Nº de abstracts = 50

Modificado em 16 Março de 2011

Bone mineral density changes after physical training and calcium intake in students with attention deficit and hyper activity disorders.

Arab Ameri E, Dehkhoda MR, Hemayattalab R.: Research in Developmental Disabilities, Março 2012, 33(2):594-9.

In this study we investigate the effects of weight bearing exercise and calcium intake on bone mineral density (BMD) of students with attention deficit and hyper activity (ADHD) disorder. For this reason 54 male students with ADHD (age 8-12 years old) were assigned to four groups with no differences in age, BMD, calcium intake, and physical activity: exercise groups with or without calcium supplementation (Ex+Ca+ and Ex+Ca-) and non-exercise groups with or without calcium supplementation (Ex-Ca+ and Ex-Ca-). The intervention involved 50min of weight bearing exercise performed 3 sessions a week and/or the addition of dietary calcium rich food using enriched cow milk with vitamin D containing 250mg calcium per serving, over 9 months. Paired-samples t-test, one way ANOVA analysis, and Tukey tests were used to determine the main and combined effects of training and calcium on BMD. All groups showed greater femoral neck BMD after 9 months. The increase in femoral neck BMD was significantly different between all groups (p<0.05). Ex+Ca+ group has greater increase in BMD than other groups. Apparently, the effect of training was greater than calcium intake (p<0.05). These results help to provide more evidence for public health organizations to deal with both exercise and nutrition issues in children with ADHD disorder for the achievement of peak BMD.

Risk management: FIFA's approach for protecting the health of football players.

Fuller CW, Junge A, Dvorak J.: British Journal of Sports Medicine, Jan 2012, 46(1):11-7.

Background Sport and exercise have long-term health benefits, but there is also a risk that participants will sustain injuries and/or ill health from these activities. For this reason, international sports governing bodies have a responsibility to identify the risks that exist within their sport and to provide guidance to participants and other stakeholders on how these risks can be controlled within acceptable levels. Purpose To demonstrate how Fédération Internationale de Football Association (FIFA), as football's governing body, uses a risk management framework to identify, quantify, mitigate and communicate the risks of injury and ill health in football for men, women and children in all environments. Method All the research papers published by FIFA's Medical Assessment and Research Centre (F-MARC) during the period 1994 to 2011 were reviewed and categorised according to an established sport-related risk management framework. Conclusions F-MARC investigated and mitigated 17 areas of risk to footballers' health in a coherent and consistent approach through the process of risk management.

Prevention of sport injury II: a systematic review of clinical science research.

McBain K, Shrier I, Shultz R, Meeuwisse WH, Klügl M, Garza D, Matheson GO, British Journal of Sports Medicine, Mar 201203 46(3):174-9.

Objective To characterise the nature of the sport injury prevention literature by reviewing published articles that evaluate specific clinical interventions designed to reduce sport injury risks. Data sources PubMed, Cinahl, Web of Science and Embase. Main results Only 139 of 2525 articles retrieved met the inclusion criteria. Almost 40% were randomised controlled trials and 30.2% were cohort studies. The focus of the study was protective equipment in 41%, training in 32.4%, education in 7.9%, rules and regulations in 4.3%, and 13.3% involved a combination of the above. Equipment research studied stability devices (42.1%), head and face protectors (33.3%), attenuating devices (17.5%) as well as other devices (7%). Training studies often used a combination of interventions (eg, balance and stretching); most included balance and coordination (63.3%), with strength and power (36.7%) and stretching (22.5%) being less common. Almost 70% of the studies examined lower extremity injuries, and a majority of these were joint (non-bone)-ligament injuries. Contact sports were most frequently studied (41.5%), followed by collision (39.8%) and non-contact (20.3%). Conclusion The authors found only 139 publications in the existing literature that examined interventions designed to prevent sports injury. Of these, the majority investigated equipment or training interventions whereas only 4% focused on changes to the rules and regulations that govern sport. The focus of intervention research is on acute injuries in collision and contact sports whereas only 20% of the studies focused on non-contact sports.

Stretching before or after exercise does not reduce delayed-onset muscle soreness. Henschke N, Lin CC British journal of sports medicine 45(15):1249-50, 2011 Dez Musculoskeletal Division, The George Institute for Global Health, PO Box M201, Missenden Road, NSW 2050, Australia. Este endereço de e-mail está protegido de spam bots, pelo que necessita do Javascript activado para o visualizar .

Sports helmets now and in the future. McIntosh AS, Andersen TE, Bahr R, Greenwald R, Kleiven S, Turner M, Varese M, McCrory P

British journal of sports medicine 45(16):1258-65, 2011 Dez Risk and Safety Sciences, The University of New South Wales, Sydney, New South Wales, 2052, Australia. Este endereço de e-mail está protegido de spam bots, pelo que necessita do Javascript activado para o visualizar .

The paper reports on a symposium on sports helmets and presents a synthesis of information and opinion from a range of presenters and disciplines. A review of the literature shows that helmets play an important role in head injury prevention and control. Helmets have been shown to be very efficacious and effective in a range of sports and in preventing specific head injury risks, especially moderate to severe head injury. The symposium emphasised the importance of helmet standards and the need for further development. There are calls for helmets that address the needs of competitive (elite) athletes separate to helmets for recreational athletes. Deficiencies in the evidence base for head injury risks and helmet efficacy and effectiveness were identified in some sports. Issues in designing helmets that are suitable to prevent severe head injuries and concussion were discussed and explained from biomechanical and engineering perspectives. The need to evaluate helmet performance in oblique impacts and incorporate this into standards was covered in a number of presentations. There are emerging opportunities with in-helmet technology to improve impact performance or to measure impact exposure. In-helmet technology as it matures may provide critical information on the severity of the impact, the location of the injured athlete, for example, snowboarder, and assist in the retrieval and immediate, as well as the long-term medical management of the athlete. It was identified that athletes, families and sports organisations can benefit from access to information on helmet performance. The importance of selecting the appropriate-sized helmet and ensuring that the helmet and visor were adjusted and restrained optimally was emphasised. The translation pathway from the science to new and better helmets is the development of appropriate helmet standards and the requirement for only helmets to be used that are certified to those standards.

Coaches' perspectives on implementing an evidence-informed injury prevention programme in junior community netball (dez 2010)

Optimising ankle sprain prevention: a critical review and practical appraisal of the literature (Dez 2010)

A pragmatic randomised trial of stretching before and after physical activity to prevent injury and soreness (Nov 2010)

Low-volume resistance exercise attenuates the decline in strength and muscle mass associated with immobilization

Bryan R. Oates, Elisa I. Glover, Daniel W. West, Jessica L. Fry, Mark A., Tarnopolsky, Stuart M. Phillips: Muscle & Nerve, 2010, 42(4):539-46. Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.

We determined the effectiveness of low-volume resistance exercise (EX) for the attenuation of loss of muscle mass and strength during leg immobilization. Men (N = 5) and women (N = 12, age 24 ± 5 years, body mass index 25.4 ± 3.6 kg/m(2)) were divided into two groups: exercise (EX; n = 12) and control (CON; n = 5). Subjects wore a knee brace on one leg that prevented weight bearing for 14 days. Resistance exercise (EX; 80% of maximal) was performed by the immobilized limb every other day. Immobilization induced a significant reduction (P < 0.05) in muscle fiber and thigh cross-sectional area (CSA), isometric knee extensor, and plantarflexor strength in the CON (P < 0.01) but not in the EX group. There were significant losses in triceps surae CSA in the CON and EX groups (P < 0.05), but the losses were greater in CON subjects (P < 0.01). A minimal volume (140 contractions in 14 days) of resistive exercise is an effective countermeasure against immobilization-induced atrophy of the quadriceps femoris but is only partially effective for the triceps surae.

Factors associated with increased propensity for hamstring injury in English Premier League soccer players

Henderson G, Barnes CA, Portas MD.: Journal of Science and Medicine in Sport / Sports Medicine Australia, 2010, 13(4):397-402. School of Social Sciences and Law, University of Teesside, Middlesbrough, UK.

