Perceptions of Professional Football Players on Injury Risk Factors and Prevention Strategies.

BACKGROUND: Considering individual beliefs and preferences is a pillar of the evidence-based practice and determines compliance and outcomes of an intervention. However, little is known about the professional football (soccer) players' perceptions on injury issues. OBJECTIVE: The aim of this study was to describe the professional football players' perceptions towards injury risk factors and prevention strategies. METHODS: One-hundred male professional football players answered an online questionnaire. RESULTS: The top-five risk factors included poor muscle strength/power; poor rest/sleep; short interval between matches; high number of matches in season; and excessive training. More than ¾ of football players in our study considered the following strategies as being effective in reducing injury risk: workload monitoring; warm-up; lumbo-pelvic stability training; proprioceptive training; functional training; monitoring diet; flexibility training; and conventional strength training. CONCLUSION: Perceptions of professional male football players regarding injury risk factors and prevention strategies are only partially in line with current scientific evidence. These perceptions have been usually overlooked, and should be considered by medical/coaching staffs in order to get greater compliance to injury prevention programs.

Preseason intrinsic risk factors-associated odds estimate the exposure to proximal lower limb injury throughout the season among professional football players.

BACKGROUND/AIM: Football players frequently face the occurrence of non-contact musculoskeletal injuries. The purpose of the study was to verify whether the evaluation of combined risk factors could produce a score system to determine the probability of injury in football players during the Brazilian football season. METHODS: Sixty-two male professional soccer players recruited from the first and second division soccer teams, with ages between 18 and 36 years. Functional performance evaluations were carried out at the beginning of the preseason which included strength and jumping tests, history of injuries and characteristics of athletes. RESULTS AND CONCLUSIONS: The results were grouped and a score/monogram was constructed.

Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises.

OBJECTIVE: To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics. METHODS: A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention. RESULTS: All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities. CONCLUSION: Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/).

Cardiac and Musculoskeletal Responses to the Effects of Passive and Active Tilt Test in Healthy Subjects.

BACKGROUND: Maintenance of orthostatism requires the interaction of autonomic and muscle responses for an efficient postural control, to minimize body motion and facilitate venous return in a common type of syncope called neurocardiogenic syncope (NCS). Muscle activity in standing position may be registered by surface electromyography, and body sway confirmed by displacement of the center of pressure (COP) on a force platform. These peripheral variables reflect the role of muscles in the maintenance of orthostatism during the active tilt test, which, compared with muscle activity during the passive test (head-up tilt test), enables the analyses of electromyographic activity of these muscles that may anticipate the clinical effects of CNS during these tests. OBJECTIVE: to evaluate and compare the effects of a standardized protocol of active and passive tests for CNS diagnosis associated with the effects of Valsalva maneuver (VM). METHODS: twenty-thee clinically stable female volunteers were recruited to undergo both tests. EMG electrodes were placed on muscles involved in postural maintenance. During the active test, subjects stood on a force platform. In addition to electromyography and the platform, heart rate was recorded during all tests. Three VMs were performed during the tests. RESULTS: progressive peripheral changes were observed along both tests, more evidently during the active test. CONCLUSION: the active test detected changes in muscle and cardiovascular responses, which were exacerbated by the VM.

Cardiac and Musculoskeletal Responses to the Effects of Passive and Active Tilt Test in Healthy Subjects / Respostas Cardíacas e Musculoesqueléticas aos Efeitos do Tilt Test Passivo e Ativo em Indivíduos Saudáveis

Abstract Background: Maintenance of orthostatism requires the interaction of autonomic and muscle responses for an efficient postural control, to minimize body motion and facilitate venous return in a common type of syncope called neurocardiogenic syncope (NCS). Muscle activity in standing position may be registered by surface electromyography, and body sway confirmed by displacement of the center of pressure (COP) on a force platform. These peripheral variables reflect the role of muscles in the maintenance of orthostatism during the active tilt test, which, compared with muscle activity during the passive test (head-up tilt test), enables the analyses of electromyographic activity of these muscles that may anticipate the clinical effects of CNS during these tests. Objective: to evaluate and compare the effects of a standardized protocol of active and passive tests for CNS diagnosis associated with the effects of Valsalva maneuver (VM). Methods: twenty-thee clinically stable female volunteers were recruited to undergo both tests. EMG electrodes were placed on muscles involved in postural maintenance. During the active test, subjects stood on a force platform. In addition to electromyography and the platform, heart rate was recorded during all tests. Three VMs were performed during the tests. Results: progressive peripheral changes were observed along both tests, more evidently during the active test. Conclusion: the active test detected changes in muscle and cardiovascular responses, which were exacerbated by the VM.

