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Liddle N, Taylor JM, Chesterton P, Atkinson G. The Effects of Exercise-Based Injury Prevention Programmes on Injury Risk in Adult Recreational Athletes: A Systematic Review and Meta-Analysis. Sports Med 2023:10.1007/s40279-023-01950-w. [PMID: 37889449 DOI: 10.1007/s40279-023-01950-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Injuries are common in adult recreational athletes. Exercise-based injury prevention programmes offer the potential to reduce the risk of injury and have been a popular research topic. Yet, syntheses and meta-analyses on the effects of exercise-based injury prevention programmes for adult recreational athletes are lacking. OBJECTIVES We aimed to synthesise and quantify the pooled intervention effects of exercise-based injury prevention programmes delivered to adults who participate in recreation sports. METHODS Studies were eligible for inclusion if they included adult recreational athletes (aged > 16 years), an exercise-based intervention and used a randomised controlled trial design. Exclusion criteria were studies without a control group, studies using a non-randomised design and studies including participants who were undertaking activity mandatory for their occupation. Eleven literature databases were searched from earliest record, up to 9 June, 2022. The Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias in all included studies. Reported risk statistics were synthesised in a random-effects meta-analysis to quantify pooled treatment effects and associated 95% confidence intervals and prediction intervals. RESULTS Sixteen studies met the criteria. Risk statistics were reported as risk ratios [RRs] (n = 12) or hazard ratios [HRs] (n = 4). Pooled estimates of RRs and HRs were 0.94 (95% confidence interval 0.80-1.09) and 0.65 (95% confidence interval 0.39-1.08), respectively. Prediction intervals were 0.80-1.09 and 0.16-2.70 for RR and HR, respectively. Heterogeneity was very low for RR studies, but high for HR studies (tau = 0.29, I2 = 81%). There was evidence of small study effects for RR studies, evidenced by funnel plot asymmetry and Egger's test for small study bias: - 0.99 (CI - 2.08 to 0.10, p = 0.07). CONCLUSIONS Pooled point estimates were suggestive of a reduced risk of injury in intervention groups. Nevertheless, these risk estimates were insufficiently precise, too heterogeneous and potentially compromised by small study effects to arrive at any robust conclusion. More large-scale studies are required to clarify whether exercise-based injury prevention programmes are effective in adult recreational athletes. CLINICAL TRIAL REGISTRATION The protocol for this review was prospectively registered in the PROSPERO database (CRD42021232697).
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Affiliation(s)
- Nathan Liddle
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BA, UK.
| | - Jonathan M Taylor
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Paul Chesterton
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Greg Atkinson
- School of Sport and Exercise Science, Liverpool John Moores University, Merseyside, UK
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Cho Y, Jang H, Kwon S, Oh H. Aerobic, muscle-strengthening, and flexibility physical activity and risks of all-cause and cause-specific mortality: a population-based prospective cohort of Korean adults. BMC Public Health 2023; 23:1148. [PMID: 37316812 DOI: 10.1186/s12889-023-15969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Studies have shown that aerobic and muscle-strengthening physical activities reduce mortality risk. However, little is known about the joint associations of the two activity types and whether other type of physical activity, such as flexibility activity, can provide similar mortality risk reduction. OBJECTIVES We examined the independent associations of aerobic, muscle-strengthening, and flexibility physical activities with all-cause and cause-specific mortality in a population-based prospective cohort of Korean men and women. We also examined the joint associations of aerobic and muscle-strengthening activities, the two physical activity types that are recommended by the current World Health Organization physical activity guidelines. DESIGN This analysis included 34,379 Korea National Health and Nutrition Examination Survey 2007-2013 participants (aged 20-79 years) with mortality data linkage through December 31, 2019. Engagement in walking, aerobic, muscle-strengthening, and flexibility physical activities was self-reported at baseline. Cox proportional hazards model was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders. RESULTS Flexibility physical activity (≥ 5 vs. 0 d/wk) was inversely associated with all-cause (HR [95% CI] = 0.80 [0.70-0.92]; P-trend < 0.001) and cardiovascular mortality (0.75 [0.55-1.03], P-trend = 0.02). Moderate- to vigorous-intensity aerobic physical activity (≥ 50.0 vs. 0 MET-h/wk) was also associated with lower all-cause (HR [95% CI] = 0.82 [0.70-0.95]; P-trend < 0.001) and cardiovascular mortality (0.55 [0.37-0.80]; P-trend < 0.001). Similar inverse associations were observed with total aerobic physical activity, including walking. Muscle-strengthening activity (≥ 5 vs. 0 d/wk) was inversely associated with all-cause mortality (HR [95% CI] = 0.83 [0.68-1.02]; P-trend = 0.01) but was not associated with cancer or cardiovascular mortality. Compared to participants meeting the highest guidelines for both moderate- to vigorous-intensity aerobic and muscle-strengthening physical activities, those not meeting in any guideline were associated with higher all-cause (1.34 [1.09-1.64]) and cardiovascular mortality (1.68 [1.00-2.82]). CONCLUSIONS Our data suggest that aerobic, muscle-strengthening, and flexibility activities are associated with lower risk of mortality.
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Affiliation(s)
- Yoonkyoung Cho
- Interdisciplinary Program in Precision Public Health, College of Health Science, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hajin Jang
- Interdisciplinary Program in Precision Public Health, College of Health Science, Graduate School of Korea University, Seoul, Republic of Korea
| | - Sohyeon Kwon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, College of Health Science, Graduate School of Korea University, Seoul, Republic of Korea.
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
- Korea University, 145 Anam-ro, Seongbuk-gu Hana Science Bldg B358, Seoul, Republic of Korea.
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Khan M, Alghadir AH. Time-based effects of different duration stretching on calf muscle strength. ISOKINET EXERC SCI 2022. [DOI: 10.3233/ies-220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: There are conflicting reports on the acute effects of stretching on muscle strength. Some studies report reduction in muscle strength however others report no change following stretching. OBJECTIVE: To assess the acute effects of static stretching (SS) of different durations on the isometric maximum voluntary contraction force (MVCF) of the calf muscle. METHODS: Pretest-posttest experimental design was used. Ten male participants (mean age 25.4 ± 2.11 years) participated in three experimental trials: SS for 2-minutes (SS2), 4-minutes (SS4), and 8-minutes (SS8). MVCF was measured before, immediately after, at 10- and 20-minutes post-stretch intervals. Each SS trial involved varied repetitions of 30-seconds stretches and 20-seconds relaxation periods. The isometric maximum voluntary contraction force (MVCF) was the outcome measure. RESULTS: SS2, SS4, and SS8 did not change the MVCF at 0-, 10- and 20-minutes post stretching intervals (p> 0.05). CONCLUSIONS: 2-, 4-, and 8-minutes intermittent SS did not change the isometric muscle strength in the Calf muscle up to 20 minutes after stretching and thus can safely be performed before those sporting events that require significant muscle strength.
