Little associations exist between the three commonly used functional screening tests in collegiate athletes.

Although an abundant number of studies have investigated the predictability of the commonly used functional screening tests and despite their popularity and applicability, the relationships between these tests have rarely been studied and have not been well established. This study aimed to examine the potential association between the Functional Movement Screen (FMS), Y Balance Test (YBT), and Landing Error Scoring System (LESS). Six hundred twenty-seven Iranian collegiate athletes (347 males, age = 22.63 ± 4.07, weight = 75.98 ± 13.79, height = 181.99 ± 10.15, BMI = 22.84 ± 3.16; and 280 females, age = 22.22 ± 3.37, weight = 60.63 ± 9.58, height = 166.55 ± 6.49, BMI = 21.81 ± 2.84) participated in this study. Following a 5-min warm-up, each participant underwent a standardized screening battery including the FMS, YBT, and LESS, and the scores were recorded and live coded for the statistical analysis, except for the LESS. The LESS tests were video recorded and scored by one expert examiner using an open-source 2D video analysis software (Kinovea- version 0.9.5), afterwards. The Spearman correlation was utilized as a measure for the correlation, and the Mann‒Whitney U test with a significance level of 0.05 was used to check the differences between male and female athletes. The statistical analysis was performed with RStudio 2023.03.0 using R 4.3.1. A small correlation (0.364) was observed between the FMS composite score and the YBT in male athletes. All other pairwise correlations were negligible among male and female athletes, ranging from - 0.096 to 0.294. Reducing the FMS to the component scores targeting the lower extremities did not alter the correlation to the other screening scores. The median FMS composite score in female athletes was significantly higher than that in males (p < 0.001). Negligible correlations exist between the FMS, LESS, and YBT; they do not measure the same values and therefore are irreplaceable with one another. A combination of these tests as a standardized screening battery may potentially better identify injury-predisposed athletes than the application of each test as a stand-alone screening test. Females outperformed males in the FMS test significantly, so sex must be considered a key variable in the FMS studies. Males had slightly higher LESS scores (median difference = 0.5) than females, but this difference is not clinically meaningful. Future research should continue to explore the relationships between various functional screening tests and identify the most effective combinations for comprehensive assessment in different populations and sports disciplines.

Electromyography of shoulder muscles in individuals without scapular dyskinesis during closed kinetic chain exercises on stable and unstable surfaces: a systematic review and meta-analysis.

Introduction: Unstable surfaces are commonly utilized to enhance the flexibility of the musculoskeletal system for achieving training or rehabilitation goals. However, their effects on shoulder muscle activation during various push-up (PU) exercises have not been thoroughly investigated. Therefore, the purpose of this study was to synthesize electromyography (EMG) data of shoulder muscles in individuals without scapular dyskinesis performing different PU exercises on both stable and unstable surfaces. Methods: A systematic online search was conducted in electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, up to January 16, 2024, using predefined sets of keywords. Out of the 1,971 titles and abstracts screened, 80 articles were reviewed in detail by two independent researchers to check the eligibility, of which 28 eligible studies were ultimately included. Following assessment of the quality and risk of bias, the studies were categorized based on exercises and muscle groups, and a meta-analysis using a random-effects model was performed to estimate the overall effect size. Results: The use of unstable surfaces led to a decrease in anterior deltoid activity during PU [P = 0.032; I2 = 91.34%; SMD = -0.630 (95% CI -1.205, -0.055)], an increase in pectoralis major activity during PU [P = 0.006; I2 = 63.72%; SMD = 0.282 (95% CI 0.079, 0.484)], as well as during knee PU [P = 0.018; I2 = 32.29%; SMD = 0.309 (95% CI 0.052, 0.565)], and an increase in triceps brachii activity during PU [P = 0.000; I2 = 85.05%; SMD = 0.813 (95% CI 0.457, 1.168)], knee PU [P = 0.000; I2 = 0.00%; SMD = 0.589 (95% CI 0.288, 0.891)], as well as during push-up plus [P = 0.006; I2 = 13.16%; SMD = 0.563 (95% CI 0.161, 0.965)]. However, the use of unstable surfaces did not show a significant effect on the EMG activity of the pectoralis major during push-up plus [P = 0.312; I2 = 22.82%; SMD = 0.207 (95% CI -0.194, 0.609)]. Conclusions: Unstable surfaces can modulate muscle activity in different PU exercises, while the effects on the targeted muscles depend on the type of exercise. The findings of this review provide a framework based on the level of activity of each shoulder muscle during different PU exercises, which can help coaches, trainers, and sports therapists select the most suitable type of PU for designing training or rehabilitation programs. Particularly, the most suitable exercise for increasing anterior deltoid activity is PU on a stable surface. To concurrently increase activity of the pectoralis major and triceps brachii, adding unstable surfaces under hands during knee PU and standard PU is recommended. Systematic Review Registration: PROSPERO, identifier CRD42021268465.

Electromyography of scapular stabilizers in people without scapular dyskinesis during push-ups: a systematic review and meta-analysis.

