The efficacy of exercise in preventing injury in adult male football: a systematic review of randomised controlled trials

STRENGTH MAINTENANCE TRAINING IN THE REHABILITATION OF COMMON INJURIES IN SOCCER ATHLETES DURING THE WINTER

ABSTRACT Introduction: The level of soccer athletics develops rapidly, requiring athletes to be more capable of training, strengthening, and competitive readiness. Often, these characteristics are compromised by preventable injuries resulting from excessive or unreasonable training, especially in winter. The outcome is the athlete’s absence from games during the season, compromising the team’s qualification. Objective: Improve the treatment and prevention of the major injuries caused to soccer athletes in winter. Methodology: The main injuries resulting from poor training and the best practices of awareness and recovery were researched. The selected actions were implemented on ten athletes with follow-up during the entire annual season, totaling 50 games. Results: An increase in the number of active athletes during the competition phase was observed in 7 games, and competition efficiency was increased by 14%. Conclusion: Soccer players can get better rehabilitation through practical strength maintenance training in the rehabilitation phase between winter training and competitions. This scientific and rational method has a significantly positive effect on the physical performance of athletes. Evidence Level II; Therapeutic Studies – Investigating the results.

A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies

Background

A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.

Purpose

To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.

Study Design

Systematic review; Level of evidence, 4.

Methods

We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).

Results

A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.

Conclusion

This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.

Effects of an Injury Prevention Program in CrossFit Athletes: A Pilot Randomized Controlled Trial

The present study aimed to assess the effects of an injury prevention program in CrossFit athletes. Thirty-two CrossFit athletes were randomized to either an intervention group (n=16), that performed mobility and stability exercises during the warm-up of all CrossFit sessions for a 10-week period or to a control group (n=16) that kept performing their usual warm-up. Incidence of injuries (primary outcome) as well as average training loads, fatigue and pain perception were registered during the study. The overall injury incidence rate was 0.04 per 1000 training hours, with no differences between groups (p>0.05). Similarly, no between-group differences were found for injury severity, nor for average training volume, intensity, training load, pain, or fatigue perception during the study (all p>0.05 with trivial-to-small effect sizes). In summary, a 10-week injury prevention program consisting of stability and mobility exercises provided no benefits on injury rates, fatigue and pain perception in recreational CrossFit athletes. Further research might corroborate the preliminary evidence reported here.

Semitendinosus and biceps femoris long head active stiffness response until failure in professional footballers with vs. without previous hamstring injury

This study sought to examine the active stiffness of semitendinosus (ST) and biceps femoris long head (BFlh) during a knee flexor isometric contraction at 20% of maximal voluntary isometric contraction until failure in elite footballers (n=50, age: 22.3±5.3 years; height: 1.82±0.08 m; body mass: 74.7±9.0 kg). Active stiffness was assessed using ultrasound-based shear wave elastography by means of shear modulus quantification. Comparisons were performed between limbs with (n=11) vs. without (n=89) previous hamstring injury. Similar time until failure in the knee flexor fatigue task was observed between groups (p=0.401). At the start of the task, lower limbs with previous hamstring injury showed a lower BFlh active stiffness (31.0.1±10.4 kPa, p=0.023) and BFlh/ST active stiffness ratio (0.50±0.29), and no differences for ST (72.8±26.8 kPa, p=0.221) compared to lower limbs without previous hamstring injuries (BFlh: 38.0±9.6 kPa; ST: 64.0±18.4 kPa; BFlh/ST: 0.65±0.27). During the task, the ST active stiffness in both groups decreased from 80% of task time (p=0.032), in the absence of changes in BFlh active stiffness (p=0.534), resulting in an increase in BFlh/ST active stiffness from 80% of task time (p=0.029). No differences between limbs were observed during the fatigue task for all parameters (p>0.099). Future research is warranted to verify if the differences found represent an increased risk of hamstring injury.

