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Sadeghi M, Alizadeh MH, Minoonejad H. Acute effects of Nordic hamstring exercise on hip and knee joints proprioception. J Bodyw Mov Ther 2024; 39:382-389. [PMID: 38876656 DOI: 10.1016/j.jbmt.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/27/2023] [Accepted: 03/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Nordic Hamstring Exercise (NHE) is one of the best exercises proposed for injury prevention of hamstring muscles. However, its effects on lower extremity proprioception are unclear. The aim of this study was to investigate the immediate effects of a single bout of NHE on hip and knee joints' proprioception. METHODS Forty collegiate male soccer players participated in this study with a mean age of 22.85 ± 1.82 years and were randomized into either control (n = 20) or experimental (n = 20) groups. Each subject participated in pre-test measurements in which hip and knee active joints position sense (JPS) were assessed in standing and lying tasks using the image-capturing method. The experimental group then performed three sets of NHE with 10 repetitions in each set, while the control group rested for 10 min. Paired and independent t-tests were used for calculating the differences within and between groups on SPSS software, respectively. The level of significance was P ≤ 0.05. RESULTS Hip JPS in the lying task and knee JPS in both of the standing and lying tasks were impaired significantly after performing a single bout of NHE (P ≤ 0.05). However, the effects of this exercise on hip JPS in the standing task were not significant (P ≥ 0.05). CONCLUSIONS NHE performing with three sets of 10 repetitions can significantly impair hip and knee JPS immediately after exercise and reduce the proprioception acuity of the lower limbs. It is recommended to perform this exercise at a time rather than before training or match sessions.
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Affiliation(s)
- Mohsen Sadeghi
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
| | - Mohammad H Alizadeh
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Hooman Minoonejad
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
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Magistrali M, Stefanini L, Abate M, Biancalana G, Stegagno A, Cugia P, Candoli P, Anania G, Lucchese PL, Gaddi D, Volpi P, Mariani F, Boldrini L, Filippi N, Cerrone A, Sirtori C, Battaglino P, Bravin G, Del Fabro E, Berti M, Vecchini E, Minetto MA. Epidemiology of Non-Contact Muscle Injuries in the Italian Male Elite Under-19 Football (Soccer) Championship. SPORTS MEDICINE - OPEN 2024; 10:75. [PMID: 38902551 PMCID: PMC11190129 DOI: 10.1186/s40798-024-00738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND While extensive research exists on muscle injuries among adult football players, a notable gap persists in studies concerning younger footballers. The aim of the current study is to provide epidemiological data on the characteristics of time-loss muscle injuries in young football players participating in the Italian Under-19 male elite Championship ("Primavera 1"). RESULTS Conducted as a multicentre, prospective, observational cohort study, this research gathered injury data from the 2022-23 season across 14 of the 18 Clubs in the first Italian Under-19 championship. The cohort comprised 391 players with a mean age (± standard deviation) of 18.0 ± 0.4 years. A total of 479 injuries were reported, resulting in 14,231 days of activity lost. Of these, muscle injuries were 209 (44%), accounting for 4,519 (32%) days lost. Overall muscle injuries incidence was 1.82/1000 hours, with a mean injury burden of 39.4 days lost/1000 hours. Almost all muscle injuries (206 out of 209: 98.5%) occurred in hamstrings, quadriceps, adductors, calf and iliopsoas. Hamstrings injuries were the most burdensome (18.8 days lost/1000 hours) accounting for nearly half of all days lost due to muscle injuries. Incidence and burden of adductors injuries (0.25 injuries and 4.1 days lost/1000 hours, respectively) were found to be comparable to calf injuries (0.24 injuries and 4.7 days lost/1000 hours, respectively). Iliopsoas injuries accounted for a noteworthy portion of the total, with an injury incidence of 0.16/1000 hours and a burden of 3.3 days lost/1000 hours. Injuries with myo-tendinous or myo-aponeurotic involvement demonstrated delayed return-to-football compared to those without such involvement (35.6 vs. 18.5 days, p < 0.0001). CONCLUSIONS The study highlighted a peculiar distribution of non-contact muscle injuries among elite young football players. While hamstring injuries were confirmed as the most burdensome, incidence and burden of adductors and calf injuries were found to be similar. A significant incidence and burden of iliopsoas injuries were observed. These findings suggest potential implementations for targeted injury prevention strategies in the Italian male elite Under-19 football Championship.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Diego Gaddi
- FC Internazionale Milano SpA, Milano, Italy
- Department of Orthopedics and Traumatology, Policlinico San Pietro, Ponte San Pietro, Bergamo, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Piero Volpi
- Istituto Clinico Humanitas IRCCS Rozzano, Milano, Italy
- FC Internazionale Milano SpA, Milano, Italy
| | | | | | | | | | | | | | - Guido Bravin
- SOC Ortopedia e Traumatologia ASUFC, Udine, Italy
- Udinese Calcio, Udine, Italy
| | | | - Mattia Berti
- Department of Knee Surgery, Policlinico Abano Terme, Abano Terme, Italy
- Hellas Verona Calcio, Verona, Italy
| | - Eugenio Vecchini
- Hellas Verona Calcio, Verona, Italy
- Clinica Ortopedica, University of Verona, Verona, Italy
| | - Marco A Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Torino, Italy
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Kekelekis A, Manuel Clemente F, Kellis E. Muscle injury characteristics and incidence rates in men's amateur soccer: A one season prospective study. Res Sports Med 2024; 32:411-424. [PMID: 36120742 DOI: 10.1080/15438627.2022.2122827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
The objectives of the study were to examine the incident rate (IR), characteristics, and mechanisms of muscle injuries of 121 men amateur soccer players that voluntarily participated in this project. Sixty-five muscle injuries with an overall IR of 3.62/1000 h, 95% CI 2.7-4.5, were reported. The most frequently injured muscle groups were the hamstrings (IR 1.78/1000 h, 95% CI 1.1-2.3), followed by the adductors (IR 1.5/1000 h, 95% CI 0.93-2.06). Most muscle injuries were characterized as mild (IR 2.3/1000 h, 95% CI 1.53-2.92) or minimal (IR 1.28/1000 h, 95% CI 1.16-2.39. Higher incidence of injury sustained during matches (IR 14.09 injuries/1000 h, 95% CI 9.49-18.7), than in training (IR 1.88 injuries/1000 h, 95% CI 1.19-2.56). The most frequent injury mechanisms were high-speed running (84.4%) and change of direction (44.4%), for hamstring and adductors-related groin injuries, respectively. Players aged over 24 years had a 7-fold increased risk to sustain a hamstring injury but a lower risk to sustain an adductor-related groin injury. Injury prevention and rehabilitation management strategies may reduce muscle injury rates in amateur soccer.
