Plyometric type neuromuscular exercise is a treatment to postural control deficits of volleyball players: A case study

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Gomides, O.C. Moreira, R.A.R. Oliveira, D.G. Matos, C.E.P. Oliveira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "P.H.G." "apellidos" => "Gomides" ] 1 => array:2 [ "nombre" => "O.C." "apellidos" => "Moreira" ] 2 => array:2 [ "nombre" => "R.A.R." "apellidos" => "Oliveira" ] 3 => array:2 [ "nombre" => "D.G." "apellidos" => "Matos" ] 4 => array:2 [ "nombre" => "C.E.P." 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São Bonifácio, Brazil, 2010. *p<0.05 for differences between sexes in each age." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Minatto, E.L. Petroski, D.A.S. Silva" "autores" => array:3 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Minatto" ] 1 => array:2 [ "nombre" => "E.L." "apellidos" => "Petroski" ] 2 => array:2 [ "nombre" => "D.A.S." "apellidos" => "Silva" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888754615001069?idApp=UINPBA00004N" "url" => "/18887546/0000000900000002/v1_201604230023/S1888754615001069/v1_201604230023/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Plyometric type neuromuscular exercise is a treatment to postural control deficits of volleyball players: A case study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "75" "paginaFinal" => "79" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "A. Asadi" "autores" => array:1 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Asadi" "email" => array:1 [ 0 => "Abbas_asadi1175@yahoo.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Roudbar Branch, Islamic Azad University, Roudbar, Iran" "identificador" => "aff1" ] ] ] ] "titulosAlternativos" => array:2 [ "es" => array:1 [ "titulo" => "Ejercicios neuromusculares de tipo pliométrico como tratamiento de déficits de control postural de jugadores de voleibol: a propósito de un caso" ] "pt" => array:1 [ "titulo" => "Exercícios neuromusculares do tipo pliométrico como tratamento de déficits no controle postural de jogadores de voleibol: um estudo de caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1003 "Ancho" => 1628 "Tamanyo" => 84534 ] ] "descripcion" => array:1 [ "en" => "Plyometric effect (%) and effect size in reaching directions for the volleyball players. A; anterior, AM; anteromedial, AL; anterolateral, M; medial, L; lateral, P; posterior, PM; posteromedial, PL; posterolateral. *Significant differences compared with AM direction (p≤0.05). †Significant differences compared with PM direction (p≤0.05)." ] ] ] "textoCompleto" => "IntroductionKnee ligament injuries occur several times during training and competition in volleyball players. Among some ligaments in the knee, anterior cruciate ligament (ACL) plays a critical role to stability of the joint.<a class="elsevierStyleCrossRefs" href="#bib0130">1,2</a> ACL injuries account for 50% or more of all knee injuries, making this ligament especially important in any discussion of knee injuries. Most ACL injuries in volleyball players occur when a player lands awkwardly after jumping. Usually ACL tears are associated with a “pop” and immediate knee swelling. Previous authors reported that annual incidence of ACL injury is about 38000 cases in the United States.<a class="elsevierStyleCrossRef" href="#bib0140">3</a>One possible explanation to increase ACL injury could be deficits in postural control. It has been well documented that poor postural control is associated with injury of the joint and therefore enhancing joint awareness and postural control could be a modality to decrease injuries.<a class="elsevierStyleCrossRef" href="#bib0145">4</a>The common method of training for power-type athletes (i.e., volleyball players) is plyometric training. It has been reported that plyometric training is an effective training modality for improving joint awareness, balance and neuromuscular properties that used by strength and conditioning professional at pre- and in season of training schedule for athletes.<a class="elsevierStyleCrossRefs" href="#bib0150">5,6</a> Plyometric training is a form of training techniques which used by athletes in all types of sports to increase performance adaptations.<a class="elsevierStyleCrossRef" href="#bib0160">7</a> Plyometrics consists of a rapid stretching of a muscle (eccentric action) immediately followed by a concentric or shortening action of the same muscle.<a class="elsevierStyleCrossRef" href="#bib0160">7</a> The stored elastic energy within the muscle is used to produce more force than can be provided by a concentric action alone.<a class="elsevierStyleCrossRef" href="#bib0160">7</a>Although, with review in literature, plyometric training could be an effective training method for enhancing balance and postural control in athletes,<a class="elsevierStyleCrossRefs" href="#bib0150">5,6</a> the acute effects of plyometric training on postural control are poorly understood. Deficits in postural control after several fatigue protocols (i.e., running and resistance exercise) has been supported by previous authors,<a class="elsevierStyleCrossRefs" href="#bib0165">8–14</a> but the influence of plyometric exercise on balance performance is not clear. To the authors’ knowledge, only Twist et al.<a class="elsevierStyleCrossRef" href="#bib0200">15</a> examined the influence of 200 countermovement jump plyometric exercise on unilateral balance performance by using the Biodex Stabiliometer and found deficits at 24h post exercise. Since, plyometric training can be used in some sport teams (i.e., volleyball) and those athletes perform plyometric training for increasing muscle explosiveness, determining the acute effects of plyometric exercise on balance and postural control is vital.Compared with previous study that used Biodex Stabiliometer to analyze balance changes after plyometric exercise,<a class="elsevierStyleCrossRef" href="#bib0200">15</a> Gribble et al.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> reported that Star Excursion Balance Test (SEBT) should be considered a highly representative, noninstrumented dynamic balance test for physically active individual. The SEBT has been shown to be a reliable measure and has validity as a dynamic balance test to predict risk of lower extremity injury, to identify dynamic balance deficits in patients with a variety of lower extremity conditions, and to be responsive to training programmes in both healthy people and people with injuries to the lower extremity and this note have been confirmed by clinicians and researchers that employed the SEBT for the lower extremity functional test.With regard to importance of plyometric training on athletes training schedule and highly representative of SEBT to determine the deficits in postural control, no study has focused on the analysis of a specific plyometric exercise programme on postural control performance in volleyball players. Therefore, the aim of this study was to examine the effects of plyometric type neuromuscular exercise on postural control (SEBT) in volleyball players. It was hypothesized that a session of plyometric exercise would impair postural control performance and would induce reduction of joint awareness in volleyball players.MethodsParticipantsTen national level young male volleyball players (age 19±1.5 years, height 181.6±12.7cm, weight 69.5±10.8kg and training age 4.1±0.7 years) volunteered for the study. Athletes were free from lower extremity injury for at least 6 months prior to testing, have no history of hip, knee or ankle surgery and participated in a minimum of 2h volleyball