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To verify the association of the isometric strength of the shoulder external rotators (ER) and serratus anterior (SA) with the performance of functional tests CKCUEST, SMB-T, and USSP-T in overhead athletes.Cross-sectional study.Eighty overhead athletes with no history of surgery in the upper and lower limbs and trunk in the past year, and no painful symptoms in the upper body during the physical assessment were included.Preseason assessment included isometric strength of shoulder ER and SA, and performance of the CKCUEST, SMB-T, and USSP-T. Multiple linear regression analysis was performed to identify if the isometric strength of the shoulder ER and SA could explain the performance during the tests after controlling for sex.The isometric strength of SA was associated (p 0.05) with the SMB-T and USSP-T with 4% of explain. The isometric strength of the SA was not associated (p 0.05) with the CKCUEST. The isometric strength of the ER was not associated (p 0.05) with any of the tests.The isometric strength of the SA predicted the SMB-T and USSP-T performance. Isometric strength of SA and shoulder ER was not associated with CKCUEST results in athletes overhead.

Objective To investigate the effects of an intervention with tailored exercises on the incidence of patellar tendinopathy (PT) in elite youth jumping athletes. Design Prospective crossover cohort. Setting One sport club facility. Participants 271 elite youth basketball and volleyball player were followed in the first year of the study (Observation year) and 270 athletes were followed in the second year (intervention year). Main outcome measure Incidence rates of PT per 1,000h of exposure. Cox survival analysis was used to verify the effects of the intervention (exercises implemented according to the findings of a preseason assessment) on PT incidence. Results The exercise prevention program significantly reduced the number of cases of PT, with athletes submitted to the intervention showing 51% less risk of developing PT. The overall PT incidence in the Observation year (5.9 per 1,000h of exposure) was significantly higher than that in the intervention year (2.8 per 1,000h of exposure) (P = .037). Twenty-six athletes developed PT in the observation year, whereas 13 athletes developed PT in the intervention year. Conclusions A tailored preventive program may be able to reduce the incidence of patellar tendinopathy, especially in male youth volleyball athletes. Randomized controlled trials are encouraged to confirm these findings.

Objective To characterize the Physical Therapy Services delivered at the Polyclinic during the Rio 2016 Paralympic Games. Design Retrospective Cohort Study. Setting Physical Therapy Services (PTS) of the Polyclinic. Participants Athletes attended for Physical Therapy treatment at the Polyclinic during Rio 2016 Paralympic Games. Main outcome measures The number of athletes treated, their nationalities, their sports modality, the most frequently treated regions and the interventions applied. Results A total of 4504 interventions were delivered and 399 athletes were treated in the PTS. Athletes representing athletics and sitting volleyball were the most frequently attended for treatment. The main diagnoses were muscle tension and tendinopathy. Analgesia was the main purpose of treatment and myofascial release and electrotherapy was the most frequent interventions. Recovery service had a total of 1579 encounters and male athletes used cryo-immersion 3 times more when compared to female. Conclusion Athletes representing athletics and sitting volleyball were the most frequently attended for treatment and the thoracic/lumbar spine and pelvis/hip were the most commonly affected regions. Muscle strain and tendinopathy were the most frequent diagnoses and myofascial release and electrotherapy were the most frequent therapies used to achieve analgesia.

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.

Objective To identify the role of sports physical therapists (PT) in the injury prevention process and to compare the structure of preventive programs and associated (organization) policies applied in athletic organizations and sports teams of varying gender and level world-wide. Design: cross-sectional study. Setting LimeSurvey platform. Participants Sports PT working with athletes invited through the International Federation of Sports Physical Therapy. Main outcome measures Sports injury prevention program (IPP) structure and implementation. Results 414 participants fully participate in this survey study. Athlete's injury history (68.84%), the most common injuries within the sport modality (67.87%) and athlete's preseason screening results (64.01%) were most frequently used to customize IPPs. Warm-up (70.04%) and individually PT-guided exercise-therapy (70.04%) were the preferred methods to organize the prevention routine. The main barrier for IPP implementation was lack of time within the athlete's weekly training schedule (66.66%). The majority of the participants (72.84%) reported to evaluate the perception of IPP's effect by comparing current and preceding seasons' injury occurrences. Conclusion These survey results are the first identifying contemporary sports injury prevention organization and implementation policies on an international level. This information might support the sports PT community in improving and standardizing IPP (implementation) strategies worldwide.

Objective To identify the role of sports physical therapists (PT) in the organization of injury registration and preseason assessment, applied in athletic organizations and sports teams of different gender and level world-wide. Design cross-sectional study. Setting LimeSurvey platform. Participants Sports PTs working with athletes invited through International Federation of Sports Physical Therapy. Main outcome measures injury registration and athlete's screening. Results 414 sports PTs participated in this international survey (mean age of 37.66 (SD = 9.38) years). 340 participants indicated that the PT as the responsible for injury registration. Barriers to properly register injury throughout the season were indicated by 157 sports PT and 86 (54.77%) indicated a lack of time on their routine as the main factor. 93 participants (30.09%) indicated that they customize the prevention program based on the preseason assessment. Sports PTs who reported not performing a preseason assessment (92 participants - 22.22%) mainly indicated this to be consequence of lack of structure in the organization (44 participants – 47.82%). Conclusion The majority of the sports PTs participate on injury registration and perform preseason assessment in athletes. However, lack of time in their routine and structure in the organization were recognized as the most important barriers to organize these properly.

BackgroundDespite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap.MethodsWe used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses.ResultsSixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement—PAASS: Pain (during sport participation and over the last 24 hours), Ankle impairments (range of motion; muscle strength, endurance and power), Athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), Sensorimotor control (proprioception; dynamic postural control/balance), Sport/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session).ConclusionExpert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury.Trial registration numberACTRN12619000522112.

