Risk of unfavorable pain prognosis impacts walking physiomechanical parameters and psychophysiological workload in sufferers of chronic low back pain.

BACKGROUND: Tolerating physical tasks depends not only on task-specific characteristics but also on an individual's psychophysiological capacity to respond to the imposed load. People suffering from chronic low back pain (CLBP) may experience reduced psychophysiological capacity and are at risk for poor pain prognosis, which could lead to an increased walking workload. AIM: To investigate how the risk of unfavorable pain prognosis in CLBP can impact walking physiomechanical parameters and psychophysiological workload. METHODS: A cross-sectional observational study. The study classified 74 volunteers into four groups based on their prognosis for pain: pain-free control (CG/n = 20), low (LrG/n = 21), medium (MrG/n = 22), and high (HrG/n = 11) risk of poor prognosis for CLBP. The ground assessments identified the self-selected (SSW) and optimal (OWS) walking speeds, as well as the locomotor rehabilitation index (LRI). Treadmill assessments were conducted at two different speeds (0.83 and 1.11 m s-1, SSW and OWS) to record physiomechanical parameters. Psychophysiological workloads during walking were measured via workload impulse for the session (TRIMP), determined by variations in heart rate. RESULTS: CLBP groups exhibited slower SSW and lower LRI compared to the CG. The TRIMP was lower in the LrG. However, both MrG and HrG exhibited a comparable overload to the CG, even while walking at a lower intensity with a psychophysical demand. SSW and OWS displayed an increased TRIMP compared to fixed speeds. CONCLUSION: Psychosocial factors may affect SSW in people with CLBP but not among the risk strata. An unfavorable prognosis for pain could jeopardize the psychophysiological capacity to withstand walking demands.

Efeitos imediatos da terapia auricular em indivíduos hipertensos de uma unidade de pronto atendimento / The immediate effects of auricular therapy in hypertensive individuals at an emergency medical unit

A hipertensão arterial sistêmica (HAS) se caracteriza por níveis elevados de pressão arterial (PA) de maneira contínua. É uma doença de causas multifatoriais, difícil diagnóstico e com altas taxas de mortalidade. Um método com efeito hipotensor rápido é a terapia auricular por sangria, proveniente da Medicina Tradicional Chinesa (MTC). O objetivo deste estudo foi analisar os efeitos imediatos da terapia auricular em indivíduos hipertensos de uma unidade de pronto atendimento da cidade de Cascavel-PR. Para tanto, foi verificada a PA antes do procedimento (PA inicial), e se estivesse ≥ 140/90 mmHg, era realizada a técnica de sangria no ponto Erjian auricular. Dez minutos após, aferia-se novamente a PA (PA final). Os resultados demonstraram redução significativa tanto na PA sistólica (PAS) inicial (157,27 ± 14,49) quando comparada à PAS final (142,97 ± 14,01), quanto na PA diastólica (PAD) inicial (99,83 ± 11,26) em comparação com a PAD final (90,66 ± 8,82). Conclui-se que a sangria no ápice da orelha foi capaz de reduzir significativamente a PA nos indivíduos investigados. Entretanto, tornam-se necessários novos estudos neste sentido, a fim de comprovar os reais benefícios da acupuntura sobre a HAS (AU)

Systemic arterial hypertension (SAH) is characterized by continuously elevated blood pressure (BP) levels. It is a multifactorial disease, difficult to be diagnosed and presents high mortality rates. One method with a rapid hypotensive effect is an auricular bloodletting therapy from Traditional Chinese Medicine. The aim of this study was to analyze the immediate effects of auricular therapy in hypertensive individuals at an Emergency Medical Unit in the city of Cascavel-PR. To do so, the BP was verified before the procedure (initial BP), and if it was within the required criteria, the bloodletting technique was performed at the Erjian auricular point. Ten minutes later, BP was measured (end BP). A significant decrease in the results for initial systolic BP (SBP) (157,27 ± 14,49) compared to end SBP (142,97 ± 14,01), as well as for initial diastolic BP (DBP) (99,83 ±BP11,26) compared to end DBP (90,66 ± 8,82) has been shown. Therefore, it is concluded that the bleeding of ear apex has been able to cut down significantly the BP of the examined individuals. Nevertheless, in order to prove the real benefits of acupuncture on SAH further studies in this respect are necessary (AU)

Correction: Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain.

[This corrects the article DOI: 10.1371/journal.pone.0205553.].

Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain.

The present study aimed at investigating whether the neuromuscular system behaves differently (in terms of force and muscle activity generation) as a function of the task being performed (i.e. maximal voluntary efforts vs stair negotiation) and the presence of patellofemoral pain (PFP) and possible influences of pain intensity. Thirty-eight women with (n = 19) and without PFP (n = 19) had their knee strength (extension joint torque) measured during maximal voluntary isometric contractions (MVIC) and electromyography (EMG) data recorded during both MVIC and stair ascent tasks, which were performed before and after a loading protocol designed to exacerbate pain symptoms. Women with PFP displayed lower levels of vastus medialis (p = 0.002) and vastus lateralis (p = 0.032) EMG activation during MVIC assessments. Conversely, the PFP group showed higher levels of vastus medialis muscle activity during stair climbing (p = 0.007), which happened exclusively after the loading protocol. Similarly, women with PFP displayed lower knee extensor torque only during the MVIC tests performed after the loading protocol, which was moderately correlated with the increase in self-reported pain (p = 0.041, r = 0.37), whereas the changes in EMG activity during stair ascent were not correlated with changes in pain intensity (p = 0.215, r = 0.12). These results suggest that, in comparison to pain-free controls, women with PFP display lower levels of quadriceps EMG activation during maximal contractions, but higher activation during dynamic tasks (stair ascent). In addition, the moderate association between the decrease in knee extensor torque and increase in self-reported pain indicates that care should be taken by clinicians during quadriceps strength evaluation in women with PFP, as misleading outcomes may emerge if the intensity of knee pain is not considered during screening. Additionally, rehabilitation strategies should focus on both restoring neuromuscular control and increasing muscle strength.

Which is the best predictor of excessive hip internal rotation in women with patellofemoral pain: Rearfoot eversion or hip muscle strength? Exploring subgroups.

