Profile of Ankle Isokinetic Strength and Proprioception in Elite Female Handball Players / Perfil de Fuerza Isokinética del Tobillo y Propiocepción en Jugadoras de Balonmano de Élite

SUMMARY: The evaluation of the invertor and evertor muscle strength and proprioception are important in terms of determining the risk of injury in handball players. The aim of this study was to determine the isokinetic strength and proprioception profile of the ankle invertor and evertor muscles of elite female handball players. Fifteen elite female handball players were included. Ankle invertor and evertor muscle strength and proprioception were evaluated using the isokinetic system. The isokinetic strength test was performed in concentric mode at 30°/s (5 repetitions) and 120°/s (10 repetitions). Proprioception sense was evaluated as active joint position sense. There was no statistically significant difference between the dominant and nondominant sides in terms of invertor and evertor muscle strength, evertor/invertor (Ever/Inver) ratio, and active joint position sense at both angular speeds (p>0.05). The Ever/Inver ratio on both sides was lower than normal values. It was concluded that the female handball players showed bilateral symmetry in the invertor and evertor muscles. However, the fact that the Ever/Inver strength ratio was lower than normal values on both sides suggested that caution should be exercised in terms of risks such as ankle sprain or chronic ankle instability. Pre-season evaluations should be made and it would be beneficial to add strengthening exercises to related muscle groups in training programs to normalize the unilateral ratios in these athletes.

La evaluación de la fuerza muscular inversora y eversora y la propiocepción son importantes para determinar el riesgo de lesión en los jugadores de balonmano. El objetivo de este estudio fue determinar la fuerza isocinética y el perfil de propiocepción de los músculos inversores y eversores del tobillo de jugadoras de balonmano de élite. Se incluyeron 15 jugadoras de élite de balonmano. La fuerza muscular inversora y eversora del tobillo y la propiocepción se evaluaron mediante el sistema isocinético. El test de fuerza isocinética se realizó en modo concéntrico a 30º/s (5 repeticiones) y 120º/s (10 repeticiones). El sentido de propiocepción se evaluó como sentido activo de posición articular. No hubo diferencias estadísticamente significativas entre los lados dominante y no dominante en términos de fuerza muscular inversora y eversora, relación eversor/inversor (Ever/ Inver) y sentido activo de la posición de la articulación en ambas velocidades angulares (p>0.05). La relación Ever/Inver en ambos lados fue inferior a los valores normales. Se concluyó que las jugadoras de balonmano presentaron simetría bilateral en los músculos inversores y eversores. Sin embargo, el hecho de que la relación de fuerza Ever/Inver fuera inferior a los valores normales en ambos lados sugirió que se debe tener precaución en términos de riesgos como el esguince de tobillo o la inestabilidad crónica de tobillo. Se deben realizar evaluaciones de pretemporada y sería beneficioso agregar ejercicios de fortalecimiento a los grupos musculares relacionados en los programas de entrenamiento para normalizar las proporciones unilaterales en estas atletas.

Analysis of postural control and muscle function performance of older adults participating in a multicomponent exercise program in primary health care / Análise do desempenho do controle postural e da função muscular de idosos participantes de um programa de exercício multicomponente na Atenção Primária à Saúde

Objectives: This cross-sectional study aimed to investigate (1) postural control performance in different postural tasks and (2) muscle strength and power of the hip, knee, and ankle of active vs inactive older adults. Methods: The sample consisted of 61 healthy community-dwelling older adults, classified into 2 groups: active, consisting of participants of a multicomponent exercise program offered through the Exercise Orientation Service; and inactive. Participants were considered physically active/inactive in the past 3 months. Postural control was assessed using a force plate in 8 postural tasks. Muscle function was evaluated using an isokinetic dynamometer. T-tests were used to compare clinical characteristics between the groups. ANCOVA and MANCOVA were used to compare differences in variables of postural control and muscle function. Results: Active participants had higher levels of physical activity, clinical balance, and quality of life than inactive participants. The active group had lower values for area (center of pressure) than the inactive group under the following conditions: bipedal stance on an unstable surface with eyes open and with eyes closed, and semi-tandem stance on an unstable surface with eyes open. The active group showed greater muscle power, with higher mean power values for hip abduction and adduction, knee extension, and knee flexion and shorter time to peak torque for hip adduction and ankle dorsiflexion than the inactive group. Conclusions: Multicomponent exercise programs delivered in primary health care settings contributed to improving postural control and muscle power in this sample of older adults, which can potentially help prevent falls and improve quality of life.