training four times a week. All athletes signed an informed consent form and the study was approved by the University Research and Ethics Committee.DesignAthletes reported to the laboratory at 4:00 PM. On entering the laboratory, height (cm), body mass (kg), and training age (year) were measured in each subject. Body mass was obtained to the nearest 0.1kg using an electronic scale (Tanita, BC-418MA, Tokyo, Japan). Height was measured to the nearest 0.1cm using a stadiometer (Seca 222, Terre Haute, IN). The athletes were familiarized with the testing and plyometric exercise protocols in this session. Each player was instructed and verbally encouraged to give a maximal effort during all plyometric exercises and testing. A standardized warm-up, consisting of jogging, dynamic stretching, and then a series of increasing intensity sprints, was performed before initiation of study. Before and after plyometric treatment, each volleyball player performed SEBT to determine postural control changes.Postural control assessmentIn this study the Star Excursion Balance Test (SEBT) was used for the postural control assessment because Gribble et al.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> reported highly representative, noninstrumented dynamic balance test to assess postural control. The SEBT was performed as described by Robinson and Gribble.<a class="elsevierStyleCrossRef" href="#bib0210">17</a> Participants stood in the middle of a grid laid on the floor with 8 lines extending at 45° angles from the centre of the grid, each of which is labelled according to the direction of excursion in relation to the standing leg: anterior (A), anteromedial (AM), medial (M), posteromedial (PM), posterior (P), posterolateral (PL), and lateral (L) anterolateral (AL). Participants undertook the testing barefoot, with foot position controlled by aligning the heel with the centre of the grid and great toe with the anteriorly projected line. Participants were asked to maintain a single-leg stance on the test leg whilst reaching the opposite leg to touch as far as possible along the chosen line with the most distal part of their foot. The foot was only allowed to touch lightly so as not to aid balance. The athlete then returned to bilateral stance. The point at which the subject touched was marked by the examiner and measured manually using a measuring tape. The same investigator measured all participants, and marks were erased after each trial.For a trial to be successful the participants hands had to remain on their hips, the reach leg could not provide support upon touching down, the heel of the stance leg had to remain in its position in the centre of the grid and not lift from the ground and balance had to be maintained. Each athlete performed six trials in each direction for familiarization of testing and then performed three reaching trials with one leg before switching to the other leg with 30s recovery allowed between them. The best score in between three trials was chosen for further analysis. This approach allowed for the effect of repeated trials to be examined to determine whether a learning effect was present and decreases the fatigue induced by direction trials.Normalizing SEBT dataAthlete's legs were measured from the anterior superior iliac spine to the distal tip of the medial malleolus using a standard tape measure while participants lay supine. Leg length was used to normalize excursion distances by dividing the distance reached by leg length then multiplying by 100.<a class="elsevierStyleCrossRef" href="#bib0215">18</a>TreatmentVolleyball players performed squat jump, broad jump, tuck jump with knee to chest, and depth jump from 45-cm box high four sets with ten repetitions, respectively. There were 60 and 90s rest between sets and exercises, respectively. This type and repetition of plyometric intervention is common in volleyball players.<a class="elsevierStyleCrossRef" href="#bib0160">7</a> The athletes were instructed to perform each jump with maximal effort and minimal contract on land. All exercises were supervised by strength and conditioning specialist and author.Statistical analysisDescriptive statistics [mean±standard deviation (SD)] for the SEBT values were calculated. To determine the effect of plyometric intervention on postural control changes a two times (pre and post) for eight directions (A, AM, M, PM, P, PL, L, AL), ANOVA was applied. When a significant F value was achieved, Tukey post hoc procedures were performed to locate the pairwise differences between the means. The effect sizes (ESs) were calculated using Cohen's d. The level of significance was set at p≤0.05.ResultsThe results of this study indicated that a session of plyomeric exercise induced significant decrease in reaching direction for the M (p=0.05); however changes in other reaching directions were no statistically significant (p>0.05) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). With comparing the % of changes in between directions, there were significant differences between them. The greater changes were observed in the M, P and AL directions and these differences were maintained compared with AM and PM, respectively (p≤0.05). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows differences in % of change and ES in between reaching directions.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionThe aim of this study was to examine the influence of a session of plyometric type neuromuscular exercise on postural control changes which assessed by SEBT. The results indicated that plyometric intervention induced deficits in balance. The impairments in postural control were greater in M, P and AL directions in volleyball players. In accordance with these findings, some studies reported impairments of postural control after different exercises. For example, Crowell et al.<a class="elsevierStyleCrossRef" href="#bib0165">8</a> investigated postural stability after exercise protocol including squat jumps, sprints, and treadmill running in male and female club-sport athletes. Differences between baseline and post exercise balance were observed, leading to the conclusion that any decrease in performance on the postural control might be attributed to the fatigue that had occurred in the lower extremity. Similarly, Wilkins et al.<a class="elsevierStyleCrossRef" href="#bib0170">9</a> examined the effects of a 20min exercise, including a 5min moderate jog, 3min of sprints, 2min of push-ups, 2min of sit-ups, 3min of step-ups, 3min of sprints, and a 2-min run on balance performance in NCAA Division I collegiate athletes. Total errors increased from pretest to posttest in the exercise group. It appears that a contribution of both central (i.e., changes in force perception by the brain) and peripheral mechanisms (i.e., disruption to extrafusal and intramuscular fibres) might play a role in exacerbating balance performance. Several studies have alluded to the possibility that muscle spindles and Golgi tendon organs become desensitized as a result of fatiguing<a class="elsevierStyleCrossRef" href="#bib0220">19</a> or eccentric exercise.