Limb Symmetry Index
Original Editors - Nupur Smit Shah,
Top Contributors - Nupur Smit Shah, Ewa Jaraczewska, Rachael Lowe, Vidya Acharya and Habibu Salisu Badamasi
Introduction
Limb symmetry test is a commonly used test which defines the function of an injured limb as compared to normal limb, calculated as percentage (score of injured limb divided uninjured limb x 100)[1]. The LSI score of >85% on the functional test battery defines muscle recovery and return to sports clearance. [1]It is the most important test to determine the return to sports/activity[2]. In ACL rehabilitation, if there is significant difference among both the limbs after 6 months of rehabilitation then it is two times more likely to continue this difference 1 to 2 years after ACL reconstruction. Greater level of asymmetry results in poor self reported function in the later stages of life.[3][4]
Method Of Performing the test
- Hops tests / strength tests /balance tests or functional tests are usually performed to measure Limb Symmetry Index.
- For example if the therapist chooses to perform single limb sit to stand test. The total number of repeatitions are measured on each leg before loosing the balance. Suppose the total number of repeatitions are 10 on injured limb and 12 on uninjured limb then the following calculation is done : 10/12 x 100. The total score is 83 which is less than 90%.
- Studies have shown that 90% is the reliable cutt off score for returning to non contact sports at recreative or competitive level after ACL injury.[2]
Clinical Applications
- Return to sports after ACL reconstruction[4]
- Can be applied after various lowerlimb injuries like: ankle injuries/Hamstring Injuries.[5]
- Monitoring rehabilitation progress
- Less commonly used in upper limb.
- Other knee injuries(meniscal tear,patellar tendinopathy)[6]
- Elderly populations
Limitations
- In this test there is an assumption that the uninjured limb is completely conditioned and it represents normal function but the contralateral limb may be deconditioned because of under usage during the recovery time. Pre-injury comparison data is rarely available.[7]
- Hence considering bilateral strength training is very necessary throughout the rehabilitation.
References
- ↑ 1.0 1.1 Patterson, B.E., Crossley, K.M., Perraton, L.G., Kumar, A.S., King, M.G., Heerey, J.J., Barton, C.J. and Culvenor, A.G., 2020. Limb symmetry index on a functional test battery improves between one and five years after anterior cruciate ligament reconstruction, primarily due to worsening contralateral limb function. Physical Therapy in Sport, 44, pp.67-74.
- ↑ 2.0 2.1 Wilke C, Scinicarelli G, Schoser DS, Offerhaus C, Froböse I. Limb symmetry index and pre-injury performance level after anterior cruciate ligament reconstruction: A case report on a female gymnast. Sports Orthopaedics and Traumatology. 2022 Sep 1;38(3):318-25.
- ↑ Farmer B, Anderson D, Katsavelis D, Bagwell JJ, Turman KA, Grindstaff TL. Limb preference impacts single‐leg forward hop limb symmetry index values following ACL reconstruction. Journal of Orthopaedic Research®. 2022 Jan;40(1):200-7.
- ↑ 4.0 4.1 Werner JL, Burland JP, Mattacola CG, Toonstra J, English RA, Howard JS. Decision to return to sport participation after anterior cruciate ligament reconstruction, part II: self-reported and functional performance outcomes. Journal of athletic training. 2018 May 1;53(5):464-74.
- ↑ Madou K. Wingate-based shuttle run test and limb symmetry index (back to activity algorithm) as the basis for a function-based rehabilitation of a young soccer player with torn ligament injury of the left ankle due to inversion trauma. Haemostasis. 2022;1(3):1.
- ↑ Janewanitsataporn S. The Functional Tests after ACL Reconstruction with and without Meniscal Repair. Journal of Health Science and Medical Research. 2020 Mar 30;38(2):73-9.
- ↑ Ignozzi AJ, Grindem H, Saliba SA, et al. Deficits in Contralateral Limb Strength Can Overestimate Limb Symmetry Index After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2022;10(10):23259671221125997. doi:10.1177/23259671221125997