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Lima YL, Collings TJ, Hall M, Bourne MN, Diamond LE. Injury Prevention Programmes Fail to Change Most Lower Limb Kinematics and Kinetics in Female Team Field and Court Sports: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Sports Med 2024; 54:933-952. [PMID: 38044391 DOI: 10.1007/s40279-023-01974-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND One mechanism by which exercise interventions may be effective in reducing anterior cruciate ligament (ACL) injury risk is through changes in lower limb biomechanics. Understanding how training programmes affect lower-limb kinematics and kinetics may help refine injury prevention programmes. OBJECTIVE The aim of this systematic review and meta-analysis was to assess the effect of injury prevention programmes on kinematics and kinetics during tasks related to ACL injury in female team field and court sports. DATA SOURCES Five databases were searched in October 2022. ELIGIBILITY CRITERIA Randomised controlled trials assessing the effect of injury prevention programmes compared with usual training/no training on lower limb kinematics and kinetics in female team field and court sports were eligible for review. RESULTS Sixteen studies were included. A total of 976 female athletes were included. Most of the studies included interventions with multiple components (12/16). Commonly used components were plyometrics (12/16), strength (8/16), and balance/stability (7/16). Thirteen studies had routine training or sham interventions as the control group and three studies had no training. Very low certainty evidence suggests that injury prevention programmes increase knee flexion angles (mean difference = 3.1° [95% confidence interval 0.8-5.5]); however, very low to low certainty evidence suggests no effect on hip flexion angles/moments, knee flexion moments, hip adduction angles/moments, knee adduction angles/moments, hip internal rotation angles/moments, ankle dorsiflexion angles, and ground reaction forces, compared with usual training/no training. CONCLUSION Injury prevention programmes may be effective in increasing knee flexion angles during dynamic landing and cutting tasks but may have no effect on other lower limb biomechanical variables. As such, the benefits of injury prevention programmes may be mediated by factors other than altered biomechanics and/or may happen through other biomechanical measures not included in this review.
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Affiliation(s)
- Yuri Lopes Lima
- School of Health Sciences and Social Work, Clinical Sciences G02, Griffith University, Parklands Drive, Southport, QLD, 4215, Australia.
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Southport, Australia.
| | - Tyler J Collings
- School of Health Sciences and Social Work, Clinical Sciences G02, Griffith University, Parklands Drive, Southport, QLD, 4215, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Michelle Hall
- Sydney Musculoskeletal Health, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Matthew N Bourne
- School of Health Sciences and Social Work, Clinical Sciences G02, Griffith University, Parklands Drive, Southport, QLD, 4215, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Laura E Diamond
- School of Health Sciences and Social Work, Clinical Sciences G02, Griffith University, Parklands Drive, Southport, QLD, 4215, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Southport, Australia
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Muramoto Y, Iwamoto W, Iida S, Sasagawa K, Kobayashi H, Ishibuchi S, Murakami J, Maehara Y, Tanaka N, Wagatsuma K, Kuruma H. Effectiveness of warm-up and dynamic balance training in preventing anterior cruciate ligament injuries in college gymnasts: a 3-year prospective study for one team. J Sports Med Phys Fitness 2024; 64:167-174. [PMID: 38093642 DOI: 10.23736/s0022-4707.23.15539-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The effect of trunk stability and dynamic balance warm-up exercises on physical functional improvement remains unelucidated. This study examined whether exercises could prevent anterior cruciate ligament (ACL) injury and improve trunk muscle activation and dynamic balance in gymnasts. METHODS This comparison study, involving gymnastics practice sessions, included 31 university gymnasts and was conducted in two periods: 1 year of observation followed by 2 years of intervention. Participants performed a trunk and dynamic balance warm-up exercise program during the intervention. The effect of exercise on the incidence of ACL injury was evaluated. In addition, the paired t-test was used to compare the Y-balance distance and the changes in muscle thickness associated with trunk muscle activation at rest and during plank. RESULTS ACL injury risk during the intervention was significantly lower, with a relative risk of 0.23 (P=0.02, 95% CI: 0.06-0.88). Changes in muscle thickness with activation of the transversus abdominis (P<0.01, mean difference 4.1, 95% CI: 9.97-28.07, Cohen's d=0.52), internal oblique (P<0.01, mean difference 5.2, 95% CI: 9.72-21.55, Cohen's d=0.65), and external oblique (P<0.01, mean difference 5.5, 95% CI: 20.44-39.09, Cohen's d=0.71) muscles were significantly higher during the intervention. The Y-balance distance was also significantly greater in the posterior medial reach (P<0.01, mean difference 3.3, 95% CI: 1.56-6.26, Cohen's d=0.46) during the intervention. CONCLUSIONS Exercise-based warm-up programs may decrease ACL injuries. It can improve physical functions, such as the rate of change in trunk muscle thickness and the posterior medial distance during Y balance.
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Affiliation(s)
- Yuki Muramoto
- Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo, Japan -
- Department of Sports Medicine, Edogawa Hospital, Tokyo, Japan -
| | - Wtataru Iwamoto
- Department of Sports Medicine, Edogawa Hospital, Tokyo, Japan
| | - Syota Iida
- Department of Sports Medicine, Edogawa Hospital, Tokyo, Japan
| | - Kaoru Sasagawa
- Department of Sports Medicine, Edogawa Hospital, Tokyo, Japan
| | | | | | | | - Yuko Maehara
- Department of Sports Medicine, Edogawa Hospital, Tokyo, Japan
| | - Naoki Tanaka
- Faculty of Health Care and Medical Sports, Teikyo Heisei University, Chiba, Japan
| | - Koji Wagatsuma
- Department of Sports Medicine, Edogawa Hospital, Tokyo, Japan
| | - Hironobu Kuruma
- Department of Physical Therapy Science, Tokyo Metropolitan University Graduate School of Human Health Sciences, Tokyo, Japan
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Dewig DR, Boltz AJ, Moffit RE, Rao N, Collins CL, Chandran A. Epidemiology of Anterior Cruciate Ligament Tears in National Collegiate Athletic Association Athletes: 2014/2015-2018/2019. Med Sci Sports Exerc 2024; 56:29-36. [PMID: 37616175 DOI: 10.1249/mss.0000000000003281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aimed to describe the epidemiology of ACL tears in NCAA men's and women's sports. METHODS Injury and exposure data collected within the NCAA Injury Surveillance Program from 2014/2015 to 2018/2019 were analyzed. ACL tear frequencies, injury rates (IR), and injury proportions were used to describe injury incidence by sport, event type, injury mechanism, and injury history. Injury rate ratios (IRR) were used to examine differential injury rates, and injury proportion ratios (IPR) were used to examine differential distributions. RESULTS A total of 729 ACL tears were reported from 8,474,401 recorded athlete exposures (AE) during the study period (IR = 0.86 per 10,000 AE), and the competition-related ACL tear rate was higher than the practice-related rate (IRR = 5.52, 95% confidence interval [CI] = 4.75-6.39). Among men's sports, the highest overall ACL tear rate was observed in men's football (IR = 1.44 per 10,000 AE), whereas among women's sports, the highest overall rate was observed in women's soccer (IR = 2.60 per 10,000 AE). Among sex-comparable sports, ACL tear rates were higher in women's basketball, softball, and soccer, as compared with their men's counterparts. ACL tears were more prevalently attributed to player contact mechanisms in men's sports than women's sports (IPR = 1.73, 95% CI = 1.37-2.19), but more prevalently attributed to noncontact mechanisms in women's sports than men's sports (IPR = 1.17, 95% CI = 1.01-1.35). CONCLUSIONS ACL tear risk in women's sports continues to warrant attention and prevention efforts. Given the differential rates by event type, future research efforts may also evaluate initiatives to reduce competition-related injury burden in NCAA sports.
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Affiliation(s)
- Derek R Dewig
- College of Education, Health and Human Performance, Fairmont State University, Fairmont WV
| | | | - Reagan E Moffit
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Neel Rao
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
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Feria-Madueño A, Hewett TE, Sánchez-Arteaga A, Sañudo B. Neuromuscular Response during Different Side-Cutting Maneuvers and Its Influence on the Risk of Knee Injuries. Sports (Basel) 2023; 11:190. [PMID: 37888517 PMCID: PMC10611348 DOI: 10.3390/sports11100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The objective of this study was to investigate the impact of a customized exercise program on electromyographic (EMG) variables during side-cutting maneuvers. METHODS Fifty-seven physically active volunteers were recruited and randomized into two groups: a control group (CG) and an experimental group (EG). The CG maintained their regular physical activity, while the EG followed an individualized, integrated exercise regimen that included strength, neuromuscular, proprioceptive, eccentric training, and whole-body vibration (WBV) exercises, lasting for 12 weeks. EMG-Root Means Square (RMS) values for the quadriceps (Q) and hamstrings (H) were measured immediately following initial foot contact at 50, 100, 150, and 200 milliseconds. Changes in EMG activity were evaluated before and after a twelve-week intervention, and the effect size (ES, 90% confidence limit [90%CL]) was calculated. RESULTS The results showed that the EG participants exhibited enhanced co-contraction as measured by the hamstring/quadriceps ratio (H/Q ratio) during both open and cross-cutting side maneuvers after the twelve-week intervention. CONCLUSION Furthermore, the customized, integrated exercise program that combined strength, neuromuscular, proprioceptive, eccentric training, and WBV exercises were could potentially serve as a beneficial neuromuscular and biomechanical strategy for addressing knee injury risk in non-professional, physically active populations at high risk for such injuries.
