Clinical rearfoot and knee static alignment measurements are not associated with patellofemoral pain syndrome / Medidas clínicas estáticas do retropé e joelho não estão associadas à síndrome da dor patelofemoral

The aim of the present study was to investigate the association between the patellofemoral pain syndrome and the clinical static measurements: the rearfoot and the Q angles. The design was a cross-sectional, observational, case-control study. We evaluated 77 adults (both genders), 30 participants with patellofemoral pain syndrome, and 47 controls. We measured the rearfoot and Q angles by photogrammetry. Independent t-tests were used to compare outcome continuous measures between groups. Outcome continuous data were also transformed into categorical clinical classifications, in order to verify their statistical association with the dysfunction, and χ2 tests for multiple responses were used. There were no differences between groups for rearfoot angle [mean differences: 0.2º (95%CI -1.4-1.8)] and Q angle [mean differences: -0.3º (95%CI -3.0-2.4). No associations were found between increased rearfoot valgus [Odds Ratio: 1.29 (95%CI 0.51-3.25)], as well as increased Q angle [Odds Ratio: 0.77 (95%CI 0.31-1.93)] and the patellofemoral pain syndrome occurrence. Although widely used in clinical practice and theoretically thought, it cannot be affirmed that increased rearfoot valgus and increased Q angle, when statically measured in relaxed stance, are associated with patellofemoral pain syndrome (PFPS). These measures may have limited applicability in screening of the PFPS development.

O objetivo deste estudo foi investigar se existe associação entre a síndrome da dor patelofemoral e as medidas clínicas estáticas: os ângulos do retropé e Q. Foi realizado um estudo observacional, transversal, caso-controle, no qual foram avaliados 77 adultos (ambos os sexos), 30 participantes com síndrome da dor patelofemoral e 47 controles. Foram medidos os ângulos do retropé e Q, por meio da fotogrametria. Testes t para amostras independentes foram usados para comparações dos resultados das variáveis contínuas entre os grupos. Os resultados das variáveis contínuas foram transformados em classificações clínicas categóricas, para verificar a associação estatística com a disfunção, e o teste do χ2 para respostas múltiplas também foi utilizado. Não houve diferença entre os grupos para o ângulo do retropé [média da diferença: 0,2º (IC95% -1,4-1,8)] e ângulo Q [média da diferença: -0,3º (IC95%-3,0-2,4). Não houve associação entre o ângulo do retropé [Odds Ratio: 1,29 (IC95% 0,51-3,25)], assim como entre o ângulo Q [Odds Ratio: 0.77 (IC95% 0,31-1,93)] e a ocorrência da síndrome da dor patelofemoral. Apesar de serem teoricamente justificadas e amplamente utilizadas na prática clínica fisioterapêutica, não pode-se afirmar que as medidas dos ângulos do retropé e Q, quando mensuradas em posição ortostática, estão associadas com a ocorrência da síndrome da dor patelofemoral. Essas medidas podem ter aplicabilidade limitada na triagem desta disfunção.

Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

OBJECTIVE: To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF). INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms.

Global body posture evaluation in patients with temporomandibular joint disorder

AIM: To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified. INTRODUCTION: Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint. METHODS: Global posture evaluation was performed in a group of 10 female patients (20 to 30 years of age) with temporomandibular joint disc displacement and in a control group of 16 healthy female volunteers matched for age, weight and height. Anterior disc displacement signs, symptoms and the presence of parafunctional habits were also identified through interview. RESULTS: Patients with disc displacement showed a higher incidence of pain in the temporomandibular joint area, but there were no differences in parafunctional habits between the groups. In the disc displacement group, postural deviations were found in the pelvis (posterior rotation), lumbar spine (hyperlordosis), thoracic spine (rectification), head (deviation to the right) and mandibles (deviation to the left with open mouth). There were no differences in the longitudinal plantar arches between the groups. CONCLUSION: Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.

Alteração do arco longitudinal medial na neuropatia periférica diabética / Medial longitudinal arch change in diabetic peripheral neuropathy

OBJETIVO: Descrever e comparar as características antropométricas dos pés de sujeitos saudáveis e diabéticos neuropatas por meio de índices classificatórios do Arco Longitudinal Medial (ALM): Índice do Arco (IA), Índice de Chippaux-Cmirak (CSI) e Ângulo  (Â) e comparar a classificação destes métodos nestes grupos. MATERIAIS E MÉTODO: Grupo controle (GC) composto por 21 sujeitos saudáveis, e grupo diabético (GD), formado por 46 diabéticos portadores de neuropatia diabética. Pela impressão plantar foram calculados os índices. RESULTADOS: Houve maior proporção de pés planos no GD para os três índices (IA: 32,2 por cento, CSI: 59,7 por cento, A: 17,5 por cento), enquanto os pés cavos comportaram-se de forma contrária. Os grupos foram estatisticamente diferentes em relação à proporção de pés planos no IA (p=0,0080) e no CSI (p=0,0000) e de pés cavos no  (p=0,0036). Houve diferença significativa quando comparados GC e GD para os três índices: IA (p=0,0027), CSI (p=0,0064),  (p=0,0296). CONCLUSÃO: Os dados demonstram alterações motoras e ortopédicas decorrentes da neuropatia periférica, responsável pela desestruturação do pé, levando ao desabamento do ALM. Observou-se que o ângulo A destoou fortemente da classificação do arco feita pelos outros dois índices, e com isso destacamos que sua utilização merece cuidado.