The aim of this study was to concurrently model the influence of a number of physical and performance parameters on subsequent incidence of hamstring injury in a squad of English Premier League soccer players. Thirty six healthy, male, elite, professional soccer players (age 22.6+/-5.2 years, height 1.81+/-0.08 m, mass 75.8+/-9.4 kg, lean mass 69.0+/-8.0 kg) were assessed during the first week of pre-season training for anthropometry, flexibility, lower limb strength and power, speed and agility. Over the subsequent 45 week competitive season all hamstring injuries were diagnosed and recorded. Multiple logistic regression analysis was performed to link individual physical and performance capabilities with propensity to sustain a hamstring injury. A model containing age, lean mass, non-counter movement jump (NCM) performance and active hip flexion range of movement (ROM) was significantly (p<0.05) associated with increased propensity for hamstring injury. Odds for sustaining an injury increased x 1.78 for each 1 year increase in age, x 1.47 for each 1cm increase in NCM and x 1.29 for each 1 degrees decrease in active range of hip flexion. Older, more powerful and less flexible soccer players are at greater risk of sustaining a hamstring injury. Support staff should identify such individuals and make appropriate interventions to minimise risk without compromising performance capabilities.

A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes.

Yoo JH, Lim BO, Ha M, Lee SW, Oh SJ, Lee YS, Kim JG.: Knee Surgery, Sports Traumatology, Arthroscopy , 2010, 18(6):824-30. Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Bucheon, South Korea.

Female athletes are more prone to anterior cruciate ligament (ACL) injury than their male counterparts, presumably because of anatomical, hormonal, and neuromuscular differences. Of these three, only the neuromuscular component can be modified by preventive exercise. We aimed to evaluate the effect of a neuromuscular protocol on the prevention of ACL injury by performing meta-analysis, and to identify essential factors by subgroup analysis. An extensive literature review was conducted to identify relevant studies, and eventually, only seven randomized controlled trials or prospective cohort studies were included in the analysis. The odds ratios (OR) and the confidence interval (CI) for the overall effects of training and of potentially contributory factors were estimated. The OR and the 95% CI for the overall effect of the preventive training were 0.40 and [0.27, 0.60], respectively. Subgroup analysis revealed that an age under 18, soccer rather than handball, pre- and in-season training rather than either pre- or in-season training, and the plyometrics and strengthening components rather than balancing were significant. Meta-analysis showed that pre- and in-season neuromuscular training with an emphasis on plyometrics and strengthening exercises was effective at preventing ACL injury in female athletes, especially in those under 18 years of age. Further study is required to develop a relevant training program protocol of appropriate intensity.

Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study.

Buist I, Bredeweg SW, Lemmink KA, van Mechelen W, Diercks RL.: The American Journal of Sports Medicine, 2010, 38(2):273-80. University Center for Sport, Exercise and Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Background: The popularity of running is still growing. As participation increases, running-related injuries also increase. Until now, little is known about the predictors for injuries in novice runners. HYPOTHESIS: Predictors for running-related injuries (RRIs) will differ between male and female novice runners. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were 532 novice runners (226 men, 306 women) preparing for a recreational 4-mile (6.7-km) running event. After completing a baseline questionnaire and undergoing an orthopaedic examination, they were followed during the training period of 13 weeks. An RRI was defined as any self-reported running-related musculoskeletal pain of the lower extremity or back causing a restriction of running for at least 1 week. Results: Twenty-one percent of the novice runners had at least one RRI during follow-up. The multivariate adjusted Cox regression model for male participants showed that body mass index (BMI) (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.05-1.26), previous injury in the past year (HR, 2.7; 95% CI, 1.36-5.55), and previous participation in Sports without axial load (HR, 2.05; 95% CI, 1.03-4.11) were associated with RRI. In female participants, only navicular drop (HR, 0.85; 95% CI, 0.75-0.97) remained a significant predictor for RRI in the multivariate Cox regression modeling. Type A behavior and range of motion (ROM) of the hip and ankle did not affect risk. Conclusion: Male and female novice runners have different risk profiles. Higher BMI, previous injury, and previous Sports participation without axial loading are important predictors for RRI in male participants. Further research is needed to detect more predictors for female novice runners.

Influence of external ankle support on lower extremity joint mechanics during drop landings.

Cordova ML, Takahashi Y, Kress GM, Brucker JB, Finch AE.: Journal of Sport Rehabilitation, 2010, 19(2):136-48. Biodynamics Research Laboratory, Department of Kinesiology, and Center for Biomedical Engineering Systems, University of North Carolina, Charlotte, NC, USA.

Objective: To investigate the effects of external ankle support (EAS) on lower extremity joint mechanics and vertical ground-reaction forces (VGRF) during drop landings. Design: A 1 x 3 repeated-measures, crossoverDesign. Setting: Biomechanics research laboratory. PATIENTS: 13 male recreationally active basketball players (age 22.3 +/- 2.2 y, height 177.5 +/- 7.5 cm, mass 72.2 +/- 11.4 kg) free from lower extremity pathology for the 12 mo before the study. Interventions: Subjects performed a 1-legged drop landing from a standardized height under 3 different ankle-support conditions. Main Outcome Measures: Hip, knee, and ankle angular displacement along with specific temporal (TGRFz1, TGRFz2; s) and spatial (GRFz1, GRFz2; body-weight units [BW]) characteristics of the VGRF vector were measured during a drop landing. Results: The tape condition (1.08 +/- 0.09 BW) demonstrated less GRFz1 than the control (1.28 +/- 0.16 BW) and semirigid conditions (1.28 +/- 0.21 BW; P < .0001), and GRFz2 was unaffected. For TGRFz1, no-support displayed slower time (0.017 +/- 0.004 s) than the semirigid (0.014 +/- 0.001 s) and tape conditions (0.014 +/- 0.002 s; P < .05). For TGRFz2, no-support displayed slower time (0.054 +/- 0.006 s) than the semirigid (0.050 +/- 0.006 s) and tape conditions (0.045 +/- 0.004 s; P < .05). Semirigid bracing was slower than the tape condition, as well (P < .05). Ankle-joint displacement was less in the tape (34.6 degrees +/- 7.7 degrees) and semirigid (36.8 degrees +/- 9.3 degrees) conditions than in no-support (45.7 degrees +/- 7.3 degrees; P < .05). Knee-joint displacement was larger in the no-support (45.1 degrees +/- 9.0 degrees) than in the semirigid (42.6 degrees +/- 6.8 degrees; P .05). Hip angular displacement was not affected by EAS (F(2,24) = 1.47, P = .25). Conclusions: EAS reduces ankle- and knee-joint displacement, which appear to influence the spatial and temporal characteristics of GRFz1 during drop landings.

Prevention of running injuries.

Fields KB, Sykes JC, Walker KM, Jackson JC.: Current Sports Medicine Reports, 2010, 9(3):176-82. Moses Cone Family Medicine Center, Greensboro, NC 27401, USA.

Evidence for preventive strategies to lessen running injuries is needed as these occur in 40%-50% of runners on an annual basis. Many factors influence running injuries, but strong evidence for prevention only exists for training modification primarily by reducing weekly mileage. Two anatomical factors - cavus feet and leg length inequality - demonstrate a link to injury. Weak evidence suggests that orthotics may lessen risk of stress fracture, but no clear evidence proves they will reduce the risk of those athletes with leg length inequality or cavus feet. This article reviews other potential injury variables, including strength, biomechanics, stretching, warm-up, nutrition, psychological factors, and shoes. Additional research is needed to determine whether interventions to address any of these will help prevent running injury.

Injury trends and prevention in rugby union football.

MacQueen AE, Dexter WW.: Current Sports Medicine Reports, 2010, 9(3):139-43. Maine Medical Center Sports Medicine Program, Portland, ME 04101, USA.

Rugby union football has long been one of the most popular Sports in the world. Its popularity and number of participants continue to increase in the United States. Until 1995, rugby union primarily was an amateur sport. Worldwide there are now flourishing professional leagues in many countries, and after a long absence, rugby union will be returning to the Olympic games in 2016. In the United States, rugby participation continues to increase, particularly at the collegiate and high school levels. With the increase in rugby professional athletes and the reported increase in aggressive play, there have been changes to the injury patterns in the sport. There is still significant need for further epidemiologic data as there is evidence that injury prevention programs and rule changes have been successful in decreasing the number of catastrophic injuries in rugby union.

Injury prevention strategies in skiers and snowboarders.

Hansom D, Sutherland A.: Current Sports Medicine Reports, 2010, 9(3):169-75. Department of Accident and Emergency, Dumfries Royal Infirmary, Dumfries, Scotland, UK.

With associated snow Sports injury risks being well documented, the scope for preventative medicine is clear. This article focuses on potential precautions taken by skiers/snowboarders and how they vary between different snow sport groups. A total of 181 randomly selected individuals from the Whistler/Blackcomb Medical Centre, Canada, took part in this questionnaire-based cohort study, examining snow Sports activity, preventive measures, and protective equipment use. Most individuals were ski area residents of advanced expertise, with 50% having had a previous snow-riding injury. The most commonly reported significant ski injury was anterior cruciate ligament (ACL) rupture, while in snowboarders, it was wrist fracture. Skiers were more likely to improve fitness levels before going onto the slopes, whereas crossover riders (both skiing and snowboarding) were more likely to take lessons. Most individuals used eye and sun protection and had adequately warm clothing. Beyond basic precautions, protective equipment and preventive measures are used infrequently. It is suggested that by increasing awareness and use of such equipment, injury rates may be reduced.