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Affiliation(s)
- Adrián Feria-Madueño
- Department of Physical Education and Sport, University of Seville. Pirotecnia Street, 41013 Seville, Spain;
| | - Timothy E. Hewett
- Biomechanics Laboratories and Sports Medicine Research, Department of Orthopedics, Marshall University, Huntington, WV 25755, USA;
- Hewett Global Consulting, Newport, KY 25701, USA
| | | | - Borja Sañudo
- Department of Physical Education and Sport, University of Seville. Pirotecnia Street, 41013 Seville, Spain;
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Phrathep DD, Glover J, Valls B, Fischer S, Nguyen J, Boesler D. Throwing Shoulder Range of Motion and Hamstring Flexibility in Adolescent Baseball Players: A Pilot Study. Cureus 2023; 15:e46159. [PMID: 37905252 PMCID: PMC10613122 DOI: 10.7759/cureus.46159] [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: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Overhead throwing athletes with limited hamstring flexibility should be counseled appropriately regarding their risk for shoulder injury. Baseball players should stretch and prepare their bodies to throw to reduce the compensatory mechanisms that may occur from hamstring stiffness. We aim to identify the association between the contralateral hamstring-popliteal angle and throwing shoulder total range of motion (ROM) in high school baseball players. Fifteen high school varsity baseball players (ages 14-18 years old) volunteered for this observational study. All the athletes played five times a week and played different positions. Bilateral hamstring and throwing shoulder total ROMs were measured using a goniometer by the same examiner. Three examiners determined the maximum ROM by joint end feel for each measurement to ensure quality control. Contralateral hamstring flexibility was measured using the popliteal angle test. These measurements were compared to the throwing shoulder total ROM to determine the presence of an association. The relationship between the contralateral hamstring flexibility and throwing shoulder total ROM was determined using a linear regression analysis. The correlation coefficient (r) was +0.3928, indicating a positive linear relationship. We conclude that higher contralateral hamstring-popliteal angles may cause a compensatory increase in throwing shoulder total ROM. We highlight the role hamstring stiffness may play in shoulder injury development in adolescent baseball players.
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Affiliation(s)
- Davong D Phrathep
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Jayden Glover
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Brandon Valls
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Steven Fischer
- Department of Urology, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
- Department of Pain Management, Lake Erie College of Osteopathic Medicine, Tampa, USA
| | - Jonathan Nguyen
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - David Boesler
- Department of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
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Gómez EM, Atef H, Elsayed SH, Zakaria HM, Navarro MP, Sulé EM. Effects of high-intensity interval training with an eccentric hamstring exercise program in futsal players: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e34626. [PMID: 37543767 PMCID: PMC10402967 DOI: 10.1097/md.0000000000034626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Physiotherapy protocols based on high-intensity interval training (HIIT) or eccentric hamstring exercises like Nordic Curl (NC) have been scarcely studied in futsal players. The objective of this study was to compare the effectiveness of a HIIT combined with an NC exercise program versus a HIIT-only program in futsal players. METHODS Twenty-one futsal players were divided into (1) HIIT + NC group (n = 11, mean age = 21.55 [4.25]); and (2) HIIT group (n = 10, mean age = 20.90 [1.29]). The HIIT + NC group performed a HIIT circuit combined with 3 sets of 10 NC repetitions for 4 weeks, while the HIIT group performed the same protocol without NC exercise. Body mass index, intermittent work performance, vertical jump performance without and with arms, isometric strength of quadriceps and hamstrings, and the isometric hamstrings/quadriceps (H/Q) ratio, were assessed before and after the interventions. RESULTS The HIIT + NC group and the HIIT group showed a significant improvement in intermittent work performance after the intervention (P = .04 and P = .01, respectively). Also, both groups showed a trend of increasing quadriceps and hamstring isometric strength, although no significant changes were found (P > .05). In addition, neither the HIIT + NC protocol nor the HIIT protocol was sufficient to yield changes in body mass index nor to improve the vertical jump performance (P > .05). CONCLUSION Both an isolated HIIT protocol and HIIT in combination with NC exercise improved intermittent work performance in futsal players. The present study's findings may guide futsal players' physical preparation and injury prevention programs.
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Affiliation(s)
- Elena Muñoz Gómez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Hady Atef
- School of Allied Health Professions, Keele University, Staffordshire, United Kingdom
- Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Shereen Hamed Elsayed
- Department of Rehabilitation Sciences, Faculty of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hoda M Zakaria
- Department of Physical Therapy for Neurology, College of Physical Therapy, Cairo University, Cairo, Egypt
| | - Miguel Pérez Navarro
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Elena Marqués Sulé
- Physiotherapy in Motion, Multi-Speciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
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Ling DI, Janosky J, Schneider B, Russomano J, Boyle C, Kinderknecht J, Marx RG. A Controlled Trial of the Effects of Neuromuscular Training on Physical Performance in Male and Female High School Athletes. Sports Health 2023; 15:386-396. [PMID: 35499093 PMCID: PMC10170228 DOI: 10.1177/19417381221089917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neuromuscular training (NMT) has demonstrated efficacy as an intervention to decrease the risk of anterior cruciate ligament injuries and improve sports performance. The effect of this training on the mechanisms that contribute to improved physical performance has not been well defined. HYPOTHESIS Athletes in the NMT group will have better mechanisms of fundamental movements and agility tests that may contribute to improved sports performance. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 2. METHODS Eight high school teams (111 athletes, 53% male, mean age 16 years) participated, with half performing NMT. Physical performance was measured using the dorsaVi ViPerform system, a US Food and Drug Administration-cleared wireless sensor system. Agility was assessed using a timed 3-cone test. Independent sample t tests were used to compare differences between the intervention and control groups. RESULTS Matched pre- and postseason data were collected from 74 athletes after excluding athletes with injury and those lost to follow-up. Significant improvements were observed in the NMT group for loading/landing speed ratios during a single-leg hop test (right lower extremity = -0.19 [-0.37, 0.03], P = 0.03 and left lower extremity = -0.27 [-0.50, -0.03], P = 0.03). The control group had lower ground reaction forces compared with the NMT group (P < 0.02), while significant improvements were found in the NMT group for initial peak acceleration (P < 0.02) and cadence (P = 0.01) during a straight-line acceleration/deceleration test. For the 3-cone agility test, the postseason time decreased compared with preseason in the NMT group, whereas the time for the control group increased (-0.37 s vs 0.14 s, P < 0.00). CONCLUSION The results demonstrate that NMT administered by sports medicine clinicians can significantly improve some physical performance of fundamental movements in high school athletes. CLINICAL RELEVANCE Coaches should be trained to effectively deliver NMT in order to improve sports performance.
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Affiliation(s)
- Daphne I. Ling
- Sports Medicine Institute, Hospital for
Special Surgery, New York
- Department of Population Health
Sciences, Weill Cornell Medical College, New York
| | - Joseph Janosky
- Sports Safety Program, Sports Medicine
Institute, Hospital for Special Surgery, New York
| | | | | | - Caroline Boyle
- Sports Medicine Institute, Hospital for
Special Surgery, New York
| | | | - Robert G. Marx
- Sports Medicine Institute, Hospital for
Special Surgery, New York
- Department of Orthopedic Surgery, Weill
Cornell Medical College, New York
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Brito J, Mendes R, Figueiredo P, Marques JP, Beckert P, Verhagen E. Is it Time to Consider Quaternary Injury Prevention in Sports? Sports Med 2023; 53:769-774. [PMID: 36178596 DOI: 10.1007/s40279-022-01765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
Prevention has traditionally been categorized into three main areas: primary, secondary, and tertiary. In this Current Opinion, we present and discuss the concept of quaternary prevention in sports. Quaternary prevention aims to protect individuals from interventions that likely cause more harm than good, such as overdiagnosis, overtreatment, and overmedication. It includes preventing all types of harm associated with training and clinical interventions. Therefore, any sports injury prevention model or strategy should acknowledge the risks associated with training-related (i.e., overreaching and overuse) and clinical-related (i.e., overdiagnosis, over medicalization, and overtreatment) features. We propose a conceptual framework that integrates quaternary prevention into the contemporary injury prevention models in sports, taking into account that injury prevention is just one branch of the managerial, decision-making, and active hazard control process of risk management that athletes, coaches, and health and performance staff need to deal with. Therefore, we argue that integrating the concept of quaternary prevention into any form of prevention will significantly protect athletes from excessive, inappropriate, and ethically questionable interventions that may likely cause more harm than good.
