Elias Tsepis

Background/Objectives: This study examined whether adding trunk neuromuscular training to knee-focused rehabilitation offers additional pain reduction in adults with knee osteoarthritis (OA) and sway-back posture. The study also assessed effects on muscle strength, knee range of motion, and postural alignment. Methods: Thirty adults with symptomatic knee OA and sway-back posture were randomized to knee-focused rehabilitation (KNEE; n = 15) or the same intervention with added trunk neuromuscular exercises (KNEE-CORE; n = 15). Twenty-four participants completed the study and were included in the analysis (12 per group). Both groups completed 12 supervised sessions, twice weekly. Outcomes included pain, muscle strength, knee range of motion, and postural alignment. Results: Both interventions resulted in substantial pain reduction. By session 6, pain decreased from 7.67 ± 1.07 to 3.75 ± 1.06 in KNEE and from 7.42 ± 1.68 to 1.58 ± 0.67 in KNEE-CORE, with a significant group-by-time interaction favouring KNEE-CORE (β = −1.92, 95% CI −2.80 to −1.04; p < 0.001). By session 12, pain was low in both groups (0.92 ± 0.67 and 0.17 ± 0.39), and the difference in change from baseline was no longer significant (p = 0.378). No consistent additional benefits were observed for knee range of motion or muscle strength. Some postural outcomes favoured KNEE-CORE, but these findings were exploratory. Conclusions: Trunk neuromuscular training accelerated early pain reduction but did not produce a clearly greater overall reduction by the end of treatment. Proximal neuromuscular training may influence the timing of symptomatic response rather than the final level of improvement.

Background: Lee Silverman Voice Treatment (LSVT) BIG is a well-established exercise program in Parkinson’s Disease (PD), but its effectiveness in other neurological disorders is not well studied. This pilot study examined whether LSVT-BIG similarly improves balance and gait in MS patients compared to PD. Methods: A pilot clinical trial was conducted with two participant groups: MS and PD. Assessments were performed before, during, and after the 4-week LSVT BIG intervention, which followed the established PD protocol of one-hour sessions, four consecutive days per week. Balance and gait were evaluated using the mini-Balance Evaluation Systems Test (mini-BESTest), Timed Up and Go (TUG), and Functional Gait Assessment (FGA). Single-leg stance time on firm, foam, and inclined surfaces was also measured. Data analysis was carried out using mixed ANOVA in SPSS v24. Results: Twelve participants completed the study (6 PD, 6 MS). Both groups significantly improved in mini-BESTest, FGA scores, and timed tasks (p < 0.001). Comparable between-group results revealed, with no significant differences between MS and PD groups (p > 0.5). Conclusions: Similar improvements across groups suggest that LSVT BIG may also benefit patients with MS. Larger randomized trials are needed to confirm its suitability for this population.

Background and Objectives: Recent research has highlighted the importance of examining risk factors and their complex interrelationships in the development of lower limb injuries. This study aimed to investigate the direct, indirect, and mediating effects of endogenous neuromuscular and psychological risk factors on the incidence of non-contact lower limb injuries in football players. Materials and Methods: A sample of ninety-seven male football players underwent a structured preseason, on-field assessment. Demographic characteristics, injury history, and athlete burnout were collected through standardized questionnaires. Preseason evaluations included assessments of lower limb flexibility; isometric strength assessment of hamstring, hip abductors, and quadriceps using a handheld dynamometer; hamstring and core endurance; and the single-leg triple hop for distance test. All non-contact lower limb injuries were prospectively recorded throughout the competitive season. Partial Least Squares Structural Equation Modeling (PLS-SEM) method was applied to examine both direct and indirect associations between preseason risk factors and injury incidence. Results: Lower limb strength asymmetries (path coefficient (PC) 0.293, p = 0.004) and previous injuries (PC 0.233, p = 0.015) exhibited the strongest direct effects on the occurrence of new non-contact lower limb injuries. In addition, age acted as a moderating factor, amplifying the effect of lower limb strength asymmetries on injury risk. Moreover, previous injuries demonstrated both direct and indirect effects on neuromuscular characteristics and perceived burnout. Core and hamstring endurance tended to influence new injuries indirectly through strength asymmetries and were significantly affected by hamstring strength (PC 0.248, p = 0.015) and prior injuries (PC −0.207, p = 0.029). Conclusions: Injury prevention strategies should prioritize the improvement of core and hamstring endurance and the reduction in lower limb Strength Asymmetries, particularly among older football players. Furthermore, individualized preventive interventions for athletes with a previous history of injury are strongly recommended.