BACKGROUND: Patellofemoral pain (PFP) has been linked to increased patellofemoral joint stress as a result of excessive hip internal rotation. Lower hip strength and/or excessive rearfoot eversion have been used to explain such altered movement pattern; however, it is unknown which one is the best predictor of excessive hip internal rotation. RESEARCH QUESTION: To investigate if peak rearfoot eversion and/or peak concentric hip abductor strength can predict peak hip internal rotation during stair ascent in women with PFP. METHODS: This cross-sectional study included thirty-seven women with PFP which underwent three-dimensional kinematic analysis during stair ascent and hip abductor strength analysis in an isokinetic dynamometer. A forced entry linear regression model analysis was carried out to determine which independent variables present the best capability to predict the hip internal rotation. RESULTS: Peak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R2 = 0.27, p = 0.001). Peak rearfoot eversion did not predict peak hip internal rotation during stair ascent (R2 < 0.01, p = 0.62). A Post-hoc analysis was conducted to explore if a subgroup with excessive rearfoot eversion would predict hip internal rotation. Based on a previous reported cut-off point, 48.6% of the participants were classified as excessive rearfoot eversion. For the subgroup with excessive rearfoot eversion, peak concentric hip abductor strength and peak rearfoot eversion significantly predicted peak hip internal rotation during stair ascent (R2 = 0.26, p = 0.02; R2 = 0.42, p = 0.003, respectively). For non-excessive rearfoot eversion subgroup, peak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R2 = 0.53; p < 0.001); and peak rearfoot eversion did not (R2 = 0.01; p = 0.65). SIGNIFICANCE: Findings indicate that hip muscle strength seems to be related with hip internal rotation in all women with PFP. Rearfoot eversion seems to be related with hip internal rotation only in a subgroup with excessive rearfoot eversion.

Comparison of the effects of interferential current between male and female healthy adults / Comparação dos efeitos da corrente interferencial entre homens e mulheres saudáveis

AIMS: To assess accommodation phenomena characteristics (threshold, time and amplitude/intensity) during stimulation with interferential current, comparing male and female healthy adults. METHODS: A non randomized clinical trial with intentional sampling by gender included 30 healthy adult volunteers aged between 18 and 25 years, who were divided in two groups (15 in the Female Group and 15 in the Male Group) and received a tetrapolar interferential current for 20 minutes, close to L1 and L5 vertebrae. The subjects were instructed to refer an intense but comfortable paresthesia sensation and to report the moment it diminished (accommodation), requiring increasing of the current intensity. The first three events of accommodation (AV1, AV2 and AV3), including time and amplitude threshold, were analyzed. The differences from AV1 to AV2 (D1) and AV2 to AV3 (D2) were also considered. The number of accommodations for each subject during the 20 minutes experiment was identified. ANOVA and Student's t-test were used for analysis and the significance level was set at 5%. RESULTS: In the Male Group the mean time for accommodation was higher in AV3 compared to AV1 and AV2. In the Female Group the accommodation mean time was higher in AV3 in relation to AV2, and in AV2 in relation to AV1. No differences were found in the Male Group for D1 and D2, but in the Female Group, D2 was superior to D1. Women were accommodated more quickly than men in all three assessments, but the differences between one evaluation and another were constant considering both groups. Both groups showed similar current intensity behavior comparing the three evaluations within the same group. In the comparison between groups, women had lower mean values of intensity in the three evaluations. The Female Group had 7.5±1.5 accommodations, and the Male Group had 5.9±2.0 accommodations (p=0.0367) during the 20 minutes of the experiment. CONCLUSIONS: In this sample of healthy young adults, men required higher interferential current amplitude to obtain a comfortable paresthesia and took more time to have accommodations, while women had more accommodation episodes.

OBJETIVOS: Avaliar características dos fenômenos de acomodação (limiar, tempo e amplitude/intensidade) durante estimulação com corrente interferencial, comparando adultos saudáveis do gênero masculino e feminino. MÉTODOS: Um ensaio clínico não randomizado com amostragem intencional por gênero incluiu 30 voluntários adultos saudáveis com idade entre 18 e 25 anos, que foram divididos em dois grupos (15 no Grupo Feminino e 15 no Grupo Masculino) e receberam uma corrente interferencial tetrapolar por 20 minutos, na altura das vértebras L1 e L5. Os sujeitos foram instruídos a referir uma sensação de parestesia intensa mas confortável e relatar o momento em que ela diminuiu (acomodação), requerendo aumento da intensidade da corrente. Foram analisados os três primeiros fenômenos de acomodação (AV1, AV2 e AV3), incluindo tempo e limiar de amplitude. Foram consideradas também as diferenças entre AV1 e AV2 (D1) e entre AV2 e AV3 (D2). Foi identificado o número total de acomodações para cada sujeito nos 20 minutos do experimento. Para a análise foram usados ANOVA e teste t de Student e o nível de significância foi definido em 5%. RESULTADOS: No Grupo Masculino, o tempo médio para acomodação foi maior em AV3 comparado com AV1 e AV2. No Grupo Feminino, o tempo médio foi maior em AV3 em relação a AV2 e em AV2 em relação a AV1. Não foram encontradas diferenças no Grupo Masculino entre D1 e D2, mas no Grupo Feminino, D2 foi superior a D1. As mulheres apresentaram acomodação mais rapidamente do que os homens em todas as três avaliações, mas as diferenças entre uma avaliação e outra foram constantes considerando os dois grupos. Ambos os grupos apresentaram comportamento semelhante na intensidade da corrente, comparando as três avaliações dentro do mesmo grupo. Na comparação entre os grupos, as mulheres apresentaram valores médios de intensidade mais baixos em todas as três avaliações. O Grupo Feminino apresentou 7,5±1,5 acomodações e o Grupo Masculino 5,9±2,0 acomodações (p=0,0367) durante os 20 min do experimento. CONCLUSÕES: Nesta amostra de jovens adultos saudáveis, os homens necessitaram de corrente interferencial com maior amplitude para obter uma parestesia confortável e demoraram mais tempo para apresentar acomodação, enquanto as mulheres tiveram mais episódios de acomodação.