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Affiliation(s)
- Afxentios Kekelekis
- Laboratory of Neuromechanics, Aristotle University of Thessaloniki, Department of Physical Education and Sport Sciences at Serres, Serres, Greece
- Departement of Rehabilitation, Sport Injury Clinic for Prevention & Rehabilitation, Crete, Aghios Nikolaos, Greece
| | - Filipe Manuel Clemente
- Escola SuperiorDesporto e Lazer, Instituto Politécnico de Viana do Castelo
- Research Center in Sports Performance, Recreation, Innovation and Technology (SPRINT), Instituto Politécnico deViana do Castelo, Rua Escola Industrial e Comercial de Nun'Álvares, Viana do Castelo, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, Lisboa, Portugal
| | - Eleftherios Kellis
- Laboratory of Neuromechanics, Aristotle University of Thessaloniki, Department of Physical Education and Sport Sciences at Serres, Serres, Greece
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Bramah C, Mendiguchia J, Dos'Santos T, Morin JB. Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence. Sports Med 2024; 54:783-793. [PMID: 37725240 PMCID: PMC11052868 DOI: 10.1007/s40279-023-01925-x] [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: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Hamstring strain injuries are one of the most common injuries in sprint-based sports with the mechanism of injury considered the result of an interaction between applied mechanical strain and the capacity of the muscle to tolerate strain. To date, injury prevention and rehabilitation strategies have frequently focused on enhancing the capacity of the hamstrings to tolerate strain, with little consideration of factors directly influencing mechanical strain. Sprint running biomechanics are one factor proposed to influence the mechanical strain applied to the hamstrings that may be modified (towards reduced strain) within rehabilitation and injury prevention programs. This article aims to explore the theoretical mechanistic link between sprint running mechanics and hamstring strain injury, along with the available supporting evidence. In doing so, it hopes to provide practitioners with an understanding of mechanical parameters that may influence hamstring strain injury whilst also identifying areas for further research exploration.
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Affiliation(s)
- Christopher Bramah
- School of Health and Society, University of Salford, Allerton Building, Frederick Road Campus, Salford, M6 6PU, UK.
- Manchester Institute of Health and Performance, Manchester, UK.
| | - Jurdan Mendiguchia
- Department of Physical Therapy, ZENTRUM Rehab and Performance Centre, Barañain, Spain
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
- Manchester Institute of Sport, Metropolitan University, Manchester, UK
| | - Jean-Benoȋt Morin
- University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, Inter-University Laboratory of Human Movement Biology, EA 7424, Saint-Etienne, France
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Gudelis M, Pruna R, Trujillano J, Lundblad M, Khodaee M. Epidemiology of hamstring injuries in 538 cases from an FC Barcelona multi sports club. PHYSICIAN SPORTSMED 2024; 52:57-64. [PMID: 36695100 DOI: 10.1080/00913847.2023.2170684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Hamstring injuries are the most common muscle injuries in team sports. The aims of this study were to describe the epidemiology of hamstring muscle injuries in the professional and amateur sport sections of a multi-sport club Football Club Barcelona (FCB) and to determine any potential correlation between return-to-play (RTP) and injury location, severity of connective tissue damage, age, sex, and athlete's level of competition. METHODS This descriptive epidemiological study with data collected from September 2007 to September 2017 stored in the FCB database. The study included non-contact hamstring injuries sustained during training or competition. RESULTS A total of 538 hamstring injuries were reported in the club's database, of which 240 were structurally verified by imaging as hamstring injuries. The overall incidence for the 17 sports studied was 1.29 structurally verified hamstring injuries per 100 athletes per year. The muscle most commonly involved in hamstring injuries was the biceps femoris, and the connective tissue most frequently involved was the myofascial. There was no evidence of a statistically significant association between age and RTP after injury, and no statistically significant difference between sex and RTP. However, the time loss by professionals was shorter than for amateurs, and proximal hamstring injuries took longer RTP than distal ones. CONCLUSION In the 17 sports practiced at multi-sport club, the incidence of hamstring injury was 1.29 per 100 athletes per year. Players from sports in which high-speed sprinting and kicking are necessary, and amateurs, were at higher risk of suffering a hamstring injury. In addition, proximally located hamstring injuries involving tendinous connective tissue showed the longest RTP time. Age did not seem to have any influence on RTP. Documenting location and the exact tissue involved in hamstring injuries may be beneficial for determining the prognosis and RTP.
