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Armitage M, McErlain-Naylor SA, Devereux G, Beato M, Iga J, McRobert A, Roberts S, Buckthorpe M. On-field rehabilitation in football: current practice and perceptions. A survey of the English Premier League and Football League. SCI MED FOOTBALL 2024:1-10. [PMID: 38456365 DOI: 10.1080/24733938.2024.2313529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Return to play related research is increasing rapidly, with two recent competency-based frameworks offering conceptualised support for on-field rehabilitation (OFR) decision-making. It is still unknown, however, who is responsible for OFR and how they typically select, monitor, and progress OFR processes. AIMS The purpose of this study was to investigate current OFR practice within English professional football to support practitioners with decision-making and highlight opportunities for future research related to the design, monitoring, and progression of OFR. METHODS Sixty-nine practitioners responsible for the design and implementation of OFR at 69 clubs (75% of the English Premier League and Football League) responded to a survey containing 30 questions (14 open and 16 closed). RESULTS The main findings were that therapists (physiotherapists/sports therapists) have the largest influence on OFR, followed by physical performance coaches (sports scientists/strength and conditioning coaches), technical coaches and medical doctors. There was more agreement for the ordering of specific OFR drills earlier in the process when activities are easier to control. The most frequently reported objective monitoring tool was global positioning systems (GPS), with functional/clinical experience/expertise remaining subjectively vital. GPS outputs (e.g., sprint metrics and accelerations/decelerations) were most used for between session decision-making, with verbal communication being key for within session decision-making. CONCLUSION Future research should use evidence of current practice, such as drill design and monitoring techniques, to explore drill-level analysis and give practitioners greater insights into which stage of current OFR frameworks specific drills fall, and how they might be more objectively progressed/regressed.
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Affiliation(s)
- Mark Armitage
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
- Faculty of Sport, Applied Health and Science, St Mary's University Twickenham, London, UK
- Performance Services Department, Ipswich Town Football Club, Ipswich, UK
| | - Stuart A McErlain-Naylor
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Gavin Devereux
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
| | - Marco Beato
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
| | - John Iga
- Performance Services Department, Norwich City Football Club, Norwich, UK
| | - Allistair McRobert
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Simon Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Matt Buckthorpe
- Faculty of Sport, Applied Health and Science, St Mary's University Twickenham, London, UK
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Fernandes A, Pinto J, Cunha P, Duarte C, Estaca A, Pereira T, Bettencourt M, Candelária I, E Silva MR. Complete Distal Rupture of the Rectus Femoris in an Elite Football Player: A Non-operative Treatment. Cureus 2023; 15:e45494. [PMID: 37859921 PMCID: PMC10584386 DOI: 10.7759/cureus.45494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Although muscle injuries represent the most frequent injury in professional football, isolated complete distal ruptures of the rectus femoris (RF) muscle are rare, and there is no consensus on their treatment and return to play (RTP). In this article, we report a clinical case of successful non-surgical management of an RF grade 4c muscle injury in a professional football player, in which the athlete was able to RTP 21 weeks after the injury, had no re-injury >1 year after RTP, and is playing at an elite level in the Portuguese Football First League.