Efeito da Realidade Virtual no deslocamento do COP de indivíduos com hemiplegia / Effect of Virtual Reality on the COP displacement of individuals with hemiplegia

Introdução: O Traumatismo Cranioencefálico (TCE) é uma das principais causas de incapacidade funcional e alteração motora na população adulta. Objetivo: Avaliar o efeito da terapia com Wii no deslocamento do COP de hemiplégicos devido à sequela TCE. Métodos: Foram realizadas 10 sessões de treinamento com o Nintendo Wii Fit® em 10 indivíduos hemiplégicos pós TCE, do sexo masculino, com média de 31,3 ± 2,9 anos de idade. Os participantes foram avaliados antes, após e 3 meses após o protocolo de treinamento, nas quais mediu-se os dados cinéticos. Resultados: Não foram encontradas diferenças na RMS e velocidade do deslocamento do COP nos sentidos ântero-posterior e médio-lateral dos sujeitos hemiplégicos após as 10 sessões de treinamento com o console Wii. Esses valores se mantiveram após 3 meses. Conclusão: A terapia com o console Wii não alterou o deslocamento do COP nos sentidos ântero-posterior e médio-lateral de indiví-duos com hemiplegia.

Introducion: The Traumatic brain injury (TBI) is a major cause of disability and motor disorders in adults. Objective: To evaluate the effects of Wii rehabilitation therapy on COP displacement of hemiplegic individuals due to traumatic brain injury. Methods: 10 hemiplegic individuals after TBI were recruited for this study. Mean age, height and weight were 31.3 ± 2.9 years, 1.72 ± 0.03 m and 74.5 ± 5.1 kg, respectively. The individuals were evaluated before and after the training protocol and after 3 months again, in which kinetic data of the ground reaction force were measured. Results: There were no significant differences in the anterior-posterior and medio-lateral displacement of hemiplegic subjects after the 10 training sessions with the Wii console and these values remained the same after 3 months. Conclusion: The therapy with the Wii console was unable to alter the COP displacement of individuals with hemiplegia.

Contribution of altered hip, knee and foot kinematics to dynamic postural impairments in females with patellofemoral pain during stair ascent.

BACKGROUND: Altered hip, knee and foot kinematics have been systematically observed in individuals with patellofemoral pain (PFP). However, less attention has been given to the altered dynamic postural control associated with PFP. Additionally, the relative contribution of kinematic impairments to the postural behavior of subjects with PFP remains an open question that warrants investigation. The aims of this study were: i) to investigate possible differences in hip adduction, rearfoot eversion, knee flexion and displacement area of the center of pressure (COP) in individuals with PFP in comparison to controls during stair ascent; and (ii) to determine which kinematic parameter is the best predictor of the displacement area of the COP measured during the stance phase of the stair ascent. METHODS: Twenty-nine females with PFP and 25 asymptomatic pain-free females underwent three-dimensional kinematic and COP analyses during stair ascent. Between-group comparisons were made using independent t-tests. Regression models were performed to identify the capability of each kinematic factor in predicting the displacement area of the COP. RESULTS: Reduced knee flexion and displacement area of the COP as well as increased peak hip adduction and peak rearfoot eversion were observed in individuals with PFP as compared to controls. Peak hip adduction was the best predictor of the displacement area of the COP (r(2)=23.4%). CONCLUSIONS: The excessive hip adduction was the biggest predictor of the displacement area of the COP. CLINICAL RELEVANCE: Based on our findings, proximally targeted interventions may be of major importance for the functional reestablishment of females with PFP.

Time performance and CoP displacement of hemiplegic subjects in a virtual reality game task: short and long-term effects of a training protocol / Desempenho de tempo e deslocamento do centro de pressão em hemiplégicos em uma tarefa de jogo de realidade virtual: efeitos de curto e longo prazo de um protocolo de treinamento / Desempeño de tiempo y desplazamiento del centro de presión en hemipléjicos en una tarea de juego de realidad virtual: efectos de curto y longo plazo de un protocolo de capacitación

ABSTRACT Video games with virtual interaction have been successfully used in physical therapy programs, although there is a lack of knowledge regarding evidence involving clinical results. This study aimed to evaluate learning and some parameters of the center of pressure (COP) displacement of a Nintendo Wii Fit task in hemiplegic and healthy subjects immediately after a rehabilitation training program and after a 3-month washout period. Twenty subjects being 10 hemiplegic and 10 healthy performed three assessments over different periods; Pre, Post and 3-months after rehabilitation training. Participants were positioned on the Wii Balance Board(r). The game task performed (Ski Slalom(r) game) involved mediolateral movements. During the task's execution, the Wii Balance Board(r) was placed on a force plate (AMTI OR-6, USA). As such, COP data displacement could be collected during the game. After the training, the hemiplegic subjects showed no change in COP sway pattern and this condition persisted after three months. However, both groups improved their time performance to finish the task after training and maintained the improvement in performance after 3-months. COP displacement of hemiplegic subjects did not change after training, healthy subjects were able to reduce their mediolateral and anteroposterior COP displacement.

RESUMO Jogos de vídeo game com interação virtual têm sido utilizados com sucesso em programas de tratamento fisioterapêuticos, embora, existam lacunas de conhecimento de evidências com relação a resultados clínicos. Esse estudo teve como objetivo avaliar parâmetros do centro de pressão (COP) e o desempenho em uma tarefa do Nintendo Wii Fit em sujeitos hemiplégicos e saudáveis imediatamente após um programa de treinamento e após um período de 3 meses sem treino. Vinte sujeitos, 10 hemiplégicos e 10 saudáveis foram avaliados em 3 diferentes momentos Pré, Pós e 3 Meses após o treinamento. Os participantes foram posicionados sob a Wii Balance Board(r). O jogo executado (Ski Slalom(r) game) envolvia deslocamento no sentido médio-lateral. Durante a execução, a Wii Balance Board(r) foi colocada sob uma plataforma de força. Então, os dados de deslocamento do COP puderam ser coletados durante a realização do jogo. Após o treinamento, os sujeitos hemiplégicos não alteraram o padrão de deslocamento do COP. Entretanto, ambos os grupos melhoraram o tempo de execução da tarefa e mantiveram a melhora após 3 meses. Apesar disso, os sujeitos hemiplégicos não reduziram o deslocamento do COP e os sujeitos assintomáticos reduziram o deslocamento do COP no sentido mediolateral e anteroposterior.