Objetivo: Este estudo transversal visou investigar: (1) o desempenho no controle postural em diferentes tarefas e (2) a força e a potência musculares de quadril, joelho e tornozelo de idosos ativos vs. inativos. Metodologia: A amostra foi composta de 61 idosos comunitários saudáveis, classificados em dois grupos: os ativos, participantes do programa de exercício multicomponente ofertado pelo Serviço de Orientação ao Exercício, e os inativos. Os participantes foram considerados fisicamente ativos/inativos nos três meses anteriores. O controle postural foi avaliado em oito tarefas usando-se uma plataforma de força. A função muscular foi mensurada com um dinamômetro isocinético. Foram utilizados testes t para comparar as características clínicas entre os grupos. Análise de covariância e análise multivariada de covariância foram utilizadas para comparar diferenças nas variáveis de controle postural e função muscular. Resultados: Os participantes ativos apresentaram maiores níveis de atividade física, equilíbrio e qualidade de vida que os inativos. O grupo ativo apresentou menores valores de área (centro de pressão) que o inativo nas seguintes condições: base bipodal em superfície instável com olhos abertos e fechados e base semitandem em superfície instável com olhos abertos. O grupo ativo apresentou maior potência que o inativo, com maior valor de potência média para abdução e adução de quadril, extensão e flexão de joelho, e menor tempo de pico de torque para adução de quadril e dorsiflexão de tornozelo. Conclusão: Programas de exercício multicomponente ofertados na Atenção Primária à Saúde contribuíram para melhorar o controle postural e a potência muscular nesta a

Effects of ankle exoskeleton assistance during human walking on lower limb muscle contractions and coordination patterns / 生物医学工程学杂志

Lower limb ankle exoskeletons have been used to improve walking efficiency and assist the elderly and patients with motor dysfunction in daily activities or rehabilitation training, while the assistance patterns may influence the wearer's lower limb muscle activities and coordination patterns. In this paper, we aim to evaluate the effects of different ankle exoskeleton assistance patterns on wearer's lower limb muscle activities and coordination patterns. A tethered ankle exoskeleton with nine assistance patterns that combined with differenet actuation timing values and torque magnitude levels was used to assist human walking. Lower limb muscle surface electromyography signals were collected from 7 participants walking on a treadmill at a speed of 1.25 m/s. Results showed that the soleus muscle activities were significantly reduced during assisted walking. In one assistance pattern with peak time in 49% of stride and peak torque at 0.7 N·m/kg, the soleus muscle activity was decreased by (38.5 ± 10.8)%. Compared with actuation timing, the assistance torque magnitude had a more significant influence on soleus muscle activity. In all assistance patterns, the eight lower limb muscle activities could be decomposed to five basic muscle synergies. The muscle synergies changed little under assistance with appropriate actuation timing and torque magnitude. Besides, co-contraction indexs of soleus and tibialis anterior, rectus femoris and semitendinosus under exoskeleton assistance were higher than normal walking. Our results are expected to help to understand how healthy wearers adjust their neuromuscular control mechanisms to adapt to different exoskeleton assistance patterns, and provide reference to select appropriate assistance to improve walking efficiency.

Effects of wearing an ankle brace on ground reaction forces during jumps in basketball game simulation / Efectos del uso de órtesis de tobillo sobre las fuerzas de reacción del suelo durante los saltos en simulación de juego de baloncesto / Efeitos do uso de órtese de tornozelo sobre as forças de reação do solo durante saltos em simulação do jogo de basquetebol

ABSTRACT Introduction: The use of ankle braces reduces the risk of ankle injuries in basketball players. However, the mechanisms of injury protection provided by the ankle braces in the basketball game are still unknown. Objectives: To analyze the effects of wearing a lace-up ankle brace, and to conduct an exercise protocol that simulated the intensity of the basketball game on ground reaction force (GRF) during basketball-specific vertical jumps. Methods: Eleven male younger basketball players aged under 18 completed 48 vertical jumps, with and without ankle braces, during an exercise protocol composed of four 10-minute periods, simulating the activity profile and intensity of the basketball game as well as the typical intervals between periods. Mediolateral (variables: the greatest medial and lateral peaks) and vertical (variables: vertical peak, impulse peak, impulse at 50 ms of landing, loading rate and jump height) GRF were measured during takeoff and landing for all the jumps performed in the exercise protocol. Results: The use of the ankle brace reduced mediolateral GRF in all periods of the exercise protocol during takeoff and landing ( P < 0.05), without affecting the vertical GRF ( P > 0.05). Mediolateral and vertical GRF (takeoff mediolateral vertical peaks, landing mediolateral peaks, landing impulse peak, takeoff and landing loading rate) increased significantly during four subsequent 10-minute periods ( P < 0.05). However, for mediolateral GRF, the increase overtime was higher without braces. Conclusions: The use of the ankle brace reduced the mediolateral GRF on the lower limb, while there was a progressive increase in the external load applied to the body during the vertical jumps in the subsequent periods of the exercise protocol performed at the same intensity of the basketball game. Level of evidence I; Randomized clinical trial .

