O protocolo da presente pesquisa obedece aos Critérios da Ética em Pesquisa com Seres Humanos conforme Resolução n°466/12 do Conselho Nacional de Saúde. Os procedimentos usados foram de riscos considerados mínimos à saúde dos voluntários e os dados coletados foram utilizados apenas para cunho científico, garantindo-se o sigilo e anonimato. O projeto foi submetido e aprovado pelo Comitê de Ética em Pesquisa da Pontifícia Universidade Católica do Rio Grande do Sul
(PUCRS) sob o n° 2.561.459. (ANEXO B). Todos os responsáveis que concordaram em participar do estudo assinaram o Termo de Consentimento Livre e Esclarecido (TCLE) e as crianças e adolescentes menores de dezoito anos assinaram o Termo de Assentimento (TALE).
7 CONCLUSÕES
O organismo dos adolescentes em fase de desenvolvimento, pode ficar mais suscetível as sobrecargas externas dos treinos e jogos intensivos, consequentemente levando a lesões mais precocemente, que podem ocorrer em qualquer articulação do corpo, inclusive na coluna vertebral.
Dessa forma esse trabalho concluiu que os jovens atletas jogadores de futebol apresentam maior número de lesão na coluna lombar, em relação aqueles que não praticam nenhum esporte de impacto regularmente, quando avaliados por meio de Ressonância Magnética de 1.5T. Dentre as lesões vertebrais encontradas nos jovens atletas de Futebol, as mais frequentes foram as lesões dos elementos vertebrais posteriores da coluna lombar, como a artrite/ sinovite facetaria por sobrecarga mecânica.
Diante do encontrado, propomos que os profissionais envolvidos na promoção da prática de futebol profissional se atentem para a realização de estratégias de prevenção das lesões da coluna lombar, mesmo sendo essas de menor prevalência quando comparadas as lesões do membro inferior, devido ao impacto que podem ter na saúde do jovem atleta. É importante a identificação de fatores individuais e de treino para que sejam incorporadas medidas preventivas dentro da rotina desses atletas, incluindo o preparo da musculatura da região.
Os resultados deste estudo, levam a hipótese da possibilidade de realizar exames de imagem na coluna lombar, periodicamente, mesmo em atletas assintomáticos e em adolescentes dessa faixa etária, visto que também apresentaram considerável índice de lesões, com intuito de diagnosticar precocemente, possibilitando tratamento preciso, particularmente em atletas de alto risco.
8 REFERÊNCIAS
1. Meyer T, Faude O, der Fünten K aus. Sports Medicine for Football. Insight from Professional Football for All Levels of Play. 2015. 200 p.
2. Pfirrmann D, Herbst M, Ingelfinger P, Simon P, Tug S. Analysis of injury incidences in male professional adult and elite youth soccer players: A systematic review. J Athl Train. 2016;51(5):410–24.
3. Jarvinen MJ, Lehto MU. The effects of early mobilisation and immobilisation on the healing process following muscle injuries. Sports Med. 1993;15:78-89. 4. FIFA C. FIFA Big Count 2006: 270 million people active in football. FIFA
Commun Div Inf Serv. 2007;31:1–12.
5. Rommers, N., Rössler, R., Goossens, L., Vaeyens, R., Lenoir, M., Witvrouw, E., & D’Hondt, E. Risk of acute and overuse injuries in youth elite soccer players: body size and growth matter. Journal of Science and Medicine in Sport. 2019. 6. Cohen M, Abdalla RJ, Ejnisman B, Amaro JT. Lesões ortopédicas no futebol.
Rev Bras Ortop. 1997;32(12):940-4.
7. Gebert A, Gerber M, Pühse U, Gassmann P, Stamm H, Lamprecht M. Injuries in formal and informal non-professional soccer – an overview of injury context, causes, and characteristics. European Journal of Sport Science. 2018;18(8), 1168–1176.
8. Ekstrand J, Gillquist J. Soccer injuries and their mechanisms. Medicine & Science in Sports & Exercise. 1983;15(3):267-70.
9. Kerr ZY, Putukian M, Chang CJ, DiStefano LJ, Currie DW, Pierpoint LA, Knowles SB, Wasserman EB, Dompier TP, Comstock RD, Marshall SW. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in US high school Boys' soccer (2005-2006 through 2013-2014) and National Collegiate Athletic Association Men's soccer (2004- 2005 through 2013-2014). J Athl Train. 2018;53(9):893–905.