Resumo Fundamento: A manutenção do ortostatismo requer interação das respostas autonômicas e musculares para um controle postural eficiente e minimizar oscilações do corpo e facilitar o retorno venoso frente a um tipo comum de síncope chamada neurocardiogênica (SNC). A atividade da musculatura na posição de pé pode ser documentada por meio da eletromiografia de superfície (EMG) e as oscilações do corpo confirmadas pelo deslocamento do centro de pressão (CP) sobre uma plataforma de força. Estas variáveis periféricas mostram o papel muscular na manutenção do ortostatismo durante o tilt test ativo bem como esta atividade muscular ser comparada durante o teste passivo, Head-Up Tilt test, na tentativa de verificar alterações na atividade eletromiográfica destes músculos que podem antecipar os efeitos clínicos da SNC durante estes testes. Objetivo: Avaliar e comparar os efeitos de um protocolo padronizado para testes ativo e passivo de detecção da SNC associado ao efeito da manobra de valsalva (MV). Métodos: 23 voluntárias mulheres clinicamente saudáveis foram recrutadas para realizar ambos os testes. Os eletrodos da EMG foram posicionados em músculos associados com a manutenção postural, além de durante o teste ativo os sujeitos realizarem a postura ortostática sobre uma plataforma de força. Foi registrado além da EMG e da plataforma, a frequência cardíaca durante todo o teste. Três MV foram realizadas durante os testes. Resultados: Alterações periféricas foram verificadas de maneira progressiva ao longo dos testes, sendo mais evidente durante o teste ativo. Conclusão: o teste ativo verificou mudanças mais evidentes nas respostas musculares e cardiovasculares, amplificadas pela MV.

Contribuição da avaliação dos sinais clínicos em pacientes com síndrome da dor patelofemural / Contribution of the evaluation of the clinical signals in patients with patellofemoral pain syndrome

Objetivo: Como a síndrome da dor patelofemoral (SDPF) é uma desordem comum, caracterizada por etiologia multifatorial e o mais prevalente sintoma na SDPF é uma dor difusa e usualmente localizada na região retropatelar, entretanto, com sinais e sintomas que podem estar relacionados como pronação subtalar excessiva, torsão tibial externa, alterações no deslocamento patelar, amplitude de movimento do joelho dolorosa, dor nas bordas patelares, tensão muscular e alterações no ângulo quadricipital (ângulo Q). O objetivo deste trabalho foi verificar a frequência destes sinais e sintomas associados a um questionário de dor anterior no joelho. Métodos: Trinta e nove voluntárias sedentárias foram avaliadas, divididas em dois grupos, SDPF (19) e controle (20). Estas voluntárias foram avaliadas quanto aos sinais e sintomas supracitados além da avaliação da dor por meio de questionário. Resultados: os resultados demonstraram uma frequência elevada de relatos dolorosos em seis de treze questões, em relação ao grupo controle. Conclusão: De acordo com estes achados, concluímos que a avaliação funcional de indivíduos com SDFP deve ser constituída de um questionário de dor anterior no joelho e uma avaliação das características de sinais e sintomas para exame de todo o membro inferior estático e durante situações funcionais. Nível de Evidência II, Estudos Diagnósticos.

Objective: As patellofemoral pain syndrome (PFPS) is a common disorder characterized by multifactorial etiology and whose the most prevalent symptom is a diffuse pain, usually located on the retropatellar region, however, it also shows signs and symptoms that can be related as excessive subtalar pronation, external tibial torsion, patellar displacement alterations, painful range of motion of the knee, pain in the patellar borders, muscular tightness and changes in quadriceps angle (Q Angle), the objective of this work was to determine the frequency of these signs and symptoms associated to a previous knee pain questionnaire. Methods: thirty-nine sedentary female volunteers had been evaluated, divided in two groups, PFPS (19) and Control (20). These subjects were evaluated for signs and symptoms described above, in addition to pain assessment by questionnaire. Results: the results demonstrated a high frequency of pain in six of the thirteen questions in relation to the control group. Conclusion: according to these findings, we conclude that the functional evaluation of individuals with PFPS should consist of a previous knee pain questionnaire and an evaluation of the characteristic signs and symptoms for examination of the entire lower limb during static and functional situations. Level of Evidence II, Diagnostic Studies.

Contribution of the evaluation of the clinical signals in patients with patellofemoral pain syndrome.