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Affiliation(s)
- Alexandre Fernandes
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
- Physical Medicine and Rehabilitation, Hospital de Cascais, Lisbon, PRT
| | - Julio Pinto
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Pedro Cunha
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Carlos Duarte
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Alexandre Estaca
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Tiago Pereira
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
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Taberner M, Spencer N, Murphy B, Antflick J, Cohen DD. Progressing On-Court Rehabilitation After Injury: The Control-Chaos Continuum Adapted to Basketball. J Orthop Sports Phys Ther 2023; 53:498–509. [PMID: 37555664 DOI: 10.2519/jospt.2023.11981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND: Sport-specific training is an integral component of returning to sport following injury. Frameworks designed to guide sport-specific rehabilitation need to integrate and adapt to the specific context of elite sport. The control-chaos continuum (CCC) is a flexible framework originally designed for on-pitch rehabilitation in elite football (soccer). The concepts underpinning the CCC transfer to other elite sport rehabilitation environments. CLINICAL QUESTION: How can practitioners and clinicians transfer the CCC to elite basketball, to support planning and return to sport? On-court rehabilitation is a critical sport-specific rehabilitation component of return to sport, yet there are no frameworks to guide practitioners when planning and delivering on-court rehabilitation. KEY RESULTS: Based on our experience working in the National Basketball Association, we report how the CCC framework can apply to elite basketball. We focus on the design and delivery of progressive training in the presence of injury in this basketball-specific edition of the CCC. Given the challenges when quantifying "load" in basketball, we encourage practitioners and clinicians to consider the qualitative aspects of performance such as skill, sport-specific movement, contact, and decision making. CLINICAL APPLICATION: The 5-phase framework describes training progression from high control, a return to on-court running, to high chaos, a return to "live" unrestricted basketball. The model can be adapted to both short- and long-term injuries based on injury and progression criteria. Strength and power "diagnostics" can be strategically implemented to enhance decision making throughout the return to sport continuum. J Orthop Sports Phys Ther 2023;53(9):1-12. Epub: 9 August 2023. doi:10.2519/jospt.2023.11981.
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Afonso J, Olivares-Jabalera J, Fernandes RJ, Clemente FM, Rocha-Rodrigues S, Claudino JG, Ramirez-Campillo R, Valente C, Andrade R, Espregueira-Mendes J. Effectiveness of Conservative Interventions After Acute Hamstrings Injuries in Athletes: A Living Systematic Review. Sports Med 2023; 53:615-635. [PMID: 36622557 DOI: 10.1007/s40279-022-01783-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hamstrings injuries are common in sports and the reinjury risk is high. Despite the extensive literature on hamstrings injuries, the effectiveness of the different conservative (i.e., non-surgical) interventions (i.e., modalities and doses) for the rehabilitation of athletes with acute hamstrings injuries is unclear. OBJECTIVE We aimed to compare the effects of different conservative interventions in time to return to sport (TRTS) and/or time to return to full training (TRFT) and reinjury-related outcomes after acute hamstrings injuries in athletes. DATA SOURCES We searched CINAHL, Cochrane Library, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science databases up to 1 January, 2022, complemented with manual searches, prospective citation tracking, and consultation of external experts. ELIGIBILITY CRITERIA The eligibility criteria were multi-arm studies (randomized and non-randomized) that compared conservative treatments of acute hamstrings injuries in athletes. DATA ANALYSIS We summarized the characteristics of included studies and conservative interventions and analyzed data for main outcomes (TRTS, TRFT, and rate of reinjuries). The risk of bias was judged using the Cochrane tools. Quality and completeness of reporting of therapeutic exercise programs were appraised with the i-CONTENT tool and the certainty of evidence was judged using the GRADE framework. TRTS and TRFT were analyzed using mean differences and the risk of reinjury with relative risks. RESULTS Fourteen studies (12 randomized and two non-randomized) comprising 730 athletes (mostly men with ages between 14 and 49 years) from different sports were included. Nine randomized studies were judged at high risk and three at low risk of bias, and the two non-randomized studies were judged at critical risk of bias. Seven randomized studies compared exercise-based interventions (e.g., L-protocol vs C-protocol), one randomized study compared the use of low-level laser therapy, and three randomized and two non-randomized studies compared injections of platelet-rich plasma to placebo or no injection. These low-level laser therapy and platelet-rich plasma studies complemented their interventions with an exercise program. Only three studies were judged at low overall risk of ineffectiveness (i-CONTENT). No single intervention or combination of interventions proved superior in achieving a faster TRTS/TRFT or reducing the risk of reinjury. Only eccentric lengthening exercises showed limited evidence in allowing a shorter TRFT. The platelet-rich plasma treatment did not consistently reduce the TRFT or have any effect on the risk of new hamstrings injuries. The certainty of evidence was very low for all outcomes and comparisons. CONCLUSIONS Available evidence precludes the prioritization of a particular exercise-based intervention for athletes with acute hamstrings injuries, as different exercise-based interventions showed comparable effects on TRTS/TRFT and the risk of reinjuries. Available evidence also does not support the use of platelet-rich plasma or low-level laser therapy in clinical practice. The currently available literature is limited because of the risk of bias, risk of ineffectiveness of exercise protocols (as assessed with the i-CONTENT), and the lack of comparability across existing studies. CLINICAL TRIAL REGISTRATION PROSPERO CRD42021268499 and OSF ( https://osf.io/3k4u2/ ).