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Affiliation(s)
- Mindaugas Gudelis
- Medical Department of Football Club Barcelona (FIFA Medical Centre of Excellence), Barcelona, Spain
- Barça Innovation Hub of Football Club Barcelona, Barcelona, Spain
- Clinica Tenis Teknon, Bracelona, Spain
- Reabilitacijos ir sporto medicinos centras, Vilnius, Lithuania
| | - Ricard Pruna
- Medical Department of Football Club Barcelona (FIFA Medical Centre of Excellence), Barcelona, Spain
- Barça Innovation Hub of Football Club Barcelona, Barcelona, Spain
| | | | - Matilde Lundblad
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Health and Performance, Department of Food and Nutrition and Sports Science, University of Gothenburg, Gothenburg, Sweden
| | - Morteza Khodaee
- Department of Family Medicine Department of Orthopedics, University of Colorado School of Medicine Denver, Denver, CO, USA
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Lunn DE, Nicholson G, Cooke M, Crespo R, Robinson T, Price RJ, Walker J. Discrete Hamstring: Quadriceps Strength Ratios Do Not Represent Angle-Specific Ratios in Premier League Soccer Players. J Strength Cond Res 2023; 37:2417-2422. [PMID: 37815243 DOI: 10.1519/jsc.0000000000004574] [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: 10/11/2023]
Abstract
ABSTRACT Lunn, DE, Nicholson, G, Cooke, M, Crespo, R, Robinson, T, Price, RJ, and Walker, J. Discrete hamstring: quadriceps strength ratios do not represent angle-specific ratios in Premier League soccer players. J Strength Cond Res 37(12): 2417-2422, 2023-This study compared angle-specific hamstring:quadriceps (H:Q) ratios with their discrete counterparts during strength testing in professional male soccer players. Twenty-seven professional English Premier League soccer players were recruited for this study (age: 22 ± 4 years; stature: 1.81 ± 0.08 m; body mass: 74.7 ± 6.5 kg). Isokinetic testing of the knee flexors and extensors was conducted concentrically at two angular velocities (60° and 240°·s -1 ) and eccentrically (for the knee flexors only) at 30°·s -1 . Conventional H:Q ratio was calculated as the ratio between peak joint moment in the flexors and extensors at 60°·s -1 . Functional H:Q ratio was calculated as the peak joint moment in the flexors during the eccentric condition and the extensors at 240°·s -1 . Discrete conventional and functional H:Q ratios were 0.56 ± 0.06 and 1.28 ± 0.22, respectively. The residual differences between discrete values and angle-specific residual values were 13.60 ± 6.56% when normalized to the magnitude of the discrete value. For the functional ratios, the normalized residual was 21.72 ± 5.61%. Therefore, neither discrete ratio was representative of angle-specific ratios, although the conventional ratio had lower error overall. Therefore, practitioners should consider H:Q ratio throughout the full isokinetic range of motion, not just the discrete ratio calculated from peak joint moments, when designing and implementing training programs or monitoring injury risk, recovery from injury, and readiness to return to play.
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Affiliation(s)
- David E Lunn
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; and
| | - Gareth Nicholson
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; and
| | - Mark Cooke
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; and
| | - Rubén Crespo
- Leeds United Football Club, Leeds, United Kingdom
| | - Tom Robinson
- Leeds United Football Club, Leeds, United Kingdom
| | - Rob J Price
- Leeds United Football Club, Leeds, United Kingdom
| | - Josh Walker
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; and
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Freitas SR, Radaelli R, Oliveira R, Vaz JR. Hamstring Stiffness and Strength Responses to Repeated Sprints in Healthy Nonathletes and Soccer Players With Versus Without Previous Injury. Sports Health 2023; 15:824-834. [PMID: 37254837 PMCID: PMC10606964 DOI: 10.1177/19417381231175474] [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: 06/01/2023] Open
Abstract
BACKGROUND The effect of 10 × 30 m repeated sprints on passive and active stiffness of semitendinosus (ST) and biceps femoris long head (BFlh), and knee flexor maximal voluntary isometric contraction (MVIC) and rate of force development (RFD), and whether athletes with previous hamstring injury have a different response, is unknown. HYPOTHESIS Repeated sprints would (1) increase BFlh stiffness and decrease ST stiffness and knee flexors MVIC and RFD in healthy participants; and (2) greater magnitude of response would be seen in athletes with previous hamstring injury. STUDY DESIGN Case series (experiment I) and case control (experiment II) study designs. LEVEL OF EVIDENCE Level 3. METHODS Healthy nonathletes attended 2 replicated sessions (experiment I, n = 18), while soccer players with (n = 38) and without (n = 67) previous hamstring injury attended 1 testing session (experiment II). RESULTS In both experiments, the knee flexors MVIC and RFD decreased after the sprints (P < 0.05). In experiment I, the ST and BFlh passive stiffness reduced after the sprints (P < 0.02), while a small BFlh active stiffness increase was noted (P = 0.02); however, no correlation was observed between the 2 testing sessions for the postsprint muscle stiffness responses (r = -0.07-0.44; P > 0.07). In experiment II, only an ST passive stiffness reduction was observed after the sprints (P < 0.01). No differences were noted between injured and noninjured lower limbs for any variable (P > 0.10). CONCLUSION Repeated sprints are likely to decrease the knee flexor's maximal and rapid strength, and to alter the hamstring stiffness in the nonathlete population. Previous hamstring injury does not apparently affect the footballer's hamstring functional and mechanical responses to repeated sprints. CLINICAL RELEVANCE The responses of hamstring stiffness and knee flexor strength to repeated sprints are unlikely to be associated with hamstring injury.