OBJECTIVE: To describe and compare foot anthropometry in healthy and diabetic subjects using Medial Longitudinal Arch (MLA) classificatory indexes: Arch Index (AI), Chippaux-Smirak Index (CSI) and  Angle (Â), as well as to compare the classification of these methods in each group. MATERIALS AND METHODS: Control Group (CG) composed by 21 healthy subjects and Diabetic Group (DG), with 46 diabetic neuropathy subjects. The indexes were calculated from footprints. RESULTS: A larger proportion of flat feet was seen in DG for the three indexes (AI: 32,2 percent, CSI: 59,7 percent, A: 17,5 percent), while highly arched feet acted oppositely. The groups were statistically different for the proportion of flat feet in AI (p=0,0080) and CSI (p=0,0000) and high feet in  (p=0,0036). There were significant differences when compared GC and GD in the three indexes: IA (p=0,0027), CSI (p=0,0064),  (p=0,0296). CONCLUSION: Data showed motor and orthopedic changes originated by peripheral neuropathy, which is responsible for foot changes, causing longitudinal arch crumbling. It was seen that A Angle strongly disagreed when compared with the arch classification made by the other two indexes and therefore, its application needs care.

Mudanças no padrão temporal da EMG de músculos do tornozelo e pé pré e pós-aterrissagem em jogadores de voleibol com instabilidade funcional / Changes in the EMG temporal pattern of pre and post-landing of ankle and foot muscles in volleyball players with functional instability

INTRODUÇÃO: A instabilidade funcional (IF) é a complicação mais comum após o entorse de tornozelo; acomete até 52 por cento dos atletas com história de entorse. O entorse de tornozelo é uma das lesões esportivas mais comuns, inclusive no voleibol, em que 90 por cento dos entorses de tornozelo ocorrem durante a aterrissagem, após o movimento de bloqueio. A IF é definida por queixas de falseios e entorses recorrentes, sem que haja evidências clínicas de lesão ligamentar, sendo extremamente prejudicial para a prática do voleibol, pois interfere na realização dos fundamentos envolvidos na modalidade. OBJETIVOS: Comparar os padrões temporais e de magnitude da atividade eletromiográfica dos músculos tibial anterior (TA), fibular longo (FL) e gastrocnêmio lateral (GL) durante a aterrissagem do salto vertical após a execução da habilidade do bloqueio do voleibol entre jogadores com e sem IF de tornozelo. MÉTODOS: Foi adquirida a atividade EMG do tibial anterior, do fibular longo e do gastrocnêmio lateral em 21 atletas com IF (GI) e em 19 atletas controle (GC) - idade média de 20 ± 4 anos. Os envoltórios lineares foram calculados para cada um dos grupos no período de tempo entre 200ms antes e 200ms após o instante do impacto, determinados por meio da componente vertical da FRS. A magnitude e o instante do pico máximo de cada um dos músculos também foram determinados matematicamente. Os grupos foram comparados por meio do teste t (α = 0,05). RESULTADOS: O grupo com instabilidade apresentou instante de pico do TA mais tardio ± (GC = -107,4 ± 29,6ms; GI = -134,0 ± 26,0ms) e FL (GC = -11,0 ± 55,9ms; GI = -41,7 ± 49,8ms) e menor pico de TA (GC = 68,5 ± 17,2 por cento; GI = 81,2 ± 28,8 por cento) e FL (GC = 72,9 ± 27,3 por cento; GI = 59,1 ± 16,0 por cento), CONCLUSÕES: Os resultados mostram um padrão de alteração mais tardio e com menor magnitude nos músculos de atletas com IF que podem predispô-los à condição de instabilidade, mesmo na ausência...