<a class="elsevierStyleCrossRefs" href="#bib0225">20,21</a> Therefore, given the significance of these intramuscular receptors in controlling joint movement and position, it is plausible that the plyometric exercise could have potentially led to changes in afferent receptor activity, which resulted in reduction of balance performance.It seems that the main reason for decreasing balance performance becomes plyometric-induced muscle fatigue. Due to the fact the muscular fatigue decreases the neural transmission velocity,<a class="elsevierStyleCrossRef" href="#bib0235">22</a> maybe the ability in creating efficient compensatory contractions around the joint is reduced, resulting in a loss of the neuromuscular control and decreases in reaching directions. But no physiological and neural assessments were made and this is only a speculative statement. In the literature, the negative effects of fatigue protocols (i.e., cycle ergometer, aerobic and anaerobic exercise) on postural control deficits have been supported.<a class="elsevierStyleCrossRefs" href="#bib0165">8,9</a> Indeed, several studies have demonstrated that muscle fatigue can impair joint proprioception.<a class="elsevierStyleCrossRefs" href="#bib0175">10–13</a> It has been suggested that impaired proprioception can delay stabilizing muscle activation, leading to decrements in postural control.<a class="elsevierStyleCrossRef" href="#bib0195">14</a>In this study, muscle fatigue could not be separated because of the plyometric exercises involved hip, knee and ankle muscles and the effects of each muscle groups on balance performance could not determine. However, there were available data about the local muscle fatigue and postural control deficits. Gribble and Hertel<a class="elsevierStyleCrossRef" href="#bib0240">23</a> reported that fatigue at the knee caused greater postural sway than fatigue at the ankle during unipedal stance. Bellew and Fenter<a class="elsevierStyleCrossRef" href="#bib0245">24</a> examined the effects of muscle fatigue at the ankle and knee on balance using three different clinical tests. Their results indicated that postural control, as measured using the lower-extremity reach test, decreased significantly only after knee fatigue, while postural control measured with the single-limb stance time test was significantly reduced only after ankle fatigue.In the present study, it seems that knee fatigue occurred because the most jump and plyometrics which used in this protocol involved knee extensor muscles. The results have shown a deterioration in the reflection sensitivity after the fatigue, and they suggest that the modulation of the neural input to the muscle has at least partial reflective origin in the contracted muscles, and the decreasing muscular rigidity that followed the decreasing reflection sensitivity, and such lower rigidity may induce deficits in joint awareness and consequently decreases in reaching directions and postural control deficits.<a class="elsevierStyleCrossRef" href="#bib0250">25</a> According to the results found in the present paper, the neuromuscular control is partially compromised with the fatigue onset, and this can be a predisposing factor to future injuries and it is better that strength and conditioning in the field of volleyball did not perform other type of landing exercise in plyometric training session and separate plyometric training with regular volleyball training to reduce probability of lower extremity injuries.From a practical point of view, it must be considered that a session of plyometric exercise tends to decrease balance and postural control performance of volleyball players. The reduction in neuromuscular control (i.e., SEBT) was possibly attributed to a complex interaction of central and peripheral mechanisms, although this study was unable to distinguish the precise contribution of each and further studies are necessary for this subject. Overall, the findings have implications for coaches and athletes who should be conscious of the use of skill-based activities and for increased injury risk following plyometric training.Conflicts of interestThe author has no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres630598" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec643446" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres630597" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec643445" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "xres630596" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Conclusão" ] ] ] 5 => array:2 [ "identificador" => "xpalclavsec643447" "titulo" => "Palavras-chave" ] 6 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 7 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Postural control assessment" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Normalizing SEBT data" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Treatment" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-20" "fechaAceptado" => "2016-02-18" "PalabrasClave" => array:3 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec643446" "palabras" => array:3 [ 0 => "Postural control" 1 => "Stretch shortening cycle" 2 => "SEBT" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec643445" "palabras" => array:3 [ 0 => "Control postural" 1 => "Ciclo estiramiento-acortamiento" 2 => "SEBT" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec643447" "palabras" => array:3 [ 0 => "Controle postural" 1 => "Ciclo alongamento encurtamento" 2 => "SEBT" ] ] ] ] "tieneResumen" => true "resumen" => array:3 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe effects of exercise protocols on postural control changes have been supported, but the influence of a common and specific type neuromuscular exercise such as plyometric on postural control is not clear. Therefore, the aim of this study was to examine the effects of plyometric type neuromuscular exercise on balance or postural control performance of young male volleyball players. MethodTen professional young male volleyball players participated in this study and performed plyomeric exercises including 4×10 squat jump, broad jump, tuck jump with knee to chest, and depth jump from 45-cm box high 60 and 90s rest between sets and exercises, respectively. Before and immediately after completing the plyometric exercise, postural control was assessed by the Star Excursion Balance Test (SEBT) at 8 directions (anterior, A; anteromedial, AM; anterolateral, AL; medial, M; lateral, L; posterior, P; posteromedial, PM; and posterolateral, PL). ResultsThe results indicated that plyometric exercise induced deficits in reach directions and greater changes occurred in the M, P and AL directions. ConclusionsIt can be recommend that strength and conditioning professionals in the field of volleyball do not perform other type of landing exercise in plyometric training sessions because of postural control impaired and consequently the probability of lower extremity injuries will increase." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEl efecto de protocolos de ejercicios, en cambios del control postural, son bien conocidos, pero la influencia de un sencillo y específico tipo de ejercicio neuromuscular, como los ejercicios pliométricos, en el control postural, no está clara. Por tanto, el objetivo de este estudio fue examinar los efectos de los ejercicios neuromusculares, de tipo pliométrico, en el equilibrio o en el control postural, de varones jóvenes jugadores de voleibol. MétodoDiez varones jóvenes jugadores profesionales de voleibol participaron en este estudio y realizaron ejercicios pliométricos incluyendo 4×10 saltos con sentadilla, saltos de longitud, saltos con rodillas al pecho y saltos con rebote desde un cajón de 45cm de altura, con 60 y 90s de reposo entre series y ejercicios, respectivamente. Antes e inmediatamente después de completar los ejercicios pliométricos se midió el control postural mediante el Star Excursion Balance Test (SEBT) en 8 direcciones (anterior: A; anteromedial: AM; anterolateral: AL; medial: M; lateral: L; posterior: P; posteromedial: PM y posterolateral: PL). ResultadosLos resultados indican que los ejercicios pliométricos indujeron déficits en las direcciones analizadas y que los mayores cambios se produjeron en las direcciones M, P y AL. ConclusiónSe puede recomendar, a los profesionales del voleibol, en el campo del entrenamiento de la fuerza, que no realicen otros tipos de ejercicios de suelo en las sesiones de entrenamiento pliométrico, porque la disminución del control postural podría incrementar secundariamente la probabilidad de lesión del miembro inferior." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoO efeito de protocolos de exercícios sobre as mudanças no controle postural ébem conhecido, mas a influência de um tipo de treinamento neuromuscular comum e específico como o pliométrico no controle postural não está claro. O objetivo deste estudo foi examinar os efeitos dos exercícios neuromusculares do tipo pliométrico no equilíbrio e controle postural de jovens jogadores de voleibol masculino. MétodosDez jovens, jogadores profissionais de voleibol, participaram desse estudo e realizaram exercícios pliométricos que incluíram: 4×10 saltos partindo da posição de agachamento, saltos longitudinais, saltos com joelho encostando no peito e salto com rebote sob uma caixa de 40cm de altura, com descanso entre 60-90 segundos entre as séries e exercícios, respectivamente. Antes e imediatamente após completarem o exercício de pliometria, o controle postural foi medido com as 8 direções do Star Excursion Test (SEBT) (anterior: A; antero-medial; AM; antero-lateral: AL; medial: M; lateral: L; posterior: P; póstero-medial: PM e postero-lateral: PL). ResultadosOs resultados indicam que os exercícios pliométricos induziram déficits no alcance das direções do SEBT e as maiores mudanças ocorrem nas direções M, P e AL. ConclusãoPode ser recomendado que os profissionais que trabalham com força e condicionamento físico voltado ao voleibol não realizem outro tipo de exercício com carga nas sessões de pliometria, por causa da debilidade no controle postural que o treinamento pliométrico ocasiona e consequentemente na probabilidade de aumentar o risco de lesões nos membros inferiores." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1003 "Ancho" => 1628 "Tamanyo" => 84534 ] ] "descripcion" => array:1 [ "en" => "Plyometric effect (%) and effect size in reaching directions for the volleyball players. A; anterior, AM; anteromedial, AL; anterolateral, M; medial, L; lateral, P; posterior, PM; posteromedial, PL; posterolateral. *Significant differences compared with AM direction (p≤0.05). †Significant differences compared with PM direction (p≤0.05)." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reaching directions \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Post \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-to-post p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterior (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82±5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.3±4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.697 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anteromedial (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.6±5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.758 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medial (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.8±4.9<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posteromedial (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.8±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.1±4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92±5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.6±6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterolateral (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.6±8.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.8±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.534 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateral (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80±6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.1±5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.368 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterolateral (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.5±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71±3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.486 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034652.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Significant differences compared with pre value (p≤0.05)." ] ] ] "descripcion" => array:1 [ "en" => "Pre to post changes in postural control performance. Values are mean±standard deviation." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.L. Ardern" 1 => "K.E. Webster" 2 => "N.F. Taylor" 3 => "J.A. Feller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjsm.2010.076364" "Revista" => array:6 [ "tituloSerie" => "Br J Sports Med" "fecha" => "2011" "volumen" => "45" "paginaInicial" => "596" "paginaFinal" => "606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21398310" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0135" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.E. Oiestad" 1 => "I. Holm" 2 => "A.K. Aune" 3 => "R. Gunderson" 4 => "G. Myklebust" 5 => "L. Engebretsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0363546510373876" "Revista" => array:6 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2010" "volumen" => "38" "paginaInicial" => "2201" "paginaFinal" => "2210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20713644" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0140" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anterior cruciate ligament injuries in the female athlete" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.P. Toth" 1 => "F.A. 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Asadi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hum Sport Exerc" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "101" "paginaFinal" => "111" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0155" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of plyometric type neuromuscular training on postural control performance of male team basketball players" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Asadi" 1 => "E. Saez de Villarreal" 2 => "H. Arazi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1519/JSC.0000000000000832" "Revista" => array:6 [ "tituloSerie" => "J Strength Cond Res" "fecha" => "2015" "volumen" => "29" "paginaInicial" => "1870" "paginaFinal" => "1875" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25563677" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0160" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plyometrics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.A. Chu" 1 => "G. Myer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2013" "editorial" => "Human Kinetics" "editorialLocalizacion" => "Champaign, IL" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0165" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of fatigue on postural stability and neuropsychological function" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.H. Crowell" 1 => "K.M. Guskiewicz" 2 => "W.E. Prentice" 3 => "J.A. 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Ejercicios neuromusculares de tipo pliométrico como tratamiento de déficits de control postural de jugadores de voleibol: a propósito de un caso

Exercícios neuromusculares do tipo pliométrico como tratamento de déficits no controle postural de jogadores de voleibol: um estudo de caso

A. Asadi

Roudbar Branch, Islamic Azad University, Roudbar, Iran

