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Dr P.-E. Fournier Centre Thermal - Yverdon-les-Bains
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5696 to 13746 m covered
Di Salvo et al. Int J Sports Med 2007; 28: 222-227
Performance Characteristics According toPlaying Position in Elite Soccer
Positional roleMean distancecovered (m)
S
Independent of position 11393 1016Central defender 10627 893
External defender 11410 708
Central midfield 12027 625
External midfield 11990 776
Forward 11254 894
More distance covered at the lowest work intensity during the 2nd halfNo difference > 19 km/h
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17.3 7.7 (range 3-40) bursts of high intensity activity
(>23km/h)
19.3 3.2 meters (range 9.9 32.5)
External defenders (20 7.0), external midfield (22.0 6.7),
forward (20.7 6.9) significantly more burst of high internsity
than central defender (11.2 5.2) and central midfield (13.7
6.2)
Di Salvo et al. Int J Sports Med 2007; 28: 222-227
Performance Characteristics According toPlaying Position in Elite Soccer
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Total distance covered in possession of the ball
Di Salvo et al. Int J Sports Med 2007; 28: 222-227
Performance Characteristics According toPlaying Position in Elite Soccer
Positional roleDistance covered
(m)%
Central defender 11967 1.20.6
External defender 22099 1.90.9
Central midfield 23092 1.90.8
External midfield 286114 2.41.1
Forward 21292 1.90.8
No difference between 1st and 2nd half except for forward
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23 teams belonging to the 50 best European teams2001-2008, 5 clubs trough all 7 seasons
34 matches and 162 training sessions each season
254 hours (213 training, 41 match hours)
4483 injuries during 566 000 hours of exposure
8.0 injuries / 1000 hours 27.5 /1000 hours matches 4.1 / 1000 hours training
Injury Incidence and Injury Pattern inProfessional Football The UEFA Injury Study
Ekstrand et al. Br J Sport Med 2009
http://images.google.ch/imgres?imgurl=http://www.bloc.com/images_administrables/bibliotheque/grande/psv-eindhoven.jpg&imgrefurl=http://www.bloc.com/article/sport/club/le-psv-eindhoven-l-un-des-meilleurs-clubs-des-pays-bas-20080409.html&usg=__n_tEWCHGgVxDtw-i0t0xt3Vpy_s=&h=311&w=401&sz=31&hl=fr&start=15&um=1&tbnid=hfpZB-lcSKd8BM:&tbnh=96&tbnw=124&prev=/images?q=eindhoven+psv&hl=fr&rlz=1T4SUNA_frCH236CH236&um=1http://images.google.ch/imgres?imgurl=http://bajnokokligaja.lapunk.hu/tarhely/bajnokokligaja/kepek/real_madrid_logo_1_.png&imgrefurl=http://bajnokokligaja.lapunk.hu/&usg=__CWRn89cx8ZTYuHdBz5Dnjw-pwT8=&h=599&w=428&sz=114&hl=fr&start=4&um=1&tbnid=NVhtjtZTMaK-JM:&tbnh=135&tbnw=96&prev=/images?q=real+madrid&hl=fr&rlz=1T4SUNA_frCH236CH236&um=1http://images.google.ch/imgres?imgurl=http://www.pronoplus.com/blog/wp-content/uploads/2008/05/intermilan-299x300.jpg&imgrefurl=http://www.pronoplus.com/blog/tag/inter-milan/&usg=__MI64mrTvKdNkgzlCLDn9OUVOb6Q=&h=300&w=299&sz=29&hl=fr&start=9&um=1&tbnid=WzJzdpv7uQsLtM:&tbnh=116&tbnw=116&prev=/images?q=inter+milan&hl=fr&rlz=1T4SUNA_frCH236CH236&um=1http://images.google.ch/imgres?imgurl=http://upload.wikimedia.org/wikipedia/fi/thumb/9/9f/Manchester_United_Football_Clubin_logo.svg/632px-Manchester_United_Football_Clubin_logo.svg.png&imgrefurl=http://www.blognow.com.au/ManUnited/&usg=__sDEmAObM_raUBWOsLHNtqOQqyrQ=&h=600&w=632&sz=78&hl=fr&start=11&um=1&tbnid=D4C8QWrUnUJFVM:&tbnh=130&tbnw=137&prev=/images?q=manchester+united+fc&hl=fr&rlz=1T4SUNA_frCH236CH236&sa=N&um=1http://images.google.ch/imgres?imgurl=http://www.buffalocityfc.com/images/Arsenal_FC.png&imgrefurl=http://www.afamarbella.com/afa_partners.asp&usg=__CDEjKE27CImBWdrVG72_UTO3OoE=&h=384&w=328&sz=32&hl=fr&start=2&um=1&tbnid=0aF0a7ZVQ-pRdM:&tbnh=123&tbnw=105&prev=/images?q=arsenal+fc&hl=fr&rlz=1T4SUNA_frCH236CH236&sa=N&um=17/30/2019 Lesions Musculaires Sion 2010