RESUMEN Introducción: El uso de órtesis de tobillo reduce el riesgo de lesiones en el tobillo en jugadores de baloncesto. Sin embargo, los mecanismos de protección de lesión proporcionados por las órtesis durante el juego de baloncesto aún son desconocidos. Objetivos: Analizar el efecto del uso de órtesis de tobillo lace-up (con cordón) y de un protocolo de ejercicio que simuló la intensidad del juego de baloncesto sobre la fuerza de reacción del suelo (FRS) durante saltos verticales específicos del baloncesto. Métodos: Once jugadores de baloncesto del sexo masculino con menos de 18 años realizaron 48 saltos verticales, con y sin órtesis de tobillo, durante un protocolo de ejercicios compuesto por cuatro períodos de 10 minutos, que simularon el perfil de actividad e intensidad del juego de baloncesto, así como los intervalos típicos entre los períodos. Las FRS mediolaterales (variables: mayores picos medial y lateral) y verticales (variables: pico vertical, pico de impulso, impulso en 50 ms de aterrizaje, tasa de sobrecarga y altura del salto) fueron medidas durante las fases de despegue y aterrizaje de todos saltos realizados en el protocolo de ejercicio. Resultados: El uso de órtesis redujo la FRS mediolateral en todos los períodos analizados, durante las fases de despegue y aterrizaje (P < 0,05), sin afectar la FRS vertical (P > 0,05). La FRS mediolateral y vertical (picos mediolateral y vertical de despegue, picos mediolaterales de aterrizaje, pico de impulso de aterrizaje, tasa de sobrecarga en el despegue y aterrizaje) aumentaron significativamente durante cuatro períodos subsiguientes de 10 minutos (P < 0,05). Sin embargo, para la FRS mediolateral, el aumento a lo largo del tiempo fue mayor sin el uso de órtesis. Conclusiones: El uso de órtesis de tobillo redujo la FRS mediolateral en el miembro inferior, mientras que hubo un aumento progresivo de la carga externa aplicada al cuerpo durante los saltos en los períodos subsiguientes del protocolo de ejercicios con la misma intensidad del juego de baloncesto. Nivel de evidencia I; Ensayo clínico aleatorizado.

RESUMO Introdução: O uso de órtese de tornozelo reduz o risco de lesões no tornozelo em jogadores de basquetebol. No entanto, os mecanismos de proteção de lesão fornecidos pelas órteses durante o jogo de basquetebol ainda são desconhecidos. Objetivos: Analisar o efeito do uso de órtese de tornozelo lace-up (com cordão) e de um protocolo de exercício que simulou a intensidade do jogo de basquetebol sobre a força de reação do solo (FRS) durante saltos verticais específicos do basquetebol. Métodos: Onze jogadores de basquetebol do sexo masculino com menos de 18 anos realizaram 48 saltos verticais, com e sem órtese de tornozelo, durante um protocolo de exercícios composto por quatro períodos de 10 minutos, que simularam o perfil de atividade e intensidade do jogo de basquetebol, assim como os intervalos típicos entre os períodos. As FRSs mediolaterais (variáveis: maiores picos medial e lateral) e verticais (variáveis: pico vertical, pico de impulso, impulso em 50 ms da aterrissagem, taxa de sobrecarga e altura do salto) foram medidas durante as fases de decolagem e aterrissagem de todos os saltos realizados no protocolo de exercício. Resultados: O uso de órtese reduziu a FRS mediolateral em todos os períodos analisados, durante as fases de decolagem e aterrissagem (P < 0,05), sem afetar a FRS vertical (P > 0,05). A FRS mediolateral e vertical (picos mediolateral e vertical de decolagem, picos mediolaterais de aterrissagem, pico de impulso de aterrissagem, taxa de sobrecarga na decolagem e aterrissagem) aumentaram significativamente durante quatro períodos subsequentes de 10 minutos (P < 0,05). No entanto, para a FRS mediolateral, o aumento ao longo do tempo foi maior sem o uso de órtese. Conclusões: O uso de órtese de tornozelo reduziu a FRS mediolateral no membro inferior, enquanto houve um aumento progressivo da carga externa aplicada ao corpo durante os saltos nos períodos subsequentes do protocolo de exercícios com mesma intensidade do jogo de basquetebol. Nível de evidencia I; Estudo clínico randomizado .

Analysis of acceleration time of ankle in long-distance runners and triathletes / Análise de tempo de aceleração do tornozelo em corredores de longa distância e triatletas

INTRODUCTION: Adequate muscle reaction time is essential for protecting the joints against injuries during sports activities. This phenomenon of time of acceleration has been investigated through methodologies such as trapdoor experiments and electromyography. However, isokinetic analysis is an assessment method that is more dynamic and shows behavior closer to the functionality of the sport. Sports that involve running, such as long distance running and triathlon, have high lower-limb injury rates, particularly in relation to the ankle joint. The objective of this study was to evaluate and compare isokinetic acceleration and deceleration times of the dorsiflexor and plantar flexor musculature of the ankle in long-distance runners, triathletes and non-athletic individuals. METHOD: The sample comprised 75 individuals (men aged 18-42 years), divided into three groups: triathlete group, long-distance runner group and control group. The individuals were tested bilaterally on an isokinetic dynamometer. The evaluation modes used were (i) concentric/eccentric for plantar flexion and dorsiflexion, and (ii) eccentric/concentric for plantar flexion and dorsiflexion. We used (a) analysis of variance and Tukey's post hoc test; (b) Kruskal-Wallis and Müller-Dunn post hoc tsts; (c) Chi-square tests. RESULTS: The acceleration time during concentric contraction was statistically different only between the control group and the long-distance runner group, such that the controls presented faster acceleraton. CONCLUSION: This may signify a deficiency in their motor sensory control during concentric activity of the dorsiflexors.