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Jacob CDS, Barbosa GK, Rodrigues MP, Pimentel Neto J, Rocha LC, Ciena AP. Stretching prior to resistance training promotes adaptations on the postsynaptic region in different myofiber types. Eur J Histochem 2022; 66. [PMID: 35164481 PMCID: PMC8875788 DOI: 10.4081/ejh.2022.3356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
The morphology of the neuromuscular junction adapts according to changes in its pattern of use, especially at the postsynaptic region according to the myofibrillar type and physical exercise. This investigation revealed the morphological adaptations of the postsynaptic region after static stretching, resistance training, and their association in adult male Wistar rats. We processed the soleus and plantaris muscles for histochemical (muscle fibers) and postsynaptic region imaging techniques. We observed muscle hypertrophy in both groups submitted to resistance training, even though the cross-section area is larger when there is no previous static stretching. The soleus postsynaptic region revealed higher compactness and fragmentation index in the combined exercise. The resistance training promoted higher adaptations in the postsynaptic area of plantaris; moreover, the previous static stretching decreased this area. In conclusion, the neuromuscular system’s components responded according to the myofiber type even though it is the same physical exercise. Besides, static stretching (isolated or combined) plays a crucial role in neuromuscular adaptations.
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Stephenson SD, Kocan JW, Vinod AV, Kluczynski MA, Bisson LJ. A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies. Orthop J Sports Med 2021; 9:23259671211035776. [PMID: 34734094 PMCID: PMC8558815 DOI: 10.1177/23259671211035776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs. Purpose To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries. Study Design Systematic review; Level of evidence, 4. Methods We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version). Results A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias. Conclusion This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.
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Affiliation(s)
- Samuel D Stephenson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Joseph W Kocan
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
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Abstract
Flexibility refers to the intrinsic properties of body tissues that determine maximal joint range of motion without causing injury. For many years, flexibility has been classified by the American College of Sports Medicine as a major component of physical fitness. The notion flexibility is important for fitness has also led to the idea static stretching should be prescribed to improve flexibility. The current paper proposes flexibility be retired as a major component of physical fitness, and consequently, stretching be de-emphasized as a standard component of exercise prescriptions for most populations. First, I show flexibility has little predictive or concurrent validity with health and performance outcomes (e.g., mortality, falls, occupational performance) in apparently healthy individuals, particularly when viewed in light of the other major components of fitness (i.e., body composition, cardiovascular endurance, muscle endurance, muscle strength). Second, I explain that if flexibility requires improvement, this does not necessitate a prescription of stretching in most populations. Flexibility can be maintained or improved by exercise modalities that cause more robust health benefits than stretching (e.g., resistance training). Retirement of flexibility as a major component of physical fitness will simplify fitness batteries; save time and resources dedicated to flexibility instruction, measurement, and evaluation; and prevent erroneous conclusions about fitness status when interpreting flexibility scores. De-emphasis of stretching in exercise prescriptions will ensure stretching does not negatively impact other exercise and does not take away from time that could be allocated to training activities that have more robust health and performance benefits.
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Affiliation(s)
- James L Nuzzo
- Neuroscience Research Australia, Barker Street, Randwick, NSW, Australia, 2031.
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.
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Støve MP, Hirata RP, Palsson TS. The tolerance to stretch is linked with endogenous modulation of pain. Scand J Pain 2021; 21:355-363. [PMID: 34387949 DOI: 10.1515/sjpain-2020-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The effect of stretching on joint range of motion is well documented, and although sensory perception has significance for changes in the tolerance to stretch following stretching the underlining mechanisms responsible for these changes is insufficiently understood. The aim of this study was to examine the influence of endogenous pain inhibitory mechanisms on stretch tolerance and to investigate the relationship between range of motion and changes in pain sensitivity. METHODS Nineteen healthy males participated in this randomized, repeated-measures crossover study, conducted on 2 separate days. Knee extension range of motion, passive resistive torque, and pressure pain thresholds were recorded before, after, and 10 min after each of four experimental conditions; (i) Exercise-induced hypoalgesia, (ii) two bouts of static stretching, (iii) resting, and (iv) a remote, painful stimulus induced by the cold pressor test. RESULTS Exercise-induced hypoalgesia and cold pressor test caused an increase in range of motion (p<0.034) and pressure pain thresholds (p<0.027). Moderate correlations in pressure pain thresholds were found between exercise-induced hypoalgesia and static stretch (Rho>0.507, p=0.01) and exercise-induced hypoalgesia and the cold pressor test (Rho=0.562, p=0.01). A weak correlation in pressure pain thresholds and changes in range of motion were found following the cold pressor test (Rho=0.460, p=0.047). However, a potential carryover hypoalgesic effect may have affected the results of the static stretch. CONCLUSIONS These results suggest that stretch tolerance may be linked with endogenous modulation of pain. Present results suggest, that stretch tolerance may merely be a marker for pain sensitivity which may have clinical significance given that stretching is often prescribed in the rehabilitation of different musculoskeletal pain conditions where reduced endogenous pain inhibition is frequently seen.
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Affiliation(s)
- Morten Pallisgaard Støve
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg East, Denmark
| | - Rogerio Pessoto Hirata
- Department of Health Science and Technology, SMI®, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
| | - Thorvaldur Skuli Palsson
- Department of Health Science and Technology, SMI®, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
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López Mariscal S, Sánchez Garcia V, Fernández-García JC, Sáez de Villarreal E. Acute Effects of Ballistic vs. Passive Static Stretching Involved in a Prematch Warm-up on Vertical Jump and Linear Sprint Performance in Soccer Players. J Strength Cond Res 2021; 35:147-153. [PMID: 29389694 DOI: 10.1519/jsc.0000000000002477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT López Mariscal, S, Sánchez Garcia, V, Fernández-García, JC, and Sáez de Villarreal, E. Acute effects of ballistic vs. passive static stretching involved in a prematch warm-up on vertical jump and linear sprint performance in soccer players. J Strength Cond Res 35(1): 147-153, 2021-The purpose of this study was to compare the effects of introducing passive static and ballistic stretching in a standard soccer match warm-up. The variables addressed were the counter movement jump (CMJ), Abalakov jump, and the 40-m linear sprint. The sample was composed of 33 male subjects, divided into 2 age groups. U16 and adult players formed the groups, to cross check whether there were differences between them. Each group was further subdivided into 2 groups regarding the type of stretching carried out during the stretching phase. Before the warm-up, the tests previously described were assessed. In the experimental phase, standard stretching was carried out, consisting of an initial phase in which players had to execute continuous running; a general phase in which players had to make articulate moves; a technical phase in which players had to execute exercises with the ball; a 5 vs. 5 small-sided game was carried out during the tactical phase; and in the final phase, activation exercises and sprints were carried out by the players. Eventually, the same variables were assessed again once the warm-up was finished. There were no statistically significant differences between the 2 types of stretching included in the prematch warm-up. It can be concluded that ballistic and passive static stretching (<10 seconds) did not cause, under these circumstances, any effect in the assessed variables related to soccer performance (linear sprint, CMJ, and Abalakov). This has to be considered by coaches when devising soccer-related warm-ups.