The understanding that sports injury is the result of the interaction among many factors and that specific profiles could increase the risk of the occurrence of a given injury was a significant step in establishing programs for injury prevention. However, injury forecasting is far from being attained. To be able to estimate future states of a complex system (forecasting), it is necessary to understand its nature and comply with the methods usually used to analyze such a system. In this sense, sports injury forecasting must implement the concepts and tools used to study the behavior of self-organizing systems, since it is by self-organizing that systems (i.e., athletes) evolve and adapt (or not) to a constantly changing environment. Instead of concentrating on the identification of factors related to the injury occurrence (i.e., risk factors), a complex systems approach looks for the high-order variables (order parameters) that describe the macroscopic dynamic behavior of the athlete. The time evolution of this order parameter informs on the state of the athlete and may warn about upcoming events, such as injury. In this article, we describe the fundamental concepts related to complexity based on physical principles of self-organization and the consequence of accepting sports injury as a complex phenomenon. In the end, we will present the four steps necessary to formulate a synergetics approach based on self-organization and phase transition to sports injuries. Future studies based on this experimental paradigm may help sports professionals to forecast sports injuries occurrence.

Outra Agência Background: Investigations on the causes of patellar tendinopathy should consider impairments at the hip and foot/ankle because they are known to influence movement patterns and affect patellar tendon loading. Objectives: To investigate hip and foot/ankle impairments associated with patellar tendinopathy in volleyball and basketball athletes using classification and regression tree analysis. Methods: In this clinical measurement, cross-sectional study, 192 athletes were assessed for impairments of the hip and foot/ankle, including shank-forefoot alignment, dorsiflexion range of motion (ROM), iliotibial band flexibility, passive hip internal rotation ROM, and hip external rotator and hip abductor isometric strength. Athletes with tenderness and/or pain at the inferior pole of the patella were considered to have patellar tendinopathy. Athletes with scores higher than 95 points on the Victorian Institute of Sport Assessment-patella (VISA-P), no pain during the single-leg decline squat, and no history of patellar tendon pain were considered not to have patellar tendinopathy. Classification and regression tree analyses were performed to identify interacting factors associated with patellar tendinopathy. Results: Interactions among passive hip internal rotation ROM, shank-forefoot alignment, and hip external rotator and abductor strength identified athletes with and without patellar tendinopathy. The model achieved 71.2% sensitivity and 74.4% specificity. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval: 0.70, 0.84; P

Introduction: Overhead-throwing athletes undergo changes in shoulder range of motion (ROM) due to sports activities, such as excessive amplitude, lateral rotation (LR) increase and medial rotation (MR) restriction. Asymmetry greater than 20° may render athletes more prone to injuries. There are similarities among sports featuring overhead throwing due to the considerable amount of movements involving maximum lateral rotation. In these sports, medial rotation (MR) restriction, excess of lateral rotation (LR) and shoulder pain are common, particularly in overhead-throwing athletes. Objective: To assess shoulder MR and LR ROM in athletes participating in different sports, considering the influence of these variables on injuries and functional performance. Methods: The rotation ROM of the glenohumeral joint was assessed in 477 young athletes, who were categorized in three sports groups: swimming, overhead-throwing and non-overhead throwing, distributed by age group. Analyses of Variance (ANOVA) were performed to verify if there were differences in MR and LR between groups and paired Student t test was used to verify differences between sides (asymmetry). Results: Youngest athletes showed significant shorter LR than the oldest, in both sides. This study demonstrated that the right side has less MR and greater LR in all groups. Conclusion: The findings showed that overhead-throwing and swimming groups have similarities in shoulder rotation ROM. Level of evidence III; Diagnostic Studies - Investigating a Diagnostic Test. RESUMO Introdução: Os atletas arremessadores sofrem adaptações na amplitude de movimento (ADM) do ombro, como amplitude excessiva, ganho de rotação lateral (RL) e restrição de rotação medial (RM) devido à prática esportiva. Uma assimetria maior que 20° pode tornar o atleta mais suscetível a lesões. Existem semelhanças entre os esportes que utilizam arremesso devido à ampla quantidade de movimentos em rotação lateral máxima. Nesses esportes, a restrição de rotação medial (RM), o excesso de rotação lateral (RL) e as dores no ombro são frequentes, principalmente, em atletas que são expostos aos arremessos. Objetivo: Avaliar a ADM de RM e RL do ombro de atletas de diferente modalidades esportivas considerando sua influência nas lesões e no desempenho funcional. Métodos: Avaliou-se a ADM de rotação da articulação glenoumeral em 477 atletas jovens. Os atletas foram categorizados em três grupos de esportes: natação; arremesso e não-arremesso, distribuídos em relação à faixa etária. As Análises de Variância (ANOVA) foram realizadas para verificar diferenças nas RM e RL entre os grupos e o Teste t Student pareado para verificar diferenças entre os lados (assimetria). Resultados: Os atletas mais novos apresentaram média de RL significativamente menor em relação aos mais velhos, em ambos os lados. O presente estudo demonstrou que o lado direito possui menor RM e maior RL em todos os grupos. Conclusão: Os achados desse estudo comprovaram que os grupos de arremesso e natação têm características semelhantes quanto à ADM de rotação do ombro. Nível de evidência III; Estudos diagnósticos – Investigação de um exame para diagnóstico. RESUMEN Introducción: Los atletas lanzadores sufren adaptaciones en la amplitud de movimiento (ADM) del hombro, como amplitud excesiva, aumento de rotación lateral (RL) y restricción de rotación medial (RM), debido a la práctica deportiva. Una asimetría mayor que 20° puede hacer que el atleta sea más susceptible a las lesiones. Hay similitudes entre los deportes que utilizan el lanzamiento debido a la gran cantidad de movimientos en rotación lateral máxima. En estos deportes, la restricción de rotación medial (RM), exceso de rotación lateral (RL) y dolores en el hombro son frecuentes, principalmente en atletas que están expuestos a los lanzamientos. Objetivo: Evaluar la ADM de RM y RL del hombro de atletas de diferentes modalidades deportivas teniendo en vista su influencia en las lesiones y en el desempeño funcional. Métodos: Se evaluó la ADM de rotación de la articulación glenohumeral en 477 atletas jóvenes. Los atletas se clasificaron en tres grupos de deportes: natación; lanzadores y no Lanzadores, distribuidos con relación al grupo de edad. Los análisis de varianza (ANOVA) se realizaron para verificar diferencias en las RM y RL entre los grupos y el test t Student pareado para verificar diferencias entre los lados (asimetría). Resultados: Los atletas más jóvenes presentaron un promedio de RL significativamente menor con relación a los más viejos, en ambos lados. Este estudio demostró que el lado derecho posee menor RM y mayor RL en todos los grupos. Conclusión: Los hallazgos de este estudio comprobaron que los grupos de lanzadores y natación tienen características similares cuanto a la ADM de rotación del hombro. Nivel de evidencia III; Estudios de diagnósticos - Investigación de un examen para diagnóstico.

