Dynamic Balance, Flexibility and Agility as Predictors of Lower-extremity Injury in Football Players

Study Overview
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Brief Summary
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This research investigates the reliability of tests to assess injury risk. Participants will be tested at the beginning of the survey and will be monitored for over 5 months. Participants will take 4 types of tests related to dynamic balance, flexibility, and agility. Subsequently, the relationship between test results and the incidence of injury in the subjects will be analyzed. If the tests prove reliable, they will be included in standard tests to assess the risk of injury to football players.

Detailed Description
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Too often, injuring athlete results in a large amount of money being spent on rehabilitation. In a world of sports where the speed of recovery means a lot, ways are sought first and foremost to minimize the frequency of non-contact injuries. To prevent certain things, it is important to know the initial state, therefore, to see if certain factors at the outset indicate to us that there is a certain imbalance that can result in the injury. Since we live in a country where sports clubs are unable to spend large amounts of money on rehabilitation, it would be of great benefit to find reliable tests that can help to prevent an injury. Studies have shown that tests of balance, flexibility, and agility can help to prevent injury to football players in other countries. The same tests will be applied to Premier League footballers in Bosnia and Herzegovina and their effectiveness in assessing the degree of risk of lower limb injuries will be tested. If they prove reliable, they can become a standard in the prevention of these injuries, that is, they will help in the development of injury prevention programs, which would be of great benefit to both clubs and football players. The study aims to determine whether dynamic balance and flexibility tests can be used as reliable predictors of lower limb injuries in football players and whether reduced agility influences the increased risk of injury.

Official Title
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Prospective Cohort Study, Follow-up of Subjects Over Long Periods, Assessment of Test Reliability in Predicting Injury Risk

Conditions
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LOWER-LIMB INJURY

Intervention / Treatment
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* Diagnostic Test: Y Balance Test
* Diagnostic Test: Sit and Reach Test
* Diagnostic Test: Maximum Legs Abduction Test
* Diagnostic Test: S_RAG (reactive agility) Test
* Diagnostic Test: S_CODS (change of direction speed) Test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Professional players Age above 18 years Voluntary access to research Exclusion Criteria: Age under 18, Refusal to take the research, Remaining in the club until the end of the examination, Errors in keeping records of injuries by responsible persons, Injuries to the lower limbs in the last ten days, Vestibular disorders.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Male

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Professional Footballers<br>About 110 players (out of about 400 competing in the Premier League of Bosnia and Herzegovina) would be included in the research. | Diagnostic Test: Y Balance Test<br>* The footballer will place one foot on the stationary platform of the test set during the test so that the top of the sneaker does not exceed the starting line. The second foot, or the tip of the foot, will push the movable part of the platform down the measuring tube, which is marked by half-inch intervals. Any lifting of the standing leg on the heel, on the toes or loss of balance will be considered a mistake and the attempt will be repeated. Mobility will be tested through 3 trial and 3 valid measurements of the lower limbs in the anterior, posteromedial, and posterolateral directions. The arms should rest on the hips.<br>Diagnostic Test: Sit and Reach Test<br>* This test involves sitting on the floor with your legs stretched straight forward. Shoes should be removed. The feet themselves are set straight against the box. Both knees must be stretched. With the palms facing down and the palms side-by-side or side-by-side, the subject approaches the measurement line as far as possible. It is important to keep your hands in the same position level, not that one reaches further than the other. Once the subject has reached the maximum distance, hold this position for one to two seconds and record the distance.<br>Diagnostic Test: Maximum Legs Abduction Test<br>* Seated legs abduction is a test to assess the flexibility of the groin region. Respondent without the shoe sits with its back and head resting against the wall. As a sign, the subject extends the legs (stretches) to the maximum extent. During the test, the legs should not be bent at the knee joint.<br>Diagnostic Test: S_RAG (reactive agility) Test<br>* The test consist of fast-moving forward, and a change of direction conditioned by visual stimuli.<br>Diagnostic Test: S_CODS (change of direction speed) Test<br>* S_CODS (change of direction speed) is a test that allows athletes to outperform their opponents in situations where they can pre-define a movement pattern.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence | The main outcome measure is the incidence, that is, the number of newly injured players over almost five months. | 5 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Questionnaire to evaluate the current situation with lower limb injuries in football players | It consists of 20 questions that ask about the condition of the lower limbs in tested football players. | 5 minutes | 
| Y balance test | Mobility will be tested through 3 trial and 3 valid measurements of the lower limbs in the anterior, posteromedial, and posterolateral directions. | 15 minutes | 
| Sit and Reach test | The Sit and Reach Test is a common muscle and lower back flexion test and is now widely used as a general flexibility test. | 5 minutes | 
| Maximum legs abduction Test | A seat abduction test is a test to assess the flexibility of the groin regions. The footballer extends his legs as far as possible (stretches). The distance between the inner malleolus is measured in centimeters tape. | 5 minutes | 
| S_RAG (reactive agility) Test | S_RAG (reactive agility) Test is emphasized when athletes perform a change of direction while responding to an external visual stimulus. | 10 minutes | 
| Measuring the length of the legs | Anthropological measures will be taken (from the spin of the iliac anterior superior to the middle of the inner malleolus). | 2 minutes | 
| S_CODS (change of direction speed) Test | S_CODS (change of direction speed) is a test that allows athletes to outperform their opponents in situations where they can pre-define a movement pattern. | 2 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dynamic balance, Stretching, Flexibility, Agility