Konstantinos Fousekis

Intrinsic risk factors of non-contact quadriceps and hamstring strains in soccer: a prospective study of 100 professional players

Objectives To identify the intrinsic risk factors of non-contact strains in the hamstrings and quadriceps muscles of professional soccer players via a cohort prospective design. Methods A total of 100 professional soccer players (aged 19.4–27.8 years) from four professional teams underwent a composite musculoskeletal assessment at preseason. Intrinsic risk factors included dichotomies of asymmetries in muscle strength, flexibility, proprioception, anthropometry and knee joint stability, and of previous injuries. Muscle strains were prospectively monitored during the subsequent season using questionnaires. The data were analysed via binary logistic regression. Results Thirty-eight percent of the players sustained one or more lower-extremity muscle strains. Sixteen (42.1 %) and seven (18.4 %) of them were clinically diagnosed as having non-contact muscle strains at their hamstrings and quadriceps, respectively. Players with eccentric hamstring strength asymmetries (OR=3.88; 95% CI 1.13 to 13.23), functional leg length asymmetries (OR=3.80; 95% CI 1.08 to 13.33) and no previous hamstrings injuries (OR=0.15; 95% CI 0.029 to 0.79) were at greater risk of sustaining a hamstring muscle strain. Players with eccentric strength (OR=5.01; 95% CI 0.92 to 27.14) and flexibility asymmetries (OR=4.98; 95% CI 0.78 to 31.80) in their quadriceps as well as heavier (OR=10.70; 95% CI 0.73 to 156.37) and shorter players (OR=0.08; 95% CI 0.00 to 1.35) were at greater risk of sustaining a strain in this muscle group. Conclusions Professional soccer players with functional asymmetries possess a higher risk of sustaining hamstring strains. Previous injury seems not to constitute a risk factor. The systematic isokinetic evaluation of the lower extremities during the preseason period can provide therapists and trainers with valuable data regarding the predictive elements of non-contact hamstring strains in professional soccer players.

Intrinsic Risk Factors of Noncontact Ankle Sprains in Soccer A Prospective Study on 100 Professional Players

Background: Ankle sprain is an extremely common injury in soccer players. Despite extensive research, the intrinsic cause of this injury under noncontact conditions remains unclear. Purpose: To identify intrinsic risk factors for noncontact ankle sprains in professional soccer players. Study Design: Cohort study; Level of evidence, 2 Methods: One hundred professional soccer players were assessed in the preseason for potential risk factors of noncontact ankle sprains. The assessment included (A) ankle joint asymmetries (right-left) in isokinetic muscle strength, flexibility, proprioception, and stability; (B) somatometric asymmetries; (C) previous injuries; and (D) lateral dominance traits. Noncontact ankle sprains were prospectively recorded and diagnosed for a full competition period (10 months). Results: Seventeen of the players sustained at least 1 noncontact ankle sprain. Logistic regression revealed that players with (A) eccentric isokinetic ankle flexion strength asymmetries (odds ratio [OR] = 8.88; 95% confidence interval [CI], 1.95-40.36, P = .005), (B) increased body mass index (OR = 8.16; 95% CI, 1.42-46.63, P = .018), and (C) increased body weight (OR = 5.72; 95% CI, 1.37-23.95, P = .017 ) each had a significantly higher risk of a noncontact ankle sprain. A trend for younger players (OR = 0.28; 95% CI, 0.061-1.24, P = .092) and for players with ankle laxity asymmetries (OR = 3.38; 95% CI, 0.82-14.00, P = .093) to be at greater risk for ankle sprain was also apparent to the limit of statistical significance (.05 < P < .10). Conclusion: Functional strength asymmetries of the ankle flexors and increased body mass index and body weight raise the propensity for ankle sprains in professional soccer players. Age and asymmetries in ankle laxity are potential factors worth revisiting, as there was an indication for younger players and players with ankle instability to be at higher risk for ankle injury. Proper preseason evaluation may improve prevention strategies for this type of injury in soccer.

Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review

CONTEXT Elastic bandages are commonly used in sports to treat and prevent sport injuries. OBJECTIVE To conduct a systematic review assessing the effectiveness of elastic bandaging in orthopedic- and sports-injury prevention and rehabilitation. EVIDENCE ACQUISITION The researchers searched the electronic databases MEDLINE, CINAHL, SPORTDiscus, EMBASE, and Physiotherapy Evidence Database (PEDro) with keywords elastic bandaging in combination, respectively, with first aid, sports injuries, orthopedic injuries, and sports injuries prevention and rehabilitation. Research studies were selected based on the use of the term elastic bandaging in the abstract. Final selection was made by applying inclusion and exclusion criteria to the full text. Studies were included if they were peer-reviewed clinical trials written in English on the effects of elastic bandaging for orthopedic-injury prevention and rehabilitation. EVIDENCE SYNTHESIS Twelve studies met the criteria and were included in the final analysis. Data collected included number of participants, condition being treated, treatment used, control group, outcome measures, and results. Studies were critically analyzed using the PEDro scale. CONCLUSIONS The studies in this review fell into 2 categories: studies in athletes (n = 2) and nonathletes (n = 10). All included trials had moderate to high quality, scoring ≥5 on the PEDro scale. The PEDro scores for the studies in athletes and nonathletes ranged from 5 to 6 out of 10 and from 5 to 8 out of 10, respectively. The quality of studies was mixed, ranging from higher- to moderate-quality methodological clinical trials. Overall, elastic bandaging can assist proprioceptive function of knee and ankle joint. Because of the moderate methodological quality and insufficient number of clinical trials, further effects of elastic bandaging could not be confirmed.