INTRODUÇÃO: O tempo adequado de reação muscular é essencial para proteger as articulações contra lesões durante atividades esportivas. Este fenômeno de tempo de aceleração tem sido investigado por meio de metodologias como experimentos com trampolim e eletromiografia. No entanto, a análise isocinética é um método de avaliação que é mais dinâmico e mostra comportamento mais próximo da funcionalidade do esporte. Corrida de longa distância e triatlo têm altas taxas de lesão de membros inferiores, particularmente em relação à articulação do tornozelo. O objetivo deste estudo foi avaliar e comparar os tempos de aceleração e desaceleração isocinética do dorsiflexor e da musculatura flexora plantar do tornozelo em corredores de longa distância, triatletas e indivíduos não atléticos. MÉTODO: A amostra incluiu 75 indivíduos (homens com idade entre 18-42 anos), divididos em três grupos: triatletas, corredores de longa distância e grupo controle. Os indivíduos foram testados bilateralmente em um dinamômetro isocinético. Os modos de avaliação utilizados foram: 1. concêntricos/excêntricos para flexão plantar e dorsiflexão; 2. excêntricos/concêntricos para flexão plantar e dorsiflexão. A análise estatística utilizou análise de variância e teste post hoc de Tukey; Testes post hoc de Kruskal-Wallis e Müller-Dunn e testes Qui-quadrado. RESULTADOS: O tempo de aceleração durante a contração excêntrica foi estatisticamente diferente apenas entre o grupo controle e o grupo corredor de longa distância: os controles apresentaram aceleração mais rápida. CONCLUSÃO: Este resultado pode indicar uma deficiência no controle sensorial do seu motor durante a atividade concêntrica dos dorsiflexores.

Analysis of isokinetic muscle function and postural control in individuals with intermittent claudication

BACKGROUND: Intermittent claudication (IC) is a debilitating condition that mostly affects elderly people. IC is manifested by a decrease in ambulatory function. Individuals with IC present with motor and sensory nerve dysfunction in the lower extremities, which may lead to deficits in balance. OBJECTIVE: This study aimed to measure postural control and isokinetic muscle function in individuals with intermittent claudication. METHOD: The study included 32 participants of both genders, 16 IC participants (mean age: 64 years, SD=6) and 16 healthy controls (mean age: 67 years, SD=5), which were allocated into two groups: intermittent claudication group (ICG) and control group (CG). Postural control was assessed using the displacement and velocity of the center of pressure (COP) during the sensory organization test (SOT) and the motor control test (MCT). Muscle function of the flexor and extensor muscles of the knee and ankle was measured by an isokinetic dynamometer. Independent t tests were used to calculate the between-group differences. RESULTS: The ICG presented greater displacement (p =0.027) and speed (p =0.033) of the COP in the anteroposterior direction (COPap) during the MCT, as well as longer latency (p =0.004). There were no between-group differences during the SOT. The ICG showed decreased muscle strength and power in the plantar flexors compared to the CG. CONCLUSION: Subjects with IC have lower values of strength and muscle power of plantiflexores, as well as changes in postural control in dynamic conditions. These individuals may be more vulnerable to falls than healthy subjects.

Effects of Community-based Comprehensive Fall Prevention Program on Muscle Strength, Postural Balance and Fall Efficacy in Elderly People

PURPOSE: The purposes of this study was to develop a comprehensive community-based fall prevention program and to test the effects of the program on the muscle strength, postural balance and fall efficacy for elderly people. METHODS: The design of this study was a nonequivalent control group pretest-posttest design. There were 28 participants in the experimental group and 29 in the control group. The program consisted of balance exercises, elastic resistance exercises and prevention education. The program was provided five times a week for 8 weeks and each session lasted 90 minutes. Data were analyzed using chi2-test, independent t-test and paired t-test using the SPSS program. RESULTS: Muscle strength of the lower extremities, postural balance and fall efficacy scores significantly improved in the experimental group compared to the control group. CONCLUSION: These results suggest that this program can improve lower extremity muscle strength, postural balance and fall efficacy in elders. Therefore, this program is recommended for use in fall prevention programs for elders living in the community.

Isokinetic analysis of ankle and ground reaction forces in runners and triathletes

OBJECTIVE: To analyze and compare the vertical component of ground reaction forces and isokinetic muscle parameters for plantar flexion and dorsiflexion of the ankle between long-distance runners, triathletes, and nonathletes. METHODS: Seventy-five males with a mean age of 30.26 (±6.5) years were divided into three groups: a triathlete group (n=26), a long-distance runner group (n = 23), and a non-athlete control group. The kinetic parameters were measured during running using a force platform, and the isokinetic parameters were measured using an isokinetic dynamometer. RESULTS: The non-athlete control group and the triathlete group exhibited smaller vertical forces, a greater ground contact time, and a greater application of force during maximum vertical acceleration than the long-distance runner group. The total work (180º/s) was greater in eccentric dorsiflexion and concentric plantar flexion for the non-athlete control group and the triathlete group than the long-distance runner group. The peak torque (60º/s) was greater in eccentric plantar flexion and concentric dorsiflexion for the control group than the athlete groups. CONCLUSIONS: The athlete groups exhibited less muscle strength and resistance than the control group, and the triathletes exhibited less impact and better endurance performance than the runners.

