL)—while standing on the contralateral leg on a central platform with hands on the pelvis. Each participant was allowed six practice trials in each direction and then performed three test trials in each direction. The reach distance was recorded as the point where the participant pushed the reach indicator block closest to the central platform to the nearest 1 cm. The testing order was as follows: three trials standing on the right foot reaching in the anterior direction (right anterior reach) followed by three trials standing on the left foot reaching in the anterior direction. This procedure was repeated for the posteromedial and the posterolateral reach directions. The trail was discarded and repeated if the subject: (i) failed to maintain a unilateral stance on the platform (e.g., touched down to the oor with the reaching foot or fell off the stance platform); (ii) failed to maintain the reach foot in contact with the reach indicator on the target area while in motion (e.g., kicked the reach indicator); (iii) used the reach indicator for stance support (e.g., placed foot on top of reach indicator); (iv) failed to return the reach foot to the starting position under control; (v) broke stance foot–heel from central platform. The average of three successful test trails for each reach direction was used for data analysis. Normalised reach distance and composite scores (CS) were calculated according to the formula proposed by Bulow et al. [57]: normalised reach distance= excursion distance leg length 100% (1) CS= RD(anterior)+RD(posteromedial)+RD(posterolateral) 3 leg length 100% (2) The reported reliability of the YBT-LQ was 0.85–0.91 for the ICC intra-rater and 0.85–0.93 for ICC inter-rater [45,58]. 2.6. Overuse Injury Survey A retrospective survey was used to collect information about overuse injuries in

according to the formula proposed by Bulow et al. [57]: normalised reach distance= excursion distance leg length 100% (1) CS= RD(anterior)+RD(posteromedial)+RD(posterolateral) 3 leg length 100% (2) The reported reliability of the YBT-LQ was 0.85–0.91 for the ICC intra-rater and 0.85–0.93 for ICC inter-rater [45,58]. 2.6. Overuse Injury Survey A retrospective survey was used to collect information about overuse injuries in ve anatomical locations (knee, hip, back, neck, and other body areas) that occurred during the previous 18 weeks. Five questions included in Table Before the survey, subjects were informed and familiarised with the de nition of overuse injury (any pain or discomfort that was not directly associated with a traumatic event and was different from the normal pain associated with competitive cycling). Any physical complaint sustained by cyclists that resulted in training volume reduction was adopted as an injury criterion for sensitivity, speci city, and odds ratio calculation [59]. 2.7. Statistical Analyses Statistical analysis was performed using SPSS Statistics 26 (IBM, Armonk, NY, USA). Differences between the right and left sides (for Y-balance test reach distances and composite score) were evaluated with thet-test for independent samples or the Mann–Whitney's U test, depending on the assessment of normal distribution. The normality of distribution was examined via the Shapiro–Wilk test. The probability of Type I error below 0.05 was adopted as the level of signi cance. The median as well as the rst and third quartiles were used to present the results of the study. Sensitivity, speci city, odds ratio, and 95% con dence interval were calculated according to the proposal by Altman [60] and Altman et al. [61].

Int. J. Environ. Res. Public Health2022,19, 12109 5 of 12 Table 2.Overuse injury survey. Question 1 Have you experienced (location) overuse injury during the past 18 weeks? a. Yes b. No Question 2 How many days in total have you had dif culties due to (location) overuse injury during the past 18 weeks? a. 1–3 days b. 4–7 days c. 8–28 days d. >28 days Question 3 To what extent have you reduced your training volume due to (location) overuse injury during the past 18 weeks? a. No reduction b. To a minor extent c. To a moderate extent d. To a major extent Question 4 To what extent has (location) overuse injury affected your performance during the past 18 weeks? a. No effect b. To a minor extent c. To a moderate extent d. To a major extent Question 5 To what extent have you experienced pain related to (location) overuse injury during past 18 weeks? a. To minor extent b. To moderate extent c. To major extent 3. Results 3.1. Functional Movement Screen Test (FMS) The FMS test indicated a high percentage (in total >30% all cases) of scores totalling 0 and 1 in hurdle step and trunk stability push-up tests compared to the remaining tests (Table). The median as well as rst and third quartiles of FMS composite score reached a value of 15 (13–17). Table 3.Score distributions for FMS component tests. Score, N (%) 0 1 2 3 Deep squat 0 (0.0%) 1 (4.4%) 13 (56.5%) 9 (39.1%) Hurdle step 0 (0.0%) 7 (30.4%) 16 (69.6%) 0 (0.0%) In-line lunge 0 (0.0%) 2 (8.7%) 16 (69.6%) 5 (21.7%) Shoulder mobility 0 (0.0%) 0 (0.0%) 3 (13.0%) 20 (87.0%) Active straight leg raise 0 (0.0%) 0 (0.0%) 15 (65.2%) 8 (34.8%) Trunk stability push-up 2 (8.7%) 7 (30.4%) 8 (34.8%) 6 (26.1%) Rotatory stability 0 (0.0%) 0 (0.0%) 23 (100.0%) 0 (0.0%) N—number of observations, (%)—percentage of observations. 3.2. Lower Quarter Y-Balance Test (LQ-YBT) There were no demonstrated statistically signi cant differences between the right and left sides in the YBT-LQ composite score (Table). There were also

15 (65.2%) 8 (34.8%) Trunk stability push-up 2 (8.7%) 7 (30.4%) 8 (34.8%) 6 (26.1%) Rotatory stability 0 (0.0%) 0 (0.0%) 23 (100.0%) 0 (0.0%) N—number of observations, (%)—percentage of observations. 3.2. Lower Quarter Y-Balance Test (LQ-YBT) There were no demonstrated statistically signi cant differences between the right and left sides in the YBT-LQ composite score (Table). There were also no statistically signi cant differences between the right and left sides with regard to anterior, posterolateral, posteromedial raw (cm), and normalized (% leg length) reach distances (Table). Table 4.Summary of Lower Quarter Y-balance test composite scores. Median Q1–Q3 Min. Max. CQV (%) p YBT-LQ composite score-L (%) 97.9 96.0–101.7 78.0 104.2 2.9 NA YBT-LQ composite score-R (%) 99.2 95.5–102.8 89.6 108.3 3.7 NA Difference L vs. R (%) 1.53 0.67–4.05 0.12 6.47 80.5 0.622 Q1–Q3— rst and third quartiles, Min.—minimum, Max.—maximum, CQV—coef cient of quartile variation, p—probability of Type-1 error.

This pilot study evaluates the impact of cycling training on movement quality in adolescent cyclists.