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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 provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports. Design: Delphi. Setting: LimeSurvey platform. Participants: Experienced sports physical therapists from the International Federation of Sports Physical Therapy member countries. Main outcome measures: Factors related to sports IPP planning, organization and implementation. Results: We included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement). Conclusion: Strong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist. (c) 2022 Elsevier Ltd. All rights reserved.

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.

Purpose Injuries are common in sports and can have significant physical, psychological and financial consequences. Machine learning (ML) methods could be used to improve injury prediction and allow proper approaches to injury prevention. The aim of our study was therefore to perform a systematic review of ML methods in sport injury prediction and prevention. Methods A search of the PubMed database was performed on March 24th 2020. Eligible articles included original studies investigating the role of ML for sport injury prediction and prevention. Two independent reviewers screened articles, assessed eligibility, risk of bias and extracted data. Methodological quality and risk of bias were determined by the Newcastle–Ottawa Scale. Study quality was evaluated using the GRADE working group methodology. Results Eleven out of 249 studies met inclusion/exclusion criteria. Different ML methods were used (tree-based ensemble methods (n = 9), Support Vector Machines (n = 4), Artificial Neural Networks (n = 2)). The classification methods were facilitated by preprocessing steps (n = 5) and optimized using over- and undersampling methods (n = 6), hyperparameter tuning (n = 4), feature selection (n = 3) and dimensionality reduction (n = 1). Injury predictive performance ranged from poor (Accuracy = 52%, AUC = 0.52) to strong (AUC = 0.87, f1-score = 85%). Conclusions Current ML methods can be used to identify athletes at high injury risk and be helpful to detect the most important injury risk factors. Methodological quality of the analyses was sufficient in general, but could be further improved. More effort should be put in the interpretation of the ML models.

Background A better understanding about the relationship between trunk and hip muscles strength and core stability may improve evaluation and interventions proposed to improve core stability. Objectives To investigate if trunk and hip muscles strength predict pelvic posterior rotation during the bridge test with unilateral knee extension. Methods This is a cross-sectional study. Sixty-one healthy individuals of both sexes (age, 28 ± 6.4 years, weight, 66.5 ± 10.9 kg, height, 167 ± 9.5 cm) performed the bridge test with unilateral knee extension. The pelvic posterior rotation during the bridge test was obtained with two-dimensional video analysis. Isometric strength of the trunk extensors and rotators, and hip abductors, external and internal rotators and extensors were measured with a hand-held dynamometer. Multiple linear regression analysis was performed to identify if the strength variables could explain the pelvic posterior rotation during the test. Results Muscle strength predicted pelvic posterior rotation during the bridge test (r = 0.54; p = 0.003). Strength of the trunk rotators (p = 0.045) and hip internal rotators (p = 0.015) predicted reduced magnitude of pelvic posterior rotation during the bridge test, and strength of the hip extensors (p = 0.003) predicted increased magnitude of pelvic posterior rotation. Conclusions Trunk rotators and hip internal rotators and extensors strength predict 29% of the performance during the bridge test with unilateral knee extension. The strength of these muscles should be evaluated in individuals with increased pelvic posterior rotation during the bridge test with unilateral knee extension.

ObjectiveTo determine the effectiveness of conservative treatment (CT) on pain and function in patients with patellar tendinopathy (PT) compared with minimal intervention (MI) or other invasive intervention, or in addition to decline eccentric squat.MethodsSearches were performed in MEDLINE, Embase, Cochrane, PEDro, SPORTDiscus, CINAHL and AMED databases. All randomised trials that evaluated CT (any intervention not involving invasive procedures or medication) in individuals with PT were included. Two reviewers screened studies, extracted data and assessed risk of bias of all included studies. Where suitable, meta-analyses were conducted; we assessed certainty of the evidence using GRADE methodology.ResultsWhen compared with MI, CT did not improve pain (weighted mean difference (WMD) −2.6, 95% CI −6.5 to 1.2) or function (WMD 1.8, 95% CI −2.4 to 6.1) in the short-term (up to 3 months) follow-up. When compared with invasive intervention, CT did not improve pain (WMD 0.7, 95% CI −0.1 to 1.4) or function (WMD −6.6, 95% CI −13.3 to 0.2) in the short-term follow-up. No overall effects were found for combined CT (when a conservative intervention was added to decline eccentric squat) on pain (WMD −0.5, 95% CI −1.4 to 0.4) or function (WMD −2.3, 95 % –9.1 to 4.6) at short-term follow-up. Single studies showed an effect on pain with iontophoresis at short-term follow-up (d = 2.42) or dry needling at medium/long-term follow-up (d = 1.17) and function with exercise intervention at medium/long-term follow-up (over 3 months) (d = 0.83).Summary/ConclusionOur estimates of treatment effect have only low to very low certainty evidence to support them. This field of sports medicine/sports physiotherapy urgently needs larger, high-quality studies with pain and function among the potential primary outcomes.

