Relationship between postural changes and injuries of the locomotor system in indoor soccer athletes

Treating Dystonia in a Soccer Player Through an Integrated Rehabilitative Approach: A Case Report

CONTEXT

Sport-related dystonia is a rare form of activity-specific dystonia that can severely impair an athlete's ability to perform. Due to a lack of data on the condition, it is difficult to diagnose and often overlooked, and no gold standard treatment has yet been defined.

CASE PRESENTATION

We present a rare and challenging case of sport-related dystonia that affected a 24-year-old male professional soccer player. The patient presented with severe rigidity and dystonia of the right lower-extremity, particularly the ankle and foot. The symptoms set on >1 year prior to the presentation to our outpatient clinic. He began to complain of stiffness and difficulty moving his lower limbs, especially his right leg, initially when playing soccer, but then also when walking normally. On presentation, he was unable to run and walked with difficulty, supporting his body weight only on the outside of his right foot. He also reported a motor trick and reverse motor trick involving the oral musculature in order to move his lower limb more freely.

MANAGEMENT AND OUTCOMES

An integrated rehabilitation approach based on postural rehabilitation, neuromuscular rehabilitation, and dental intervention was used to successfully treat this condition. The approach included: (1) postural rehabilitation with the Mézières-Bertelè method to reduce muscular stiffness, (2) neuromuscular re-education with Tai Chi exercises and electromyography-guided biofeedback, and (3) dental intervention and swallowing rehabilitation to limit impaired oral habits (due to the relationship between his impaired lower limb movements and motor tricks of the oral musculature). After 7 months of integrated rehabilitation, the patient returned to professional soccer.

CONCLUSIONS

This case report highlights the potential efficacy of an integrative rehabilitation approach for sports dystonia, particularly in cases where traditional treatments may not be effective. Such an approach could be considered a valuable option in the management of this rare, but debilitating, condition in athletes. Further research is needed to assess the effectiveness of this approach in larger populations.

The Assessment of Ankle Range-of-Motion and Its Relationship with Overall Muscle Strength in a Cross-Section of Soccer Players

Soccer (football) practice can induce a limitation of ankle range of motion (ROM) that is a possible risk factor for injury and other negative consequences over time. The main objective of this research was to investigate the effects of soccer practice on ankle ROM throughout the entire period of a sports career of soccer players (SP). Furthermore, the relationship between ankle ROM and muscle strength in SP of different ages was studied. A total of 204 SP (range 6.7−45.1 years) and 87 controls (range: 7.5−45.2 years) matched for age, body mass index (BMI), and gender, were assessed. Ankle ROM in both plantar flexion (APF) and dorsiflexion (ADF) in addition to handgrip strength (HGS) were evaluated using an inclinometer and the Jamar hydraulic hand dynamometer, respectively. The comparison between SP and control groups showed a significant reduction in ankle ROM of both APF (26.3 ± 7.2° vs. 32.6 ± 7.4°; d = −0.90; p < 0.001) and ADF (95.5 ± 15.6° vs. 105.5 ± 15.8°; d = −0.66; p < 0.001). In SP, the results of the ANOVAs test indicate that age had a significant effect on ADF (F = 4.352, p = 0.038, partial eta-squared (ηp2) = 0.015) but not on APF (F = 0.430, p = 0.746, ηp2 = 0.001). Moreover, considering only the SP, a weak inverse correlation between ADF and HGS group ADF was found (rs = −0.27; p < 0.001). Factors such as the non-linear trend of growth in young SP could hinder the definition of the relationship between ankle ROM, age, and muscle strength. However, the appropriate consideration of age and muscle strength could facilitate the management of ankle ROM in PF of different ages.