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INJURY %
THIGH STRAINS 17 %(12 % HAMSTRINGS)( 5 % QUADRICEPS)
ADDUCTOR PAIN/STRAIN 9 %
ANKLE SPRAIN 7 %
MCL INJURIES 5 %
Injury Incidence and Injury Pattern inProfessional Football The UEFA Injury Study
Ekstrand et al. Br J Sport Med 2009
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11 teams, 7 countries
Arsenal, Manchester U, Paris St Germain, St Rennais, Lens, AC Milan,
Juventus, Inter Milan, Eindhoven, Real Madrid, Ajax
69 707 hours of exposure (58 149 training, 11 558 match)
Highest number of match played by one player : 69
30.5 injuries / 1000 hours Match, 5.8 / 1000 hours Training
148 players in national teams
Tendency of lower incidence in training
No difference in match play
Walden et al. Br J Sports Med 2005; 39: 542-546
UEFA Champions Leage Study: A ProspectiveStudy of Injuries in Professional Football During
The 2001-2002 Season
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Final 15 min first half, last 30 min. second half
More injuries in the first month of competition
50 % dominant side versus 37 %
38 % contact with another player or the ball
Hawkins et al. Br J Sports Med 2001; 35: 43-47
The Association Football Medical ResearchProgramme: An Audit of Injuries In
Professional Football
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MUSCLEINJURIES
STRAIN
LACERATIONCONTUSION
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LOCALISATION OF MOST COMMON MUSCLESINJURIES
HAMSTRING BICEPS FEMORIS
QUADRICEPS RECTUS FEMORIS
CALF MEDIAL HEAD GASTROCNEMIUS
DISTAL MUSCLE-TENDON JUNCTIONOR MIDBELLY OF THE MUSCLE
ADDUCTORS ADDUCTOR LONGUS
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DANCERS SPRINTERS
Dancers :
Proximal lesions ~ 2cm ischial tuberosity
87 % semimembranous Seldom restricted to 1 muscle-tendon complex
Slow-speed stretch (sagittal split)
No correlation IRM and time to return
Mean time to return 50 weeks
Askling et al.Am J Sports Med 2007; 35: 1716-1724 -- Am J Sports Med 2007; 35: 197-
206 -- Br J Sports Med 2006; 40: 40-44 -- Scand J Med Sci Sports 2000; 10: 304-307
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Whole body kinematics collected in 14 subjects
Sprint on a high-speed treadmill, 80-100 % of their
maximum speed
Thelen et al. Exerc Sport Sci Rev 2006; 34: 135-141
Neuromusculoskeletal Models Provide InsightsInto The Mechanism And Rehabilitation
of Hamstring Strains
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Thelen et al. Exerc Sport Sci Rev 2006; 34: 135-141
Neuromusculoskeletal Models Provide InsightsInto The Mechanism And Rehabilitation
of Hamstring Strains
End of swing phase ecc con
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Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
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Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
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Bone heals by a regeneration process healing tissue identical to
preexisting tissue
Most of the other tissues in the body
including muscle heal with a scar
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Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
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Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
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Huard et al. J Bone J Surg [Am] 2002; 84: 822-832
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Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
Each myofiber contains specific chainsof molecules called integrins anddystrophin, which connect thecontractile myofilament to the ECMthrough the sarcolemma
The majority of integrin are located atthe myotendinous junction