To stretch or not to stretch: the role of stretching in injury prevention and performance.

McHugh MP, Cosgrave CH.: Scandinavian Journal of Medicine & Science in Sports, 2010-04 20(2):169-81. Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York 10075, USA.

Stretching is commonly practiced before sports participation; however, effects on subsequent performance and injury prevention are not well understood. There is an abundance of literature demonstrating that a single bout of stretching acutely impairs muscle strength, with a lesser effect on power. The extent to which these effects are apparent when stretching is combined with other aspects of a pre-participation warm-up, such as practice drills and low intensity dynamic exercises, is not known. With respect to the effect of pre-participation stretching on injury prevention a limited number of studies of varying quality have shown mixed results. A general consensus is that stretching in addition to warm-up does not affect the incidence of overuse injuries. There is evidence that pre-participation stretching reduces the incidence of muscle strains but there is clearly a need for further work. Future prospective randomized studies should use stretching interventions that are effective at decreasing passive resistance to stretch and assess effects on subsequent injury incidence in sports with a high prevalence of muscle strains.

Tibiofemoral angle and its relation to ankle sprain occurrence.

Pefanis N, Karagounis P, Tsiganos G, Armenis E, Baltopoulos P.: Foot & Ankle Specialist, 2009-12 2(6):271-6. Laboratory of Functional Anatomy and Sports Medicine, University of Athens, Greece.

The lack of a normal joint orientation generates translational or shear forces across the joint. These forces can put abnormally high strain on the cartilage and the surrounding capsuloligamentous tissues. Ankle joint structure can affect or be affected by bony malformations of the surrounding areas, including the knee and hip. The aim of the current study is to examine the possible relationship between the tibiofemoral (TFA) angle and other factors (anthropometric characteristics, medical history, and age) on the occurrence of ankle sprains because its value provides useful information for the anatomical alignment of the lower extremity. The study sample consisted of 45 high-level athletes, evenly distributed among 3 sports (basketball, soccer, and volleyball). TFA measurements were made on radiographs. The study lasted 2 years. A logistic regression was used to determine the importance of each factor on the probability in question. A significance level of P = .1 was used. The factors contributing more to an ankle sprain were a previous injury of the same type followed by body mass index (BMI) and age. On the contrary, TFA was proven to be statistically nonsignificant. When the BMI variable was substituted with body inertia propensity, a derived variable, the TFA remained statistically nonsignificant. TFA magnitude does not seem to be a determinant factor that could increase the probability of spraining an ankle.

Risk of injury according to participation in specific physical activities: a 6-year follow-up of 14 356 participants of the SUN cohort.

Pons-Villanueva J, Seguí-Gómez M, Martínez-González MA.: International Journal of Epidemiology, 2010-04 39(2):580-7. Preventive Medicine and Public Health Department, School of Medicine, University of Navarra, Pamplona, Spain.

BACKGROUND: Physical activity is generally accepted as a healthy habit. Nevertheless, its associated risk to cause injuries has not been sufficiently evaluated. Measuring this risk more precisely would contribute to giving more accurate health advice to the general population. METHODS: Data are from participants (60% women, mean age 38 years) in a cohort of university graduates in Spain (1999-2008). Among other exposures and outcomes, they self report on frequency of participation in several physical activities over 1 year, and on incidence of sports-related injuries after 2, 4 or 6 years follow-up. Participation in 17 physical activities was categorized as a dichotomous variable (yes/no) and also according to average time per week spent in each one. Proportional hazards regression was used to estimate the adjusted relative risks [hazard ratios (HRs)] of incident injury associated with each specific physical activity or with total weekly energy expenditure in leisure-time activity [metabolic equivalents (METs)-h/week]. Statistical analyses were stratified by sex. RESULTS: We identified 1658 incident sports-related injuries among 14 356 participants after a median follow-up of 4.6 years. When we adjusted for overall energy expenditure (METs-h/week) in other activities, age and body mass index (BMI), a higher risk of injury was associated with participation in soccer, other team sports, skiing, tennis, running and athletics (HRs ranging from 1.50 to 1.86) among men. With the exception of soccer (rarely practiced by women in Spain), similar results were found for women (HRs ranging from 1.61 to 2.04). Walking, gymnastics, swimming, mountain hiking and gardening were associated with a low injury risk. CONCLUSIONS: Despite the healthy effects of physical activity, we consider that the higher risk for injuries related to soccer, team sports, skiing, tennis, running or athletics should be taken into consideration when advice for more physical activity is given to the general population. Daily routine physical activities such as walking or gardening should be encouraged.

Prophylactic ankle brace use in high school volleyball players: a prospective study.

Frey C, Feder KS, Sleight J.: Foot & Ankle international, 2010-04 31(4):296-300. Orthopaedic Foot and Ankle Center-Manhattan Beach, University of California at Los Angeles, 1200 Rosecrans Avenue, Manhattan Beach, CA 90266, USA. Este endereço de e-mail está protegido de spam bots, pelo que necessita do Javascript activado para o visualizar

INTRODUCTION: The purpose of this study was to determine the effect of prophylactic ankle bracing on the incidence of ankle injuries in a high school population of interscholastic volleyball players followed prospectively for one season. MATERIALS AND METHODS: The study was designed to evaluate the effect of different types of ankle braces on the incidence of ankle sprains in high school volleyball players. There were 957 players in the group that wore braces and 42 in the control group who did not wear a brace. Information was collected on age, sex, previous injury, incidence of injury, and time off from play. Only the dominant ankle was studied. RESULTS: Overall, the use of a prophylactic ankle brace did not significantly alter the incidence of ankle sprains in high school volleyball players. However, in players without a previous ankle sprain, the use of an ankle brace did make a significant difference in two of the braced groups. The Active Ankle Trainer II and the Aircast Sports Stirrup protected volleyball players from a sprain only if they had not had a previous sprain. If the player had a history of a previous ankle sprain, these two brace groups did not protect the ankle from another ankle sprain (p < 0.05). In addition, there were significantly more injuries in the female group of players who wore a non-rigid brace versus those who wore a more rigid brace. CONCLUSION: This information may be helpful in deciding whether to recommend prophylactic ankle braces in volleyball players.

Fatigue effects on knee joint stability during two jump tasks in women.

Ortiz A, Olson SL, Etnyre B, Trudelle-Jackson EE, Bartlett W, Venegas-Rios HL.: Journal of Strength and Conditioning research / National Strength & Conditioning Association, 2010-04 24(4):1019-27. Physical Therapy Program, School of Health Professions, University of Puerto Rico-Medical Sciences Center, San Juan, Puerto Rico.

Dynamic knee joint stability may be affected by the onset of metabolic fatigue during sports participation that could increase the risk for knee injury. The purpose of this investigation was to determine the effects of metabolic fatigue on knee muscle activation, peak knee joint angles, and peak knee internal moments in young women during 2 jumping tasks. Fifteen women (mean age: 24.6 +/- 2.6 years) participated in one nonfatigued session and one fatigued session. During both sessions, peak knee landing flexion and valgus joint angles, peak knee extension and varus/valgus internal moments, electromyographic (EMG) muscle activity of the quadriceps and hamstrings, and quadriceps/hamstring EMG cocontraction ratio were measured. The tasks consisted of a single-legged drop jump from a 40-cm box and a 20-cm, up-down, repeated hop task. The fatigued session included a Wingate anaerobic protocol followed by performance of the 2 tasks. Although participants exhibited greater knee injury-predisposing factors during the fatigued session, such as lesser knee flexion joint angles, greater knee valgus joint angles, and greater varus/valgus internal joint moments for both tasks, only knee flexion during the up-down task was statistically significant (p = 0.028). Metabolic fatigue may perhaps predispose young women to knee injuries by impairing dynamic knee joint stability. Training strength-endurance components and the ability to maintain control of body movements in either rested or fatigued situations might help reduce injuries in young women athletes.

Long-term neuromuscular training and ankle joint position sense.

Kynsburg A, Pánics G, Halasi T.: Acta Physiologica Hungarica, 2010, 97(2):183-91. Department of Sports Surgery, National Institute for Sports Medicine, Budapest, Hungary.