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Affiliation(s)
- Samuel López Mariscal
- Section of Physical Education and Sport, Department of Sport and Informatics, Pablo de Olavide University, Sevilla, Spain.,Research Department of Malaga C.F. S.A.D, Malaga, Spain; and
| | - Víctor Sánchez Garcia
- Section of Physical Education and Sport, Department of Sport and Informatics, Pablo de Olavide University, Sevilla, Spain
| | | | - Eduardo Sáez de Villarreal
- Section of Physical Education and Sport, Department of Sport and Informatics, Pablo de Olavide University, Sevilla, Spain
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9
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Reply to: Comment on: "The Case for Retiring Flexibility as a Major Component of Physical Fitness". Sports Med 2020; 51:189-191. [PMID: 33057933 DOI: 10.1007/s40279-020-01358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Acute Effects of Intermittent and Continuous Static Stretching on Hip Flexion Angle in Athletes with Varying Flexibility Training Background. Sports (Basel) 2020; 8:sports8030028. [PMID: 32138183 PMCID: PMC7183084 DOI: 10.3390/sports8030028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
Τhis study examined changes in hip joint flexion angle after an intermittent or a continuous static stretching protocol of equal total duration. Twenty-seven female subjects aged 19.9 ± 3.0 years (14 artistic and rhythmic gymnasts and 13 team sports athletes), performed 3 min of intermittent (6 × 30 s with 30 s rest) or continuous static stretching (3 min) of the hip extensors, with an intensity of 80–90 on a 100-point visual analogue scale. The order of stretching was randomized and counterbalanced, and each subject performed both conditions. Hip flexion angle was measured with the straight leg raise test for both legs after warm-up and immediately after stretching. Both stretching types equally increased hip flexion angle by ~6% (continuous: 140.9° ± 20.4° to 148.6° ± 18.8°, p = 0.047; intermittent: 141.8° ± 20.3° to 150.0° ± 18.8°, p = 0.029) in artistic and rhythmic gymnasts. In contrast, in team sports athletes, only intermittent stretching increased hip flexion angle by 13% (from 91.0° ± 7.2° to 102.4° ± 14.5°, p = 0.001), while continuous stretching did not affect hip angle (from 92.4° ± 6.9° vs. 93.1° ± 9.2°, p = 0.99). The different effect of intermittent vs. continuous stretching on hip flexion between gymnasts and team sports athletes suggests that responses to static stretching are dependent on stretching mode and participants training experience.
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Siebert T, Donath L, Borsdorf M, Stutzig N. Effect of Static Stretching, Dynamic Stretching, and Myofascial Foam Rolling on Range of Motion During Hip Flexion: A Randomized Crossover Trial. J Strength Cond Res 2020; 36:680-685. [PMID: 34379375 DOI: 10.1519/jsc.0000000000003517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Siebert, T, Donath, L, Borsdorf, M, and Stutzig, N. Effect of static stretching, dynamic stretching, and myofascial foam rolling on range of motion during hip flexion: A randomized crossover trial. J Strength Cond Res XX(X): 000-000, 2020-Static and dynamic stretching (DS) are commonly used in sports and physical therapy to increase the range of motion (ROM). However, prolonged static stretching (SS) can deteriorate athletic performance. Alternative methods to increase ROM are thus needed. Foam rolling (FR) may initiate muscle relaxation, improve muscular function, physical performance, and ROM. Previous studies that examined effects of FR on ROM did not control for increased tissue compliance or shifted pain threshold. In this study, the isolated influence of altered tissue compliance on ROM after FR, SS, and DS was investigated using a randomized crossover design. Hip flexion ROM at given joint torques before and after SS, DS, and FR was randomly assessed in 14 young male adults (age: 23.7 +/- 1.3 years; height: 182 +/- 8 cm; body mass: 79.4 +/- 6.9 kg). Hip flexion ROM was measured in the sagittal plane with the subjects lying in a lateral position (no gravitational effects on ROM measurements). Surface electromyographic (EMG) analysis of 2 representative hip extensors (M. biceps femoris and M. semitendinosus) was applied to control for active muscle contribution during ROM measurements. Significant increases in ROM for SS (3.8 +/- 1.1[degrees]; p < 0.001) and DS (3.7 +/- 1.8[degrees]; p < 0.001) were observed, but not for FR (0.8 +/- 3.1[degrees]; p = 0.954). Because stretch forces on tendon and muscle tissue during SS and DS predominately act in longitudinal direction, FR induces mainly transversal forces in the muscle tissue. Thus, increased ROM after FR reported in the literature is more likely due to a shift in the pain threshold. These results provide a better understanding of differential loading conditions during SS, DS, and FR for coaches and practitioners.
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Affiliation(s)
- Tobias Siebert
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Mischa Borsdorf
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Norman Stutzig
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
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Donti O, Panidis I, Terzis G, Bogdanis GC. Gastrocnemius Medialis Architectural Properties at Rest and During Stretching in Female Athletes with Different Flexibility Training Background. Sports (Basel) 2019; 7:sports7020039. [PMID: 30781768 PMCID: PMC6410170 DOI: 10.3390/sports7020039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/01/2019] [Accepted: 02/10/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study examined gastrocnemius medialis (GM) architectural properties and ankle joint range of motion (ROM) between female athletes with different flexibility training background. METHODS Elite rhythmic gymnasts (n = 10) were compared to national level volleyball athletes (n = 10). Fascicle length, pennation angle and muscle thickness at the medial and the distal part of GM, and ankle ROM were measured at rest and during 1 min of static stretching. RESULTS At rest, rhythmic gymnasts displayed longer fascicles compared to volleyball athletes, at the medial (5.93 ± 0.27 vs. 4.74 ± 0.33 mm, respectively, p = 0.001) and the distal part of GM (5.63 ± 0.52 vs. 4.57 ± 0.51 mm, respectively, p = 0.001), smaller pennation angle at the medial part (22.4 ± 2.5 vs. 25.8 ± 2.4°; respectively, p = 0.001) and greater ankle angle (121.7 ± 4.1 vs. 113.2 ± 3.7°, respectively, p = 0.001). During the 1 min of static stretching, gymnasts displayed greater fascicle elongation at the distal part (p = 0.026), greater maximal ankle dorsiflexion (p < 0.001) and muscle tendon junction displacement (p < 0.001) with no difference between groups in pennation angles (p > 0.145), muscle thickness (p > 0.105), and fascicle elongation at mid-belly (p = 0.063). CONCLUSIONS Longer muscle fascicles at rest and greater fascicle elongation at the distal part of GM may contribute to the greater ankle ROM observed in rhythmic gymnasts.
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Affiliation(s)
- Olyvia Donti
- Sports Performance Laboratory, School of Physical Education & Sport Science, National and Kapodistrian University of Athens, Athens 17237, Greece.
| | - Ioli Panidis
- Sports Performance Laboratory, School of Physical Education & Sport Science, National and Kapodistrian University of Athens, Athens 17237, Greece.
| | - Gerasimos Terzis
- Sports Performance Laboratory, School of Physical Education & Sport Science, National and Kapodistrian University of Athens, Athens 17237, Greece.
| | - Gregory C Bogdanis
- Sports Performance Laboratory, School of Physical Education & Sport Science, National and Kapodistrian University of Athens, Athens 17237, Greece.
