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Benno Ejnisman,1 Gisele Barbosa,1 Carlos V Andreoli,1 A de Castro Pochini,1 Thiago Lobo,2 Rodrigo Zogaib,2 Moises Cohen,1 Mario Bizzini,3 Jiri Dvorak3 1Department of Orthopaedics, Federal University of São Paulo, 2Sports Medicine Department, Santos FC, São Paulo, Brazil; 3FIFA-Medical Assessment and Research Centre, Schulthess Clinic, Zurich, Switzerland Abstract: In the last years, shoulder injuries have represented an increasing health problem in soccer players. The goalkeepers are more exposed to shoulder disorders than other field players. Injury prevention exercises for upper limbs were cited in few studies involving throwing athletes, but we know that goalkeepers need a specific program. The purpose of this study is to describe the development of an adapted Fédération Internationale de Football Association (FIFA) 11+ program, namely the FIFA 11+ shoulder, which targets the prevention of shoulder injuries in soccer goalkeepers. The FIFA 11+ shoulder program is structured into three parts: general warming-up exercises, exercises to improve strength and balance of the shoulder, elbow, wrist, and finger muscles, and advanced exercises for core stability and muscle control. The exercises were selected based on recommendations from studies demonstrating high electromyographic activity. Keywords: goalkeeper, shoulder, injury prevention, prevention program

The present study evaluated the effects of a newly developed injury prevention programme for children’s football (“FIFA 11+ Kids”) on motor performance in 7–12-year-old children. We stratified 12 football teams (under-9/-11/-13 age categories) into intervention (INT,N = 56 players) and control groups (CON,N = 67). INT conducted the 15-min warm-up programme “FIFA 11+ Kids” twice a week for 10 weeks. CON followed a standard warm-up (sham treatment). Pre- and post-tests were conducted using: single leg stance; Y-balance test; drop and countermovement jump; standing long jump; 20-m sprint; agility run; slalom dribble; and wall volley test. We used magnitude-based inferences and linear mixed-effects models to analyse performance test results. We observed likely beneficial effects favouring INT in Y-balance (right leg; +3.2%; standardised mean difference (SMD) = 0.34;P = 0.58) and agility run (+3.6%; SMD = 0.45;P = 0.008). Possibly beneficial effects were found in Y-balance, drop jump reactive strength index, drop jump height, countermovement jump, standing long jump, slalom dribble and wall volley test. At least possibly beneficial improvements in favour of “FIFA 11+ Kids” were observed in nearly all parameters. Most effects were small, but slight improvements in motor performance may potentially contribute to a reduction of injury risk. [ABSTRACT FROM AUTHOR]