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Affiliation(s)
- José Afonso
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal.
| | - Jesús Olivares-Jabalera
- Sport Research Lab, Football Science Institute, Granada, Spain
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Ricardo J Fernandes
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Filipe Manuel Clemente
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Delegação da Covilhã, Instituto de Telecomunicações, Covilhã, Portugal
| | - Sílvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Tumor & Microenvironment Interactions Group, INEB-Institute of Biomedical Engineering, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Research Center in Sports Performance, Recreation, Innovation and Technology (SPRINT), Melgaço, Portugal
| | - João Gustavo Claudino
- Group of Research, Innovation and Technology Applied to Sport (GSporTech), Multi-user Laboratory of the Department of Physical Education (MultiLab of the DPE), Department of Physical Education, Center for Health Sciences, Federal University of Piauí, Teresina, Piauí, Brazil
- Department of Physical Education, Center for Health Sciences, Federal University of Piauí, Teresina, Piauí, Brazil
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Cristina Valente
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
| | - Renato Andrade
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal.
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal.
- Dom Henrique Research Centre, Porto, Portugal.
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805 017, Guimarães, Portugal
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Alfonso Mantilla JI. Readaptación deportiva y retorno deportivo en el alto rendimiento. Del laboratorio al campo de juego: Una revisión de la literatura. REVISTA IBEROAMERICANA DE CIENCIAS DE LA ACTIVIDAD FÍSICA Y EL DEPORTE 2022. [DOI: 10.24310/riccafd.2022.v11i3.15381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introducción En la actualidad, la readaptación deportiva se conoce como un proceso dinámico a nivel estructural y funcional de elementos del movimiento corporal humano tales como la caracterización de cualidades físicas, sinergias articulares y musculares, eficiencia y eficacia del movimiento y potencialización de habilidades funcionales para el deporte de alto rendimiento después de una lesión deportiva Metodología revisión de la literatura basados en los criterios PRISMA donde se hizo la búsqueda en las principales bases de datos tales como: Pubmed, Ebsco, Medline, Scopus, Science Direct con los siguientes terminos DeCS: Return to sport, Performance, sports, Return to training, Return to play, Rehabilitation, sports idioma de evidencia inglés, español, portugués, catalán y francés Resultados se pudo obtener la información de 74 artículos donde se estableció que el proceso de readaptación deportiva se basa en pilares específicos tales como movimiento, patrones funcionales, control de carga, monitorización, criterios de seguimiento por fase que permiten desarrollar un retorno exitoso al alto rendimiento deportivo. Conclusión la readaptación deportiva es un proceso que permite tomar decisiones basados en un proceso sistematizado generando la evolución del concepto de readaptador deportivo como un pilar esencial en el trabajo en el deporte de alto rendimiento en cualquier disciplina deportiva.