Potential prognostic factors for hamstring muscle injury in elite male soccer players: A prospective study

Hamstring injuries remain the most common injury type across many professional sports. Despite a variety of intervention strategies, its incidence in soccer players playing in the UEFA Champions League has increased by 4% per year over the last decade. Test batteries trying to identify potential risk factors have produced inconclusive results. The purpose of the current study was to prospectively record hamstring injuries, to investigate the incidence and characteristics of the injuries, and to identify possible risk factors in elite male soccer players, playing in the Kosovo national premier league. A total of 143 soccer players from 11 teams in Kosovo were recruited. To identify possible prevalent musculoskeletal or medical conditions a widespread health and fitness assessment was performed including isokinetic strength testing, Nordic hamstring strength test, functional tests, and a comprehensive anamnesis surveying previous hamstring injuries. On average 27.9% of the players sustained at least one hamstring injury with three players suffering bilateral strains with the re-injury rate being 23%. Injured players were significantly older and heavier and had a higher body mass index compared to non-injured ones (p < 0.05). There was a lower passing rate in the Nordic hamstring strength test and a higher injury incidence among the previously injured players compared to non-injured ones (p < 0.05). Except for hamstring/quadriceps ratio and relative torque at 60°/sec (p < 0.05) for dominant and non-dominant leg, there were no other significant differences in isokinetic strength regardless of the angular velocity. No differences were observed for functional tests between cohorts. Regression analysis revealed that age, Nordic hamstring strength test, previous injury history, and isokinetic concentric torque at 240°/sec could determine hamstring injuries by 25.9%, with no other significant predicting risk factors. The battery of laboratory and field-based tests performed during preseason to determine performance related skills showed limited diagnostic conclusiveness, making it difficult to detect players at risk for future hamstring injuries.

Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review

OBJECTIVE

To identify which exercise combinations are most effective as part of a lower extremity injury prevention programme for team-sport athletes.

DESIGN

Umbrella review.

DATA SOURCES

A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and PEDro databases. Studies published between January 2000 and March 2017 were included in this umbrella review.

STUDY ELIGIBILITY CRITERIA

Moderate to high-quality systematic reviews that investigated the effectiveness of a combination of two or more exercise components, that is, strength, agility, plyometrics, balance, stretching, technique, warm-up and functional activity, regarding injury incidence/rate of lower extremity injuries in team-sport athletes. The methodological quality of the included systematic reviews was independently assessed by two reviewers using the Assessing the Methodological Quality of Systematic Reviews measurement tool and the Grading of Recommendations Assessment, Development and Evaluation guidelines were used to assess the overall quality of evidence for particular outcomes.

RESULTS

Twenty-four systematic reviews met the inclusion criteria. Multicomponent exercise interventions were effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries, but not groin injuries. Strength and balance exercise components were included in 10 of 11 effective injury prevention programmes for the lower extremity, knee, ACL and ankle injuries.

SUMMARY/CONCLUSION

Lower extremity injury prevention programmes in team sports are effective in preventing lower extremity, knee, ACL and ankle injuries. Lower extremity muscle strength and balance exercises should be prioritised in lower extremity injury prevention programmes for team-sport athletes.

Hamstring injuries: update article

Hamstring (HS) muscle injuries are the most common injury in sports. They are correlated to long rehabilitations and have a great tendency to recur. The HS consist of the long head of the biceps femoris, semitendinosus, and semimembranosus. The patient's clinical presentation depends on the characteristics of the lesion, which may vary from strain to avulsions of the proximal insertion. The most recognized risk factor is a previous injury. Magnetic resonance imaging is the method of choice for the injury diagnosis and classification. Many classification systems have been proposed; the current classifications aim to describe the injury and correlate it to the prognosis. The treatment is conservative, with the use of anti-inflammatory drugs in the acute phase followed by a muscle rehabilitation program. Proximal avulsions have shown better results with surgical repair. When the patient is pain free, shows recovery of strength and muscle flexibility, and can perform the sport's movements, he/she is able to return to play. Prevention programs based on eccentric strengthening of the muscles have been indicated both to prevent the initial injury as well as preventing recurrence.