OBJECTIVE: As patellofemoral pain syndrome (PFPS) is a common disorder characterized by multifactorial etiology and whose the most prevalent symptom is a diffuse pain, usually located on the retropatellar region, however, it also shows signs and symptoms that can be related as excessive subtalar pronation, external tibial torsion, patellar displacement alterations, painful range of motion of the knee, pain in the patellar borders, muscular tightness and changes in quadriceps angle (Q Angle), the objective of this work was to determine the frequency of these signs and symptoms associated to a previous knee pain questionnaire. METHODS: Thirty-nine sedentary female volunteers had been evaluated, divided in two groups, PFPS (19) and Control (20). These subjects were evaluated for signs and symptoms described above, in addition to pain assessment by questionnaire. RESULTS: The results demonstrated a high frequency of pain in six of the thirteen questions in relation to the control group. CONCLUSION: According to these findings, we conclude that the functional evaluation of individuals with PFPS should consist of a previous knee pain questionnaire and an evaluation of the characteristic signs and symptoms for examination of the entire lower limb during static and functional situations. Level of Evidence II, Diagnostic Studies.

Correlation between trochlear groove depth and patellar position during open and closed kinetic chain exercises in subjects with anterior knee pain.

The purpose of this study was to correlate the trochlear shape and patellar tilt angle and lateral patellar displacement at rest and maximal voluntary isometric contraction (MVIC) exercises during open (OKC) and closed kinetic chain (CKC) in subjects with and without anterior knee pain. Subjects were all women, 20 who were clinically healthy and 19 diagnosed with anterior knee pain. All subjects were evaluated and subjected to magnetic resonance exams during OKC and CKC exercise with the knee placed at 15, 30, and 45 degrees of flexion. The parameters evaluated were sulcus angle, patellar tilt angle and patellar displacement using bisect offset. Pearson's r coefficient was used, with p < .05. Our results revealed in knee pain group during CKC and OKC at 15 degrees that the increase in the sulcus angle is associated with a tilt increase and patellar lateral displacement. Comparing sulcus angle, patellar tilt angle and bisect offset values between MVIC in OKC and CKC in the knee pain group, it was observed that patellar tilt angle increased in OKC only with the knee flexed at 30 degrees. Based on our results, we conclude that reduced trochlear depth is correlated with increased lateral patellar tilt and displacement during OKC and CKC at 15 degrees of flexion in people with anterior knee pain. By contrast, 30 degrees of knee flexion in CKC is more recommended in rehabilitation protocols because the patella was more stable than in other positions.

Analysis of the center of pressure displacement, ground reaction force and muscular activity during step exercises.

Anterior Knee Pain (AKP) is considered as one of the most common, yet misunderstood, knee pathologies. The aim of this study was to evaluate the displacement area of the center of pressure, Ground Reaction Force (GRF), and the electromyography activity of the hip and the quadriceps muscles in healthy and AKP individuals during the step-up and step-down exercises. Both groups (Control group and AKP group) were composed of 15 volunteers submitted to the exercises on a force plate. The AKP group presented greater displacement area of the center of pressure for all the situations evaluated than the Control group (p<0.05), as well as a lesser magnitude of the GRF during the step-down exercise. The AKP group presented lower electromyography activity than the Control group in all situations evaluated. AKP individuals do not have muscle imbalances; they present a lower electromyography activity of the stabilizing muscles of the patella and hip and show greater instability in activities such as step up and down compared to normal subjects.

Evaluating patellar kinematics through magnetic resonance imaging during open- and closed-kinetic-chain exercises.

PURPOSE: To evaluate patellar kinematics of volunteers without knee pain at rest and during isometric contraction in open-and closed-kinetic-chain exercises. METHODS: Twenty individuals took part in this study. All were submitted to magnetic resonance imaging (MRI) during rest and voluntary isometric contraction (VIC) in the open and closed kinetic chain at 15 degrees, 30 degrees, and 45 degrees of knee flexion. Through MRI and using medical e-film software, the following measurements were evaluated: sulcus angle, patellar-tilt angle, and bisect offset. The mixed-effects linear model was used for comparison between knee positions, between rest and isometric contractions, and between the exercises. RESULTS: Data analysis revealed that the sulcus angle decreased as knee flexion increased and revealed increases with isometric contractions in both the open and closed kinetic chain for all knee-flexion angles. The patellar-tilt angle decreased with isometric contractions in both the open and closed kinetic chain for every knee position. However, in the closed kinetic chain, patellar tilt increased significantly with the knee flexed at 15 degrees. The bisect offset increased with the knee flexed at 15 degrees during isometric contractions and decreased as knee flexion increased during both exercises. CONCLUSION: VIC in the last degrees of knee extension may compromise patellar dynamics. On the other hand, it is possible to favor patellar stability by performing muscle contractions with the knee flexed at 30 degrees and 45 degrees in either the open or closed kinetic chain.