Background: Quadriceps muscle strength, which is essential for the function and stability of the knee, has been found to be impaired even years after arthroscopic partial meniscectomy. However, the neuromuscular alterations that could account for such muscle weakness remain unclear.Questions/purposes: We investigated (1) the side-to-side asymmetries in quadriceps muscle strength 6 months after arthroscopic partial meniscectomy, (2) the physiologic mechanisms (neural versus muscular) underlying muscle weakness, and (3) the impact of quadriceps weakness on muscle control at submaximal force levels.Patients and Methods: We tested 14 volunteers (10 men, four women) with an average age of 44 +/- 9 years (range, 24-59 years) at 6 +/- 1 months after unilateral medial arthroscopic partial meniscectomy. We measured maximal voluntary strength and muscle activation during isometric, concentric, and eccentric contractions using isokinetic dynamometry and surface EMG, respectively. We assessed vastus lateralis muscle size and architecture using ultrasonography. We measured muscle control at submaximal force levels with a repositioning test (knee proprioception) and a low-force target-tracking task (steadiness, accuracy).Results: Isometric and concentric quadriceps strength and vastus lateralis EMG activity were lower on the involved than on the uninvolved side. Muscle architecture and muscle control did not differ between the involved and uninvolved sides.Conclusions: Our results showed quadriceps weakness exists 6 months after arthroscopic partial meniscectomy. As suggested by the EMG results, this is likely attributable to neural impairments (activation failure) that affect muscle control at maximal but not submaximal force outputs.Level Of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Objective: To analyze the extent and characteristics of injuries and musculoskeletal complaints in elite football referees and to analyze differences between match and assistant referees. Design: Retrospective cohort study. Setting: Training camp organized by the Swiss Referees Association. Participants: All 71 referees of the 2 top divisions of the Swiss Football League (2005-2006 season). Interventions: The referees (66 males and 5 females) completed a questionnaire on their personal characteristics, referee qualifications, time spent in training and matches, career history of injuries, and musculoskeletal complaints caused by training or refereeing and were subsequently interviewed about the location, type, circumstances, and consequences of reported injuries. Main Outcome Measures: Incidence of injuries, frequency of musculoskeletal complaints, type of injuries, and complaints. Results: A total of 41 injuries during the career were reported by 31 of 71 referees (44%). Injuries were incurred more frequently in training than during matches, and all injuries reported resulted in at least 2 weeks of absence from sport. About a quarter of the referees reported an injury, and almost 90% of the referees reported musculoskeletal complaints caused by refereeing during the preceding 12 months. In male referees, hamstring strains and ankle sprains were the most common injuries, and the hamstrings, knee, Achilles tendon, and calf were the most prevalent locations of musculoskeletal complaints. No significant difference in the incidence of injury or in the frequency of complaints was observed between match and assistant referees. Conclusions: Future studies should be designed prospectively and should include a larger group of female referees. Regarding the incidence of injuries and frequency of musculoskeletal complaints related to refereeing, prevention programs for football referees should be developed, evaluated, and implemented. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To analyze ligamentous stability and isokinetic strength of knee extensor and flexor muscles after anterior cruciate ligament reconstruction using 2 different autografts with identical fixation. DESIGN: This study implements a comparative case series design. SETTING: Schulthess Clinic, Switzerland. PATIENTS: A total of 153 consecutive patients (n = 87 bone-patellar tendon-bone [BPTB]/66 quadruple semitendinosus/gracilis tendons [QSGT] patients) who underwent BPTB and QSGT surgery were functionally assessed. INTERVENTION: All patients were functionally assessed (knee extension/flexion isokinetic strength and knee joint laxity) at a mean follow-up time of 11 months. MAIN OUTCOME MEASUREMENTS: Laxity was measured utilizing the Kneelax arthrometer, whereas isokinetic strength of the knee extensor/flexor muscle groups was measured using the Biodex Multi Joint System 2 (180 degrees /s and 300 degrees /s). RESULTS: The QSGT group had significantly greater knee joint laxity when compared with the BPTB group (P < 0.001). Furthermore, females in the QSGT group demonstrated the greatest knee joint laxity overall (P < 0.001). Additionally, a significant flexor torque deficiency was demonstrated in the QSGT group (P < 0.001); however, no differences in extensor torque were observed. CONCLUSIONS: The use of a BPTB autograft achieved better knee joint stability as well as greater knee flexor torque than the QSGT autograft. Both grafts exhibited a similar knee extensor torque deficit, indicating that only quadriceps strength is not graft-dependent. [ABSTRACT FROM AUTHOR]

Background: Precompetition screening was implemented for male referees during the 2010 Fédération Internationale de Football Association (FIFA) Word Cup. In contrast, female football referees have been neglected in this respect although they experience similar physical work loads compared to male referees.Methods: The standardised football-specific pre-competition medical assessment (PCMA) was performed in 51 referees and assistant referees selected for the 2011 FIFA Women's World Cup.Results: Family history for sudden cardiac death (SCD) was positive in four referees (7.8%), but cardiac examinations did not reveal any pathological findings. Training-unrelated ECG changes were identified in three referees (5.9%), all without correlates in echocardiography or clinical examination. Most common echocardiography findings (66.6%, n=34) were asymptomatic tricuspid and mitral regurgitations.Conclusions: During the present screening, no elite female referee was identified being at risk for SCD, and no referee had to be excluded from participating in the 2011 FIFA Women's World Cup. [ABSTRACT FROM AUTHOR]

The use of inulin in food is highly appreciated by consumers because of its prebiotic effect. In this study, the effects of increasing additions (5, 10 and 20%) of inulin as a substitute for wheat flour in bread production were investigated with regard to the physical, technological and rheological properties of the flour blends. Inulin reduced the water-binding capacity from 1.4 g/100 g with 0 flour to 0.80 g/100 g with the 20% inulin addition, while there were no statistical differences in the oil-binding capacity. The addition of inulin also influenced the yeast rates, especially in the samples with 5 and 10% addition. On the farinograph, inulin caused a reduction in water absorption (40.75 g/100 g with 20% inulin), an increase in dough development time (18.35 min with 10% inulin) and dough stability (13.10 min with 10% inulin). The mixograph showed a longer kneading time for the sample with 20% inulin (8.70 min) than for the control (4.61 min). In addition, there was an increase in dough firmness and tightness due to the addition of inulin (W: 203 × 10 -4 J; P/L: 4.55 for the 20% inulin sample) compared with the control. The physical and technological properties of the loaves were evaluated at time 0 and after 4 days (T4). The addition of inulin reduced the volume of the bread while increasing the weight, albeit with a weight loss at T4 (compared to T0) of 4.8% for the 20% inulin and 14.7% for the control. The addition of inulin caused a darkening of the crust of the enriched bread, proportional to the increase in inulin content. In addition, the inulin content ranged from 0.82 g/100 g in the control to 14.42 g/100 g in the 20% inulin bread, while the predicted glycemic index ranged from 94.52 in the control to 89.39 in the 20% inulin bread. The available data suggest that the formulation with 5% inulin provides the highest performance.