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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Plyometric effect &#40;&#37;&#41; and effect size in reaching directions for the volleyball players&#46; A&#59; anterior&#44; AM&#59; anteromedial&#44; AL&#59; anterolateral&#44; M&#59; medial&#44; L&#59; lateral&#44; P&#59; posterior&#44; PM&#59; posteromedial&#44; PL&#59; posterolateral&#46; &#42;Significant differences compared with AM direction &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; &#8224;Significant differences compared with PM direction &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Knee ligament injuries occur several times during training and competition in volleyball players&#46; Among some ligaments in the knee&#44; anterior cruciate ligament &#40;ACL&#41; plays a critical role to stability of the joint&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1&#44;2</span></a> ACL injuries account for 50&#37; or more of all knee injuries&#44; making this ligament especially important in any discussion of knee injuries&#46; Most ACL injuries in volleyball players occur when a player lands awkwardly after jumping&#46; Usually ACL tears are associated with a &#8220;pop&#8221; and immediate knee swelling&#46; Previous authors reported that annual incidence of ACL injury is about 38000 cases in the United States&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One possible explanation to increase ACL injury could be deficits in postural control&#46; It has been well documented that poor postural control is associated with injury of the joint and therefore enhancing joint awareness and postural control could be a modality to decrease injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The common method of training for power-type athletes &#40;i&#46;e&#46;&#44; volleyball players&#41; is plyometric training&#46; It has been reported that plyometric training is an effective training modality for improving joint awareness&#44; balance and neuromuscular properties that used by strength and conditioning professional at pre- and in season of training schedule for athletes&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5&#44;6</span></a> Plyometric training is a form of training techniques which used by athletes in all types of sports to increase performance adaptations&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Plyometrics consists of a rapid stretching of a muscle &#40;eccentric action&#41; immediately followed by a concentric or shortening action of the same muscle&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> The stored elastic energy within the muscle is used to produce more force than can be provided by a concentric action alone&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although&#44; with review in literature&#44; plyometric training could be an effective training method for enhancing balance and postural control in athletes&#44;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5&#44;6</span></a> the acute effects of plyometric training on postural control are poorly understood&#46; Deficits in postural control after several fatigue protocols &#40;i&#46;e&#46;&#44; running and resistance exercise&#41; has been supported by previous authors&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#8211;14</span></a> but the influence of plyometric exercise on balance performance is not clear&#46; To the authors&#8217; knowledge&#44; only Twist et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> examined the influence of 200 countermovement jump plyometric exercise on unilateral balance performance by using the Biodex Stabiliometer and found deficits at 24<span class="elsevierStyleHsp" style=""></span>h post exercise&#46; Since&#44; plyometric training can be used in some sport teams &#40;i&#46;e&#46;&#44; volleyball&#41; and those athletes perform plyometric training for increasing muscle explosiveness&#44; determining the acute effects of plyometric exercise on balance and postural control is vital&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Compared with previous study that used Biodex Stabiliometer to analyze balance changes after plyometric exercise&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> Gribble et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> reported that Star Excursion Balance Test &#40;SEBT&#41; should be considered a highly representative&#44; noninstrumented dynamic balance test for physically active individual&#46; The SEBT has been shown to be a reliable measure and has validity as a dynamic balance test to predict risk of lower extremity injury&#44; to identify dynamic balance deficits in patients with a variety of lower extremity conditions&#44; and to be responsive to training programmes in both healthy people and people with injuries to the lower extremity and this note have been confirmed by clinicians and researchers that employed the SEBT for the lower extremity functional test&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">With regard to importance of plyometric training on athletes training schedule and highly representative of SEBT to determine the deficits in postural control&#44; no study has focused on the analysis of a specific plyometric exercise programme on postural control performance in volleyball players&#46; Therefore&#44; the aim of this study was to examine the effects of plyometric type neuromuscular exercise on postural control &#40;SEBT&#41; in volleyball players&#46; It was hypothesized that a session of plyometric exercise would impair postural control performance and would induce reduction of joint awareness in volleyball players&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">Ten national level young male volleyball players &#40;age 19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5 years&#44; height 181&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;7<span class="elsevierStyleHsp" style=""></span>cm&#44; weight 69&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;8<span class="elsevierStyleHsp" style=""></span>kg and training age 4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7 years&#41; volunteered for the study&#46; Athletes were free from lower extremity injury for at least 6 months prior to testing&#44; have no history of hip&#44; knee or ankle surgery and participated in a minimum of 2<span class="elsevierStyleHsp" style=""></span>h volleyball training four times a week&#46; All athletes signed an informed consent form and the study was approved by the University Research and Ethics Committee&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Design</span><p id="par0040" class="elsevierStylePara elsevierViewall">Athletes reported to the laboratory at 4&#58;00 PM&#46; On entering the laboratory&#44; height &#40;cm&#41;&#44; body mass &#40;kg&#41;&#44; and training age &#40;year&#41; were measured in each subject&#46; Body mass was obtained to the nearest 0&#46;1<span class="elsevierStyleHsp" style=""></span>kg using an electronic scale &#40;Tanita&#44; BC-418MA&#44; Tokyo&#44; Japan&#41;&#46; Height was measured to the nearest 0&#46;1<span class="elsevierStyleHsp" style=""></span>cm using a stadiometer &#40;Seca 222&#44; Terre Haute&#44; IN&#41;&#46; The athletes were familiarized with the testing and plyometric exercise protocols in this session&#46; Each player was instructed and verbally encouraged to give a maximal effort during all plyometric exercises and testing&#46; A standardized warm-up&#44; consisting of jogging&#44; dynamic stretching&#44; and then a series of increasing intensity sprints&#44; was performed before initiation of study&#46; Before