10. Netto, D. C., Arliani, G. G., Thiele, E. S., Cat, M. N. L., Cohen, M., & Pagura, J. R. (2019). Avaliação prospectiva das lesões esportivas ocorridas durante as partidas do Campeonato Brasileiro de Futebol em 2016. Revista Brasileira de Ortopedia, 2019 54(03).
11. Roos K, Kucera KL, Golightly Y, Myers JB, Rosamond W, Marshall SW. Capture of Time-Loss Overuse Soccer Injuries in the National Collegiate Athletic Association’s Injury Surveillance System, 2005-2006 Through 2007-2008. J Athl Train. 2018;53(3):271-278.
12. Souza, RFRD, Mainine, S, Souza, FFRD, Zanon, EM, Nishimi, AY, Dobashi ET, & Fernandes, FA. Orthopedic injuries in soccer - an analysis of a professional championship tournament in brazil. Acta Ortopédica Brasileira, 2017 25(5), 216– 219.
13. D’Hemecourt PA, Gerbino PG, Micheli LJ. Back Injuries in the young athlete. Clinics in Sports Medicine. 2000;19(4):663–79.
14. Öztürk, A., Özkan, Y., Özdemir, R. M., Yalçın, N., Akgöz, S., Saraç, V., & Aykut, S. Radiographic changes in the lumbar spine in former professional football players: a comparative and matched controlled study. European Spine Journal. 2007 17(1), 136–1.
15. Micheli LJ, Allison G. Lumbar spine injury in the young athlete. Revista Brasileira de Medicina do Esporte. 1999 ;5(2):59–65.
16. Faude O, Rößler R, Junge A. Football injuries in children and adolescent players: Are there clues for prevention? Sport Med. 2013;43(9):819–37.
17. Organization WH. Global recommendations on physical activity for health. World Health Organization; 2010.
18. Wu M, Fallon R, Heyworth BE. Overuse injuries in the pediatric population. Sports Med Arthrosc Rev. 2016;24(4):150–158pmid:27811514.
19. McGuine T. Sports injuries in high school athletes: A review of injury risk and injury prevention research. Clin J Sport Med 2006;16(6):488–99.
20. Huguenin L. Paediatric sports injuries. Aust Fam Physician. 2016;45(7):466–9. 21. Ribeiro CZP, Akashi PMH, Sacco ICN, Pedrinelli A. Relação entre alterações posturais e lesões do aparelho locomotor em atletas de futebol de salão. Rev. Bras Med Esporte. 2003 Apr;9(2):98-103.
22. Zito M. The adolescent athlete: A Musculoskeletal update. Journal of Orthopaedic & Sports Physical Therapy. 1983;5(1):20–25.
23. Hutchinson MR. Low back pain in elite rhythmic gymnasts. Med Sci Sports Exerc.1999;31(11):1686-8.
24. Rosendahl K, Strouse PJ. Sports injury of the pediatric musculoskeletal system. Radiol Medica. 2016;121(5):431–41.
25. Loose O, Fellner B, Lehmann J, Achenbach L, Krutsch V, Gerling S, Krutsch W. Injury incidence in semi-professional football claims for increased need of injury prevention in elite junior football. Knee Surg Sports Traumatol Arthrosc. 2019 ;27(3):978-98.
26. Falção, LFR. Manual de Medicina Esportiva: Manual do Residente da Universidade Federal de São Paulo. 1 ed. São Paulo: Roca, 2010.
27. Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sportrelated injuries. Clin J Sport Med. 2006;16(6):500-13.
28. Hughes T, Sergeant JC, van der Windt DA, Riley R, Callaghan MJ. Periodic Health Examination and Injury Prediction in Professional Football (Soccer) Theoretically, the Prognosis is Good. Sports Med. 2018;48(11):2443-2448. 29. Stinson JT. Spine problems in the athlete. Maryland Med J. 1996;45(8):655–658.
18.
30. Gebert A, Gerber M, Pühse U, Faude O, Stamm H, Lamprecht M. Changes in injury incidences and causes in Swiss amateur soccer between the years 2004 and 2015. Swiss Med Wkly. 2018;148.
