EXERCISES AND NEUROMUSCULAR ELECTRIC STIMULATION FOR MEDIAL LONGITUDINAL ARCH: CLINICAL TRIAL.

Objective: The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch. Methods: This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period. Results: No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle. Conclusion: NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.

Objetivo: Os músculos extrínsecos, como o tibial posterior e flexor longo do hálux e os intrínsecos do pé fazem parte do subsistema ativo do foot core system e exercem papel essencial no controle do arco longitudinal medial. Devido à dificuldade na contração desses músculos, a eletroestimulação neuromuscular (EENM) torna-se um recurso aliado ao fortalecimento e é recomendada para reabilitação. O objetivo desse trabalho é avaliar a eficácia da EENM associada ao exercício na deformação do arco longitudinal medial. Métodos: Este é um ensaio clínico randomizado cego. 60 participantes assintomáticos foram divididos em três grupos: EENM, exercício e controle. O grupo EENM e exercício realizaram sete exercícios para os músculos intrínsecos e extrínsecos duas vezes por semana por seis semanas, sendo o grupo EENM utilizou a EENM associada a cinco exercícios. A altura do navicular e o ângulo do arco longitudinal medial foram medidos antes e após o período de intervenção. Resultados: Não houve diferenças estatisticamente significativas entre os grupos para a altura do navicular e ângulo do arco longitudinal medial. Conclusão: A EENM associada ao exercício não altera as características do arco longitudinal medial em indivíduos assintomáticos. Nível de Evidência I; Estudo Clínico Randomizado.

A influência dos pontos-gatilho latente na lombalgia aguda: um estudo prospectivo longitudinal / Influence of latent trigger points in acute low back pain: a prospective longitudinal study

Pontos-gatilho são nódulos musculares que podem desenvolver dor. A dor lombar é um importante problema de saúde pública e estudos apontam que todas as pessoas que sofrem de dor na coluna apresentam ponto-gatilho. Objetivo: Analisar o nível dor de pacientes com dor lombar aguda que quando assintomáticos apresentava pontos-gatilho latente, comparado com os níveis de dor de pacientes com dor lombar aguda que quando assintomáticos não apresentava pontos-gatilho. Método:96 indivíduos de ambos os sexos entre 18 -60 anos participaram de um estudo transversal com avaliador cego. Foram analisados o nível de dor, função, atividade física, cinesiofobia, algometria e mensurada a força do músculo glúteo máximo e médio do membro dominante e não-dominante, no memento que os participantes estavam assintomáticos e após desenvolverem dor lombar aguda. Para análise estatística consideramos valores de significância igual ou menor que 0,05. Resultados: Foi observado diferenças significativas entre os grupos na intensidade da dor (p=0,01), na funcionalidade (p=0,02), na algometria (p=0,00), na dinamometria do músculo glúteo máximo do membro não-dominante (p=0,05) e da dinamometria do glúteo médio do membro dominante (p=0,01) e não-dominante (p=0,00). Conclusão: Indivíduos assintomáticos com pontos-gatilho latente nos músculos paravertebrais lombares apresentam pior intensidade da dor e outros desfechos quando evoluem dor lombar aguda, comparados com indivíduos que não apresentam pontos-gatilho no momento que estão assintomáticos

Trigger points are muscle nodules that can lead to pain. Low back pain is an important problem of public health and studies point out all the people who suffer from spinal pain present trigger points. Objective: To analyze the pain level of the asymptomatic patients, with acute low back pain, who present latent trigger point, when compared to the pain level of the asymptomatic patients with acute low back pain who did not present latent trigger point. Method:96 individuals of both genres, aged 18 to 60 years took part in a transversal, evaluator-blind study. Level pain, function, physical activity, kynesiophobia, algometer were analyzed and the gluteus maximus and gluteus medius muscles' strength of the dominant limb and non-dominant were measured, at the moment the participants were asymptomatic and after developing acute back low pain. For statistical analysis, we considered significant value ≤ 0.05 Results: It was observed significant differences between the groups in relation to pain intensity (p=0.01), functionality (p=0.02), algometer (p=0.05), gluteus maximus muscle dynamometry of the non-dominant limb (p=0.05) and in the gluteus medius muscle of the dominant limb (p=0.01) and non-dominant (p=0.00). Conclusion: Asymptomatic individuals with latent trigger points in the paravertebral lumber muscles present worse pain intensity and other outcomes when it evolves to acute back pain if compared to individuals who don't present trigger points at the moment they, are considered asymptomatic.

Exercises and neuromuscular electric stimulation for medial longitudinal arch: clinical trial / Exercícios e estimulação elétrica neuromuscular para arco longitudinal medial: ensaio clínico

ABSTRACT Objective The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch. Methods This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period. Results No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle. Conclusion NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.