Relationship between Posture and Non-Contact Lower Limb Injury in Young Male Amateur Football Players: A Prospective Cohort Study

Posture, a potentially modifiable injury risk factor, is considered important in injury screening/prevention in athletes, yet few studies investigate relationships between posture and injury. This prospective cohort study investigated whether static posture is associated with lower limb injury risk in male football players (n = 263). Nine aspects of static standing posture (left and right rearfoot, knee interspace, lateral knee, lumbar lordosis, thoracic kyphosis, scoliosis S and C, forward head) were assessed from photographs during the pre-season using the modified Watson and Mac Donncha scale, which was dichotomised for analysis (deviated or normal). Player characteristics (age, height, mass, body mass index, competition level), match/training exposure, and previous and in-season non-contact lower limb injuries were recorded. Binary logistic regression investigated relationships between posture and injury (previous and in-season). Eighty previous and 24 in-season lower limb injuries were recorded. Previous injury was not associated with any postural variable. In-season injury was associated with previous injury (OR = 3.04, 95% CI 1.20-7.68, p = 0.02) and having a normal thoracic curve compared to kyphosis (OR = 0.38, 95% CI 0.15-1.00, p = 0.05) but no other postural variables. Static postural deviations observed in male football players in the pre-season are not typically associated with non-contact lower limb injury risk; thus, they are unlikely to add value to pre-season screening programs.

Genu varum and football participation: Does football participation affect lower extremity alignment in adolescents?

BACKGROUND

Genu varum is one of the most common anatomical variations of knee alignment which is considered a risk factor for anterior knee pain and anterior cruciate ligament injury among football players. Considering that millions of children participate in high-level football training, the purpose of this study was to determine the genu varum development in adolescent football players and non-athlete peers. The hypothesis of this study was that genu varum incidence was higher in adolescent football players compared with non-athletic peers.

METHODS

The design was a cross-sectional study. Two-hundred and thirty-seven male football players (FG) and aged-matched and anthropometrically similar non-athletes (CG) were recruited into the study. The quadriceps angle and intercondylar-intermalleolar distance were measured to evaluate the leg alignment. The distance between the medial edges of the condyles and malleoli was measured in millimeters using a digital caliper while angle measurements were performed using a photographic technique in a standing position. To analyze the variables, comparison, correlation and regression statistical tests were performed.

RESULTS

The intercondylar-intermalleolar distance and quadriceps angle values were significantly higher in FG than CG in all ages. In FG, a very strong correlation was found between number of training years and the intercondylar-intermalleolar distance. The prevalence of genu varum was markedly higher in FG than CG (~37% vs. 2%, respectively) based on intercondylar-intermalleolar distance.

CONCLUSION

This study determined that the prevalence of genu varum and abnormal quadriceps angles in adolescent football players is significantly higher compared with their non-athletic peers.

Posture of adolescent volleyball players – a two-year study

Study aim: The aim of this study was to assess and compare the posture of male and female adolescent volleyball players and non-training individuals over a 2-year period.

Material and methods: The study group comprised 32 volleyball players and 30 non-athlete peers. Posture was assessed with a photogrammetric method based on the moiré phenomenon. Participants were examined 3 times at the ages of 14, 15 and 16 years. Training experience of the studied volleyball players at the time of the 1st measurement was less than 5 months.

Results: In volleyball players greater asymmetry in the pelvis position was noted (rotation to the right). The right scapula was more outlying than the left, and the right shoulder was more elevated than the left. Volleyball training did not result in sagittal spinal curvatures. Male non-athlete participants exhibited a significant increase in thoracic kyphosis and a decrease in lumbar lordosis over a two-year period.

Conclusion: Volleyball training affects the alignment of the pelvis, shoulder girdle and scapulae. The study revealed a number of differences in spinal curvatures between male volleyball players and non-athletes which could be associated with growth velocity and differences in body height.

Validity and Reliability of Standing Posture Measurements Using a Mobile Application

OBJECTIVE

The purpose of this study was to evaluate the validity and reliability of standing posture assessments in asymptomatic men using the PostureScreen Mobile (PSM) iOS application.

METHODS

The standing posture of 50 asymptomatic male participants (24.04 ± 1.81 years) was measured during 3 trials on the same day. The following 10 measurements using the PSM app were compared to the criterion VICON 3-dimensional analysis: from the frontal plane, shift and tilt of the head, shoulders, and hips; and from the sagittal plane, shift of the head, shoulders, hips, and knees. We used Bayesian methods to analyze the data.

RESULTS

Compared with the VICON measurements, PSM assessments of head tilt, shoulder tilt and shift, and hip tilt and shift in the frontal plane were biased. In the sagittal plane, PSM measurements of shoulder, hip, and knee shift were biased. Only head shift in the frontal and sagittal planes were comparable between the VICON and the PSM. The VICON and PSM had similar intraclass correlations in 6 of 10 measurements. The PSM assessments of head shift and tilt and shoulder tilt in the sagittal plane were significantly less reliable than with VICON.