31. Ho-Fung VM, Jaramillo D. Cartilage imaging in children: current indications, magnetic resonance imaging techniques, and imaging findings. Radiol Clin North Am. 2013;51(4):689-702.
32. d’Amato C. Pediatric spinal trauma: injuries in very young children. Clin Orthop Relat Res 2005.34-40.
33. Butcher J, Lindner KJ, Johns DP. Withdrawal from competitive youth sport: a retrospective ten-year study. J Sport Behav. 2002;25(2):145–163.
34. Shanmugam C, Maffulli N. Sport’s injuries in children. British Medical Bulletin. 2008;86(1):33–57.
35. Froes NDTC, Nunes FTB, Negrelli WF. Influência genética na degeneração do disco intervertebral. Acta Ortopédica Brasileira. 2005;13(5):255-257.
36. Krist MR, van Beijsterveldt AM, Backx FJ, de Wit GA. Preventive exercises reduced injury-related costs among adult male amateur soccer players: a cluster-randomised trial. J Physiother. 2013;59(1):15-23.
37. Haus BM, Micheli LJ. Back pain in the pediatric and adolescent athlete. Clinics in Sports Medicine. 2012;31(3):423-440.
38. Paterson A. Soccer injuries in children. Pediatric radiology. 2009;39(12):1286- 1298, 2009.
39. Smith JS, Shaffrey CI, Fu KM, et al. Clinical and radiographic evaluation of the adult spinal deformity patient. Neurosurg Clin N Am 2013;24(2):143Y156. 40. Hale, A. T., Alvarado, A., Bey, A. K., Pruthi, S., Mencio, G. A., Bonfield, C. M.,
… Naftel, R. P. X-ray vs. CT in identifying significant C-spine injuries in the pediatric population. Child’s Nervous System. 2017 33(11), 1977–1983.
41. Leone, A., Cassar-Pullicino, V. N., D’Aprile, P., Nasuto, M., & Guglielmi, G. Computed Tomography and MR Imaging in Spondyloarthritis. Radiologic Clinics of North America. 2017 55(5), 1009–1021.
42. Junge, A., & Dvorak, J. Soccer injuries: a review on incidence and prevention. Sports medicine. 2004 34(13), 929-938.
43. DIESPORTE. Diagnóstico Nacional do Esporte. Ministério do Esporte [Internet]. 2016;70. Available from: www.esporte.gov.br/diesporte
44. Paluska SA. Textbook of Sports Medicine: Basic Science and Clinical Aspects of Sports Injury and Physical Activity. Med Sci Sport Exerc. 2003;1461.
45. IBGE. Sports and Physical Activity Practices in 2015 [Internet]. 2015. 81 p. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv100364.pdf 46. Keller C, Noyes F, Buncher C. The medical aspects of soccer injury
epidemiology. The American Journal of Sports Medicine. 1987;15(3):230-237. 47. Rommers N, Rössler R, Goossens L, Vaeyens R, Lenoir M, Witvrouw E, et al.
Risk of acute and overuse injuries in youth elite soccer players: Body size and growth matter. J Sci Med Sport [Internet]. 2019; Available from: https://doi.org/10.1016/j.jsams.2019.10.001
48. Hresko MT, Micheli LJ. Sports medicine and the lumbar spine. In: Floman Y, editor. Disorders of the lumbar spine. Baltimore: Aspen, 1990:879-894.
49. Kujala UM, Salminen JJ, Taimela S, Oksanen A, Jaakkola L. Subject characteristics and low back pain in young athletes and nonathletes, Med. Sci. Sports Exerc. 1992;24(6):627–632.
50. Ball JR, Harris CB, Lee J, Vives MJ. Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations. Sport Med - Open. 2019;5(1).
51. De Luigi AJ. Low back pain in the adolescent athlete. Phys Med Rehabil Clin N Am. 2014;25(4):763–88.
52. Ong A, Anderson J, Roche J. A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Br J Sports Med 37 (3) : 263-6, 2003.
53. Kartal A, Yildiran I, Senköylü A, Korkusuz F. Soccer causes degenerative changes in the cervical spine. Eur Spine J. 2004;13(1):76–82.
