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CLINICAL OUTCOMES RESEARCH 

 

37 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018 
 

Assessing Lower Extremity Injury Risk in a Mid-Atlantic Drum Corps 
Using the Weight Bearing Lunge Test 
Nicolás C Merritt, DAT, SCAT, ATC, NS1 and Cameron J Powden PhD, LAT, ATC2 

1Furman University, Greenville, SC; 2Indiana State University, Terre Haute, IN 
 

 
ABSTRACT 
 
With athletic training’s expansion into non-traditional 
settings, it is important to assess if screening tools can provide 
value in range of settings. Currently, there is a dearth of 
information regarding specific models for injury risk 
assessment in drum corps patients. The Weight Bearing Lunge 
Test (WBLT) has been used to evaluate those at risk for 
suffering a lower extremity injury (LEI) in a traditional athletic 
population. This practice-based research is an attempt to 
apply current evidence of injury risk assessment use in the 
traditional settings to performing arts. The purpose of our 
investigation was to determine the effect of WBLT motion on 
LEI in Drum Corps. All participating Drum Corps members 
were measured using the WBLT during the preseason 
screening process. Injury record keeping was completed 
through electronic medical records (EMR) and all LEI were 
recorded over two consecutive, 85-day seasons. The average 
of the maximal distance in centimeters of the great toe from 
the wall indicated the WBLT Average (WBLTAv). WBLT 
Asymmetry (WBLTAsy) was the absolute difference between 
limbs. T-tests were used to determine if there was a significant 
difference between those who sustained a LEI (Injured) and 
those who did not (Uninjured) for WBLTAv and WBLTAsy. For 
dependent measures associated with significant group 
differences, receiver operator characteristic curves (ROC) 
were performed to examine injury risk using area under the 
curve (AUC). Lastly, cut-off scores that produced the maximal 
values of sensitivity and specificity were identified. Alpha 
level was set a priori at p<0.05. Drum Corps patients with 
lower WBLTAv (<11.47cm) or higher WBLTAsy (>0.75cm) 
measures were more likely to sustain a LEI during a 
competitive drum corps season. These data demonstrates that 
the WBLT could be viable as a screening tool in the marching 
arts and provides initial cut-off values. 
 
Key Phrases 
Injury risk reduction, injury surveillance, performing arts 
 
Correspondence 
Dr. Nico Merritt, Furman University, Timmons Arena, 3300 
Poinsett Highway, Greenville, SC 29613. 
E-mail: Nico.Merritt@furman.edu 
Twitter: @bostonandbeyond 
 
 
 
 
 

Full Citation 
Merritt NC, Powden CJ. Assessing Lower Extremity Injury 
Risk in a Mid-Atlantic Drum Corps Using the Weight Bearing 
Lunge Test. Clin Pract Athl Train. 2018;1(2):37-41. 
https://doi.org/10.31622/2018/0002.6 

Submitted: September 13, 2018 Accepted: October 15, 
2018 

INTRODUCTION 

A modern drum and bugle corps is a musical 
marching ensemble consisting of brass instruments, 
percussion instruments, synthesizers, and color 
guard. Drum and bugle corps are considered 
marching music’s major league. These groups 
practice for over 10 hours a day, on their feet, 
and have high incidence of lower extremity injury 
(LEI). LEI is more common to occur in marching 
ensembles than injury to the upper extremity.1 The 
most common injuries are medial tibial stress 
syndrome, achilles tendonitis, and ankle sprain. 
The commonality of these injuries in combination 
with their impact on heath and participation 
signifies the need to develop LEI preventative 
practices in this population to enhance patient 
safety.1  

The first step to injury prevention is identifying 
those individuals that may be most at risk. In order 
to accomplish this, clinicians need efficient and 
effective screening tools. Screening tools usually 
examine range of motion, balance, strength, 
and/or other modifiable risk factors as potential 
injury risk predictors. There are many tools that 
may be effective in assessing injury risk in 
populations with high incidence of LEI.2-6 Ankle 
dorsiflexion range of motion (DROM) is a simple 
measure that has a lot of supportive research in 
relation to LEI risk.2-6 DROM has been used with 
basketball, volleyball, gymnastics, and other 
various sports and activities.7 The weight bearing 
lunge test (WBLT), specifically, is a common 
quantification technique that measures DROM in a 

https://doi.org/10.31622/2018/0002.6


Assessing Lower Extremity Injury Risk in a Mid-Atlantic Drum Corps  
Using the Weight Bearing Lunge Test 

 

38 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

weight bearing position. Research has 
demonstrated that the WBLT can be used to 
quantify DROM and predict LEI.7 Additionally, the 
WBLT has been associated with measures of 
dynamic movement8 and balance9 which have 
also been associated with injury risk in physically 
active populations.10 
 
DFROM has been shown to have utility to predict 
individuals at risk of LEI in sports populations. This 
method, however, has not been conducted with the 
Drum Corps population. Therefore, the purpose of 
this study is to determine the effect of DROM on 
LEI risk within a Mid Atlantic Drum Corps by 
assessing DROM using the WBLT.  
 