INTRODUCTION: The ankle sprain is one of the most common injuries in athletes, including volleyball. 90 percent of ankle injuries in volleyball occur during landing after a blocking maneuver. The most common complication following ankle sprains is functional instability (FI), a condition that affect about 52 percent of the patients that suffered an ankle sprains . Functional ankle instability (FI) has been defined as a tendency for the foot to give way after an ankle sprain with no evidence of ligament injury. Hence, FI is an impairing condition for volleyball performance since it interferes in its basic skills. AIMS: The purpose of this study was to compare the EMG activation patterns of tibialis anterior (TA), peroneus longus (PL) and gastrocnemius lateralis (GL) in volleyball players with and without FI during landing after the blocking movement. METHODS: EMG activity was acquired for 21 subjects (mean age 20 ± 4 yrs) with FI (IG) and 19 control ones (CG). Linear envelopes were calculated for both groups for the time period between 200 ms before and 200 ms after the instant of impact, and time and magnitude of peak occurrence were extracted from the envelopes. Groups were compared using T test (α < 0.05). RESULTS: IG subjects showed a later peak occurrence for TA (CG = -107.4 ± 29.6 ms; IG = -134.0 ± 26.0 ms) and PL (CG = -11.0 ± 55.9 ms; IG = -41.7 ± 49.8 ms) and a lower peak magnitude for TA (CG = 68.5 ± 17.2 percent; FIG = 81.2 ± 28.8 percent) and PL (CG = 72.9 ± 27.3 percent; FIG = 59.1 ± 16.0 percent). CONCLUSIONS: These results suggest that individuals with FI present a later and lower activation pattern of muscular activity and different activation magnitudes that predispose them to ankle sprains, even in the absence of an anatomical damage.

Distribuição da pressão plantar: definição, caracterização e aplicações no estudo do movimento humano / Plantar pressure distribution: definition, characterization and applications in human movement studies

Este ensaio discute aspectos históricos, procedimentos de mensuração, sistemas de avaliação e aplicações do estudo das pressões plantares na análise do movimento humano. A mensuração dinâmica das pressões plantares é importante, pois pode revelar a intensidade de estresses normais sobre a planta dos pés em condição de movimento, como a marcha, permitindo prevenção e intervenção sob condições patológicas relacionadas, a fim de recuperar a função biomecânica dos pés. Inicialmente, é apresentada a importância dessas mensurações para o conhecimento da estrutura e função do pé, em seguida, é exibido um histórico das técnicas e uma comparação entre diferentes sistemas comerciais de medição. Por fim, descreve-se a aplicação clínica destas medidas em duas populações, exemplarmente, obesos e diabéticos, incluindo algumas recomendações para futuros estudos.

This review discusses historical aspects, measurement and assessment proceedings, as well as selected applications of the study of plantar pressure distribution in the analysis of human movement. The dynamic measurement of plantar pressure distribution is an important tool for understanding the normal foot loading pattern during locomotion activities, allowing the development of preventive and treatment approaches in order to off-load the foot and to recover its biomechanical function. Initially, the focus on the importance of the pressure distribution knowledge for the understanding of foot structure and function is addressed; next, a historical perspective of the methods and a qualitative analysis of the different commercial systems are presented. Finally, clinical applications are presented in obesity and diabetes treatment, including some recommendations for future studies.

Fisioterapia em pacientes com síndrome fêmoro-patelar: comparação de exercícios em cadeia cinética aberta e fechada / Physical therapy in patellofemoral syndrome patients: comparison of open and closed kinetic chain exercises

Este estudo teve como objetivo comparar a eficácia do fortalecimento muscular na recuperação funcional da síndrome fêmoro-patelar (SFP). Foram selecionadas 20 mulheres com SFP divididas em dois grupos: o Grupo 1 (G1) realizou fortalecimento do músculo quadríceps femoral em cadeia cinética aberta (CCA) e o Grupo 2 (G2) em cadeia cinética fechada (CCF), durante oito semanas com freqüência de duas vezes semanais. Foi avaliada a dor, capacidade funcional, flexibilidade, encurtamento dos músculos isquiotibiais, ângulo Q e eletromiografia (EMG) dos músculos vasto medial (VM) e vasto lateral (VL) durante extensão isométrica da perna. Antes e após o tratamento, as variáveis foram analisadas pelo teste de Wilcoxon, e entre os grupos pelo teste t para amostras independentes ou Anova de Friedman ou Manova (a<0,05). Após o tratamento, os resultados mostram que houve melhora da capacidade funcional, encurtamento dos músculos isquiotibiais e flexibilidade. Porém, somente o G1 apresentou diminuição da intensidade da dor e aumento da atividade EMG do músculo VL, enquanto ambos não modificaram o ângulo Q. Os dados sugerem que os tratamentos baseados no fortalecimento do músculo quadríceps femoral possibilitaram melhoras importantes nos principais sinais e sintomas apresentados pelas pacientes, não havendo diferenças evidentes entre os realizados em CCA e CCF.

