The Potential Role of Hamstring Extensibility on Sagittal Pelvic Tilt, Sagittal Spinal Curves and Recurrent Low Back Pain in Team Sports Players: A Gender Perspective Analysis

Potential neurophysiological and biomechanical risk factors for sport-related back problems: A scoping review

This scoping review aims (1) to map the literature dealing with neurophysiological and biomechanical aspects of back problems in athletes in order to identify valid risk-factors for their prevention, plus (2) to identify gaps in the existing research and propose suggestions for future studies. A literature search conducted with Scopus, Web of Science, MEDLINE and Cochrane Library was completed by Elsevier, SpringerLink and Google Scholar. The main neurophysiological risk factors identified leading to back problems in athletes are neuromuscular imbalance, increased muscle fatigability, muscle dysfunction and impaired motor control, whilst biomechanical risk factors include maladaptive spinal, spinopelvic and lower limb kinematics, side-to-side imbalances in axial strength and hip rotation range of motion, spinal overloading and deficits in movement pattern. However, most studies focused on back pain in the lumbar region, whereas less attention has been paid to thoracic and cervical spine problems. The range of sports where this topic has been studied is relatively small. There is a lack of research in sports in which the core muscles are highly involved in specific movements such as lifting weights or trunk rotations. A limited number of studies include female athletes and master athletes of both genders. In addition to chronic back pain patients, it is equally important to conduct research on healthy athletes with a predisposition to spine problems. Investigators should focus their empirical work on identifying modifiable risk factors, predict which athletes are at risk for back problems, and develop personalized sport-specific assessment tools and targeted prevention strategies for them. This review was registered using the Open Science Framework Registries (https://osf.io/ha5n7).

Combining Static and Dynamic Myofascial Dry Cupping Therapy to Improve Local and Regional Symptoms in Individuals with Low Back Pain: A Case Series

Introduction

Chronic low back pain is a common musculoskeletal healthcare presentation with an expense of over $100 billion annually. The clinical effect of myofascial cupping on pain and function is not clear, especially when different cupping techniques are combined. The purpose of this case series was to explore changes in pain and function following local static and distal dynamic myofascial dry cupping treatments in patients with chronic low back pain.

Case Descriptions

Three adults from the general population received three ten-minute treatment sessions, 48 hours between each session, of static dry cupping to the low back followed by dynamic myofascial cupping of the quadriceps and hamstring musculature. Outcome measures were taken at two different time points within one-week per participant. Subjective measures included the numeric pain rating scale and the Oswestry Disability Index, objective measures included passive straight leg raise measurements, and pressure pain threshold.

Results and Discussion

Local static combined with distal dynamic myofascial cupping reduced pain, pain sensitivity and perceived disability, and improved hamstring muscle extensibility in all three participants. These encouraging results support the initiation of a larger controlled trial aimed at investigating the efficacy of combined dry cupping interventions to treat musculoskeletal dysfunction and pain.

Level of Evidence

4 (case series).

Muscular Strategies for Correcting the Pelvic Position to Improve Posture-An Exploratory Study

The correction of postural weaknesses through the better positioning of the pelvis is an important approach in sports therapy and physiotherapy. The pelvic position in the sagittal plane is largely dependent on the muscular balance of the ventral and dorsal muscle groups. The aim of this exploratory study was to examine whether healthy persons use similar muscular activation patterns to correct their pelvic position or whether there are different motor strategies. The following muscles were recorded in 41 persons using surface electromyography (EMG): M. trapezius pars ascendens, M. erector spinae pars lumbalis, M. gluteus maximus, M. biceps femoris, M. rectus abdominis, and M. obliquus externus. The participants performed 10 voluntary pelvic movements (retroversion of the pelvis). The anterior pelvic tilt was measured videographically via marker points on the anterior and posterior superior iliac spine. The EMG data were further processed and normalized to the maximum voluntary contraction. A linear regression analysis was conducted to assess the relationship between changes in the pelvic tilt and muscle activities. Subsequently, a Ward clustering analysis was applied to detect potential muscle activation patterns. The differences between the clusters and the pelvic tilt were examined using ANOVA. Cluster analysis revealed the presence of four clusters with different muscle activation patterns in which the abdominal muscles and dorsal muscle groups were differently involved. However, the gluteus maximus muscle was involved in every activation pattern. It also had the strongest correlation with the changes in pelvic tilt. Different individual muscle patterns are used by different persons to correct pelvic posture, with the gluteus maximus muscle apparently playing the most important role. This can be important for therapy, as different muscle strategies should be trained depending on the individually preferred motor patterns.