CONCLUSION

The use of the PSM app introduced significant bias in postural measurements in the frontal and sagittal plane. Until further research reports additional validity and reliability data of the PSM app, we suggest caution in the use of PSM app when highly accurate postural assessments are necessary.

Characteristics of anteroposterior curvatures of the spine in soccer and futsal players

Purpose. The aim of the study was to determine differences in anteroposterior spine curvatures between futsal players, soccer players, and non-training students. The results may contribute to the development of present-day knowledge of posturometry, and its implementation in training can help reduce the risk of body posture disorders in athletes. Methods. The examined group consisted of 48 athletes and 38 non-training college students. Body posture parameters were measured with the use of Posturometr-S. The normality of distribution was checked with the Shapiro-Wilk test, and the differences between the groups were measured with ANOVA and the Bonferroni post-hoc test. The level of statistical significance was set at p < 0.05. Results. The analysis of angle values revealed the widest and most similar measurements in the group of futsal players and soccer players. The analysis of variance proved statistically significant differences between the soccer players and futsal players (p = 0.003). The difference between the soccer players and non-training students was statistically significant. The highest γ angular value was measured in non-training students, followed by futsal players and soccer players. The statistical analysis revealed significant differences between the non-training students and futsal players, as well as non-training students and soccer players (p < 0.001). Conclusions. A complex assessment of athletes’ body posture is crucial in injury prevention. Training overloads may often lead to disorders of the organ of locomotion and affect the correct body posture in athletes. This, in turn, may result in pains and injuries.

Análise da flexibilidade segmentar e prevalência de lesões no futebol segundo faixa etária

Retrações musculares têm apresentado relações com má postura e Lesões Desportivas (LD) em jogadores de futebol jovens e adultos. Este estudo teve por objetivo avaliar a flexibilidade articular, extensibilidade muscular e prevalência de LD em praticantes de futebol, relacionando-as com a faixa etária. A casuística integrou 170 participantes do sexo masculino, procedentes das equipes de base profissionalizante e profissional de um clube desportivo de Campo Grande (MS). Os participantes foram distribuídos em três grupos: G1 (infantojuvenil), G2 (adolescentes) e G3 (adultos). Para a tomada de informações sobre lesões, utilizou-se de um inquérito de morbidade referida. Foram realizadas análises para caracterização antropométrica, flexibilidade articular, extensibilidade muscular e alinhamento corporal. Em relação à prevalência de LD, foram registrados 55 LD durante as duas últimas temporadas, sendo que 48 participantes (28,23%) relataram presença de LD. O G3 revelou a maior taxa de prevalência de LD, totalizando 0,68 LD/atleta. A taxa de lesão por atleta lesionado apresentou-se maior no G2, com 1,4 LM/atleta lesionado. O G2 apresentou maior grau de flexibilidade articular do quadril, com alcance de 26,3±8,0 cm no teste de sentar e alcançar. O G3 apresentou os maiores índices de prevalência de retração para flexores de quadril. Ao teste de Schöber, o G2 mostrou a maior prevalência de inflexibilidade lombar. Conclui-se que atletas profissionais têm maior incidência e prevalência de LD. Os índices de inflexibilidade foram particularmente importantes em faixas etárias mais jovens, sugerindo que uma possível interação entre atributos intrínsecos e extrínsecos se associe a distúrbios musculoesqueléticos em jovens atletas.