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Vriend I, Gouttebarge V, Finch CF, van Mechelen W, Verhagen EALM. Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix. Sports Med 2018; 47:2027-2043. [PMID: 28303544 PMCID: PMC5603636 DOI: 10.1007/s40279-017-0718-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered. OBJECTIVE Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps. METHODS Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure. RESULTS A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5). CONCLUSIONS Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.
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Affiliation(s)
- Ingrid Vriend
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Caroline F Finch
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
| | - Willem van Mechelen
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Evert A L M Verhagen
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands. .,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia.
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14
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Oosterhoff JHF, Gouttebarge V, Moen M, Staal JB, Kerkhoffs GMMJ, Tol JL, Pluim BM. Risk factors for musculoskeletal injuries in elite junior tennis players: a systematic review. J Sports Sci 2018; 37:131-137. [PMID: 29912622 DOI: 10.1080/02640414.2018.1485620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The objective was to systematically review the literature on risk factors and prevention programs for musculoskeletal injuries among tennis players. PubmedMedline, Embase, CINAHL, Cochrane, SportDiscus were searched up to February 2017. Experts in clinical and epidemiological medicine were contacted to obtain additional studies. For risk factors, prospective cohort studies (n > 20) with a statistical analysis for injured and non-injured players were included and studies with a RCT design for prevention programs. Downs&Black checklist was assessed for risk of bias for risk factors. From a total of 4067 articles, five articles met our inclusion criteria for risk factors. No studies on effectiveness of prevention programs were identified. Quality of studies included varied from fair to excellent. Best evidence synthesis revealed moderate evidence for previous injury regardless of body location in general and fewer years of tennis experience for the occurrence of upper extremity injuries. Moderate evidence was found for lower back injuries, a previous back injury, playing >6hours/week and low lateral flexion of the neck for risk factors. Limited evidence was found for male gender as a risk factor. The risk factors identified can assist clinicians in developing prevention-strategies. Further studies should focus on risk factor evaluation in recreational adult tennis players.
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Affiliation(s)
- Jacobien H F Oosterhoff
- a Amsterdam Center of Evidence Based Sports Medicine , Academic Medical Center , Amsterdam , the Netherlands
| | - Vincent Gouttebarge
- a Amsterdam Center of Evidence Based Sports Medicine , Academic Medical Center , Amsterdam , the Netherlands
| | - Maarten Moen
- b Department of Sports Medicine , Bergman Clinics , Naarden , the Netherlands.,c The Sports Physician Group , Onze Lieve Vrouwe Gasthuis West , Amsterdam , the Netherlands
| | - J Bart Staal
- d Radboud University Medical Center , Radboud Institute for Health Science, Scientific Institute for Quality of Healthcare , Nijmegen , the Netherlands
| | - Gino M M J Kerkhoffs
- e Department of Orthopaedic Surgery , Academic Medical Center , Amsterdam , the Netherlands
| | - Johannes L Tol
- a Amsterdam Center of Evidence Based Sports Medicine , Academic Medical Center , Amsterdam , the Netherlands.,f Amsterdam Collaboration for Health and Safety in Sports , Academic Medical Center , Amsterdam , the Netherlands.,g Department of Sports Medicine , Aspetar Qatar Orthopaedic and Sports Medicine Hospital , Doha , Qatar
| | - Babette M Pluim
- h KNLTB , Royal Netherlands Lawn Tennis Association , Amersfoort , the Netherlands
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15
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Notarnicola A, Perroni F, Campese A, Maccagnano G, Monno A, Moretti B, Tafuri S. Flexibility responses to different stretching methods in young elite basketball players. Muscles Ligaments Tendons J 2018; 7:582-589. [PMID: 29721460 DOI: 10.11138/mltj/2017.7.4.582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The aims of study were: 1) to verify the effectiveness of different stretching methods and training; 2) to compare the effects with only training on the flexibility of joints in basketball players. Methods 30 males basketball players (age: 17±1yrs; BMI: 23.4±3.1), divided into 2 groups (15 experimental group - EG - and 15 control group, CG), participated to study. EG performed 5 different stretching method: passive stretching, active stretching, postural protocol, PNF and dynamic stretching. To assess differences (p<0.05) between groups, an ANOVA was applied to anthropometrics characteristic (age; height; weight and BMI) and flexibility performances (leg raise in a supine position; forward trunk bending). ANOVA for repeated measurements was conducted to asses differences in each group with time (i.e., pre-post). Results Results showed a variation linked to time (F=21.9; p<0.0001) and an effect of the treatment of the leg raise in a supine position test (F=25.1; p<0.0001). Also in flexion test of trunk, the average values could be linked to time of measurement (F=9.96; p<0.0001) and group (F=8.65; p<0.0001). Conclusion The results suggest that a specific different stretching protocol should be used in different part of body to offer performance benefit and decreasing of the incidents of injuries. Level of evidence IV.
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Affiliation(s)
- Angela Notarnicola
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy.,Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Bari, Italy
| | - Fabrizio Perroni
- Department of Medical Sciences, School of Exercise and Sport Sciences (SUISM), University of Turin, Italy
| | - Alessio Campese
- Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Bari, Italy
| | - Giuseppe Maccagnano
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy
| | - Antonio Monno
- Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Bari, Italy
| | - Biagio Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy.,Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Bari, Italy
| | - Silvio Tafuri
- Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Bari, Italy.,Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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16
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The Efficacy of Dynamic Contract-Relax Stretching on Delayed-Onset Muscle Soreness Among Healthy Individuals: A Randomized Clinical Trial. Clin J Sport Med 2018; 28:28-36. [PMID: 28742609 DOI: 10.1097/jsm.0000000000000442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy of dynamic contract-relax stretching on delayed-onset muscle soreness (DOMS) in the calf muscle of healthy individuals. DESIGN Randomized clinical trial. SETTING Research laboratory. PARTICIPANTS Three groups of 16 healthy participants (n = 48) were recruited by convenience sampling. INTERVENTIONS Three sets of resisted bilateral heel-raising exercises until exhaustion were conducted to initiate DOMS. Participants were randomly allocated into control group without any interventions, dynamic contract-relax stretching (DS), or static stretching (SS) groups. Dynamic contract-relax stretching and SS groups performed DS and SS, respectively, on the dominant leg twice a day for 5 consecutive days (before time points of outcome measurements at 24, 48, 72, 96, and 120 hours postexercise, respectively). MAIN OUTCOME MEASURES Muscle soreness, lower leg girth, pressure pain threshold (PPT), range of motion (ROM), and muscle strength were measured before exercise, immediately after, and at 24, 48, 72, 96, and 120 hours postexercise. RESULTS There was a significant effect of time in all outcome measures including muscle soreness, lower leg girth, PPT, ROM, and muscle strength; however, there were no significant group differences or group by time interactions. CONCLUSIONS The effect of DS on relieving DOMS in the calf muscle is insignificant in this study. Further evidence is needed to prove the efficacy of DS on DOMS. CLINICAL RELEVANCE Stretching is commonly recommended before and after exercise; however, this study showed no significant impact of DS or SS in treating DOMS.