Preventive effect of proprioceptive training is proven by decreasing injury incidence, but its proprioceptive mechanism is not. Major hypothesis: the training has a positive long-term effect on ankle joint position sense in athletes of a high-risk sport (handball). Ten elite-level female handball-players represented the intervention group (training-group), 10 healthy athletes of other sports formed the control-group. Proprioceptive training was incorporated into the regular training regimen of the training-group. Ankle joint position sense function was measured with the "slope-box" test, first described by Robbins et al. Testing was performed one day before the intervention and 20 months later. Mean absolute estimate errors were processed for statistical analysis. Proprioceptive sensory function improved regarding all four directions with a high significance (p<0.0001; avg. mean estimate error improvement: 1.77 degrees). This was also highly significant (p< or =0.0002) in each single directions, with avg. mean estimate error improvement between 1.59 degrees (posterior) and 2.03 degrees (anterior). Mean absolute estimate errors at follow-up (2.24 degrees +/-0.88 degrees) were significantly lower than in uninjured controls (3.29 degrees +/-1.15 degrees) (p<0.0001). Long-term neuromuscular training has improved ankle joint position sense function in the investigated athletes. This joint position sense improvement can be one of the explanations for injury rate reduction effect of neuromuscular training.

An injury prevention program to prevent gymnastic injuries in children and teenagers.

Edlich RF, Swainston EM, Dahlstrom JJ, Gubler K, Long WB, Beaton J.: Journal of Environmental Pathology, Toxicology and Oncology, 2010, 29(1):13-5. Distinguished Professor Emeritus of Plastic Surgery, Biomedical Engineering, and Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA.

There are more than 5 million participants in 1 of 6 gymnastic disciplines that are prone to spinal cord injuries. Working with the gifted scholar and attorney, Jeffrey Beaton, the authors have participated in developing an injury prevention program for children and teenagers who participate in gymnastics. This program includes the following components: (1) a gymnastics center that complies with the e-Book design of gymnasticszone.com; (2) all teachers and students in gymnastics should be members of USA Gymnastics (USAG) and purchase a copy of the USA Gymnastics Safety Manual, the official manual of the United States Gymnastics Safety Association; (3) trampolines should be sunk in the ground with the bed level with the floor; and finally, (4) immediate emergency access of the injured gymnast to either a skilled orthopedic or neurosurgeon.

Helmet use and risk of neck injury in skiers and snowboarders.

Hagel BE, Russell K, Goulet C, Nettel-Aguirre A, Pless IB.: American Journal of Epidemiology, 20100515 171(10):1134-43. Department of Paediatrics, University of Calgary, Alberta, Canada.

In a case-control study, the authors examined the relation between helmet use and neck injury among Québec, Canada, skiers and snowboarders using 10 years of ski patrol data (1995-1996 to 2004-2005). Cases were defined as persons with any neck injury (n = 2,986), an isolated neck injury requiring ambulance evacuation (n = 522), or a cervical spine fracture or dislocation (n = 318). The control group included persons with non-head, non-neck injuries (n = 97,408) in an unmatched analysis. The authors also matched cases with controls injured at the same ski area, during the same activity (skiing vs. snowboarding), and during the same season. Helmet use was the primary exposure variable. For the unmatched analysis, the authors used unconditional logistic regression and adjusted for clustering by ski area and other covariates. They used conditional logistic regression for the matched analysis. Multiple imputation was used to address missing values. The adjusted odds ratio was 1.09 (95% confidence interval (CI): 0.95, 1.25) for any neck injury, 1.28 (95% CI: 0.96, 1.71) for isolated ambulance-evacuated neck injuries, and 1.02 (95% CI: 0.79, 1.31) for cervical spine fractures or dislocations. Similar results were found in the conditional logistic regression analysis and in analyses restricted to children under age 11 years. These results do not suggest that helmets increase the risk of neck injuries among skiers and snowboarders.

Motion control shoe delays fatigue of shank muscles in runners with overpronating feet.

Cheung RT, Ng GY.: The American Journal of Sports Medicine, 201003 38(3):486-91. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.

Background: The motion control shoe is a well-developed technology in running shoe design for controlling excessive rearfoot pronation and plantar force distribution. However, there is little information on the leg muscle activation with different shoe conditions. Hypothesis: The motion control shoe can prevent excessive shank muscle activation and delay fatigue. Study design: Controlled laboratory study. Methods: Twenty female recreational runners with excessive rearfoot pronation were tested with running 10 km on a treadmill on 2 days. Participants wore either a motion control running shoe or neutral running shoe on each day. Activities of their right tibialis anterior and peroneus longus were recorded with surface electromyography. The normalized root-mean-square electromyography and median frequency were compared between the 2 shoe conditions. Results: Significant positive correlations were found between the root-mean-square eletromyography and running mileage in both the tibialis anterior and peroneus longus in the neutral shoe condition (P <.001). The median frequency dropped in both shoe conditions with mileage, but paired t tests revealed a significantly larger drop in the neutral shoe (P < .001 for peroneus longus, P = .074 for tibialis anterior). Conclusions: The motion control shoe may facilitate a more stable activation pattern and higher fatigue resistance of the tibialis anterior and peroneus longus in individuals with excessive rearfoot pronation during running. Clinical relevance: The motion control shoe may increase the running endurance, thus reduce overuse injuries, in athletes with unstable feet during long-distance running.

In-shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners.

Tessutti V, Trombini-Souza F, Ribeiro AP, Nunes AL, Sacco Ide C.: Journal of Science and Medicine in Sport / Sports Medicine Australia, 201001 13(1):151-5. Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, Brazil.

The type of surface used for running can influence the load that the locomotor apparatus will absorb and the load distribution could be related to the incidence of chronic injuries. As there is no consensus on how the locomotor apparatus adapts to loads originating from running surfaces with different compliance, the Objective of this study was to investigate how loads are distributed over the plantar surface while running on natural grass and on a rigid surface--asphalt. Forty-four adult runners with 4+/-3 years of running experience were evaluated while running at 12 km/h for 40 m wearing standardized running shoes and Pedar insoles (Novel). Peak pressure, contact time and contact area were measured in six regions: lateral, central and medial rearfoot, midfoot, lateral and medial forefoot. The surfaces and regions were compared by three ANOVAS (2 x 6). Asphalt and natural grass were statistically different in all variables. Higher peak pressures were observed on asphalt at the central (p<0.001) [grass: 303.8(66.7)kPa; asphalt: 342.3(76.3)kPa] and lateral rearfoot (p<0.001) [grass: 312.7(75.8)kPa; asphalt: 350.9(98.3)kPa] and lateral forefoot (p<0.001) [grass: 221.5(42.9)kPa; asphalt: 245.3(55.5)kPa]. For natural grass, contact time and contact area were significantly greater at the central rearfoot (p<0.001). These results suggest that natural grass may be a surface that provokes lighter loads on the rearfoot and forefoot in recreational runners.

Effectiveness of a 6-week injury prevention program on kinematics and kinetic variables in adolescent female soccer players: a pilot study.

Ortiz A, Trudelle-Jackson E, McConnell K, Wylie S.: Puerto Rico Health Sciences Journal, 201003 29(1):40-8. University of Puerto Rico-Medical Sciences Campus, School of Health Professions, Physical Therapy Program, San Juan, PR.

Background: Incidence of knee injuries in female soccer players is 2-6 times that of male counterparts. The Objective was to determine whether an injury prevention program incorporated into the athlete's regular soccer practice is effective for improving landing mechanics. Methods: Two competitive adolescent female soccer teams (n = 30) participated in the study. One team served as the control group while the other team participated in a 6-week injury prevention program. Muscle strength, muscle length, and 3-dimensional kinematics and kinetics during a single legged drop jump and single legged squat task were measured pre and post-intervention. A 2 x 2 repeated measures multivariate analyses of variance (MANOVA's) were used to compare Strength and flexibility measures as well as knee joint kinematics and kinetics. Significant multivariate results were followed with appropriate univariate analyses. Results: Quadriceps Strength increased significantly (p = .004) following the injury prevention program while other Strength and flexibility measurements were unchanged. Differences in knee joint angles and moments during the drop jump and squat tasks showed varied results with a tendency for improvement in the intervention group. Conclusions : Flexibility and Strength do not appear to be affected by a short injury prevention program. Knee joint injury predisposing factors improved minimally but did not reach statistical significance with a short injury prevention program integrated as warm-up into soccer practice. Further Research with a larger sample size is needed to explore the effectiveness of such programs.

Neuromuscular training for sports injury prevention: a systematic review.

Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W.: Medicine and Science in Sports and Exercise, 201003 42(3):413-21. Department of Sports Medicine, Goethe-University Frankfurt, Frankfurt, Germany.

Purpose: The aim of this systematic review was to assess the effectiveness of proprioceptive/neuromuscular training in preventing sports injuries by using the best available evidence from methodologically well-conducted randomized controlled trials and controlled clinical trials without randomization. Methods: Two independent researchers performed a literature search in various electronic databases and reference lists. The reviewers independently assessed trials for inclusion criteria and methodological quality and extracted the data. Focusing on studies of high methodological quality, relative risks (RR) and 95% confidence intervals (CI) were used to estimate treatment effects. Results: From a total of 32 relevant studies, 7 methodologically well-conducted studies were considered for this review. Pooled analysis revealed that multi-intervention training was effective in reducing the risk of lower limb injuries (RR = 0.61, 95% CI = 0.49-0.77, P < 0.01), acute knee injuries (RR = 0.46, 95% CI = 0.28-0.76, P < 0.01), and ankle sprain injuries (RR = 0.50, 95% CI = 0.31-0.79, P < 0.01). Balance training alone resulted in a significant risk reduction of ankle sprain injuries (RR = 0.64, 95% CI = 0.46-0.9, P < 0.01) and a nonsignificant risk reduction for injuries overall (RR = 0.49, 95% CI = 0.13-1.8, P = 0.28). Exercise interventions were more effective in athletes with a history of sports injury than in those without. Conclusion: On the basis of the results of seven high-quality studies, this review showed evidence for the effectiveness of proprioceptive/neuromuscular training in reducing the incidence of certain types of sports injuries among adolescent and young adult athletes during pivoting sports. Future Research should focus on the conduct of comparative trials to identify the most appropriate and effective training components for preventing injuries in specific sport

Integrated injury prevention program improves balance and vertical jump height in children.

DiStefano LJ, Padua DA, Blackburn JT, Garrett WE, Guskiewicz KM, Marshall SW.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 201002 24(2):332-42. Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.

Implementing an injury prevention program to athletes under age 12 years may reduce injury rates. There is limited knowledge regarding whether these young athletes will be able to modify balance and performance measures after completing a traditional program that has been effective with older athletes or whether they require a specialized program for their age. The Purpose of this study was to compare the effects of a pediatric program, which was designed specifically for young athletes, and a traditional program with no program in the ability to change balance and performance measures in youth athletes. We used a cluster-randomized controlled trial to evaluate the effects of the programs before and after a 9-week intervention period. Sixty-five youth soccer athletes (males: n = 37 mass = 34.16 +/- 5.36 kg, height = 143.07 +/- 6.27 cm, age = 10 +/- 1 yr; females: n = 28 mass = 33.82 +/- 5.37 kg, height = 141.02 +/- 6.59 cm) volunteered to participate and attended 2 testing sessions in a Research laboratory. Teams were cluster-randomized to either a pediatric or traditional injury prevention program or a control group. Change scores for anterior-posterior and medial-lateral time-to-stabilization measures and maximum vertical jump height and power were calculated from pretest and post-test sessions. Contrary with our original hypotheses, the traditional program resulted in positive changes, whereas the pediatric program did not result in any improvements. Anterior-posterior time-to-stabilization decreased after the traditional program (mean change +/- SD = -0.92 +/- 0.49 s) compared with the control group (-0.49 +/- 0.59 s) (p = 0.003). The traditional program also increased vertical jump height (1.70 +/- 2.80 cm) compared with the control group (0.20 +/- 0.20 cm) (p = 0.04). There were no significant differences between control and pediatric programs. Youth athletes can improve balance ability and vertical jump height after completing an injury prevention program. Training specificity appears to affect improvements and should be considered with future program design.

Efficacy of injury prevention related coach education within netball and soccer.

Gianotti S, Hume PA, Tunstall H.: Journal of Science and Medicine in Sport / Sports Medicine Australia

201001 13(1):32-5. Accident Compensation Corporation, Wellington, New Zealand.

In 2004, Netball New Zealand and New Zealand Football adapted a generic 10-point action plan for sports injury prevention, SportSmart, to create NetballSmart and SoccerSmart, as part of their coach education programmes. A small-size descriptive study was conducted in both sports, to assess the efficacy of integrating sports injury prevention into coach education. NetballSmart was evaluated at the end of 2005, via a telephone survey of 217 coaches (53% response rate) who had attended a NetballSmart course earlier in the year. SoccerSmart was evaluated at the start of 2007, via an Internet questionnaire completed by 71 coaches (20% response rate) who had attended a SoccerSmart course in 2006. The evaluations focused on the quality and use of the course resource material, as well as assessing the extent to which coaches had incorporated injury prevention behaviours into player practices. After attending a NetballSmart course, 89% of coaches changed the way they coached, with 95% reported using knowledge from the course and passing it on to players. Ninety-six percent of football/soccer coaches also changed the way they coached, with most change relating to warm-up/cool-down and stretch (65%), technique (63%), fitness (60%) and nutrition/hydration (58%) practices. Although this was a descriptive study in nature, with a small sample size, we conclude that integration of injury prevention content within coach education courses and resources may be a viable and effective strategy to help community coaches--and therefore community players--help reduce their risk of injury.

Determining a "do not start" temperature for a marathon on the basis of adverse outcomes.

Roberts WO.: Medicine and Science in Sports and Exercise, 2010, 42(2):226-32. Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.

Introduction: Marathon races faced with unexpectedly hot conditions must make a decision to start or not to start. The current race cancellation parameters may not reflect the safety profile of an individual race, and a universal temperature may not work an individual race. Methods: A retrospective review of the number of starters, finishers, and finish line medical encounters was used to calculate the rate of "unsuccessful" marathon starters from race records, where unsuccessful is defined as medical encounters seen for any reason in the finish medical area plus marathon starters who did not finish. Unsuccessful marathon starters were plotted against the race start wet bulb globe temperature (WBGT), and the WBGT level at which a mass casualty incident (MCI) occurred was used to calculate a "do not start" WBGT. Results: A start WBGT of >21 degrees C resulted in MCI or midrace cancellation in several races. Twin Cities Marathon data show a rapid increase in the rate of unsuccessful marathoner starters above a start WBGT of 13 degrees C. The event experienced an area-wide MCI at a start WBGT of 22 degrees C with an unsuccessful starter rate of 160 per 1000 finishers. Conclusions: Marathons in northern latitudes (>40 degrees) held in "unexpectedly" hot conditions when the participants are not acclimatized and the start WBGT is >21 degrees C often end in either race cancellation or an MCI. It would seem prudent not to start these races in similar conditions. The rate of unsuccessful marathon starters per 1000 marathon finishers plotted against start WBGT generates a curve that can be used to estimate a do not start level. The do not start WBGT for Twin Cities Marathon is 20.5 degrees C on the basis of this model.

Modificado em 03 de Junho de 2010

Interventions for preventing hamstring injuries.

Goldman EF, Jones DE.: Cochrane database of systematic reviews (Online), 2010 (1):CD006782

Synergy Healthcare, 1-4 Stokers Buildings, Front Street East, Bedlington, Northumberland, UK, NE22 5DS.

Background: Some sports, such as football, have a high incidence of hamstring injuries. Various interventions targeting the prevention of such injuries are in common use. Objectives: To assess the effects (primarily, on the incidence of hamstring injuries) of interventions used for preventing hamstring injuries in physically active individuals. Search Strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to December 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2008, Issue 4), MEDLINE and other databases (to December 2008), reference lists and clinical trials registers. Selection criterea: Randomised or quasi-randomised trials of interventions for preventing hamstring injuries were included; as were trials testing interventions for the prevention of lower-limb injuries, provided that hamstring injuries were reported. Secondary outcomes included compliance, severity and the occurrence of other leg injuries. Dana collection and analysis : Two authors independently screened search results, assessed methodological quality and extracted data. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated for dichotomous variables and are reported for individual and pooled data. Main results: Seven randomised controlled trials involving 1919 participants were included. All trials involved people, predominantly young adults, participating in regular sporting activities. Some trials were compromised by poor methodology, including lack of blinding and incomplete outcome data.Four trials, including 287 participants, examined interventions directly targeted at preventing hamstring injuries. Three of these trials, which tested hamstring strengthening protocols, had contradictory findings, with one small trial showing benefit (although the control rate of mainly minor hamstring injury was unusually high). The other two trials found no benefit, with a greater incidence of hamstring injury in the intervention group. One unpublished and underpowered trial provided some evidence that manual therapy may prevent lower-limb muscle strain (RR 0.13, 95% CI 0.02 to 0.97), although the finding for hamstring injury did not reach statistical significance (RR 0.21, 95% CI 0.03 to 1.66).Three trials testing interventions for preventing lower limb injuries for which data for hamstring injury were available found no statistically significant effect for hamstring injury for either proprioceptive protocols (two cluster randomised trials) or a warm up/cool down and stretching protocol (one trial). Authors conclusion: There is insufficient evidence from randomised controlled trials to draw conclusions on the effectiveness of interventions used to prevent hamstring injuries in people participating in football or other high risk activities for these injuries. The findings for manual therapy need confirmation.