and after plyometric treatment&#44; each volleyball player performed SEBT to determine postural control changes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Postural control assessment</span><p id="par0045" class="elsevierStylePara elsevierViewall">In this study the Star Excursion Balance Test &#40;SEBT&#41; was used for the postural control assessment because Gribble et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> reported highly representative&#44; noninstrumented dynamic balance test to assess postural control&#46; The SEBT was performed as described by Robinson and Gribble&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> Participants stood in the middle of a grid laid on the floor with 8 lines extending at 45&#176; angles from the centre of the grid&#44; each of which is labelled according to the direction of excursion in relation to the standing leg&#58; anterior &#40;A&#41;&#44; anteromedial &#40;AM&#41;&#44; medial &#40;M&#41;&#44; posteromedial &#40;PM&#41;&#44; posterior &#40;P&#41;&#44; posterolateral &#40;PL&#41;&#44; and lateral &#40;L&#41; anterolateral &#40;AL&#41;&#46; Participants undertook the testing barefoot&#44; with foot position controlled by aligning the heel with the centre of the grid and great toe with the anteriorly projected line&#46; Participants were asked to maintain a single-leg stance on the test leg whilst reaching the opposite leg to touch as far as possible along the chosen line with the most distal part of their foot&#46; The foot was only allowed to touch lightly so as not to aid balance&#46; The athlete then returned to bilateral stance&#46; The point at which the subject touched was marked by the examiner and measured manually using a measuring tape&#46; The same investigator measured all participants&#44; and marks were erased after each trial&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">For a trial to be successful the participants hands had to remain on their hips&#44; the reach leg could not provide support upon touching down&#44; the heel of the stance leg had to remain in its position in the centre of the grid and not lift from the ground and balance had to be maintained&#46; Each athlete performed six trials in each direction for familiarization of testing and then performed three reaching trials with one leg before switching to the other leg with 30<span class="elsevierStyleHsp" style=""></span>s recovery allowed between them&#46; The best score in between three trials was chosen for further analysis&#46; This approach allowed for the effect of repeated trials to be examined to determine whether a learning effect was present and decreases the fatigue induced by direction trials&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Normalizing SEBT data</span><p id="par0055" class="elsevierStylePara elsevierViewall">Athlete&#39;s legs were measured from the anterior superior iliac spine to the distal tip of the medial malleolus using a standard tape measure while participants lay supine&#46; Leg length was used to normalize excursion distances by dividing the distance reached by leg length then multiplying by 100&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Treatment</span><p id="par0060" class="elsevierStylePara elsevierViewall">Volleyball players performed squat jump&#44; broad jump&#44; tuck jump with knee to chest&#44; and depth jump from 45-cm box high four sets with ten repetitions&#44; respectively&#46; There were 60 and 90<span class="elsevierStyleHsp" style=""></span>s rest between sets and exercises&#44; respectively&#46; This type and repetition of plyometric intervention is common in volleyball players&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> The athletes were instructed to perform each jump with maximal effort and minimal contract on land&#46; All exercises were supervised by strength and conditioning specialist and author&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Descriptive statistics &#91;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#93; for the SEBT values were calculated&#46; To determine the effect of plyometric intervention on postural control changes a two times &#40;pre and post&#41; for eight directions &#40;A&#44; AM&#44; M&#44; PM&#44; P&#44; PL&#44; L&#44; AL&#41;&#44; ANOVA was applied&#46; When a significant <span class="elsevierStyleItalic">F</span> value was achieved&#44; Tukey post hoc procedures were performed to locate the pairwise differences between the means&#46; The effect sizes &#40;ESs&#41; were calculated using Cohen&#39;s <span class="elsevierStyleItalic">d</span>&#46; The level of significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">The results of this study indicated that a session of plyomeric exercise induced significant decrease in reaching direction for the M &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#59; however changes in other reaching directions were no statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; With comparing the &#37; of changes in between directions&#44; there were significant differences between them&#46; The greater changes were observed in the M&#44; P and AL directions and these differences were maintained compared with AM and PM&#44; respectively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows differences in &#37; of change and ES in between reaching directions&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The aim of this study was to examine the influence of a session of plyometric type neuromuscular exercise on postural control changes which assessed by SEBT&#46; The results indicated that plyometric intervention induced deficits in balance&#46; The impairments in postural control were greater in M&#44; P and AL directions in volleyball players&#46; In accordance with these findings&#44; some studies reported impairments of postural control after different exercises&#46; For example&#44; Crowell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> investigated postural stability after exercise protocol including squat jumps&#44; sprints&#44; and treadmill running in male and female club-sport athletes&#46; Differences between baseline and post exercise balance were observed&#44; leading to the conclusion that any decrease in performance on the postural control might be attributed to the fatigue that had occurred in the lower extremity&#46; Similarly&#44; Wilkins et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> examined the effects of a 20<span class="elsevierStyleHsp" style=""></span>min exercise&#44; including a 5<span class="elsevierStyleHsp" style=""></span>min moderate jog&#44; 3<span class="elsevierStyleHsp" style=""></span>min of sprints&#44; 2<span class="elsevierStyleHsp" style=""></span>min of push-ups&#44; 2<span class="elsevierStyleHsp" style=""></span>min of sit-ups&#44; 3<span class="elsevierStyleHsp" style=""></span>min of step-ups&#44; 3<span class="elsevierStyleHsp" style=""></span>min of sprints&#44; and a 2-min run on balance performance in NCAA Division I collegiate athletes&#46; Total errors increased from pretest to posttest in the exercise group&#46; It appears that a contribution of both central &#40;i&#46;e&#46;&#44; changes in force perception by the brain&#41; and peripheral mechanisms &#40;i&#46;e&#46;&#44; disruption to extrafusal and intramuscular fibres&#41; might play a role in exacerbating balance performance&#46; Several studies have alluded to the possibility that muscle spindles and Golgi tendon organs become desensitized as a result of fatiguing<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> or eccentric