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17
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Donti Ο, Papia K, Toubekis A, Donti A, Sands WA, Bogdanis GC. Flexibility training in preadolescent female athletes: Acute and long-term effects of intermittent and continuous static stretching. J Sports Sci 2017; 36:1453-1460. [PMID: 29086625 DOI: 10.1080/02640414.2017.1397309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study compared the acute and long-term effects of intermittent and continuous static stretching training on straight leg raise range of motion (ROM). Seventy-seven preadolescent female gymnasts were divided into a stretching (n = 57), and a control group (n = 20). The stretching group performed static stretching of the hip extensors of both legs, three times per week for 15 weeks. One leg performed intermittent (3 × 30 s with 30 s rest) while the other leg performed continuous stretching (90 s). ROM pre- and post-stretching was measured at baseline, on weeks 3, 6, 9, 12, 15 and after 2 weeks of detraining. ROM was increased during both intermittent and continuous stretching training, but remained unchanged in the control group. Intermittent stretching conferred a larger improvement in ROM compared to both continuous stretching and control from week 3, until the end of training, and following detraining (p = 0.045 to 0.001 and d = 0.80 to 1.41). During detraining, ROM after the intermittent protocol decreased (p = 0.001), while it was maintained after the continuous protocol (p = 0.36). Acute increases in ROM following the intermittent stretching were also larger than in the continuous (p = 0.038). Intermittent stretching was more effective than continuous, for both long-term and acute ROM enhancement in preadolescent female athletes.
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Affiliation(s)
- Οlyvia Donti
- a School of Physical Education and Sport Science , National and Kapodistrian University of Athens , Athens , Greece
| | - Konstantina Papia
- a School of Physical Education and Sport Science , National and Kapodistrian University of Athens , Athens , Greece
| | - Argyris Toubekis
- a School of Physical Education and Sport Science , National and Kapodistrian University of Athens , Athens , Greece
| | - Anastasia Donti
- a School of Physical Education and Sport Science , National and Kapodistrian University of Athens , Athens , Greece
| | - William A Sands
- b High-Performance , United States Ski and Snowboard Association (USSA) , Park City , UT , USA
| | - Gregory C Bogdanis
- a School of Physical Education and Sport Science , National and Kapodistrian University of Athens , Athens , Greece
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18
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Wardle SL, Greeves JP. Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel. J Sci Med Sport 2017; 20 Suppl 4:S3-S10. [PMID: 29103913 DOI: 10.1016/j.jsams.2017.09.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To update the current injury prevention strategy evidence base for making recommendations to prevent physical training-related musculoskeletal injury. DESIGN We conducted a systematic review to update the evidence base on injury prevention strategies for military personnel. METHODS Literature was systematically searched and extracted from five databases, and reported according to PRISMA guidelines. Sixty one articles meeting the inclusion criteria and published during the period 2008-2015 were selected for systematic review. RESULTS The retrieved articles were broadly categorised into six injury prevention strategies; (1) conditioning, (2) footwear modifications, (3) bracing, (4) physical activity volume, (5) physical fitness, and (6) leadership/supervision/awareness. The majority of retrieved articles (n=37 (of 61) evaluated or systematically reviewed a conditioning intervention of some nature. However, the most well-supported strategies were related to reducing physical activity volume and improving leadership/supervision/awareness of injuries and injury prevention efforts. CONCLUSIONS Several injury prevention strategies effectively reduce musculoskeletal injury rates in both sexes, and many show promise for utility with military personnel. However, further evaluation, ideally with prospective randomised trials, is required to establish the most effective injury prevention strategies, and to understand any sex-specific differences in the response to these strategies.
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Affiliation(s)
- Sophie L Wardle
- Division of Applied Human Physiology, Army Personnel Research Capability, Army Headquarters, Andover, UK.
| | - Julie P Greeves
- Division of Applied Human Physiology, Army Personnel Research Capability, Army Headquarters, Andover, UK
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19
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van Reijen M, Vriend I, van Mechelen W, Finch CF, Verhagen EA. Compliance with Sport Injury Prevention Interventions in Randomised Controlled Trials: A Systematic Review. Sports Med 2017; 46:1125-39. [PMID: 26869058 PMCID: PMC4963451 DOI: 10.1007/s40279-016-0470-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for. OBJECTIVE The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention. METHODS An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport- or physical activity-related injuries were included. RESULTS Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented. CONCLUSIONS Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.
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Affiliation(s)
- Miriam van Reijen
- Department of Public & Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands
| | - Ingrid Vriend
- Department of Public & Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Department of Public & Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
| | - Evert A Verhagen
- Department of Public & Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands. .,Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands. .,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. .,UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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20
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Baxter C, Mc Naughton LR, Sparks A, Norton L, Bentley D. Impact of stretching on the performance and injury risk of long-distance runners. Res Sports Med 2016; 25:78-90. [PMID: 27912252 DOI: 10.1080/15438627.2016.1258640] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Stretching, either prior to exercise or at the end, or both, is typically carried out by all individuals undertaking sporting activity whether they be elite or recreational athletes. The many forms of stretching available to the athlete, either passive or active, have long been thought to improve performance, decrease injury and generally be advantageous to the athlete. This review examines the current state of the literature and evaluates what athletes can and should do with respect to this controversial topic.
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Affiliation(s)
- Claire Baxter
- a School of Health Science , Flinders University , Adelaide , South Australia , Australia
| | - Lars R Mc Naughton
- b Sport and Physical Activity , Edge Hill University , Ormskirk , United Kingdom
| | - Andy Sparks
- b Sport and Physical Activity , Edge Hill University , Ormskirk , United Kingdom
| | - Lynda Norton
- a School of Health Science , Flinders University , Adelaide , South Australia , Australia
| | - David Bentley
- a School of Health Science , Flinders University , Adelaide , South Australia , Australia
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21
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Behm DG, Blazevich AJ, Kay AD, McHugh M. Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Appl Physiol Nutr Metab 2015; 41:1-11. [PMID: 26642915 DOI: 10.1139/apnm-2015-0235] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, there has been a shift from static stretching (SS) or proprioceptive neuromuscular facilitation (PNF) stretching within a warm-up to a greater emphasis on dynamic stretching (DS). The objective of this review was to compare the effects of SS, DS, and PNF on performance, range of motion (ROM), and injury prevention. The data indicated that SS- (-3.7%), DS- (+1.3%), and PNF- (-4.4%) induced performance changes were small to moderate with testing performed immediately after stretching, possibly because of reduced muscle activation after SS and PNF. A dose-response relationship illustrated greater performance deficits with ≥60 s (-4.6%) than with <60 s (-1.1%) SS per muscle group. Conversely, SS demonstrated a moderate (2.2%) performance benefit at longer muscle lengths. Testing was performed on average 3-5 min after stretching, and most studies did not include poststretching dynamic activities; when these activities were included, no clear performance effect was observed. DS produced small-to-moderate performance improvements when completed within minutes of physical activity. SS and PNF stretching had no clear effect on all-cause or overuse injuries; no data are available for DS. All forms of training induced ROM improvements, typically lasting <30 min. Changes may result from acute reductions in muscle and tendon stiffness or from neural adaptations causing an improved stretch tolerance. Considering the small-to-moderate changes immediately after stretching and the study limitations, stretching within a warm-up that includes additional poststretching dynamic activity is recommended for reducing muscle injuries and increasing joint ROM with inconsequential effects on subsequent athletic performance.