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Affiliation(s)
- João Brito
- Portugal Football School, Federação Portuguesa de Futebol, Avenida das Seleções, 1495-433 Cruz Quebrada-Dafundo, Oeiras, Portugal.
| | - Romeu Mendes
- Portugal Football School, Federação Portuguesa de Futebol, Avenida das Seleções, 1495-433 Cruz Quebrada-Dafundo, Oeiras, Portugal
- Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Portuguese Northern Region Health Administration, Porto, Portugal
| | - Pedro Figueiredo
- Portugal Football School, Federação Portuguesa de Futebol, Avenida das Seleções, 1495-433 Cruz Quebrada-Dafundo, Oeiras, Portugal
- Physical Education Department, College of Education, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
| | - José Pedro Marques
- Portugal Football School, Federação Portuguesa de Futebol, Avenida das Seleções, 1495-433 Cruz Quebrada-Dafundo, Oeiras, Portugal
- Hospital da Luz, Lisbon, Portugal
| | - Paulo Beckert
- Portugal Football School, Federação Portuguesa de Futebol, Avenida das Seleções, 1495-433 Cruz Quebrada-Dafundo, Oeiras, Portugal
- Unidade Medicina Desportiva e Performance, Unidade de Medicina Fisica e Reabilitaçao, Hospital CUF Tejo, Clínica CUF Alvalade, Lisbon, Portugal
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers-Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Straub RK, Powers CM. Is muscular strength a predictor for primary or secondary ACL injury? A scoping review of prospective studies. Phys Ther Sport 2023; 61:91-101. [PMID: 36965459 DOI: 10.1016/j.ptsp.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To identify strength-related risk factors of ACL injury by conducting a scoping review of the peer-reviewed literature. METHODS PubMed and EBSCO host (CINAHL Complete, MEDLINE Complete, SPORTDiscus) were searched from inception to August 2022. Prospective studies that examined strength strength-related risk factors for ACL injury (primary and secondary) were included. PRISMA Extension for Scoping Reviews guided data charting/extraction. RESULTS 17 studies were included (eight primary ACL injury, nine secondary ACL injury). Knee flexor strength was the most studied predictor (10 studies), followed by hip abductor strength (9 studies). Across studies, measures of muscle performance were inconsistent. Significant strength-related risk factors were reported in seven of 17 studies. Potential strength-related risk factors of primary ACL injury included measures of hip strength (abductor or external rotator) and knee strength (knee flexor/extensor ratio and knee extensor strength symmetry) for secondary ACL injury. Limited/conflicting evidence was found for all strength-related risk factors. CONCLUSION Measures of muscle strength appear to be predictive of primary and secondary ACL injury in a subset of identified studies. The heterogeneity of study designs and lack of standardization related to strength testing make it difficult to determine the overall impact of strength in predicting ACL injury.
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Affiliation(s)
- Rachel K Straub
- University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA, USA
| | - Christopher M Powers
- University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA, USA.
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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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11
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Cummings P, Schilaty ND, Nagai T, Rigamonti L, Ueno R, Bates NA. Application of Shear-Wave Elastography in the Evaluation of Hamstring Stiffness in Young Basketball Athletes. Int J Sports Phys Ther 2022; 17:1236-1248. [PMID: 36518841 PMCID: PMC9718691 DOI: 10.26603/001c.55757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 08/09/2022] [Indexed: 11/11/2023] Open
Abstract
Background Previous literature has postulated a relationship between greater hamstring stiffness and a higher risk of sustaining injury. Shear wave elastography (SWE) presents a relatively new means for non-invasive evaluation of soft tissue elasticity pre- and post- injury or intervention. Purpose 1. To establish baseline hamstring stiffness measures for young competitive athletes and (2) determine effect of targeted neuromuscular training (TNMT) on shear wave stiffness of the hamstring. Study Design Un-blinded, prospective, non-randomized, cohort study. Methods Six-hundred forty-two lower extremities from 321 high school and collegiate basketball athletes (177 F: 139 M) were examined for hamstring stiffness prior to the start of their competitive basketball season. Teams were cluster assigned to either the control or intervention (TNMT) group. Subjects in the control group underwent regular season activities as directed, with no influence from the research team. For the TNMT group, the research team introduced a hamstring targeted dynamic warm-up program as an intervention focused on activating the hamstring musculature. Results Collegiate status was significant to hamstring stiffness for both sexes (p ≤ 0.02), but hamstring stiffness did not correlate to age or sex (r2 ≤ 0.08). Intervention was a significant factor to hamstring stiffness when the hip was positioned in extension (p ≤ 0.01), but not in deeper flexion (p = 0.12). This effect was sex-specific as TNMT influenced hamstring stiffness in females (p = 0.03), but not in males (p ≥ 0.13). Control athletes suffered three HAM injuries; TNMT athletes suffered 0 hamstring injuries. Conclusion Higher SWE measurements correlated with increased risk of injury, male sex, and collegiate athletics. TNMT intervention can lessen muscle stiffness which may reduce relate to injury incidence. Intervention effectiveness may be sex specific. Level of Evidence II.
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Affiliation(s)
- Paige Cummings
- Department of Orthopedic Surgery Mayo Clinic
- Alix School of Medicine Mayo Clinic
| | - Nathan D Schilaty
- Department of Orthopedic Surgery Mayo Clinic
- Department of Neurosurgery & Brain Repair University of South Florida
- Center for Neuromusculoskeletal Research University of South Florida
| | - Takashi Nagai
- United States Army Research Institute of Environmental Medicine
| | - Luca Rigamonti
- School of Medicine and Surgery University of Milano-Bicocca
| | - Ryo Ueno
- Department of Sport Science University of Innsbruck
| | - Nathaniel A Bates
- Department of Orthopedic Surgery Mayo Clinic
- Department of Orthopaedics The Ohio State University Wexner Medical Center
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12
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Gomes D, de Brito Fontana H, da Costa GV, Ribeiro DC, Canella RP, Ferreira T, Ruschel C, de Castro MP. Differences in hip torque ratios between individuals with femoroacetabular impingement syndrome and asymptomatic individuals: A cross-sectional study. Clin Biomech (Bristol, Avon) 2022; 100:105809. [PMID: 36335663 DOI: 10.1016/j.clinbiomech.2022.105809] [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] [Received: 06/02/2022] [Revised: 10/03/2022] [Accepted: 10/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip torque ratios are considered a useful measure for patients with hip pain. However, evidence regarding this measure for patients with femoroacetabular impingement syndrome is scarce. The primary aim of this study was to compare hip external-internal rotation and abduction-adduction torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. The secondary aim was to compare hip torque ratios between the asymptomatic group and femoroacetabular impingement syndrome patients grouped according to the severity of symptoms and functional limitations. METHODS Hip abduction-adduction and external-internal rotation torque ratios of 134 individuals with femoroacetabular impingement syndrome and 134 asymptomatic matched controls was assessed through isokinetic testing. Severity of symptoms and functional limitations was assessed through the iHOT-33. Mann Whitney U and Kruskall-Wallis tests were used to compare hip torque ratios between asymptomatic individuals and patients with femoroacetabular impingement syndrome and to patients with femoroacetabular impingement syndrome with different severities of symptoms and functional limitations. FINDINGS No differences were identified in hip abduction-adduction (U = 7659.5, p = 0.192) and external-internal rotation (U = 8787.5, p = 0.764) torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. Hip abduction-adduction torque ratio was higher (p = 0.0127) in patients with a severe state (median = 1.80, IQR = 0.61) when compared to asymptomatic individuals (median = 1.52, IQR = 0.45) (moderate effect size, r = 0.45). INTERPRETATION Patients with severe symptoms and functional limitations related to FAI syndrome presented greater hip abduction-adduction torque ratio than asymptomatic individuals, suggesting a decreased adduction torque capacity relative to abduction torque in this subgroup of femoroacetabular impingement.
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Affiliation(s)
- Diogo Gomes
- Morphological Sciences Department, Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Heiliane de Brito Fontana
- Morphological Sciences Department, Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Guilherme V da Costa
- Center of Health and Sports Science, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR) School of Physiotherapy, University of Otago, New Zealand
| | - Richard P Canella
- Core Centre of Orthopedics and Rehabilitation, Florianópolis, Brazil
| | | | - Caroline Ruschel
- Center of Health and Sports Science, University of the State of Santa Catarina, Florianópolis, Brazil
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13
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Pietrzak K, Miechowicz I, Nowocień K, Kraszewski B, Rzymski P. The agreement and repeatability of measurements of ankle joint dorsiflexion and poplietal angle in healthy adolescents. J Foot Ankle Res 2022; 15:67. [PMID: 36071503 PMCID: PMC9450273 DOI: 10.1186/s13047-022-00572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background The intra-rater repeatability and inter-rater agreement of orthopaedics measurements are important for estimating injury risk and appropriate treatment. In clinical practice, it is often unavoidable to trust the measurements of other health professionals. Methods This study tested the agreement and repeatability of measurements of the dorsiflexion of the foot, dorsiflexion with 90-degrees knee flexion, and popliteal angle test in healthy adolescents performed twice by three raters differing in clinical experience. Three raters, i.e., an orthopaedics specialist (16 years of experience), a resident medical doctor in orthopaedics (4 years of experience), and a physiotherapy student (1 year of experience) measured the ankle joint dorsiflexion and the popliteal angle in 142 healthy adolescent subjects. Results The student outperformed more experienced raters by displaying good repeatability for all the evaluated parameters. The orthopaedics specialist failed to replicate the measurements of the left ankle joint passive dorsiflexion and the left popliteal angle. The medical resident in orthopaedics displayed a lack of repeatability in evaluating the right ankle joint dorsiflexion with the knee joint bent. Kendall’s W value for all parameters ranged 0.66–0.78, indicating a good inter-rater agreement. Conclusions The study highlights that measurements of the ankle joint dorsiflexion and popliteal angle test by different health professionals can generally be trusted. It indicates that novice health professionals could potentially evaluate such parameters in healthy subjects without a quality loss.
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Affiliation(s)
- Krzysztof Pietrzak
- Department of Spondyloorthopedics and Biomechanics of the Spine, Poznan University of Medical Sciences, Poznań, Poland.
| | - Izabela Miechowicz
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | - Krzysztof Nowocień
- Department of Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Bartosz Kraszewski
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806, Poznań, Poland.,Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806, Poznań, Poland
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Mattu AT, Ghali B, Linton V, Zheng A, Pike I. Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084648. [PMID: 35457516 PMCID: PMC9027388 DOI: 10.3390/ijerph19084648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18–0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.