Objective (1) To determine the reference values of hip abductor torque in youth athletes; (2) To investigate the influence of sex, age and sports on hip abductors torque. Design Cross-sectional. Setting Sports clubs. Subjects 301 volleyball, basketball and futsal athletes between 10 and 19 years of age. Main outcome measures Mean value of three maximal isometric hip abductor torques, evaluated using a hand-held dynamometer. Results The mean values of maximal isometric hip abductor torque ranged from 1.03 to 1.50 Nm/kg. The dominant hip abductor torque values were greater in 15–19 years old (1.41 ± 0.27 Nm/kg) than in 10–14 years old (1.12 ± 0.31 Nm/kg). In addition, the hip abductor torque values were smaller in basketball players (1.15 ± 0.31 Nm/kg) than futsal (1.34 ± 0.37 Nm/kg) and volleyball players (1.28 ± 0.25 Nm/kg). The comparison of hip abductor torque between futsal and volleyball players revealed no difference. The hip abductor torque values were greater in male volleyball athletes (1.28 ± 0.25 Nm/kg) than female volleyball athletes (1.13 ± 0.22 Nm/kg). Conclusion This study established reference values for maximal isometric hip abductor torque in youth volleyball, basketball and futsal athletes. In addition, the results demonstrated that sex, age and sports influenced hip abductor torque.

Objectives (1) To identify the type and frequency of interventions used by Brazilian physical therapists to treat and prevent the occurrence of patellar tendinopathy in athletes and the criteria used to return to sport; (2) to compare the interventions used to the grade of recommendation of current evidence. Methods Design: cross-sectional study. Setting: online survey throughout sports physical therapy association. Participants: Physical therapists who were invited to complete a structured questionnaire. Main Outcome Measures: Interventions more frequently used for treating and preventing PT in athletes and the criteria used to define return to sport. Results One-hundred and twenty-one physical therapists participated in this study. Quadriceps eccentric strengthening (75.2%), education (61.2%) and lower limb joint/lumbo-pelvic stabilization/hamstrings stretching (59.5%) were more frequently cited for prevention purposes, while lower limb joint stabilization (81.8%), education (80.2%) and myofascial release (78.5%) were more frequently reported for treatment. The majority of the physical therapists based their decision of athlete discharge on a combination of pain intensity, function and functional test results (44.6%). Conclusion There was inconsistency between interventions used in clinical practice and interventions recommended by the best available evidence.

Background The shank-forefoot alignment (SFA) measurement has been previously developed to enhance the applicability of foot alignment measurement in sports preseason assessment because it is reliable and less time consuming. The use of SFA measurements in the clinical context, usually done with photogrammetry, may be simplified by using the universal goniometer and no longer requiring the image processing step that takes additional time and equipment. Objective Investigate the correlation between the goniometric and photogrammetric assessment of shank-forefoot alignment in athletes. Participants Thirty volleyball athletes were recruited during a preseason assessment. Methods SFA measurements were assessed with a universal goniometer and photogrammetry. For both assessments the participants were positioned in prone with the rearfoot facing up and the ankle actively maintained in 90° of dorsiflexion. The examiner did not have access to the SFA outcome values from both measurements. A second examiner did the bi-dimensional analysis with SIMI MOTION (photogrammetric measure) and read the goniometer measures during the other SFA assessment. Data normality was tested using Shapiro-Wilk test and Pearson was used to determine the correlation between both measurements. Results A reliability study determined the Intraclass Correlation Coefficient (ICC3,3) for intra-rater reliability of 0.93 for photogrammetry and of 0.81 for goniometry assessment. The correlation (p Conclusions This study describes a reliable and practical measurement procedure for shank-forefoot alignment using the universal goniometer that can be easily applied in clinical context.