RESUMEN Se utilizan juegos de videojuego con interacción virtual con suceso en programas de tratamientos terapéuticos, aunque existan déficits de conocimiento de evidencias en relación a resultados clínicos. Este estudio tuvo como objetivo evaluar parámetros del centro de presión (COP) y el desempeño en una tarea del Nintendo Wii Fit en sujetos hemipléjicos y saludables inmediatamente después de un programa de capacitación y después de un período de 3 meses sin entrenamiento. Se evaluaron veinte sujetos, 10 hemipléjicos y 10 saludables, en 3 diferentes momentos: pre, pos y 3 meses después del entrenamiento. Se posicionaron los participantes sobre la Wii Balance Board(r). El juego ejecutado (Ski Slalom(r) game) se trataba del desplazamiento en el sentido medio-lateral. Durante la ejecución, se colocó la Wii Balance Board(r) en una plataforma de fuerza. Entonces, los datos de desplazamiento del COP pudieron ser colectados durante la realización del juego. Después de la capacitación, los sujetos hemipléjicos no alteraron el patrón de desplazamiento del COP. Sin embargo, ambos los grupos mejoraron el tiempo de ejecución de la tarea y mantuvieron la mejora después de 3 meses. A pesar de esto, el desplazamiento del COP de los sujetos hemipléjicos no disminuyó, y los sujetos asintomáticos tuvieron su desplazamiento reducido en el sentido mediolateral y anteroposterior.

Comparison of temporal and kinetic walking parameters among young people and falling and non-falling elderly persons / Comparação de parâmetros temporais e cinéticos da caminhada entre indivíduos jovens, idosas caidoras e não caidoras

Objective : Comparison of the biomechanical parameters (spatiotemporal and kinetic) during walking of young people, falling, and non-falling elderly persons. Methods : A cross-sectional study was performed of 29 individuals divided into three groups: young persons (n=10); falling elderly individuals (n=7) and non-falling individuals (n=12). Gait analysis was performed based on the recording of three walking gait cycles along an 8 meter platform, which was attached to a force plate with a recording frequency of 200 Hz. Gait cycles were also recorded by three video cameras positioned perpendicular to the force plate with a recording frequency of 60 Hz. The data analyzed was: average step velocity, stance time, Froude number and anteroposterior ground reaction force. Results : The average step velocity was higher among young persons and there was no difference in the Froude number among the three groups. During the stance and impulse phase, anterior and posterior force was higher among young persons than in the non-falling elderly group. The foot stance time of young individuals was also lower than the non-falling elderly group (p=0.000) and the foot stance time of the falling elderly group was lower than that of the non-falling elderly group (p=0.004). Conclusion : Falling and non-falling elderly persons have different gait biomechanical characteristics than young women, other than with respect to the Froude number. Furthermore, falling elderly persons spend more time in the gait swing phase than non-falling elderly persons.

Objetivo : Comparar parâmetros biomecânicos espaço-temporais e cinéticos da caminhada de jovens, idosas caidoras e não caidoras. Metodologia : Estudo transversal composto por 29 indivíduos divididos em três grupos: Grupo Jovens (n=10); Grupo Idosas Caidoras (n=7) e Grupo Idosas não Caidoras (n=12). Realizou-se análise biomecânica da marcha por meio da gravação de três ciclos de marcha ao longo de uma passarela de caminhada de 8 metros, na qual havia inserida uma plataforma de força no seu centro com frequência de amostragem de 200 Hz. Os ciclos de marcha também foram gravados por três câmeras de vídeo posicionadas perpendicularmente à plataforma de força com frequência de amostragem de 60 Hz. Os dados analisados foram: velocidade média da passada, tempo de apoio do membro, número de Froude e força anteroposterior de reação do solo. Resultados : A velocidade média foi maior no Grupo Jovens e o número de Froude foi igual entre os três grupos. Durante a fase de apoio, a força no sentido anterior foi maior no Grupo Jovens comparado ao Grupo Idosas não Caidoras, sendo da mesma forma durante a fase de impulso. Também foi encontrado menor tempo de apoio do Grupo Jovens em relação ao Grupo Idosas Caidoras (p=0,000) e menor tempo de apoio do Grupo Idosas Caidoras em relação ao Grupo Idosas não Caidoras (p=0,004). Conclusão : Idosas caidoras e não caidoras apresentam características biomecânicas da marcha diferentes de mulheres jovens, exceto pelo número de Froude. Além disso, idosas caidoras permanecem mais tempo na fase de balanço que idosas não caidoras.

Q-angle static or dynamic measurements, which is the best choice for patellofemoral pain?

BACKGROUND: The elevated Q-angle seems to be one of the most suggested factors contributing to patellofemoral pain. Females with patellofemoral pain are often evaluated through static clinical tests in clinical practice. However, the adaptations seem to appear more frequently in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Therefore, the aim of this study was to determine the reliability and discriminatory capability of three Q-angle measurements: a static clinical test, peak dynamic knee valgus during stair ascent and a static measurement using a three-dimensional system. METHOD: Twenty-nine females with patellofemoral pain and twenty-five pain-free females underwent clinical Q-angle measurement and static and dynamic knee valgus measurements during stair ascent, using a three-dimensional system. All measurements were obtained and comparisons between groups, reliability and discriminatory capability were calculated. FINDINGS: Peak dynamic knee valgus was found to be greater in the patellofemoral pain group. On the other hand, no significant effects were found for static knee valgus or clinical Q-angle measurements between groups. The dynamic variable demonstrated the best discriminatory capability. Low values of reliability were found for clinical Q-angle, in contrast to the high values found for the three-dimensional system measurements. INTERPRETATION: Based on our findings, avoiding or correcting dynamic knee valgus during stair ascent may be an important component of rehabilitation programs in females with patellofemoral pain who demonstrate excessive dynamic knee valgus. Q-angle static measurements were not different between groups and presented poor values of discriminatory capability.