The Effects of Hamstrings’ Cooling and Cryostretching on Sit and Reach Flexibility Test Performance in Healthy Young Adults

Aims: To investigate the effect of hamstrings’ cooling and short-duration Cryostretching on sit and reach flexibility test (SR) performance. Study Design: Crossover Randomized Clinical Trial. Place and Duration of the Study: Department of Physical Therapy, Technological Educational Institute (TEI) of Western Greece, Aigio Achaias, Greece, 3 months. Methodology: Eighteen (18) healthy male (age: 21,3±4,5 yr, weight: 79,0±12,7 Kg, body fat: 14,6± 4,0%) participated in the present study. Subjects were randomly divided into 3 groups which received in a random and counterbalanced order: a) hamstrings’ cooling with cold packs for 15 minutes, b) hamstrings’ cooling and static stretching for 14 minutes and 1 minute (30’’ for each extremity), respectively and c) passive rest (control status) for 15 minutes, on three visits made. Sit and Reach (SR) test, was applied before and after each intervention to assess the hamstrings’ flexibility. Original Research Article Gkrilias et al.; BJMMR, 19(6): xxx-xxx, 2017; Article no.BJMMR.31034 2 Results: Baseline Sit-and Reach results (SR 1) did not differ significantly between all 3 conditions (Cooling vs Control: 13,6±5,8 cm vs 13,8±7,1 cm P = 0,817; Cryostretching vs Control: 13,4±6,3 cm vs 13,8±7,1 cm P=0,620; Cooling vs Cryostretching: 13,6±5,8 vs 13,4±6,3 cm P=0,817). A significant improvement of hamstrings’ flexibility in SR2, was observed after hamstrings’ cooling intervention compared to corresponding values of Control (14,5±6,1 cm vs 13,2±7,0 cm P=0,026) and after cryostretching intervention compared to corresponding values of Control (14,9 ± 6,6 cm vs 13,2±7,0 cm, P=0,011). Flexibility values of hamstrings’ cooling alone compared with those after hamstrings’ cooling associated with a short bout of cryostretching (in SR 2), did not differ significantly (14,5±6,1 cm vs 14,9±6,6 cm, P= 0,502). Conclusion: Hamstrings’ cooling and cryostretching can improve performance in SR test and thus can be used as alternative methods for increasing the hamstrings’ flexibility in short term.

The Effectiveness of Instrument-assisted Soft Tissue Mobilization Technique(Ergoné Technique), Cupping and Ischaemic Pressure Techniques in theTreatment of Amateur AthletesàMyofascial Trigger Points

Objective: To compare the effectiveness of a novel Instrument-assisted soft tissue mobilization technique (Ergon© Technique), cupping therapy, and ischaemic pressure technique in the treatment of active myofascial Trigger-points (MTrPs) at the low-back region of amateur soccer players. Design: Randomised controlled clinical trial. Methods: Seventy (70) amateur soccer players (age=24.76 ± 4.39; height=174.98 ± 8.31 cm; weight=73.26 ± 11.21 kg) were evaluated for the presence of active MTrPs in their low-back region and were randomly allocated to three subgroups. The first group (N=20) was treated with Ergon-IASTM Technique©, the second (N=20) with a static application of cupping therapy and the third group (N=20) with ischaemic pressure. Ten (10) players received no treatment and served as controlsgroup. All athletes received one (1) therapeutic intervention per week for three (3) weeks. Outcome measures were MTrPs pain pressure threshold (PPT) and pain sensitivity (VAS). Results: All three therapeutic interventions led to a significant (p 0.05) was observed between cupping and ischaemic pressure techniques for their impact on MTrPs. Conclusions: The Ergon©-IASTM technique can serve as a first treatment options for sports physiotherapists when they manage Low-back MTrPs in amateur athletes. More research is needed in order definite conclusion to be drawn regarding the effects of this novel therapeutic intervention on MTrPs.

