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OBJECTIVES: To describe the perceptions of physiotherapists and the injury prevention practices implemented within elite women's football clubs in Brazil. DESIGN: Cross-sectional study. SETTING: Online survey. PARTICIPANTS: Head physiotherapists from 32 Brazilian elite clubs. MAIN OUTCOME MEASURES: Structured questionnaire. RESULTS: Physiotherapists identified ACL rupture as the primary target for prevention. The top-five perceived injury risk factors included 'early return to sport after injury', 'workload too high', 'previous injury', 'poor sleep/rest', and 'muscle strength/power deficit'. 'Adoption of return to sport criteria' was almost unanimously recognized as a very important preventive strategy. 'Poor infrastructure' was elected as the main barrier to implementing prevention programs. From a practical standpoint, at least two-third of clubs implemented multi-component exercise interventions for injury prevention. These interventions typically encompassed flexibility/mobility, balance/proprioception, lumbo-pelvic stability, and agility exercises, alongside exposure to sprinting. Strength training routines typically included traditional, functional, and eccentric exercises. Most teams also employed other prevention strategies, including adoption of return to sport criteria, internal workload monitoring, post-exercise recovery modalities, preseason risk factor screening, and application of rigid strapping tapes. CONCLUSIONS: This study provided unprecedented insights into the physiotherapists' perceptions and injury prevention practices implemented within elite women's football clubs.

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OBJECTIVE: To identify the association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes. METHODS: Search performed at PubMed/Medline, Embase, CINAHL, LILACS, Cochrane, Web of Science and SPORTDiscus for observational studies. Methodological quality and strength of the evidence was assessed with the Newcastle-Ottawa Scale and GRADE. Meta-analysis and effects sizes analysis were calculated when possible. RESULTS: Sixty-five studies were included. Low to very-low evidence suggests no association of trunk/lower limb strength, endurance, power, jump or balance with shoulder complaints and/or throwing performance. Athletes with shoulder complaints performed worse in trunk stability and endurance tests (mean difference: -6.83 (95%CI: -8.78, -4.88)). Athletes with high throwing performance presented better results in CMJ, horizontal jump, power measures and knee extension strength. For swimmers, there was no association of trunk/lower limb endurance with shoulder complaints (moderate evidence) and no association of balance and swimming performance (low evidence). Better trunk/lower limb strength, power and vertical jumps measures were associated with better swimming performance. CONCLUSIONS: In methodologically similar studies, some trunk/lower limb outcomes are associated with shoulder complaint or sport/swimming performance. Results should be considered with caution and future studies should use better methodologies.

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Background: Social distancing may affect athletes' training, causing negative effects on mental and physical health. Objective: This study therefore aimed to characterize the perception of Brazilian athletes about their physical and psychosocial aspects, sleep quality and coping strategies during the quarantine of the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a cross-sectional study with online survey, performed with Brazilian athletes (amateur and professional) over 18 years. The main outcomes measures assessed were physical and psychosocial aspects, sleep quality and coping strategies. Results: A total of 214 athletes were included. The average weekly hours of training during the quarantine was 4.71 ± 3.71 h, of which 64.5% athletes (138/214) were oriented by medical staff during training. For 52.8% (113/214) of athletes, training intensity during the quarantine was different/very different from the intensity before the quarantine. 79.4% athletes (170/214) reported moderate to extreme difficulties in keeping the same level of training during the quarantine. 77.1% athletes (165/214) had moderate to extreme anxiety and each of the athletes had concern about his or her athletic career future, including return to the sport. 72.9% athletes (156/214) reported change in sleep schedule during the quarantine period. Conclusion: The quarantine period during COVID-19 pandemic negatively affected the athlete's perception about training routine, since athletes reported reduction in training hours and training intensity. Overall, the athletes reported that they were moderately to extremely anxious. They also had concerns about their career in the future, as well as concerns regarding return to sport.

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BACKGROUND: Alterations of frontal plane patellar alignment could be related to lower limb disorders. Clinical assessment must be able to identify the influence of non-local factors in patellar alignment. OBJECTIVE: To identify the influence of lower limb torque, range of motion (ROM), and foot alignment on patellar rotation in healthy athletes. METHODS: This cross-sectional study was performed with 232 healthy basketball and volleyball elite athletes. Participants were assessed in preseason for: patellar medial and lateral rotation (Arno angle), passive hip internal rotation (IR) ROM, iliotibial band flexibility, hip abductors and external rotators (ER) torque, shank-forefoot alignment (SFA), and ankle dorsiflexion ROM. Hierarchical multiple linear regression was performed to identify if these variables and sex, age, and body mass could be associated with patellar rotation in a standing position. RESULTS: Hip ER isometric torque explained a small part (10%) of the variance of the Arno angle in healthy athletes (R² change=0.10; unstandardized ß=11.74 (95% CI 6.82, 16.65); Standardized Coefficient Beta=0.32) and sex explained 2% of its variance (R² change=0.02; unstandardized ß= 2.42 (95% CI 0.32, 4.52); Standardized Coefficient Beta=0.15). After controlling for sex, hip ER torque explained 9% of Arno angle variance (R² change=0.09; unstandardized ß= 11.09 (95% CI 6.43, 15.76; Standardized Coefficient Beta=0.31). The other variables were not associated with patellar rotation. CONCLUSIONS: Hip ER torque may influence patellar rotation in different directions (medial or lateral rotation). Possible mechanisms that explain the contribution of higher and lower hip ER torque in lateral and medial patellar rotation, respectively, are discussed.

