Soft-Tissue Techniques in Sports Injuries Prevention and Rehabilitation

Participation in sports, in addition to its positive effects, leads to injuries caused by contact with the opponent or the high loads that develop on the musculoskeletal structures during the sports activities. Sports injuries mainly include (a) acute injuries such as muscle strains and ligament sprains, tendon injuries, dislocations and subluxations, fractures, and skin injuries but also (b) overuse injuries such as tendinopathies and painful myofascial syndromes. Many therapeutic techniques are used to treat these injuries, such as therapeutic exercise, various electrotherapy procedures and soft tissue techniques. Soft tissue techniques aim to promote health and well-being through their mechanical effects on the body’s soft tissues such as friction, compression, tissues sliding and myofascial release. Sports soft-tissue procedures are applied either directly with the hands of therapists such as classical massage or with the use of special equipment such as tools made of stainless steel (ERGON instrument-assisted soft tissue mobilization), elastic ischemic bandages (Kinetic flossing technique) and cups (cupping therapy). The following chapter analyzes the therapeutic effects of the above therapeutic interventions by presenting recent scientific evidence that supports their effects on the soft tissue’s dysfunctions of the human body and various pathological conditions

Blood Flow Restriction Training in Cardiovascular Disease Patients

Over the past two decades, blood flow restriction training (BFRT) has gained popularity not only in athletic performance training, but also with many researchers and physical therapists as an innovative rehabilitation tool. Blood flow restriction (BFR) exercise is a novel exercise modality in clinical settings, which induces muscle hypertrophy and increases strength with low to moderate training intensity through increased anabolic processes mediated by BFR (usually with cuff inflation). BFR limits arterial and venous blood flow and leads to blood pooling, which could increase the effects of exercise-induced training. Strength training at lower intensities (20–40% of maximum strength) in combination with BFR showed similar effects on muscle hypertrophy as training at 70% strength level without BFR. In this context, considering that periods of immobilization (or reduced functionality) due to pathology, injury, or surgery cause harmful effects on muscle mass and strength in both young and old people, muscular adaptations of occlusion exercise could be beneficial to the elderly and post-operative patients in rehabilitation regarding muscle regeneration. Furthermore, as this type of exercise does not require high loads, it might be a feasible method in cardiac rehabilitation. Therefore, this chapter aims to review all recent literature regarding the impact of low-load BFR resistance training in patients with cardiovascular pathologies on muscle strength and hypertrophy, vascular function, safety, cardiovascular responses, and inflammatory markers

Manual therapy versus localisation (tactile, sensory training) in patients with non-specific neck pain: a randomised clinical pilot trial

Manual therapy (MT) techniques typically incorporate localised touch on the skin with the application of specific kinetic forces. The contribution of localised touch to the effectiveness of MT techniques has not been evaluated. This study investigated the immediate effects of MT versus localisation training (LT) on pain intensity and range of movement (ROM) for neck pain. In this single-blind randomised controlled trial thirty eligible neck pain volunteers (23 females and 7 males), aged 28.63 ± 12.49 years, were randomly allocated to MT or to a motionless (LT) group. A single three-minute treatment session was delivered to each group’s cervico-thoracic area. The LT involved tactile sensory stimulation applied randomly to one out of a nine-block grid. Subjects were asked to identify the number of the square being touched, reflecting a different location on the region of skin. MT involved three-minute anteroposterior (AP) glides and sustained natural apophyseal glides (SNAG) techniques. Pre- and post-intervention pain intensity were assessed using a pressure pain threshold (PPT) algometer and the numeric pain rating scale (NPRS). Neck ROM was recorded with a bubble inclinometer. Improvements in ROM and self-reported pain were recorded in both groups (p 0.05). Tactile sensory training (localisation) was as effective as MT in reducing neck pain, suggesting a component of MT’s analgesic effect to be related with the element of localised touch rather than the forces induced during passive movements

Reliability and clinical applicability of lower limp strength using an enhanced paper grip strength