The aim of this study was to compare the efficacy of muscular strengthening in the functional recovery of patellofemoral syndrome (PFS) patients. Twenty female patients with PFS were divided into two groups: Group 1 (G1) performing quadriceps femoris strengthening exercises in open kinetic chain (OKC) and Group 2 (G2) in closed kinetic chain (CKC), twice a week for eight weeks. Pain, functional capacity, flexibility, hamstring tightness, Q angle and electromyography (EMG) were measured for vastus medialis (VM) and vastus lateralis (VL) muscles during isometric leg extension. The data obtained before and after treatment were analyzed by Wilcoxon test, and the data between groups by t-test for independent samples or Friedman Anova or Manova (á<0.05). After treatment, the results showed a significant improvement in terms of functional capacity, hamstring tightness and flexibility. However, only G1 showed decreased pain and improved EMG activity of VL muscle, while both groups showed unchanged Q angles. These data suggest that treatments based on exercises for quadriceps femoris strengthening produced improvements on a number of PFS signals and symptoms, with no evidences of differences between OKC and CKC exercises.

Mecanismos de ativação agonista e antagonista no joelho de indivíduos com reconstrução de ligamento cruzado anterior: estudo cinético e eletromiográfico / Mechanisms of agonist and antagonist activation in the knee of individuals with anterior cruciate ligament reconstruction: kinetic and eletromyographic study

OBJETIVO: Avaliar e comparar o torque e a atividade eletromiográfica dos músculos vasto lateral e bíceps femoral durante a extensão e a flexão do joelho em cadeia cinética aberta. MÉTODO: 15 sujeitos do sexo masculino, distribuídos em: cinco no Grupo Teste (GT) (32,2 ± 7,1 anos) com reconstrução do ligamento cruzado anterior via artroscópica (tendão patelar), e dez no Grupo Controle (GC) sem lesão (30,1 ± 10,7 anos). Foi utilizado o Cybex 6000 a 100º.s-1 e eletrodos bipolares diferenciais ativos (Delsys-Bagnoli 8), com a freqüência de amostragem de 1000 Hz e tempo de aquisição de 10 segundos. Foram considerados os valores do Root Mean Square (RMS) e o padrão temporal de ativação dos músculos em função da fase do movimento (envoltório linear). RESULTADOS: O lado lesado apresentou maior pico de torque flexor e menor pico de torque extensor. Maior ativação agonista e menor ativação antagonista para o bíceps femoral e menor ativação agonista para o vasto lateral. Pelo envoltório linear a ativação do vasto lateral no grupo teste foi diminuindo. CONCLUSÃO: Apesar de reabilitados, o membro lesado permaneceu com déficits no torque extensor, apresentando menor, mais precoce e decrescente ativação do músculo vasto lateral e menor ativação antagonista do músculo bíceps femoral, apesar do maior torque flexor e da maior ativação de unidades motoras durante a flexão do joelho. Estes déficits podem explicar algumas queixas clínicas que permaneceram nestes indivíduos.

PURPOSE: To assess and compare torque and electromyographic activity of the vastus lateralis and biceps femoris muscles upon knee extension and flexion in open kinetic chain. METHODS: Fifteen male subjects were distributed in two groups: Test Group (TG) (32.2 ± 7.1 years) composed by five subjects who had previously been submitted to anterior cruciate ligament arthroscopic reconstruction (patellar tendon); and Control Group (CG) (30.1 ± 10.7 years) composed by ten uninjured subjects. Data acquisition was performed using Cybex 6000 at 100º.s-1; 10 seconds of electromyography data were obtained using active differential electrodes (Delsys-Bagnoli 8) at a sample rate of 1000 Hz. Root Mean Square (RMS) values and temporal pattern of muscles activation based on movement phase were considered (linear envelope). RESULTS: Injured legs showed greater flexor peak torque and smaller extension peak torque; greater agonist activation and smaller antagonist activation for the biceps femoris muscle, and smaller agonist activation for the vastus lateralis muscle. Linear envelope showed that test group showed smaller vastus lateralis muscle activation comparing to control group. CONCLUSION: Despite the rehabilitation period, injured legs still showed extensor torque deficit, which may explain the remaining complains presented by anterior cruciate ligament reconstructed subjects.

Desigualdade estrutural discreta de membros inferiores é suficiente para causar alteração cinética na marcha de corredores? / Is structural and mild leg length discrepancy enough to cause a kinetic change in runners' gait?