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Affiliation(s)
- Sandro R. Freitas
- Laboratório de Função Neuromuscular, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Lisboa, Portugal
| | - Régis Radaelli
- Laboratório de Função Neuromuscular, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Lisboa, Portugal
- Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Monte de Caparica, Setúbal, Portugal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Lisboa, Portugal
| | - Raúl Oliveira
- Laboratório de Função Neuromuscular, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Lisboa, Portugal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Lisboa, Portugal
| | - João R. Vaz
- Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Monte de Caparica, Setúbal, Portugal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Lisboa, Portugal
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Crawford SK, Hickey J, Vlisides J, Chambers JS, Mosiman SJ, Heiderscheit BC. The effects of hip- vs. knee-dominant hamstring exercise on biceps femoris morphology, strength, and sprint performance: a randomized intervention trial protocol. BMC Sports Sci Med Rehabil 2023; 15:72. [PMID: 37365624 DOI: 10.1186/s13102-023-00680-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The hamstrings are an important muscle group that contribute to horizontal force during sprint acceleration and are also the most injured muscle group in running-based sports. Given the significant time loss associated with hamstrings injury and impaired sprinting performance following return to sport, identifying exercises that drive adaptations that are both protective of strain injury and beneficial to sprint performance is important for the strength and conditioning professional. This paper describes the study protocol investigating the effects of a 6-week training program using either the hip-dominant Romanian deadlift (RDL) or the knee-dominant Nordic hamstring exercise (NHE) on hamstring strain injury risk factors and sprint performance. METHODS A permuted block randomized (1:1 allocation) intervention trial will be conducted involving young, physically-active men and women. A target sample size of 32 will be recruited and enrolled participants will undergo baseline testing involving extended-field-of-view ultrasound imaging and shear wave elastography of the biceps femoris long head muscle, maximal hamstrings strength testing in both the RDL and NHE, and on-field sprint performance and biomechanics. Participants will complete the 6-week training intervention using either the RDL or NHE, according to group allocation. Baseline testing will be repeated at the end of the 6-week intervention followed by 2 weeks of detraining and a final testing session. The primary outcome will be regional changes in fascicle length with secondary outcomes including pennation angle, muscle cross sectional area, hamstring strength, and maximal sprint performance and biomechanics. An exploratory aim will determine changes in shear wave velocity. DISCUSSION Despite extensive research showing the benefits of the NHE on reducing hamstring strain injury risk, alternative exercises, such as the RDL, may offer similar or potentially even greater benefits. The findings of this study will aim to inform future researchers and practitioners investigating alternatives to the NHE, such as the RDL, in terms of their effectiveness in reducing rates of hamstring strain injury in larger scale prospective intervention studies. TRIAL REGISTRATION The trial is prospectively registered on ClinicalTrials.gov (NCT05455346; July 15, 2022).
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Affiliation(s)
- Scott K Crawford
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Kinesiology, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1300 University Ave, Madison, WI, 53706, USA.
| | - Jack Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies Research Centre, Australian Catholic University, Fitzroy, VIC, Australia
- Department of Sport Science and Nutrition, Maynooth University, County Kildare, Ireland
| | - Jessica Vlisides
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jennifer S Chambers
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Samuel J Mosiman
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
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9
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Perkins S, Canavan P. Isokinetic Assessment of Knee Flexor and Extensor Strength and Lower Extremity Flexibility Assessment of an NCAA Division III Men's Soccer Team. Int J Sports Phys Ther 2023; V18:626-635. [PMID: 37425103 PMCID: PMC10324297 DOI: 10.26603/001c.74971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background Strength imbalances and flexibility deficits of the hamstrings and hip flexors have been identified as potential risk factors for hamstring injuries, but research on athletes at the Division III level are limited, potentially due to a lack of resources and technology. Purpose The purpose of this study was to conduct isokinetic and flexibility assessments to screen male soccer athletes at risk of sustaining a hamstring injury. Study Design Observational cohort. Methods Standardized isokinetic testing of concentric muscle performance, measured by peak torque of the quadriceps and hamstrings and hamstring-to-quadriceps ratios, was conducted using a Biodex isokinetic dynamometer at speeds of 60 and 180°/sec. Additionally, the Active Knee Extension (AKE) test and the Thomas test were performed bilaterally to objectively measure flexibility. Paired sample t-tests were used to compare left and right lower extremities for all outcomes, with the level of significance set at p<0.05. Participants were ranked for risk and given a set of exercises sourced from the FIFA 11 Injury Prevention Program. Results At 60°/sec, the mean PT/BW bilateral deficit was 14.1% for extension and 12.9% for flexion. At 180°/sec, the mean deficit was 9.9% for extension and 11.4% for flexion. The team's average for left and right H:Q ratios for each speed were 54.4 and 51.4 at 60°/sec and 61.6 and 63.1 at 180°/sec, respectively. The team's average AKE range of motion was 158° for the left leg and 160° for the right leg. The mean Thomas test measurements were 3.6° away from the neutral position on the right and 1.6° on the left, with nine positive tests. There were no statistically significant differences between left and right knee extension or flexion PT/BW or H:Q ratios at either speed. There was no significant difference between left and right AKE measurements (p=0.182). Conclusion The results of this screening suggest that isokinetic testing and flexibility testing may be useful to identify non-optimal strength ratios and flexibility deficits in male collegiate soccer players. The benefits of this research have direct implications, as participants received both their screening data and a set of exercises aimed to help decrease their injury risk, in addition to the offering data that is useful for determining what normative values for flexibility and strength profiles might look like for Division III male soccer players. Level of Evidence Level 3.