exercise&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20&#44;21</span></a> Therefore&#44; given the significance of these intramuscular receptors in controlling joint movement and position&#44; it is plausible that the plyometric exercise could have potentially led to changes in afferent receptor activity&#44; which resulted in reduction of balance performance&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">It seems that the main reason for decreasing balance performance becomes plyometric-induced muscle fatigue&#46; Due to the fact the muscular fatigue decreases the neural transmission velocity&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> maybe the ability in creating efficient compensatory contractions around the joint is reduced&#44; resulting in a loss of the neuromuscular control and decreases in reaching directions&#46; But no physiological and neural assessments were made and this is only a speculative statement&#46; In the literature&#44; the negative effects of fatigue protocols &#40;i&#46;e&#46;&#44; cycle ergometer&#44; aerobic and anaerobic exercise&#41; on postural control deficits have been supported&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#44;9</span></a> Indeed&#44; several studies have demonstrated that muscle fatigue can impair joint proprioception&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">10&#8211;13</span></a> It has been suggested that impaired proprioception can delay stabilizing muscle activation&#44; leading to decrements in postural control&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In this study&#44; muscle fatigue could not be separated because of the plyometric exercises involved hip&#44; knee and ankle muscles and the effects of each muscle groups on balance performance could not determine&#46; However&#44; there were available data about the local muscle fatigue and postural control deficits&#46; Gribble and Hertel<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> reported that fatigue at the knee caused greater postural sway than fatigue at the ankle during unipedal stance&#46; Bellew and Fenter<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> examined the effects of muscle fatigue at the ankle and knee on balance using three different clinical tests&#46; Their results indicated that postural control&#44; as measured using the lower-extremity reach test&#44; decreased significantly only after knee fatigue&#44; while postural control measured with the single-limb stance time test was significantly reduced only after ankle fatigue&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the present study&#44; it seems that knee fatigue occurred because the most jump and plyometrics which used in this protocol involved knee extensor muscles&#46; The results have shown a deterioration in the reflection sensitivity after the fatigue&#44; and they suggest that the modulation of the neural input to the muscle has at least partial reflective origin in the contracted muscles&#44; and the decreasing muscular rigidity that followed the decreasing reflection sensitivity&#44; and such lower rigidity may induce deficits in joint awareness and consequently decreases in reaching directions and postural control deficits&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> According to the results found in the present paper&#44; the neuromuscular control is partially compromised with the fatigue onset&#44; and this can be a predisposing factor to future injuries and it is better that strength and conditioning in the field of volleyball did not perform other type of landing exercise in plyometric training session and separate plyometric training with regular volleyball training to reduce probability of lower extremity injuries&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">From a practical point of view&#44; it must be considered that a session of plyometric exercise tends to decrease balance and postural control performance of volleyball players&#46; The reduction in neuromuscular control &#40;i&#46;e&#46;&#44; SEBT&#41; was possibly attributed to a complex interaction of central and peripheral mechanisms&#44; although this study was unable to distinguish the precise contribution of each and further studies are necessary for this subject&#46; Overall&#44; the findings have implications for coaches and athletes who should be conscious of the use of skill-based activities and for increased injury risk following plyometric training&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Methods"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Participants"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Design"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Postural control assessment"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Normalizing SEBT data"
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            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Treatment"
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              "identificador" => "sec0040"
              "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-10-20"
    "fechaAceptado" => "2016-02-18"
    "PalabrasClave" => array:3 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec643446"
          "palabras" => array:3 [
            0 => "Postural control"
            1 => "Stretch shortening cycle"
            2 => "SEBT"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec643445"
          "palabras" => array:3 [
            0 => "Control postural"
            1 => "Ciclo estiramiento-acortamiento"
            2 => "SEBT"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec643447"
          "palabras" => array:3 [
            0 => "Controle postural"
            1 => "Ciclo alongamento encurtamento"
            2 => "SEBT"
          ]
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      ]
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    "tieneResumen" => true
    "resumen" => array:3 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The effects of exercise protocols on postural control changes have been supported&#44; but the influence of a common and specific type neuromuscular exercise such as plyometric on postural control is not clear&#46; Therefore&#44; the aim of this study was to examine the effects of plyometric type neuromuscular exercise on balance or postural control performance of young male volleyball players&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ten professional young male volleyball players participated in this study and performed plyomeric exercises including 4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10 squat jump&#44; broad jump&#44; tuck jump with knee to chest&#44; and depth jump from 45-cm box high 60 and 90<span class="elsevierStyleHsp" style=""></span>s rest between sets and exercises&#44; respectively&#46; Before and immediately after completing the plyometric exercise&#44; postural control was assessed by the Star Excursion Balance Test &#40;SEBT&#41; at 8 directions &#40;anterior&#44; A&#59; anteromedial&#44; AM&#59; anterolateral&#44; AL&#59; medial&#44; M&#59; lateral&#44; L&#59; posterior&#44; P&#59; posteromedial&#44; PM&#59; and posterolateral&#44; PL&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The results indicated that plyometric exercise induced deficits in reach directions and greater changes occurred in the M&#44; P and AL directions&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">It can be recommend that strength and conditioning professionals in the field of volleyball do not perform other type of landing exercise in plyometric training