Desigualdade de membros inferiores (DMI) está presente em cerca de 70 por cento da população geral, podendo ser do tipo estrutural onde existe diferença no comprimento de estruturas ósseas, ou funcional, como resultado de alterações mecânicas dos membros inferiores. A desigualdade pode ainda ser classificada quanto a sua magnitude, sendo discreta, moderada, ou grave. As desigualdades discretas têm sido associadas especificamente à fratura por estresse, dor lombar e osteoartrite, e quando uma desigualdade está presente em indivíduos cuja sobrecarga mecânica é acentuada pela sua prática profissional, diária ou recreativa, estas alterações ortopédicas podem se manifestar precoce e gravemente. O objetivo deste estudo foi analisar e comparar a força reação do solo (FRS) durante a marcha de corredores com e sem DMI discreta. Os resultados mostraram que os sujeitos com desigualdades de 0,5 a 2,0 cm apresentaram no membro menor maiores valores da força vertical mínima (0,57 ± 0,07 PC) em relação ao membro maior (0,56 ± 0,08 PC). Logo, sujeitos com DMI discreta adotam mecanismos compensatórios capazes de gerar sobrecarga adicional ao sistema musculoesquelético para promover uma marcha simétrica como demonstrado pelos valores do Índice de Simetria Absoluto das variáveis da FRS vertical e horizontal.

Leg length discrepancy (LLD) affects about 70 percent of the general population, and can be either structural - when the difference occurs in bone structures - or functional, because of mechanical changes at the lower limbs. The discrepancy can be also classified by its magnitude into mild, intermediate, or severe. Mild LLD has been particularly associated with stress fracture, low back pain and osteoarthritis, and when the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these orthopaedic changes may appear early and severely. The aim of this study was to analyze and compare ground reaction force (GRF) during gait in runners with and without mild LLD. Results showed that subjects with mild LLD of 0.5 to 2.0 cm presented higher values of minimum vertical GRF (0.57 ± 0.07 BW) at the shorter limb compared to the longer limb (0.56 ± 0.08 BW) Therefore, subjects with mild LLD adopt compensatory mechanisms that cause additional overloads to the musculoskeletal system in order to promote a symmetrical gait pattern as showed by the values of absolute symmetric index of vertical and horizontal GRF variables.

Força reação do solo durante a marcha com uso do tênis e sandália plataforma / Ground reaction force during gait with shoes and high-heel sandal

O objetivo deste estudo foi analisar a força reação do solo durante a marcha em cadência auto-selecionada, comparando as características entre a marcha descalça e com o uso de sandálias de salto plataforma e tênis esportivo. A amostra constituiu-se de 8 mulheres com média de idade de 22,9 (4,1) anos. A força reação do dolo foi adquirida com uma plataforma de força da AMTI e analisada no Origin v 6..0. Os resultados demonstraram um aumento do primeiro e do segundo picos verticais de força com o uso de sandália em relação à marcha descalça de 1,09 (0,06) PC para 1,18 (0,07) PC, diminuição do pico passivo de 0,61 (0,12) PC para 0,40 (0,16) PC e sua taxa de crescimento de 33,64 (16,91) PC/s para 16,19 (4,93) PC/s. A taxa de crescimento do primeiro pico de força diminuiu, mas não apresentou diferenças significativas de 7,98 (1,78) PC/s para 7,86 (3,82) PC/s. Essa diminuição das taxas de crescimento e aumento dos picos de força com o uso de sandália sugerem aumento de sobrecarga nas articulações dos membros inferiores, resultado principalmente da rigidez do solado e da instabilidade provocada pela elevação do centro de gravidade, justificando a diminuição de velocidade verificada. A menor magnitude do primeiro pico da FRS vertical de 1,14 (0,05) PC, com a utilização do tênis demonstra que na comparação com a sandália cujo primeiro pico foi de 1,18 (0,07) PC/s, a rigidez do solado é fator determinante para a magnitude desta variável. Esses resultados deveriam ser considerados para o desenvolvimento e a produção de sandálias com salto que promovessem maior conforto aos usuários

The purpose of this study was to analyze the ground reaction force during gait in auto-selected cadence, comparing the characteristic of barefoot gait between wearing of high-heel sandal and the wearing of sport shoes. The sample was constituted with 8 women with average age of 22,9(4,1) years old. The ground reaction force was acquired with a force platform by AMTI and analyzed with the Origin v 6.0. The results showed an increase of the first and second force vertical peaks with the wearing of sandal comparing to barefoot gait of 1,09 (0,06)BW to 1,18(0,07)BW, reduction of passive peak from 0,61(0,12)BW to 0,40(0,16)BW and it’s growth rate from 33,64(16,91)BW/ s to 16,19(4,93)BW/s. The growth rate of the first force peak decreased, but didn’t show significant differences from 7,98 (1,78)BW/s to 7,86 (3,82)BW/s. This reduction of the growth rate and increase of the force peaks on the wearing sandals situation suggests an increase on overload of the lower extremities, mainly caused by rigid-soled and instability generated by gravity center raise, justifying the decrease of speed encountered. The first peak’s minor magnitude of the vertical GRF of 1,14(0,05)BW verified on the sport shoes situation when comparing to the first peak’s when wearing the sandals 1,18(0,07)BW suggests that the rigid-soled is determinant factor for this variable magnitude. These results should be considered for development and production of high-heel sandals that would promote more comfort for the users.