Correlação da força vertical de reação do solo e da velocidade angular do joelho de jovens e idosas durante descida de escada / Correlation between vertical ground reaction force and knee angular velocity of young and elderly individuals during stair descent

Objetivo:Correlacionar a força vertical de reação do solo e da velocidade angular do joelho de jovens e idosas durante descida de escada.Métodos:A amostra foi dividida em dois grupos: Grupo Idosas (GI; n=10) e Grupo Jovens (GJ; n=16). Foi utilizada uma escada de teste composta por sete degraus, onde uma plataforma de força estava acoplada ao quarto degrau para aquisição dos dados cinéticos e determinação do momento de contato do pé com o degrau; também foi usado um sistema de cinemetria tridimensional, com quatro câmeras infravermelhas. As voluntárias desceram os degraus de forma contínua, com velocidade e ritmo autosselecionados. Para comparação dos dados, foi utilizado o teste t Student para amostras independentes e para a correlação das variáveis, o teste de correlação de Pearson, adotando nível de significância α=0,05.Resultados:Os resultados mostraram diferença significativa para a média dos picos das velocidades angulares do joelho, com o GJ apresentando maior pico (240,7±10,5 g/s) comparado ao GI (186,4±13,2 g/s). Em relação ao pico de força vertical (Fz), o GJ obteve maior magnitude de força (1,39±0,03) comparado ao GI (1,15±0,02), apresentando diferença significativa (p=0,00). Os resultados apontaram ainda uma correlação positiva entre as variáveis (r=0,4).Conclusão:Os resultados indicam que idosas apresentam menor velocidade angular de joelho e menor força vertical durante descida de escadas comparadas a jovens, e que há correlação entre as variáveis.

Objective:To analyze the relationship between vertical ground reaction force and knee angular velocity of young and elderly persons during stair descent.Methods:The sample consisted of two groups: the Elderly Group (EG; n=10) and the Young Group (YG; n=16). A ladder test consisting of seven steps, with a force plate coupled to the fourth step to acquire kinetic data and determine the moment of foot contact with the step, was used, as well as a system of three-dimensional kinematics with four infrared cameras. The volunteers descended the stairs continuously, at a self-selected speed and pace. The Student's t-test was used for independent samples and the Pearson correlation test was used to test the correlation of the variables, with a level of significance of α=0.05.Results:The results showed a significant difference between the YG group (240.7±10.5 g/s) and the EG group (186.4±13.2 g/s) for mean peak knee angular velocity. Regarding peak vertical force (Fz), YG had a higher magnitude of force (1.39±0.03) than EG (1.15±0.02), with a significant difference between the groups (p=0.00). The results also showed a positive correlation between variables (r=0.4).Conclusion:The results indicate that elderly persons have a lower knee angular velocity and lower vertical force during stair descent than young people and that there was a correlation between the variables.

Ângulo Q e pronação subtalar não são bons preditores de dor e função em indivíduos com síndrome da dor femoropatelar / Ángulo Q y pronación subtalar no son buenos predictores del dolor y función en individuos con síndrome de dolor femoropatelar / Q angle and subtalar pronation are not good predictors of pain and function in individuals with patellofemoral pain syndrome

RESUMO Este estudo teve como objetivo avaliar a capacidade dos testes clínicos de mensuração do ângulo Q e pronação subtalar em predizer a dor e as limitações funcionais referidas por indivíduos com Síndrome da Dor Femoropatelar (SDFP). Trinta e um indivíduos com SDFP foram recrutados para este estudo. O questionário Anterior Knee Pain Scale foi utilizado para identificar as limitações funcionais, e a Escala Visual Analógica de dor para a dor vivenciada por esses indivíduos referente ao último mês. Foram realizados dois testes clínicos estáticos, mensuração do ângulo Q e mensuração da postura da pronação subtalar. Os valores dos testes foram inseridos em modelos de regressão linear e múltipla para a obtenção do R2 e dos coeficientes de regressão para medidas não contínuas padronizadas com o nível de significância estabelecido em α=0,05. Ambos os testes, quando inseridos isoladamente em modelos de regressão lineares, obtiveram resultados baixos de predição de dor e função. Por outro lado, quando inseridos conjuntamente em modelos de regressão múltipla, os testes explicaram 9% e 4% da dor e das limitações funcionais de indivíduos com SDFP, respectivamente. Embora tenha sido observada melhora da predição da dor e limitação funcional quando os testes foram avaliados em conjunto, os achados deste estudo mostram que ambas as medidas - ângulo Q e pronação subtalar - não são bons preditores de dor e limitações funcionais de indivíduos com SDFP.a prática do método Pilates, houve melhora na atividade física de lazer, mobilidade toracoabdominal, força muscular respiratória e redução da circunferência da cintura. No entanto, em comparação com o Grupo Controle, o método Pilates não promoveu alterações relevantes na função pulmonar, mobilidade toracoabdominal, força muscular respiratória e características antropométricas de mulheres saudáveis que não realizaram programa de exercício físico.

RESUMEN El objetivo de este estudio fue evaluar la capacidad de de las pruebas clínicas de medición del ángulo Q y pronación subtalar en predecir el dolor y las limitaciones funcionales mencionados por individuos con Síndrome de Dolor Femoropatelar (SDFP). Treinta y un individuos con SDFP fueron reclutados para este estudio. El cuestionario Anterior Knee Pain Scale fue utilizado para identificar las limitaciones funcionales; mientras la Escala Visual Analógica del dolor para identificar el dolor experimentado por los individuos en el último mes. Se realizaron dos ensayos clínicos estadísticos, medición del ángulo Q y medición de la postura de la pronación subtalar. Los valores de las pruebas fueron insertados en modelos de regresión linear y múltiple para obtener el R2 y los coeficientes de regresión para medidas no continuas estandarizadas con el nivel de significancia establecido en α=0,05. Ambas pruebas cuando insertadas aisladamente en modelos de regresión lineares obtuvieron resultados bajos de predicción de dolor y función. Por otro lado, cuando insertados en modelos de regresión múltiple, los ensayos explicaron el 9% y 4% del dolor y de las limitaciones funcionales de individuos con SDFP, respectivamente. Aunque hubo mejora de la predicción del dolor y de la limitación funcional cuando las pruebas se evaluaron juntas, los resultados de este estudio muestran que ambas las medidas, el ángulo Q y la pronación subtalar, no son buenos predictores del dolor y de las limitaciones funcionales de individuos con SDFP.