54. Ribeiro RN, Vilaça F, Oliveira HU, Vieira LS, Silva AA. Prevalência de lesões no futebol em atletas jovens: Estudo comparativo entre diferentes categorias. Revista Brasileira de Educação Física e Esporte. 2007 Set; 21(3): 189–194. 55. Gillis C, Kennedy L, Bar-Or O. Overweight children reduce their activity levels
earlier in life than healthy weight children. Clin J Sport Med 2006;16(1):51–55. 56. Davis KW. Imaging pediatric sports injuries: Lower extremity. Radiologic Clinics
57. Braun HJ, Dragoo JL, Hargreaves BA, Levenston ME, Gold GE. Application of advanced magnetic resonance imaging techniques in evaluation of the lower extremity. Radiol Clin North Am. 2013;51(3):529-45.
58. Merrit HH: A Textbook of Neurology, 5.ed. Philadelphia, Lea & Febiger, 1973;353.
59. Conn JM, Annest JL, Gilchrist J. Sports and recreation related injury episodes in the US population, 1997-99. Inj Prev. 2003;9(2):117–123pmid:12810736. 60. Beers Mark H, MD, Robert Berkow MD. editors. Common Sports Injuries.
Section 5, Chapter 62 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
61. Bak MJ, Doerr TD. Craniomaxillofacial Fractures during Recreational Baseball and Softball. Journal of Oral and Maxillofacial Surgery 62 October 2004, 1209- 1212.
62. Sorensen L, Larsen SE, Rock ND. The epidemiology of sports injuries in school- aged children. Scand J Med Sci Sports 1996; 6:281-6.
63. Baldisserotto M, Bernardi Soder R, BerwigMatiotti S. Avaliação por ressonância magnética em equipamento de 3,0T do joelho de adolescentes assintomáticos praticantes de futebol. Rio Grande do Sul. Dissertação [Mestrado em Medicina/ Pediatria e Saúde da Cri.
64. Baker RJ, Patel D. Lower back pain in the athlete: Common conditions and treatment. Prim Care - Clin Off Pract. 2005;32(1):201–29.
65. Dowdell J, Mikhail C, Robinson J, Allen A. Anatomy of the pediatric spine and spine injuries in young athletes. Ann Jt. 2018;3(1):28–28.
66. Settineri IC. Biomecânica da coluna vertebral. In: Settineri IC. Biomecânica: noções gerais. São Paulo: Atheneu; 1988. p. 93-100.
67. Bogduk N. Clinical Anatomy of the Lumbar Spine and Sacrum, 4th ed. Churchill Livingstone, 2005.
68. Micheli LJ, Wood R. Back pain in young adults. Significant differences from adults in causes and patterns. Paediatric and Adolescent Medicine1995;Vol 149. 69. Standaert C. Low Back Pain in the Adolescent Athlete.Phys Med RehabilClin N
Am.2008; 19(2):287-304.
70. Lawrence JP, Greene HS, Grauer JN, et al. Back pain in athletes. J Am Acad Orthop Surg 2006;14:726-35.
71. Mautner KR, Huggins MJ. The young adult spine in sports. Clin Sports Med 2012;31:453-72.
Can Exercise Positively Influence the Intervertebral Disc? Sports Medicine. 2015;46(4):473–485.
73. Belavý DL, Quittner MJ, Ridgers N, Ling Y, Connell D., & Rantalainen T. Running exercise strengthens the intervertebral disc. Scientific Reports. 2017;7(1). 74. Kleinpaul JF, Mann L, Santos SG. Lesões e desvios posturais na prática de
futebol em jogadores jovens. Fisioterapia e Pesquisa. 2010 Sep;17(3):236-241. 75. Castiglia PT. Sport’s injuries in children. Journal of Pediatric Health Care. 1995
;9(1):32–33.
76. Noormohammadpour P, Mirzaei S, Moghadam N, Mansournia MA, Kordi R. Comparison of Lateral Abdominal Muscle Thickness in Young Male Soccer Players With and Without Low Back Pain. Int J Sports Phys Ther. 2019;14(2):273–281.
77. Maxfield BA.Sports-Related Injury of the Pediatric Spine. Radiologic Clinics of North America. 2010;48(6):1237–1248.
78. El Rassi G, Takemitsu M, Woratanarat P, Shah SA. Lumbar spondylolysis in pediatric and adolescent soccer players. M.J. Sports Med. 2005;33(11):1688- 1693.