Objective: To examine the specificities and limitations of bilateral and unilateral tasks for the assessment of hip abductor and adductor strength with a commercially-available fixed-frame dynamometer., Design: Correlational/validity study., Methods: Maximal voluntary isometric strength of hip abductors and adductors was evaluated in 130 healthy participants using unilateral and bilateral tasks. Surface EMG activity of agonist and stabilizer muscles was concomitantly recorded in a subgroup of 15 participants., Results: For both muscle groups, bilateral tasks resulted in higher strength values than unilateral tasks (∼25%; p < 0.001). The correlation between left- and right-side data was higher for bilateral than unilateral tasks (p < 0.05), thereby resulting in lower interlimb asymmetries (p < 0.001). Agonist EMG activity was lower for unilateral than bilateral tasks (p < 0.01). Stabilizer EMG activity (external abdominal oblique) was higher for unilateral than bilateral tasks (p < 0.05) on the ipsilateral and contralateral side for hip abductors and adductors, respectively., Conclusions: A large (25%) and quasi-systematic bilateral facilitation of strength was observed for both hip abductors and adductors. Bilateral testing led to an underestimation of interlimb asymmetries, due to higher side equivalence than unilateral tasks. Unilateral testing resulted in lower agonist EMG activity and higher stabilizer activity than bilateral tasks, especially in weaker subjects., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To investigate if the 11+ injury prevention programme decreases the risk of hamstring injury and improves recovery time and determine whether compliance with the 11+ affects hamstring injury risk., Methods: This study is a secondary analysis from a prospective cluster randomised controlled trial that included 65 National Collegiate Athletic Association (NCAA) division I and II men's soccer teams over the fall 2012 season. Thirty-one teams were randomised to the intervention group that were using the 11+ as their warm-up and 35 teams to the control group that continued to use their traditional warm-up. Each certified athletic trainer (ATC) collected data on demographics, hamstring injury (HSI), mechanism of injury, position, playing surface, time lost due to injury and compliance to the 11+ programme., Results: The 11+ decreased the risk of HSI by 63% compared with the control group (RR=0.37, 95% CI 0.21 to 0.63). Difference in return to play after HSI between the control (9.4±11.2 days) and intervention groups (10.2±11.3 days) was not significant (p=0.8). High compliance (>2 or more doses on average per week) reduced the risk of HSI by 78% (RR=0.22, 95% CI 0.06 to 0.87) compared with low compliance (<1 dose on average per week), and moderate compliance (1 to <2 doses on average per week) decreased the risk of HSI by 67% (RR=0.33, 95% CI 0.11 to 0.97) compared with low compliance. There was no significant difference between high and moderate compliance., Conclusion: The 11+ decreased the risk of HSI by 63% but did not improve recovery time. High to moderate compliance is essential and makes the programme more effective at reducing HSI., Competing Interests: Competing interests: The authors have not indicated any direct competing interests in conjunction with this manuscript. HS-G is a research consultant for Major League Soccer (MLS), National Football League (NFL) and the Aspetar Scientific Board. KT and MB both have editorial board positions with the British Journal of Sports Medicine., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To investigate current clinical practice of Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction (ACLR) from pre-operative rehabilitation until return to sport (RTS). We assessed optimisation strategies in daily practice and the perceived barriers to these optimisations, and evaluated whether there was a relevant difference in clinical practice for physiotherapists with post-graduate certification in sports physiotherapy or deep clinical experience and those without such experience., Design: Cross-sectional survey., Setting: Online survey platform., Participants: Swiss physiotherapists., Main Outcome Measures: The survey comprised six sections: participant information, pre-operative rehabilitation, post-operative rehabilitation, RTS, re-injury prevention, and optimisation strategies and barriers., Results: A minority of physiotherapists treated ACLR patients pre-operatively. Overall, 91% included quadriceps open kinetic chain exercise in their treatment, 37% used patient-reported outcomes measures (PROMs) and 39% considered psychological criteria when making decisions about RTS. Most physiotherapists (67%) felt limited due to the time available, the number of prescriptions and the tariffication system., Conclusion: This study highlights areas within ACLR rehabilitation practice in Switzerland that could be improve. Improvements in understanding of the barriers to implementation of best evidence in practice and a redefinition of the clinical process around ACLR rehabilitation in Switzerland are necessary., Competing Interests: Declaration of competing interest None declared., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Non-arthritic intra-articular hip pain, caused by various pathologies, leads to impairments in range of motion, strength, balance, and neuromuscular control. Although functional performance tests offer valuable insights in evaluating these patients, no clear consensus exists regarding the optimal tests for this patient population., Purpose: This study aimed to establish expert consensus on the application and selection of functional performance tests in individuals presenting with non-arthritic intra-articular hip pain., Study Design: A modified Delphi technique was used with fourteen physical therapy experts, all members of the International Society for Hip Arthroscopy (ISHA). The panelists participated in three rounds of questions and related discussions to reach full consensus on the application and selection of functional performance tests., Results: The panel agreed that functional performance tests should be utilized at initial evaluation, re-evaluations, and discharge, as well as criterion for assessing readiness for returning to sports. Tests should be as part of a multimodal assessment of neuromuscular control, strength, range of motion, and balance, applied in a graded fashion depending on the patient's characteristics. Clinicians should select functional performance tests with objective scoring criteria and prioritize the use of tests with supporting psychometric evidence. A list of recommended functional performance tests with varying intensity levels is provided. Low-intensity functional performance tests encompass controlled speed in a single plane with no impact. Medium-intensity functional performance tests involve controlled speed in multiple planes with low impact. High-intensity functional performance tests include higher speeds in multiple planes with higher impact and agility requirements. Sport-specific movement tests should mimic the patient's particular activity or sport., Conclusion: This international consensus statement provides recommendations for clinicians regarding selection and utilization of functional performance tests for those with non-arthritic intra-articular hip pain. These recommendations will encourage greater consistency and standardization among clinicians during a physical therapy assessment., Competing Interests: The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. The authors declare no conflict of interest., (© The Author(s).)