Eficácia de duas técnicas de alongamento muscular no tratamento da síndrome femoropatelar: um estudo comparativo / Efficacy of two muscle stretching modalities in treating the patellofemoral syndrome: a comparative study

Este estudo visou comparar a eficácia do alongamento muscular na recuperação funcional de pacientes com síndrome femoropatelar (SFP). Foram selecionadas 20 mulheres jovens sedentárias com SFP, divididas em dois grupos: o grupo 1 (G1)realizou alongamento dos músculos da cadeia posterior pela técnica de reeducação postural...

The aim of this was to compare the efficacy of muscle stretching exercises on the functional recovery of patients with patellofemoral syndrome. Twenty female young nonathletes with PFS were divided into two groups: group 1 (G1) performed superior chain global...

Ground reaction force in basketball cutting maneuvers with and without ankle bracing and taping

CONTEXT AND OBJECTIVE: In basketball, the most common injuries are ankle sprains. For this reason, players frequently use external ankle devices or taping as prophylactic and rehabilitation measures. The purpose of this study was to evaluate ground reaction force (GRF) responses in basketball players while performing typical cutting maneuvers with and without ankle bracing and ankle taping. DESIGN AND SETTING: Comparative study with experimental design of single-group repeated measurements, at Medical Rehabilitation Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. METHODS: Vertical (Fy) and medial-lateral (Fz) GRF measurements were made under three conditions (taping, Aircast-type orthosis and basketball shoes alone), with analysis of peak forces at foot contact (Fymax1, Fzmax1, Fymax2 and Fzmax2), growth gradient (peak/time) (GG Fymax1, GG Fzmax1, GG Fymax2 and GG Fzmax2) and impulse after foot contact. RESULTS: Bracing significantly reduced Fymax2 and GG Fymax2. GG Fzmax1 was significantly higher for the sport shoe condition than for the taping condition. Taping increased Fy in relation to the sport shoe at foot contact, but over a longer time interval, without increasing excessive ankle loading. Fz reached a peak in less time, which might generate greater inversion/eversion loading on a player's foot. The Aircast exerted better shock-absorbing effect than did the other two conditions, since it generated less vertical force over longer time intervals and smaller medial-lateral forces in relation to taping. CONCLUSIONS: Ankle bracing and ankle taping action mechanisms are still unclear and therefore should be carefully prescribed. More studies are needed to clarify taping and bracing effects on sporting activities.

CONTEXTO E OBJETIVO: A lesão mais comum no basquetebol é a entorse de tornozelo. Assim, os atletas freqüentemente utilizam suportes externos como medidas profiláticas. O objetivo deste estudo é avaliar as respostas da força de reação do solo (FRS) durante a execução do movimento de cutting do basquetebol com e sem acessórios de tornozelo. TIPO DE ESTUDO E LOCAL: Estudo comparativo. Delineamento experimental de grupo único com medidas repetidas; Divisão de Medicina de Reabilitação, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil. MÉTODOS: Foram colhidas as forças vertical (Fy) e médio-lateral (Fz) em três condições (bandagem, Aircast e calçado esportivo) e analisados os picos de força e de propulsão no contato com o solo (Fymax1, Fzmax1, Fymax2 e Fzmax2), o gradiente de crescimento (pico/tempo) (GC Fymax1, GC Fzmax1, GC Fymax2 e GC Fzmax2) e o impulso após o contato. RESULTADOS: Os acessórios reduziram significativamente Fymax2 e GC Fymax2. GC FZmax1 foi maior na situação com tênis quando comparado com bandagem. No momento do impacto, a bandagem aumentou a Fy em relação ao calçado, mas em um intervalo de tempo maior, não aumentando a carga articular. Fz atingiu um pico em menor tempo, podendo gerar maior carga eversora/inversora. O Aircast exerceu um melhor efeito de absorção de impacto, pois gera menor Fy em um maior intervalo de tempo. CONCLUSÕES: Apesar do uso freqüente deste tipo de recurso pelos atletas, seu mecanismo de ação ainda é confuso. Mais estudos são necessários para esclarecer seus efeitos nas atividades esportivas a longo prazo.