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Affiliation(s)
- Anmol T. Mattu
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - Brianna Ghali
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Vanessa Linton
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada
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Olivares-Jabalera J, Fílter-Ruger A, Dos’Santos T, Afonso J, Della Villa F, Morente-Sánchez J, Soto-Hermoso VM, Requena B. Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13351. [PMID: 34948963 PMCID: PMC8704173 DOI: 10.3390/ijerph182413351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023]
Abstract
Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.
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Affiliation(s)
- Jesús Olivares-Jabalera
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
| | | | - Thomas Dos’Santos
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, All Saints Building, Manchester Campus John Dalton Building, Manchester Campus, Manchester Metropolitan University, Manchester M15 6BH, UK
- Manchester Institute of Sport 2.01, Manchester Metropolitan University, Manchester M1 7EL, UK
| | - Jose Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sports of the University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, 40132 Bologna, Italy;
| | | | - Víctor Manuel Soto-Hermoso
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
| | - Bernardo Requena
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
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16
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Stephenson SD, Kocan JW, Vinod AV, Kluczynski MA, Bisson LJ. A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies. Orthop J Sports Med 2021; 9:23259671211035776. [PMID: 34734094 PMCID: PMC8558815 DOI: 10.1177/23259671211035776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Samuel D Stephenson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Joseph W Kocan
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
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17
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Hamstring Strain Injury (HSI) Prevention in Professional and Semi-Professional Football Teams: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168272. [PMID: 34444026 PMCID: PMC8394329 DOI: 10.3390/ijerph18168272] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/28/2022]
Abstract
Hamstring Strain Injuries (HSIs) are the most common type of lesion in professional footballers and the leading cause of absence days from sports. However, recent studies have shown that high-level football teams apparently do not apply any HSI prevention protocol. The aim of the study was to determine the effect of preventive strategies and protocols in reducing the incidence of hamstring muscle injuries in professional and semi-professional football teams. A literature search of PubMed/MEDLINE, ISI/Web of Science and Scopus databases was conducted with the keywords “hamstring* and (injury* or strain) and prevent* and (soccer or football)”. Quality and bias assessment was completed through the Kennelly modified scale. The Injury Incidence Rate (IIR) and the Incidence Rate Ratio (IRR) were assessed in the statistical analysis. In the meta-analysis, data were extracted, pooled and analysed with “Comprehensive Meta-Analysis Version 3.3.070” software. In total, 8 of the 1017 original search studies met the inclusion criteria of this review. The total exposure of the studies was 170,221.8 h, while the number of HSIs recorded was 165 in the intervention groups and 224 in the control groups. The average score of the quality assessment was 23.6/34. The meta-analysis of six of the eight included studies provided strong evidence that interventions are effective in reducing hamstring injuries. The IRR of the effect size was 0.443, with p-value = 0.001. The studies analysed applied different preventive strategies: the Nordic hamstring exercise, the FIFA 11+ programme and exercises for core stability or balance training. All these interventions proved to have a successful effect on prevention of hamstring injuries.
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18
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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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Chang WG, Lin KY, Chu MY, Chow TH. Differences in Pivot Leg Kinematics and Electromyography Activation in Various Round House Kicking Heights. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2021; 20:457-465. [PMID: 34267585 DOI: 10.52082/jssm.2021.457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
The round house kick (RHK) is a common technique in taekwondo (TKD). The kicking action originates from the dynamic stability of the pivot leg. However, some knee injuries are caused by more difficult kicking strategies, such as kicks to the opponent's head. This study analyses the effects on TKD players in the lower extremity kinematic and neuromuscular reactions from different kicking heights. This study recruited 12 TKD players (age=20.3 ± 1.3 years, height = 1.72 ± 0.09 m, mass = 62.17 ± 9.45 kg) with no previous lower extremity ligament injuries. All athletes randomly performed 3 RHK at different heights (head, chest, and abdomen), repeating each kick 5 times. During the RHK action, the kinematics and muscle activations of the pivot leg were collected using six high-speed cameras and electromyography devices. The results found that during the RHK return period a high kicking position demonstrated larger knee valgus with the straight knee, and more hamstring activation on the pivot leg. The RHK pivot foot for TKD players encountered more risk of injury from high target kicking. The hamstring muscle played an important stabilizing role. It is recommended that sports medicine clinicians or sports coaches use this information to provide further protective injury prevention strategies.
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Affiliation(s)
- Wei-Gang Chang
- Department of Athletic Training and Health, National Taiwan Sport University, Taoyuan, R.O.C., Taiwan
| | - Kuan-Yu Lin
- Department of Athletic Training and Health, National Taiwan Sport University, Taoyuan, R.O.C., Taiwan
| | - Mu-Yen Chu
- Department of Sports Training Science-Combats, National Taiwan Sport University, Taoyuan, R.O.C., Taiwan
| | - Tong-Hsien Chow
- Department of Leisure Sports & Health Management, St. John's University, New Taipei City, R.O.C., Taiwan
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20
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Monajati A, Larumbe-Zabala E, Goss-Sampson M, Naclerio F. Injury Prevention Programs Based on Flywheel vs. Body Weight Resistance in Recreational Athletes. J Strength Cond Res 2021; 35:S188-S196. [PMID: 30273287 DOI: 10.1519/jsc.0000000000002878] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Monajati, A, Larumbe-Zabala, E, Sampson, MG, and Naclerio, F. Injury prevention programs based on flywheel vs. body weight resistance in recreational athletes. J Strength Cond Res 35(2S): S188-S196, 2021-This study compares the effect of an isoinertial flywheel technology vs. a traditional gravity-dependent exercise protocol on modifiable factors associated with the incidence of hamstring strain (HAM) and anterior cruciate ligament (ACL) injuries. Furthermore, the effect on repeated sprint ability was also considered. Eighteen recreationally trained volleyball players completed one of the following 6-week protocols: (a) flywheel (FY) included 3 exercises using a YoYo isoinertial-squat machine and 3 exercises with a Versa-Pulley isoinertial device, and (b) gravity-dependent (GT) involved 6 similar exercises with no external resistance (participants' body weight). Both programs consisted in 2 sessions·wk-1 performing 2 sets of 8 repetitions with 2 minutes of rest. Outcomes included a 10-second tuck jump assessment (TJA), landing knee valgus score, hamstring and quadriceps concentric and eccentric isokinetic 60°·s-1 peak torque, optimal peak torque localization, conventional and functional hamstring-to-quadriceps ratio, and 30-m repeated shuttle sprint ability (RSSA) test. FY improved TJA (-2, interquartile range [IQR] = -3 to -1) and valgus (-1, IQR = -1 to 0) scores, hamstring eccentric (20.37, 95% confidence interval [CI] = 9.27-31.47 N·m) and concentric (17.87, 95% CI = 0.40-35.34 N·m) peak torque, as well as the RSSA (-0.28, 95% CI = -0.45 to -0.10 seconds), whereas GT only improved hamstring eccentric peak torque (21.41, 95% CI = 9.00-33.82 N·m). A 6-week protocol using flywheel technology seems to elicit better positive adaptations to protect athletes from HAM and ACL injuries and to enhance RSSA performance compared to exercising with no external resistance other than athletes' body weight.
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Affiliation(s)
- Alireza Monajati
- Department of Life and Sports Science, University of Greenwich, London, United Kingdom; and
| | | | - Mark Goss-Sampson
- Department of Life and Sports Science, University of Greenwich, London, United Kingdom; and
| | - Fernando Naclerio
- Department of Life and Sports Science, University of Greenwich, London, United Kingdom; and
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21
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Infrared Thermography Protocol on Reducing the Incidence of Soccer Injuries. J Sport Rehabil 2020; 29:1222-1227. [DOI: 10.1123/jsr.2019-0056] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 11/18/2022]
Abstract
Context: Infrared thermography has been used to detect skeletal muscle overload and fatigue in athletes, but its use in injury prevention in professional soccer has not been studied to date. Objectives: To establish a novel injury prevention program based on infrared thermography and to determine its influence on the injury incidence in professional soccer players in the preseason. Design: A cross-sectional, prospective study design was used to compare a conventional injury prevention program (CPP) applied over the first preseason and an infrared thermography injury prevention program (IRTPP) carried out in the following preseason. Setting: Soccer training ground. Participants: Twenty-four players belonging to a first division soccer team from Spain. Main Outcome Measures: Injury incidences of each player were recorded according to the Orchard Sports Injury Classification System (version 10.0) convention to determine the injury classification, location, and type. Results: The incidence of injuries decreased from 15 injuries in the CPP preseason (0.63 [0.77] injuries per player) to 6 injuries in the second preseason when the IRTPP was applied (0.25 [0.53] injuries per player). The days of absence due to injuries also decreased from the CPP preseason (156 d, 10.4 [11.0] d per injury) to the IRTPP preseason (14 d, 2.3 [2.8] d per injury). The injury severity also decreased from the first preseason to the second preseason, and fewer musculoskeletal injuries in the thigh, hip, and groin were reported. Conclusions: The implementation of an IRTPP can reduce the presence of injuries by identifying players potentially at risk and as a result, reducing the injury severity and days lost as a consequence.
