Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function / Ângulo-q na dor patelofemoral: relação com valgo dinâmico de joelho, torque abdutor do quadril, dor e função

OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19), functional capacity (r = -0.08; p = 0.72), FPPA (r = -0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35). CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.

OBJETIVO: Investigar a relação entre o ângulo-q e intensidade da dor anterior no joelho, capacidade funcional, valgo dinâmico de joelho e torque abdutor do quadril em mulheres com síndrome da dor patelofemoral (SDPF). MÉTODOS: Participaram do estudo 22 mulheres com SDPF. O ângulo-q foi avaliado pela goniometria, as participantes foram posicionadas em decúbito dorsal com joelho e quadril estendido e quadril e pé em rotação neutra. A intensidade da dor anterior do joelho foi avaliada pela escala visual analógica de dor e a capacidade funcional com a escala de dor anterior no joelho. O valgo dinâmico foi avaliado pelo ângulo de projeção no plano frontal do joelho (APPF), registrado com câmera digital durante step down, e o pico de torque dos abdutores do quadril com dinamômetro manual. RESULTADOS: O ângulo-q não apresentou correlação significativa com a intensidade da dor no joelho (r = -0,29; p = 0,19), capacidade funcional (r = -0,08; p = 0,72), ângulo de projeção no plano frontal do joelho (r = -0,28; p = 0,19) e pico de torque isométrico dos músculos abdutores (r = -0,21; p = 0,35). CONCLUSÃO: O ângulo-q não apresentou relação com a intensidade da dor, capacidade funcional, ângulo de projeção no plano frontal do joelho e pico de torque dos abdutores do quadril em pacientes com SDPF.

Estabilização segmentar lombar e TENS na hérnia discal lombar: um ensaio clínico randomizado / Lumbar segmental stabilization and TENS in lumbar disc herniation: a randomized controlled trial

INTRODUÇÃO: A hérnia de disco lombar (HDL) acomete cerca de 5% dos pacientes com de dor lombar e o tratamento cirúrgico nestes casos é cada vez menos indicado, optando-se, na maior parte dos casos, pelo conservador. Embora o método estabilização lombar (EL) e a estimulação elétrica nervosa transcutânea (TENS) tenham mostrado bons resultados em indivíduos portadores de dor lombar inespecífica, há escassa literatura que tenha verificado a eficácia destes tratamentos isoladamente em sujeitos acometidos por hérnia de disco lombar. OBJETIVO: Comparar a eficácia dos exercícios de estabilização lombar e da TENS na dor, incapacidade funcional, e capacidade de ativação do músculo transverso do abdome (TrA) de indivíduos com hérnia de disco lombar. METODOLOGIA: Participaram da pesquisa 40 indivíduos com idade variando de 25 a 58 anos com dor lombar e hérnia de disco, e foram randomizados em dois grupos: Grupo estabilização lombar (EL) (exercícios específicos para os músculos TrA e multífido lombar(ML)) (n=20) e Grupo TENS (GT) (n=20) que receberam atendimento com corrente de estimulação elétrica nervosa transcutânea. Foram avaliados quanto à dor (Escala Visual Analógica e Questionário McGill de Dor), incapacidade funcional (Índice de Incapacidade de Oswestry), e capacidade de recrutamento do TrA (Unidade de Biofeedback Pressórico-UBP). Os grupos foram tratados em duas sessões semanais com duração de 60 minutos por oito semanas. Cada indivíduo foi avaliado antes e após o tratamento. O nível de significância estabelecido foi de alfa=0,05. RESULTADOS: Após oito semanas, o grupo estabilização lombar mostrou melhora significativa na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). O grupo TENS apresentou diferença estatisticamente significante apenas na dor (p < 0,012). A estabilização foi superior à TENS na melhora na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). CONCLUSÃO:...

INTRODUCTION: Lumbar disc herniation (LDH) affects about 5% of low back pain (LBP) patients. Surgical treatment in these cases is increasingly less suitable, opting, in most cases, for the conservative. Although lumbar stabilization method and transcutaneous electric nerve stimulation (TENS) have shown good results in patients with nonspecific low back pain, there is scarce literature that has verified the effectiveness of these treatments alone in subjects suffering from lumbar disc herniation.OBJECTIVE: To compare the effectiveness of lumbar stabilization exercises and transcutaneous electrical nerve stimulation (TENS), on pain, functional disability and activation of the transversus abdominis muscle (TrA), in individuals with lumbar disc herniation (LDH). METHODS: This study involved 40 patients (age range 25-58 years) with lumbar disc herniation randomized into two groups: Stabilization group (SG: n=20); which received of stabilization exercises (transversus abdominis and lumbar multifidus muscles) and TENS group (TG: n=20), which received electrotherapy. The following instruments were used: visual analogue pain scale and McGill Pain Questionnaire for pain, Oswestry Disability Index for functional disability, and pressure biofeedback unit (PBU) for ability to contract the TrA. Analyses within and between groups were performed after treatment. Groups underwent 16 sessions, for 60 minutes, twice a week and they were evaluated before and after eight weeks. Significance level was set at alfa= 0.05. RESULTS: After eight weeks, lumbar stabilization group showed significant improvements in pain (p < 0.001), functional disability (p < 0.001), and the ability to contract the TrA (p < 0.001). There were no significant differences in TENS group in terms of disability (p < 0.264) or ability to contract the TrA muscle (p < 0.181), however, improvement in pain was demonstrated (p < 0.012). The stabilization was superior to TENS in terms of improvements in pain...

