Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

Introduction: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1) to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2) to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength. .

Muscular performance characterization in athletes: a new perspective on isokinetic variables

Background: Isokinetic dynamometry allows the measurement of several variables related to muscular performance, many of which are seldom used, while others are redundantly applied to the characterization of muscle function. Objectives: The present study aimed to establish the particular features of muscle function that are captured by the variables currently included in isokinetic assessment and to determine which variables best represent these features in order to achieve a more objective interpretation of muscular performance. Method: This study included 235 male athletes. They performed isokinetic tests of concentric knee flexion and extension of the dominant leg at a velocity of 60º/s. An exploratory factor analysis was performed. Results: The findings demonstrated that isokinetic variables can characterize more than muscle torque production and pointed to the presence of 5 factors that enabled the characterization of muscular performance according to 5 different domains or constructs. Conclusions: The constructs can be described by torque generation capacity; variation of the torque generation capacity along repetitions; movement deceleration capacity; mechanical/physiological factors of torque generation; and acceleration capacity (torque development). Fewer than eight out of sixteen variables are enough to characterize these five constructs. Our results suggest that these variables and these 5 domains may lead to a more systematic and optimized interpretation of isokinetic assessments. .

Validity and reliability of clinical tests for assessing passive ankle stiffness / Validade e confiabilidade de medidas clínicas para avaliação da rigidez passiva da articulação do tornozelo

BACKGROUND: The presence of inadequate levels of passive ankle stiffness have been associated with the occurrence of movement disorders, the development of pathological conditions and the reduction in the performance of functional activities such as walking, running and jumping. Therefore, clinical tests to evaluate ankle stiffness may be useful for the physical therapy assessment. OBJECTIVES: To investigate the concurrent validity and the intra- and inter-examiner reliability of clinical measures developed to assess passive stiffness of the ankle joint during dorsiflexion movement. METHODS: Fifteen healthy participants underwent to test-retest evaluations of their ankles by two examiners. Two clinical measures were performed: 'position of first detectable resistance' and 'change in passive resistance torque'. The results of these tests were compared to the passive stiffness measured with an isokinetic dynamometer, in which the electromyography activity of specific muscles was monitored to ensure that the test was performed passively (gold standard measure). RESULTS: Pearson correlation coefficients ranged from r=-0.81 to -0.88 (p<0.001) for the correlation between the passive ankle stiffness measured with the isokinetic dynamometer and the results of the clinical measure 'position of the first detectable resistance'. For the measure of 'change in passive resistance torque', these coefficients ranged from r=0.72 to 0.83 (p<0.004). The Intraclass Correlation Coefficients (ICCs) for the intra- and inter-examiner reliability ranged from 0.75 to 0.98. CONCLUSION: The clinical measures presented satisfactory validity and reliability to be used in clinical practice.

CONTEXTUALIZAÇÃO: Níveis inadequados de rigidez passiva do tornozelo têm sido associados à ocorrência de disfunções de movimento, ao desenvolvimento de patologias e à redução no desempenho em atividades como marcha, corrida e salto. Testes clínicos para investigar a rigidez dessa articulação podem ser úteis no processo de avaliação fisioterápica. OBJETIVOS: Investigar a validade concorrente e as confiabilidades intra e interexaminadores de medidas clínicas para avaliação da rigidez passiva do tornozelo durante o movimento de dorsiflexão. MÉTODOS: Quinze voluntários saudáveis foram submetidos a avaliações teste-reteste do tornozelo por dois examinadores. Duas medidas clínicas foram realizadas: "posição de primeira resistência detectável" e "mudança do torque passivo de resistência". Os resultados desses testes foram comparados à medida da rigidez passiva realizada com um dinamômetro isocinético, no qual a atividade eletromiográfica dos músculos foi monitorada para garantir que o teste fosse realizado passivamente (medida padrão-ouro). RESULTADOS:Os Coeficientes de Pearson variaram de r=-0,81 a -0,88 (p<0,001) para a correlação entre a medida da rigidez com o dinamômetro isocinético e os resultados da medida "posição de primeira resistência detectável". Para a medida "mudança do torque passivo de resistência", esses coeficientes variaram de r=0,72 a 0,83 (p<0,004). Os Coeficientes de Correlação Intraclasse (CCIs) obtidos para as confiabilidades intra e interexaminadores variaram de 0,75 a 0,98. CONCLUSÃO: Os testes propostos apresentaram validade e confiabilidades satisfatórias para serem utilizados na prática clínica.

Caracterização da performance muscular em atletas profissionais de futebol / Characterization of professional soccer players' muscle performance

INTRODUÇÃO E OBJETIVOS: Estudos que relacionam parâmetros de performance muscular com risco de lesão e desempenho em diferentes esportes têm sido freqüentemente reportados na literatura. Entretanto, há carência de dados que caracterizem a performance muscular em atletas profissionais do futebol brasileiro. Portanto, o objetivo deste estudo foi realizar uma análise descritiva dos parâmetros relacionados à performance muscular dessa população. MÉTODOS: A amostra consistiu de 117 atletas pertencentes a clubes de elite do futebol mineiro. Para avaliação da performance muscular foi utilizado um dinamômetro isocinético e os testes consistiram de contrações concêntricas máximas das musculaturas avaliadas. No quadril, as musculaturas adutora e abdutora foram avaliadas nas velocidades 30º/s, 60º/s e 120º/s. No joelho, foram avaliados os músculos flexores e extensores a 60º/s, 180º/s e 300º/s. No tornozelo, os músculos dorsoflexores, flexores plantares, inversores e eversores foram avaliados nas velocidades 30º/s, 60º/s e 180º/s. Para análise dos dados foram utilizados estatística descritiva e testes t pareados para avaliar diferenças entre pernas. RESULTADOS: Os resultados deste estudo caracterizam o perfil de atletas profissionais do futebol relativo à capacidade de produção de torque, trabalho máximo e potência média. Além disso, foram observadas diferenças significativas entre pernas em algumas variáveis. CONCLUSÃO: Os dados normativos estabelecidos podem ser utilizados como valores de referência na prevenção, treinamento e reabilitação dos atletas, além de servirem de referência para futuros estudos que tenham como objetivo relacionar os parâmetros de performance muscular à incidência de lesões no futebol.

INTRODUCTION AND OBJECTIVE: The association of muscular performance with risk of injury and functional performance in different sports has been reported in numerous studies in the literature. However, there is a paucity of data that characterizes the muscular performance in Brazilian professional soccer athletes. Therefore, the objective of this study was to make a descriptive analysis of parameters related to the muscular performance of this population. METHODS: The sample of this study was composed of 117 athletes belonging to professional soccer clubs in Minas Gerais State. In order to evaluate the muscular performance of the athletes, an isokinetic dynamometer was used and the tests involved maximum voluntary contractions of the selected muscles. Hip abductors and adductors were assessed at the speeds of 30º/s, 60º/s and 120º/s; knee flexors and extensors at 60º/s, 180º/s and 300º/s; and ankle dorsiflexors, plantarflexors, invertors and evertors at 30º/s, 60º/s and 180º/s. Descriptive statistics were used to present the normative data and paired t-tests were used to identify significant differences between legs considering the parameters evaluated in this study. RESULTS: This study generated normative data to characterize the profile of Brazilian professional soccer players relative to their capacity of producing torque, muscle work and power. Significant differences were observed between legs considering some of the study's variables. CONCLUSION: The established normative data can be used as reference values in the prevention, training and rehabilitation of the athletes. In addition, these data may be used as reference for future studies with the objective of testing the association between muscular performance and incidence of injury in soccer practice.