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Affiliation(s)
- Savanna Perkins
- Department of Health Sciences Eastern Connecticut State University
| | - Paul Canavan
- Department of Health Sciences Eastern Connecticut State University
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10
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Martínez-Serrano A, Freitas TT, Franquesa X, Enrich E, Mallol M, Alcaraz PE. Does External Load Reflect Acute Neuromuscular Fatigue and Rating of Perceived Exertion in Elite Young Soccer Players? J Strength Cond Res 2023; 37:e1-e7. [PMID: 35836311 DOI: 10.1519/jsc.0000000000004296] [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: 11/08/2022]
Abstract
ABSTRACT Martínez-Serrano, A, Freitas, TT, Franquesa, X, Enrich, E, Mallol, M, and Alcaraz, PE. Does external load reflect acute neuromuscular fatigue and rating of perceived exertion in elite young soccer players? J Strength Cond Res 37(3): e1-e7, 2023-This study aimed to analyze the acute and residual effects of increased high-speed running (HSR) demands during an in-season training microcycle in young elite soccer players on localized neuromuscular fatigue (NMF) of the knee extensors (KE), posterior chain muscles, and rating of perceived exertion (RPE). Thirty-four elite young soccer players (age = 17.1 ± 0.8 years) were assessed in 2 consecutive days at different time points (baseline, POST-activation gym-based session, POST-small-sided game [SSG], POST-training 1 [TR1], POST-6H, POST-24H, POST-preventive gym-based session, and POST-training 2 [TR2]). Neuromuscular fatigue of the KE and posterior chain muscles was measured with a maximum voluntary isometric contraction (MVIC). External (total distance, number of accelerations or decelerations, and HSR distance) and internal (RPE) load was assessed during the SSG, TR1, and TR2 sessions. Players were divided through a median split, into "HIGH" or "LOW" group according to the training demands. The alpha level was set at p ≤ 0.05. A 2-way mixed effects model ANOVA showed a significant decreased in 90:20 MVIC after TR1 in the "HIGH" HSR group ( p = 0.037; effect size [ES] = 0.45). No significant differences in RPE were found after TR1 ( p = 0.637; ES = 0.58) and TR2 ( p = 0.109; ES = 0.62) when comparing the "HIGH" HSR group with the "LOW" HSR group. Assessing player's force production capabilities can be an effective strategy to detect NMF when HSR demands are acutely increased. Special caution should be taken when prescribing the training load of the training session based solely on RPE, as NMF might be present.
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Affiliation(s)
- Antonio Martínez-Serrano
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
- Strength and Conditioning Society, Rome, Italy
| | - Tomás T Freitas
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
- Strength and Conditioning Society, Rome, Italy
- NAR-Nucleus of High Performance in Sport, São Paulo, Brazil
- Faculty of Sport Sciences, Catholic University of Murcia, Murcia, Spain
| | - Xavi Franquesa
- Strength and Conditioning Department, Futbol Club Barcelona, Barcelona, Spain; and
- Barça Innovation Hub, Futbol Club Barcelona, Barcelona, Spain
| | - Edgar Enrich
- Strength and Conditioning Department, Futbol Club Barcelona, Barcelona, Spain; and
- Barça Innovation Hub, Futbol Club Barcelona, Barcelona, Spain
| | - Milos Mallol
- Strength and Conditioning Department, Futbol Club Barcelona, Barcelona, Spain; and
- Barça Innovation Hub, Futbol Club Barcelona, Barcelona, Spain
| | - Pedro E Alcaraz
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain
- Strength and Conditioning Society, Rome, Italy
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11
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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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12
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Differences in Peak Knee Flexor Force between Eccentric-Only and Combined Eccentric-Concentric Nordic Hamstring Exercise. Sports (Basel) 2023; 11:sports11020041. [PMID: 36828326 PMCID: PMC9961423 DOI: 10.3390/sports11020041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
In many sports, the hamstring strain injury is a common injury. There is evidence that the Nordic hamstring exercise (NHE), a knee flexor exercise, can reduce hamstring injury risk in athletes. In research on hamstring injury prevention, eccentric-only NHE is typically performed, whereas in sports, it is relatively common for athletes to perform NHE eccentrically-concentrically. Further, NHE strength is generally assessed by measuring knee flexor force through an ankle brace, attached atop of a load cell. An alternative method might be to assess knee flexor force about the knee joint using a force plate. The aim of the study was to investigate differences in peak knee flexor force between eccentric-only and combined eccentric-concentric NHE. The purpose was also to determine the correlation between hamstring force measured at the ankle using a load cell (current gold standard) and force assessed about the knee joint using a force plate during NHE. Fifteen junior and senior elite soccer and track and field athletes (3 women and 12 men aged 17-27 years) performed eccentric NHE (ENHE) in which they leaned forward as far as possible until breakpoint and eccentric-concentric NHE (ECNHE) where they returned to the starting position. A linear encoder measured the position at which peak force occurred during the NHEs. Force assessed at the ankle differed significantly (678 vs. 600 N, p < 0.05), whereas force about the knee joint did not (640 vs. 607 N, p > 0.05) between ENHE and ECNHE (12 and 5% difference, respectively). The forward distance achieved by the participants in cm at breakpoint for ENHE was 37% higher than at the coupling phase for ECNHE (74 vs. 54 cm, p < 0.001). Very strong significant (p < 0.01) correlations were noted between peak force assessed at the ankle and about the knee joint for ENHE and ECNHE, r = 0.96 and r = 0.99, respectively. Our results suggest that ECNHE, where peak knee flexor force was reached with 37% less forward movement, may complement ENHE, i.e., during hamstring injury rehabilitation, where a position of great knee extension may not be well tolerated by the athlete. Further, assessing knee flexor force about the knee joint using a force plate may provide an alternative to measuring force at the ankle using a load cell when testing NHE strength.