The enhanced paper grip test (EGPT) quantitatively assesses lower limb strength. EGPT assesses the hallux grip force by reacting a pulling force derived from a card, being positioned underneath the participant's hallux. This study aimed to investigate the repeatability and clinical applicability of the EPGT for assessing foot muscle strength. EPGT force was measured using a dynamometer. The reliability of the measurement of EPGT force was assessed by having two examiners performing the test on the same group of healthy adults. Clinical applicability was assessed in community-dwelling adults of both genders. EPGT force was recorded for both feet using the same standardised protocol for all participants. Regarding reliability, 20 healthy adults aged 23.04±5.5 years participated in the present study. The EGPT demonstrated good to excellent test-retest (ICC1,2 0.8 to 0.86) and interrater reliability (ICC1,2 0.82 to 0.88). A convenience sample of 15 community-dwelling adults (71.6±7.8 years, 68.5% women) was recruited for clinical applicability testing. All participants performed the test with mean score 15±5.7 N. EPGT is a reliable measurement of the hallux grip force strength and can be used for clinical and research purposes

Recovery kinetics of knee flexor and extensor strength after a football match

© 2015 The Authors. Published by PLOS. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1371/journal.pone.0128072We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12h, 36h and 60h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12h, 36h and 60h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (P<0.05) at 12h (both limbs) and 36h (dominant limb only), b) eccentric and concentric peak torque of knee extensors and flexors declined (P<0.05) in both limbs for 36h at 60°/s and for 60h at 180°/s with eccentric peak torque of knee flexors demonstrating a greater (P<0.05) reduction than concentric peak torque, c) strength deterioration was greater (P<0.05) at 180°/s and in dominant limb, d) the functional ratio was more sensitive to match-induced fatigue demonstrating a more prolonged decline. Discriminant and regression analysis revealed that strength deterioration and recovery may be related to the amount of eccentric actions performed during the match and athletes' football-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players' physical conditioning level.Published versio

Πολυμεταβλητή ανάλυση λειτουργικών πλευρικοτήτων, μυοδυναμικών ασυμμετριών και τραυματισμών των κάτω άκρων σε ποδοσφαιριστές