Determinants of Brachial-Ankle Pulse Wave Velocity in Normotensive Young Adults with Type 2 Diabetes Mellitus

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, gamma-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), gamma-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.

Determinants of Brachial-Ankle Pulse Wave Velocity in Normotensive Young Adults with Type 2 Diabetes Mellitus

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, gamma-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), gamma-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.

Biofeedback eletromiográfico e parâmetros da dinamometria isocinética de joelho e tornozelo de jogadores de futebol amador / Electromyographic biofeedback and parameters of isokinetic dynamometry of knee and and ankle in amateur soccer players

A eletromiografia tem sido utilizada para avaliar o controle voluntário da atividade muscular. Dentre as técnicas destaca-se o biofeedback eletromiográfico como facilitador do aprendizado neuromotor, inclusive na prática esportiva. Objetivo: Analisar o efeito do biofeedback eletromiográfico nos parâmetros isocinéticos dos flexores e extensores do joelho e inversores e eversores do tornozelo em jogadores de futebol amador. Casuística: 14 atletas de futebol amador do gênero masculino randomizados em dois grupos: Grupo Treino (GT) - sete atletas, idade de 23 ± 2 (22 e 28) anos, massa corpórea 75,7 ± 4,0(72 e 80) kg , estatura 182 ± 4 (176 e 188) cm e Grupo Controle (GC) - sete atletas com idade 24 ± 2 (21 e 28) anos, massa corpórea 72,3± 9,4 (59 e 79) kg, estatura 175± 5 (169 e 180) cm. Método: Todos os atletas foram avaliados por um protocolo clínico: anamnese, incidência de lesões e escala visual análoga de dor e foram submetidos à dinamometria isocinética dos inversores e eversores do tornozelo e flexores e extensores do joelho. O GT realizou 12 sessões de biofeedback eletromiográfico, uma vez por semana. No final das sessões, todos os atletas foram reavaliados. Resultados: Na velocidade de 30º/ seg., o pico de torque 0,18 segundos (PT 0,18s) dos eversores do tornozelo foi maior no GT e no joelho, na velocidade de 60º/seg. o PT 0,18s dos flexores de joelho foram maiores no GT. Conclusão: O biofeedback eletromiográfico melhorou os parâmetros isocinéticos dos jogadores de futebol amador.

Electromyography has been used to evaluate the voluntary control of muscular activity. One of the highlights among the techniques is electromyography biofeedback (EMGBio), which works as a facilitator of neuromotor development, including playing sports. Objective: To analyze the effect of EMGBio within the isokinetic parameters of knee flexion and extension and ankle inversion and eversion in amateur soccer players. Subjects: Two randomized groups of fourteen male amateur soccer players: Training group (TG) - seven athletes, with an age of 23 ± 2 (22 and 28) years old, body mass 75.7kg ± 4.0kg (72 and 80), height 182cm ± 4cm (176 and 188) and Control Group (CG) - seven athletes, with an age of 24 ± 2 (21 and 28) years old, body mass 72.3kg ± 9.4kg (59 and 79), height 175cm ± 5cm (169 and 180). Methods: all athletes were evaluated by a clinical protocol: anamnesis, occurrence of injuries and visual analogue scale of pain and were subjected to knee flexion and extension and ankle inversion and eversion isokinetic dynamometry. The training group had twelve sessions of EMGBio once a week. At the end of the sessions, all athletes were revaluated. Results: At a velocity of 30 deg/s, the ankle eversion peak torque of 0.18 seconds (PT of 0.18s) was higher in the training group and at a velocity of 60 deg/s, the knee flexion PT of 0.18s was higher in the training group. Conclusion: Electromyographic biofeedback improved the isokinetic parameters of the amateur soccer players.

Using standing postures as a practical alternative to gait analysis for assessing normal neuromotor activity variation of the ankle muscle antagonists: a soleus H-reflex and EMG activity study comparing patients with hemiplegia to healthy subjects / Uso de posturas erguidas como alternativa práctica al análisis de marcha para evaluar la actividad neuromotora normal de los antagonistas del tobillo: una comparación entre pacientes hemiplégicos y sujetos normales

The purpose of this study was to evaluate and compare the soleus H-reflex amplitudes recorded in three standing postures between a group of patients with stroke and a group of healthy subjects. Nine ambulatory patients were compared with 10 healthy subjects. Measures were recorded during quiet standing (QS), heels raised (PO) and with the foot of the measured leg held just off the ground while standing on the opposite leg (SW). The results showed that patients, as opposed to the healthy group, did not inhibit soleus H-reflex in the SW posture. As opposed to evaluating ankle motor control during gait, the PO and SW standing postures appeared to offer a practical and objective method to assess soleus H-reflex when the purpose is to determine impairment (or recovery) of ankle neuromotor control in stroke survivors.