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Restoration of vascular supply isthe first sign of regeneration
Young myotube have anincreased anaerobic metabolism,during final stages ofregeneration aerobic metabolismconstitute the principal pathway
In mobilized muscle intensiveingrowth of new capillaries
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IMMOBILISATION
MOBILISATION
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Stages Pain Clinical Ex. Strength Recovery
0Reversible
Limited lesionModerate Contracture () Hours
1
No more reversible,some muscle ff.,
connective tissue notinjured
(+) Contracture()
Days
2
No more reversible,some muscle ff.,
connective tissue notinjured
+ Contracture 10 15 Days
3
No more reversible,numerous muscle ff.injured, connective
tissue injuredHEMATOMA
+Sports
activity nomore
possible
ContractureTumefaction
4-12 weeks
4Partial or total rupturescattered hematoma
+Sports
activity nomore
possible
gap ?
Rodineau J. in Muscle traumatique et mcanique. Masson 2005
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Avulsion FractureRodineau J. in Muscle traumatique et mcanique. Masson 2005
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Rodineau J. in Muscle traumatique et mcanique. Masson 2005
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Rodineau J. in Muscle traumatique et mcanique. Masson 2005
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Rodineau J. in Muscle traumatique et mcanique. Masson 2005
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Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
No false negativ
Overestimation
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58 players, Hamstring injury (team physician) within 3 days
MRI and clinical evaluation by an independant physiotherapist
MRI
Muscle(s) involved, site of injury within the muscle, injured area,
injured length, intra-, intermuscular hemorrhage
Clinical assessement Passive straight leg raise, active knee extension, manual testing,
active slump
Schneider-Kolsky et al. Am J Sports Med 2006; 34: 1008-1015
A Comparison Between Clinical Assessment AndMagnetic Resonance Imaging of Acute
Hamstring Injuries
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Diagnosis
65.5 % in accordance
31 % clinical assessment +, IRM
3.5 % (2 cases) clinical assessement -, IRM +
Time until return to competition Significative positive correlation, better for clinical assessment,
particularly for minor lesions
Schneider-Kolsky et al. Am J Sports Med 2006; 34: 1008-1015
A Comparison Between Clinical Assessment AndMagnetic Resonance Imaging of Acute
Hamstring Injuries
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lack of firm scientific basis
Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
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Recommended but.. No randomized
study to prove effectivness of RICE
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Immediate mobilisation could be deleterious Larger connective tissue scar
Penetration of muscles fibers through the scar impaired
Delayed restoration of mecanical strength (Risk of re-ruptureincreased)
Short relative immobilisation D 0D 2-3 5
Rest period allows the scar to gain the strength to withstand thecontraction-induced forces applied on it without a rerupture
Muscle injuries: Biology and treatment. Jrvinen et al. Am J Sports Med 2005; 33: 745-764
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Relative immobilisation (Tape, cast, )
Crutches
Carefull mobilisation Days 3 5 (7)
Jrvinen 2005, Ziltener 2006
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Painfree
Contractions against weak load, concentric work
Decreasing resistance for one exercise, increasing from one
session to the other Contractions speed initially rapid concentric then slow to