Modified Graded Motor Imagery programme containing âFekos MirrorTherapy methodâ: Î novel therapeutic method for the treatment ofshoulder dysfunctions - a pilot study

Objective: Mirror therapy (MT) is an important technique in the rehabilitation of patients who experience pain and decreased function. However, there are limited research studies on its application and effectiveness in shoulder pathologies, especially when it is applied as a part of graded motor imagery (GMI). The present study aims to highlight a novel therapeutic approach for the treatment of shoulder painful pathologies, using an innovative Mirror Therapy (Fekos Mirror Therapy) method in combination with motor imagery. Purpose: To investigate the efficacy of a novel MT included in an aggressive GMI protocol regarding pain reduction and range of motion (active shoulder flexion) restoration in patients with painful shoulder conditions. Methods: A novel GMI programme (Implicit Motor Imagery, EMI, and Fekos Mirror Therapy) was applied in five female patients (age: 18 -77 years) with symptoms of pain and decreased active range of motion for more than three months, for four treatment sessions (one-hour sessions). Variables assessed in each session included the active shoulder flexion (SpineCor®), pain (VAS), accuracy and response time in laterality recognition of the body (Recognise OnlineTM) and the motor imagery ability (the Kinesthetic and Visual Imagery Questionnaire/KVIQ - 10). Results: KVIQ-10 showed improvement in the motor imagery ability for the two sub-scales. The active shoulder flexion was increased and the pain decreased in all five patients, but the last one with fluctuation. According to Recognise OnlineTM programme, only one patient scored higher response times and lower accuracy for the affected limb compared to the healthy one. Conclusions: Central nervous system damage is present in chronic musculoskeletal patients, and GMI protocol containing Fekos Mirror Therapy technique may have a positive effect on the recovery of painful joint functional capacities. This method is in need of further implementation in randomized control studies for the confirmation of its efficacy.

Musculoskeletal Disorders among Greek Professional Ballet Dancers

Aim: To determine the incidence rate, type and anatomical distribution of musculoskeletal disorders and injuries of Greek professional Ballet Dancers. Study Design: Cross-sectional study. Place and Duration of the Study: Greek National Opera, Athens, Greece, 2 months. Methods: A self-administered questionnaire, containing primarily items related to the presence of injury and the body regions involved was given to all elite ballet dancers working in the Greek National Opera. Results: 31 ballet dancers (11 males, 20 females) participated in the study, providing a response rate of 59.61%. 62% of dancers (mean age 36 years) reported at least one musculoskeletal injury during the last year. In total, 98 injuries were registered.65% of all injuries were reported to be due to overuse and 35% were traumatic. The incidence of injury among professional dancers was 1.10 and 1,55 injuries per 1000 dance hours in males and females, respectively. The most frequent injury location was the neck and low back area (61.3%) in both sexes among the professional Original Research Article Tsekoura et al.; BJMMR, 19(11): 1-8, 2017; Article no.BJMMR.31876 2 dancers followed by the shoulders (48.4%) and ankles (45.2%). Ninety four percent (94%) of the injured dancers needed physiotherapy and only 23% needed surgery. The majority of injured dancers (55%) were absent from dance training for more than a week after the injury. Dancers believed that several factors were associated with risk of injuries, including training (90%) and muscle weakness (74%). Conclusions: Ballet dancers have high prevalence rates of musculoskeletal injuries and disorders. The findings of this study suggest that there is a need to apply primary injury prevention schemes in Greek ballet dancers.

Aggressive Musculoskeletal Physiotherapy: Should We Treat Pain with Pain?

Musculoskeletal physiotherapy (MP) is a non-invasive intervention which uses specific therapeutic techniques to help overcome pathologies and injuries of the human musculoskeletal system [1]. These kinds of pathologies include musculoskeletal disorders with high epidemiological incidence rate such as low back and cervical pain, myofascial trigger points and sports injuries [2-4]. All such musculoskeletal injuries and pathologies include, among others, a common clinical characteristic the musculoskeletal pain.

Aggressive Massage Techniques can Accelerate Safe Return after Hamstrings Strain: A Case Study of a Professional Soccer Player

Study Background: Hamstrings strains are very common in soccer players and their rehabilitation involves a demanding process which may be considerably time consuming depending on the severity of the injury. Traditional treatment for these injuries includes conservative forms of treatment such as gentle massage, passive stretching, electrotherapy and functional exercises during training. The aim of this case study was to evaluate the effectiveness of an aggressive rehabilitation program in the treatment of grade I hamstring strain in a professional athlete. Methods: A 30 year old professional soccer player clinically diagnosed with grade I hamstrings’ strain underwent a 15 days aggressive rehabilitation program. This included aggressive massage techniques with cups, instruments and stripping techinques, cryostretching/cryokinetics exercises, core strengthening and supervised functional exercises in the field. Results: The applied aggressive rehabilitation techniques reduced the conventional time of the athlete’s absence from sports participation by almost 50%. In addition, further relapses in the following period were prevented. Conclusion: This case study provides some evidence that aggressive physiotherapy techniques can reduce the absence from sports participation after hamstrings strain. Implementation and testing of these techniques in large randomised control studies is necessary for securing firm conclusions regarding their effectiveness in muscle strain rehabilitation.