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.

The number one goal of the sports physical therapist is to make sure that the athlete is in optimal shape to perform, but with a minimal risk for developing an injury at the same time. The aim of this International Federation of Sports Physical Therapy (IFSPT) Perspective is to raise awareness about the importance of contextual and behavioral factors when planning and implementing injury prevention. Also, it outlines the potential role of the IFSPT as a facilitator of data and information exchange among sports physical therapists worldwide., This International Perspective aims to describe the role of IFSPT in prevention of injuries throughout the world.

Introduction Single-leg squat (SLS) is a test commonly used to assess lower limb function in rehabilitation. Increased hip adduction and internal rotation (IR) is associated with dynamic knee valgus, which is related to hip and knee overload. Proximal and distal factors, such as hip passive stiffness, poor hip muscle strength and excessive foot misalignment may influence hip movement. However, previous studies focus on how proximal and distal factors affected knee joint movement and did not reported the influence on hip joint. Objective This study investigated the association of hip external rotators (ER) strength, hip passive stiffness and shank-forefoot alignment (SFA) with hip adduction and IR during SLS. Design Cross-sectional study. Method Forty-six health participants of both sexes (23.47 ± 4.29 years, 60.40 ± 11.28 kilograms, 1.67 ± 8.9 meters) had SFA, hip ER torque, hip passive stiffness and hip kinematics assessed. Multiple linear regressions were performed to identify the factors which associated with mean and peak hip adduction and IR movement during SLS. Results Only hip passive stiffness was associated with mean (R2= 0.164; Confidence Interval (CI) 95%= [-0.250, -0.048]; p= 0.005) and peak (R2= 0.116; CI 95%= [-0.223, -0.210]; p= 0.019) hip IR movement. Conclusion Hip passive stiffness was associated with mean and peak hip IR movement during the SLS. These results suggest that individuals with reduced hip passive stiffness demonstrate increased hip IR movement during SLS.

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.

Background: The risk of a second anterior cruciate ligament (ACL) injury when participating in pivoting sports after ACL reconstruction is high. Risk factors associated with a second ACL injury are complex. Purpose: To investigate the combinations of various clinical risk factors associated with second ACL injury in female soccer players with a primary unilateral ACL reconstruction, using Classification and Regression Tree (CART) analysis. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 117 active female soccer players (mean ± SD age, 20 ± 2 years) were included. Athletes were enrolled 19 ± 9 months after ACL reconstruction and were prospectively followed for 2 years. At baseline, all players underwent assessment of knee and ankle joint range of motion (ROM), participated in functional tests (postural control, hop performance, and movement asymmetries in the lower limbs and trunk), and answered questionnaires (patient-reported knee function, knee-related quality of life, psychological and personality factors). A clinical prediction model using CART was developed. Results: A total of 28 players (24%) sustained a second ACL injury (21 ipsilateral and 7 contralateral ruptures) while playing soccer. CART analysis selected 9 of 19 independent variables associated with second ACL injury: the 5-jump test, knee collapse on the non–ACL reconstructed leg in a drop vertical jump, tuck jump, limb symmetry index on side hop and the single hop for distance, side difference in ankle dorsiflexion ROM, and scores for the questionnaires ACL-Return to Sport After Injury and the Swedish Universities Scales of Personality subscales of Stress Susceptibility and Adventure Seeking. The accuracy of the model was 89%, with 100% sensitivity and 76% specificity. CART analysis indicated that the interaction of longer jumps in the 5-jump test (>916 cm) with more side difference in ankle dorsiflexion ROM (>–2.5°) and more knee valgus collapse in the nonreconstructed knee (>−1.4 cm) (relative risk, 4.03; 95% CI, 2.21-7.36) best predicted an increased likelihood of a second ACL injury. Conclusion: The risk profiles selected by CART could accurately identify female soccer players at high risk for a second ACL injury. There was an interaction between functional performance, clinical assessment, and psychological factors, and it is reasonable to include these factors in return-to-sport decisions and in athlete screening after ACL injury.