The objective of this study was to provide normative data of frontal plane patellar alignment according to McConnell and Arno angles, verify the association between theses angles and identify the presence of patellar rotation in different sports.Cross-sectional.Nine participants (18 knees) were assessed in a preliminary study to verify the intra and inter-examiner reliabilities of the patellar alignment measures. In the main study, 230 volleyball, basketball, gymnastics and soccer athletes (460 knees) were evaluated in order to obtain normative data of patellar alignment.Frontal plane patellar alignment (McConnell and Arno angles) measured in standing position by means of photogrammetry.The standardized method demonstrated intra and inter-examiner reliability coefficients varying from .85 to .98. The mean McConnell and Arno angles were 2.05° (±5.9) and 2.89° (±7.57), respectively. A low association was observed (r = .189, p .0001) between these angles. There was a difference in distribution of medial and lateral rotations, according to the McConnell angle, between different sports (p .014).The proposed procedure for measuring patellar alignment according to McConnell and Arno angles proved to be highly reliable. This made possible the establishment of normative data in a large sample of healthy athletes.

Study Design Cross-sectional clinical assessment. Background Patellar tendinopathy is not always accompanied by patellar tendon abnormalities (PTAs). Thus, clinical screening tools to help identify patients with patellar tendon pain who have PTAs could enhance clinical decision making and patient prognosis. Objectives To test the diagnostic accuracy of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire, a single-leg decline squat (SLDS), tendon pain history, age, and years of sports participation to identify athletes with symptomatic patellar tendons who have PTAs confirmed on imaging. Methods Data provided by ultrasound examination, the VISA-P questionnaire, the SLDS, tendon pain history, age, and years of sport participation were collected in 43 athletes. A classification and regression tree (CART) model was developed to verify variables associated with PTA occurrence. Likelihood ratios (LRs) were computed for positive and negative tests. Results The SLDS, VISA-P questionnaire, and tendon pain history were associated with PTA occurrence. Athletes with negative results on all 3 tests (CART model) had a lower likelihood of having PTAs (negative LR = 0.3; 95% confidence interval [CI]: 0.2, 0.5). The isolated use of the SLDS or tendon pain history (positive LR = 4.2; 95% CI: 2.3, 7.14 and 4.5; 95% CI: 1.8, 11.1, respectively) had similar influence on probability of PTA presence compared to the CART model (positive LR = 4.1; 95% CI: 2.5, 6.3). Conclusion Although the objective was to investigate a clinical test to identify PTAs, the combined use of the tests had greater accuracy to identify individuals without PTAs. Level of Evidence Diagnosis, level 3b. J Orthop Sports Phys Ther 2016;46(8):673-680. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6192.

Objectives To investigate the association between lower limb alignment, range of motion/flexibility and muscle strength with the presence of patellar tendon abnormalities in male athletes. Design This was a cross-sectional study. Methods Thirty-one male basketball and volleyball athletes were assessed for ankle dorsiflexion range of motion, shank-forefoot alignment, iliotibial band flexibility, hip external rotators and abductors isometric torque, passive hip internal rotation range of motion and frontal plane knee and patellar alignment (McConnell and Arno angles). Ultrasonographic evaluations of hypoechoic areas of the patellar tendons were performed in longitudinal and transverse planes. A receiver operating characteristic curve was used to determine clinically relevant cut-off point for each variable. When the area under the curve was statistically significant, Prevalence Ratio (PR) and 95% confidence intervals were calculated to indicate the strength of the association between the independent variable and the presence of patellar tendon abnormalities. Results Receiver operating characteristic curve showed that iliotibial band flexibility (p = 0.006), shank-forefoot alignment (p = 0.013) and Arno angle (p = 0.046) were associated with patellar tendon abnormalities. Cut-off points were established and only the Prevalence Ratio of iliotibial band flexibility (cut-off point = −0.02°/kg; PR = 5.26) and shank-forefoot alignment (cut-off point = 24°; PR = 4.42) were statistically significant. Conclusions Athletes with iliotibial band or shank-forefoot alignment above the clinically relevant cut-off point had more chance to have patellar tendon abnormalities compared to athletes under the cut-off point values. These results suggest that such factors could contribute to patellar tendon overload, since patellar tendon abnormalities indicate some level of tissue damage. Both factors might be considered in future prospective studies.

Cross-sectional.To investigate predictors of increased frontal plane knee projection angle (FPKPA) in athletes.The underlying mechanisms that lead to increased FPKPA are likely multifactorial and depend on how the musculoskeletal system adapts to the possible interactions between its distal and proximal segments. Bivariate and linear analyses traditionally employed to analyze the occurrence of increased FPKPA are not sufficiently robust to capture complex relationships among predictors. The investigation of nonlinear interactions among biomechanical factors is necessary to further our understanding of the interdependence of lower-limb segments and resultant dynamic knee alignment.The FPKPA was assessed in 101 athletes during a single-leg squat and in 72 athletes at the moment of landing from a jump. The investigated predictors were sex, hip abductor isometric torque, passive range of motion (ROM) of hip internal rotation (IR), and shank-forefoot alignment. Classification and regression trees were used to investigate nonlinear interactions among predictors and their influence on the occurrence of increased FPKPA.During single-leg squatting, the occurrence of high FPKPA was predicted by the interaction between hip abductor isometric torque and passive hip IR ROM. At the moment of landing, the shank-forefoot alignment, abductor isometric torque, and passive hip IR ROM were predictors of high FPKPA. In addition, the classification and regression trees established cutoff points that could be used in clinical practice to identify athletes who are at potential risk for excessive FPKPA.The models captured nonlinear interactions between hip abductor isometric torque, passive hip IR ROM, and shank-forefoot alignment.