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OBJECTIVE: To verify the association of the isometric strength of the shoulder external rotators (ER) and serratus anterior (SA) with the performance of functional tests CKCUEST, SMB-T, and USSP-T in overhead athletes. DESIGN: Cross-sectional study. PARTICIPANTS: Eighty overhead athletes with no history of surgery in the upper and lower limbs and trunk in the past year, and no painful symptoms in the upper body during the physical assessment were included. MAIN OUTCOME MEASURES: Preseason assessment included isometric strength of shoulder ER and SA, and performance of the CKCUEST, SMB-T, and USSP-T. Multiple linear regression analysis was performed to identify if the isometric strength of the shoulder ER and SA could explain the performance during the tests after controlling for sex. RESULTS: The isometric strength of SA was associated (p < 0.05) with the SMB-T and USSP-T with 4% of explain. The isometric strength of the SA was not associated (p > 0.05) with the CKCUEST. The isometric strength of the ER was not associated (p > 0.05) with any of the tests. CONCLUSION: The isometric strength of the SA predicted the SMB-T and USSP-T performance. Isometric strength of SA and shoulder ER was not associated with CKCUEST results in athletes overhead.

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BACKGROUND: Deficits in strength of the hip external rotators (ER) affect trunk, hip, and knee movement patterns, potentially contributing to injury in athletes. OBJECTIVES: To provide normative data on isometric torque for hip ER in athletes of three distinct sports and to determine if isometric torque for the hip ER and torque asymmetry between legs differ among sports and between sexes. METHODS: Basketball, soccer, and volleyball athletes (n=451) were evaluated. Hip ER torque was quantified bilaterally with athletes in prone and 90° of knee flexion using a hand-held dynamometer. RESULTS: Data are expressed as mean and 95% confidence interval. Hip ER torque values in Nm/kg for the dominant and non-dominant limbs were, respectively, 0.46 (0.44, 0.48) and 0.42 (0.40, 0.44) for male soccer athletes; 0.35 (0.32, 0.37) and 0.27 (0.25, 0.29) for male basketball athletes; and 0.37 (0.34, 0.39) and 0.35 (0.32, 0.37) for male volleyball athletes. Hip ER torque in Nm/kg for the female volleyball athletes was 0.29 (0.26, 0.33) for the dominant and 0.29 (0.25, 0.32) for the non-dominant limb. The Limb Symmetry Index for male soccer, basketball, and volleyball players was, respectively, 94% (91, 97), 81% (75, 87), and 95% (91, 99). For female volleyball players the Limb Asymmetry Index was 102% (95, 108). Male volleyball athletes showed higher torque values than female volleyball athletes. CONCLUSIONS: This study reported normative values for hip ER isometric torque of youth athletes. Clinicians can use the reported data as reference to identify torque deficits in athletes of the three reported sports.

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OBJECTIVE: To investigate the effects of an intervention with tailored exercises on the incidence of patellar tendinopathy (PT) in elite youth jumping athletes. DESIGN: Prospective crossover cohort. SETTING: One sport club facility. PARTICIPANTS: 271 elite youth basketball and volleyball player were followed in the first year of the study (Observation year) and 270 athletes were followed in the second year (intervention year). MAIN OUTCOME MEASURE: Incidence rates of PT per 1,000h of exposure. Cox survival analysis was used to verify the effects of the intervention (exercises implemented according to the findings of a preseason assessment) on PT incidence. RESULTS: The exercise prevention program significantly reduced the number of cases of PT, with athletes submitted to the intervention showing 51% less risk of developing PT. The overall PT incidence in the Observation year (5.9 per 1,000h of exposure) was significantly higher than that in the intervention year (2.8 per 1,000h of exposure) (P = .037). Twenty-six athletes developed PT in the observation year, whereas 13 athletes developed PT in the intervention year. CONCLUSIONS: A tailored preventive program may be able to reduce the incidence of patellar tendinopathy, especially in male youth volleyball athletes. Randomized controlled trials are encouraged to confirm these findings.

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

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

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

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