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Affiliation(s)
- David G Behm
- a School of Human Kinetics and Recreation, Memorial University, St. John's, NL A1C 5S7, Canada
| | - Anthony J Blazevich
- b Centre for Exercise and Sports Science Research, Edith Cowan University, Joondalup Campus, 270 Joondalup Drive, Joondalup, WA 6027, Australia
| | - Anthony D Kay
- c Sport, Exercise and Life Sciences, School of Health, The University of Northampton, Northampton NN2 7AL, UK
| | - Malachy McHugh
- d Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY 10075, USA
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22
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Steele RJ, Shrier I, Kaufman JS, Platt RW. Simple Estimation of Patient-Oriented Effects From Randomized Trials: An Open and Shut CACE. Am J Epidemiol 2015; 182:557-66. [PMID: 26283090 DOI: 10.1093/aje/kwv065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 03/09/2015] [Indexed: 11/12/2022] Open
Abstract
In randomized controlled trials, the intention-to-treat estimator provides an unbiased estimate of the causal effect of treatment assignment on the outcome. However, patients often want to know what the effect would be if they were to take the treatment as prescribed (the patient-oriented effect), and several researchers have suggested that the more relevant causal effect for this question is the complier average causal effect (CACE), also referred to as the local average treatment effect. Sophisticated approaches to estimating the CACE include Bayesian and frequentist methods for principal stratification, inverse-probability-of-treatment-weighted estimators, and instrumental-variable (IV) analysis. All of these approaches exploit information about adherence to assigned treatment to improve upon the intention-to-treat estimator, but they are rarely used in practice, probably because of their complexity. The IV principal stratification estimator is simple to implement but has had limited use in practice, possibly due to lack of familiarity. Here, we show that the IV principal stratification estimator is a modified per-protocol estimator that should be obtainable from any randomized controlled trial, and we provide a closed form for its robust variance (and its uncertainty). Finally, we illustrate sensitivity analyses we conducted to assess inference in light of potential violations of the exclusion restriction assumption.
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23
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Wang RY, Wang YL, Cheng FY, Chao YH, Chen CL, Yang YR. Effects of combined exercise on gait variability in community-dwelling older adults. AGE (DORDRECHT, NETHERLANDS) 2015; 37:9780. [PMID: 25907712 PMCID: PMC4408301 DOI: 10.1007/s11357-015-9780-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
Training that focuses on strength, balance, and endurance, the so-called combined exercise, can enhance physical function, including gait, according to a literature review. However, the effects of combined exercise on improving gait variability are limited. The objective of this study is to investigate the effects of 12 weeks of combined exercise comprised of resistance, endurance, and balance training on gait performance in older adults. Twenty-nine community-dwelling older adults were recruited and assigned to either the experimental group (n = 17) or the control group (n = 12). The 12-week intervention was a combined exercise program at 1 h per day and 3 days per week. The participants received an assessment for both a 6-min walk and gait during both habitual walking and fast walking conditions at pre-intervention and after 8 and 12 weeks of exercise. The 6-min walk was used to assess gait endurance. GAITRite was used to evaluate gait. An analysis of covariance with the pretest score as the covariate was used to determine the difference in each dependent variable between groups. The level of significance was set as p less than 0.05. Our results showed significant between-group effects in the 6-min walk and velocity, stride time, and stride length in both conditions after 8 weeks of exercise and significant between-group effects in the 6-min walk test and all selected gait parameters in both conditions after 12 weeks of exercise. Our findings demonstrate that a 12-week combined exercise program may positively affect gait endurance and gait performance including gait variability in habitual walking and fast walking conditions among older adults. The current study provides important evidence of short-term combined exercise effects on improvements in gait performance.
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Affiliation(s)
- Ray-Yau Wang
- />Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Beitou, Taipei, Taiwan
| | - Yuan-Li Wang
- />Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Beitou, Taipei, Taiwan
| | - Fang-Yu Cheng
- />Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Beitou, Taipei, Taiwan
| | - Yuan-Hung Chao
- />Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Beitou, Taipei, Taiwan
- />School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Liang Chen
- />Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Yea-Ru Yang
- />Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Beitou, Taipei, Taiwan
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Sport-specific trunk muscle profiles in soccer players of different skill levels. Arch Orthop Trauma Surg 2015; 135:659-65. [PMID: 25726021 DOI: 10.1007/s00402-015-2178-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Physical fitness and trunk stability are essential factors for successful soccer competition. MATERIALS AND METHODS We investigated the impact of soccer exposure on the trunk muscle profile of players of different skill levels. Professional and amateur soccer players were examined for trunk flexibility and maximum isometric muscle strength in the midseason period 2011. RESULTS 24 professional soccer players who had not participated in any specific trunk muscle training programmes had significantly higher isometric trunk muscle strength in the sagittal plane (Ext: p = 0.003, Flex: p = 0.014), the frontal plane (Lat. right: p = 0.001, left: p = 0.003) and the transverse plane (Rotation right and left: p < 0.001) than 83 amateur soccer players. Professional players also had higher trunk flexibility in the sagittal plane (Flex: p = 0.001) and the transverse plane (Rotation right: p = 0.02, left: p = 0.002) than amateur players. The side of the dominant kicking leg had no influence on muscle strength and flexibility of the trunk. CONCLUSION Trunk flexibility and stability as necessary factors for avoiding physical overstress and injuries are differently trained in player of different soccer skill levels.