Modificado em 23 de Maio de 2010, Sábado

Triathlon event distance specialization: training and injury effects.

Vleck VE, Bentley DJ, Millet GP, Cochrane T.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 2010, 24(1):30-6. Faculty of Human Kinetics, Technical University of Lisbon, Cruz Quebrada, Portugal.

We conducted a preliminary, questionnaire-based, retrospective analysis of training and injury in British National Squad Olympic distance (OD) and Ironman distance (IR) triathletes. The main outcome measures were training duration and training frequency and injury frequency and severity. The number of overuse injuries sustained over a 5-year period did not differ between OD and IR. However, the proportions of OD and IR athletes who were affected by injury to particular anatomical sites differed (p < 0.05). Also, fewer OD athletes (16.7 vs. 36.8%, p < 0.05) reported that their injury recurred. Although OD sustained fewer running injuries than IR (1.6 +/- 0.5 vs. 1.9 +/- 0.3, p < 0.05), more subsequently stopped running (41.7 vs. 15.8%) and for longer (33.5 +/- 43.0 vs. 16.7 +/- 16.6 days, p < 0.01). In OD, the number of overuse injuries sustained inversely correlated with percentage training time, and number of sessions, doing bike hill repetitions (r = -0.44 and -0.39, respectively, both p < 0.05). The IR overuse injury number correlated with the amount of intensive sessions done (r = 0.67, p < 0.01 and r = 0.56, p < 0.05 for duration of "speed run" and "speed bike" sessions). Coaches should note that training differences between triathletes who specialize in OD or IR competition may lead to their exhibiting differential risk for injury to specific anatomical sites. It is also important to note that cycle and run training may have a "cumulative stress" influence on injury risk. Therefore, the tendency of some triathletes to modify rather than stop training when injured-usually by increasing load in another discipline from that in which the injury first occurred-may increase both their risk of injury recurrence and time to full rehabilitation.

Balance improvements in female high school basketball players after a 6-week neuromuscular-training program.

McLeod TC, Armstrong T, Miller M, Sauers JL.: Journal of Sport Rehabilitation, 2009, 18(4):465-81. Athletic Training Program, A.T. Still University, Mesa, AZ, USA.

Context: Poor balance has been associated with increased injury risk among athletes. Neuromuscular-training programs have been advocated as a means of injury prevention, but little is known about the benefits of these programs on balance in high school athletes. Objective: To determine whether there are balance gains after participation in a neuromuscular-training program in high school athletes. DESIGN: Nonrandomized controlled trial. Setting: All data were collected at each participating high school before and after a 6-wk intervention or control period. PARTICIPANTS: 62 female high school basketball players recruited from the local high school community and assigned to a training (n = 37) or control (n = 25) group. Intervention: Training-group subjects participated in a 6-wk neuromuscular-training program that included plyometric, functional-strengthening, balance, and stability-ball exercises. Main outcome measures: Data were collected for the Balance Error Scoring System (BESS) and Star Excursion Balance Test (SEBT) before and after the 6-wk intervention or control period. Results: The authors found a significant decrease in total BESS errors in the trained group at the posttest compared with their pretest and the control group (P = .003). Trained subjects also scored significantly fewer BESS errors on the single-foam and tandem-foam conditions at the posttest than the control group and demonstrated improvements on the single-foam compared with their pretest (P = .033). The authors found improvements in reach in the lateral, anteromedial, medial, and posterior directions in the trained group at the posttest compared with the control group (P < .05) using the SEBT. Conclusion: The study demonstrates that a neuromuscular-training program can increase the balance and proprioceptive capabilities of female high school basketball players and that clinical balance measures are sensitive to detect these differences.

The influence of ankle taping on changes in postural stability during soccer-specific activity.

Lohkamp M, Craven S, Walker-Johnson C, Greig M.: Journal of Sport Rehabilitation, 2009, 18(4):482-92. Dept of Sport, Health, and Exercise Science, University of Hull, Hull, UK.

Context: Postural stability diminishes with longer activity, which may increase the risk of injury. Tape can increase stability, but this effect diminishes after exercise. Objective: To investigate the influence of ankle taping on postural stability during soccer-specific activity. Participants: 10 male, injury-free, semiprofessional soccer players. Intervention: A 45-min treadmill protocol replicating the activity profile of soccer match play--with and without ankle tape. Postural stability was assessed every 7.5 min, requiring response to sudden ankle plantar flexion and inversion during single-leg stance. Main outcome measure: Reaction time to perturbation and center-of-gravity (CoG) displacement. Results: Reaction time was significantly longer (P < .05) with longer exercise for both movements and conditions. No significant effect was evident in CoG displacement. For both outcome measures a nonsignificant benefit of taping was observed during the first 22.5 min of activity. Conclusion: Prolonged exposure to soccer-specific activity negates any beneficial effect of taping in improving postural stability.

Modificado: 6ª feira, 16 de Abril de 2010

The injury profile of Karate World Championships: new rules, less injuries.

Arriaza R, Leyes M, Zaeimkohan H, Arriaza A

.: Knee surgery, Sports Traumatology, Arthroscopy : official journal of the ESSKA, 17(12):1437-42, 2009. Department of Orthopaedic Surgery, USP Hospital Santa Teresa, C/Londres, 2, 15008 La Coruña, Spain. The aim of this paper is to document the injury rate in high-level modern competitive karate after a change of competition rules was implemented in the year 2000, and to compare it with the injury rate found before the rules were changed. A prospective recording of the injuries resulting from 2,762 matches in three consecutive World Karate Championships (representing 7,425 min of active fighting) was performed, and compared with the results from 2,837 matches from the three last World Karate Championships (representing 7,631 min of active fighting) held before the change of competition rules. In total, 497 injuries were recorded, with an incidence of 0.180 injuries per match or 6.7 per 100 min of active fighting. There were 1,901 male category fights (in which 383 injuries were recorded), and 861 female category fights (in which 114 injuries were recorded). The global injury incidence was almost double with the old rules compared to the one with the new rules [OR 1.99, 95% CI (1.76-2.26); p < 0.00001]. In male category, the risk of injury was higher before the rules were changed [OR 1.81, 95% CI (1.56-2.09); p < 0.00001], and also in female category [OR 2.71; 95% CI (2.64-2.80); p < 0.00001]. The rate of severe injuries was not different before and after the change of rules. The implementation of the new competition rules in competitive karate has been associated with a significant reduction in injury rate, making competition safer for athletes.

Reducing the risk of noncontact anterior cruciate ligament injuries in the female athlete.

Barber-Westin SD, Noyes FR, Smith ST, Campbell TM

The Physician and Sportsmedicine, 37(3):49-61, 2009. Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, OH, USA.

High school and collegiate female athletes have a significantly increased risk of sustaining a noncontact anterior cruciate ligament injury compared with male athletes participating in the same sport. This review summarizes the current knowledge of the risk factors hypothesized to influence this problem, and the neuromuscular training programs designed to correct certain biomechanical problems noted in female athletes. The risk factors include a genetic predisposition for sustaining a knee ligament injury, environmental factors, anatomical indices, hormonal influences, and neuromuscular factors. The greatest amount of research in this area has studied differences between female and male athletes in movement patterns during athletic tasks; muscle strength, activation, and recruitment patterns; and knee joint stiffness under controlled, preplanned, and reactive conditions in the laboratory. Neuromuscular retraining programs have been developed in an attempt to reduce these differences. The successful programs teach athletes to control the upper body, trunk, and lower body position; lower the center of gravity by increasing hip and knee flexion during activities; and develop muscular strength and techniques to land with decreased ground reaction forces. In addition, athletes are taught to preposition the body and lower extremity prior to initial ground contact to obtain the position of greatest knee joint stability and stiffness. Two published programs have significantly reduced the incidence of noncontact anterior cruciate ligament injuries in female athletes participating in basketball, soccer, and volleyball. Other programs were ineffective, had a poor study design, or had an insufficient number of participants, which precluded a true reduction in the risk of this injury. In order to determine which risk factors for noncontact anterior cruciate ligament ruptures are significant, future investigations should include larger cohorts of athletes in multiple sports, analyze factors from all of the major risk categories, and follow athletes for at least one full athletic season. Future risk assessment studies should incorporate reactive tasks under more realistic sports conditions.