ABSTRACT This study aimed to evaluate the clinical trials' ability in Q angle measurement and subtalar pronation to predict the pain and functional limitations alluded by individuals with Patellofemoral Pain Syndrome (PFPS). Thirty-one individuals with PFPS were recruited for this study. The Anterior Knee Pain Scale questionnaire was used to identify the functional limitations and the Visual Analogue Scale of pain was used to identify the pain experienced by these individuals in the last month. Two clinical trials were performed, measurement of Q angle and posture measurement of the subtalar pronation. The values of the tests were inserted into linear and multiple regression models to obtain the R2and the coefficients of regression for non-continuous measures standardized with the significance level established at α = 0.05. Both tests when placed separately in linear regression models obtained low results for predicting pain and function. On the other hand, when inserted together in multiple regression models the tests explained 9% and 4% of the pain and of the functional limitations of individuals with PFPS, respectively. Although the prediction of pain and functional limitations has improved when the tests were evaluated together, our findings show that both measures, Q angle and subtalar pronation, are not good predictors of pain and functional limitations of individuals with PFPS.

Neuromuscular efficiency of the vastus lateralis and biceps femoris muscles in individuals with anterior cruciate ligament injuries.

OBJECTIVE: To analyze strength and integrated electromyography (IEMG) data in order to determine the neuromuscular efficiency (NME) of the vastus lateralis (VL) and biceps femoris (BF) muscles in patients with anterior cruciate ligament (ACL) injuries, during the preoperative and postoperative periods; and to compare the injured limb at these two times, using the non-operated limb as a control. METHODS: EMG data and BF and VL strength data were collected during three maximum isometric contractions in knee flexion and extension movements. The assessment protocol was applied before the operation and two months after the operation, and the NME of the BF and VL muscles was obtained. RESULTS: There was no difference in the NME of the VL muscle from before to after the operation. On the other hand, the NME of the BF in the non-operated limb was found to have increased, two months after the surgery. CONCLUSIONS: The NME provides a good estimate of muscle function because it is directly related to muscle strength and capacity for activation. However, the results indicated that two months after the ACL reconstruction procedure, at the time when loading in the open kinetic chain within rehabilitation protocols is usually started, the neuromuscular efficiency of the VL and BF had still not been reestablished.

OBJETIVO: Analisar a força e a integral da eletromiografia (IEMG) para obter a eficiência neuromuscular (ENM) dos músculos vasto lateral (VL) e bíceps femoral (BF) em pacientes com lesão de ligamento cruzado anterior (LCA) nas fases pré-operatória e pós-operatória, comparar o membro lesionado nos dois momentos e usar o membro não cirúrgico como controle. MÉTODOS: Foi feita a coleta de dados da EMG e da força de BF e VL durante três contrações isométricas máximas nos movimentos de flexão e extensão do joelho. O protocolo de avaliação foi aplicado nos momentos pré e pós-operatório (dois meses após a cirurgia) e obteve-se a ENM dos músculos VL e BF. RESULTADOS: Não foi encontrada diferença na ENM do músculo VL entre os momentos pré e pós-cirúrgico. Por outro lado, houve aumento da ENM do BF no membro não cirúrgico dois meses após a cirurgia. CONCLUSÕES: A ENM fornece boa estimativa da função muscular por estar diretamente relacionada à força e à capacidade de ativação dos músculos. Entretanto, os resultados apontam que dois meses após o procedimento de reconstrução do LCA, quando normalmente são iniciadas cargas em cadeia cinética aberta nos protocolos de reabilitação, a eficiência neuromuscular do VL e BF ainda não está restabelecida.

Reduced knee flexion is a possible cause of increased loading rates in individuals with patellofemoral pain.

BACKGROUND: Stair ascent is an activity that exacerbates symptoms of individuals with patellofemoral pain. The discomfort associated with this activity usually results in gait modification such as reduced knee flexion in an attempt to reduce pain. Although such compensatory strategy is a logical approach to decrease pain, it also reduces the normal active shock absorption increasing loading rates and may lead to deleterious and degenerative changes of the knee joint. Thus, the aims of this study were (i) to investigate whether there is reduced knee flexion in adults with PFP compared to healthy controls; and (ii) to analyze loading rates in these subjects, during stair climbing. METHOD: Twenty-nine individuals with patellofemoral pain and twenty-five control individuals (18-30 years) participated in this study. Each subject underwent three-dimensional kinematic and kinetic analyses during stair climbing on two separate days. Between-groups analyses of variance were performed to identify differences in peak knee flexion and loading rates. Intraclass correlation coefficient was performed to verify the reliability of the variables. FINDINGS: On both days, the patellofemoral pain group demonstrated significantly reduced peak knee flexion and increased loading rates. In addition, the two variables obtained high to very high reliability. INTERPRETATION: Reduced knee flexion during stair climbing as a strategy to avoid anterior knee pain does not seem to be healthy for lower limb mechanical distributions. Repeated loading at higher loading rates may be damaging to lower limb joints.