Background: Lee Silverman Voice Treatment (LSVT) BIG is a well-established exercise program in Parkinson’s Disease (PD), but its effectiveness in other neurological disorders is not well studied. This pilot study examined whether LSVT-BIG similarly improves balance and gait in MS patients compared to PD. Methods: A pilot clinical trial was conducted with two participant groups: MS and PD. Assessments were performed before, during, and after the 4-week LSVT BIG intervention, which followed the established PD protocol of one-hour sessions, four consecutive days per week. Balance and gait were evaluated using the mini-Balance Evaluation Systems Test (mini-BESTest), Timed Up and Go (TUG), and Functional Gait Assessment (FGA). Single-leg stance time on firm, foam, and inclined surfaces was also measured. Data analysis was carried out using mixed ANOVA in SPSS v24. Results: Twelve participants completed the study (6 PD, 6 MS). Both groups significantly improved in mini-BESTest, FGA scores, and timed tasks (p < 0.001). Comparable between-group results revealed, with no significant differences between MS and PD groups (p > 0.5). Conclusions: Similar improvements across groups suggest that LSVT-BIG may also benefit patients with MS. Larger randomized trials are needed to confirm its suitability for this population.

This paper propose a practical field-based screening protocol for evaluating the risk of hamstring injury. This is done by discerning the most important factors that better explain the underlying structure among various measurements. Following a cross-sectional study design, ninety-nine professional and semi-professional football players were assessed at the team’s facilities during the preseason period. The collected data included aspects of demographic characteristics; previous injuries; athlete sense of burnout (Athlete Burnout Questionnaire (ABQ)); hamstring (HS) flexibility (passive single leg raise test); isometric hamstring strength (make and brake test); isometric quadriceps strength; single-leg triple hop for distance; endurance of the core muscles (prone bridge, side bridge and Biering–Sørensen tests); and hamstring strength endurance (single leg hamstring bridge test). Subsequently, Exploratory Factor Analysis was performed. Following a summarized dimension reduction process, the twenty-three assessment variables were grouped into a parsimonious model of six main risk factors. Specifically, the resulting model explains 55.7% of the total variance, comprising HS and core endurance (20.2% of the variance), HS strength (12.8%), previous injuries (8.9%), ABQ (5.8%), lower limb strength (4.1%), and strength limb symmetry (3.8%). The proposed model provides a practical protocol, facilitating sports scientists in evaluating the risk for HI in the highly complex reality of field-based situations.

Objectives: Shoulder injury prevalence appears to be the highest among all injuries in CrossFit (CF) athletes. Nevertheless, there is no evidence deriving from prospective studies to explain this phenomenon. The purpose of this study was to document shoulder injury incidence in CF participants over a 12-month period and prospectively investigate the risk factors associated with their demographic, epidemiological, and functional characteristics. Methods: The sample comprised 109 CF athletes in various levels. Participants’ data were collected during the baseline assessment, using a specially designed questionnaire, as well as active range of motion, muscle strength, muscle endurance, and sport-specific tests. Non-parametric statistical tests and inferential statistics were employed, and in addition, linear and regression models were created. Logistic regression models incorporating the study’s continuous predictors to classify injury occurrence in CF athletes were developed and evaluated using the Area Under the ROC Curve (AUC) as the performance metric. Results: A shoulder injury incidence rate of 0.79 per 1000 training hours was recorded. Olympic weightlifting (45%) and gymnastics (35%) exercises were associated with shoulder injury occurrence. The most frequent injury concerned rotator cuff tendons (45%), including lesions and tendinopathies, exhibiting various severity levels. None of the examined variables individually showed a statistically significant correlation with shoulder injuries. Conclusions: This is the first study that has investigated prospectively shoulder injuries in CrossFit, creating a realistic profile of these athletes. Despite the broad spectrum of collected data, the traditional statistical approach failed to identify shoulder injury predictors. This indicates the necessity to explore this topic using more sophisticated techniques, such as advanced machine learning approaches.