Incidência e fatores de risco de lesões em jogadores de futsal portugueses

INTRODUÇÃO: A reduzida expressão de estudos publicados sobre a incidência de lesões no Futsal em Portugal justificou a realização deste trabalho. OBJETIVO: Identificar as potenciais causas de lesões nesta modalidade, referência para o desenvolvimento de protocolos específicos de prevenção de lesões. MÉTODOS: A amostra foi constituída por 411 jogadores federados de Futsal em Portugal, masculinos e femininos, de diferentes níveis competitivos. Foram utilizados os dados coletados num questionário com informação retrospectiva. O tratamento estatístico consistiu na análise inferencial entre grupos através do teste de Kruskal-Wallis e do teste para dados não paramétricos de Mann-Whitney (nível de significância de 5%). RESULTADOS: Os resultados confirmaram a entorse da articulação tíbio-társica como a lesão de maior incidência (48,8% do total) no Futsal. As lesões com período de impedimento entre oito e 28 dias tiveram a maior expressão (52,7% do total). Este estudo não revelou diferenças significativas em relação ao gênero ou posição em que os jogadores ocupam na quadra sobre a incidência, o tipo ou a região anatômica das lesões. No entanto, verificou-se significativamente maior incidência de entorses e contraturas em situação de treino e maior incidência de roturas musculares e fraturas em jogo, sendo que essas últimas provocaram um período de impedimento maior para os atletas. Também se verificou significativamente maior incidência de lesões articulares ou ósseas, entorses e fraturas, em resultado do contato com adversários e maior incidência de lesões musculares ou ligamentares sem contato com adversários. Os resultados não evidenciaram diferenças significativas na lateralidade das lesões. CONCLUSÃO: Os resultados realçam a importância de programas específicos de prevenção da entorse da tíbio-társica, especialmente nas crianças e jovens, independentemente da posição que ocupam na quadra, particularmente em situações de contato com adversários.

Lesões e desvios posturais na prática de futebol em jogadores jovens

O objetivo deste estudo foi verificar a incidência de lesões, os principais desvios posturais e a possível associação entre lesões e desvios posturais em jogadores de futebol. Foram avaliados 21 voluntários do sexo masculino tendo entre 17 e 19 anos, jogadores de futebol de uma equipe profissional, que foram divididos em dois grupos: G1 formado por 15 jogadores que sofreram lesões relacionadas à prática de futebol; e G2 composto por 6 atletas que não tiveram lesões. Foram coletados dados sobre características antropométricas, posição de jogo, tempo de prática de futebol, freqüência de prática e histórico de lesões relacionadas à prática de futebol. O alinhamento postural foi verificado utilizando um protocolo específico para detectar alterações. Os resultados mostram alterações no alinhamento corporal em ambos os grupos. Os maiores desvios posturais encontrados foram assimetria das escápulas, no alinhamento horizontal da cabeça e no da pelve, em ambos os grupos. Considerando as lesões no G1, a mais comum foi no tornozelo (35%) e a segunda mais freqüente, no joelho (23%). Embora não tenha sido encontrada associação entre desvios posturais e ocorrência de lesões, a incidência de ambos é importante, sugerindo a necessidade de intervenções de prevenção na formação de jogadores de futebol.

Prevalência de alterações posturais em praticantes de musculação

INTRODUÇÃO: Atualmente, as academias de musculação são centros de promoção de saúde procurados por um número cada vez maior de pessoas. A execução adequada dos exercícios resistidos em academia depende de um bom alinhamento postural. OBJETIVO: Verificar quantitativamente as principais alterações posturais em praticantes de exercício resistido sistematizado (musculação). MÉTODOS: Foram realizadas avaliações posturais em 306 indivíduos, de ambos os sexos e faixa etária entre 14 e 73 anos. As avaliações foram realizadas por acadêmicos de fisioterapia devidamente treinados e padronizadas de modo que os dados fossem coletados da maneira mais objetiva possível. RESULTADOS: Os resultados são apresentados de maneira geral (total da amostra), além de subdivididos conforme os gêneros masculino (n = 113) e feminino (n = 193) e de acordo com a faixa etária, adotando-se as seguintes categorias: alunos menores de 21 anos (n = 74); entre 21 e 30 anos (n = 127); entre 31 e 50 anos (n = 40); e maiores de 50 anos (n = 65). Dentre os resultados, destacam-se as alterações na coluna vertebral (aumento da curvatura ou retificação): 43,4% na região cervical, 55,2% na torácica e 73,8% na lombar. Além disso, 48,0% apresentaram atitude escoliótica, sendo que em 37,0% foi observado presença de gibosidade. CONCLUSÕES: A principal conclusão do presente estudo é de que os praticantes de musculação apresentam consideráveis índices de desvios posturais, enfatizando a necessidade de maior atenção sobre essa crescente população.