Ângulo Q e pronação subtalar não são bons preditores de dor e função em indivíduos com síndrome da dor femoropatelar / No son buenos indicadores de dolor y de limitaciones funcionales el ángulo Q y la pronación subastragalina en los sujetos con síndrome de dolor patelofemoral / Q angle and subtalar pronation are not good predictors for pain and function in subjects with patellofemoral pain syndrome

Este estudo teve como objetivo avaliar a capacidade dos testes clínicos de mensuração do ângulo Q e pronação subtalar em predizer a dor e as limitações funcionais referidas por indivíduos com Síndrome da Dor Femoropatelar (SDFP). 31 indivíduos com SDFP foram recrutados para este estudo. O questionário Anterior Knee Pain Scale foi utilizado para identificar as limitações funcionais, e a Escala Visual Analógica de dor foi utilizada para identificar a dor vivenciada por esses indivíduos referente ao último mês. Foram realizados dois testes clínicos estáticos, mensuração do ângulo Q e mensuração da postura da pronação subtalar. Os valores dos testes foram inseridos em modelos de regressão linear e múltipla para a obtenção do R2 e dos coeficientes de regressão para medidas não contínuas padronizadas com o nível de significância estabelecido em α=0,05. Ambos os testes quando inseridos isoladamente em modelos de regressão lineares obtiveram resultados baixos de predição de dor e função. Por outro lado, quando inseridos conjuntamente em modelos de regressão múltipla, os testes explicaram 9% e 4% da dor e das limitações funcionais de indivíduos com SDFP, respectivamente. Embora houve melhora da predição da dor e limitação funcional quando os testes foram avaliados em conjunto, as descobertas deste estudo mostram que ambas as medidas, ângulo Q e pronação subtalar, não são bons preditores de dor e limitações funcionais de indivíduos com SDFP.

En este estudio se buscó evaluar la capacidad de las pruebas clínicas de mediciones del ángulo Q y de la pronación subastragalina como indicadores del dolor y de las limitaciones funcionales en los sujetos con Síndrome de Dolor Patelofemoral (SDFP). A los 31 participantes con SDFP del estudio se les aplicaron el cuestionario Anterior Knee Pain Scale para identificar las limitaciones funcionales y la Escala Visual Analógica para medir el dolor sentido por ellos en el último mes. Se realizó dos pruebas clínicas estáticas, la medición del ángulo Q y la de postura de pronación subastragalina. Los valores de las pruebas se insertaron en los modelos de regresión lineal y múltiple para la obtención del R2 y de los coeficientes de regresión de las medidas no constantes con el nivel estándar de significancia de un α=0,05. Ambas pruebas fueron insertadas separadamente en los modelos de regresión lineales y resultaron en índices bajos de dolor y función. En cambio, cuando insertadas juntas a los modelos de regresión múltiple, mostraron un 9% y un 4% de los dolores y de las limitaciones de los sujetos con SDFP, respectivamente. Aunque haya demostrado esta mejora, los resultados de este estudio llaman la atención para las dos medidas, la del ángulo Q y la de la pronación subastragalina, que no son buenos indicadores del dolor y de las limitaciones funcionales en los sujetos con SDFP.

The aim of this study was to evaluate the capability of Q angle and subtalar pronation clinical tests in predict pain and functional limitations reported by individuals with patellofemoral pain syndrome (PFPS). 31 individuals with PFPS were recruited for this study. The Anterior Knee Pain Scale questionnaire was applied to identify the functional limitations and the Visual Analogue Scale was used to identify the pain referred during the last month. Two clinical tests were performed in order to obtain the Q angle and subtalar pronation measurements. The values ​​of the tests were entered in a multiple and linear regression models to obtain the R2 and the regression coefficients for non-continuous standardized measures, with a statistical significance set at α=0.05. Both tests, when entered separately into the linear regression models achieved low values of pain and function prediction. On the other hand, when placed together in a multiple regression model, the tests explained 9% and 4% of the pain and functional limitations of the individuals with PFPS, respectively. Although there was an improvement in the pain and function limitation prediction when the tests were analyzed together, our findings showed that both measurement, Q angle and subtalar pronation, are not good predictors of pain and functional limitations of individuals with PFPS.

Reliability of electromyography parameters during stair deambulation in patellofemoral pain syndrome / Reprodutibilidade de parâmetros eletromiográficos durante a subida e descida de escada na síndrome da dor femoropatelar / Reproducibilidad de los parámetros electromiográficos durante ascenso y descenso de escaleras en la síndrome de dolor patelofemoral

Reliability is essential to all aspects of the measure, as it shows the quality of the information and allows rational conclusions with regard to the data. There has been controversial results regarding the reliability of electromyographic parameters assessed during stair ascent and descent in individuals with patellofemoral pain syndrome (PFPS). Therefore, this study aims to determine the reliability of time and frequency domain electromyographic parameters on both gestures in women with PFPS. Thirty-one women with PFPS were selected to participate in this study. Data from vastus lateralis and medialis were collected during stair deambulation. The selected parameters were: automatic onset, median frequency bands of low, medium and high frequency. Reliability was determined by intraclass correlation coefficient and the standard error of measurement. The frequency domain variables have shown good reliability, with the stair ascent presenting the best rates. On the other hand, onset has proved to be inconsistent in all measures. Our findings suggest that stair ascent is more reliable than stair descent to evaluate subjects with PFPS in the most cases.

A reprodutibilidade é essencial para todos os aspectos da medida, uma vez que mostra a qualidade da informação e permite conclusões racionais no que diz respeito aos dados. Além disso, os resultados são controversos sobre parâmetros eletromiográficos avaliados durante a subida e descida de escada em indivíduos com síndrome da dor femoropatelar (SDFP). Portanto pretende-se determinar a reprodutibilidade de parâmetros eletromiográficos nos domínios do tempo e da frequência em ambos os gestos em mulheres com SDFP. Foram selecionadas 31 mulheres com SDFP. Os dados dos músculos vasto lateral e vasto medial foram coletados durante a subida e a descida de escada. Os parâmetros selecionados foram: o onset automático, frequência mediana, bandas de baixa, média e alta frequência. Determinou-se a reprodutibilidade através do coeficiente de correlação intraclasse e do erro padrão da medida. As variáveis no domínio da frequência apresentaram boa reprodutibilidade, com a subida apresentando os melhores índices, e o onset mostrou-se inconsistente. Os resultados sugerem que a subida de escada é mais confiável do que a descida da escada para avaliar indivíduos com SDPF na maioria dos casos.

