ABSTRACT
A disfunção femoropatelar é descrita como uma condição de dor anterior no joelho, agravada por movimentos que aumentam as forças compressivas na articulação femoropatelar. Acomete principalmente mulheres jovens fisicamente ativas e sabe-se que sua etiologia é multifatorial, e fatores extrínsecos e intrínsecos ao corpo estão envolvidos. Em virtude da complexidade e inúmeras intervenções fisioterapêuticas, o objetivo dessa revisão sistemática foi discutir as evidências de maior relevância clínica na prática fisioterapêutica para intervenção baseada em exercícios nos pacientes com disfunção femoropatelar. O procedimento de busca e avaliação seguiu o método recomendado pelo Preferred Reporting Items for Systematic review and Meta-Analysis Protocols e dessa forma, realizou-se uma consulta a base eletrônica de dados PubMed, no idioma inglês, entre os anos de janeiro de 2005 a dezembro de 2017, com as palavras-chave: "patellofemoral pain syndrome", "physiotherapy", "exercise" e "treatment". Para os critérios de inclusão adotaram-se apenas ensaios clínicos randomizados, caracterizados por tratamento fisioterapêutico e intervenção baseada em exercícios e classificação maior ou igual a 7/10 na escala Physiotherapy Evidence Datebase. Foram encontrados na busca 269 ensaios clínicos randomizados, com 177 artigos selecionados por títulos relacionados ao tema. Após o processo de seleção e avaliação dos artigos, 11 estudos foram selecionados para discussão. Desses, 7 ensaios clínicos randomizados abrangeram exercícios de estabilização de quadril e joelho, sendo que 2 desses estudos acrescentaram exercícios de estabilização de tronco a intervenção. Portanto, o tratamento conservador é uma estratégia eficaz e uma intervenção baseada em exercícios envolvendo fatores proximais e locais ao joelho promovem alívio da dor e melhora da função em indivíduos com disfunção femoropatelar....(AU)
Patellofemoral pain syndrome is described as an anterior pain condition in the knee, aggravated by movements that increase the compressive forces at the patellofemoral joint. It mainly affects young physically active women and it is known that its etiology is multifactorial, and extrinsic and intrinsic factors to the body are involved. Due to the complexity and numerous physiotherapeutic interventions, the objective of this systematic review was to discuss evidence of greater clinical relevance in the physiotherapeutic practice for exercise-based intervention in patients with patellofemoral pain syndrome. The search and evaluation procedure followed the method recommended by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols and, in this way, an electronic database of PubMed data was performed in the English language between January 2005 to December 2017, with the keywords: "patellofemoral pain syndrome", "physiotherapy", "exercise" and "treatment". For the inclusion criteria, only randomized clinical trials, characterized by physical therapy and exercisebased intervention, with a score greater than or equal to 7/10 on the Physiotherapy Evidence Datebase scale were adopted. 269 randomized clinical trials were found in the search, with 177 articles selected by titles related to the topic. After the selection process and evaluation of the articles, 11 studies were selected for discussion. Of these, 7 randomized clinical trials included hip and knee stabilization exercises, and 2 of these studies added trunk stabilization exercises to intervention. Therefore, conservative treatment is an effective strategy and an exercise-based intervention involving proximal and local factors to the knee promotes pain relief and improvement of function in individuals with patellofemoral pain syndrome....(AU)
Subject(s)
Physical Therapy Specialty , Patellofemoral Pain Syndrome , Knee , Physical Education and TrainingABSTRACT
The amygdala, dorsal periaqueductal gray (dPAG), and medial hypothalamus have long been recognized to comprise a neural system responsible for the generation and elaboration of unconditioned fear in the brain. This neural substrate is well known to be under tonic inhibitory control exerted by ã-aminobutyric acid (GABA) mechanisms. Some evidence also suggests that these structures integrate conditioned fear. A recent study using the fear-potentiated startle paradigm showed that GABAergic mechanisms in the anterior hypothalamic nucleus (AHN) and dorsomedial part of the ventromedial hypothalamic nucleus (VMHDM) regulate conditioned fear. The present study examined the extent to which GABAergic mechanisms in these brain regions are involved in conditioned fear by measuring freezing in response to a light used as a conditioned stimulus (CS). The GABA A receptor agonist muscimol and the GABA-synthesizing enzyme glutamic acid decarboxylase inhibitor semicarbazide were used as an enhancer and inhibitor of GABA mechanisms, respectively. Muscimol and semicarbazide were injected into the AHN or VMHDM of rats before fear conditioning. Muscimol injections into the AHN and VMHDM significantly reduced conditioned freezing, whereas inhibition of GABA transmission increased this conditioned response in the AHN. The present study further supports the hypothesis that GABAergic mechanisms in the AHN and VMHDM exert inhibitory control on the neural substrates of conditioned fear in the hypothalamus.