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22
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Ling DI, Boyle C, Janosky J, Chang B, Roselaar N, Kinderknecht J, Marx RG. Feedback cues improve the alignment and technique of children performing ACL injury prevention exercises. J ISAKOS 2020; 6:3-7. [PMID: 33833039 DOI: 10.1136/jisakos-2020-000475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The appropriateness of neuromuscular training exercises across different age groups has not yet been investigated, particularly in younger children. The purpose of this study was to determine which neuromuscular training exercises can be performed with proper neutral alignment in various age groups. METHODS Seven exercises were selected for evaluation in children ranging from 8 to 17 years of age who were recruited from schools and youth sports organisations. Participants completed two trials of each exercise and were judged on maintaining neutral body alignment after receiving visual/verbal instruction on the first trial and feedback cues on the second trial. Three evaluators judged each exercise, which was deemed as correct when at least two evaluators agreed that neutral alignment was maintained. Comparisons were made across ages and between sex using the χ² test or Fisher's exact test. The proportions of participants who performed the exercise correctly were also compared before and after feedback cues were provided. RESULTS A total of 360 participants were evaluated (8-11 years: 165, 54% female; 12-15 years: 136, 40% female, 16-17 years: 59, 53% female). There were no significant differences in performance across ages and sex for nearly all exercises. The majority of children were not able to complete the exercises with proper alignment. The use of feedback cues significantly increased the proportion of participants who correctly completed the exercise (p<0.001). CONCLUSIONS These results demonstrate the importance of training coaches and physical education teachers to provide cues that reinforce proper technique during anterior cruciate ligament injury prevention exercises. Children should perform common neuromuscular training exercises with feedback on proper technique. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
- Daphne I Ling
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Caroline Boyle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joseph Janosky
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Brenda Chang
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Naomi Roselaar
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - James Kinderknecht
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Robert G Marx
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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23
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Comstock RD, Fields SK. The Eternally Wounded Athlete: How Medical Professionals and Sports Injury Researchers Have Limited Female Athletes’ Sport Participation and Biased the Interpretation of Sports Injury Research. CURR EPIDEMIOL REP 2020; 7:327-333. [DOI: 10.1007/s40471-020-00255-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Farley JB, Barrett LM, Keogh JWL, Woods CT, Milne N. The relationship between physical fitness attributes and sports injury in female, team ball sport players: a systematic review. SPORTS MEDICINE - OPEN 2020; 6:45. [PMID: 32926228 PMCID: PMC7490320 DOI: 10.1186/s40798-020-00264-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/20/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Understanding the relationships between physical fitness characteristics and sports injury may assist with the development of injury minimisation programs. The purpose of this systematic review was to investigate the association between physical fitness attributes and sports injury in female, team ball sport players. METHODS Four scientific databases (MEDLINE, EMBASE, SPORTDiscus, Scopus) and reference lists of relevant research were searched for eligible studies up to September 2, 2019. Full-text articles examining the relationship between physical fitness and sports injury in female, team ball sport players were included. A modified Downs and Black checklist was used to assess methodological quality. Data synthesis determined summary conclusions based on the number of significant relationships divided by the total relationships investigated and reported as a percentage. Level of certainty was identified for summary conclusions based on level of evidence. Sub-analyses regarding competition level, age, and single injury types were also conducted. RESULTS A total of 44 studies were included. Data synthesis revealed no associations (low to moderate certainty) between body composition (1/9; 11%), flexibility (18-20%), and balance (2/8; 25%) and 'any injury' classification. No associations (mostly of moderate certainty) were found between flexibility (0-27%), muscular strength (0-27%), and body composition (14-33%) and various body region injury classifications, whereas mixed summary conclusions were shown for balance (0-48%). Many associations between physical fitness and sports injury were deemed 'unknown' or with an insufficient level of certainty. Sub-analyses revealed no association between strength and noncontact ACL injuries (0/5; 0%) or ankle sprains (0/12; 0%), and between flexibility and ankle sprains (1/5; 20%); however, insufficient certainty of these results exists. Clear associations were concluded between balance and lower body injuries in female, non-elite (10/16; 63%) and junior (9/12; 75%) team ball sport players, with moderate and insufficient certainty of these results, respectively. CONCLUSION Limited evidence is available to demonstrate relationships between physical fitness and sports injury in female, team ball sport players. High-quality evidence investigating the multifactorial nature of sports injury, including the interactions physical fitness qualities have with other injury determinants, is needed to better understand the role of physical fitness in minimising sports injuries in female, team ball sport players. TRIAL REGISTRATION CRD42017077374 (PROSPERO on September 14, 2017).
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Affiliation(s)
- Jessica B. Farley
- grid.1033.10000 0004 0405 3820Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD Australia
| | - Lily M. Barrett
- grid.10049.3c0000 0004 1936 9692Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Justin W. L. Keogh
- grid.1033.10000 0004 0405 3820Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD Australia
- grid.252547.30000 0001 0705 7067Sports Performance Research Centre New Zealand, AUT University, Auckland, New Zealand
- grid.1034.60000 0001 1555 3415Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia
- grid.411639.80000 0001 0571 5193Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Carl T. Woods
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, VIC Australia
| | - Nikki Milne
- grid.1033.10000 0004 0405 3820Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD Australia
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25
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Lago-Fuentes C, Jiménez-Loaisa A, Padrón-Cabo A, Calvo MM, García-Pinillos F, Rey E. Epidemiology of Injuries in Elite Female Futsal Players: A Prospective Cohort Study. Int J Sports Med 2020; 41:885-890. [PMID: 32590843 DOI: 10.1055/a-1179-6280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Injuries are one of the worst case scenarios for an athlete and a team. The aim of this study was to analyze the injury incidence, characteristics and burden among a cohort of elite female futsal players. A prospective cohort study was designed over a season. Eighty-nine players from seven elite female futsal teams were monitored during the whole season. Eight different variables were recorded when an injury happened, as well as exposure time. A total of 90 injuries were recorded so that 54 out of 89 players (60.6%) sustained an injury. The overall injury incidence was 5 injuries per 1000 h of futsal play exposure. Moderate injuries were the most frequent (1.7 injuries per 1000 h of futsal play exposure). The quadriceps and ankle were the regions where most injuries occurred. Contact injuries were more common during matches than training, and usually happened at the end of the season. Elite female futsal players are exposed to a substantial injury risk, especially on ankle and quadriceps with moderate severity, occurring at the end of the sessions, especially during matches. These results highlight the need of new preventive strategies to reduce the high injury incidence in female futsal players.
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Affiliation(s)
- Carlos Lago-Fuentes
- Facultad de Ciencias de la Salud, Universidad Europea del Atlántico, Santander, Spain
- Faculty of Education and Sport Sciences, Universidad de Vigo, Pontevedra, Spain
| | | | - Alexis Padrón-Cabo
- Faculty of Education and Sport Sciences, Universidad de Vigo, Pontevedra, Spain
| | - Marcos Mecías Calvo
- Facultad de Ciencias de la Salud, Universidad Europea del Atlántico, Santander, Spain
- Centro de Investigación y Tecnología Industrial de Cantabria (CITICAN), Santander, Spain
| | - Felipe García-Pinillos
- Department of Physical Education and Sports, University of Granada, Granada, Spain
- Physical Education, Sports and Recreation, Universidad de La Frontera, Temuco, Chile
| | - Ezequiel Rey
- Faculty of Education and Sport Sciences, Universidad de Vigo, Pontevedra, Spain
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26
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Fritsch CG, Dornelles MP, Oliveira GDS, Baroni BM. Poor hamstrings-to-quadriceps torque ratios in male soccer players: weak hamstrings, strong quadriceps, or both? Sports Biomech 2020:1-11. [PMID: 32508266 DOI: 10.1080/14763141.2020.1766100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to evaluate the influence of hamstrings and quadriceps strength on the hamstrings-to-quadriceps conventional (H:Qcon) and functional (H:Qfun) ratios in male soccer players. Quadriceps concentric peak torque (PT) and hamstrings concentric and eccentric PT were assessed with isokinetic dynamometry at 60°/s in 101 players (202 legs). The cut-points of 0.50, 0.55 and 0.60 were used to assess muscle imbalance through the H:Qcon ratio, while 0.80, 0.85 and 0.90 were used for H:Qfun ratio. Legs with lower H:Qcon ratio had decreased hamstrings concentric PT (p < 0.01; moderate and large effect sizes) and increased quadriceps concentric PT (p < 0.01; moderate effect sizes) in all cut-points. Legs with lower H:Qfun ratio had decreased hamstrings eccentric PT (p < 0.01; large effect sizes) for all cut-points, and controversial results for quadriceps concentric PT (p < 0.01 only for 0.80 cut-point; small effect sizes). H:Qcon ratio presented only weak correlations with quadriceps (r = -0.37) and hamstrings (r = 0.45) concentric PT, while H:Qfun ratio had a negligible correlation with quadriceps concentric PT (r = -0.30) and a moderate correlation with hamstrings eccentric PT (r = 0.66). In conclusion, our findings support that hamstrings strength deficit is the key factor for low H:Q ratios in male soccer players, especially those with poor H:Qfun ratio.