79. Klein, J. P. (2015). A Practical Approach to Spine Imaging. CONTINUUM:
Lifelong Learning in Neurology, 21, 36–51.
doi:10.1212/01.con.0000461083.33500.
80. Shah, L. M., & Ross, J. S. Imaging of Spine Trauma. Neurosurgery. 2016;79(5), 626–642.
81. Kawakyu-O’Connor, D., Bordia, R., & Nicola, R. Magnetic Resonance Imaging of Spinal Emergencies. Magnetic Resonance Imaging Clinics of North America. 2016; 24(2), 325–344.
82. Quattrocchi CC, Giona A, Di Martino AC, et al. Extra-spinal incidental findings at lumbar spine MRI in the general population: a large cohort study. Insights Imaging 2014;4(3): 301Y308.
83. Reed ME, Villacis DC, Hatch GF, Burke WS, Colletti PM, Narvy SJ, et al. 3.0- Tesla MRI and arthroscopy for assessment of knee articular cartilage lesions. Orthopedics. 2013;36(8):1060-1064.
84. Faingold R, Saigal G, Azouz EM, Morales A, & Albuquerque PAB. Imaging of low back pain in children and adolescents. Seminars in Ultrasound, CT and MRI. 2004;25(6):490–505.
85. Bennett DL, Nassar L, & DeLano MC. Lumbar spine MRI in the elite-level female gymnast with low back pain. Skeletal Radiology. 2006;35(7):503–509.
86. Goldstein, J. D., Berger, P. E., Windler, G. E., & Jackson, D. W. Spine injuries in gymnasts and swimmers. The American Journal of Sports Medicine. 1991;19(5):463–468.
87. Kujala, U. M., Kinnunen, J., Helenius, P., Orava, S., Taavitsainen, M., & Karaharju, E. Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis. European Spine Journal. 1999;28(6), 480–484.
88. Külling, Fabrice A., et al. “High Prevalence of Disc Degeneration and Spondylolysis in the Lumbar Spine of Professional Beach Volleyball Players.” Orthopaedic Journal of Sports Medicine,2014.
89. Suzue N, Matsuura T, Iwame T, Hamada D, Goto T, Takata Y, Sairyo K. Prevalence of childhood and adolescent soccer-related overuse injuries. The Journal of Medical Investigation. 2014;61(3.4):369–373.
90. Wasserman, Michael S., Ali Guermazi, and Mohamed Jarraya. “Correction: Evaluation of spine MRIs in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.” BMJ Open Sport Exerc Med 2018.
91. Ekin E. Altunrende ME.Pedicle Stress Injury in Children and Adolescents With Low Back Pain. Spine (Phila Pa 1976). 2019; 1;44(17):E1038-E1044.
92. Thoreson, Olof, et al. “The effect of repetitive flexion and extension fatigue loading on the young porcine lumbar spine, a feasibility study of MRI and histological analyses.” Journal of experimental orthopaedics 4.1 (2017): 16. 93. AnthroPlus for Personal Computers. Manual: Software for assessing growth of
the world’s children and adolescents. Geneva [Internet]. 2007;1–45. Available from: http://www.who.int/growthref/tools/en/
94. de Farias Júnior JC, Lopes A da S, Mota J, Santos MP, Ribeiro JC, Hallal PC. Validade e reprodutibilidade de um questionário para medida de atividade física em adolescentes: Uma adaptação do Self-Administered Physical Activity Checklist. Rev Bras Epidemiol. 2012;15(1):198–210.
APÊNDICE A- ARTIGO ORIGINAL
Artigo formatado e submetido conforme as normas da revista científica European Spine Journal.
Lesions of the Lumbar Region in Asymptomatic Young Soccer Players: A Cross-Sectional Study
Chárbel Jacob Júnior1, Rita Mattiello2.
1. School of Medicine of Santa Casa de Misericórdia de Vitória, Vitória, Espírito Santo, Brazil.
2. Pontifícia Universidade Católica, Porto Alegre, Rio Grande do Sul – Brazil.
Corresponding author: Chárbel Jacob Júnior
Address: Emescam, Avenida Nossa Senhora da Penha, 2190 Bela Vista, Vitória – ES CEP 29027-502
Phone number: +55–27–3334-3500
ABSTRACT
Purpose: To assess the frequency of abnormalities of the lumbar region in asymptomatic young soccer players.