The association of hamstring tightness with lumbar lordosis and trunk flexibility in healthy individuals: gender analysis

Objectives: The purpose of this study was to investigate if there is a relation between hamstring tightness and lumbar lordosis as well as trunk flexibility based on gender differences and to analyze the differences in hamstring tightness, lumber lordosis and trunk flexibility in healthy adults. Methods: One hundred young healthy adults were recruited and distributed into 2 equal groups according to gender: group A (female group) and group B (male group). Hamstring tightness (HT) was measured by Active Knee Extension (AKE) test and Straight Leg Raise (SLR) test, the angle of lumbar lordosis was measured with a flexible ruler from standing position and trunk flexion flexibility (TFF) was measured by Fingertip-to-Floor Test. Results: There was a significant correlation between TFF and both measures of HT (SLR, p = 0.001; AKE, p = 0.001) in females. While, there was a non-significant correlation in males (SLR, p = 0.900; AKE, p = 0.717). Moreover, there was a non-significant correlation between lumbar lordosis and HT measures in both groups as (p > 0.05). Furthermore, there were significant differences between males and females in hamstring flexibility, TFF and lumbar lordosis as (p < 0.05). Conclusion: Gender differences in the relationship between hamstring tightness and trunk flexion flexibility are significant. However, there was no significant difference between males and females in the relationship between hamstring tightness and lumbar lordosis.

Epidemiology of Injuries in Men's Professional and Amateur Football (Part I)

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur footballers; amateur football is a major and diverse area, the development of which should be a priority for football associations around the world and UEFA. The aim of this study was to perform a systematic review of epidemiological literature data on injuries in professional and amateur football players belonging to certain leagues. Methods (2): A systematic review according to the PRISMA guidelines was performed until June 2023 in the databases PubMed, Web of Science, Google Academic, Google Scholar, and Diva portal. Forty-six studies reporting injury incidence in professional and amateur men's football were selected and analyzed. Two reviewers independently extracted data and assessed study quality using an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): The overall incidence of injuries in professional male football players was 7.75 ± 2.28, 95% confidence interval, injuries/1000 h of exposure and that of amateur football players was 7.98 ± 2.95, 95% confidence interval, injuries/1000 h of exposure. The incidence of match injuries (30.64 ± 10.28, 95% confidence interval, injuries/1000 exposure hours) was 7.71 times higher than the training injury incidence rate (3.97 ± 1.35, 95% confidence interval, injuries/1000 h) in professional football players and 5.45 times higher in amateurs (17.56 ± 6.15 vs. 3.22 ± 1.4, 95% confidence interval, injuries/1000 h). Aggregate lower extremity injuries had the highest prevalence in both categories of footballers, being 83.32 ± 4.85% in professional footballers and 80.4 ± 7.04% in amateur footballers: thigh, ankle, and knee injuries predominated. Conclusions (4): Professional and amateur football players are at substantial risk of injury, especially during matches that require the highest level of performance. Injury rates have implications for players, coaches, and sports medicine practitioners. Therefore, information on football injuries can help develop personalized injury risk mitigation strategies that could make football safer for both categories of football players. The current findings have implications for the management, monitoring, and design of training, competition, injury prevention, especially severe injury, and education programs for amateur football players.

Translational and Rotational Postural Aberrations Are Related to Pulmonary Functions and Skill-Related Physical Fitness Components in Collegiate Athletes

