Association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes: A systematic review including GRADE recommendations and meta-analysis.

OBJECTIVE: To identify the association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes. METHODS: Search performed at PubMed/Medline, Embase, CINAHL, LILACS, Cochrane, Web of Science and SPORTDiscus for observational studies. Methodological quality and strength of the evidence was assessed with the Newcastle-Ottawa Scale and GRADE. Meta-analysis and effects sizes analysis were calculated when possible. RESULTS: Sixty-five studies were included. Low to very-low evidence suggests no association of trunk/lower limb strength, endurance, power, jump or balance with shoulder complaints and/or throwing performance. Athletes with shoulder complaints performed worse in trunk stability and endurance tests (mean difference: -6.83 (95%CI: -8.78, -4.88)). Athletes with high throwing performance presented better results in CMJ, horizontal jump, power measures and knee extension strength. For swimmers, there was no association of trunk/lower limb endurance with shoulder complaints (moderate evidence) and no association of balance and swimming performance (low evidence). Better trunk/lower limb strength, power and vertical jumps measures were associated with better swimming performance. CONCLUSIONS: In methodologically similar studies, some trunk/lower limb outcomes are associated with shoulder complaint or sport/swimming performance. Results should be considered with caution and future studies should use better methodologies.

Influence of quarantine during the coronavirus disease 2019 (COVID-19) pandemic on physical and psychosocial aspects: perceptions of 214 Brazilian athletes.

Background: Social distancing may affect athletes' training, causing negative effects on mental and physical health. Objective: This study therefore aimed to characterize the perception of Brazilian athletes about their physical and psychosocial aspects, sleep quality and coping strategies during the quarantine of the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a cross-sectional study with online survey, performed with Brazilian athletes (amateur and professional) over 18 years. The main outcomes measures assessed were physical and psychosocial aspects, sleep quality and coping strategies. Results: A total of 214 athletes were included. The average weekly hours of training during the quarantine was 4.71 ± 3.71 h, of which 64.5% athletes (138/214) were oriented by medical staff during training. For 52.8% (113/214) of athletes, training intensity during the quarantine was different/very different from the intensity before the quarantine. 79.4% athletes (170/214) reported moderate to extreme difficulties in keeping the same level of training during the quarantine. 77.1% athletes (165/214) had moderate to extreme anxiety and each of the athletes had concern about his or her athletic career future, including return to the sport. 72.9% athletes (156/214) reported change in sleep schedule during the quarantine period. Conclusion: The quarantine period during COVID-19 pandemic negatively affected the athlete's perception about training routine, since athletes reported reduction in training hours and training intensity. Overall, the athletes reported that they were moderately to extremely anxious. They also had concerns about their career in the future, as well as concerns regarding return to sport.

Immediate effects of hip strap and foot orthoses on self-reported measures and lower limb kinematics during functional tasks in individuals with patellofemoral osteoarthritis: protocol for a randomised crossover clinical trial.

BACKGROUND: Elevated patellofemoral joint stress has been associated with patellofemoral osteoarthritis (PFOA). Changes in lower limb kinematics, such as excessive femoral adduction and internal rotation and excessive rearfoot eversion during the stance phase of functional activities, may increase patellofemoral stress. There is a lack of studies that assess the effects of interventions for controlling femur and subtalar joint movements during functional activities on self-reported measures in individuals with PFOA. Thus, the primary aim of the study is to determine the immediate effects of the hip strap and foot orthoses during level-ground walking and the single-leg squat test on self-reported outcomes. The secondary aim is to investigate whether the hip strap and foot orthoses result in the kinematic changes that these devices are purported to cause. METHODS: Twenty-nine individuals with PFOA aged 50 years or older will take part in the study. The main outcome is pain intensity. The secondary outcomes are other self-reported measures (global rating of change, acceptable state of symptoms, ease of performance, and confidence) and lower limb kinematics (peak femoral adduction and internal rotation, and peak rearfoot eversion). These outcomes will be assessed during functional tasks performed under three conditions: (i) control condition, (ii) hip strap intervention, and (iii) foot orthoses intervention. To investigate whether these interventions result in the lower limb kinematic changes that they are purported to cause, three-dimensional kinematics of the femur and rearfoot will be captured during each task. Linear mixed models with two fixed factors will be used to test associations between the interventions (control, hip strap, and foot orthoses) and conditions (level-ground walking and single-leg squat test) as well as interactions between the interventions and conditions. DISCUSSION: To the best of the authors' knowledge, this is the first study to evaluate the immediate effects of the hip strap and foot orthoses on self-reported measures and lower limb kinematics during functional tasks in individuals with PFOA. The findings of this study will enable future trials to investigate the effects of these interventions in rehabilitation programmes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04332900 . Registered on 3 April 2020.

Influence of lower limb torque, range of motion, and foot alignment in patellar rotation (Arno angle) in athletes.