La reproducibilidad es esencial para todos los aspectos de la medida, ya que muestra la calidad de la información y permite conclusiones racionales con respecto a los datos. Además, los resultados son controvertidos en parámetros electromiográficos evaluados durante el ascenso y descenso escaleras en las personas con síndrome de dolor patelofemoral (SDPF). Por eso tenemos la intención de determinar la reproducibilidad de los parámetros electromiográficos en el tiempo y la frecuencia en ambos gestos en mujeres con SDPF. 31 mujeres com SDPF fueron seleccionadas. Se recogieron datos del vasto lateral y medial durante ascenso y descenso de escaleras. Los parámetros seleccionados fueron: inicio automático, frecuencia mediana, bandas de baja, media y alta frecuencia. La reproducibilidad se determinó mediante el coeficiente de correlación intraclase y el error estándar de medición. Las variables en el dominio de la frecuencia mostraron buena reproducibilidad, el ascenso presentó lós mejores índices, y el inicio demostró ser inconsistente. Estos resultados sugieren que el ascenso de la escalera es más confiable que el descenso para evaluar individuos con SDPF en la mayoría de los casos.

Neuromuscular efficiency of the vastus lateralis and biceps femoris muscles in individuals with anterior cruciate ligament injuries / Eficiência neuromuscular dos músculos vasto lateral e bíceps femoral em indivíduos com lesão de ligamento cruzado anterior

OBJECTIVE: To analyze strength and integrated electromyography (IEMG) data in order to determine the neuromuscular efficiency (NME) of the vastus lateralis (VL) and biceps femoris (BF) muscles in patients with anterior cruciate ligament (ACL) injuries, during the preoperative and postoperative periods; and to compare the injured limb at these two times, using the non-operated limb as a control. METHODS: EMG data and BF and VL strength data were collected during three maximum isometric contractions in knee flexion and extension movements. The assessment protocol was applied before the operation and two months after the operation, and the NME of the BF and VL muscles was obtained. RESULTS: There was no difference in the NME of the VL muscle from before to after the operation. On the other hand, the NME of the BF in the non-operated limb was found to have increased, two months after the surgery. CONCLUSIONS: The NME provides a good estimate of muscle function because it is directly related to muscle strength and capacity for activation. However, the results indicated that two months after the ACL reconstruction procedure, at the time when loading in the open kinetic chain within rehabilitation protocols is usually started, the neuromuscular efficiency of the VL and BF had still not been reestablished. .

OBJETIVO: Analisar a força e a integral da eletromiografia (IEMG) para obter a eficiência neuromuscular (ENM) dos músculos vasto lateral (VL) e bíceps femoral (BF) em pacientes com lesão de ligamento cruzado anterior (LCA) nas fases pré-operatória e pós-operatória, comparar o membro lesionado nos dois momentos e usar o membro não cirúrgico como controle. MÉTODOS: Foi feita a coleta de dados da EMG e da força de BF e VL durante três contrações isométricas máximas nos movimentos de flexão e extensão do joelho. O protocolo de avaliação foi aplicado nos momentos pré e pós-operatório (dois meses após a cirurgia) e obteve-se a ENM dos músculos VL e BF. RESULTADOS: Não foi encontrada diferença na ENM do músculo VL entre os momentos pré e pós-cirúrgico. Por outro lado, houve aumento da ENM do BF no membro não cirúrgico dois meses após a cirurgia. CONCLUSÕES: A ENM fornece boa estimativa da função muscular por estar diretamente relacionada à força e à capacidade de ativação dos músculos. Entretanto, os resultados apontam que dois meses após o procedimento de reconstrução do LCA, quando normalmente são iniciadas cargas em cadeia cinética aberta nos protocolos de reabilitação, a eficiência neuromuscular do VL e BF ainda não está restabelecida. .

Reliability and differentiation capability of dynamic and static kinematic measurements of rearfoot eversion in patellofemoral pain.

BACKGROUND: Excessive rearfoot eversion is thought to be a risk factor for patellofemoral pain development, due to the kinesiological relationship with ascendant adaptations. Individuals with patellofemoral pain are often diagnosed through static clinical tests, in scientific studies and clinical practice. However, the adaptations seem to appear in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Thus, the aim of this study was to determine the reliability and differentiation capability of three rearfoot eversion measures: rearfoot range of motion, static clinical test and static measurement using a three-dimensional system. METHOD: A total of 29 individuals with patellofemoral pain and 25 control individuals (18-30 years) participated in this study. Each subject underwent three-dimensional motion analysis during stair climbing and static clinical tests. Intraclass correlation coefficient and standard error measurements were performed to verify the reliability of the variables and receiver operating characteristic curves to show the diagnostic accuracy of each variable. In addition, analyses of variance were performed to identify differences between groups. FINDINGS: Rearfoot range of motion demonstrated higher diagnostic accuracy (an area under the curve score of 0.72) than static measures and was able to differentiate the groups. Only the static clinical test presented poor and moderate reliability. Other variables presented high to very high values. INTERPRETATION: Rearfoot range of motion was the variable that presented the best results in terms of reliability and differentiation capability. Static variables do not seem to be related to patellofemoral pain and have low accuracy values.

Comparison of frequency and time domain electromyography parameters in women with patellofemoral pain.

BACKGROUND: Despite its high incidence, patellofemoral pain etiology remains unclear. No prior study has compared surface electromyography frequency domain parameters and surface electromyography time domain variables, which have been used as a classic analysis of patellofemoral pain. METHODS: Thirty one women with patellofemoral pain and twenty eight pain-free women were recruited. Each participant was asked to descend a seven step staircase and data from five successful trials were collected. During the task, the vastus medialis and vastus lateralis muscle activities were monitored by surface electromyography. The data were processed and analyzed in four variables of the frequency domain (median frequency, low, medium and high frequency bands) and three time domain variables (Automatic, Cross-correlation and Visual Onset between the vastus medialis and vastus lateralis muscles). Reliability, Receiver Operating Characteristic curves and regression models were performed. FINDINGS: The medium frequency band was the most reliable variable and different between the groups for both muscles, also demonstrated the best values of sensitivity and sensibility, 72% and 69% for the vastus medialis and 68% and 62% for the vastus lateralis, respectively. The frequency variables predicted the pain of individuals with patellofemoral pain, 26% for the vastus medialis and 20% for the vastus lateralis, being better than the time variables, which achieved only 7%. INTERPRETATION: The frequency domain parameters presented greater reliability, diagnostic accuracy and capacity to predict pain than the time domain variables during stair descent and might be a useful tool to diagnose individuals with patellofemoral pain.