Effects of transcranial direct current stimulation associated or combined with exercise on musculoskeletal pain: systematic review / Efeitos da estimulação transcraniana por corrente contínua associada ou combinada ao exercício na dor musculoesquelética: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Aerobic/resistance exercises and transcranial direct current stimulation (tDCS) can produce analgesic effects in patients with musculoskeletal pain, however, the summed effect of these two therapeutic resources remains unclear. The present study aimed to verify the effects of tDCS associated or combined with aerobic/resistance exercise on musculoskeletal pain. CONTENTS: The search was carried out in the databases: Pubmed, LILACS, Scielo. The intervention considered was tDCS associated or combined with exercises and the comparison was exercise without tDCS or with sham tDCS. Randomized controlled trials enrolling patients with musculoskeletal pain were included. There were no restrictions on the language and year of publication and the methodological quality was verified with PEDro Scale. Three trials were included with a total of 110 participants. The methodological quality was high, with an average of 9 points on the PEDro Scale. The studies used tDCS in the primary motor cortex with an intensity of 1 or 2 mA, for 20 minutes. The participants included were aged between 18 and 75 years and had the following diseases: fibromyalgia, osteoarthritis or chronic low back pain. CONCLUSION: Overall, tDCS did not overcome the sham tDCS to enhance the effects of exercise in reducing musculoskeletal pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os exercícios aeróbios/resistidos e a estimulação transcraniana por corrente contínua (ETCC) podem produzir efeitos analgésicos em pacientes com dores de origem musculoesquelética, porém, o efeito somado destes dois recursos terapêuticos ainda não está claro. O objetivo do presente estudo foi verificar os efeitos da ETCC associada ou combinada ao exercício aeróbio/resistido na dor musculoesquelética. CONTEÚDO: A busca foi realizada nas bases de dados Pubmed, LILACS e Scielo. A intervenção considerada foi ETCC associada ou combinada a exercícios e a comparação foi exercício sem ETCC ou com ETCC simulada. Foram incluídos ensaios clínicos randomizados envolvendo pacientes com dor musculoesquelética aguda ou crônica. Não houve restrições quanto ao idioma e ano de publicação e a qualidade metodológica dos estudos foi verificada por meio da escala PEDro. Três ensaios foram incluídos com um total de 110 participantes. A qualidade metodológica foi alta, com uma média de 9 pontos na escala PEDro. Os estudos utilizaram a ETCC no córtex motor primário com intensidade de 1 ou 2 mA, por 20min. Os participantes tinham idade entre 18 e 75 anos e eram portadores de fibromialgia, osteoartrite ou lombalgia crônica. CONCLUSÃO: A ETCC não superou a ETCC simulada para potencializar os efeitos do exercício na redução de dor musculoesquelética.

Skin temperature of middle distance runners after a maximum effort test

The purposeof this study was to analyze skin temperature(Tsk)responses after a short-term maximum effort test in middle-distance runners.Aquasi-experimental study was conducted with ten men (age 23.5±5.10 years)who trained 5 days per week, 2 to 3 hours per day,and were submitted to thermographic evaluationbefore and after Cooper's 12-minute run test (CRT). The mean temperature of the anterior-superior,posterior-superior,anterior-inferior,and posterior-inferiorregionswas compared between the sides(i.e., left and right)before and after CRT.The paired t-testshowed asignificantdecrease in Tskafter CRT in thefollowingregions:right pectoralis major (-3.4%), left pectoralis major (-3.4%),and abdomen (-5%) in the anterior-superior view (p<0.01); and in the upper right trunk (-1.9%),upper lefttrunk(-1.9%) and lower back (-2.9%) in the posterior-superior view (p<0.05). In the lower limbs,asignificantincreaseintemperature of the left knee (1.6%),and right (3.6%) and left ankles (2.9%) in the anteriorview (p<0.05),as well as in theright (4.3%) and left ankles (3.7%) in the posteriorview (p<0.05)wereobserved. There was no difference in temperature between the right and left sides. In conclusion, the Tskchange of middle-distance runners wassymmetricalbetween sides,decreasing in upper limbs and trunk and increasing in lower limbs after a short-term maximum effort test.