Independent physiotherapy at home is a crucial element of rehabilitative care for a wide range of conditions as it constitutes a large portion of the overall therapy dose. However, up to 80% of individuals who are prescribed at-home physiotherapy do not consistently adhere to their treatment schedule, resulting in poor treatment outcomes. This is likely due to a lack of motivation and progress tracking in the current standard of care. We have developed a novel software prototype that allows users to control commercial entertainment content, such as video games or interactive music videos, with their movements during physiotherapy. By connecting therapy to proven entertainment content, we aim to improve on the current motivational deficits. This study investigated the safety and feasibility of this concept in a controlled environment over four physical therapy sessions with seven patients suffering from musculoskeletal and neurological conditions. As a secondary outcome, patients were asked about their enjoyment, perceived competence and effort using the Intrinsic Motivation Inventory (IMI) questionnaire. All participants were able to interact with the presented entertainment content and completed the study with no adverse events. Despite the diversity in pathology, age and training scenarios, the entertainment content maintained the patients' enjoyment with a high average rate of 6/7 on the IMI scale. Interacting with commercial entertainment content by doing physical therapy exercises was feasible, safe, and well-received over the six-week study period.

Background: The 11+ injury prevention program (IPP) has been shown to decrease injury rates. However, few studies have investigated compliance and its overall relationship to team performance., Hypothesis/purpose: To examine if level of compliance while implementing the 11+ would impact team performance outcomes (wins, losses and ties). The authors hypothesized that higher team compliance to the IPP would be consistent with improved overall team performance (more wins and fewer losses)., Study Design: Prospective, cluster randomized controlled trial., Methods: This study was conducted in NCAA men's soccer teams for one season and examined the efficacy of the 11+ IPP. The outcome variables examined were levels of compliance and team performance record: wins, losses, and ties. Twenty-seven teams (n=675 players) served as the intervention group (IG) and used the 11+ program while 34 teams (n=850 players) served as the control group (CG). Compliance and team performance were recorded. There were three compliance categories that were defined prospectively, low (LC, < 1 dose/week), moderate (MC, >1 and <2 doses/week), and high (HC, >2 doses/week). Descriptive and inferential tests were used to compare the CG, the IG, and compliance to team performance. Three independent t-tests were used to analyze outcome to group (IG vs. CG). A one way-MANOVA test was used to analyze compliance to win/loss/tie record, followed up by one-way ANOVA tests to analyze how compliance impacted wins, losses and ties, independently. Partial η2 measures were calculated to determine the effect size of level of compliance on outcome. A Tukey post-hoc analysis was used to analyze specific differences between levels of compliance and specific outcome measures., Results: There were significantly more wins (IG: 10.67±2.63 versus CG: 8.15±3.83, CI, 7.95 - 9.69, p = 0.005) and fewer losses (IG: 5.56±1.97 versus CG: 8.12±3.59, CI, 5.66 to 7.43, p = 0.002) recorded for the teams using the 11+ program. There was a statistically significant difference between levels of compliance (high, moderate or low) on the dependent variables (wins, losses, and ties), F(3, 22) = 3.780, p =0.004; Wilks' Λ = .435; partial η2 = .340., Conclusion: The 11+ has the capacity to improve overall team performance in male collegiate soccer teams. The higher the compliance, the more favorable the team performance. This research may be a vital addition when attempting to persuade coaching staffs to adopt an IPP into their training regimen., Level of Evidence: Level I., Competing Interests: The authors declare no conflicts of interest.

In recent years, the growth of tetraploid Sicilian wheat landraces has been arousing increasing interest. In this study, eighteen local genotypes of Triticum turgidum subsp. turgidum , belonging to the groups 'Bufala', 'Ciciredda', 'Bivona' and 'Paola', and two cultivars of Triticum turgidum subsp. durum (the old variety 'Bidì', and a more recent variety 'Simeto') were assessed for the characteristics of the grain and bread-making performance of their flours and doughs, as well as the quality of the loaves. The grain of the twenty genotypes came from a field trial conducted during 2018-2019 in south-eastern Sicily. The main commercial features of the grain (thousand kernel weight and hectolitre weight), including the defects (starchy, black pointed and shrunken kernels), were determined. The wholemeal flours and doughs obtained from the grain of each genotype were evaluated for the main technological quality (physico-chemical and rheological characteristics), and processed into loaves, whose main quality indices (volume, height, weight, moisture and porosity) were assessed. The results from such analyses allowed the authors to evaluate the genotypes' bread-making suitability. In particular, for the grain characteristics, hectolitre weight varied from 68.23 ('Bufala Rossa Lunga 01') to 77.43 ('Bidì 03') kg/hL, passing through the typical values for common and durum wheat. Among the grain defects, the black point defect was absent in all the grain samples, except for that of 'Bufala Nera Corta 01' (2%). Dry gluten content varied from 6.22 to 10.23 g/100 g, and sedimentation test values were low or medium-low, with values ranging from 22 to 35 mL. Amylase activity was low and highly variable among the genotypes, with the maximum value observed for 'Bufala Rossa Corta b01' (509 s). The doughs evidenced a poor quality for bread making with alveograph values of W ranging from 12 to 145 (10 -4 × Joule) and thus the volume of the loaves varied from 346.25 cm 3 of 'Bivona' and 'Ciciredda' to 415.00 cm 3 of 'Bufala Rossa Lunga'. A Tandem Cluster Analysis was conducted on a set of all the response variables. The Hierarchical Cluster Analysis was initially run. A five-cluster solution identified three clusters further segmented and two single branches. Overall, the study highlighted the possibility of using some of these landraces alone for the production of traditional breads locally appreciated or together with other ingredients for the production of crumbly baked goods such as substitutes for bread and biscuits.

