Efficacy of the Most Commonly Used Physiotherapeutic Treatments for Acute Lower Limb Fatigue in Athletes

Study Overview
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Brief Summary
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Acute fatigue is the inability to generate a required or expected level of force or exercise intensity, whether or not preceded by previous exercise. It is an important risk factor in overuse injuries. It is multifactorial in nature and its mechanisms of formation are imprecise. This type of fatigue can affect both the peripheral level, generating neuromuscular or peripheral fatigue, and the central level, generating central fatigue Objective: To study several physiotherapeutic protocols, analyzing the degree of effectiveness of each one for the recovery of acute fatigue in athletes. Design: Prospective randomized experimental study with 4 groups of physiotherapeutic protocols suitable in acute fatigue recovery. Participants: Presentation of 80 patients treated with 4 therapeutic protocols, equally divided and purposely sexed. The four protocols were divided into: Active recovery (n=20) hydrotherapy (n=20) massage (n=20) and compression (n=20) for 4 weeks of treatment. Intervention: Active recovery protocols (group 1) hydrotherapy protocol (group 2) massage protocol (group 3) and comprehension protocol (group 4). Keywords: Lower limbs, physiotherapy, athlete, biomechanics, protocol.

Detailed Description
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The etiology of injury in sport is multifactorial, generated by both intrinsic and extrinsic factors. There is evidence that supports that the management and handling of loads is the factor that generates the greatest risk of injury and that not respecting the load-recovery balance can lead to an accumulation of fatigue resulting in poor training adaptation which leads to increased risk of injury. From a physiological approach, fatigue is defined as a functional failure of the organism which, due to excessive energy expenditure and depletion of substrates necessary for energy production, leads to a decrease in performance. Acute fatigue is the inability to generate a required or expected level of exercise force or intensity, whether or not preceded by previous exercise. Acute fatigue is an important risk factor in overuse injuries. It is multifactorial in nature and its mechanisms of formation are imprecise. This type of fatigue can affect both the peripheral level, generating neuromuscular or peripheral fatigue, and the central level, generating central fatigue. Peripheral or neuromuscular fatigue is the result of altered musculoskeletal homeostasis due to a limitation or failure of one or more motor unit processes, producing a dysfunction in the contraction process. Central fatigue is an involuntary failure in brain function or nerve impulse conduction, resulting in impaired transmission from the central nervous system (CNS) and impaired motor axon recruitment. One of the main factors associated with central fatigue is the alteration of synthesis and activity of some neurotransmitters. Elite athletes push their training to the limit in order to maximize their performance. This generates muscle damage that results in a breakdown of structural proteins of muscle fibers and connective tissues, causing tissue inflammation, Delayed Onset Muscle Soreness (DOMS) and an increase in perceived fatigue. To maximize an athlete's ability to perform, it is not only the training that must be addressed, but also the balance between training and recovery. This prevents maladaptation to physiological and psychological stresses induced by the load. Therefore, it is important for the athlete to optimize the recovery period to reduce the risk of injury. The purpose of this research is to demonstrate the efficacy of various physiotherapeutic protocols, analyzing the degree of effectiveness in each of these for recovery from acute fatigue in athletes.

Official Title
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Efficacy of the Most Commonly Used Physiotherapeutic Treatments for Acute Lower Limb Fatigue in Athletes

Conditions
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Lower Limb Injury

Intervention / Treatment
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* Diagnostic Test: State-Trait Anxiety Questionnaire
* Diagnostic Test: Rating of Perceived Exertion
* Diagnostic Test: Motor coordination tests
* Procedure: Physiotherapeutic intervention
* Other: Data Analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Active athletes Presentation of typical clinical signs of acute fatigue in one of the two lower limbs Positive diagnosis of acute fatigue Exclusion Criteria: Not compatible with age range Healthy athletes Diagnosed injuries other than acute fatigue