This study assessed the relationship between body posture displacements, cardiopulmonary exercise testing (CPET), and skill-related physical fitness tests. One hundred male (60%) and female collegiate athletes (22.2 ± 4 yrs) with normal body mass indexes (BMI up to 24.9) were assessed via the PostureScreen Mobile^® app to quantify postural displacements such as head, thorax, and pelvis rotations and translations. CPET and physical performance tests, including the agility t-test, vertical jump test, stork static balance test (SSBT), and dynamic Y-balance test (YBT), were performed. Spearman correlation (r) and p-values are reported. The postural parameters were found to have moderate-to-high associations with the CPET and agility test, moderate correlations with the vertical jump test and SSBT (head and pelvic postures only), and weak correlations with the YBT. As the postural parameters were more asymmetric, both the CPET and performance skills scores were worse. For example: (1) a medium positive correlation was found between cranio-vertebral angle (CVA) and the vertical jump test (r = 0.54; p-value < 0.001) and SSBT (r = 0.57; p-value < 0.001), while a strong negative correlation was found between CVA and the agility test (r = -0.86; p-value < 0.001). (2) A strong positive correlation was found between CVA and oxygen uptake efficiency slope, load watts VO2 at VT, VO2/kg, and load watts at the respiratory compensation point (RCP) (r = 0.65 and r = 0.71; p < 0.001). Conversely, a significant negative correlation was found between CVA and VE/VO2 at VT (r = -0.61; p < 0.001). Postural rotations and translations of the head, thorax, and pelvis were statistically correlated with the physical performance skills and CPET in the young collegiate athletes. There were moderate-to-high associations with cardiopulmonary functions and the agility tests, moderate correlations with the vertical jump test, and weak correlations with the YBT. Postural alignment may be important for optimal physical performance and optimal cardiopulmonary function. Further research is necessary to elucidate the reasons for these correlations found in our sample of young and healthy athletes.

Effects of Pelvic-Tilt Imbalance on Disability, Muscle Performance, and Range of Motion in Office Workers with Non-Specific Low-Back Pain

Imbalance in the pelvic tilt is considered to be a major variable in low back pain. The purpose of this study was to investigate the effects of pelvic-tilt imbalance on trunk- and hip-muscle performance, range of motion, low-back pain, and the degree of disability in office workers. This was a cross-sectional study conducted in a physical therapy clinic on forty-one office workers diagnosed with non-specific low-back pain. Among the office workers with non-specific low-back pain, 25 were assigned to the pelvic-tilt-imbalance group and 16 to the normal group without pelvic-tilt imbalance. In order to determine the differences according to the imbalance in pelvic tilt, the pain intensity and disability indices were compared between the groups. In addition, the muscle performance and range of motion of the trunk and hip joints and foot pressure were measured and compared. There were differences between the groups in the disability indices and the ratio of internal and external rotation of the hip joint. However, there were no differences in the other variables. Pelvic-tilt imbalance in office workers with non-specific chronic low-back pain may exacerbate the degree of disability and be related to hip-joint rotational range of motion.

Description of ROM-SPORT I Battery: Keys to Assess Lower Limb Flexibility

Limited range of motion (ROM) is considered one of the most important intrinsic and modifiable risk factors for the most common sports-related injuries. In addition, controlling and monitoring an athlete's ROM is a strategy to achieve optimal ROM and improve athletic performance in sports, especially those that require high ROM in the major joints. Therefore, assessing ROM (pre-participation, during a rehabilitation process, on return to play, etc.) is important not only as a method to prevent sports injuries, but also as a quantitative determinant of the potential of athletic performance. However, despite the variety of different ROM assessment methods described in the literature, there is no consensus on which methods are best suited for this goal. Recently, the ROM-SPORT I battery has been shown to have advantages over other ROM assessment methods. This tool has not yet been fully described in detail for researchers, sports professionals, and clinicians to learn. The main objective of this study is to describe the ROM-SPORT I battery tests in detail using the following criteria: test description, simplicity of the test procedure, low need for human and material resources, predictive validity, and reliability.

Lower-Limb Range of Motion Predicts Sagittal Spinal Misalignments in Children: A Case-Control Study