PALABRAS CLAVE: Return to Sport, Performance, sports, Return to training, Return to play
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Armitage M, McErlain-Naylor SA, Devereux G, Beato M, Buckthorpe M. On-field rehabilitation in football: Current knowledge, applications and future directions. Front Sports Act Living 2022; 4:970152. [PMID: 36544545 PMCID: PMC9760760 DOI: 10.3389/fspor.2022.970152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mark Armitage
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom,Performance Services Department, Norwich City Football Club, Norwich, United Kingdom,Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, London, United Kingdom,*Correspondence: Mark Armitage
| | - Stuart A. McErlain-Naylor
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Gavin Devereux
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Marco Beato
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Matthew Buckthorpe
- Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, London, United Kingdom
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Return to sport and beyond following intramuscular hamstring injury: A case report of an English Premier League football player. Phys Ther Sport 2022; 56:38-47. [DOI: 10.1016/j.ptsp.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022]
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Afonso J, Rocha-Rodrigues S, Clemente FM, Aquino M, Nikolaidis PT, Sarmento H, Fílter A, Olivares-Jabalera J, Ramirez-Campillo R. The Hamstrings: Anatomic and Physiologic Variations and Their Potential Relationships With Injury Risk. Front Physiol 2021; 12:694604. [PMID: 34305648 PMCID: PMC8294189 DOI: 10.3389/fphys.2021.694604] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/16/2021] [Indexed: 01/11/2023] Open
Abstract
The incidence and recurrence of hamstrings injuries are very high in sports, posing elevated performance and financial-related costs. Attempts to identify the risk factors involved in predicting vulnerability to hamstrings injury is important for designing exercise-based programs that aim to mitigate the rate and severity of hamstrings injuries and improve rehabilitation strategies. However, research has shown that non-modifiable risk factors may play a greater role than modifiable risk factors. Recognizing non-modifiable risk factors and understanding their implications will afford the prescription of better suited exercise programs, i.e., that are more respectful of the individual characteristics. In a nutshell, non-modifiable risk factors can still be acted upon, even if indirectly. In this context, an underexplored topic is how intra and inter- individual anatomic and physiologic variations in hamstrings (e.g., muscle bellies, fiber types, tendon length, aponeurosis width, attachment sites, sex- and age-related differences) concur to alter hamstrings injuries risk. Some anatomic and physiologic variations may be modifiable through exercise interventions (e.g., cross-sectional area), while others may not (e.g., supernumerary muscle bellies). This apparent dichotomy may hide a greater complexity, i.e., there may be risk factors that are partially modifiable. Therefore, we explored the available information on the anatomic variations of the hamstrings, providing a deeper insight into the individual risk factors for hamstrings injuries and contributing with better knowledge and potential applications toward a more individualized exercise prescription.
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Affiliation(s)
- José Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sport of the University of Porto, Porto, Portugal
| | - Sílvia Rocha-Rodrigues
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Centre in Sports Sciences, Health Sciences and Human Development, Vila Real, Portugal
- Tumor & Microenvironment Interactions Group, Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Filipe M. Clemente
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, Covilhã, Portugal
| | - Michele Aquino
- Department of Health and Sport Sciences, Adelphi University, New York, NY, United States
| | | | - Hugo Sarmento
- Research Unit for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Alberto Fílter
- FSI Sport Research Lab, Football Science Institute, Granada, Spain
- Research Group Physical Activity, Health and Sport CTS-948, University of Pablo de Olavide, Seville, Spain
| | - Jesús Olivares-Jabalera
- FSI Sport Research Lab, Football Science Institute, Granada, Spain
- Sport and Health University Research Institute, Department of Physical and Sports Education, University of Granada, Granada, Spain
| | - Rodrigo Ramirez-Campillo
- Department of Physical Activity Sciences, Universidad de Los Lagos, Santiago, Chile
- Centro de Investigación en Fisiología del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
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Allen T, Wilson S, Cohen DD, Taberner M. Drill design using the 'control-chaos continuum': Blending science and art during return to sport following knee injury in elite football. Phys Ther Sport 2021; 50:22-35. [PMID: 33862346 DOI: 10.1016/j.ptsp.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 11/15/2022]
Abstract
Establishing the level of risk, planning and adapting the return to sport (RTS) process following a complex knee injury involves drawing on a combination of relevant high-quality evidence and practitioner experience. On-pitch rehabilitation is a critical element of this process, providing an effective transition from rehabilitation to team training. The 'control-chaos continuum' (CCC) is an adaptable framework for on-pitch rehabilitation moving from high control to high chaos, progressively increasing running load demands and incorporating greater perceptual and neurocognitive challenges within sport-specific drills. Drills are a key element of the CCC, and are designed to ensure specificity, ecological validity and maintaining player interest. We showcase drill progression through the phases of the CCC, highlighting the use of constraints to create drills that incorporate the physical, technical, tactical and injury-specific needs of the player. We also provide recommendations to help practitioners create training session content using the CCC to help replicate the demands of team training within their own environment.
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Affiliation(s)
- T Allen
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK; Institute of Coaching and Performance, University of Central Lancashire, Preston, UK.
| | - S Wilson
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
| | - D D Cohen
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia; Sports Science Center (CCD), Colombian Ministry of Sport (Mindeporte), Colombia
| | - M Taberner
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
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