PATIENTS: 
 
Two hundred thirty-eight patients from a Drum 
Corps International group from the Mid-Atlantic 
region that competes seasonally (Male=173, 
Female=65, Age=19.49± 1.05yrs) were 
screened as part of the pre-participation exam 
prior to the 2016 and 2017 seasons. Patients with 
current lower extremity injury at the time of data 
collection did not participate and were not 
included in the study. Patients who were included 
in this study were then monitored throughout the 
competitive season for lower extremity injury (LEI).  
 
INTERVENTION: 
 
The WBLT was used to measure weight bearing 
dorsiflexion ROM bilaterally in all patients. 
Assessment of the WBLT measurement in a 
systematic review suggested strong evidence that 
the inter-clinician reliability (ICC=0.80-0.99, 
MDC 4.6° or 1.6cm) and the intra-clinician 
reliability (ICC=0.65-0.99, MDC 4.7° or 1.9cm) 
were good.11 The WBLT was performed using 
the knee-to-wall principle (Figure 1).10,11 Patients 
were in a standing position facing a wall with the 
test foot parallel to and on top of a measuring 
tape. The measuring tape was secured to the 
floor with athletic tape or an equivalent.  The 
second toe, heel, and knee of the test foot were 
perpendicular to the wall during the testing 
session. While maintaining a single leg stance, 

patients were instructed to perform a lunge 
towards the wall by flexing the knee while 
keeping the heel of the test foot firmly fixed to 
the testing surface and without letting the knee 
sway medially or laterally. The opposite limb of 
the test foot was allowed to be suspended in 
knee flexion and non-weight bearing while the 
test foot went through the proper motion. Patients 
were able to place their hands on the wall for 
balance if desired. The test foot was progressed 
away from the wall in one centimeter (cm) 
increments and repeated until the knee or heel of 
the test limb lost contact with the wall and/or 
floor respectively.  The foot placement was then 
adjusted in smaller increments in order to have 
the foot the farthest point away from the wall 
while maintaining knee and heel contact and 
maximum lunge distance was recorded. The final 
successful trial was recorded for statistical 
analysis. WBLT measurements were completed 
by four individuals, two athletic trainers with 1-2  
 
Figure 1. Weight Bearing Lunge Test (WBLT). 



Assessing Lower Extremity Injury Risk in a Mid-Atlantic Drum Corps  
Using the Weight Bearing Lunge Test 

 

39 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

years of experience and two athletic training 
students.  

OUTCOME MEASURES: 
 
Injury electronic medical records were stored in a 
password protected, HIPAA compliant, online 
spreadsheet (G suiteTM by Google©) and was 
used to keep track of the number of lower 
extremity injuries sustained over the two 85 day 
seasons. Each patient injury was recorded into the 
online spreadsheet; patients sustaining multiple 
injuries were included in the analysis for their first 
LEI only. The definition of a lower extremity injury 
was an injury that caused removal from activity 
and loss of practice time for a total of four or 
more cumulative hours (one practice block).  
 
Analyses were completed using a statistical 
software program (IBM Corp. Released 2015. 
IBM SPSS Statistics for Windows, Version 23.0 
Armonk, NY: IBM Corp). Means and standard 
deviations of WBLT, average, and asymmetry 
measures were calculated for injured and non-
injured patients. The average of the maximal 
distance in centimeters of the great toe from the 
wall indicated the WBLT Average (WBLTAv). 
WBLT Asymmetry (WBLTAsy) was the absolute 
difference between limbs. T-tests were used to 
determine if there was a significant difference 
between those who sustained a LEI (Injured) and 
those who did not (Uninjured) for WBLTAv and  
 

WBLTAsy. For dependent measures associated 
with significant group differences, receiver 
operator characteristic curves (ROC) were 
performed to examine injury risk using area under 
the curve (AUC). Lastly, cut-off scores that 
produced the maximal values of sensitivity and 
specificity were identified. Alpha level was set a 
priori at p<0.05. 
 
RESULTS: 
 
LEI occurred in 87 of 238 patients during the 
2016 and 2017 drum corps regular seasons 
(Table 1). The normalized WBLTAv and WBLTAsy 
for injured and uninjured patients are presented 
in Table 2. The injured WBLTAv was significantly 
less compared to the uninjured (p=0.005). The 
injured WBLTAsy was significantly greater 
compared to the uninjured (p=0.015). The AUC 
from the ROC analysis (Figure 2) for WBLTAv and 
WBLTAsy was 0.596 and 0.601 respectively. A 
WBLTAv cutoff score of 11.47cm was associated 
with a sensitivity of 0.678 and a specificity of 
0.510. A WBLTAsy cutoff score of 0.75cm was 
associated sensitivity of 0.552 and a specificity of 
0.629. This data demonstrates that if a drum corps 
individual has a WBLTAv measure less than 
11.47cm, they are 40% more likely to sustain an 
LEI; if a drum corps individual has a WBLTAsy 
measure greater than 0.75cm, then they are 49% 
more likely to sustain an LEI (Figure 2).  