Correlação entre padrão postural em jovens praticantes do atletismo

O estudo objetivou observar o alinhamento corporal de jovens atletas praticantes de atletismo e analisar a associação de tais padrões dentro e entre os grupos de provas desta modalidade. Participaram 63 atletas de ambos os sexos e o protocolo de coleta para análise postural baseou-se na observação e registro fotográfico com marcações nos principais acidentes ósseos visando à verificação do alinhamento dessas estruturas. Os segmentos considerados para análise foram: tronco, pelve, joelho e tornozelo. Foi utilizado para análise dos dados o teste de Goodman para contrastes entre e dentro de proporções binomiais. Os resultados mostraram que saltadores (58,33%) e arremessadores/lançadores (50,00%) apresentam o tronco em posição mais equilibrada que atletas de resistência (5,56%). Na região do quadril, arremessadores/lançadores apresentaram predomínio de pelve com rotação esquerda (66,67%), enquanto nos saltadores foi observada elevada frequência de anteversão pélvica (58,33%). A observação do joelho revelou altas taxas de normalidade e recurvatum em fundistas, valgo nos arremessadores/lançadores (50,00%) e varo para os demais grupos. Para a articulação do tornozelo, nota-se que, exceto os saltadores, os grupos apresentaram predominância de valgismo. Conclui-se que, para atender às características particulares de cada prova, níveis distintos de postura são estabelecidos.

Avaliação da curvatura torácica e da presença de dor em mulheres de diferentes faixas etárias

OBJETIVO: demonstrar a utilização do método flexicurva para avaliação e comparação da cifose torácica em mulheres saudáveis de diferentes faixas etárias, além de detectar se há correlação entre dor e grau de cifose torácica utilizando-se a Escala Visual Analógica (EVA). MÉTODOS: o estudo foi composto por um grupo de mulheres G1 (n=24), com média de 20,67±1,69 anos e outro grupo G2 (n=24), com média de 65,63 ±8,07 anos, que foram submetidas à avaliação da curvatura torácica, com a utilização do método flexicurva, e dor nas costas, com a EVA. RESULTADOS: foi encontrada uma diferença estatisticamente significante no ângulo de cifose torácica no grupo 2 quando comparada ao grupo 1 e uma fraca correlação entre o ângulo de cifose torácica e a classificação da dor pela escala EVA nos grupos 1 e 2. CONCLUSÃO: o grupo 1 apresentou um grau de curvatura torácica dentro da normalidade e o grupo 2 apresentou um exacerbado grau de cifose torácica, caracterizando-se como hipercifose. Entretanto, não houve correlação entre dor e grau de cifose torácica em ambos os grupos.

Ground reaction force in basketball cutting maneuvers with and without ankle bracing and taping

CONTEXT AND OBJECTIVE

In basketball, the most common injuries are ankle sprains. For this reason, players frequently use external ankle devices or taping as prophylactic and rehabilitation measures. The purpose of this study was to evaluate ground reaction force (GRF) responses in basketball players while performing typical cutting maneuvers with and without ankle bracing and ankle taping.

DESIGN AND SETTING

Comparative study with experimental design of single-group repeated measurements, at Medical Rehabilitation Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.

METHODS

Vertical (Fy) and medial-lateral (Fz) GRF measurements were made under three conditions (taping, Aircast-type orthosis and basketball shoes alone), with analysis of peak forces at foot contact (Fymax1, Fzmax1, Fymax2 and Fzmax2), growth gradient (peak/time) (GG Fymax1, GG Fzmax1, GG Fymax2 and GG Fzmax2) and impulse after foot contact.

RESULTS

Bracing significantly reduced Fymax2 and GG Fymax2. GG Fzmax1 was significantly higher for the sport shoe condition than for the taping condition. Taping increased Fy in relation to the sport shoe at foot contact, but over a longer time interval, without increasing excessive ankle loading. Fz reached a peak in less time, which might generate greater inversion/eversion loading on a player's foot. The Aircast exerted better shock-absorbing effect than did the other two conditions, since it generated less vertical force over longer time intervals and smaller medial-lateral forces in relation to taping.

CONCLUSIONS

Ankle bracing and ankle taping action mechanisms are still unclear and therefore should be carefully prescribed. More studies are needed to clarify taping and bracing effects on sporting activities.