ΕΙΣΑΓΩΓΗ Το ποδόσφαιρο αποτελεί σύνθετο κινητικό πρότυπο και εμπεριέχει μονόπλευρες σωματικές κινήσεις μέγιστης προσπάθειας (π.χ. λάκτισμα και προώθηση της μπάλας), που καταλήγουν σε ασύμμετρες φορτίσεις και προσαρμογές καθώς και σε υψηλή επιδημιολογική εμφάνιση μυοσκελετικών τραυματισμών στα κάτω άκρα. Ο προβληματισμός της παρούσας μελέτης σχετίζεται με την δημιουργία συνθηκών πρόληψης των τραυματισμών στο ποδόσφαιρο, μέσω της ερευνητικής κατοχύρωσης και ανάλυσης της αιτιολογίας τους. Ιδιαίτερη βάση δόθηκε στην σύνθετη στατιστική αξιολόγηση με σχεδιασμό προοπτικής (prospective study) των ενδογενών κινησιολογικών μηχανισμών (ποδοπλευρικότητα, ασυμμετρίες στην μυοδυναμική λειτουργία, ελαστικότητα, ιδιοδεκτικότητα, ανατομικές ασυμμετρίες, προηγούμενες κακώσεις), που μπορούν να οδηγήσουν σε τραυματισμούς διαφορετικής βαρύτητας, συχνότητας και πλευρίωσης. ΜΕΘΟΔΟΣ Εκατό επαγγελματίες ποδο- σφαιριστές ηλικίας 23,4±4,8 ετών, ύψους 178±6,7 εκ. και σωματικής μάζας 74,2±7,6 κιλών αξιολογήθηκαν προ-αγωνιστικά ως προς την λειτουργική ικανότητα των κάτω άκρων, και ως προς επιλεγμένα ανατομικά και ανθρωπομετρικά χαρακτηριστικά. Η μυοδυναμική αξιολόγηση του γόνατος (κάμψη – έκταση) έγινε ισοκινητικά (Biodex, System III) στις 60o /sec, 180o /sec και 300o /sec για την σύγκεντρη και στις 60o /sec και 180o /sec για την έκκεντρη συστολή, ενώ της ποδοκνημικής (ραχιαία –πελματιαία κάμψη) έγινε στις 60o /sec τόσο για τη σύγκεντρη όσο και για την έκκεντρη συστολή. Η μυϊκή ελαστικότητα των κάτω άκρων αξιολογήθηκε με γωνιομέτρηση, και η πρόσθια αστάθεια του γόνατος με το αρθρόμετρο ΚΤ-1000 (MedmetricUSA). Τα ανθρωπομετρικά χαρακτηριστικά (περιφέρειες, μήκη οστών) αξιολογήθηκαν με την μέθοδο του I.S.A.K (International Society of Kinanthropometry) και η νευρομυϊκή συναρμογή με την ηλεκτρονική πλατφόρμα Prokin- 200 (Technobody-Italy). Καταγράφηκαν οι τραυματισμοί που οδήγησαν σε απουσία από τουλάχιστον μια προπόνηση ή έναν αγώνα στη διάρκεια μιας αγωνιστικής περιόδου, και αξιολογήθηκαν οι σωματικές πλευρικότητες. Τα αρχικά δεδομένα αναλύθηκαν πολυμεταβλητά (MANOVA) και μέσω λογιστικής παλινδρόμησης (Logistic regression). Ασυμμετριες – Τραυματισμοί Ποδοσφαιριστών ΑΠΟΤΕΛΕΣΜΑΤΑ Σημαντικές ασύμμετρες προσαρμογές διαπιστώθηκαν στο γόνατο και στην ποδοκνημική ως προς (α) τη μυοδυναμική λειτουργία (εναλλασσόμενες Wilks’ Λ=0.667, p=0.001, απόλυτες ασυμμετρίες, Wilks’ Λ=0.047, p=0.000 πλευρικής κυριαρχίας, Wilks’ Λ=0.613, p=0.00), (β) την ελαστικότητα (εναλλασσόμενες Wilks’ Λ=0.793, p=0.028, απόλυτες ασυμμετρίες, Wilks’ Λ=0.926, ρ=0.000) και (γ) την πρόσθια χαλάρωση του γόνατος (εναλλασσόμενες Wilks’ Λ=7.15, p=0.001, απόλυτες ασυμμετρίες, Wilks’ Λ=41.91, p=0.000 πλευρικής κυριαρχίας, Wilks’ Λ=3.89, p=0.024). Σημαντικές ασυμμετρίες διαπιστώθηκαν επίσης στα επιλεγμένα ανθρωπομετρικά χαρακτηριστικά (μήκη -περιφέρειες του κάτω άκρου, p0.05). Εξήντα-δυο ποδοσφαιριστές (62%) τραυματίστηκαν την περίοδο που ακολούθησε τις αρχικές μετρήσεις και εμφάνισαν ογδόντα-δύο (82) τραυματικά συμβάντα, συνολικά. Η επιδημιολογική εικόνα των τραυματισμών έδειξε 21.8 τραυματισμούς/1000 ώρες αγώνα και 1.1 κακώσεις/1000 ώρες προπόνησης ανά αθλητή. Οι ανατομικές περιοχές με την υψηλότερη συχνότητα κακώσεων ήταν ο μηρός (35%), η ποδοκνημική (25%) και το γόνατο (21% ). Αντίστοιχα, οι συχνότεροι τραυματισμοί αφορούσαν μυϊκές θλάσεις (46,3%), συνδεσμικές κακώσεις- διαστρέμματα (25,6%), ενώ χαμηλότερα ποσοστά εμφάνισαν οι τενοντοπάθειες (12.2%) και οι οστικοί τραυματισμοί (κατάγματα) (3,7%). Οι ποδοσφαιριστές με ασυμμετρίες κλινικής βαρύτητας τόσο στην έκκεντρη ισοκινητική δύναμη(&gt;15%) (OR=3.88; 95% CI: 1.13-13.23, p= 0.030) των οπίσθιων μηριαίων όσο και στο λειτουργικό μήκος των κάτω άκρων (&gt;1,8 cm) (OR =3.80; 95% CI:1.08-13.33, p= 0.037) εμφάνισαν σημαντικά μεγαλύτερη πιθανότητα να υποστούν θλάση μη-επαφής στους οπίσθιους μηριαίους, συγκριτικά με όσους δεν εμφάνισαν αντίστοιχες λειτουργικές και ανατομικές ασυμμετρίες. Οι προηγούμενοι τραυματισμοί των οπίσθιων μηριαίων αποτέλεσαν προστα- τευτικό παράγοντα για την πρόκληση νέων μυϊκών θλάσεων μη-επαφής σε αυτούς τους μύς (OR=0.15; 95% CI:0.029-0.791, p= 0.025). Οι ποδοσφαιριστές που εμφάνισαν έκκεντρες ισοκινητικές ασυμμετρίες στους ραχιαίους και πελματιαίους καμπτήρες της ποδοκνημικής (OR=4.25; 95% CI:1.135-19.411, p= 0.033)και είχαν βάρος πάνω από το μέσο όρο του δείγματος (OR=3.72; 95% CI:1.035- 51.530, p= 0.046) αντιμετώπισαν σημαντικά μεγαλύτερο κίνδυνο να υποστούν συνδεσμική κάκωση (διάστρεμμα) μη-επαφής στην ποδοκνημική, συγκριτικά με όσους δεν εμφάνισαν λειτουργικές ασυμμετρίες (έκκεντρης ισχύος) και είχαν σωματικό βάρος μικρότερο του μέσου όρου (&lt;Μ). ΣΥΜΠΕΡΑΣΜΑΤΑ Η συστηματική και μακροχρόνια ενασχόληση με το ποδόσφαιρο οδηγεί σε σημαντικές ασύμμετρες λειτουργικές και ανατομικές προσαρμογές, που συσχετίζονται άμεσα με την πρόκληση εξειδικευμένων μυϊκών και συνδεσμικών κακώσεων στα κάτω άκρα των αθλητών. Η αναγνώριση και ανάδειξη των αιτιολογικών αυτών παραγόντων τραυματισμών στο ποδόσφαιρο μπορεί να οδηγήσει σε καλύτερες συνθήκες πρόληψης τους μέσω της σχεδίασης εύστοχων προγραμμάτων εκγύμνασης και αποκατάστασης. Τα παραπάνω ευρήματα αναδεικνύουν την αξία της προ-αγωνιστικής αξιολόγησης των ποδοσφαιριστών που στοχεύει στην αναγνώριση και εξισορρόπηση των λειτουργικών ασυμμετριών μέσω εξατομικευμένων προγραμμάτων