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Affiliation(s)
- Carolina G Fritsch
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Maurício P Dornelles
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Gabriel Dos S Oliveira
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Bruno M Baroni
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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27
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Lago-Fuentes C, Jiménez-Loaisa A, Padrón-Cabo A, Mecías-Calvo M, Rey E. Perceptions of the technical staff of professional teams regarding injury prevention in Spanish national futsal leagues: a cross-sectional study. PeerJ 2020; 8:e8817. [PMID: 32257644 PMCID: PMC7102501 DOI: 10.7717/peerj.8817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/27/2020] [Indexed: 11/30/2022] Open
Abstract
Futsal is a sport with increasing popularity and level of performance, both in male and female categories. Also, there are several injuries along a season, so it is needed to know how to reduce this burden. The purpose of this study was to describe the perceptions of technical staff on injury risk factors, risk testing and preventive measures, and the strategies used by them within professional male and female futsal teams. A cross-sectional study was designed during the 2017–2018 season. A total of 32 futsal teams involved in male and female Spanish national futsal leagues completed, through an online survey platform, a questionnaire about injury risk factors, risk testing and preventive measures. Findings showed that: (a) most teams reported enough human resources, but insufficient material and time resources, (b) the main risk factors detected were previous injuries, strength deficits and dehydration, (c) functional movement patterns, flexibility tests and self-report questionnaires were the most applied tests for detecting injury risks in their players and (d) most of the main preventive measures used by technical staff matched with the best valued by them. Technical staff defined properly the main risk factors in futsal performance, as well as they applied preventive strategies with scientific support. The information provided in this research could be of interest for sport scientists and technical staff when designing more accurate and efficient injury prevention programs in futsal.
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Affiliation(s)
- Carlos Lago-Fuentes
- Faculty of Education and Sport Sciences, Universidad de Vigo, Pontevedra, Spain.,Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
| | - Alejandro Jiménez-Loaisa
- Department of Sport Sciences, Sport Research Center, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Alexis Padrón-Cabo
- Faculty of Education and Sport Sciences, Universidad de Vigo, Pontevedra, Spain
| | - Marcos Mecías-Calvo
- Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
| | - Ezequiel Rey
- Faculty of Education and Sport Sciences, Universidad de Vigo, Pontevedra, Spain
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28
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Baroni BM, Ruas CV, Ribeiro-Alvares JB, Pinto RS. Hamstring-to-Quadriceps Torque Ratios of Professional Male Soccer Players: A Systematic Review. J Strength Cond Res 2020; 34:281-293. [PMID: 29794893 DOI: 10.1519/jsc.0000000000002609] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Baroni, BM, Ruas, CV, Ribeiro-Alvares, JB, and Pinto, RS. Hamstring-to-quadriceps torque ratios of professional male soccer players: A systematic review. J Strength Cond Res 34(1): 281-293, 2020-The goal of this review was to determine the isokinetic hamstring-to-quadriceps (H/Q) torque ratios of professional male soccer players. Systematic searches were independently carried out by 2 researchers in 7 electronic databases. Only studies with teams from the first or second national leagues were included. From these studies, we extracted the players' H/Q conventional (concentric/concentric) and/or functional (eccentric/concentric) ratios. The initial search resulted in 2,128 articles that were filtered to 30 articles (1,727 players) meeting the inclusion criteria. The H/Q conventional ratio was assessed in 27 studies (1,274 players), whereas the H/Q functional ratio was assessed in 15 studies (1,082 players). The H/Q conventional ratio mean scores of professional male soccer players were close to 60% when tested at low to intermediate angular velocities (12°·s = 52 ± 7%; 30°·s = 52 ± 8%; 60°·s = 65 ± 12%; 90°·s = 57 ± 6%; 120°·s = 65 ± 16%; 180°·s = 67 ± 17%) and around 70-80% at fast angular velocities (240°·s = 80 ± 40%; 300°·s = 70 ± 15%; 360°·s = 80 ± 13%). The H/Q functional ratio mean scores of professional male soccer players were close to 80% at 60°·s (79 ± 19%), around 100-130% at intermediate to fast angular velocities (120°·s = 127 ± 42%; 180°·s = 96 ± 19%; 240°·s = 109 ± 22%; 300°·s = 123 ± 18%), and near or above 130% when angular testing velocities were mixed (eccentric hamstring < concentric quadriceps; 30/240°·s = 132 ± 26%; 60/180°·s = 129 ± 20%; 60/240°·s = 153 ± 30%). In conclusion, considering the tested isokinetic angular velocity, professional male soccer players do not meet the traditional reference landmarks used to assess the strength balance between quadriceps and hamstring muscles (i.e., 60 and 100% for H/Q conventional and functional ratios, respectively), which supports a need for specific reference values according to the angular velocity selected for testing H/Q torque ratios.
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Affiliation(s)
- Bruno Manfredini Baroni
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cassio Victora Ruas
- Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Edith Cowan University, Joondalup, Australia
| | | | - Ronei Silveira Pinto
- Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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29
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Ling DI, Cepeda NA, Marom N, Jivanelli B, Marx RG. Injury prevention programmes with plyometric and strengthening exercises improve on-field performance: a systematic review. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
ImportanceInjury prevention programmes (IPPs) have been demonstrated to be highly efficacious in protecting young athletes from anterior cruciate ligament and other lower-extremity injuries. However, the effectiveness of these programme in practice has been limited due to poor adherence among coaches of organised sports teams.ObjectiveA change in messaging from injury reduction to performance enhancement may be an effective strategy for improving adherence. We conducted a systematic review to address whether implementing IPP can also provide benefits on sports performance as measured by on-field tests.Evidence reviewData Sources: PubMed, EMBASE and Cochrane Library databases were searched from January 2000 to August 2018.Study Selection: English-language studies were selected if they evaluated on-field performance testing before and after participation in the IPP or compared with another programme/control. No limitations were placed on study design or study population. Studies were excluded if they evaluated programme without an explicit focus on injury prevention or reported on injury risk factors that were not related to athletic performance.Study designSystematic reviewData extractionStudy design, population, sport and level, comparison group and duration/frequency of the IPP were extracted from full-text articles. The results of performance testing were summarised into the following categories: balance, sprinting, agility, jumping, physical fitness and sport-specific skills.FindingsThe evidence shows that IPP can have beneficial effects on measures of sports performance and physical fitness. Factors that resulted in significant improvement included longer frequency and duration of the programme, as well as inclusion of plyometric and muscle strengthening exercises.ConclusionsThere is a wide variety of measures used for athletic performance. IPPs that are done more frequently for longer durations and that include strengthening and plyometric exercises have been shown to improve athletic performance. Enhanced performance with tests that can be conducted on the field with existing equipment may help convince coaches and athletes to improve adherence with the IPP exercises.Level of evidenceLevel II
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30
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Niederer D, Willberg C, Kruse A, Exler N, Giesche F, Vogt L, Banzer W. Acute effects of preventive warm-up exercises on modifiable risk factors for anterior cruciate ligament injuries: a three-arm randomized-controlled crossover trial. J Sports Med Phys Fitness 2019; 60:92-101. [PMID: 31663311 DOI: 10.23736/s0022-4707.19.09949-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to compare the potential acute effects of single bouts of a classic prevention and a risk factor-focus training aiming to target modifiable anterior cruciate ligament (ACL) rupture risk factors and the impact of neuromuscular fatigue on relevant ACL rupture risk factors. METHODS Two preventive warm-up (standard and ACL rupture risk factor training) and one inactive arm were compared; each of these were followed by a standardized neuromuscular fatigue protocol. The assessments included two Trail making tests (TMT-A; TMT-B, time to complete), drop jump landings (knee separation distance, normalized at hip width), as well as unanticipated counter movement jump landings (time to stabilization and peak ground reaction force). RESULTS We included 18 participants (25±2years). No differences were found between times and conditions for TMT (P>0.05). A significant time effect occurred in time to stabilization (F=2.6; P<0.05) and a significant time*baseline-value*jumping time interaction was seen in peak ground reaction force (F=3.1; P<0.05). No time effect was found for any knee separation distance (F=.1-2.4; P>0.05); but a significant time*baseline-value*jumping time interaction was seen at initial ground contact (F=2.8; P<0.05), and lowest point (F=4.2; P<0.01). CONCLUSIONS Risk factor-focus and classic warm-up may not differ in their acute effects on modifiable functional ACL (re-)injury risks factors.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University, Frankfurt, Germany -
| | - Christina Willberg
- Department of Sports Medicine, Goethe University, Frankfurt, Germany.,Department of Movement and Training Science, Goethe University, Frankfurt, Germany
| | - Adele Kruse
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | - Nicola Exler
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | - Florian Giesche
- Department of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | - Winfried Banzer
- Department of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt, Germany
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Abstract
The aim of this study was to perform an electromyography comparison of three commonly used lower limb injury prevention exercises: a single-leg squat on a bench (SLSB), a double-leg squat (DLS) and a double-leg squat on a BOSU® balance trainer (DLSB). After determining the maximum isometric voluntary contraction of the hamstring and quadriceps, eight female athletes performed 3 repetitions of each exercise, while electromyography activity of the biceps femoris (BF), semitendinosus (ST), vastus lateralis (VL) and vastus medialis (VM) was monitored. Comparisons between exercises revealed higher activation in BF (descending phase: p = 0.016, d = 1.36; ascending phase: p = 0.046, d = 1.11), ST (descending phase: p = 0.04, d = 1.87; ascending phase: p = 0.04, d = 1.87), VL (ascending phase: p = 0.04, d = 1.17) and VM (descending phase: p = 0.05, d = 1.11; ascending phase: p = 0.021, d = 1.133) muscles for the SLSB compared to the DLSQ. Furthermore, higher muscular activation of the ST (ascending phase: p = 0.01, d = 1.51; descending phase: p = 0.09, d = 0.96) and VM (ascending phase: p = 0.065, d = 1.03; descending phase: p = 0.062, d = 1.05) during the SLSB with respect to the DLSB was observed. In conclusion, the SLSB elicits higher neuromuscular activation in both hamstring and quadriceps muscles compared to the other two analysed exercises. Additionally, the higher muscle activation of both medial muscles (ST and VM) during the SLSB suggests that single leg squatting exercises may enhance lower limb medial to lateral balance, and improve knee stability in the frontal plane.