Background The Y-balance test has been used clinically to assess neuromuscular control deficits and a composite score of 4 cm have been associated with lower limb injuries in basketball athletes. Objective To compare Y-test performance during the pre-season to in-season in injury-free athletes. Design Prospective study. Setting Brazilian sports club, mixed sports. Patients (or Participants) 182 injury-free youth athletes (145 male and 37 female) from judo, volleyball, basketball, gymnastics and indoor soccer were assessed (age 14.3±2.8; height 168±19 cm, body mass 60±18 kg). Assessment of Risk Factors The Y-test was assessed during the pre-season (February) and in-season (June). Athletes practiced 6 trials on each leg prior to formal testing. While maintaining single-leg stance, they were asked to reach with the free limb in the anterior, posteromedial, and posterolateral directions. Main Outcome Measurements Y-test performance was calculated as the composite score (sum of the three reach distances, divided by 3 times limb length, then multiplied by 100). Anterior distance asymmetry was calculated as the difference between the dominant limb (DL) and non-dominant limb (NDL) values. Both measures were compared between pre- and in-season. Results The pre-season average composite score for DL was 87.5% and for NDL 87.8%, while the average anterior distance asymmetry was 3.7 cm. During in-season, the average composite score was 85.4% for DL and NDL, and the anterior distance asymmetry was 3.0 cm. T-tests revealed statistically significant differences for the composite score (p Conclusions Athletes showed poorer composite score values during in-season compared to pre-season and the values were below the risk cut-off point reported in the literature. This group did not present substantial anterior distance asymmetry .

Background Patellar tendinopathy is a clinically identified overload injury associated to jumping activities. The symptoms may last for years, affect sports participation and even lead to the end of a sport career. Therefore, is necessary to understand the profile of injury/complain in a sports team in order to plan preventive strategies. Objective The purpose of this study was to identify the prevalence of patellar tendon pain history in Brazilian volleyball and basketball athletes. Design Cross-sectional . Setting Sports Science Laboratory in the Universidade Federal de Minas Gerais. Patients (or Participants) One-hundred and ninety and one volleyball and basketball athletes with a mean age of 18.29 (+4.9) years, body mass of 76.50 (+13.8) kilograms and height of 1.85 (0,11) meters participated in this study. Interventions (or Assessment of Risk Factors) The athletes were questioned by the examiner about patellar tendon pain history related to sports practice. If the athlete had history of other knee complains (as patellofemoral pain and bursitis) and/or Osgood-Schlatter, he/she was excluded. Main Outcome Measurements History of pain, in the last 6 months, localized at the patellar tendon, which compromised the sports participation and/or sports performance. Results The prevalence of patellar tendon pain history was 22.5% (n=43) in the athletes participating in this study. Fifteen were female and 28 male, 25 were juvenile and 18 adult and 34 practiced volleyball and 9 basketball. Ten athletes reported patellar tendon pain in left lower limb, 14 in right lower limb and 19 bilaterally. Therefore, 147 athletes did not had patellar tendon pain history in the last 6 months. Conclusions The prevalence of patellar tendon pain history in this study was 22.5%. The major occurrence was bilateral pain history and the results suggest that male volleyball athletes had higher prevalence.

Background Knee valgus is associated with non-contact anterior cruciate ligament rupture and this injury commonly occurs at the end of competition and/or training sessions. Probably, muscle fatigue is associated to this injury occurrence. Clinically, knee valgus is easily identified by the quantification of frontal plane knee projection angle (FPKPA). Objective The purpose of this study was to compare FPKPA before and after a maximal, incremental shuttle-run testing protocol used to induce fatigue in elite male volleyball athletes. Design Cross-sectional study. Setting Sports Sciences Laboratory at the Universidade Federal de Minas Gerais. Patients (or Participants) Thirteen elite male volleyball athletes with a mean age of 27.69 (+7.85) years, body mass of 92.00 (+8.97) kilograms and height of 1.94 (0.06) meters participated in a preseason assessment. Interventions (or Assessment of Risk Factors) Fatigue was induced by performing a maximal-incremental shuttle-run test for the estimation of maximal aerobic power according to the protocol proposed by Ramsbotton et al. (1988). Main Outcome Measurements FPKPA was measured during single-leg squat and involved a line connecting antero-superior iliac spine, a middle point between knee condyles and a middle point between the malleolus. The athletes performed 3 single-leg squats and a mean of the 3 FPKPA on the dominant lower limb was analyzed. Results The dominant lower limb had a mean FPKPA of 3,18 o (±4.23) prior to and a mean FPKPA of 3.73 o (±4.03) after the fatigue protocol. A Studen9s t-test analysis showed a statistical significant difference (p=0.019; mean difference=3.18; IC 95% of 0.62–5.74). Conclusions Elite male volleyball athletes had higher values of FPKPA on the dominant lower limb after a maximal, progressive exercise leading to fatigue. Probably, elite volleyball players may be under a higher risk of muscle-skeletal injuries under muscle fatigue conditions.

Background:Quick procedures with proper psychometric properties that can capture the combined alignment of the foot-ankle complex in a position that may be more representative of the status of the lower limb during ground contact are essential for assessing a large group of athletes.Methods:The assessed lower limb was positioned with the calcaneus surface facing upward in a way that all of the marks could be seen at the center of the camera display. After guaranteeing maintenance of the foot at 90° of dorsiflexion actively sustained by the athlete, the examiner took the picture of the foot-ankle alignment.Results:Intraclass correlation coefficients ranging from 0.82 to 0.93 demonstrated excellent intratester and intertester reliability for the proposed measurements of forefoot, rearfoot, and shank-forefoot alignments. The intraclass correlation coefficient between the shank-forefoot measures and the sum of the rearfoot and forefoot measures was 0.98, suggesting that the shank-forefoot alignment measures can represent the combined rearfoot and forefoot alignments.Conclusions:This study describes a reliable and practical measurement procedure for rearfoot, forefoot, and shank-forefoot alignments that can be applied to clinical and research situations as a screening procedure for risk factors for lower-limb injuries in athletes. (J Am Podiatr Med Assoc 103(5): 405–410, 2013)