The main objective of this study was to determine lower-limb range of motion (ROM) as a risk factor associated with sagittal spinal misalignments in children. Two hundred and one children (10.9 ± 0.7 years old) from five different primary schools were recruited for this retrospective case-control study. Anthropometric variables, sagittal spinal alignment in habitual everyday postures, and lower-limb ROM, such as ankle dorsiflexion with the knee flexed (ADF-KF), hip extension with the knee relaxed (HE), and hip flexion with the knee extended (HF-KE) were measured. Multivariate and univariate analyses revealed differences between the means of HE and HF-KE ROM, and the thoracic and lumbar curves (p ≤ 0.034; η² ≥ 0.052). The HE (p ≤ 0.028; OR ≥ 1.066) predicted sagittal thoracic misalignment in the slump sitting (SSP) and relaxed standing (RSP) postures in males and the sagittal lumbar misalignment in the RSP in female children; while HF-KE (p ≤ 0.006; OR ≥ 1.089) predicted sagittal thoracic misalignment in the maximum trunk forward flexion posture (MTFP) and sagittal lumbar misalignment in SSP and MTFP in males. In this study, the reference values for restricted HE and HF-KE were significantly associated with sagittal spinal misalignment in male children but not for the ankle ROM. Physical education teachers should include stretching exercises in the ISQUIOS programme to increase the extensibility of the iliopsoas (HE) and hamstrings (HF-KE) and prevent sagittal spinal misalignments in habitual everyday postures.

The Sagittal Integral Morphotype in Male and Female Rowers

The goal of this study was to describe the integrated spinal assessment of the sagittal morphotype in rowers to determine whether the intense practice of rowing causes a modification of the sagittal curvatures of the spine, its relationship with the rowing technique, and training background. The second goal was to analyse how the dorsal and lumbar curves behave in the three phases of the rowing gesture, and to determine which phases can be detrimental to the correct development of the spine during growth. We analysed the spine curvatures in the sagittal plane of 29 females and 82 males, which were measured with an inclinometer in standing, slump sitting, maximal trunk flexion and during rowing performance. The average value of thoracic kyphosis in the rowers was 30° (mean, 30 + 8.27°). Thoracic hyperkyphosis was found in only two rowers (1.8%). Lumbar lordosis was within normal range in 84.1% of the males (mean, 27 + 9.57°) and 75.9% of female rowers (mean, 33°). Functional thoracic hyperkyphosis was observed in 57.4% of the males and 17.1% of the females. Functional lumbar hyperkyphosis was observed in 28 of the 69 males (40.5%) and five of 22 females (17.2%). Rowing seems to provide adequate spine alignment in the sagittal plane on standing. The integrated spinal assessment of the sagittal morphotype showed that half or our rowers presented with functional thoracic hyperkyphosis, and 43.2% presented with functional lumbar hyperkyphosis. Spine behaviour during the rowing technique shows that the thoracic kyphosis (98.2%) and lumbar spine (91%) perform within normative ranges and could explain the adequate positioning of the spine in the sagittal plane on standing. Years of rowing training tend to reduce thoracic kyphosis in males.

Lower Extremity Flexibility Profile in Basketball Players: Gender Differences and Injury Risk Identification

Analysis of the flexibility profile of basketball players (BPs) can reveal differences in range of motion (ROM) by gender and also identify those players who are at higher risk for sports injuries. A descriptive observational study was conducted to determine the lower extremity flexibility profile of sixty-four basketball players and gender differences to identify players at higher risk of injury due to limited and asymmetric ROM in one or more movements. Participants: Sixty-four (33 male and 31 female) competitive athletes from the national leagues of the Spanish basketball league system participated in the present study (power of sample size ≥0.99). The eight passive ROM tests of the hip, knee and ankle were assessed using the ROM-SPORT battery. Each player completed a questionnaire on age, basic anthropometric data, dominant extremities, and training and sport-related variables. The lower extremity flexibility profile was established at 15° and 10° hip extension (HE), 39° and 38° ankle dorsiflexion with knee extended (ADF-KE), 40° and 39° ankle dorsiflexion with knee flexed (ADF-KF), 43° and 43° hip abduction (HAB), 75° and 61° hip abduction with the hip flexed (HAB-HF), 78° and 83° hip flexion with the knee extended (HF-KE), 134° and 120° knee flexion (KF), and 145° and 144° hip flexion (HF) by male and female basketball players, respectively. Sex differences in HE, HAB-HF, and KF were observed in BPs (p ≤ 0.01; Hedges’ g ≥ 1.04). Players reported limited ROM in ADF-KF, HE, HAB-HF, HF-KE, and KF; and asymmetric ROM mainly in HE, ADF-KE, KF, ADF-KF, and HF-KE. In conclusion, this study provides gender-specific lower extremity flexibility profile scores in BPs that can help athletic trainers and athletic and conditioning trainers to identify those players who are at higher risk of injury due to abnormal ROM scores.