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32
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Characteristics of Contact Force and Muscle Activation During Choreographed Falls With 2 Common Landing Techniques in Contemporary Dance. J Appl Biomech 2019; 35:256-262. [PMID: 31034327 DOI: 10.1123/jab.2018-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigated the contact forces and muscle activation during 2 choreographed fall techniques in contemporary dancers and how these were affected by the fall technique. Ten collegiate-level dancers were instructed in 2 choreographed falls: (1) an anteriorly focused fall involving ankle plantar flexion, knee flexion, and hip flexion with dispersion of forces up the anterior surface of the shank (technique 1) and (2) a laterally focused fall involving inversion at the ankle with dispersion of forces up the lateral aspect of the shank (technique 2). The knee and hip contact forces were 26.3% smaller (technique 1: 1743 N vs technique 2: 1284 N) and 24.1% greater (technique 1: 1334 N vs technique 2: 1656 N), respectively, in technique 2 (P < .03). At the time of knee contact, percentage of maximal voluntary isometric contraction (%MVIC) was 45.8% greater for rectus femoris muscle (technique 1: 7.2% vs technique 2: 10.5%) and 96.9% greater for gluteus medius muscle (technique 1: 3.2% vs technique 2: 6.3%) (P < .01) in technique 2. The results provide insight into determining safer landing strategies to avoid knee injuries in individuals who experience a fall (ie, dancers, athletes, and older adults).
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Vidmar MF, Baroni BM, Michelin AF, Mezzomo M, Lugokenski R, Pimentel GL, Silva MF. Isokinetic eccentric training is more effective than constant load eccentric training for quadriceps rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial. Braz J Phys Ther 2019; 24:424-432. [PMID: 31351901 DOI: 10.1016/j.bjpt.2019.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functional performance in recreational athletes following anterior cruciate ligament (ACL) reconstruction. METHODS Thirty recreational male athletes (25 years old) undergoing ACL reconstruction received a standard rehabilitation program. Volunteers were randomized to conventional group (CG; n = 15) or isokinetic group (IG; n = 15) to be engaged in a 6-week (2 sessions/week) quadriceps eccentric training program at the extensor chair or at the isokinetic dynamometer, respectively. Assessments of quadriceps muscle mass (through magnetic resonance imaging), strength (through isokinetic dynamometry) and self-aware functionality (through questionnaire) were performed before and after the training programs. Single leg hop test performance was assessed only at post-training evaluation. RESULTS IG had significantly higher improvements than CG (p < 0.05) for all muscle mass outcomes (+17-23% vs. +5-9%), as well as for isometric (+34% vs. +20%) and eccentric (+85% vs. +23%) peak torques. There was no between-group difference (p > 0.05) for concentric peak torque, Lysholm score, and single leg hop test. CONCLUSION Isokinetic eccentric training promotes greater responses than conventional eccentric training on quadriceps muscle mass and strength of recreational athletes following ACL reconstruction.
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Affiliation(s)
- Marlon Francys Vidmar
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Hospital Ortopédico de Passo Fundo, Passo Fundo, RS, Brazil.
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Márcio Mezzomo
- Hospital Ortopédico de Passo Fundo, Passo Fundo, RS, Brazil
| | | | - Gilnei Lopes Pimentel
- Physical Therapy Department, Universidade de Passo Fundo (UPF), Passo Fundo, RS, Brazil
| | - Marcelo Faria Silva
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Mugele H, Plummer A, Steffen K, Stoll J, Mayer F, Müller J. General versus sports-specific injury prevention programs in athletes: A systematic review on the effect on injury rates. PLoS One 2018; 13:e0205635. [PMID: 30339685 PMCID: PMC6195266 DOI: 10.1371/journal.pone.0205635] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/28/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction Annually, 2 million sports-related injuries are reported in Germany of which athletes contribute to a large proportion. Multiple sport injury prevention programs designed to decrease acute and overuse injuries in athletes have been proven effective. Yet, the programs’ components, general or sports-specific, that led to these positive effects are uncertain. Despite not knowing about the superiority of sports-specific injury prevention programs, coaches and athletes alike prefer more specialized rather than generalized exercise programs. Therefore, this systematic review aimed to present the available evidence on how general and sports-specific prevention programs affect injury rates in athletes. Methods PubMed and Web of Science were electronically searched throughout April 2018. The inclusion criteria were publication dates Jan 2006–Dec 2017, athletes (11–45 years), exercise-based injury prevention programs and injury incidence. The methodological quality was assessed with the Cochrane Collaboration assessment tools. Results Of the initial 6619 findings, 15 studies met the inclusion criteria. In addition, 13 studies were added from reference lists and external sources making a total of 28 studies. Of which, one used sports-specific, seven general and 20 mixed prevention strategies. Twenty-four studies revealed reduced injury rates. Of the four ineffective programs, one was general and three mixed. Conclusion The general and mixed programs positively affect injury rates. Sports-specific programs are uninvestigated and despite wide discussion regarding the definition, no consensus was reached. Defining such terminology and investigating the true effectiveness of such IPPs is a potential avenue for future research.
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Affiliation(s)
- Hendrik Mugele
- Department of Sport and Health Sciences, Clinical Exercise Science, University of Potsdam, Potsdam, Germany
| | - Ashley Plummer
- Department of Sport and Health Sciences, Clinical Exercise Science, University of Potsdam, Potsdam, Germany
| | | | - Josefine Stoll
- Department of Sport and Health Sciences, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
- * E-mail:
| | - Frank Mayer
- Department of Sport and Health Sciences, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Juliane Müller
- Department of Sport and Health Sciences, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
- Department of Computer Science – Therapy Science: Exercise Science and Applied Biomechanics, Trier University of Applied Science, Trier, Germany
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Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. J Orthop Res 2018; 36:2696-2708. [PMID: 29737024 DOI: 10.1002/jor.24043] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
Several meta-analyses have been published on the effectiveness of anterior cruciate ligament (ACL) injury prevention training programs to reduce ACL injury risk, with various degrees of risk reduction reported. The purpose of this research was to perform a systematic review and meta-analysis of overlapping meta-analyses evaluating the effectiveness of ACL injury prevention training programs so as to summarize the amount of reduction in risk for all ACL and non-contact ACL injuries into a single source, and determine if there were sex differences in the relative efficacy of ACL injury prevention training programs. Five databases (Medline, PubMed, Embase, CINAHL, and Cochrane) were searched to identify meta-analyses that evaluated the effectiveness of ACL injury prevention training programs on ACL injury risk. ACL injury data were extracted and the results from each meta-analysis were combined using a summary meta-analysis based on odds ratios (OR). Eight meta-analyses met eligibility criteria. Six of the eight only included data for female athletes. Summary meta-analysis showed an overall 50% reduction (OR = 0.5 [0.41-0.59]; I2 = 15%) in the risk of all ACL injuries in all athletes and a 67% reduction (OR = 0.33 [0.27-0.41]; I2 = 15%) for non-contact ACL injuries in females. This paper combines all previous meta-analyses into a single source and shows conclusive evidence that ACL injury prevention programs reduce the risk of all ACL injuries by half in all athletes and non-contact ACL injuries by two-thirds in female athletes. There is insufficient data to make conclusions as to the effectiveness of ACL injury prevention programs in male athletes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2696-2708, 2018.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, La Trobe University, Victoria, Australia
| | - Timothy E Hewett
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota.,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Nunes RFH, Dellagrana RA, Nakamura FY, Buzzachera CF, Almeida FAM, Flores LJF, Guglielmo LGA, da Silva SG. ISOKINETIC ASSESSMENT OF MUSCULAR STRENGTH AND BALANCE IN BRAZILIAN ELITE FUTSAL PLAYERS. Int J Sports Phys Ther 2018; 13:94-103. [PMID: 29484246 PMCID: PMC5808018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
PURPOSE/BACKGROUND Strength asymmetries are related to knee injuries in intermittent sports players. The purpose of this study was to examine whether elite futsal players demonstrate strength asymmetries during knee isokinetic testing applying the Croisier et al.21 criteria. METHODS Forty male elite (27.9 ± 6.5 years) Brazilian futsal players participated in the study. The testing protocol required players to perform concentric contractions of both quadriceps and hamstring muscles at angular velocities of 60 °·s-1 and 240 °·s-1 and eccentric contractions of hamstring at 30 °·s-1 and 120 °·s-1. Conventional (concentric:concentric) and mixed (eccentric:concentric) hamstrings/quadriceps (H/Q) ratios were calculated. Subjects were determined to have an imbalanced strength profile if an athlete had at least two parameters that were asymmetrical across speeds and conditions. Asymmetry was operationally defined as peak torque asymmetry greater than 15% in bilateral comparison, and H/Q ratio less than 0.47 for conventional and 0.80 for mixed conditions. RESULTS Significant differences were observed between preferred and nonpreferred limbs in the concentric contractions of flexors at 240 °·s-1 and eccentric contractions of extensors and flexors at 30 °·s-1 and 120 °·s-1. However, these asymmetries did not exceed 15%. The conventional and mixed H/Q ratios were greater in the preferred than in nonpreferred limbs, but only the mixed hamstringsecc/quadricepsconc in the nonpreferred limbs showed values lower than recommended (<0.80). In addition, 50% of elite futsal players had preseason strength imbalances per the developed criteria. CONCLUSION The studied elite futsal players had preseason strength imbalances, which may increase the risk of hamstring injuries. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Rodolfo A Dellagrana
- Departament of Physical Education, Federal University of Santa Catarina (UFSC), Florianópolis-SC, Brazil
| | - Fábio Y Nakamura
- The College of Healthcare Sciences, James Cook University, Queensland, Australia
| | - Cosme F Buzzachera
- Center for Biological & Health Sciences, North University of Parana, Paraná, Brazil
| | - Flavia A M Almeida
- Laboratory of Research Center for Exercise and Sport (CEPEE), Federal University of Paraná (UFPR), Curitiba-PR, Brazil
| | - Lucinar J F Flores
- Department of Physical Education, State University of Western Parana, Paraná, Brazil
| | - Luiz G A Guglielmo
- Departament of Physical Education, Federal University of Santa Catarina (UFSC), Florianópolis-SC, Brazil
| | - Sérgio G da Silva
- Laboratory of Research Center for Exercise and Sport (CEPEE), Federal University of Paraná (UFPR), Curitiba-PR, Brazil
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Monajati A, Larumbe-Zabala E, Goss-Sampson M, Naclerio F. Analysis of the Hamstring Muscle Activation During two Injury Prevention Exercises. J Hum Kinet 2017; 60:29-37. [PMID: 29339983 PMCID: PMC5765783 DOI: 10.1515/hukin-2017-0105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to perform an electromyographic and kinetic comparison of two commonly used hamstring eccentric strengthening exercises: Nordic Curl and Ball Leg Curl. After determining the maximum isometric voluntary contraction of the knee flexors, ten female athletes performed 3 repetitions of both the Nordic Curl and Ball Leg Curl, while knee angular displacement and electromyografic activity of the biceps femoris and semitendinosus were monitored. No significant differences were found between biceps femoris and semitendinosus activation in both the Nordic Curl and Ball Leg Curl. However, comparisons between exercises revealed higher activation of both the biceps femoris (74.8 ± 20 vs 50.3 ± 25.7%, p = 0.03 d = 0.53) and semitendinosus (78.3 ± 27.5 vs 44.3 ± 26.6%, p = 0.012, d = 0.63) at the closest knee angles in the Nordic Curl vs Ball Leg Curl, respectively. Hamstring muscles activation during the Nordic Curl increased, remained high (>70%) between 60 to 40° of the knee angle and then decreased to 27% of the maximal isometric voluntary contraction at the end of movement. Overall, the biceps femoris and semitendinosus showed similar patterns of activation. In conclusion, even though the hamstring muscle activation at open knee positions was similar between exercises, the Nordic Curl elicited a higher hamstring activity compared to the Ball Leg Curl.