INTRODUÇÃO E OBJETIVO: A musculatura do complexo do ombro possui um papel importante na produção de força e potência articular no voleibol, permitindo a realização do gesto esportivo de maneira coordenada. A documentação objetiva produzida pela avaliação isocinética auxilia no diagnóstico e na prevenção de lesões do complexo do ombro, além de ser uma ferramenta útil no prognóstico do retorno rápido e seguro para a prática esportiva do atleta lesionado. O objetivo deste estudo foi avaliar o desempenho muscular isocinético dos músculos rotadores laterais e mediais da articulação glenoumeral em atletas de voleibol da Seleção Brasileira Masculina sub-19 e sub-21. MÉTODOS: O protocolo realizado durante o teste foi de cinco repetições máximas de rotação lateral e medial de ombro no modo concêntrico-concêntrico na velocidade de 60º/s e 30 repetições na velocidade de 360º/s. Análise de variância (ANOVA) mista foi utilizada para avaliar as variáveis dependentes: trabalho máximo e torque máximo normalizados pela massa corporal dos músculos rotadores laterais e mediais do ombro, razão agonista/antagonista nas duas velocidades e índice de fadiga muscular. RESULTADOS: A análise dos dados demonstrou haver um desequilíbrio entre os rotadores laterais e mediais (razão agonista/antagonista) da articulação do ombro em atletas brasileiros de voleibol da categoria sub-21, revelando menor força relativa dos rotadores laterais. CONCLUSÃO: Foi possível identificar alterações em atletas de voleibol que, associadas a demandas específicas do esporte, podem levar à sintomatologia no complexo do ombro e/ou queda da performance. INTRODUCTION AND PURPOSE: The shoulder complex muscles play an important role in force, power and endurance production in volleyball, allowing the accomplishment of movement in a coordinated manner. The objective written account produced by isokinetic evaluations assists in the diagnosis and prevention of shoulder complex injuries. In addition, it is a useful tool in promoting safe and fast return of the injured athlete to sports practice. The purpose of this study was to analyze the isokinetic muscle performance of the lateral and medial rotators of the glenohumeral joint in Brazilian male volleyball teams (under-19 and under-21). METHODS: The protocol used during the test included five maximum repetitions of shoulder lateral and medial rotation in concentric-concentric mode at 60º/s and 30 repetitions at 360º/s. Analysis of variance was used to evaluate the dependent variables: maximum work and maximum torque of shoulder lateral and medial rotators normalized by body mass, antagonist/agonist ratio at the two speeds and muscular fatigue index. RESULTS: Data analysis demonstrated an imbalance between the shoulder lateral and medial rotators (antagonist/agonist ratio) in the under-21 category of the Brazilian volleyball athletes, demonstrating relative weakness of the lateral rotators. CONCLUSION: It was possible to identify changes in volleyball players, which added to specific demands of the sport, can lead to symptoms in the shoulder complex and / or decrease of performance.

Background Volleyball and basketball are among the sports with a higher incidence of knee injuries. The inability to maintain a proper alignment of the lower limbs during functional activities could create a knee valgus which predisposes to injury. Thus, the quantification of knee valgus is necessary to guide prevention and clinical interventions. Objective To establish normative values for dynamic knee valgus during the single leg squat (SLS) in volleyball and basketball athletes. Design Observational cross-sectional. Setting Minas Tenis Club, Brazil, youth sports. Participants 151 athletes (108 male and 43 female) were assessed during national championship preseason. All participants were healthy, with no current pain of lower limb injury and no history of previous lower extremity surgery. The mean age, weight and height were 14.21+2.09; 62.75+14.20 and 173.89+13.42, respectively. Assessment of risk factors Gender, age and sport. Main outcome measurements Knee valgus was measured as frontal plane projection angle of the knee (FPPAK) during SLS up to 60° of knee flexion. The mean of three repetitions of SLS from each limb was used for analysis, using SIMI Motion Twinner software. The FPPAK was defined as the connections between ASIS, midpoint of femoral epicondyles and anterior midpoint of the malleolis. Results The mean FPPAK during SLS for right leg was 7.08+4.0 and 8.68+4.2 for left leg. There were no differences between ages and genders. There were significant differences between sides in both modalities (p Conclusion All athletes showed an inability to maintain proper alignment during dynamic squat. The differences found between modalities may be linked to the specific technique of each sport and are important to guide an intervention focused on injury prevention.

Background Knee injuries in soccer are common regardless of age, gender or playing level. The injury that draws most attention is the anterior cruciate ligament tear and adolescent females seem to have the highest risk. Le Gall and associates (2009) reported 12% of incidence in female soccer players. Several potential risk factors, for example anatomical and biomechanical factors, have repeatedly been discussed in the literature, but lack scientific evidence. Objective assess the potential predictors of frontal plane knee angle (FPKA) and the interplay between them, through a non-linear statistical model (Classification and Regression Tree-CART). Design Observational cross sectional. Setting A professional female soccer team was evaluated in Sports Prevention and Rehabilitation Laboratory (LAPREV) at Federal University of Minas Gerais (CENESP-UFMG). Participants 19 female soccer athletes, mean age 18.27 (2.79) years were included in this study. All participants were healthy, with no current complaints of lower limb injury or pain and no history of previous lower extremity surgery. Assessment of risk factors The independent variables were shank-forefoot alignment (SFA), hip abductor torque, hip passive internal rotation (HPIR). Main outcome measurements The FPKA during three single leg squat with dominant leg in front of a camera (reflexive marcs were located in ASIS, femoral condyles and in a middle point of the medial and lateral maleolus). Results The HPIR was the main predictor of High-FPKA. 15.8% presented high-FPKA with a HPIR 33.55° and SFA>17.10° also presented High-FPKA (21%). The model9s estimate risk was 15% and the sensibility and specificity were 78% and 84% respectively. Conclusion The extreme low and great ranges available of HIPR associated with high values of SFA were predictor of knee malalignment in frontal plane. Also the SFA must be considered part of athletes9 preseason assessment.