Prevention of soccer-related knee injuries in teenaged girls.

Kiani A, Hellquist E, Ahlqvist K, Gedeborg R, Michaëlsson K, Byberg L.

Archives of Internal Medicine, 170(1):43-9, 2010. Uppsala Clinical Research Center, Sweden.

Background: Knee injuries end many careers among female soccer players. The number of injuries can be anticipated to increase because of the increasing popularity of the sport worldwide and the higher incidence of knee injuries among young females compared with males. Methods: In a community-based intervention trial performed from February 1 through October 31, 2007, we sought to reduce the number of knee injuries among female soccer players aged 13 to 19 years (N = 1506), representing 97 teams from 2 Swedish counties. A physical exercise program designed exclusively for female soccer players was combined with education of athletes, parents, and coaches to increase awareness of injury risk. The training program aimed to improve motor skills, body control, and muscle activation. New acute knee injuries, diagnosed by the physician, were the main outcome measure. Results: Three knee injuries occurred in the intervention group and 13 occurred in the control group, corresponding to incidence rates of 0.04 and 0.20, respectively, per 1000 player hours. The preventive program was associated with a 77% reduction in knee injury incidence (crude rate ratio, 0.23; 95% confidence interval, 0.04-0.83). The noncontact knee injury incidence rate was 90% lower in the intervention group (crude rate ratio, 0.10; 95% confidence interval, 0.00-0.70). Adjustment for potential confounders strengthened the estimates. Forty-five of the 48 intervention teams (94%) reported a high adherence of at least 75%. Conclusion: The incidence of knee injuries among young female soccer players can be reduced by implementation of a multifaceted, soccer-specific physical exercise program including education of individual players.

Physical activity guidelines for older adults.

Elsawy B, Higgins KE.

American Family Physician, 81(1):55-9, 2010. Methodist Charlton Medical Center, Dallas, TX 75237, USA.

Few older adults in the United States achieve the minimum recommended amount of physical activity. Lack of physical activity contributes to many chronic diseases that occur in older adults, including heart disease, stroke, diabetes mellitus, lung disease, Alzheimer disease, hypertension, and cancer. Lack of physical activity, combined with poor dietary habits, has also contributed to increased obesity in older persons. Regular exercise and increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity, and are proven to reduce disease and disability, and improve quality of life in older persons. In 2008, The U.S. Department of Health and Human Services released guidelines to provide information and guidance on the amount of physical activity recommended to maintain health and fitness. For substantial health benefits, the guidelines recommend that most older adults participate in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination of each per week. Older adults should also engage in strengthening activities that involve all major muscle groups at least two days a week. Those at risk of falling should add exercises that help maintain or improve balance. Generally healthy adults without chronic health conditions do not need to consult with a physician before starting an exercise regimen.

Dorsiflexion deficit during jogging with chronic ankle instability.

Drewes LK, McKeon PO, Kerrigan DC, Hertel J. Journal of science and medicine in sport / Sports Medicine Australia, 12(6):685-7, 2009.

Australia University of Virginia, Department of Kinesiology, United States.

The purpose of the study was to determine whether individuals with chronic ankle instability (CAI) demonstrate altered dorsiflexion/plantar flexion range of motion (ROM) compared to controls during jogging. The case control study took place in a university motion analysis laboratory. Fourteen volunteers participated in the study, seven suffered from CAI (age 25+/-4.2 years, height 173+/-9.4 cm, mass 71+/-8.1kg) and seven were healthy, matched controls (age 25+/-4.5 years, height 168+/-5.9 cm, mass 67+/-9.8kg). All subjects jogged on an instrumented treadmill while a ten-camera motion analysis system collected three-dimensional kinematics of the lower extremities. The main outcome measure was sagittal plane (dorsiflexion/plantar flexion) range of motion of the ankle throughout the gait cycle. CAI subjects had significantly less dorsiflexion compared to the control group from 9% to 25% during jogging (4.83+/-0.55 degrees ). CAI subjects demonstrated limited ankle dorsiflexion ROM during the time of maximal dorsiflexion during jogging. Limited dorsiflexion ROM during gait among individuals with CAI may be a risk factor for recurrent ankle sprains. These deficits should be treated appropriately by rehabilitation clinicians.

Functional balance training in collegiate women athletes.

Oliver GD, Di Brezzo R.: Journal of strength and conditioning research / National Strength & Conditioning Association, 23(7):2124-9, 2009.

Department of Health, Kinesiology, Recreation, and Dance, Graduate Athletic Training Education Program, University of Arkansas, Fayetteville, Arkansas, USA.

This study examined the effects of functional balance training implemented in addition to regular season practice, competition, and strength and conditioning training for collegiate women athletes. Twenty-six members of National Collegiate Athletic Association (NCAA) Division I collegiate women's volleyball and soccer teams volunteered. A pre-test, post-test group design was used for the study. Pre- and post-test measures were the following: Skindex, body mass index (BMI), single-leg squat, prone quadra-ped core test, Biodex balance test, and a 1-minute sit-up test. The intervention consisted of 10 minutes of Indo Board (a dynamic balance board) training 4 days a week throughout the entire season. The volleyball team served as the intervention group, whereas the soccer team had no intervention. A dependent t-test demonstrated a statistically significant (p<0,05).

Evaluation and opportunities in overtraining approaches.

Roose J, de Vries WR, Schmikli SL, Backx FJ, van Doornen LJ.: Research quarterly for exercise and sport, 80(4):756-64, 2009.

Department of Rehabilitation and Sports Medicine at the University of Utrecht Medical Center, Utrecht, The Netherlands.

Overtraining (OT) as a sports phenomenon can be caused by stressors on various levels (physical, emotional, psychological, and social) and evokes responses on these levels. This study evaluated research and new opportunities in the field of OT by introducing an integrated multidisciplinary approach, based on the single and multistressors approach. The single stressor approach focuses on the training load-recovery imbalance, which results in a stagnating performance, excluding the etiology by nonsport-related factors. The multistressors approach includes all factors as relevant in the etiology of a stagnating performance. In future studies on OT an integrative approach should not only highlight changes in training regimes and specific responses to training stressors but also focus on the role of training-related recovery, the impact of stressors, and personality factors influencing stress appraisal. This will provide a better insight into the etiology and consequences of OT necessary for prevention and treatment in sport practice, and enhance the focus on adequate recovery (good sleep, sufficient rest periods) and athletes' stress-related responses.

Effect of 830 nm low-level laser therapy applied before high-intensity exercises on skeletal muscle recovery in athletes.

Leal Junior EC, Lopes-Martins RA, Baroni BM, De Marchi T, Taufer D, Manfro DS, Rech M, Danna V, Grosselli D, Generosi RA, Marcos RL, Ramos L, Bjordal JM.: Lasers in Medical Science, 24(6):857-63, 2009. Sports Medicine Institute (IME), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil.

Our aim was to investigate the immediate effects of bilateral, 830 nm, low-level laser therapy (LLLT) on high-intensity exercise and biochemical markers of skeletal muscle recovery, in a randomised, double-blind, placebo-controlled, crossover trial set in a sports physiotherapy clinic. Twenty male athletes (nine professional volleyball players and eleven adolescent soccer players) participated. Active LLLT (830 nm wavelength, 100 mW, spot size 0.0028 cm(2), 3-4 J per point) or an identical placebo LLLT was delivered to five points in the rectus femoris muscle (bilaterally). The main outcome measures were the work performed in the Wingate test: 30 s of maximum cycling with a load of 7.5% of body weight, and the measurement of blood lactate (BL) and creatine kinase (CK) levels before and after exercise. There was no significant difference in the work performed during the Wingate test (P > 0.05) between subjects given active LLLT and those given placebo LLLT. For volleyball athletes, the change in CK levels from before to after the exercise test was significantly lower (P = 0.0133) for those given active LLLT (2.52 U l(-1) +/- 7.04 U l(-1)) than for those given placebo LLLT (28.49 U l(-1) +/- 22.62 U l(-1)). For the soccer athletes, the change in blood lactate levels from before exercise to 15 min after exercise was significantly lower (P < 0.01) in the group subjected to active LLLT (8.55 mmol l(-1) +/- 2.14 mmol l(-1)) than in the group subjected to placebo LLLT (10.52 mmol l(-1) +/- 1.82 mmol l(-1)). LLLT irradiation before the Wingate test seemed to inhibit an expected post-exercise increase in CK level and to accelerate post-exercise lactate removal without affecting test performance. These findings suggest that LLLT may be of benefit in accelerating post-exercise recovery.