Figure 2. Receiver Operator Curve: A) WBLT Average and B) WBLT Asymetry.



CLINICAL OUTCOMES RESEARCH 

 

40 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018 
 

DISCUSSION:  
 
The purpose of this study was to determine if a 
relationship exists between DROM and LEI risk in 
the drum corps population. Slightly over one-third 
of the patients sustained an LEI during the 170 
days of participation. This study demonstrate that 
individuals with greater measures of average 
weight bearing DROM (WBLTAv > 11.47cm) are 
less likely to become injured and individuals with 
a greater asymmetry of weight bearing DROM 
(WBLTAsy > 0.75cm) between limbs are more 
likely to become injured. These findings are the 
stepping stone to say that weight bearing DROM 
may be a predictor of injury in the drum corps 
population.   
 
The results of this practice-based research 
identified WBLTAv (p=0.005) and WBLTAsy 
(p=0.015) differences between those that 
sustained a LEI and those that did not. To further 
analyze the utility of the WBLT, cutoff scores were 
calculated. While our findings indicated relatively 
low predictive accuracy overall, as signified by 
moderate AUC values (0.596 and 0.601), each 
measure fared well at either ruling in or out injury. 
This was indicated by WBLTAv sensitivity and 
WBLTAsy specificity values of almost 0.70. In 
terms of positive and negative likelihood ratios, 
this indicates that a drum corps member who have 
less than a 11.47cm WBLTAv are about 40% 
more likely to sustain a LEI than a member over 
that value (LR+ = 1.38). Additionally, if a member 
has greater than 0.75cm WBLTAsy, then they are 
49% more likely to sustain a LEI than an individual 
with less asymmetry.  
 
Overall, the results of this study indicate that the 
WBLT is a feasible screening method that does 
demonstrate useful data for a clinician to 
determine a drum corps member’s LEI risk. These 
findings are similar to previous literature on LEI 
risk in traditional athletic populations.2-6 
Furthermore, due to DROM’s nature as a 
modifiable risk factor, injury prevention programs 
could be implemented to reduce an individual’s 
risk of LEI. We propose that this method of 
screening can be completed prior to the season, 
and could allow clinicians to identify at risk 

individuals and ultimately decrease the overall 
frequency of LEI for the season once these 
individuals have modified their weight bearing 
DROM through prevention programs. At this time 
however, there is a need to evaluate the best 
practices for increasing DROM in a prophylactic 
manner.  
 
We experienced a number of obstacles during the 
implementation of the WBLT, however, we 
determined how to overcome these obstacles in 
the future. The implementation of the WBLT 
screening with multiple individuals in a short time 
span could have resulted in possible error.  The 
WBLT takes approximately thirty seconds to one 
minute to perform with one patient. Therefore, it is 
suggested for future studies to either increase the 
number of trained individuals administering the 
screening, or increase the amount of time 
available to complete the screening with the drum 
corps Members. An athletic training student was 
trained and completed practice sessions, but since 
the WBLT was a new procedure for the athletic 
training student, this inexperience may have 
compromised the ability to record accurate 
measurements. In order to reduce error, it is 
recommended that individuals who are properly 
trained and who have previous experience should 
administer the screening. The number of 
participants participating in the study may have 
been too low to provide accurate data for 
analysis. Additional participants may be needed 
in future studies. This can be accomplished by 
introducing multiple drum corps groups to the 
screening and conducting data on all the groups 
combined, not just one corps for two seasons. 
Additionally, the definition of LEI included any 
injury distal to the hip. Although DROM can be 
associated with injuries proximal to the ankle, it is 
not the only correlating factor. These factors may 
have produced inaccurate measurements causing 
a misrepresentation of the studied population. 
Additional research in this area could explore 
other modifiable risk factors such as knee and hip 
posture/range of motion, as well as factors such 
as sex and instrument type, as these could play a 
contributing role to injury risk within Drum Corps.   
 
 



Assessing Lower Extremity Injury Risk in a Mid-Atlantic Drum Corps  
Using the Weight Bearing Lunge Test 

 

41 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

CLINICAL IMPLICATIONS:    
 
Little research has been conducted regarding 
injury prevalence and injury risk factors within the 
performing arts athlete population, specifically 
drum corps. Our study provides an initial look into 
potential risk factors for LEI. Clinicians could utilize 
this data and the WBLT within the drum corps 
population to screen for LEI risk and identify 
individuals with higher risk of LEI. Cutoff scores of 
greater than 0.75cm WBLTAsy and less than 
10.40cm WBLTAv should be used to identify drum 
corps members that may be at greater risk of 
sustaining a LEI. With this information, healthcare 
providers can identify at-risk individuals and 
prescribe preventative measures in order to 
mitigate the potential injury during the drum corps 
season. In conclusion, our research study provides 
a starting point for prevention research in this 
unique population. However, additional research 
studies are needed regarding risk factors that 
predispose performing arts athletes to injury. Such 
studies can indicate how to best provide 
prevention strategies for the performing arts 
athletes in order to increase health related quality 
of life. 
 
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