The effects of free weights and iso-inertial resistance during semi-squatting exercise on amateur soccer players&apos; physical performance indicators: a randomized controlled study.

BACKGROUND: The aim was to compare the effects of two lower extremity strengthening programs using iso-inertial resistance or free weights on amateur soccer players’ physical performance indicators. METHODS: Thirty-five amateur soccer players (average age 22.6±5.1 years) were randomly assigned to iso-inertial group (n=11) or free-weight group (n=11), or control group (n=13). The groups performed two training sessions per week for six weeks. Before and after the strengthening implementation, physical performance indicators were evaluated, including the isokinetic knee extensors and flexors’ strength, power, speed, and agility. The significance level was set at p&lt;0.05. RESULTS: The iso-inertial training resistance led to an increase in the hamstrings’ eccentric strength at 60°/s and 150°/s (p&lt;0.05) compared to the free-weight resistance (p&gt;0.05) and the controls (p&gt;0.05). No other significant adaptations were observed in the other isokinetic strength, power, speed (10-m, p=0.052) and agility measurements (Illinois agility test, p=0.059). In ratio (knee flexors/knee extensors) the only differences observed was at 150 o/s for iso-inertial group (p&lt;0.05). CONCLUSIONS: Iso-inertial resistance training during semi squatting can enhance the hamstrings’ eccentric performance andthe soccer players’ speed and agility compared to the classic free-weight training program, which should considered when designing strength and injury prevention programs