Study Design: Cross-sectional study.
Methods: Male adolescents from schools of grassroots soccer clubs and non- practicing activity controls of the State of Espírito Santo, Brazil, from April to October 2018, were included by convenience. The frequency of abnormalities of the lumbar region was evaluated by magnetic resonance testing, performed using 1.5T devices with multi-channel coils in model equipment models. The types of lesions evaluated were general, warning signs, initiated, anterior and posterior, and of the column. Comparisons between groups and the relative percentage of each lesion type were compared by Pearson’s chi-squared test and Fischer’s exact test. The inter and intra- observer analyses were compared by the Kappa test.
Results: Forty-five adolescents were included, of whom 25 (56%) were soccer- practicing teenagers. No significant differences were identified between the variables age (P = 0.960) and the BMI Z index score (P = 0.540) between the group of soccer practitioners and the controls. However, the percentages of lesions (general, instituted, anterior and posterior, and in the spinal column) were significantly higher in the practicing football group than in the control group (P=0.002, P<0.001, P=0.012, and P=0.006, respectively).
Conclusion: Young adolescent asymptomatic soccer players have more lumbar spine lesions than less active controls who do not practice sports regularly.
INTRODUCTION
Athletes generally exceed the limits of the body, which can result in various lesions [1-3]. In soccer adult players, 60-80% of such lesions are located on the lower extremities especially the knees and ankles [4-10]. In adult athletes, the lumbar region is the most common vertebral lesion site[11]. Chronic lesions—those that occur due to excessive use of the joints—are the most common [12,13]. These lesions can start in adolescence and worsen in adulthood [14,15]. While spinal column lesions are relatively rare, they can lead to permanent disability [12,16].
Studies on spinal lesions in young athletes are rare [4]. The pediatric musculoskeletal system is particularly susceptible to lesions through overuse for various reasons including an immature growth plate [17,18]. Chronic lesions formed through overuse occur via repetitive microtrauma to a tissue that exceeds the capacity to be repaired. This can lead to an increase in pressure at this articulation[17,19]. In addition, during the fastest growth period of adolescents (i.e., growth spurts during puberty) can lead to locally imbalanced bone tissue and musculature—this may cause an increased risk of lesions especially on growth plates[14,15]. Growth cartilage and centers of immature ossification are also more susceptible to lesions due to compression, distraction, and rotation. Deficits in the ossification of pars interarticularis—especially at L5—contribute to the incidence of lesions in the posterior vertebral elements [13]. In addition to these injuries, such lesions can cause pain in the affected region to limit children’s daily activities [18,20].
Unfortunately, there are relatively few studies focused on lesions of the vertebral column in asymptomatic young soccer players. Existing studies have limitations including the use of niche groups and methods [20-22]. Thus, this study evaluated the frequency of abnormalities in the lumbar region that were diagnosed via magnetic resonance imaging of asymptomatic young soccer players.
MATERIALS AND METHODS
Study design
Cross-sectional study. Participants
Participants were recruited by convenience from schools and two soccer clubs. Two groups of asymptomatic male adolescents were included: soccer players and adolescents not performing similar impact physical activity (control group), aged 13 to 18 years. The inclusion criteria for the asymptomatic adolescent soccer players were to have practiced the sport for at least two consecutive years with a minimum frequency of three times per week for a period of one to three consecutive hours. All soccer players were enrolled in the State Football Federation.
The control group contained asymptomatic adolescents and was matched for age, gender, height, and weight. The inclusion criterion for the controls were an absence of soccer or similar sport more than once a week for more than one hour.
The exclusion criteria for both groups were a history of lesions, surgery or osteoarticular alterations, malformations, history of chronic disease (diabetes; hypertension; rheumatic, cardiac, renal, respiratory or neurological disease; chronic hepatitis disease; or a z-score of body mass index (BMIz) greater than +3. Thirty individuals in each group were invited to participate in the study. Five participants were excluded from the athletes due to previous surgery, while on control group 2 participants were excluded due to previous injuries, 5 for soccer-related sports participants and 3 due to symptoms.
The anthropometric evaluation measured weight and height for further BMI