BACKGROUND: Alterations of frontal plane patellar alignment could be related to lower limb disorders. Clinical assessment must be able to identify the influence of non-local factors in patellar alignment. OBJECTIVE: To identify the influence of lower limb torque, range of motion (ROM), and foot alignment on patellar rotation in healthy athletes. METHODS: This cross-sectional study was performed with 232 healthy basketball and volleyball elite athletes. Participants were assessed in preseason for: patellar medial and lateral rotation (Arno angle), passive hip internal rotation (IR) ROM, iliotibial band flexibility, hip abductors and external rotators (ER) torque, shank-forefoot alignment (SFA), and ankle dorsiflexion ROM. Hierarchical multiple linear regression was performed to identify if these variables and sex, age, and body mass could be associated with patellar rotation in a standing position. RESULTS: Hip ER isometric torque explained a small part (10%) of the variance of the Arno angle in healthy athletes (R² change=0.10; unstandardized ß=11.74 (95% CI 6.82, 16.65); Standardized Coefficient Beta=0.32) and sex explained 2% of its variance (R² change=0.02; unstandardized ß= 2.42 (95% CI 0.32, 4.52); Standardized Coefficient Beta=0.15). After controlling for sex, hip ER torque explained 9% of Arno angle variance (R² change=0.09; unstandardized ß= 11.09 (95% CI 6.43, 15.76; Standardized Coefficient Beta=0.31). The other variables were not associated with patellar rotation. CONCLUSIONS: Hip ER torque may influence patellar rotation in different directions (medial or lateral rotation). Possible mechanisms that explain the contribution of higher and lower hip ER torque in lateral and medial patellar rotation, respectively, are discussed.

A efetividade do Método Pilates no tratamento da dor lombar crônica inespecífica: ensaio clínico randomizado / The effectivity of a Pilates protocol in the treatment of chronic nonspecific low-back pain: a randomized clinical trial

A dor lombar crônica é um problema de saúde pública. Intervenções voltadas para seu tratamento envolvem tanto exercícios quanto a educação do indivíduo. Objetivo: Avaliar a efetividade de um protocolo de exercícios do método Pilates e do programa "Escola de Coluna" na redução dor e incapacidade funcional, na melhora da qualidade de vida, flexibilidade e qualidade do sono em indivíduos com dor lombar crônica inespecífica. Método: Ensaio controlado aleatorizado, 84 indivíduos com dor lombar crônica. Os participantes foram aleatoriamente alocados no Grupo Pilates (n= 43) ou Grupo Controle (n= 41). Os desfechos primários foram dor (Escala Visual Numérica), incapacidade funcional (Roland-Morris Disability Questionnaire - RMDQ) e qualidade de vida (SF-36). Os desfechos secundários foram flexibilidade (teste do 3o dedo ao chão) e qualidade do sono (Pittsburgh Sleep Quality Index - PSQI). Resultados: O Grupo Pilates foi superior ao Grupo Controle (p < 0,05) na intensidade da dor, incapacidade funcional, flexibilidade e em cinco domínios de qualidade de vida (capacidade funcional, aspectos físicos, dor, vitalidade e estado geral de saúde). Não houve diferença entre os grupos para a qualidade do sono. Conclusão: Exercícios do método Pilates podem ser considerados como uma alternativa de intervenção para indivíduos com dor lombar crônica não específica. O Grupo Pilates foi superior ao programa "Escola de Coluna" nos desfechos dor, incapacidade funcional, flexibilidade e em cinco domínios de qualidade de vida. Devido à baixa aderência às intervenções propostas, alternativas para melhorar a aderência devem ser estabelecidas em estudos futuros.

Low back pain is a major health and socioeconomic problem. Exercises and patient awareness are among the possible positive strategies for treating nonspecific chronic low back pain. Objective: The objective of this study was to determine the effectiveness of the Pilates Method and the "Back School" program in the treatment of nonspecific chronic low back pain. Method: A randomized controlled trial with blinded assessors. Eighty-four individuals with chronic nonspecific low back pain.Interventions: Participants were randomly allocated into two groups: Pilates Group (n= 43) or Control Group - "Back School" (n= 41). The primary outcomes were: pain (Numeric Rating Scale), quality of life (SF-36), and disability (Roland-Morris Disability Questionnaire - RMDQ). The secondary outcomes were: Flexibility (Fingertip-to-Floor Test ­ FTF) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). Results: The Pilates Group was superior to the Control Group (p<0.05) in outcomes of pain intensity, disability, flexibility, and in five domains of SF-36 (physical functioning, role limitations due to physical health, pain, vitality, and general health). There was no significant difference between groups for sleep quality. Conclusion: The Pilates protocol provided significant improvements and can be considered an option for treating nonspecific chronic low back pain. The Pilates Group was superior to the "Back School" program for pain reduction, improved functional capacity, flexibility, and five quality of life domains. Due to the considerable low adhesion to both interventions, alternatives to improve adherence should be proposed in future studies.