Preventing lower limb injuries: is the latest evidence being translated into the football field?

Twomey D, Finch C, Roediger E, Lloyd DG.: Journal of Science and Medicine in Sport / Sports Medicine Australia, 12(4):452-6, 2009.

School of Human Movement and Sport Sciences, University of Ballarat, Ballarat, Australia.

There is accumulating international evidence that lower limb injuries in sport can be prevented through targeted training but the extent to which this knowledge has been translated to real-world sporting practice is not known. A semi-structured questionnaire of all coaches from the nine Sydney Australian Football League Premier Division teams was conducted. Information was sought about their knowledge and behaviours in relation to delivering training programs, including their uptake of the latest scientific evidence for injury prevention. Direct observation of a sample of the coach-delivered training sessions was also undertaken to validate the questionnaire. Coaches ranked training session elements directly related to the game as being of most importance. They strongly favoured warming-up and cooling-down as injury prevention measures but changing direction and side-stepping training was considered to be of little/no importance for safety. Only one-third believed that balance training had some importance for injury prevention, despite accumulating scientific evidence to the contrary. Drills, set play, ball handling and kicking skills were all considered to be of least importance to injury prevention. These views were consistent with the content of the observed coach-led training sessions. In conclusion, current football training sessions do not give adequate attention to the development of skills most likely to reduce the risk of lower limb injury in players. There is a need to improve the translation of the latest scientific evidence about effective injury prevention into coaching practices.

Pilot study of female high school basketball players' anterior cruciate ligament injury knowledge, attitudes, and practices.

Iversen MD, Friden C.: Scandinavian Journal of Medicine & Science in Sports. 19(4):595-602, 2009.

Graduate Programs in Physical Therapy, MGH Institute of Health Professions, Boston, Massachusetts 02129, USA.

An anterior cruciate ligament (ACL) injury prevention program was evaluated. One hundred and thirteen female high school varsity and junior varsity basketball players and 12 coaches participated in an 8-week educational and skills program. Demographic and injury history data were collected. At pre-intervention and at the end of season, knowledge, attitudes, and practices about ACL risk and injury prevention were assessed via questionnaires, and frequency of two-footed landings were videotaped during games. Univariate statistics described the sample. Paired t-tests evaluated the program's impact. Cronbach's alpha, correlations, and kappa statistics assessed the validity and reliability of questionnaires and video analysis. Of the 113 players, 74 completed the study. The players' mean age was 16.25 years (SD=1.07; range=14.2-18.8). Baseline knowledge score was 57.2%, practice 58.4%, and attitude 73.5%. The mean baseline knowledge score of the 12 coaches (mean age=40.8 years; SD=10.3; range=26.9-56.3) was 68.7%. Players' knowledge about ACL injury prevention improved (t=2.57; P<0.01). No changes in attitudes toward injury prevention were found (t(diff)=1.88; P<0.06). Inter-rater reliability of two-footed landings observed was acceptable (kappa=0.72). Videotape analyses revealed a 5.5% increase in landing performance (t(diff)=9.6; P<0.0001). The program increased knowledge about ACL injury risk and improved player's landing skills.

Physical activity/exercise training in type 2 diabetes. The role of the Italian Diabetes and Exercise Study. Balducci, S., Zanuso, S., et al: Metabolic Fitness Association, Via Nomentana, 27 - 00015 Monterotondo (Rome), Italy.Diabetes/metabolism research and reviews, 25 Suppl1:S29-33, 2009.

Cardiorespiratory fitness is inversely related to the development of type 2 diabetes and cardiovascular morbidity and mortality. Trials in individuals with impaired glucose tolerance have highlighted the role of physical activity/exercise in the prevention of type 2 diabetes. Moreover, physical activity and exercise training have been recognized as treatment options for patients with type 2 diabetes. Both aerobic and resistance training were shown to produce beneficial effects by reducing HbA(1c), inducing weight loss and improving fat distribution, lipid profile and blood pressure in patients with type 2 diabetes. Mixed aerobic and resistance training was recently shown to be more effective than either one alone in ameliorating HbA(1c). However, further research is needed to establish the volume, intensity and type of exercise that are required to reduce cardiovascular burden and particularly to define the best strategy for promoting long-term compliance and durable lifestyle changes in individuals with type 2 diabetes. The Italian Diabetes Exercise Study (IDES) is a prospective Italian multicentre randomized controlled trial, of larger size and longer duration than previously published trials. It has been designed to assess the combined effect of structured counselling and supervised mixed (aerobic plus resistance) exercise training, as compared with counselling alone, on HbA(1c) and other cardiovascular risk factors as well as fitness parameters in individuals with type 2 diabetes and the metabolic syndrome. This study was also aimed at testing a sustainable strategy for promoting and maintaining a sufficient level of physical activity among individuals with type 2 diabetes to be implemented at the population level.

Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men. Lee, C. C., Sui, X., Blair, S. N.: Department of Exercise and Wellness, Arizona State University, Mesa, 85212, USA.Archives of internal medicine, 169(22):2096-101, 2009.

BACKGROUND: Physical inactivity, cigarette smoking, and abdominal obesity are key modifiable risk factors for coronary heart disease (CHD). We investigated the combined effects of not having these risk factors on CHD events and cardiovascular disease (CVD) and all-cause mortality in men. METHODS: We followed up 23 657 men, aged 30 to 79 years, who completed a medical evaluation including a maximal treadmill exercise test and self-reported health habits. A low-risk profile was defined as not smoking, moderate or high fitness, and normal waist girth. There were 482 CHD events (nonfatal myocardial infarction or fatal CHD) and 1034 deaths (306 CVD, 387 cancers, and 341 others) during a mean 14.7 years of follow-up (348 811 man-years). RESULTS: After adjustment for age, examination year, and multiple baseline risk factors, there was an inverse association between a greater number of low-risk factors and CHD events, and CVD and all-cause mortality in men (P value for trend, <.001 for all). Men with a normal waist girth and who were physically fit and not smoking had a 59% lower risk of CHD events (95% confidence interval [CI], 39%-72%), a 77% lower risk of CVD mortality (95% CI, 65%-85%), and a 69% lower risk of all-cause mortality (95% CI, 60%-76%) compared with men with none of these low-risk factors. Men with 0 compared with 3 low-risk factors had a shorter life expectancy by 14.2 years (95% CI, 12.2-15.9 years). CONCLUSION: Being physically fit, not smoking, and maintaining a normal waist girth is associated with lower risk of CHD events, and CVD and all-cause mortality in men.

Cardiorespiratory fitness and mortality in diabetic men with and without cardiovascular disease. McAuley, P., Muers, J., et al: Department of Human Performance and Sport Sciences, Winston-Salem State-University, Winston-Salem, NC 27110, USA.Diabetes research and clinical practice, 85(3):e30-3, 2009.

We assessed joint associations of cardiorespiratory fitness and diabetes, cardiovascular disease (CVD), or both with all-cause mortality. High-fitness eliminated mortality risk in diabetes (P<0.001) and halved risk of death in diabetes/CVD (P<0.001). Fitness was a potent effect modifier in the association of diabetes and CVD to mortality.

Dynamic trunk stabilization: a conceptual back injury prevention program for volleyball athletes.

Smith, C. E., Nyland, J., Caudill, P., Brosky, J., & Caborn, D. N.. Journal of Orthopaedic and Sports Therapy, 38(11), 703-720, 2008.

The sport of volleyball creates considerable dynamic trunk stability demands. Back injury occurs all too frequently in volleyball, particularly among female athletes. The purpose of this clinical commentary is to review functional anatomy, muscle coactivation strategies, assessment of trunk muscle performance, and the characteristics of effective exercises for the trunk or core. From this information, a conceptual progressive 3-phase volleyball-specific training program is presented to improve dynamic trunk stability and to potentially reduce the incidence of back injury among volleyball athletes. Phase 1 addresses low-velocity motor control, kinesthetic awareness, and endurance, with the clinician providing cues to teach achievement of biomechanically neutral spine alignment. Phase 2 focuses on progressively higher velocity dynamic multiplanar endurance, coordination, and strength-power challenges integrating upper and lower extremity movements, while maintaining neutral spine alignment. Phase 3 integrates volleyball-specific skill simulations by breaking down composite movement patterns into their component parts, with differing dynamic trunk stability requirements, while maintaining neutral spine alignment. Prospective research is needed to validate the efficacy of this program.