Reliability and Validity of a Wall Sit Test for Monitoring Growth-Related Lower Limb Pain in Elite Youth Footballers

Sam Blanchard; Sinead Holden; Liam Dadd; Sean Cumming; Sean Williams

doi:10.1016/j.ptsp.2026.101913

Reliability and Validity of a Wall Sit Test for Monitoring Growth-Related Lower Limb Pain in Elite Youth Footballers

Sam Blanchard, Sinead Holden, Liam Dadd, Sean Cumming, Sean Williams

University College Dublin

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: To develop and evaluate the reliability and validity of a novel Wall Slide Test for monitoring pain and knee flexion in youth athletes with growth-related lower-limb pathologies.

Design: Reliability and prospective longitudinal cohort study.

Setting: A Category 1 English Premier League football academy.

Participants: Eighty-one male academy footballers aged 9–17 years with clinically diagnosed lower-limb pain conditions (including Osgood–Schlatter disease, patellofemoral joint pain, Sinding-Larsen–Johansson syndrome, and Sever’s disease) and 45 asymptomatic controls.

Main Outcome Measures: Pain at onset of loaded knee flexion (0–10 numerical rating scale), knee flexion range (cm), and a composite Wall Slide Test score. Reliability was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Validity was evaluated using mixed-effects models and receiver operating characteristic (ROC) analysis.

Results: Within-day reliability was excellent (ICC = 0.96–0.97). MDC values indicated meaningful detectable change (pain 0.74 points; range 9.1 cm). The composite score demonstrated good to excellent discriminative ability between symptomatic and asymptomatic players (AUC = 0.81–0.94).

Conclusions: The Wall Slide Test is a simple, reliable, and valid field-based tool for monitoring pain and functional knee flexion in youth athletes, supporting clinical decision-making and longitudinal management.

Original language	English
Article number	101913
Journal	Physical Therapy in Sport
Early online date	12 Mar 2026
DOIs	https://doi.org/10.1016/j.ptsp.2026.101913
Publication status	Published - 12 Mar 2026

Acknowledgements

The lead author thanks the players, parents, and staff at Manchester City Football Club for their cooperation and support during data collection. Particular thanks are extended to James Thomas, Rachael Dawe, and Neval Grazette for their contributions to the conception of the PhD project, and to James Cheeseman, Simon Timpson and Matt Connery for their encouragement to disseminate this work within the medical community. Appreciation is expressed to all staff who contributed to the objective monitoring of Academy players, including Tom Butterfield, Alex Owen, Kirsty Boybon, Reiss Fitts, Jack Greendale, Rob LeGuen, Emily Cain, Connor Aldridge, Nathan Sellars, Dr Alan Burton, and Gavin Connor.

Funding

No external funding was received for this research project

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10.1016/j.ptsp.2026.101913Licence: CC BY

https://linkinghub.elsevier.com/retrieve/pii/S1466853X26000349Licence: CC BY

Cite this

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title = "Reliability and Validity of a Wall Sit Test for Monitoring Growth-Related Lower Limb Pain in Elite Youth Footballers",

abstract = "Objectives: To develop and evaluate the reliability and validity of a novel Wall Slide Test for monitoring pain and knee flexion in youth athletes with growth-related lower-limb pathologies. Design: Reliability and prospective longitudinal cohort study. Setting: A Category 1 English Premier League football academy. Participants: Eighty-one male academy footballers aged 9–17 years with clinically diagnosed lower-limb pain conditions (including Osgood–Schlatter disease, patellofemoral joint pain, Sinding-Larsen–Johansson syndrome, and Sever{\textquoteright}s disease) and 45 asymptomatic controls. Main Outcome Measures: Pain at onset of loaded knee flexion (0–10 numerical rating scale), knee flexion range (cm), and a composite Wall Slide Test score. Reliability was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Validity was evaluated using mixed-effects models and receiver operating characteristic (ROC) analysis. Results: Within-day reliability was excellent (ICC = 0.96–0.97). MDC values indicated meaningful detectable change (pain 0.74 points; range 9.1 cm). The composite score demonstrated good to excellent discriminative ability between symptomatic and asymptomatic players (AUC = 0.81–0.94). Conclusions: The Wall Slide Test is a simple, reliable, and valid field-based tool for monitoring pain and functional knee flexion in youth athletes, supporting clinical decision-making and longitudinal management.",

author = "Sam Blanchard and Sinead Holden and Liam Dadd and Sean Cumming and Sean Williams",

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AB - Objectives: To develop and evaluate the reliability and validity of a novel Wall Slide Test for monitoring pain and knee flexion in youth athletes with growth-related lower-limb pathologies. Design: Reliability and prospective longitudinal cohort study. Setting: A Category 1 English Premier League football academy. Participants: Eighty-one male academy footballers aged 9–17 years with clinically diagnosed lower-limb pain conditions (including Osgood–Schlatter disease, patellofemoral joint pain, Sinding-Larsen–Johansson syndrome, and Sever’s disease) and 45 asymptomatic controls. Main Outcome Measures: Pain at onset of loaded knee flexion (0–10 numerical rating scale), knee flexion range (cm), and a composite Wall Slide Test score. Reliability was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Validity was evaluated using mixed-effects models and receiver operating characteristic (ROC) analysis. Results: Within-day reliability was excellent (ICC = 0.96–0.97). MDC values indicated meaningful detectable change (pain 0.74 points; range 9.1 cm). The composite score demonstrated good to excellent discriminative ability between symptomatic and asymptomatic players (AUC = 0.81–0.94). Conclusions: The Wall Slide Test is a simple, reliable, and valid field-based tool for monitoring pain and functional knee flexion in youth athletes, supporting clinical decision-making and longitudinal management.

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DO - 10.1016/j.ptsp.2026.101913

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ER -

Reliability and Validity of a Wall Sit Test for Monitoring Growth-Related Lower Limb Pain in Elite Youth Footballers

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