El propósito de este estudio fue evaluar y comparar la amplitud de el reflejo H en el músculo sóleo en tres posturas en la posición de pie entre un grupo de pacientes con hemiplejia y un grupo de individuos sanos. Nueve pacientes ambulatorios fueron comparados con diez individuos sanos. Registros fueron obtenidos en la posición de pie bipedal (QS), bipedal con talones elevados (PO), y unipedal manteniendo el pie afectado ligeramente elevado sin contacto con el piso (SW). Los resultados mostraron que los pacientes, en contraste con el el grupo sano, no presentaron inhibición del reflejo H en la postura SW. Comparado a registros del reflejo H obtenidos durante la marcha, aquellos obtenidos con las posturas PO y SW aparecen como un método más práctico y objetivo para evaluar el reflejo H del soleus si el propósito es determinar nivel de pérdida (o recuperación) de el control neuromotor del tobillo en pacientes con hemiplejia.

Using standing postures as a practical alternative to gait analysis for assessing normal neuromotor activity variation of the ankle muscle antagonists: a soleus H-reflex and EMG activity study / Uso de posturas erguidas como alternativa al análisis de marcha para evaluar la variación en la actividad neuromotora de los músculos antagonistas del tobillo: un estudio utilizando el reflejo H del músculo sóleo y EMG

Soleus and tibialis anterior muscle EMG and soleus H-reflex are widely used to study ankle motor control during gait. Normally, the soleus H-reflex amplitude and EMG activity varies greatly through the course of walking. The examining of these events during walking requires space and resources that are generally found only in research oriented facilities, making difficult a more practical use. Earlier reports have suggested that normal variation of the soleus H-reflex and EMG could be determined from standing postures. Therefore, the main purpose of this study was to examine and determine which standing postures would reproduce the normal neuromotor variation of the ankle muscle antagonists. A total of five postures were investigated. The results of this study demonstrated that the normal variation in the soleus H-reflex amplitude and the associated EMG activity can be comparably reproduced from two selected standing postures (PO and SW). The described method presents a practical and functional alternative to gait analysis when the goal is determining normal ankle neuromotor control.

La actividad electromiográfica (EMG) de los músculos tibial anterior y sóleo junto al reflejo H del sóleo han sido extensamente usados en el estudio del control motor del tobillo durante la marcha. Normalmente, la amplitud del reflejo H del sóleo y EMG varía ampliamente durante el curso de la marcha. El estudio de estos eventos durante la marcha requiere de espacio y equipamiento generalmente sólo disponible en laboratorios de investigación, por lo que resulta difícil su aplicación práctica. Previos estudios han sugerido que la variación normal del reflejo H del sóleo y EMG pudiese ser obtenida utilizando posturas en la posición de pie. El propósito principal de este estudio fue examinar y determinar qué posturas reproducirían la variación neuromotora normal en los músculos antagonistas del tobillo. Un total de cinco posturas fueron investigadas. Los resultados de este estudio demostraron que la variación normal de la amplitud del reflejo H del sóleo y EMG asociada, puede ser similarmente reproducida a partir de dos posturas (PO y SW). El método descrito presenta una alternativa práctica y funcional a la marcha, cuando el objetivo es la determinación del control neuromotor normal en el tobillo.

Índice Tornozelo-Braquial (ITB) determinado por esfigmomanômetros oscilométricos automáticos / Assessing Ankle-Brachial Index (ABI) by using automated oscillometric devices

FUNDAMENTO: Índice Tornozelo-Braquial (ITB) é essencial na prática clínica, mas dificuldades técnicas na sua execução pelo padrão de referência Doppler vascular (DV) tornam-no ainda pouco utilizado. OBJETIVO: Avaliar aplicabilidade da determinação do ITB com uso de esfigmomanômetros oscilométricos automáticos (EOA) e sugerir a utilização dos índices delta-Bráquio-Braquial (delta-BB) e delta-ITB como marcadores de risco cardiovascular. MÉTODOS: Estudo descritivo e observacional de 247 pacientes ambulatoriais (56,2 por cento feminino, média 62,0 anos) submetidos à determinação do ITB com aferição simultânea da pressão arterial (PA) em membros superiores (MMSS) e inferiores (MMII) utilizando-se dois EOA (OMRON-HEM705CP). Nos casos em que não foi possível aferir PA em pelo menos um dos MMII utilizou-se DV. Os pacientes divididos em Grupo N (ITB normal: 0,91 a 1,30) e Grupo A (ITB alterado: <0,90 ou >1,30) tiveram comparados entre si os valores de delta-ITB (diferença absoluta ITB/MMII) e delta-BB (diferença absoluta PAS/MMSS). RESULTADOS: Utilizando-se EOA foi possível determinar ITB em 90,7 por cento. Com dados do Grupo N determinaram-se valores de referência (VR) no percentil 95 de delta-ITB (0-0,13) e delta-BB (0-8 mmHg). Quando comparado com o Grupo N, o Grupo A apresentou prevalência mais elevada tanto de delta-ITB (30/52 contra 10/195; Razão de Chances: 25,23; p<0,0001) como de delta-BB (13/52 contra 7/195; Razão de Chances: 8,95; p<0,0001) acima dos VR. CONCLUSÃO: O ITB pode ser determinado na maioria das vezes com EOA. Delta-ITB e delta-BB acima dos VR estiveram significativamente mais prevalentes nos portadores de ITB alterado e podem ser sugeridos como marcadores de risco cardiovascular em futuros estudos epidemiológicos.