Background Patellar tendinosis is a degenerative condition that could lead to tendon rupture. Conservative treatment is long-term and surgery may be required to enhance tissue regeneration. Therefore, the athlete could have his/her successful career jeopardized. Some clinical tests, usually used in patellar tendon assessment, could be associated to patellar tendon morphologic abnormalities (PTA). However, their relationship to PTA is not established and they could be used in sports practice as a strategy for preventive care. Objective To investigate the association of VISA-P questionnaire, single-leg decline squat test and patellar tendon pain history to tendon morphological abnormalities at ultrasound. Design Cross-sectional study. Setting Athletes filled in VISA-P questionnaire, performed the single-leg decline squat test (SLDS) and informed about patellar tendon pain history. Athletes with Osgood-Schlater and/or Siding-Larsen-Johansson disease were excluded. An experienced examiner performed the ultrasonographic exam in tendon sagittal and transverse planes. Tendons that presented hypoechoic areas and thickness were considered as positive for morphological abnormalities. Participants 43 athletes (26 volleyball, 14 basketball, 3 running) participated in this study, 38 males and 5 females, mean age of 24.8±6.7 years, weight of 87.6±13.7 kg and height of 1.93 ±0.1 m. Risk factor assessment VISA-P, single-leg decline squat test and patellar tendon pain history. Main outcome measurements Patellar tendon hypoechoic areas and thickness at ultrasound. Results Significant associations to PTA were found. VISA-P showed an OR of 5.4 (1.3–26), SLDS of 3.8 (1.4–11) and pain history of 7.5 (1.6–42). Therefore, an athlete who presents a score under 80 points at VISA-P, for example, have 5.4 more chance to present PTA compared to an athlete that does not have PTA. Conclusions VISA-P, SLDS and patellar tendon pain history can be easily applied in clinical practice and should be used as a screening tool in sports modalities that present a high PTA prevalence.

Background Patellar tendon abnormalities (PTA) are frequent in volleyball and basketball athletes. Tendon degeneration happens through chronic process, related to the amount of stress applied in musculoskeletal system. An appropriated mechanical behaviour of lower limb may be key factor to properly distribute forces in patellar tendon during landing. Identify biomechanical factors associated to patellar tendinosis process could guide preventive attitudes to athletes in risk of chronic dysfunction and/or tendon rupture. Objective To investigate the association of lower limb biomechanical factors to patellar tendon morphological abnormalities at ultrasound. Design Cross-sectional. Setting Institutional clinical care and sports facility. Participants 35 basketball and volleyball athletes participating on preseason assessment with mean age of 24.0±5.7 years, body mass of 88.9±13.3 kg and height of 1.9±0.1 m. Risk factor assessment Ankle dorsiflexion range (ADR), shank-forefoot alignment (SFA), iliotibial band flexibility (IBF), hip lateral rotators and abductors isometric strength, hip passive medial rotation range, patellar rotation and knee alignment in the frontal plane were measured during preseason assessment. Ultrasonographic evaluation was performed in both patellar tendons in longitudinal and transverse planes. Main outcome measurements Patellar tendon hypoechoic areas and thickness at ultrasound. Results The results showed that low ADR, high IBF and high SFA were associated to PTA. These three variables presented significant areas under ROC curve (P=.008; P=.011; P=.012, respectively). Based on ROC curve sensitivity and specificity values, cut-off points were determined. SFA presented the highest OR; 13.1 (2.1–296); with a cut-off point of 20 o . ADR (cut-off point=36 o ) presented an OR of 4.10 (1.3–13.5) and IBF (cut-off point=-0.04 o ) presented an OR of 4.53 (1.2–21.6). Conclusions High shank-forefoot varus alignment, ankle dorsiflexion restriction and iliotibial band flexible were associated to PTA. These results show that biomechanical factors could participate on patellar tendon mechanical overload in athletes.

Background Knee valgus during landing has been identified as a risk factor for anterior cruciate ligament injury. Component motions of knee malalignment are femoral internal rotation and adduction, tibial abduction and ankle eversion. This excessive eversion is frequently attributed to the presence of forefoot varus alignment. Therefore, the proximal and distal segments of the kinetic chain must be assessment to better understanding of high frontal plane knee angle – FPKA (2D valgus analysis). Objective access the potential predictors of FPKA and the interplay between them, through a non-linear statistical model (Classification and Regression Tree-CART). Design observational cross-sectional. Setting all testing took place at Minas Tenis Club and at Sports Injury Prevention and Rehabilitation Laboratory – LAPREV in youth and elite sports. Participants 72 volleyball and basketball athletes (22 female and 50 male) were assessed during national championship preseason. All participants were healthy, with no current complaints of lower limb injury or pain and no history of previous lower extremity surgery. The average+SD age, height and mass of the athletes was 16.7+4.6 years, 179.7+14.7 cm, 68.6+16 Kg. Assessment of risk factors the independent variables were shank-forefoot alignment (SFA), hip abductor torque, hip passive internal rotation and gender. Main outcome measurements frontal plane knee angle during landing from countermovement jump. Results the SFA was the main predictor of High-FPKA. 75% of the athletes with SFA 17° and hip passive IR ROM >47° presented High-FPKA. Conclusion the SFA and interaction between it with reduced abductor torque and great hip passive IR ROM were predictors of knee malalignment in frontal plane. Thus, measuring foot alignment must be simultaneous with hip joint dysfunctions and should be part of athletes9 preseason assessment.

