Original research| Volume 26, ISSUE 2, P114-119, February 2023

Reactive postural responses predict risk for acute musculoskeletal injury in collegiate athletes

Published:January 10, 2023DOI:


      Identifying risk factors for musculoskeletal 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 musculoskeletal injury than traditional tests alone.


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


      Prospective survival analysis.


      191 Division I National Collegiate Athletic Association 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. Acute lower extremity musculoskeletal 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.


      Longer time-to-stability was associated with increased risk of injury; every 250 ms increase in dual-task median time-to-stability was associated with a 36% increased risk of acute, lower-extremity musculoskeletal injury.


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


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