BACKGROUND: Assessing Ankle-Brachial Index is an essential procedure in clinical settings, but since its measurement by the gold standard Doppler Ultrasonic (DU) technique is impaired by technical difficulties, it is underperformed. OBJECTIVE: The aim of this study was to assess the efficacy of an automated oscillometric device (AOD) by performing Ankle-Brachial Index (ABI) assessments and to suggest delta brachial-brachial (delta-BB) and delta-ABI as markers of cardiovascular risk. METHODS: In this observational and descriptive study, 247 patients (56.2 percent females, mean age 62.0 years) had their arterial blood pressure (ABP) measured for ABI calculation. Two AOD (OMRON-HEM705CP) devices were used for simultaneous measurements of the ABP, first of the two arms and then of the arm with higher systolic ABP and a leg, first the left and then the right one. When leg ABP measurements were not possible, ABI determination was performed by using the standard Doppler Ultrasonic (DU) technique. Patients were designated to Group N (normal ABI: 0.91 to 1.30) or Group A (abnormal ABI: <0.90 or >1.30). Other indexes were also calculated: delta-BB (absolute difference in mmHg of systolic ABP between arms) and delta-ABI (absolute difference of ABI between legs) and the results were compared. RESULTS: In most patients (90.7 percent), it was possible to determine the ABI. Group N data allowed calculation of the 95th percentile reference values (RV) of delta-BB (0 to 8 mmHg) and delta-ABI (0 to 0.13). When compared to Group N, Group A had a significantly higher prevalence of high values greater than the RVs of delta-ABI (30 of 52 and 10 of 195, respectively; Odds Ratio = 25.23; p<0.0001) and delta-BB (13 of 52 and 7 of 195, respectively; Odds Ratio = 8.95; p<0.0001). CONCLUSION: In most patients, the ABI could be measured by AOD. Both indexes, delta-BB and delta-ABI greater than the RVs, were significantly more prevalent in patients with abnormal ABI ...

Ankle movements during normal gait evaluated by flexible electrogoniometer

OBJECTIVE: To evaluate ankle movements of healthy individuals walking on a treadmill, by means of a flexible electrogoniometer. METHOD: Dorsiflexion and plantar flexion and eversion/inversion movements were recorded for 90 seconds at a velocity of 5.0 km/h. Ten healthy young men of mean age 21.4 ± 2.99 years and mean height 1.62 ± 0.22 meters took part in this study. The data were analyzed descriptively (mean, standard deviation, maximum and minimum). In the sagittal plane, the gait cycle was analyzed at three times, taking the movement peaks: foot flat (FF), midstance (M) and toe off (TO). The inversion and eversion angles corresponding to these phases were identified, as well as movement peaks during gait cycles. Inter and intra-subject coefficients of variability (CV) were calculated. RESULTS: The mean values for the sagittal plane, for the left and right ankles were, respectively: 7º and 4º at FF, 2º and 7º at M, and 24º and 19º at TO. For the frontal plane, the results were inversion of 5º and 3º FF, 4º and 5º at M, and 15º and 16º at TO. The peak values were inversion of 17º and 18º and eversion of 1º. The maximum intra-subject CV was 0.39, and the maximum inter-subject CV was 0.44. CONCLUSION: The results obtained from the electrogoniometer were relatively similar to data reported in the literature for the sagittal plane, but not for the frontal plane. The discrepancies between studies measuring ankle movements suggest the need for standardization of the recording procedures.

OBJETIVO: Avaliar os movimentos do tornozelo de indivíduos saudáveis durante a marcha em esteira por eletrogoniometria flexível. MÉTODO: Os movimentos de dorsiflexão/flexão plantar e inversão/eversão foram registrados durante 90 segundos na velocidade de 5,0 km/h. Dez jovens saudáveis do gênero masculino, com idade média de 21,4 ± 2,99 anos, altura média de 1,62 ± 0,22 metros participaram do estudo. Os dados foram analisados descritivamente (média, desvio-padrão, valores mínimo e máximo). No plano sagital, o ciclo da marcha foi analisado em três momentos, considerando os picos de movimento: pé plano (PP), médio apoio (MA) e retirada dos dedos (RD). Foram identificados os ângulos de inversão/eversão correspondentes a essas fases, bem como os picos de movimento durante os ciclos da marcha. Foi calculado o coeficientes de variação (CV) inter e intra-sujeitos. RESULTADOS: Os valores médios do plano sagital para o tornozelo esquerdo e direito foram respectivamente: 7º e 4º no PP, 2º e 7º no MA, 24º e 19º na RD. No plano frontal, os resultados foram: 5º e 3º de inversão no PP, 4º e 5º de inversão no MA, 15º e 16º de inversão na RD, valores picos foram 17º e 18º de inversão e 1º de eversão. O CV intra-sujeito máximo foi de 0,39 e o intersujeitos foi 0,44. CONCLUSÃO: Os resultados obtidos por meio do eletrogoniômetro são relativamente similares aos dados reportados pela literatura para o plano sagital, mas não para o plano frontal. As discrepâncias entre os estudos que avaliam movimentos do tornozelo sugerem a necessidade de padronização dos procedimentos de registro.