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Affiliation(s)
- Alireza Monajati
- Department of Life and Sports Science, University of Greenwich, Medway Campus, Greenwich, Kent (UK)
| | - Eneko Larumbe-Zabala
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX (USA)
| | - Mark Goss-Sampson
- Department of Life and Sports Science, University of Greenwich, Medway Campus, Greenwich, Kent (UK)
| | - Fernando Naclerio
- Department of Life and Sports Science, University of Greenwich, Medway Campus, Greenwich, Kent (UK)
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Dargo L, Robinson KJ, Games KE. Prevention of Knee and Anterior Cruciate Ligament Injuries Through the Use of Neuromuscular and Proprioceptive Training: An Evidence-Based Review. J Athl Train 2017; 52:1171-1172. [PMID: 29172648 DOI: 10.4085/1062-6050-52.12.21] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Reference/Citation: Donnell-Fink LA, Klara K, Collins JE, et al. Effectiveness of knee injury and anterior cruciate ligament tear prevention programs: a meta-analysis. PLoS One. 2015;10(12)e0144063. CLINICAL QUESTION Is neuromuscular and proprioceptive training effective in preventing knee and anterior cruciate ligament (ACL) injuries? DATA SOURCES The authors searched CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE/EMBASE, PubMed, and Web of Science databases from 1996 through December 2014 and limited the results to peer-reviewed manuscripts published in English. Search terms for all databases were knee injury OR knee injuries; OR anterior cruciate ligament injury OR anterior cruciate ligament injuries; OR ACL injury OR ACL injuries; OR lower limb injury OR lower limb injuries AND prevention. STUDY SELECTION Inclusion criteria were (1) English language, (2) published from 1996 through 2014, (3) the intervention used neuromuscular or proprioceptive training to prevent knee or ACL injuries, (4) human participants, (5) the incidence of knee or ACL injury was provided. DATA EXTRACTION For the articles that met the inclusion criteria, 2 authors worked independently using the Jadad scale to extract the first author, year of publication, title, sport type, participant sex, participant age, country in which the study was conducted, number of participants in the control and intervention groups, intervention characteristics or components, and knee or ACL injury outcome. MAIN RESULTS A total of 24 studies with 1093 participants were included in this review. Intervention efficacy was determined from weighted incidence rate ratios. After the intervention of neuromuscular and proprioceptive training exercises, the incidence ratio (frequency of a disease or injury occurrence in a population over a specific time frame) was calculated at 0.731 (95% confidence interval = 0.614, 0.871) for knee injury and at 0.493 (95% confidence interval = 0.285, 0.854) for ACL injury. This indicated a link between neuromuscular and proprioceptive training programs and injury reduction. No significant correlation was present between more components added to training and a greater decrease in injury to either the knee or ACL. CONCLUSIONS Neuromuscular and proprioceptive training appeared to decrease the incidence of injury to the knee and specifically the ACL. However, no evidence suggested that a specific group of exercises was better than others.
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Affiliation(s)
- Lucas Dargo
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
| | - Kelsey J Robinson
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
| | - Kenneth E Games
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
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Trojian T, Driban J, Nuti R, Distefano L, Root H, Nistler C, LaBella C. Osteoarthritis action alliance consensus opinion - best practice features of anterior cruciate ligament and lower limb injury prevention programs. World J Orthop 2017; 8:726-734. [PMID: 28979857 PMCID: PMC5605359 DOI: 10.5312/wjo.v8.i9.726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/04/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To identify best practice features of an anterior cruciate ligament (ACL) and lower limb injury prevention programs (IPPs) to reduce osteoarthritis (OA).
METHODS This consensus statement started with us performing a systematic literature search for all relevant articles from 1960 through January 2017 in PubMed, Web of Science and CINAHL. The search strategy combined the Medical Subject Heading (MeSH) and keywords for terms: (1) ACL OR “knee injury” OR “anterior cruciate ligament”; (2) “prevention and control” OR “risk reduction” OR “injury prevention” OR “neuromuscular training”; and (3) meta-analysis OR “systematic review” OR “cohort study” OR randomized. We found 166 different titles. The abstracts were reviewed for pertinent papers. The papers were reviewed by at least two authors and consensus of best practice for IPP to prevent OA was obtained by conference calls and e-mail discussions. All authors participated in the discussion.
RESULTS The best practice features of an IPP have the following six components: (1) lower extremity and core strengthening; (2) plyometrics; (3) continual feedback to athletes regarding proper technique; (4) sufficient dosage; (5) minimal-to-no additional equipment; and (6) balance training to help prevent injuries. Exercises focused on preventing ankle sprains, hamstring injuries and lateral trunk movements are important. Plyometric exercises should focus on correcting knee valgus movement. Exercises should focus on optimizing the hamstring to quadriceps strength ratio. In order for IPP to be successful, there should be increased education and verbal feedback along with increased athletic compliance. Additional equipment is not necessary. Balance training alone does not significantly reduce injuries, but is beneficial with other exercises. Not enough evidence to recommend stretching and agility exercises, with no ill effects identified. Therefore, we suggest making these optional features.
CONCLUSION Best practice features for ACL and lower limb IPPs to help prevent OA contain six key components along with two optional.
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Affiliation(s)
- Thomas Trojian
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Jeffrey Driban
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Rathna Nuti
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Lindsay Distefano
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Hayley Root
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Cristina Nistler
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Cynthia LaBella
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
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van Beijsterveldt AM, Richardson A, Clarsen B, Stubbe J. Sports injuries and illnesses in first-year physical education teacher education students. BMJ Open Sport Exerc Med 2017; 3:e000189. [PMID: 28761698 PMCID: PMC5530103 DOI: 10.1136/bmjsem-2016-000189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
Abstract
Background/aim We aimed to investigate the magnitude and characteristics of injuries and illnesses in Dutch physical education teacher education (PETE) students. Methods During the first 21 weeks of the academic year, 245 first-year students registered their health problems online using the Oslo Sports Trauma Research Centre (OSTRC) Questionnaire on Health Problems. Results A total of 276 injuries, 140 illnesses and 69 unclassified health problems were reported. We found an injury incidence rate of 11.7 injuries per 1000 hours (95% CI 10.4 to 13.2). Injury characteristics were: 42% overuse injuries, 62% causing absence from sports (median injury time loss=2 days) and 64% reinjuries. Most injuries were located at the knee, lower leg (anterior) and ankle. The duration of the illnesses was short (<1 week). Summary and conclusions We implemented a new registration method in the PETE academic programme. The results show that the risk for health problems is high for PETE students. Prevention is necessary, and to decrease injuries prevention programmes should focus on the lower extremities.
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Affiliation(s)
| | - Angelo Richardson
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Benjamin Clarsen
- Norwegian School of Sports Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
| | - Janine Stubbe
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Codarts, University of the Arts, Rotterdam, the Netherlands
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