RESUMO Objetivo Os músculos extrínsecos, como o tibial posterior e flexor longo do hálux e os intrínsecos do pé fazem parte do subsistema ativo do foot core system e exercem papel essencial no controle do arco longitudinal medial. Devido à dificuldade na contração desses músculos, a eletroestimulação neuromuscular (EENM) torna-se um recurso aliado ao fortalecimento e é recomendada para reabilitação. O objetivo desse trabalho é avaliar a eficácia da EENM associada ao exercício na deformação do arco longitudinal medial. Métodos Este é um ensaio clínico randomizado cego. 60 participantes assintomáticos foram divididos em três grupos: EENM, exercício e controle. O grupo EENM e exercício realizaram sete exercícios para os músculos intrínsecos e extrínsecos duas vezes por semana por seis semanas, sendo o grupo EENM utilizou a EENM associada a cinco exercícios. A altura do navicular e o ângulo do arco longitudinal medial foram medidos antes e após o período de intervenção. Resultados Não houve diferenças estatisticamente significativas entre os grupos para a altura do navicular e ângulo do arco longitudinal medial. Conclusão A EENM associada ao exercício não altera as características do arco longitudinal medial em indivíduos assintomáticos. Nível de Evidência I; Estudo Clínico Randomizado.

Tradução, adaptação transcultural e análise das propriedades de medida da versão português ­ brasileiro do questionário Cares Of Older People in Europe Index (COPE Index) / Translation, cross-cultural adaptation and psychometric properties analyses of brazilian version of Cares of Older People in Europe (COPE Index)

Objetivo: Realizar a tradução e adaptação transcultural do COPE Index para o português- brasileiro e analisar as propriedades de medida do questionário em cuidadores de pacientes com deficiência de qualquer idade. Métodos: A primeira etapa foi a tradução e adaptação transcultural do questionário (n= 31). Seguida pela avaliação das propriedades de medida (n= 101). Os participantes foram cuidadores informais de pacientes com deficiência de qualquer idade, atendidos no Serviço de Reabilitação de Fisioterapia Neurofuncional e Musculoesquelética da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP). Os dados foram coletados entre agosto/2018 e dezembro/2019. A análise estatística foi feita pelo software SPSS®, versão 13.0. As entrevistas foram realizadas em três momentos diferentes, e todos responderam o Formulário Demográfico, COPE Index, Burden Interview ­ Zarit e WHOQOL ­ Bref. Resultados: Na primeira etapa, alguns termos foram discutidos na etapa de Comitê de experts, o teste da versão pré-final foi realizado e os participantes não tiveram dúvidas. Na segunda etapa, a consistência interna, medida pelo α de Cronbach, variou entre 0,54 a 0,67, a confiabilidade foi classificada como substancial (ICC= 0,81), os valores de erro de medida nos três domínios foram considerados muito bons, foi encontrada correlação moderada entre o Impacto Negativo e Burden Interview ­ Zarit, o Valor Positivo e Relações Sociais do WHOQOL ­ Bref e Qualidade de Suporte e WHOQOL ­ Bref, e foi encontrado efeito teto no Valor Positivo e Qualidade de Suporte. Conclusão: A tradução e adaptação do COPE Index se mostrou satisfatória, com valores moderados ao avaliar suas propriedades de medida, sugerindo seu uso no auxílio das equipes de saúde.

Objective: To translate and crosscultural adapt the COPE Index to Brazilian's Portuguese and to analyses the measurement properties of the questionnaire among caregivers of disabled people of different ages. Methods: The first step was the translation and cross-cultural adaptation of the questionnaire (n= 31). Followed by the psychometric properties' analyses of the questionnaire (n=101). The participants of all steps were informal caregivers of disabled people of any age, assisted at Physiotherapy Neurofunctional and Musculoskeletal Rehabilitation in Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP). The data were collected between August/2018 and December/2019. The statistical analysis was performed using SPSS® software version 13.0. The interviews were conducted in three different moments, and all the respondents answered the Demographic form, the COPE Index, the Burden Interview ­ Zarit and WHOQOL ­ Bref. Results: In the first step, some of the terms were reviewed at the Expert Committee, the test of the pre-final version was performed, and participants had no doubts. In the following step, the internal consistency, calculated with Cronbach's Alpha coefficient, varied 0,54 to 0,67, the reliability was classified as substantial (ICC=0,81), the error of measurement was considered very good in the three domains, it was observed moderate correlation with Burden Interview ­ Zarit and WHOQOL ­ Bref and ceiling effect was observed in Positive Value and Quality of Support. Conclusion: The translation and adaptation of the COPE Index proved to be satisfactory, with moderate values of the measurement properties, suggesting its use to assist the health practitioners.

