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Imagine that you are planning an injury prevention programme for your team. Chances are that you will consider including a periodic health examination (PHE) to screen athletes for injury risk as a key component. As outlined in the second step of the van Mechelen model, 1 the classic approach to sports injury prevention research, it is necessary to understand the risk factors and injury mechanisms that play a part in the occurrence of sports injuries to develop a targeted prevention programme. 2 3 This paper addresses this step, focusing on if and how a PHE to screen for risk factors for injury can be used to mitigate injury risk. I will use hamstring and anterior cruciate ligament (ACL) injuries, two of the most common injuries in team sports, 4 5 to illustrate key issues. The key question is: 'Is it possible to use screening tests to identify who is at risk for a hamstring or ACL injury-in order to address the deficit through a targeted intervention programme?'
The purpose of screening
Screening is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. The intention is to identify pathological conditions early, thus enabling earlier intervention and management in the hope of reducing future morbidity and mortality. Perhaps the most famous, and successful, example is the infant screening programmes instituted worldwide in the early 1960s for phenylketonuria (Følling's disease). 6 If left untreated, phenylketonuria leads to severe brain function abnormalities. In contrast, patients who follow the prescribed dietary treatment from birth may have no symptoms at all. Recent screening programmes include breast cancer screening with mammography and prostate cancer screening with a blood test measuring prostate-specific antigen. However, it should be noted that although screening may lead to an earlier diagnosis, not all programmes have been shown to be beneficial and the value of current programmes for breast and prostate cancer screening are being debated. 7 8
To ensure that screening programmes confer the benefits intended, the WHO published the Wilson-Jungner criteria for appraising a screening programme. 9 These are the main criteria: (1) that the condition being screened for is an important health problem (depending not just on how serious the condition is, but also how...