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: 80 patients divided into 4 groups of equal size and randomly selected. The 4 treatment methods used will be as follows: Group 1: Compression techniques (n=20). Group 2: Massage techniques (n=20) Group 3: Hydrotherapy (n=20) Group 4: Active recovery technique (n=20)
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group 1: Compression technique<br>20 participants make up the compression technique group. | Diagnostic Test: State-Trait Anxiety Questionnaire<br>* The scale measures ordinally (1 to 5) the values observed during exposure to anxiety patterns during exercise, such as higher repetitions, greater weight gain or longer exercise duration, as follows: Not at all Little Sometimes Almost always Always<br>* Other names: STAI;Diagnostic Test: Rating of Perceived Exertion<br>* The scale measures in ordinal form (1 to 6) the perceived effort during the exercise as follows: No pain Little pain Moderate Severe Very strong Unbearable<br>* Other names: RPE;Diagnostic Test: Motor coordination tests<br>* The motor coordination tests are divided into three: Jumping with 2 feet together. Throwing 2 balls from a given distance and space. Proprioception turns<br>Procedure: Physiotherapeutic intervention<br>* Participants received one session per week, until a total of 20 sessions were completed: Group 1 (n=20) received the muscle compression treatment. Group 2 (n=20) received the manual massage treatment. Group 3 (n=20) received the hydrotherapy treatment and group 4 (n=20) received the active recovery treatment.<br>Other: Data Analysis<br>* The usual descriptive parameters (mean and standard deviation) of the sample were calculated. The distribution and analysis of the other data were performed by means of a nonparametric test (Mann-Whitney U test) comparing the groups. A confidence level of 95% was established, considering a value of p<0.05 as statistically significant.<br>|
| Active Comparator: Group 2: Massage techniques<br>20 participants make up the massage technique group. | Diagnostic Test: State-Trait Anxiety Questionnaire<br>* The scale measures ordinally (1 to 5) the values observed during exposure to anxiety patterns during exercise, such as higher repetitions, greater weight gain or longer exercise duration, as follows: Not at all Little Sometimes Almost always Always<br>* Other names: STAI;Diagnostic Test: Rating of Perceived Exertion<br>* The scale measures in ordinal form (1 to 6) the perceived effort during the exercise as follows: No pain Little pain Moderate Severe Very strong Unbearable<br>* Other names: RPE;Diagnostic Test: Motor coordination tests<br>* The motor coordination tests are divided into three: Jumping with 2 feet together. Throwing 2 balls from a given distance and space. Proprioception turns<br>Procedure: Physiotherapeutic intervention<br>* Participants received one session per week, until a total of 20 sessions were completed: Group 1 (n=20) received the muscle compression treatment. Group 2 (n=20) received the manual massage treatment. Group 3 (n=20) received the hydrotherapy treatment and group 4 (n=20) received the active recovery treatment.<br>Other: Data Analysis<br>* The usual descriptive parameters (mean and standard deviation) of the sample were calculated. The distribution and analysis of the other data were performed by means of a nonparametric test (Mann-Whitney U test) comparing the groups. A confidence level of 95% was established, considering a value of p<0.05 as statistically significant.<br>|
| Active Comparator: Group 3: Hydromassage<br>20 participants make up the hydromassage technique group. | Diagnostic Test: State-Trait Anxiety Questionnaire<br>* The scale measures ordinally (1 to 5) the values observed during exposure to anxiety patterns during exercise, such as higher repetitions, greater weight gain or longer exercise duration, as follows: Not at all Little Sometimes Almost always Always<br>* Other names: STAI;Diagnostic Test: Rating of Perceived Exertion<br>* The scale measures in ordinal form (1 to 6) the perceived effort during the exercise as follows: No pain Little pain Moderate Severe Very strong Unbearable<br>* Other names: RPE;Diagnostic Test: Motor coordination tests<br>* The motor coordination tests are divided into three: Jumping with 2 feet together. Throwing 2 balls from a given distance and space. Proprioception turns<br>Procedure: Physiotherapeutic intervention<br>* Participants received one session per week, until a total of 20 sessions were completed: Group 1 (n=20) received the muscle compression treatment. Group 2 (n=20) received the manual massage treatment. Group 3 (n=20) received the hydrotherapy treatment and group 4 (n=20) received the active recovery treatment.<br>Other: Data Analysis<br>* The usual descriptive parameters (mean and standard deviation) of the sample were calculated. The distribution and analysis of the other data were performed by means of a nonparametric test (Mann-Whitney U test) comparing the groups. A confidence level of 95% was established, considering a value of p<0.05 as statistically significant.<br>|
| Active Comparator: Group 4: Active recovery technique.<br>20 participants make up the active recovery technique group. | Diagnostic Test: State-Trait Anxiety Questionnaire<br>* The scale measures ordinally (1 to 5) the values observed during exposure to anxiety patterns during exercise, such as higher repetitions, greater weight gain or longer exercise duration, as follows: Not at all Little Sometimes Almost always Always<br>* Other names: STAI;Diagnostic Test: Rating of Perceived Exertion<br>* The scale measures in ordinal form (1 to 6) the perceived effort during the exercise as follows: No pain Little pain Moderate Severe Very strong Unbearable<br>* Other names: RPE;Diagnostic Test: Motor coordination tests<br>* The motor coordination tests are divided into three: Jumping with 2 feet together. Throwing 2 balls from a given distance and space. Proprioception turns<br>Procedure: Physiotherapeutic intervention<br>* Participants received one session per week, until a total of 20 sessions were completed: Group 1 (n=20) received the muscle compression treatment. Group 2 (n=20) received the manual massage treatment. Group 3 (n=20) received the hydrotherapy treatment and group 4 (n=20) received the active recovery treatment.<br>Other: Data Analysis<br>* The usual descriptive parameters (mean and standard deviation) of the sample were calculated. The distribution and analysis of the other data were performed by means of a nonparametric test (Mann-Whitney U test) comparing the groups. A confidence level of 95% was established, considering a value of p<0.05 as statistically significant.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| State-Trait Anxiety Questionnaire (STAI) | The range or index of anxiety perceived during the exam and the ability to tolerate anxious moments are evaluated. | five months | 
| Rating of Perceived Exertion (RPE) | The range or rate of perceived exertion during the scan is evaluated. | five months | 
| Scale Countermovement jump (CMJ) | The range or index of neuromuscular performance during the scan is evaluated. | five months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants in each physical therapy application | Five reviews were carried out corresponding to the five months of treatment. During these five months, the participants received one session per week, until a total of 20 sessions were completed: Group 1 (n=20) received the muscle compression treatment. Group 2 (n=20) received the manual massage treatment. Group 3 (n=20) received the hydrotherapy treatment. Group 4 (n=20) received the active recovery treatment. | five months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lower limbs, Physiotherapy, Athlete, Biomechanics, Protocol