Objectives: To examine hip muscle strength deficits in patients with femoroacetabular impingent syndrome (FAIS), with special emphasis on potential sex- and comparison-related (between-subject vs within-subject) differences., Design: Cross-sectional comparative study., Participants: Forty FAIS patients (20 women), 40 healthy controls (20 women) and 40 athletes (20 women)., Main Outcome Measures: Hip abduction, adduction and flexion isometric strength was tested using a commercially-available dynamometer. Two between-subject comparisons (FAIS patients vs controls and FAIS patients vs athletes) and one within-subject comparison (inter-limb asymmetry) of strength deficits were conducted, based on the calculation of respective percent differences., Results: For all hip muscle groups, women were 14-18% weaker than men (p < 0.001), but no sex-related interactions were observed. For all hip muscle groups, FAIS patients were 16-19% weaker than controls (p = 0.001) and 24-30% weaker than athletes (p < 0.001). For FAIS patients, the involved hip abductors were 8.5% weaker than the uninvolved ones (p = 0.015), while no inter-limb asymmetry was observed for the other hip muscles., Conclusion: Sex had no influence on hip muscle strength deficits in FAIS patients while a major impact of comparison method/group was observed. Hip abductors showed consistent deficits for all comparison methods, suggestive of a possible greater impairment compared to hip flexors and adductors., Competing Interests: Declaration of competing interest None declared., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The Fédération Internationale de Football Association (FIFA) 11+ Kids is an exercise-based injury prevention program developed by an international group of experts to prevent injuries among child soccer players., Hypothesis: It was hypothesized that the FIFA 11+ Kids program would be more effective than performing a typical warm-up regimen in reducing overall injuries among soccer players aged 7 to 13 years., Study Design: A clustered randomized controlled trial., Level of Evidence: Level 1., Methods: A total of 94 boys' soccer teams, including 780 players, were randomly allocated into an experimental or control group. Complete datasets were collected from 45 teams (377 players) and 43 teams (363 players) in the experimental and control groups, respectively. The experimental group underwent the FIFA 11+ Kids program as a warm-up during training sessions and matches at least twice a week, and the control group continued performing their usual warm-ups. Participants were prospectively followed during 1 season (6 months). The primary outcomes included the incidence of overall and recurrent injuries and their mechanism and severity. The secondary outcome was the rate of compliance with the intervention program., Results: A total of 43 injuries were reported in the experimental group in 50,120 hours of exposure (0.85 injuries/1000 exposure hours). A total of 86 injuries were reported in the control group in 42,616 hours of exposure (2.01 injuries/1000 exposure hours). The injury risk ratio was 0.43 (0.29-0.61), suggesting that the experimental group experienced 57% fewer injuries than those in the control group., Conclusion: The FIFA 11+ Kids program reduced overall injury rates in children playing soccer more than the usual warm-ups., Clinical Relevance: The results of this study provide evidence for children's coaches to consider including the FIFA 11+ Kids program in their warm-up regimen. Such a program may prevent injury risk and decrease absenteeism and injury-related financial burdens.

Background: The side effects of the FIFA 11+ program on performance have not been generally reviewed. The objective of this study was to synthesize the literature on the effects of the 11+ on players' performance., Methods: Five online databases (PubMed, Scopus, ScienceDirect, Springer, and Google Scholar) were searched (from April 2006 to March 2022) using predefined keywords and sub-keywords. The potential references were primarily recorded through Endnote and imported to Covidence. Out of the 123 references screened by 2 blinded researchers through the software, 59 full texts were assessed for eligibility, 33 of which were ultimately included. The quality of the studies and the risk of bias were then assessed. Study ID, title, place, aim, design, start/end dates, population description, study criteria, statistical analysis, and outcomes were extracted., Results: Studies were conducted on male and female players aged 10-32 years old. The quality of the studies was moderate to high, and except for unclear bias for blinding outcome assessment, the risk of bias for all domains was low. Long-term application of the 11+ improved most biomechanical measures and physiological responses except for lower extremity stability, ankle evertors time latency, ankle dorsiflexion, and proprioception. Conversely, the 11+ showed acute negative effects on physical performance compared to dynamic warm-ups and non-significant effects on technical abilities., Conclusion: Mid-to-long-term implementation of the 11+ improved the majority of biomechanical and a couple of physical measures but showed no effects on technical skills. Precaution must be observed for using the 11+ before competitions, as it could acutely decrease physical/technical performance. Given the contradictory nature of the literature, further studies should evaluate the short-to-mid-term effects of the 11+. Further studies are required to address ankle responses to the 11+ intervention., Competing Interests: Competing interests The authors declare that they have no competing interests., (Copyright © 2022. Production and hosting by Elsevier B.V.)

The Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This guideline focuses on the exercise-based prevention of knee injuries and provides an update on the 2018 guideline, J Orthop Sports Phys Ther. 2018;48(9):A1-A42. doi:10.2519/jospt.2018.0303 J Orthop Sports Phys Ther. 2023;53(1):CPG1-CPG34. doi:10.2519/jospt.2023.0301 .