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25
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Pinto MD, Wilhelm EN, Tricoli V, Pinto RS, Blazevich AJ. Differential Effects of 30- Vs. 60-Second Static Muscle Stretching on Vertical Jump Performance. J Strength Cond Res 2014; 28:3440-6. [DOI: 10.1519/jsc.0000000000000569] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Interventions to prevent sports related injuries: a systematic review and meta-analysis of randomised controlled trials. Sports Med 2014; 44:473-86. [PMID: 24370993 DOI: 10.1007/s40279-013-0136-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effects of methods to prevent injuries have been studied in several systematic reviews. However, no meta-analysis taking into account all randomised controlled intervention trials aiming at the prevention of sports injuries has been published. OBJECTIVE To summarise the effects of sports injury prevention interventions. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES PubMed, MEDLINE, SPORTDiscus, the Cochrane Central Register of Controlled Trials, CINAHL, PEDro, and Web of Science, searched in September 2013. The reference lists of retrieved articles and reviews were hand searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES To be selected articles had to examine the effects of any preventive intervention on sports injuries, be randomised/quasi-randomised and controlled trials, published in a peer-reviewed journal. The outcome of the trial had to be injury rate or the number of injured individuals. RESULTS Of the 5580 articles retrieved after a search of databases and the relevant bibliography, 68 randomised controlled trials were included in the systematic review and 60 trials were included in the meta-analysis. Insoles (OR 0.51, 95% CI 0.32-0.81), external joint supports (OR 0.40, 95% CI 0.30-0.53), and specific training programmes (OR 0.55, 95% CI 0.46-0.66) appeared to be effective in reducing the risk of sports injuries. Stretching (OR 0.92, 95% CI 0.80-1.06), modified shoes (OR 1.23, 95% CI 0.81-1.87), and preventive videos (OR 0.86, 95% CI 0.44-1.68) seemed not to be effective. CONCLUSIONS This meta-analysis showed that certain interventions can reduce the risk of sports injuries. There were limitations regarding the quality of the trials, generalisability of the results, and heterogeneity of the study designs. In future, the mechanisms behind effective methods and the most beneficial elements of preventive training programmes need to be clarified.
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Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Clin J Sport Med 2014; 24:3-20. [PMID: 24366013 DOI: 10.1097/jsm.0000000000000060] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2013; 48:871-7. [DOI: 10.1136/bjsports-2013-092538] [Citation(s) in RCA: 254] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shrier I, Steele RJ, Verhagen E, Herbert R, Riddell CA, Kaufman JS. Beyond intention to treat: what is the right question? Clin Trials 2013; 11:28-37. [PMID: 24096636 DOI: 10.1177/1740774513504151] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most methodologists recommend intention-to-treat (ITT) analysis in order to minimize bias. Although ITT analysis provides an unbiased estimate for the effect of treatment assignment on the outcome, the estimate is biased for the actual effect of receiving treatment (active treatment) compared to some comparison group (control). Other common analyses include measuring effects in (1) participants who follow their assigned treatment (Per Protocol), (2) participants according to treatment received (As Treated), and (3) those who would comply with recommended treatment (Complier Average Causal Effect (CACE) as estimated by Principal Stratification or Instrumental Variable Analyses). As each of these analyses compares different study subpopulations, they address different research questions. PURPOSE For each type of analysis, we review and explain (1) the terminology being used, (2) the main underlying concepts, (3) the questions that are answered and whether the method provides valid causal estimates, and (4) the situations when the analysis should be conducted. METHODS We first review the major concepts in relation to four nuances of the clinical question, 'Does treatment improve health?' After reviewing these concepts, we compare the results of the different analyses using data from two published randomized controlled trials (RCTs). Each analysis has particular underlying assumptions and all require dichotomizing adherence into Yes or No. We apply sensitivity analyses so that intermediate adherence is considered (1) as adherence and (2) as non-adherence. RESULTS The ITT approach provides an unbiased estimate for how active treatment will improve (1) health in the population if a policy or program is enacted or (2) health of patients if a clinician changes treatment practice. The CACE approach generally provides an unbiased estimate of the effect of active treatment on health of patients who would follow the clinician's advice to take active treatment. Unfortunately, there is no current analysis for clinicians and patients who want to know whether active treatment will improve the patient's health if taken, which is different from the effect in patients who would follow the clinician's advice to take active treatment. Sensitivity analysis for the CACE using two published data sets suggests that the underlying assumptions appeared to be violated. LIMITATIONS There are several methods within each analytical approach we describe. Our analyses are based on a subset of these approaches. CONCLUSIONS Although adherence-based analyses may provide meaningful information, the analytical method should match the clinical question, and investigators should clearly outline why they believe assumptions hold and should provide empirical tests of the assumptions where possible.
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Affiliation(s)
- Ian Shrier
- aCentre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Taylor JB, Waxman JP, Richter SJ, Shultz SJ. Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis. Br J Sports Med 2013; 49:79-87. [PMID: 23922282 DOI: 10.1136/bjsports-2013-092358] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury prevention programmes have shown mixed results, which may be due to differing emphasis on training components. The purpose of this study was to (1) quantify the overall and relative duration of each training component encompassed within these programmes and (2) examine the effect of these durations on ACL injury rates. METHODS A systematic review was completed and meta-analyses performed on eligible studies to produce a pooled OR estimate of the effectiveness of these programmes. Meta-regression was used to detect any relationship that programme duration and the duration of individual training components had on ACL injury rates. RESULTS 13 studies were included for review. Results of the meta-analyses revealed a significant reduction of injuries after preventative training programmes for all ACL injuries (pooled OR estimate of 0.612, 95% CI 0.44 to 0.85; p=0.004) and for non-contact ACL injuries (OR 0.351, 95% CI 0.23 to 0.54; p<0.001). Results of meta-regression analysis revealed that a greater duration of balance training was associated with a higher injury risk for ACL injury (p=0.04), while greater durations of static stretching was associated with a lower injury risk for non-contact ACL injuries (p=0.04). CONCLUSIONS While ACL prevention programmes are successful in reducing the risk of ACL injury, the ideal combination and emphasis of training components within these programmes remains unclear. Evidence indicates that greater emphases on balance training and static stretching may be associated with an increase and decrease in injury risk, respectively.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA Applied Neuromechanics Research Laboratory, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Justin P Waxman
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Scott J Richter
- Department of Mathematics and Statistics, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Sandra J Shultz
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Moraes GCD, Guimarães ATB, Gomes ARS. Analysis of injuries' prevalence in surfers from Paraná seacoast. ACTA ORTOPEDICA BRASILEIRA 2013; 21:213-8. [PMID: 24453671 PMCID: PMC3862004 DOI: 10.1590/s1413-78522013000400006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/18/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to analyze the prevalence of musculoskeletal injuries of surfers from the Paraná's seacoast. METHODS Sixty men (27 ± 6 years) completed a surf semi structured questionnaire (category, time of daily practice, frequency and exercises performed before and/or after surfing) and characteristics of injuries induced by this sport. A descriptive analysis of the data on distribution of the relative frequency was performed. RESULTS It was found that 70% of the respondents practiced surfing as a relaxing activity, 28% were amateurs and 2% were professionals, who were surfing for 10 years or more. Most of them surfed between 2 to 4 times a week during 2 to 4 hours a day. The most common exercise performed before surfing was upper and lower limbs stretching and no exercises at all was done after practice. The most common injury was contusion (29%), lower limb was the most affected segment (46%) and the most common cause of injury was due to contact with the board (52%). The interruption period mostly reported was 1-3 months and the most frequent treatment was taking medicines. CONCLUSIONS Recreational was the predominant category of surfers with lower limb's contusion as the most common musculoskeletal injury, resulting from contact with the board, being treated with medication and rest. Level of Evidence II, Retrospective Study.