sessions because of postural control impaired and consequently the probability of lower extremity injuries will increase&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El efecto de protocolos de ejercicios&#44; en cambios del control postural&#44; son bien conocidos&#44; pero la influencia de un sencillo y espec&#237;fico tipo de ejercicio neuromuscular&#44; como los ejercicios pliom&#233;tricos&#44; en el control postural&#44; no est&#225; clara&#46; Por tanto&#44; el objetivo de este estudio fue examinar los efectos de los ejercicios neuromusculares&#44; de tipo pliom&#233;trico&#44; en el equilibrio o en el control postural&#44; de varones j&#243;venes jugadores de voleibol&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Diez varones j&#243;venes jugadores profesionales de voleibol participaron en este estudio y realizaron ejercicios pliom&#233;tricos incluyendo 4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10 saltos con sentadilla&#44; saltos de longitud&#44; saltos con rodillas al pecho y saltos con rebote desde un caj&#243;n de 45<span class="elsevierStyleHsp" style=""></span>cm de altura&#44; con 60 y 90<span class="elsevierStyleHsp" style=""></span>s de reposo entre series y ejercicios&#44; respectivamente&#46; Antes e inmediatamente despu&#233;s de completar los ejercicios pliom&#233;tricos se midi&#243; el control postural mediante el <span class="elsevierStyleItalic">Star Excursion Balance Test</span> &#40;SEBT&#41; en 8 direcciones &#40;anterior&#58; A&#59; anteromedial&#58; AM&#59; anterolateral&#58; AL&#59; medial&#58; M&#59; lateral&#58; L&#59; posterior&#58; P&#59; posteromedial&#58; PM y posterolateral&#58; PL&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los resultados indican que los ejercicios pliom&#233;tricos indujeron d&#233;ficits en las direcciones analizadas y que los mayores cambios se produjeron en las direcciones M&#44; P y AL&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se puede recomendar&#44; a los profesionales del voleibol&#44; en el campo del entrenamiento de la fuerza&#44; que no realicen otros tipos de ejercicios de suelo en las sesiones de entrenamiento pliom&#233;trico&#44; porque la disminuci&#243;n del control postural podr&#237;a incrementar secundariamente la probabilidad de lesi&#243;n del miembro inferior&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">O efeito de protocolos de exerc&#237;cios sobre as mudan&#231;as no controle postural &#233;bem conhecido&#44; mas a influ&#234;ncia de um tipo de treinamento neuromuscular comum e espec&#237;fico como o pliom&#233;trico no controle postural n&#227;o est&#225; claro&#46; O objetivo deste estudo foi examinar os efeitos dos exerc&#237;cios neuromusculares do tipo pliom&#233;trico no equil&#237;brio e controle postural de jovens jogadores de voleibol masculino&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">M&#233;todos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dez jovens&#44; jogadores profissionais de voleibol&#44; participaram desse estudo e realizaram exerc&#237;cios pliom&#233;tricos que inclu&#237;ram&#58; 4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10 saltos partindo da posi&#231;&#227;o de agachamento&#44; saltos longitudinais&#44; saltos com joelho encostando no peito e salto com rebote sob uma caixa de 40<span class="elsevierStyleHsp" style=""></span>cm de altura&#44; com descanso entre 60-90 segundos entre as s&#233;ries e exerc&#237;cios&#44; respectivamente&#46; Antes e imediatamente ap&#243;s completarem o exerc&#237;cio de pliometria&#44; o controle postural foi medido com as 8 dire&#231;&#245;es do Star Excursion Test &#40;SEBT&#41; &#40;anterior&#58; A&#59; antero-medial&#59; AM&#59; antero-lateral&#58; AL&#59; medial&#58; M&#59; lateral&#58; L&#59; posterior&#58; P&#59; p&#243;stero-medial&#58; PM e postero-lateral&#58; PL&#41;&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Os resultados indicam que os exerc&#237;cios pliom&#233;tricos induziram d&#233;ficits no alcance das dire&#231;&#245;es do SEBT e as maiores mudan&#231;as ocorrem nas dire&#231;&#245;es M&#44; P e AL&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclus&#227;o</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pode ser recomendado que os profissionais que trabalham com for&#231;a e condicionamento f&#237;sico voltado ao voleibol n&#227;o realizem outro tipo de exerc&#237;cio com carga nas sess&#245;es de pliometria&#44; por causa da debilidade no controle postural que o treinamento pliom&#233;trico ocasiona e consequentemente na probabilidade de aumentar o risco de les&#245;es nos membros inferiores&#46;</p></span>"
        "secciones" => array:4 [
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Plyometric effect &#40;&#37;&#41; and effect size in reaching directions for the volleyball players&#46; A&#59; anterior&#44; AM&#59; anteromedial&#44; AL&#59; anterolateral&#44; M&#59; medial&#44; L&#59; lateral&#44; P&#59; posterior&#44; PM&#59; posteromedial&#44; PL&#59; posterolateral&#46; &#42;Significant differences compared with AM direction &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; &#8224;Significant differences compared with PM direction &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
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Article information

ISSN: 18887546
Original language: English

DOI:10.1016/j.ramd.2016.02.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	3	0	3
2024 October	36	1	37
2024 September	28	8	36
2024 August	41	14	55
2024 July	19	1	20
2024 June	24	5	29
2024 May	13	4	17
2024 April	25	11	36
2024 March	34	2	36
2024 February	27	5	32
2024 January	43	10	53
2023 December	30	6	36
2023 November	38	11	49
2023 October	26	4	30
2023 September	23	1	24
2023 August	28	4	32
2023 July	16	10	26
2023 June	31	0	31
2023 May	50	10	60
2023 April	77	7	84
2023 March	47	11	58
2023 February	39	3	42
2023 January	35	10	45
2022 December	30	10	40
2022 November	45	23	68
2022 October	34	18	52
2022 September	31	44	75
2022 August	35	30	65
2022 July	30	11	41
2022 June	34	8	42
2022 May	48	13	61
2022 April	69	15	84
2022 March	104	19	123
2022 February	98	4	102
2022 January	74	10	84
2021 December	54	14	68
2021 November	60	12	72
2021 October	38	11	49
2021 September	35	14	49
2021 August	51	8	59
2021 July	33	4	37
2021 June	43	9	52
2021 May	30	11	41
2021 April	52	12	64
2021 March	76	50	126
2021 February	31	12	43
2021 January	30	15	45
2020 December	21	12	33
2020 November	21	8	29
2020 October	21	8	29
2020 September	17	11	28
2020 August	20	14	34
2020 July	17	9	26
2020 June	39	26	65
2020 May	35	36	71
2020 April	25	42	67
2020 March	23	16	39
2020 February	23	6	29
2020 January	24	8	32
2019 December	29	10	39
2019 November	30	20	50
2019 October	20	1	21
2019 September	16	16	32
2019 August	18	1	19
2019 July	18	6	24
2019 June	37	18	55
2019 May	101	34	135
2019 April	55	15	70
2019 March	14	13	27
2019 February	11	8	19
2019 January	8	9	17
2018 December	15	5	20
2018 November	14	2	16
2018 October	15	7	22
2018 September	32	10	42
2018 August	5	8	13
2018 July	3	3	6
2018 June	9	10	19
2018 May	12	12	24
2018 April	18	7	25
2018 March	10	3	13
2018 February	6	4	10
2018 January	10	0	10
2017 December	9	2	11
2017 November	12	5	17
2017 October	8	14	22
2017 September	10	9	19
2017 August	9	3	12
2017 July	15	12	27
2017 June	30	23	53
2017 May	31	20	51
2017 April	24	4	28
2017 March	19	47	66
2017 February	33	8	41
2017 January	24	8	32
2016 December	33	10	43
2016 November	37	6	43
2016 October	43	13	56
2016 September	50	16	66
2016 August	34	13	47
2016 July	133	12	145
2016 June	385	41	426
2016 May	421	1	422
2016 April	72	1	73

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