A relevant amount of waste is produced in the canning industry of globe artichoke. This study proposes to use flours of artichoke waste (stems and bracts) in durum wheat bread-making, replacing the re-milled durum wheat semolina at increasing levels (5, 7.5 and 10 g/100 g). No study had evaluated this type of enrichment in durum wheat bread, widespread in the same area where artichoke waste is mostly produced. The replacement had a visible effect on the flour color, increasing a* and reducing b* and L* , and this was reflected in the color of bread crumb. The water absorption determined by farinography, dough development time and dough stability increased as the level of replacement increased (up to 71.2 g/100 g, 7.3 min and 18.4 min, respectively). The mixograph peak height and mixing time increased compared to control. The alveograph W decreased, while the P/L ratio increased. The artichoke waste-enriched breads had a lower volume (as low as 1.37 cm 3 /g) and were harder than control, but they did not show relevant moisture losses during five days of storage. The obtained data show therefore an interesting potential of artichoke waste flours in bread-making, but further investigations are needed for achieving improved quality features.

Objectives: This project aims to assess opinions, attitudes, knowledge, beliefs, practices and perceived barriers and facilitators of injury prevention (IP) strategies in Swiss basketball teams., Methods: An online survey was sent to athletes, coaches and medical staff of the three best basketball leagues in Switzerland. The survey was subdivided in four sections: (1) characteristic of participants, (2) knowledge, opinions, attitudes and beliefs, (3) practices and (4) barriers and facilitators., Results: Among 105 persons (n=45 female, n=60 male) who answered the survey, more than 60% (n=68) considered the risk of injury for basketball athletes as being high to very high. The ankle, knee and the hand were considered as being the most at risk. More than 80% of participants considered that recovery, training load and the warm-up quality were very important factors for IP. More than 90% of participants considered IP as either important or very important with 53 (50.5%) of the participants indicating using exercise-based IP in their clubs. Athletes and coaches' motivation and compliance were judged as either important or very important for successful IP implementation by more than 80% of participants, with the coach being reported as the most influential person. Environmental barriers towards human or infrastructural resources were also reported as factors influencing IP strategies, namely by female participants., Conclusion: Good knowledge and positive attitude towards IP were reported by participants, but exercise-based IP strategies lack implementation. The coach was considered as the most influential person and was reported with the athletes as playing an important role towards successful implementation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Objective: To provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports., Design: Delphi., Setting: LimeSurvey platform., Participants: Experienced sports physical therapists from the International Federation of Sports Physical Therapy member countries., Main Outcome Measures: Factors related to sports IPP planning, organization and implementation., Results: We included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement)., Conclusion: Strong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist., Competing Interests: Declaration of competing interest LDM, CR, CN, UB are on the IFSPT executive board. The other co-authors have none declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the mid-term outcomes of exercise therapy in patients with femoroacetabular impingement syndrome (FAIS)., Design: Follow-up study., Setting: Clinical setting., Participants: Twenty-six patients with FAIS who completed a 12-week semi-standardized, progressive exercise therapy program., Main Outcome Measures: At a mid-term follow-up of 4.6 years, therapy outcome was assessed using (i) the Global Treatment Outcome questionnaire for hip pain, (ii) the Hip Outcome Score (HOS) for hip pain and function in activities of daily living (ADL) and Sport and (iii) the Hip Sports Activity Scale (HSAS) for sport activity level. Mid-term outcomes were compared to pre-symptomatic, pre-therapy, as well as to short-term follow ups (18 weeks)., Results: In patients who completed the exercise program and did not undergo hip surgery (N = 19), mid-term HOS ADL and HOS Sport (P = 0.002) were higher than pre-therapy, and comparable to the 18-week follow-up. Mid-term HSAS was lower than the pre-symptomatic status (P = 0.022), but comparable to the 18-week follow-up., Conclusion: At a mid-term follow-up of 4.6 years, FAIS patients with no subsequent hip surgery maintained the good exercise therapy outcomes and the level of sport activity achieved at short term., Competing Interests: Declaration of competing interest None declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

We compared the effectiveness of a home-based neuromuscular electrical stimulation (NMES) program applied to the quadriceps of the nonoperative side against sham-NMES as a complement to standard rehabilitation on knee extensor neuromuscular function in patients following anterior cruciate ligament (ACL) reconstruction. Twenty-four patients completed the 6 week NMES ( n = 12) and sham-NMES ( n = 12) post-operative interventions and were tested at different time points for neuromuscular function and self-reported knee function. Isometric, concentric, and eccentric strength deficits (muscle weakness) increased significantly from pre-surgery to 24 weeks post-surgery in the sham-NMES group ( p < 0.05), while no significant changes were observed in the NMES group. On the stimulated (nonoperative) side, quadriceps voluntary activation and muscle thickness were respectively maintained ( p > 0.05) and increased ( p < 0.001) as a result of the NMES intervention, contrary to sham-NMES. Self-reported knee function improved progressively during the post-operative phase ( p < 0.05), with no difference between the two groups. Compared to a sham-NMES intervention, a 6 week home-based NMES program applied to the quadriceps of the nonoperative side early after ACL reconstruction prevented the occurrence of knee extensor muscle weakness 6 months after surgery. We conclude that nonoperative-side NMES may help counteract muscle weakness after ACL reconstruction.