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Mathieu E, Barratt A, Carter SM, Jamtvedt G. Internet trials: participant experiences and perspectives. BMC Med Res Methodol 2012; 12:162. [PMID: 23092116 PMCID: PMC3533967 DOI: 10.1186/1471-2288-12-162] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/19/2012] [Indexed: 12/21/2022] Open
Abstract
Background Use of the Internet to conduct randomised controlled trials is increasing, and provides potential to increase equity of access to medical research, increase the generalisability of trial results and decrease the costs involved in conducting large scale trials. Several studies have compared response rates, completeness of data, and reliability of surveys using the Internet and traditional methods, but very little is known about participants’ attitudes towards Internet-based randomised trials or their experience of participating in an Internet-based trial. Objective To obtain insights into the experiences and perspectives of participants in an Internet-based randomised controlled trial, their attitudes to the use of the Internet to conduct medical research, and their intentions regarding future participation in Internet research. Methods All English speaking participants in a recently completed Internet randomised controlled trial were invited to participate in an online survey. Results 1246 invitations were emailed. 416 participants completed the survey between May and October 2009 (33% response rate). Reasons given for participating in the Internet RCT fell into 4 main areas: personal interest in the research question and outcome, ease of participation, an appreciation of the importance of research and altruistic reasons. Participants’ comments and reflections on their experience of participating in a fully online trial were positive and less than half of participants would have participated in the trial had it been conducted using other means of data collection. However participants identified trade-offs between the benefits and downsides of participating in Internet-based trials. The main trade-off was between flexibility and convenience – a perceived benefit – and a lack connectedness and understanding – a perceived disadvantage. The other tradeoffs were in the areas of: ease or difficulty in use of the Internet; security, privacy and confidentiality issues; perceived benefits and disadvantages for researchers; technical aspects of using the Internet; and the impact of Internet data collection on information quality. Overall, more advantages were noted by participants, consistent with their preference for this mode of research over others. The majority of participants (69%) would prefer to participate in Internet-based research compared to other modes of data collection in the future. Conclusion Participants in our survey would prefer to participate in Internet-based trials in the future compared to other ways of conducting trials. From the participants’ perspective, participating in Internet-based trials involves trade-offs. The central trade-off is between flexibility and convenience – a perceived benefit – and lack of connectedness and understanding – a perceived disadvantage. Strategies to maintain the convenience of the Internet while increasing opportunities for participants to feel supported, well-informed and well-understood would seem likely to increase the acceptability of Internet-based trials.
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Affiliation(s)
- Erin Mathieu
- School of Medicine, University of Western Sydney, Campbelltown, Australia.
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Mathieu E, McGeechan K, Barratt A, Herbert R. Internet-based randomized controlled trials: a systematic review. J Am Med Inform Assoc 2012; 20:568-76. [PMID: 23065196 DOI: 10.1136/amiajnl-2012-001175] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The internet is increasingly being used to conduct randomized controlled trials (RCTs). Knowledge of the types of interventions evaluated and the methodological quality of these trials could inform decisions about whether to conduct future trials using conventional methods, fully online or a mixture of the two. OBJECTIVE To identify and describe the scope of internet-based RCTs for human health condition interventions and evaluate their methodological quality. METHODS A systematic review of RCTs of any health intervention conducted fully or primarily on the internet was carried out. RESULTS 23 fully and 27 primarily internet-based RCTs were identified. The first was conducted in 2000. The majority of trials evaluated interventions that involved providing health information to participants, but a few evaluated self-administered interventions (eg, valerian, stretching). Methodological quality was variable and the methods were generally poorly reported. The risk of bias was low in only a small number of trials; most had substantial methodological shortcomings. Only one trial was identified as meeting all criteria for adequate methodological quality. A particular problem was high rates of loss to follow-up (fully online: mean 47%; primarily online: mean 36%). CONCLUSIONS It is theoretically possible but perhaps difficult to test the effectiveness of health interventions rigorously with RCTs conducted fully or primarily over the internet. The use of the internet to conduct trials is more suited to pragmatic rather than explanatory trials. The main limitation of these trials is that they typically experience high rates of loss to follow-up. Methodological standards now accepted for traditional RCTs needs to be evident for online RCTs as well, especially in reporting of their methods.
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Affiliation(s)
- Erin Mathieu
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
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Judge LW, Craig B, Bellar D, Wanless E. Preactivity Stretching Research and Current Coaching Practices. Strength Cond J 2012. [DOI: 10.1519/ssc.0b013e3182639793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Many people stretch before or after engaging in athletic activity. Usually the purpose is to reduce risk of injury, reduce soreness after exercise, or enhance athletic performance. This is an update of a Cochrane review first published in 2007. OBJECTIVES The aim of this review was to determine effects of stretching before or after exercise on the development of delayed-onset muscle soreness. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to 10 August 2009), the Cochrane Central Register of Controlled Trials (2010, Issue 1), MEDLINE (1966 to 8th February 2010), EMBASE (1988 to 8th February 2010), CINAHL (1982 to 23rd February 2010), SPORTDiscus (1949 to 8th February 2010), PEDro (to 15th February 2010) and reference lists of articles. SELECTION CRITERIA Eligible studies were randomised or quasi-randomised studies of any pre-exercise or post-exercise stretching technique designed to prevent or treat delayed-onset muscle soreness (DOMS). For the studies to be included, the stretching had to be conducted soon before or soon after exercise and muscle soreness had to be assessed. DATA COLLECTION AND ANALYSIS Risk of bias was assessed using The Cochrane Collaboration's 'Risk of bias' tool and quality of evidence was assessed using GRADE. Estimates of effects of stretching were converted to a common 100-point scale. Outcomes were pooled in fixed-effect meta-analyses. MAIN RESULTS Twelve studies were included in the review. This update incorporated two new studies. One of the new trials was a large field-based trial that included 2377 participants, 1220 of whom were allocated stretching. All other 11 studies were small, with between 10 and 30 participants receiving the stretch condition. Ten studies were laboratory-based and other two were field-based. All studies were exposed to either a moderate or high risk of bias. The quality of evidence was low to moderate.There was a high degree of consistency of results across studies. The pooled estimate showed that pre-exercise stretching reduced soreness at one day after exercise by, on average, half a point on a 100-point scale (mean difference -0.52, 95% CI -11.30 to 10.26; 3 studies). Post-exercise stretching reduced soreness at one day after exercise by, on average, one point on a 100-point scale (mean difference -1.04, 95% CI -6.88 to 4.79; 4 studies). Similar effects were evident between half a day and three days after exercise. One large study showed that stretching before and after exercise reduced peak soreness over a one week period by, on average, four points on a 100-point scale (mean difference -3.80, 95% CI -5.17 to -2.43). This effect, though statistically significant, is very small. AUTHORS' CONCLUSIONS The evidence from randomised studies suggests that muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayed-onset muscle soreness in healthy adults.
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Affiliation(s)
- Robert D Herbert
- Musculoskeletal Division, The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, Sydney, Australia, NWS 2050
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On "Effectiveness of stretch for the treatment and prevention of contractures..." Katalinic OM, Harvey LA, Herbert RD. Phys Ther. 2011;91:11-24. Phys Ther 2011; 91:590-5; author reply 595-6. [PMID: 21459828 DOI: 10.2522/ptj.2011.91.4.590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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