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Kekelekis A, Kounali Z, Kofotolis N, Clemente FM, Kellis E. Epidemiology of Injuries in Amateur Male Soccer Players: A Prospective One-Year Study. Healthcare (Basel) 2023; 11:healthcare11030352. [PMID: 36766927 PMCID: PMC9914725 DOI: 10.3390/healthcare11030352] [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] [Received: 12/30/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to prospectively monitor and analyze injuries in Greek amateur male soccer players over one competitive season. One hundred and thirty male soccer players in a regional amateur league participated in this study. Injury data and exposure were collected from six teams during training and competition match over one season (2018/19). Injuries were collected weekly and were classified by setting, mechanism, severity, type, calendar distribution, period of injury occurrence, and anatomical location. A total of 103 injuries were recorded during the season, with an incident rate (IR) of 5.5 injuries/1000 h with 95% confidence intervals (CI) values of 4.45 (lower limit) and 6.09 (upper limit). Furthermore, IR was greater for the posterior thigh (IR 1.83/1000 h, 95% CI 1.21-2.44) and hip/groin complex (IR 1.45/1000 h, 95% CI 0.90-1.99) compared to other anatomical locations. Similarly, muscle injuries had greater IR (IR 3.61/1000 h, 95% CI 2.74-4.47) than other tissues. Amateur soccer players had a seven-fold greater chance of getting injured during games (IR 20.76/1000 h, 95% CI 15.28-26.24) rather than during training (IR 3.077/1000 h, 95% CI 2.16-3.80), while injury rates were higher towards the end of a session and peaked in October and February of the season. Based on these results, amateur soccer may benefit from injury prevention strategies incorporated into their regular training practice and focus on muscle injuries, especially in the posterior thigh and the hip/groin complex.
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Affiliation(s)
- Afxentios Kekelekis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100 Serres, Greece
- Sport Injury Clinic for Prevention & Rehabilitation, 72100 Aghios Nicolaos, Greece
| | - Zoe Kounali
- Sport Injury Clinic for Prevention & Rehabilitation, 72100 Aghios Nicolaos, Greece
| | - Nikolaos Kofotolis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100 Serres, Greece
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
- Correspondence:
| | - Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100 Serres, Greece
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Modified surgical anchor refixation in older patients with acute proximal hamstring rupture: clinical outcome, patient satisfaction and muscle strength. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04752-3. [PMID: 36622424 PMCID: PMC9828366 DOI: 10.1007/s00402-022-04752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION After conventional surgical refixation of the hamstrings after proximal hamstring rupture, patients frequently experience pain while sitting and deficits in hamstring muscle strength of the operated side. To improve these outcomes, we have modified the surgical anchor placement and have carried out a thorough follow-up examination. MATERIALS AND METHODS Thirteen older patients (8 female, 5 males) with a median age of 64.2 (range, 52.1-80.4) years were surgically treated for acute proximal hamstring rupture using modified anchor placement and participated in a follow-up assessment at a median of 46.2 (11.2-75.0) months after surgery. Patients completed the Perth Hamstring Assessment Tool (PHAT), quality of life questionnaire (EQ-5D-5L) and the Lower Extremity Functional Scale (LEFS), and rated their satisfaction level on a scale from 0 to 100%. Local tenderness on the ischial tuberosity and maximum passive hip flexion were measured on both limbs. Maximum isokinetic knee flexor muscle strength was measured bilaterally using a dynamometer. RESULTS The median (range) PHAT, EQ-5D-5L and LEFS score were 78.8/100 (54.6-99.8), 0.94/1 (0.83-1) and 88.75/100 (61.25-100). The median satisfaction was 100% (90-100%). Only one patient felt discomfort when the ischial tuberosity was palpated. Neither maximum passive hip flexion nor maximum isokinetic flexor muscle strength differed between the operated and non-operated side (P > 0.58). Clinical scores did not correlate with the leg symmetry index of knee flexor muscle strength (Spearman's rho < 0.448, P > 0.125). There were no tendon re-ruptures, or postoperative sciatic radiculopathy, at the time of follow-up. CONCLUSIONS The modified extra-anatomical anchor placement resulted in good clinical and functional outcome of surgical repair of acute proximal hamstring rupture. Especially the absence of postoperative pain while sitting and the comparable muscle strength to the contralateral side is promising. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04867746, registered.