Implementing a clinical assessment protocol for sensory and skeletal function in diabetic neuropathy patients at a university hospital in Brazil

CONTEXTO E OBJETIVO: A fisioterapia pode contribuir na recuperação e prevenção nas alterações sensoriais e motoras em pacientes com neuropatia diabética (ND). Este protocolo foi criado e aplicado em diabéticos neuropatas clinicamente diagnosticados, com o objetivo de se avaliar funcionalmente membros inferiores (MMII), para futura indicação de tratamento fisioterapêutico. TIPO DE ESTUDO E LOCAL: Estudo clínico no Hospital Universitário e Centro de Docência e Pesquisa, Universidade de São Paulo.MÉTODOS: Amostragem intencional de diabéticos neuropatas foi utilizada. Protocolo: (1) investigação inicial: identificação de características clínicas relevantes da diabetes e da neuropatia; (2) testes de função muscular, amplitudes articulares, funcionalidade de MMII, antropometria dos pés; (3) avaliação das sensibilidades térmica, tátil e proprioceptiva dos pés. RESULTADOS: A média das idades dos pacientes foi de 57 anos, e eles apresentavam um tempo médio de diagnóstico clínico de diabetes de 13 anos. Adormecimento e agulhadas/formigamento estavam presentes em 62% e 67%, respectivamente. Alterações da sensibilidade tátil nos calcanhares foram percebidas em 50% dos pacientes, e da térmica, em 40% a 60%. As piores respostas dos testes de função muscular foram obtidas nos músculos tríceps sural e intrínsecos do pé. Os arcos longitudinais plantares estavam rebaixados em 50% dos pacientes. Houve redução geral nas amplitudes articulares. CONCLUSÕES: Os resultados possibilitam a caracterização dos pacientes avaliados. Este protocolo pode ser facilmente aplicado nos serviços de saúde, pois requer poucos equipamentos, é de baixo custo e é de fácil entendimento para os pacientes.

Relationship between postural changes and injuries of the locomotor system in indoor soccer athletes

Nowadays, the sport practice has been initiated precociously. These precocious beginning of competitive sports may result in changes on the young athletes' posture alignment, because the child's bone and muscle systems are still developing and these systems are more susceptible to stress and injuries. The purpose of this study was to verify the indoor soccer (Futsal) injuries and the changes of posture alignment in players between 9 to 16 years old. We examined the posture of 50 volunteers young futsal male players, volunteers, from a first division club team. These athletes were divided in two different groups: the group one (G1) was formed by those players who have suffered injuries related to Futsal; and group two (G2) was composed by athletes who did not have injuries related to futsal. First, the athletes or their parents answered a questionnaire about anthropometric characteristics of the subjects, player position, how long they have been practicing Futsal, how often they practiced Futsal and previous injuries related to Futsal practice. Then, we evaluated the postural alignment using an specific protocol to check the postural alterations. Both groups showed changes on the body alignment. The most common changes seen were in ankle and knee in both groups. The changes of the alignment in lumbar spine was more common in group 1. Considering injuries in group 1, the most common injury was in ankle (45.2 percent of all injuries) and the second most common injury was in knee (19 percent of all injuries). Considering the kind of injury, sprain and fracture/dislocate were the two most common (26.2 percent each one) and muscle injury comes in second with 21.4 percent of all kinds of injuries. We could discuss the relationship between the changes of posture alignment and sports injuries, once the changes of posture alignment result in stress in muscle and ligaments and it may result in injuries. We couldn't find a relationship between the cause and the consequence of these factors

Estudo biomecânico comparativo de aspectos cinemáticos do andar de judocas / Study biomechanics the aspect kinematics of judo athletes gait

The main purpose of lhe present study was to analyze the kinematics of judo athletes gait and to compare their kinematic patterns to those of healthy and sedentary subjects. We also described the anthropometric and postural parameters of Judo athletes in order to find a relationship with their sport practice. The Judo group was composed of 5 healthy university athletes (20.7±1.7 years old, 75.6± 15.2 kg, 172.8±9.7cm height and 13±1.9 years of practice). The subjects signed an agreement term and then participated in an experimental protocol which consisted of 4 stages. Initially, they answered a questionnaire regarding their training history and past injuries. In the second stage. anthropometric measures were taken, such as their Cormic Index to obtain important information about the subject proportionality (mean CI.53.6±1.9) and the BMI. Their posture was evaluated by observation in the third stage. The Judo athletes presented their knee varum, trunk rotation and scoliosis. In the last stage, we evaluated gait kinematics using the Motion Analysis System. The subjects were asked to walk naturally along an established route of approximately lO m in length while being filmed by optical-electronic cameras. The joint angles, step and stride length, velocity and temporal aspects during gait were represented as mean and standard deviation. The statistical comparative analysis was done using the t test and lhe level of significance was established by PC< 0.05. The results indicated that there were no signiflcant differences between control and Judo groups considering the linear parameters of the gait. But there were significant differences between groups considering angular aspects of the gait. We also observed higher variability (coefficient of variation) in joint angles during the Judo gait. The data analysis allowed us to suggest that there seems to exist a relationship between Judo athletes posture andtheir gait pattern, highlighted by their kinematic parameters

Biomecânica e ballet clássico: uma avaliação de grandezas dinâmicas do sauté em primeira posição e da posição en pointe em sapatilhas de pontas / Biomechanic and classical ballet: analysis of kinetics variables of saute in first position and en pointe position with pointe shoes