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.

Background Hip and groin pain or symptoms is a recurrent musculoskeletal complaint among young and active individuals. It is important to objectively measure functional limitations using patient-related outcomes that have been validated in the language of the target population. Objectives To perform a cross-cultural adaptation and to evaluate the measurement properties of the Hip and Groin Outcome Score (HAGOS) for the Brazilian population. Methods We adapted the HAGOS to Brazilian Portuguese and evaluated the following measurement properties: internal consistency, test–retest reliability, measurement error, and structural and construct validity. The sample recruited consisted of active individuals between 18 and 55 years of age with long standing hip and groin pain and individuals who participated in sports with high physical demand of the hip and groin region. Results A total of 103 athletes and physically active individuals of both sexes participated in this study. The HAGOS was successfully translated and culturally adapted to the Brazilian population. Factor analysis confirmed that the HAGOS consists of six subscales. The HAGOS-Br showed good internal consistency. The CFA revealed a Cronbach's alpha for the HAGOS subscales ranging from 0.86 to 0.96, test-retest reliability was substantial, with intraclass correlation coefficients ranging from 0.81 to 0.94 for the six subscales and an acceptable measurement error (standard error of measurement [SEM]=5.43–11.15 points; and smallest detectable chance [SDC]= 16.71–30.9 points). Good construct validity existed with more than 75% of the pre-defined hypotheses being confirmed. No ceiling or floor effects were observed. Conclusion The HAGOS-Br showed to be equivalent to the original version with adequate validity and reliability properties.

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: Lateral ankle sprains are the most prevalent injury in sports with the highest recurrence rate of all musculoskeletal injuries. Most individuals return to sport (RTS) quickly after a lateral ankle sprain, likely because lateral ankle sprains are often assumed to be minor injuries and there are currently no criteria-based guidelines to guide the RTS decision making. There is need to determine and collate expert opinion to inform RTS practice. The aim of this study was to use a Delphi approach to develop consensus for RTS criteria for individuals who have sustained an acute lateral ankle sprain injury. Methods: A Delphi approach was used to establish consensus of opinion from a panel of international experts. Panelists were required to be: i) a health professional; ii) currently working with athletes competing in nationally selected representative teams or teams in Tier/Division 1 national competitions; iii) currently working in field or court sports in which the primary gross motor skills are running and jumping/landing or changing direction and there is a high prevalence of lateral ankle sprain injuries; iv) involved in making RTS decisions for individuals with an acute lateral ankle sprain injury; v) proficiency in the English language. Consensus was a priori defined as > 70 % agreement between panelists. Results: Based on responses to the first Delphi survey, assessment of the following items reached consensus to be included as RTS criteria for individuals who have sustained an acute lateral ankle sprain injury: sport specific tasks, hopping, agility, jumping, pain severity of sport specific physical activity, pain severity of the last 24 hours, ankle range of motion, ankle muscle strength, ankle muscle endurance, dynamic postural control/balance, proprioception, perceived ankle reassurance/confidence, perceived ankle instability, and psychological readiness. Discussion: Collation of expert opinion through a Delphi approach informs the development of RTS criteria for acute lateral ankle sprain injuries. Our findings indicate the need to assess performance of sport-specific and athletic skills, pain severity, ankle muscle function, ankle range of motion, balance and proprioception, ankle perception and psychological readiness when determining the ability to athletes to RTS after an acute lateral ankle sprain injury. This information provides the basis for prospective cohort studies to test the use of the proposed criteria for successful RTS after acute lateral ankle sprain injuries.