Assessing the Efficiency of Sheep Farming in Mountainous Areas of Greece. A Non Parametric Approach

The objective of this paper is the measurement and decomposition of the overall efficiency of sheep farming in mountainous areas of Greece. To this end, both a Constant Returns to Scale (CRS) and a Variable Returns to Scale (VRS) DEA model has been applied to a sample to 101 farms located in the mountainous areas of Epirus, Sterea, and Thessaly. The empirical results suggest: a) the average overall efficiency ratio in the sample is about 80 percent; b) the pure technical and the scale efficiency are of almost equal importance in the determination of the overall efficiency. Therefore, CRS DEA models will tend to underestimate systematically the level of pure technical efficiency; c) there are differences in the overall efficiency ratios across the three regions stemming mainly from differences in pure technical efficiency

LOWER LIMB STRENGTH IN PROFESSIONAL SOCCER PLAYERS: PROFILE, ASYMMETRY, AND TRAINING AGE

Kicking and cutting skills in soccer are clearly unilateral, require asymmetrical motor patterns and lead to the development of asymmetrical adaptations in the musculoskeletal function of the lower limbs. Assuming that these adaptations constitute a chronicity-dependent process, this study examined the effects of professional training age (PTA) on the composite strength profile of the knee and ankle joint in soccer players. One hundred soccer players (n=100) with short (5-7 years), intermediate (8-10 years) and long (>11 years) PTA were tested bilaterally for isokinetic concentric and eccentric strength of the knee and ankle muscles. Knee flexion-extension was tested concentrically at 60°, 180° and 300 °/sec and eccentrically at 60° and 180 °/sec. Ankle dorsal and plantar flexions were tested at 60 °/sec for both the concentric and eccentric mode of action. Bilaterally averaged muscle strength [(R+L)/2] increased significantly from short training age to intermediate and stabilized afterwards. These strength adaptations were mainly observed at the concentric function of knee extensors at 60°/sec (p = 0. 023), knee flexors at 60°/sec (p = 0.042) and 180°/sec (p = 0.036), and ankle plantar flexors at 60o/sec (p = 0.044). A linear trend of increase in isokinetic strength with PTA level was observed for the eccentric strength of knee flexors at 60°/sec (p = 0.02) and 180°/sec (p = 0.03). Directional (R/L) asymmetries decreased with PTA, with this being mainly expressed in the concentric function of knee flexors at 180°/sec (p = 0.04) and at 300 °/sec (p = 0.03). These findings confirm the hypothesis of asymmetry in the strength adaptations that take place at the knee and ankle joint of soccer players mainly along with short and intermediate PTA. Players with a longer PTA seem to adopt a more balanced use of their lower extremities to cope with previously developed musculoskeletal asymmetries and possibly reduce injury risk. This has certain implications regarding proper training and injury prevention in relation to professional experience in soccer

Assessing the Efficiency of Sheep Farming in Mountainous Areas of Greece. A Non Parametric Approach

The objective of this paper is the measurement and decomposition of the overall efficiency of sheep farming in mountainous areas of Greece. To this end, both a Constant Returns to Scale (CRS) and a Variable Returns to Scale (VRS) DEA model has been applied to a sample to 101 farms located in the mountainous areas of Epirus, Sterea, and Thessaly. The empirical results suggest: a) the average overall efficiency ratio in the sample is about 80 percent; b) the pure technical and the scale efficiency are of almost equal importance in the determination of the overall efficiency. Therefore, CRS DEA models will tend to underestimate systematically the level of pure technical efficiency; c) there are differences in the overall efficiency ratios across the three regions stemming mainly from differences in pure technical efficiency.Livestock Production/Industries,