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15
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Aiello F, Impellizzeri FM, Brown SJ, Serner A, McCall A. Injury-Inciting Activities in Male and Female Football Players: A Systematic Review. Sports Med 2023; 53:151-176. [PMID: 36315396 PMCID: PMC9807506 DOI: 10.1007/s40279-022-01753-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND A comprehensive examination of the sport-specific activities performed around the time of injury is important to hypothesise injury mechanisms, develop prevention strategies, improve management, and inform future investigations. The aim of this systematic review is to summarise the current literature describing the activities performed around the time of injury in football (soccer). METHODS A systematic search was carried out in PubMed, Web of Science, SPORTDiscus, and OpenGrey. Studies were included if participants were football players aged > 13 years old and the activities performed at the time of injury were reported together with the total number of injuries. Risk of bias was assessed using an adapted version of checklists developed for prevalence studies. The activities reported by the studies were grouped to account for inconsistent reporting, and the proportion of each injury activity was calculated. Data were not meta-analysed due to high heterogeneity of methods and classification criteria. RESULTS We included 64 studies reporting on 56,740 injuries in total. ACL injures were analysed by 12 studies, ankle/foot and knee injuries were analysed by five studies, thigh injuries were analysed by four studies, hip/groin injuries were analysed by three studies, and hamstring injuries were analysed by two studies. Five studies analysed more than one type of injury and 38 studies did not specify the type of injuries analysed. Running and kicking were the predominant activities leading to thigh and hamstring injuries. Changing direction and kicking were the predominant activities leading to hip and groin injuries and duels were the predominant activities leading to ankle injuries. Duels and pressing seem the predominant activities leading to ACL injuries, while results for other knee and general injuries were inconsistent. CONCLUSIONS A qualitative summary of the activities performed at the time of injury has been reported. The results need to be interpreted carefully due to the risk of bias observed in the included studies. If we are to meaningfully progress our knowledge in this area, it is paramount that future research uses consistent methods to record and classify injuries and activities leading up to and performed at the time of injury. REGISTRATION The protocol of this systematic review was registered at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/U96KV ).
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Affiliation(s)
- Francesco Aiello
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Franco M Impellizzeri
- Faculty of Health, Sport and Exercise Discipline Group, University of Technology Sydney, Sydney, Australia
| | - Susan J Brown
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Alan McCall
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
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16
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Chia L, Silva DDO, Whalan M, McKay MJ, Sullivan J, Fuller CW, Pappas E. Epidemiology of gradual-onset knee injuries in team ball-sports: A systematic review with meta-analysis of prevalence, incidence, and burden by sex, sport, age, and participation level. J Sci Med Sport 2022; 25:834-844. [DOI: 10.1016/j.jsams.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 08/07/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
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17
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Whiteley R, Gregson W, Roald B, Tabben M, Chamari K, Lolli L, Di Salvo V. High‐speed running during match play before and after return from hamstring injury in professional footballers. Scand J Med Sci Sports 2022; 32:1502-1509. [DOI: 10.1111/sms.14219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rodney Whiteley
- Aspetar, Sport Medicine Department, Qatar Orthopaedic and Sports Medicine Hospital Doha Qatar
| | - Warren Gregson
- Aspire Academy, Football Performance & Science Department Doha Qatar
- Football Exchange, Research Institute of Sport Sciences Liverpool John Moores University Liverpool UK
| | - Bahr Roald
- Aspetar, Sport Medicine Department, Qatar Orthopaedic and Sports Medicine Hospital Doha Qatar
- Oslo Sports Trauma Research Center Norwegian School of Sport Sciences Oslo Norway
| | - Montassar Tabben
- Athlete Health and Performance Research Centre, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital Doha Qatar
| | - Karim Chamari
- Athlete Health and Performance Research Centre, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital Doha Qatar
| | - Lorenzo Lolli
- Aspire Academy, Football Performance & Science Department Doha Qatar
- Football Exchange, Research Institute of Sport Sciences Liverpool John Moores University Liverpool UK
| | - Valter Di Salvo
- Aspire Academy, Football Performance & Science Department Doha Qatar
- Department of Movement, Human and Health Sciences University of Rome “Foro Italico” Italy
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18
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Chia L, De Oliveira Silva D, Whalan M, McKay MJ, Sullivan J, Fuller CW, Pappas E. Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type. Sports Med 2022; 52:2447-2467. [PMID: 35622227 PMCID: PMC9136558 DOI: 10.1007/s40279-022-01697-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 01/18/2023]
Abstract
Background Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts. Objective To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports. Methods Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included. Results Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48–62, I2 = 82%; females: 63%, 95% CI 53–71, I2 = 84%; males: 50%, 95% CI 42–58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05–0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03–0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10–0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03–0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32–0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15–0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02–0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01–0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high. Conclusion This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-022-01697-w.