rapid with eccentric work
PliometryZiltener 2006
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Phase 2 : J4-J10 Phase 3 : J10-J21 Phase 4 : > 21 jours
Arrt temporaire activitphysique
Antalgie Antalgie+cicatrisation+lutte contre fibroblastie
Bandage et contention Bandage et contention Bandage : sevrageCryothrapiepluriquotidienne
Cryothrapiepluriquotidienne
Cryothrapie aprssances
Drainage lymphatique Drainage lymphatique Drainage lymphatique(si ncessaire)
lectrothrapie tirements progressifs tirements isomtriques
Fonction musculaire(cannes, travail actifsans rsistance)
Fonction musculaire(travail actif avecrsistance manuelle)
Fonction musculairerenforcement,rentranement leffort
Chanussot et al. Rducation en traumatologie du Sport, Masson 2003
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G th F t D li M th d I Th
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Creaney et al. Br J Sports Med. 2008;42(5):314-20
Growth Factor Delivery Methods In TheManagement of Sports Injuries :
The State of The Play
Platelet Rich Plasma
Autologous Blood Injection
Autologous Conditioned Serum
Platelet-derived growth factor, Vascular endothelial growth factor,
Tranforming growth factor beta-1, Epidermal growth factor, Basic
fibroblast growth factor, Insulin-like growth factor-1, Hepatocyte
growth factor
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Creaney et al. Br J Sports Med. 2008;42(5):314-20
G th F t D li M th d I Th
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Growth Factor Delivery Methods In TheManagement of Sports Injuries :
The State of The Play
Short half-life
Quick sytemic lavage
Effects mostly confined to site of delivery
Creaney et al. Br J Sports Med. 2008;42(5):314-20
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Creaney et al.Br J Sports Med.2008;42(5):314-20
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Muscle injuries and PRP: what does the science say ?
Harmon Br J Sports Med 2010; 44: 616-617
Platelet-rich plasma: any substance into it ?
Mei-Dan et al. Br J Sports Med 2010; 44: 616-617
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Sawn muscle knackered muscle outdated
Banks suture, drain hematoma and necrotic material
Microsurgery (less scar tissue)
Stage 4
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Persistence of hematoma, cyst
Seroma
Myositis ossificans
Hypertrophic scar
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SECURITY REINJURY
PRECISE GUIDE LINES NOT DESCRIBED
Labareyre et al. J Traumatol Sport 2005 22; 232-235
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12.1 % recurrence the first week of return to sport
30.6 % cummulative risk for reinjury in the 22
week-season
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Initial Evaluation imprecise delays
Roughly : muscle strain 3 weeks
torn muscle 6 weeks
From 2 (4) weeks on field 60 %
Progression each 2-4 days if : No pain at rest, at 60 %, no pain when stretching,
when isometric contraction or at palpation
No palpable mass
Labareyre et al. J Traumatol Sport 2005 22; 232-235
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Echography doesnt give any information on
scar strength
Useful for follow up particurlaly if delayedevolution
MRI delay between clinical evolution and MRIappearance
Labareyre et al. J Traumatol Sport 2005 22; 232-235
Lower Reinjury Rate With a Coach-controlled
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Hgglund et al. Am J Sports Med : 2007; 35: 1433-1442
Lower Reinjury Rate With a Coach controlledRehabilitation Program In Amateur Male Soccer a
Randomized Controlled Trial
Information about risk factors for reinjury
Rehabilitation principles
10-steps progressive rehabilitation programm including
return to play criteria
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Hgglund et al.