Cereal landraces are a very valuable resource in contemporary agriculture. A renewed focus for breeding purposes could ameliorate some negative consequences of modern agriculture and conventional breeding, such as the loss of genetic diversity. One strategy combining molecular genotyping and characterization of morpho-agronomic traits related to productivity is proposed to assess a group of tetraploid wheat landraces named Bufala, historically cultivated in the mountain areas of Sicily and characterized by adaptability in terms of cold tolerance, ability to grow in marginal soils, weed competitiveness and resistance to diseases. A total of 55 SSR molecular markers were used to detect patterns of diversity in 30 rivet and durum wheat genotypes. Furthermore, phenotyping was then conducted for 8 morpho-agronomic traits. Discriminant analysis of principal components (DAPC), STRUCTURE and phylogenetical analysis allowed to identify three groups, two of them genetically close and including both Bufala and Bufala-related rivet landraces. To the third group, old and more recent durum wheat varieties, constituting the outgroup, were assigned. Clustering was confirmed by Principal Component Analysis (PCA). Finally, a correlation analysis showed that Bufala genotypes are characterized by lower ear density, major ear length and later earing time compared with the other studied genotypes. The levels of diversity and population structure could be an important contribution to parent selection in tetraploid wheat breeding programs, as well as to germplasm conservation and management.

Synopsis: There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952 .

Background: Exercise-based injury prevention programs for athletes have demonstrated consistent results in reducing the risk of lower limb injuries. Compliance is essential for program effectiveness and may be facilitated when these programs demonstrate positive effects on athletic performance., Hypothesis/purpose: To summarize the findings of current systematic reviews on the effectiveness of lower limb injury prevention programs with multiple neuromuscular components on sports performance and quantify these effects. The authors hypothesized that injury prevention programs can improve certain sports performance criteria., Study Design: Umbrella systematic review., Methods: Systematic reviews published in French, German, or English between January 1990 and January 2020 were identified in five databases. Only articles that investigated multicomponent lower limb injury prevention programs and their effects on the performance criteria of strength, balance, agility, jumping or speed by both amateur and professional athletes of all ages and sex were included. The methodological quality of the included systematic reviews was assessed by two reviewers independently using the Assessing the Methodological Quality of Systematic Reviews measurement tool., Results: Five systematic reviews met the inclusion criteria. Overall, beneficial effects of multicomponent exercise-based injury prevention programs were observed for balance, agility, jumping and speed. While the effects on strength were more variable, there was a positive trend in favor of injury prevention programs., Conclusion: Injury prevention programs with multiple neuromuscular exercise components demonstrate overall beneficial effects on the performance criteria of balance, agility, jumping or speed. These beneficial effects may be used to promote the implementation of such programs., Level of Evidence: 2a., Competing Interests: None of the authors have any conflicts of interest pertinent to this manuscript to disclose.

Objective: The Fédération International de Football Association (FIFA) 11+ Referees Injury Prevention Program (FIFA 11+ Referees Program) is a structured warm-up program specially designed to prevent injuries in soccer referees. However, its effectiveness has yet to be fully documented in the literature. Therefore, the purpose of this study was to investigate the effectiveness of the FIFA 11+ Referees Program in reducing injury rates among soccer referees., Methods: A randomized controlled trial was conducted. Two hundred male amateur soccer referees (mean ± SD age, 31.6 ± 4.1 years) participated in this study. Participants were randomly allocated to the experimental and control groups. The experimental group performed the FIFA 11+ Referees Program as a warm-up during training sessions at least twice a week, and the control group performed their usual warm-ups. The participants were followed up for one season. The outcome measures were the incidence of overall injury, initial injury, recurrent injury, injury mechanism, and injury severity (primary), and the rate of adherence to the intervention program (secondary)., Results: A total of 24 injuries were reported among 100 referees in the control group in 16 606 h of exposure (1.45 injuries/1000 exposure h), and a total of nine injuries were reported across 100 referees within the experimental group in 17 834 exposure h (0.50 injuries/1000 exposure h). The Injury Risk Ratio (IRR) was 0.35 (95% CI 0.26-0.45)., Conclusion: The results indicated that the FIFA 11+ Referees Program effectively reduced injuries in the experimental group by 65% compared to the control group., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)