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Affiliation(s)
- Lionel Chia
- Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia. .,Cleveland Guardians Baseball Company, Cleveland, OH, USA.
| | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, VIC, Australia
| | - Matthew Whalan
- Research and Development Department, Football Australia, Sydney, NSW, Australia.,Centre of Medical and Exercise Physiology, School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Marnee J McKay
- Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
| | - Justin Sullivan
- Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
| | | | - Evangelos Pappas
- Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia.,School of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, NSW, Australia
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19
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Garcia AG, Andrade R, Afonso J, Runco JL, Maestro A, Espregueira-Mendes J. Hamstrings injuries in football. J Orthop 2022; 31:72-77. [PMID: 35464813 PMCID: PMC9026901 DOI: 10.1016/j.jor.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background Hamstrings injuries are a major concern in football (soccer), affecting both recreational players and professional athletes. Although being a recognized issue within the football community, its incidence has been increasing over the last years and still poses a challenge to all practitioners involved. Study objectives and rationale The goal of this narrative review is to outline hamstrings injuries epidemiology and mechanisms of injury, identify and discuss its risk factors, provide an approach to a proper early diagnosis, evaluate the efficacy of current treatment options and return to sports, and present the best strategies for hamstrings injury prevention. These guidelines will help the sports medicine staff team on how to better manage their players with or at risk of hamstrings injuries. Conclusion Despite several breakthroughs in research of hamstrings injuries, there is still heterogeneity across studies and lack of consensus in regards to classification, diagnosis, treatment and prevention. Hamstrings injuries compromise the athlete's performance with time loss due to injury, shortens their highest-level career longevity with higher risk of reinjury rates, and is a defying problem for clubs to balance financial losses due to having their players off the pitch. Further research is warranted to keep moving forward with evidence on treating and preventing hamstrings injuries to mitigate its high incidence and keep the players safe.
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Affiliation(s)
- André Gismonti Garcia
- Casa de Saúde São José, Rio de Janeiro, Brazil
- Clínica Espregueira – FIFA Medical Centre of Excellence, Porto, Portugal
| | - Renato Andrade
- Clínica Espregueira – FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - José Afonso
- Centre of Research, Education Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Portugal
| | | | - Antonio Maestro
- Instituto Asturiano de Traumatologia Real Sporting de Gijon, Gijon, Spain
- Corresponding author.
| | - 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, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal
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Hoppen MI, Reurink G, de Boode VA, van der Kaaden L, Jagtman L, Glazenburg T, Bruning B, Tol JL. Return to match running performance after a hamstring injury in elite football: a single-centre retrospective cohort study. BMJ Open Sport Exerc Med 2022; 8:e001240. [PMID: 35309372 PMCID: PMC8883270 DOI: 10.1136/bmjsem-2021-001240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To determine the number of matches to return to pre-injury match running performance after sustaining an acute hamstring injury. Methods In this retrospective cohort study, the injuries of the players of the first, Under21, Under19, Under18 and Under17 teams of a professional football club in the period 2017-2020 were analysed. Acute hamstring injuries with a minimal absence from training or match play of 7 days were included. For running performance, we assessed the following variables: maximal velocity (km/hour), total distance, high-intensity distance (17.5-22.5 km/hour) and sprint distance (>22.5 km/hour). We calculated the average and 95% CI for these variables during the last five matches before the injury. The primary outcome was the number of matches to reach maximal velocity within the 95% CI of the player's individual pre-injury performance. Secondary outcome scores included the duration (in days and matches) to reach the other running performance variables. Results 18 hamstring injuries in 15 players were included. 15 out of 18 injuries (83%) showed a return to pre-injury maximal velocity in the second match after return to play. The median number of matches to return to pre-injury maximal velocity was 2 (IQR 1-2). In the first match after return to play, pre-injury total distance was reached in 100% of the injuries, pre-injury sprint distance was reached in 94% of the injuries and pre-injury high-intensity distance was reached in 89% of the injuries. Conclusion Following an acute hamstring injury in elite football, pre-injury match running performance is reached in the first or second match.
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Affiliation(s)
- Marloes I Hoppen
- Academic Centre for Evidence-based Sports Medicine (ACES), University of Amsterdam, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Gustaaf Reurink
- Academic Centre for Evidence-based Sports Medicine (ACES), University of Amsterdam, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | - Vosse A de Boode
- Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | | | - Lotte Jagtman
- Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | - Tim Glazenburg
- Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | - Bastiaan Bruning
- Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | - Johannes L Tol
- Academic Centre for Evidence-based Sports Medicine (ACES), University of Amsterdam, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands.,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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21
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Predictors of time to return to play and re-injury following hamstring injury with and without intramuscular tendon involvement in adult professional footballers: A retrospective cohort study. J Sci Med Sport 2021; 25:216-221. [PMID: 34740516 DOI: 10.1016/j.jsams.2021.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In one English Premier League football club over four seasons, 1) describe the number of hamstring strain injuries (HSI) sustained using the British Athletics Muscle Injury Classification (BAMIC); 2) determine if intramuscular tendon HSI influenced the time to return to play (TTRTP) and reinjury rate; 3) determine the predictors of TTRTP and reinjury. DESIGN Retrospective cohort design. METHODS All first team players who sustained a HSI between 2014 and 2018 were included. Players underwent an MRI scan that was graded by a Radiologist using the BAMIC (0a-4) criteria. TTRTP, reinjury rate and information on suspected predictors were recorded. RESULTS Thirty-five HSI experienced by 24 players (age = 26 ± 4 years) were recorded over the 4 seasons. There was a difference in TTRTP between grades 1a and 2c (P = 0.007), but not between 2b and 2c (P = 0.845). Grade of HSI (P ≤ 0.001) and removal of the player (P < 0.001) were predictors of TTRTP, with each increase in grade resulting in an additional 3 days of TTRTP, and being removed, an additional 11 days. Grade and all other predictors did not influence reinjury rate, albeit higher odds were evident for previous HSI, experiencing the HSI during sprinting, passing a ball or stretching, and reported increase days of pain during walking. CONCLUSIONS HSIs extending into the intramuscular tendon (2b cf. 2c) did not influence TTRTP or re-injury, albeit TTRTP was affected by the BAMIC grade and if the player was removed from activity.
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22
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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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