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.

Injury prediction is one of the most challenging issues in sports and a key component for injury prevention. Sports injuries aetiology investigations have assumed a reductionist view in which a phenomenon has been simplified into units and analysed as the sum of its basic parts and causality has been seen in a linear and unidirectional way. This reductionist approach relies on correlation and regression analyses and, despite the vast effort to predict sports injuries, it has been limited in its ability to successfully identify predictive factors. The majority of human health conditions are complex. In this sense, the multifactorial complex nature of sports injuries arises not from the linear interaction between isolated and predictive factors, but from the complex interaction among a web of determinants. Thus, the aim of this conceptual paper was to propose a complex system model for sports injuries and to demonstrate how the implementation of complex system thinking may allow us to better address the complex nature of the sports injuries aetiology. According to this model, we should identify features that are hallmarks of complex systems, such as the pattern of relationships (interactions) among determinants, the regularities (profiles) that simultaneously characterise and constrain the phenomenon and the emerging pattern that arises from the complex web of determinants. In sports practice, this emerging pattern may be related to injury occurrence or adaptation. This novel view of preventive intervention relies on the identification of regularities or risk profile, moving from risk factors to risk pattern recognition.

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 Excessive foot pronation during running in individuals with foot varus alignment may be reduced by medially wedged insoles. Research question This study investigated the effects of a medially wedged insole at the forefoot and at the rearfoot on the lower limbs angles and internal moments of runners with excessive foot pronation and foot varus alignment. Methods Kinematic and kinetic data of 19 runners (11 females and 8 males) were collected while they ran wearing flat (control condition) and medially wedged insoles (insole condition). Both insoles had arch support. We used principal component analysis for data reduction and dependent t-test to compare differences between conditions. Results The insole condition reduced ankle eversion (p = 0.003; effect size = 0.63); reduced knee range of motion in the transverse plane (p = 0.012; effect size = 0.55); increased knee range of motion in the frontal plane in early stance and had earlier knee adduction peak (p = 0.018; effect size = 0.52); reduced hip range of motion in the transverse plane (p = 0.031; effect size = 0.48); reduced hip adduction (p = 0.024; effect size = 0.50); reduced ankle inversion moment (p = 0.012; effect size = 0.55); and increased the difference between the knee internal rotation moment in early stance and midstance (p = 0.012; effect size = 0.55). Significance Insoles with 7˚ medial wedges at the forefoot and rearfoot are able to modify motion and moments patterns that are related to lower limb injuries in runners with increased foot pronation and foot varus alignment with some non-desired effects on the knee motion in the frontal plane.

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.

In 2015, a website (www.allmalepanels.tumblr.com/) began documenting instances of all-male panels (colloquially known as a ‘manel’). This, along with the Twitter hashtag #manel, has helped drive recognition of the persistent and pervasive gender bias in the composition of experts assembled to present at conferences and other events. Recent social media discussions have similarly highlighted the prevalence of all-male panels in Sport and Exercise Medicine (SEM). While, to our knowledge, all-male panel trends in SEM have not yet formally been documented or published, one need look no further than SEM conference committees, keynote speaker lists, panels and other events to see that it exists in practice. Why, in 2018, is SEM and its related disciplines still failing to identify and acknowledge the role that implicit bias plays in the very structure of our own research, practice and education? SEM is, after all, a profession that contains experts, and serves populations, of all genders. This editorial will introduce the definition, implications and manifestations of implicit gender bias and then explore how the SEM community can begin to address this issue, advance the discussion and develop a more equitable global community. Social cognitive theory describes ‘implicit bias’ as the unconscious …

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.

Letter to the Editor-in-Chief of JOSPT as follows: "Use of the VISA-P as a Clinical Measure in Research" with Authors' Response J Orthop Sports Phys Ther 2016;46(11):1012-1014. doi:10.2519/jospt.2016.0203.

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.

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 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.