Os movimentos do ballet por vezes envolvem posições articulares extremas e esforços musculares que podem exceder as amplitudes normais de movimento, gerando assim, altos valores de estresse mecânico nos ossos e tecidos moles. O objetivo deste estudo é fazer uma avaliação dinâmica de movimentos selecionados do ballet clássico, com intenção de adequar a metodologia biomecânica de análise à avaliação das sobrecargas inerentes ao treinamento da dança clássica, relacionando os resultados ao problema de lesões nos pés já levantados pela literatura. Um questionário anterior identificou a presença de lesões em bailarinas não profissionais que treinam em pontas. Neste trabalho, Força Reação do Solo (FRS) e pressões plantares foram registradas através de uma plataforma de força Kistler e sensores de pressão Tekscan, respectivamente. Simultaneamente flexão articular do joelho foi observada através de um eletrogoniômetro, afim de assegurar a regularidade dos movimentos...

Características dinâmicas, cinemáticas e eletromiográficas das aterrissagens em situações esperadas e inesperadas / Characteristic dynamics, kinematics and eletromiography of landing in expected and unexpected falls

In order to analyze the mechanisms involved in expected and unexpected falls, parameters related to ground reaction force, electromyographic activity of the lateral vastus and lateral gastrocnemius muscles, and knee joint angular displacement were measured. No significant differences between these two experimental situations were found, except for the magnitude and the time to reach the second vertical force peak. ln unexpected falls there was a higher first vertical force peak (5.18±0.72 BW during unexpected falls; 4.59±0,91 BW during expected falls), less time to reach this first vertical force peak (56.50± 13.05 ms during unexpected falls; 66.10± 19.03 ms during expected falls), and higher vertical force growth rate (107.71±28.04 BW/s during unexpected falls: 86.76±45.07 BW/s during expected falls). Vertical impulses (50 and 75 ms after the contact) were also higher in unexpected falls (50.47±14.80 N.s and 108.21±26.77 N.s during unexpected falis: 41.22±25,60 N.s and 86.95±31.06 N.s during expected falls). Significant differences were found in the time to reach the lateral gastrocnemius maximum peak of activation. These findings suggest that the subjects anticipate lateral gastrocnemius activation during unexpected falls. The knee joint angular displacement did not show any significant differences in both situations. The control mechanisms can be influenced by the expectation factor

Estudo comparativo da força reação do solo, parâmetros temporais e espaciais do andar em esteira rolante entre sujeitos saudáveis e diabéticos neuropatas / The dynamic and temporal responses related to ground reaction force during gait in treadmill between diabetic neuropathic patients and control subjects

The present study aims at describing the dynamic and temporal responses related to ground reaction force during gait in treadmill in two distinct groups: diabetic neuropathic patients and control subjects. We used an instrumented treadmill (Kistler) and its software to obtain temporal, spatial and dynamic parameters during gait. Our findings suggest that the biomechanical locomotor behaviour of the neuropathic subjects is significantly different from the control subjects: lower values of vertical forces, longer temporal parameters and shorter step and stride lengths. These altered biomechanical responses were found bilaterally. They were different from what we expected and found to be related to somatosensorial deficits in neuropathic patients. These findings can indicate that the disease compromises not only the mechanical behavior during gait but also the peripheral control of movement.

Assimetria interlateral da atividade muscular dos membros inferiores no salto vertical / Interlateral asymmetry the activity of lower limb muscular during a vertical jump

It was investigated whether the activity of lower limb musculature shows any interlateral asymmetry during a vertical jump, namely the countermovement and impulsion phase, the flight phase, and the landing phase,were considered. These stages were represented by an initial burst of electromyographic activity, a between-bursts interval, and the first component of a final burst of electromyographic activity. Right-handed volunteers (6 male and 6 female), that practiced exercise irregularly, were tested. Electrodes were fixed over the motor point and a reference point of muscle vastus lateralis and of muscie soleus. These electrodes were connected to a standard electrophysiological recording system. The subjects performed three blocks of 1O lumps each. Individual electromyographic activity was bandpass filtered (30 to 1000 Hz) and sampled at a frequency of 3.12 5 Hz. This activity was subsequently rectified. The duration of each stage of the lump and the magnitude of each burst of activity were evaluated. These data were submitted to an ANOVA and a Newman-Keuls test, with significance level set at 0.05. Only the final burst of electromyographic activity showed interlateral differences. The duration of the first component of this activity was longer on the right side than on the left side for both the vastus lateralis muscle and the soleus muscle. The magnitude of this activity was also larger for the right side than for the left side for the vastus lateralis muscle and the soleus muscle. There is thus an asymmetric pattern of muscle activity in the inferior limb during the landing stage of a vertical jump. The right leg may be more involved in supporting the weight of the body when landing from a jump than the left leg.