Postural control among elderly women with and without osteoporosis: is there a difference? / Controle postural de idosas com e sem osteoporose: há diferenças?

CONTEXT AND OBJECTIVE: Little is known about postural control among elderly individuals with osteoporosis and its relationship with falls. It has been suggested that elderly women with kyphosis and osteoporosis are at greater risk of falling. The aim of this study was to evaluate posture and postural control among elderly women with and without osteoporosis. DESIGN AND SETTING: Cross-sectional study conducted at the Physical Therapy and Electromyography Laboratory, School of Medicine, Universidade de São Paulo (USP). METHODS: Sixty-six elderly women were selected from the bone metabolism disorders clinic, Division of Rheumatology, USP, and were divided into two groups: osteoporosis and controls, according to their bone mineral density (BMD). Postural control was assessed using the Limits of Stability (LOS) test and the Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) and posture, using photometry. RESULTS: The elderly women with osteoporosis swayed at higher velocity on a stable surface with opened eyes (0.30 versus 0.20 degrees/second; P = 0.038). In both groups, the center of pressure (COP) was at 30 percent in the LOS, but with different placements: 156° in the osteoporosis group and 178° in the controls (P = 0.045). Osteoporosis patients fell more than controls did (1.0 versus 0.0; P = 0.036). CONCLUSIONS: The postural control in elderly women with osteoporosis differed from that of the controls, with higher sway velocity and maximum displacement of COP. Despite postural abnormalities such as hyperkyphosis and forward head, the COP position was posteriorized.

CONTEXTO E OBJETIVO: Pouco se sabe sobre o controle postural de idosos com osteoporose e sua relação com as quedas. Foi sugerido que idosas cifóticas com osteoporose têm maior risco de quedas. Esta pesquisa teve como objetivo avaliar o controle postural e a postura em idosas com e sem osteoporose. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no Laboratório de Avaliação Fisioterapêutica e Eletromiografia da Faculdade de Medicina da Universidade de São Paulo (USP). MÉTODOS: Sessenta e seis mulheres idosas foram selecionadas da Clínica de Doenças Osteometabólicas da Divisão de Reumatologia da Universidade de São Paulo e divididas em dois grupos: osteoporose e controle, de acordo com a densidade mineral óssea (DMO). Foi avaliado o controle postural pelos testes Limite de Estabilidade (LOS) e Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) e a postura pela fotometria. RESULTADOS: As idosas com osteoporose oscilaram com maior velocidade em superfície firme com olhos abertos (0,30 x 0,20 graus/segundo, P = 0,038). O COP (centro de pressão) de ambos os grupos encontrava-se a 30 por cento do LOS, porém com posicionamentos distintos: 156° no grupo osteoporose e 178° no grupo controle (P = 0,045). As osteoporóticas caíram com maior frequência em comparação aos controles (1,0 x 0,0, P = 0,036). CONCLUSÃO: O controle postural de idosas com osteoporose diferiu dos controles, com maior velocidade de oscilação e máximo deslocamento do COP, e que apesar da presença de alterações posturais como hipercifose e anteriorização de cabeça, o COP se encontrou posteriorizado.

Estabilização segmentar da coluna lombar nas lombalgias: uma revisão bibliográfica e um programa de exercícios / Spinal segmental stabilization in low-back pain: a literature review and an exercise program

No tratamento de lombalgias, exercicios tradicionais de fortalecimento dos músculos abdominais e extensores do tronco têm sido alvo de críticas por submeter a coluna vertebral a altas cargas de trabalho, aumentando o risco de nova lesão. Estudos recentes comprovam a eficácia da estabilização segmentar como tratamento para a lombalgia...

When treating low-back pain, traditional exercises for strengthening abdomen and erector muscles have been criticised for their submitting spinal structures to high loads, thereby increasing the risk of new injury. Recent studies have pointed to the effectiveness of segmental stabilization in treating low-back pain, less damaging since it is done in neutral position...

Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial

PURPOSE: Compare the effect of conventional static stretching and muscle chain stretching, as proposed by the global posture reeducation method, in the manual therapy of patients with chronic neck pain. METHODS: Thirty-three female patients aged 35 to 60 years old, 31 of whom completed the program, were randomly divided into two groups: The global posture reeducation group (n=15) performed muscle chain stretching, while the conventional stretching group (n=16) performed conventional static muscle stretching. Both groups also underwent manual therapy. Patients were evaluated before and after treatment and at a six-week follow-up appointment and tested for pain intensity (by means of visual analog scale), range of motion (by goniometry), and health-related quality of life (by the SF-36 questionnaire). The treatment program consisted of two 1-hour individual sessions per week for six weeks. Data were statistically analyzed at a significance level of p<0.05. RESULTS: Significant pain relief and range of motion improvement were observed after treatment in both groups, with a slight reduction at follow-up time. Quality of life also improved after treatment, except for the global posture reeducation group in one domain; at follow-up, there was improvement in all domains, except that both groups reported increased pain. There were no significant differences between groups CONCLUSION: Conventional stretching and muscle chain stretching in association with manual therapy were equally effective in reducing pain and improving the range of motion and quality of life of female patients with chronic neck pain, both immediately after treatment and at a six-week follow-up, suggesting that stretching exercises should be prescribed to chronic neck pain patients.