Am J Sports Med :2007; 35: 1433-1442
Lower Reinjury Rate With a Coach-controlled
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Hgglund et al. Am J Sports Med : 2007; 35: 1433-1442
Lower Reinjury Rate With a Coach controlledRehabilitation Program In Amateur Male Soccer a
Randomized Controlled Trial
Program introduced when walking was possible without pain
and limping
Gradually increasing loadNext step when exercises possible without pain or swelling
at the injured site
If pain return to pain free step
1 to 6 without ball
Then skill training with ball
Slow pace then increasing speed
Lower Reinjury Rate With a Coach-controlled
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Hgglund et al. Am J Sports Med : 2007; 35: 1433-1442
Lower Reinjury Rate With a Coach controlledRehabilitation Program In Amateur Male Soccer a
Randomized Controlled Trial
Reinjury 2.3 / 1000 hours (intervention group)
8 / 1000 hours (control group)
66 %
85 % lower limb injuries
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Prevention of Hamstring Strains In Elite Soccer:
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Iceland 17, 15, 16, 10 teams for 1999 to 2002
Norway : 14 teams for 2001 and 2002
Hamstring injuries recorded (contact injuries excluded)
Clinical assessment (MRI not required)
Arnason et al. Scand J Med Sci Sports. 2008;18(1):40-8
Prevention of Hamstring Strains In Elite Soccer:An Intervention Study
Prevention of Hamstring Strains In Elite Soccer:
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Prevention of Hamstring Strains In Elite Soccer:An Intervention Study
All teams both countries
Before sprinting or shooting before every trainingor game
Arnason et al. Scand J Med Sci Sports. 2008;18(1):40-8
Prevention of Hamstring Strains In Elite Soccer:
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Prevention of Hamstring Strains In Elite Soccer:An Intervention Study
After training 3x / week preseason
1-2 times during the competitive season
Arnason et al. Scand J Med Sci Sports. 2008;18(1):40-8
Prevention of Hamstring Strains In Elite Soccer:
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Prevention of Hamstring Strains In Elite Soccer:An Intervention Study
5 week introductory period, load gradually increased
3 sets of 12, 10 and 8 repetition 3 x / week preseason, 1-2 during competitive period
Arnason et al. Scand J Med Sci Sports. 2008;18(1):40-8
Prevention of Hamstring Strains In Elite Soccer:
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eve t o o a st g St a s l te Socce :An Intervention Study
III
W, F, SW,F
W,SW,S
Incidence, Warm-up, Flexibility, Strength
Arnason et al. Scand J Med Sci Sports. 2008;18(1):40-8
Human Hamstring Muscle Adapt To Eccentric
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Brockett et al. Med Sci Sports Exerc 2001; 33: 783-790
g pExercise By Changing Optimum Length
10 Subjects
Eccentric hamstring exercise :
12 sets of 6 repetitions10 between repetition 2-3 minutes between sets
Isokinetic evaluation
Human Hamstring Muscle Adapt To Eccentric
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g pExercise By Changing Optimum Length
Brockett et al. Med Sci Sports Exerc 2001; 33: 783-790
Consquences et Prdiction des Lsions Musculaires desI hi j bi P ti d P t I i ti
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28 players (11 players with Hamstrings injury history)
Isokinetic evaluation 60/sec (Quad, Hamstring Conc, Ecc)
Ratio Qconc/Hcon, Hconc/Hconc, Hecc/Hecc, Hecc/Qconc
No predictive value of new muscle injury
Ratio Hecc/Qconc < 0.6 highly suggestive of old
Hamstring injury (77.5%)
Dauty et al. Ann Radapt Med Phys 2003; 46: 601-606
Ischiojambiers Partir de Paramtres IsocintiquesConcentriques et Excentriques du Joueur de Football
Professionnel
Strength Imbalance and Prevention of Hamstring
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462 players with complete follow up from Belgian, Brazilian
and French professional teams
Isokinetic evaluation (60/sec and 240/sec Quad, Hamstring Conc, Ecc,30/sec 120/sec Hamstring ecc)
Preseason cutoffs :
bilateral difference > 15 % (conc and/or ecc Hamstrings)
concentric ratio < 0.47 Cybex, 0.45 Biodex
Mixed ratio (H ecc 30sec/ Q conc 240/sec) < 0.8 Cybex, 0.89 Biodex
Croisier et al. Am J Sports Med 2008; 36: 1469-1475
Injury in Professional Soccer Players
Strength Imbalance and Prevention of Hamstring
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Croisier et al. Am J Sports Med 2008; 36: 1469-1475
Injury in Professional Soccer Players
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