Background There is a high prevalence of shoulder injuries in volleyball and their preventive management is still a challenge. Isokinetic assessment is largely used in sports injury prevention. Few studies investigate the correlation between the isokinetic profile and injuries story, furthermore these studies analyses the agonist/antagonist ratio and do not consider other parameters as fatigue. Objective to investigate the differences between injured and non injured dominant shoulder in the lateral/medial rotators ratio and fatigue index in volleyball male athletes. Setting all testing took place in the Sports Injury Prevention and Rehabilitation Laboratory-LAPREV in elite volleyball. Participants 42 athletes (mean+SD age, 21.3+4.1; height, 196.8+0.06 and body mass, 89.9+8.8) were evaluated in this study (28 at injured group). Participants with upper-extremity surgery in the previous 6 months and pain during the isokinetic test were excluded. Assessment of risk factor: agonist and antagonist ratio at 60°/s and 360°/s and index fatigue at 360°/s in 90° of abduction at dominant shoulder. Main outcome measurement trauma and overuse shoulder injuries story provided by questionnaire. Results The results showed statistical differences between groups in lateral rotators (p=0.039) and medial rotators fatigue (p=0.024). The mean fatigue of lateral rotators in the injury group was 52.9 and 37.0 for non-injured group and 31.6 and 43.8 respectively for medial rotators. No differences were found in the ratio analysis between groups (p=0.403 for 60°/s and p=0.289 for 360°/s). The means were 71.6 and 67.4 for injured and non-injured groups at 60°/s and 56.9 and 63.9 respectively at 360°/s. Conclusion The results show that lateral rotators fatigue was greater in the injured group and no differences were found in the ratio parameters. The fatigue analysis must be incorporated in the athlete9s assessment, because seems to be more informative about injury risk.

Background The knee malalignment is a risk factor of injuries such as anterior cruciate ligament tear. Most studies that analyses the knee valgus in jump tasks, investigates only this pattern at landing. It would be interesting to study the knee valgus at takeoff, because at this specific moment the active components of the movement are the primary injury contributors. Objective to compare the frontal plane knee angle (FPKA) during takeoff and landing at countermovement jump in athletes. Design Observational cross sectional. Setting Volleyball and basketball players were evaluated at Minas Tennis Club and at Sports Prevention and Rehabilitation Laboratory (CENESP-UFMG). Participants 101 athletes, mean age 15.88 (0.35) years were included in this study. All participants were healthy, with no current complaints of lower limb injury or pain and no history of lower limbs previous surgery. Assessment of risk factors High-FPKA. Reflexive markers were located in ASIS, femoral condyles and in a middle point of the medial and lateral maleolus. Main outcome measurements The FPKA was determined in SIMI motion 2D software. Results The mean angle during takeoff was 3.020 and 3.13 0 for dominant and non-dominant leg. For landing, it was 2840 and 2210 respectively. There was no significant statistical differences between the two means on both legs (p=0.73 dominant leg and p=0.13 non-dominant leg). Meanwhile, the variance was greater in the impulsion analysis (37.2 right leg and 48.3 left leg) compared to landing (24.4 and 29.8 respectively). Conclusion The analysis of FPKA during takeoff provides data about the active contribution of certain variables in knee injuries and must be better understood. Differences between the FPKA during takeoff and landing were not found in this study, although in the first movement there was a major variance. This inconsistency may demand a more thorough investigation.

Background Foot misalignments may contribute to development of sports injuries. Some evaluation protocols of foot alignment are not practical, have poor reliability and doesn9t reflect functional foot behaviour. We propose a new measurement procedure to solve these problems. We also introduce the measure of the alignment of shank relative to shank-forefoot alignment (SFA) that may be practical to assess the combined rearfoot and forefoot alignments. Objective to develop a practical and reliable foot alignment measure. Design observational cross-sectional. Setting all testing took place in the Minas Tenis Club and Sports Injury Prevention and Rehabilitation Laboratory – LAPREV in youth and elite sports. Participants 75 females and 125 male (mean+SD age, 15.6+3.8; height, 151.1+62.8; body mass, 64.53+14.9) athletes were evaluated in this study (n=200). Participants with a history of congenital deformity or lower-extremity surgery in the previous 6 months were excluded. Assessment: Shank bisection and four calcaneus marks were drawn according to the standardised parameters. A metal rod was fixed under the forefoot, the ankle was actively positioned at 90° of dorsiflexion and a picture was taken. SIMI motion 2D was used to measure the rearfoot (relative to shank), forefoot (relative to rearfoot) and SFA angles. Main outcome measurements rearfoot, forefoot and SFA angles. Results The Intraclass Correlation Coefficient (ICC) intratester was 0.89; 0.91 e 0.93 and intertester was 0.82; 0.91 e 0.90 (rearfoot, forefoot and SFA respectively). The means for each foot alignment were −1.83+3.3 (rearfoot), 16.25+8.9 (forefoot) and 13.9+2.6 (SFA). The agreement (ICC) of the sum of rearfoot and forefoot values with SFA was 0.98. Conclusion SFA reflects the sum of rearfoot and forefoot alignments, which supports the use of this measure. This protocol is reliable and it is possible to assess one athlete in proximally 5 min. Thus, these measures can be used in preseason assessments of injury risk factors in athletes.