Fall Prevention Exercise Program for Fall Risk Factor Reduction of the Community-Dwelling Elderly in Korea

A randomized comparison of pre-and post-experimental design was used to examine the effects of a fall prevention exercise program (FPEP) on muscle strength, ankle flexibility, balance, instrumental activities of daily living (IADLs), and depression for the community-dwelling elderly in Korea. Twenty-two subjects were assigned to an experimental group and twenty-three to a control group. The experimental group participated in a 4-day-per week FPEP of 8 weeks duration, twice a week by direct instruction and twice a week with videotaped instruction by the program instructor at each senior center. The eight-week FPEP turned out to be significantly effective in enhancing muscle strength, ankle flexibility and balance, and in reducing depression, after intervention among community-dwelling elderly in Korea. IADLs, however, was not changed by the intervention. Further research with a larger sample and longer follow up period is needed to expand our understanding about the effects of FPEP. Future study is also recommended to differentiate between the effects of FPEP by direct instruction and by videotaped.

Adaptaciones en el apoyo del pie en niñas que practican danza / Adaptation of feet in girls who are in dance training

Debido a que durante el crecimiento y desarrollo de los niños se llevan a cabo cambios que están modificados entre otras cosas por la actividad física. Se estudió a las niñas que acuden a la Academia Mexicana de la Danza para conocer las adaptaciones que presentan en el apoyo del pie en los diferentes tipos de danza: clásica, folklórica y contemporánea. Se les tomó impresión de la huella plantar antes y después de la realización de los tres tipos de danza, según el método del Dr. Hernández Corvo. Se encontró que antes de la actividad tenían una caracterización de normal, con tendencia al cavo, posteriormente a la realización de la danza clásica continuaron igual; en la contemporánea normal y cavo, en la folklórica cavos, pie derecho e izquierdo respectivamente. Creemos que es posible por los movimientos que se realizan durante cada ejecución de la danzas hacer funcionar diferentes grupos musculares y esto provoca una adaptación al apoyo plantar

Avaliaçäo da força muscular isocinética do pé e tornozelo após tratamento cirúrgico das lesöes do tendäo de Aquiles, utilizando a transferência do tendäo fibular curto / Evaluation of isokinetic muscle strength of the foot and ankle after surgical treatment of Achilles tendon lesions, using transfer of short fibular tendon

O tendäo de Aquiles é o mais volumoso e resistente tendäo do corpo humano, sendo imprescindível para o perfeito funcionamento do mecanismo articular do tornozelo. Esta estrutura apresenta, porém, áreas de fragilidade, principalmente quando sumetida a esforços em tensäo, o que pode resultar em lesöes. As lesöes diagnosticadas podem ser tratadas conservadoramente ou cirurgicamente. Optamos pelo tratamento cirúrgico, utilizando a técnica de reparo da lesäo e reforto com o tendäo fibular curto. Para avaliaçäo do procedimento operatório e sua evoluçäo, utilizamos um dinamômetro isocinético. Cybex 350, que permitiu a documentaçäo e análise dos dados de forma objetiva. Seis pacientes com idade média de 43,8 anos, com lesäo do tendäo de Aquiles, foram submetidos ao teste. O protocolo preestabelecido foi aplicado e as forças de eversäo/inversäo, flexäo/extensäo do pé e tornozelo, dos lados operados e näo operados, foram medidas e submetidas a análise estatística. Näo constatamos diminuiçäo no torque máximo e torque máximo percentual ao peso para a eversäo, inversäo e extensäo. Quanto a forta de flexäo, apesar de obtidos resultados com diferença percentual a favor dos lados näo operados, tampouco foram estatisticamente significantes.

Avaliaçäo isocinética pré e pós-operatória nas coalizöes tarsais / Pre and postoperative isokinetic evaluation in tarsal coalitions

O objetivo deste trabalho é o de demonstrar os resultados da avaliaçäo funcional na resseçäo operatória das colizöes tarsais talocalcaneanas e calcaneonaviculares. O ângulo máximo de movimento e o torque muscular máximo isocinético para a inversäo e eversäo do pé säo determinados em 12 pacientes (17 pés) portadores de coalizäo tarsal talocalcaneana (8) e calcaneonavicular (4). Säo avaliados oito pacientes do sexo feminino e quatro do sexo masculino com idades entre 10 e 16 anos (média = 13,2 anos). Todas as barras talocalcaneanas haviam sido tratadas com a ressecçäo da barra e interposiçäo de enxerto autógeno livre de gordura. As barras calcaneonaviculares foram tratadas através da excisäo da barra seguida da interposiçäo do tendäo do músculo extensor curto dos dedos. Os testes isocinéticos foram realizados em dinamômetro isocinético marca Cybex, modelo 350, no pré e pós-operatório. Foram avaliados os valores torque máximo por porcentagem de peso corpóreo, nas velocidades angulares de 30 a 120 graus/segundo. Os resultados demonstraram aumento significante da força muscular e dos valores do ângulo de movimento articular (p<0,05) após período pós-operatório mínimo de seis meses. Os autores concluem que a ressecçäo operatória é boa opçäo terapêutica das coalizöes tarsais talocalcaneanas e calcaneonaviculares, permitindo bons resultados funcionais.