Background: Push-up (PU) is widely considered an effective exercise to stabilize the scapular, especially if performed on unstable surfaces. However, available studies cover a wide range of exercise variations and differ according to exercise prescription, muscle selection and study design. Therefore, findings are contradictory, and conclusions for a proper application of the PU are difficult to draw. Objective: To synthesize the available literature on the changes in the activity of the periscapular muscles in individuals without scapular dyskinesis while performing different types of PU on unstable surfaces. Search procedure: Four online databases were searched from the earliest publications to 9 August 2023, using predefined keywords. Out of the 2,850 potential references identified in the primary search, 92 studies were reviewed in detail, of which 38 met the inclusion criteria and were included. Methodological quality was evaluated using a standardized form based on the Newcastle‒Ottawa scale for observational studies. Data combination was performed using CMA (v3), and the random-effects model was used to calculate the standardized mean difference (SMD) with a 95% confidence interval (CI). Results: The use of unstable surfaces in people without scapular dyskinesis led to increased activity of the upper trapezius during the PU (p = 0.017; I2 = 84.95%; SMD = 0.425 [95% CI 0.077, 0.773]) and knee PU (p = 0.023; I2 = 70.23%; SMD = 0.474 [95% CI 0.066, 0.882]) exercises and increased activity of the middle trapezius (MT) (p = 0.003; I2 = 64.50%; SMD = 0.672 [95% CI 0.225, 1.119]) and serratus anterior (SA) (p = 0.039; I2 = 4.25%; SMD = 0.216 [95% CI 0.011, 0.420]) muscles during the push-up plus (PUP) exercise. Conclusion: Using an unstable support base during PU does not necessarily increase the activity of all scapular stabilizers. The amount of muscle activity depends on the type of PU other than the type of support base. If an unstable surface is used, PUP exercise appears to be the most effective modality to increase the quality of training, improve performance, and prevent the occurrence of scapular dyskinesis due to the increase in the activity of the MT and SA muscles. Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO, CRD42021268465.

Acute effects of the FIFA11+ and Football+ warm-ups on motor performance. A crossover randomized controlled trial.

INTRODUCTION: Few studies including contradictory results have addressed the acute effects of the 11+ on motor performance, indicating a potentially reduced applicability of the program for warming up before competitions. This study aims to compare the acute effects of a soccer-specific warm-up (Football+) and the 11+ on motor performance. MATERIALS AND METHODS: Thirty-eight volunteer collegiate players (22 males; age = 21.1±1.9 years, height = 1.81± 0.06 m, weight = 73.4± 9.5 kg; 16 females; age = 21.3±1.5 years; height = 1.71± 0.07 m, weight = 67.8± 8.5 kg) underwent the 11+ and the Football+ in a randomized crossover design with a one-week washout. The Football+ starts with a self-estimated 40-50 percent running, followed by dynamic stretching of the hip muscles, shoulder contact, controlled lunge, Copenhagen exercise, and modified Nordic hamstring exercise. The second part involves roughly intensive small-sided games, followed by plyometric and anaerobic exercises in the third part. The warm ups' effects on performance were determined by a linear sprinting test (20 m), countermovement jump performance (CMJ), Illinois agility (IA), and dribbling speed (DS) tests. Within-subject differences were reported as the means and SD. Pairwise t tests at the significance level of p<0.05 were used to calculate the significant differences. RESULTS: Overall, except for the CMJ (mean = -0.43±3.20 cm, p = 0.21, d = -0.13), significant differences for the 20 m sprint (mean = 0.04±0.10 s, p = 0.005, d = 0.42), IA (mean = 0.65±0.45 s, p = 0.01, d = 1.43), and DS (mean = 0.60±1.58 s, p = 0.012, d = 0.38) were observed. In females, significant differences observed only for IA (mean difference = 0.52±0.42 s, p<0.001, d = 1.24) and DS (mean difference = 1.29±1,77 s, p = 0.005, d = 0.73), with the Football+ showing superiority. In males, significant differences were found only for 20 m sprinting (mean difference = 0.06±0.09, p = 0.005, d = 0.60) and IA (mean difference = 0.74±0.46, p<0.001, d = 1.62), with the Football+ having superiority. DISCUSSION: Although practicable for injury prevention, the 11+ may not optimize acute performance and prepare players for high-intensity physical tasks as well as a well-structured, roughly intensive warm-up. Further gender-specific studies should evaluate the long-term effects of the Football+ on performance and injury prevention.

Effects of the FIFA 11+ program on performance, biomechanical measures, and physiological responses: A systematic review.

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.

Effects of the FIFA 11+ and a modified warm-up programme on injury prevention and performance improvement among youth male football players.