Rate of force development to evaluate the neuromuscular fatigue and recovery after an intermittent isometric handgrip task with different blood flow restriction conditions

Aim: To investigate the neuromuscular fatigue and recovery after an intermittent isometric handgrip exercise (IIHE) executed until failure with different blood flow restriction (BFR) conditions (free flow, partial and total vascular restriction). Methods: Thirteen healthy men carried out an IIHE at 45% of maximum voluntary isometric force (MVIF) until failure with total restriction (TR), partial restriction (PR) or free flow (FF). The rate of force development (RFD) was extracted from the MIVF over the time intervals of 0-30, 0-50, 0-100, and 0-200ms and normalized by MVIF [relative RFD (RFDr)]. Results: The RFDr decreased significantly (p<0.01) after the IIHE in all BFR conditions and time intervals studied, remaining lower for five minutes. The medians of the RFDr in FF condition were significantly lower (p=0.01) at 30ms (1.56 %MVIF·s-1) and 50ms (1.70 %MVIF·s-1) when compared to TR at 30ms (2.34 %MVIF·s-1) and 50ms (2.63 %MVIF·s-1) in minute 1 post failure. Conclusions: These results show that, regardless of the blood flow restriction level, there is no RFD recovery five minutes after an exhaustive IIHE. When the task was executed with FF, the reduction of the RFD was greater when compared with the TR condition.(AU)

High-velocity low-amplitude manipulation (thrust) and athletic performance: a systematic review / Manipulação em alta velocidade/baixa amplitude e desempenho atlético: uma revisão sistemática

Abstract Introduction: The high demand level in sports has encouraged the search for strategies to increase the yield. In this context, manual therapy through high-velocity low-amplitude (thrust) has been employed in many sports. Despite the adhesion of manual therapists in clinical practice, there were no systematic reviews on this topic. Objective: To evaluate the effects of thrust on the performance of athletes in relation to the outcomes hand-grip strength, jump height and running speed. Methods: The databases used in the search were MEDLINE / PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL and SCOPUS, and Randomized controlled trials were included, whose participants were professionals or recreational athletes and had thrust as intervention. The methodological quality of the studies was assessed using the PEDro scale of 10 points. Intervention effects were determined by the mean difference and confidence interval. The data analysis was done in the descriptive form due to the heterogeneity found among studies. Results: Five trials were included with a total of 95 individuals. The methodological quality of studies was low, with an average value of 5.6 on the PEDro scale. It was found two articles for each outcome, but in none of them was presented differences between the experimental and control groups considering the confidence interval. Conclusion: The current evidence is insufficient to determine the use or nonuse the MAVBA in sports in order to improve performance.

Resumo Introdução: O elevado nível de exigência no meio esportivo tem incentivado a busca por estratégias para aumentar o rendimento. Nesse contexto, a terapia manual através da Manipulação em Alta e Velocidade e Baixa Amplitude (MAVBA) tem sido empregada em vários esportes. Apesar da adesão dos terapeutas manuais na prática clínica, não foram encontradas revisões sistemáticas acerca do tema. Objetivo: Avaliar os efeitos da manipulação de alta velocidade e baixa amplitude sobre o desempenho de atletas. Métodos: As bases de dados utilizadas na busca foram MEDLINE/PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL e SCOPUS. Foram incluídos Ensaios Randomizados e Controlados, cujos participantes eram atletas profissionais ou recreacionais, que aplicaram a MAVBA como intervenção. A qualidade metodológica dos estudos foi avaliada por meio da Escala PEDro. Os efeitos da intervenção foram determinados através da diferença de média e do respectivo intervalo de confiança (IC). A análise dos dados foi realizada de maneira descritiva, em virtude da heterogeneidade encontrada entre os estudos. Resultados: Cinco ensaios foram incluídos com um total de 95 indivíduos. A qualidade metodológica dos estudos foi baixa, com uma média de 5.6 na Escala de PEDro. Foram encontrados dois artigos para cada desfecho, e em nenhum deles foi detectada diferença entre o grupo experimental e controle quando levado em consideração o IC. Conclusão: A evidência atual é insuficiente para determinar o uso ou o não uso da MAVBA em com objetivo de melhorar o desempenho esportivo.