Background/Objectives: Shoulder injury prevalence appears to be the highest among all injuries in CrossFit (CF) athletes. Nevertheless, there is no evidence deriving from prospective studies to explain this phenomenon. The purpose of this study was to document shoulder injury incidence in CF participants over a 12-month period and prospectively investigate the risk factors associated with their demographic, epidemio-logical, and functional characteristics. Methods: The sample comprised of 109 CF ath-letes in various levels. Participants’ data were collected during the baseline assessment, using a specially designed questionnaire, as well as active range of motion, muscle strength, muscle endurance, and sport-specific tests. Non-parametric statistical tests and inferential statistics were employed, and in addition, linear and regression models were created. Logistic regression models incorporating the study’s continuous predictors to classify injury occurrence in CF athletes were developed and evaluated using the Area Under the ROC Curve (AUC) as the performance metric. Results: A shoulder injury incidence rate of 0.79 per 1,000 training hours was recorded. Olympic weightlifting (45%) and gymnastics (35%) exercises were associated with shoulder injury occurrence. The most frequent injury concerned rotator cuff tendons (45%), including lesions and tendinopathies, exhibiting various severity levels. None of the examined variables showed a statistically significant correlation with shoulder injuries. Conclusions: This was the first study which investigated prospectively shoulder injuries in CrossFit, creating a realistic profile of these athletes. Despite the broad spectrum of collected data, the traditional statistical approach failed to identify shoulder injury predictors. This indicates the necessity to explore this topic using more sophisticated techniques, such as advanced machine learning approaches.

Ankle sprains are considered to be the most common musculoskeletal lower limb injury, accounting for a high percentage of all sport injuries in football. Motor imagery (MI) has been widely used for sports performance optimization purposes, suggesting that athletes’ ability to reenact a motor action can improve sports performance and rehabilitation. The aim of the present study was to explore the role of MI as an adjunct intervention in VO2max and lactate in football players with Grade II ankle sprains during the return-to-play period. Fifty-eight professional football players were randomly divided into two groups: first, the MI (n = 29) and second, the placebo (n = 29). The MI group received recorded MI instructions, whereas the placebo group received only relaxation instructions. A one-way ANOVA revealed statistically significant results within the first 4 weeks following the interventions in both groups. Additionally, a t-test showed statistically significant differences between the two groups in VO2max (t = −6.04, p = 0.000, two-tailed, p < 0.05) and lactate (t = 4.33, p = 0.000, two-tailed, p < 0.05). Further research across various sports is needed to better understand the role of MI in the return-to-play period, particularly regarding injury management and sports performance.

(1) Background: A parsimonious test battery is deemed necessary to efficiently assess the functional performance of athletes avoiding redundant measurements. This study investigates the interrelationships between elements of an experimental field-based test battery during pre-season assessment (PA), with the purpose of enhancing comprehension of the underlying structure of the assessed variables and suggesting guidelines for the tests incorporated in a PA. (2) Methods: Sixty-two professional football athletes performed a PA, including isometric muscle strength, triple hop and core stability tests, the LESS, and evaluation of landing performance through kinetic and electromyographic data. (3) Results: For the dominant lower limb, the factor analysis resulted in six factors, explaining 79.04% of the variance including core stability, ground reaction forces, dynamic balance, hamstrings strength, quadriceps–hamstring EMG ratio, and quadriceps performance. For the non-dominant lower limb, factor analysis resulted in five factors, explaining 76.60% of the variance including core stability, dynamic balance, ground reaction force, quadriceps–hamstring EMG ratio, and quadriceps–abductors strength. The LESS was loaded with various factors. (4) Conclusions: Given the need for efficient field-based assessments that can be repeated throughout the season without sacrificing data quality, we suggest incorporating the LESS, the prone bridge test, and force-plate-based landing performance evaluation as key elements of the PA.

(1) Background: There is a need for a parsimonious test battery to efficiently assess the functional performance of athletes without redundant measurements. This study investigates the interrelationships between elements of an experimental field-based test battery during pre-season assessment (PA), with the purpose of enhancing comprehension of the underlying structure of the assessed variables and suggesting guidelines for the tests incorporated in a PA; (2) Methods: Sixty-two professional athletes performed a PA included strength, hop and core stability tests and evaluation of landing performance through kinetic and electromyographic data; (3) Results: For the dominant lower limb, the factor analysis resulted in 6 factors, explaining 79,04 % of the variance including core stability, Ground Reaction Forces, Dynamic balance, Hamstrings Strength, Quadriceps-Hamstring EMG ratio and Quadriceps performance. For the non-dominant lower limb, factor analysis resulted in 5 factors, explaining 76,60 % of the variance including Core stability, Dynamic balance, Ground Reaction Force, Quadriceps-Hamstring EMG ratio and Quadriceps - Abductors Strength. LESS was loaded with various factors. (4) Conclusions: Given the need for efficient field-based assessments that can be repeated throughout the season without sacrificing data quality, we suggest incorporating LESS, the prone bridge test, and force plate-based landing performance evaluation as key elements of the PA.