INTRODUCTION: The effects of the FIFA11+ programme (the 11+) on ankle and groin injuries and performance have remained questionable. The latter, particularly, has potentially reduced the implementation rate and applicability of the programme. This study aimed to evaluate the mid-to-long-term effects of the 11+ and a modified programme including football-specific exercises on injury prevention and performance improvement. MATERIALS AND METHODS: Three teams of the Iranian Youth League (division two) volunteered to participate in this study and were randomly assigned to two intervention groups (F11+; n = 29, M11+; n = 31) and a control group (n = 30). The F11+ followed the FIFA 11+ programme, whereas the M11+ performed modified exercises three times weekly as a warm-up protocol before training and competition through a football season. The control group carried out its routine warm-ups, including joggings, basic football drills, and static stretches, while having no injury prevention approaches. Lower extremity injuries, as well as exposure time for each player, were recorded. The football-specific performance was assessed using the Illinois Agility and Slalom Dribbling tests. ANOVA, Fisher Freeman Halton, and chi-square tests were used to analyze the data. RESULTS: Injury incidences differed significantly between groups (p = 0.02, C = 0.40), with M11+ reporting the lowest incidence. Significant differences between the pre- and posttest as well as differences between the groups for development over time were revealed for the Illinois agility and dribbling speed (p≤0.01). Both performance tests demonstrated a large time effect, as the effect sizes for time in agility and dribbling speed were 0.74 (CI = [0.66; 0.79]) and 0.86 (CI = [0.79; 0.87]), respectively. The effect size for the interaction can be categorized as medium, with 0.38 (CI = [0.25; 0.49]) for agility and 0.52 (CI = [0.40; 0.61]) for dribbling speed. M11+ showed the largest improvement in both. DISCUSSION: Mid-to-long-term application of a structured dynamic warm-up that integrates injury prevention and performance approaches may lower injury incidences and improve youth subelite players' performance. Although additional studies with larger samples are needed to prove the results of the current study, the amateur clubs/teams could integrate such twofold dynamic warm up into their routine training plan and benefit its advantages on injury prevention and performance improvement.

Evaluation of the Functional Movement Screen (FMS) in Identifying Active Females Who are Prone to Injury. A Systematic Review.

BACKGROUND: The validity of the Functional Movement Screen (FMS) in identifying active females who are predisposed to injury has not been specifically reviewed. This study aims to synthesize the literature on the ability of the FMS to identify at-risk active females. METHODS: Six online databases, including PubMed, Medline, Web of Science, Science Direct, SPORTDiscus and Google Scholar, were searched for the period of April 2006 to September 2021. Out of the 61 potential references, 17 were reviewed in detail with respect to the inclusion criteria; ten were ultimately included. The risk of bias, applicability and level of the studies were then identified using the QUADAS-2 and a checklist for assessing methodological quality. The following data were obtained from the included studies: year of publication, title, study type, participants' demographic, sample size, FMS cutoff point, injury definition, statistical analyses used, FMS results and study level. RESULTS: Generally, the quality of eight studies was poor to moderate due to both small sample sizes and short follow-up periods. Except for a study on military members, all studies were carried out on team sports players. The overall bias of the studies was low, but there was an unclear amount of bias for participant selection. Two studies reported no predictive validity for the FMS, while three defended its predictive validity; the rest partially supported the FMS as a valid diagnostic tool. The reliability of the recommended cutoff point was confirmed, though cutoffs higher than 14 were significantly associated with the predictive ability of the FMS. CONCLUSION: Although the FMS is reliable for clinical practice, and the current literature shows promise regarding the predictive ability of the FMS among active females, concerns remain regarding its validity in identifying at-risk females. Given the lack of clarity in the literature on the use of the FMS in females, further well-organized studies with larger sample sizes and longer monitoring periods are highly recommended. The sensitivity and specificity of the recommended cutoff of ≤ 14 has considerably decreased , and higher cutoff values should be applied to increase the FMS predictive ability. Level of evidence The level of evidence was determined to be 2b.

The 11+ Kids warm-up programme to prevent injuries in young Iranian male high-level football (soccer) players: A cluster-randomised controlled trial.

OBJECTIVE: To assess the effectiveness of the 11+ Kids warm-up programme regarding injury reduction in male high-level children's football players. DESIGN: Cluster-randomised controlled trial. METHOD: Male youth football teams of Iran's high-level football schools were invited to participate. Inclusion criteria were: teams are competing in the highest league of their province; players are between 7 and 14 years old; regular training takes place at least twice per week. Teams were excluded if they used an injury prevention measure. Participating clubs were randomised to an intervention (INT, N = 20 teams) and a control group (CON, N = 22 teams), stratified by the number of teams and the age group. The groups were blinded against each other. The follow-up period was one season (9 months). INT replaced their warm-up by 11+ Kids. CON performed a standard warm-up programme. The primary outcome was the injury incidence density (injuries per 1000 h of football exposure), compared between groups by incidence rate ratios (RR). RESULTS: In total, 64,047 h of football exposure of 962 players (INT = 443 players, 31,934 h of football, CON = 519 players, 32,113 h of football) were recorded. During the study, 90 (INT = 30; CON = 60) injuries occurred. The overall injury incidence density in INT was reduced by 50% compared to CON (RR 0.50; 95%-CI 0.32, 0.78). No injuries occurred during the execution of the intervention exercises. CONCLUSIONS: The 11+ Kids reduces injuries in high-level children's football players, thus supporting player health and potentially performance and player development.