SUBTALAR JOINT IN NEUTRAL AND RELAXED POSITIONS FOR EVALUATION OF MEDIAL LONGITUDINAL ARCH.

OBJECTIVE: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. METHODS: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson's test. RESULTS: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). CONCLUSION: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

OBJETIVO: O arco longitudinal medial é a estrutura principal para suporte de carga e absorção de impacto no pé. Medidas para avaliação do arco longitudinal medial, como a altura navicular, o ângulo do arco longitudinal medial e a linha de Feiss devem ser realizadas com a articulação subtalar na posição neutra e relaxada. Este estudo analisou a correlação entre as medidas da articulação subtalar em posições neutra e relaxada durante os testes de avaliação do arco longitudinal medial. MÉTODOS: Neste estudo transversal, 51 voluntários saudáveis (102 pés; 36 mulheres; 28 ± 5 anos, 1,66 ± 0,10 m; 24,5 ± 4,5 kg/m2) tiveram altura navicular, ângulo do arco longitudinal medial e linha de Feiss medida nas posições neutra e relaxada. A correlação entre eles foi avaliada pelo teste de Pearson. RESULTADOS: Houve uma correlação muito forte das medidas de linha de Feiss de 102 pés entre a posição neutra e relaxada (r = 0,81) e uma correlação moderada entre o ângulo do arco longitudinal medial (r = 0,78) e altura navicular nas posições neutra e relaxada (r = 0,76). CONCLUSÃO: As medidas do arco medial longitudinal entre as posições neutra e relaxada estão fortemente correlacionadas. Não é necessário, portanto, medir o arco longitudinal medial nas posições neutra e relaxada. Nível de Evidência II, Estudos diagnósticos - Investigação de um exame para diagnóstico.

Subtalar joint in neutral and relaxed positions for evaluation of medial longitudinal arch / Articulação subtalar em posições neutra e relaxada para avaliação do arco longitudinal medial

ABSTRACT Objective: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. Methods: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson's test. Results: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). Conclusion: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

RESUMO Objetivo: O arco longitudinal medial é a estrutura principal para suporte de carga e absorção de impacto no pé. Medidas para avaliação do arco longitudinal medial, como a altura navicular, o ângulo do arco longitudinal medial e a linha de Feiss devem ser realizadas com a articulação subtalar na posição neutra e relaxada. Este estudo analisou a correlação entre as medidas da articulação subtalar em posições neutra e relaxada durante os testes de avaliação do arco longitudinal medial. Métodos: Neste estudo transversal, 51 voluntários saudáveis (102 pés; 36 mulheres; 28 ± 5 anos, 1,66 ± 0,10 m; 24,5 ± 4,5 kg/m2) tiveram altura navicular, ângulo do arco longitudinal medial e linha de Feiss medida nas posições neutra e relaxada. A correlação entre eles foi avaliada pelo teste de Pearson. Resultados: Houve uma correlação muito forte das medidas de linha de Feiss de 102 pés entre a posição neutra e relaxada (r = 0,81) e uma correlação moderada entre o ângulo do arco longitudinal medial (r = 0,78) e altura navicular nas posições neutra e relaxada (r = 0,76). Conclusão: As medidas do arco medial longitudinal entre as posições neutra e relaxada estão fortemente correlacionadas. Não é necessário, portanto, medir o arco longitudinal medial nas posições neutra e relaxada. Nível de Evidência II, Estudos diagnósticos - Investigação de um exame para diagnóstico.

The Long-Term Prognosis in People With Recent Onset Low Back Pain From Emergency Departments: An Inception Cohort Study.

Most studies investigating the course of recent-onset low back pain (LBP) included patients from primary care. We aimed to describe the prognosis in people with recent-onset LBP presenting to emergency departments (EDs) and to identify prognostic factors for nonrecovery. This inception cohort study with a 1-year follow-up recruited 600 consecutive acute LBP patients presenting to 4 EDs. The outcomes measured the days to recover from pain, recover from disability, return to previous work hours and duties, and complete recovery. Within 12 months, 73% of participants (95% confidence interval [CI] = 69-77) recovered from pain, 86% (95% CI = 82-90) recovered from disability, 79% (95% CI = 71-87) returned to previous work hours and duties, and 70% (95% CI = 66-74) completely recovered. The median recovery times were 67 days (95% CI = 54-80) to recover from pain, 37 days (95% CI = 31-43) to recover from disability, 37 days (95% CI = 25-49) to return to previous work hours and duties, and 70 days (95% CI = 57-83) to recover completely. Higher pain levels, a higher perceived risk of persistent LBP, more days of reduced activity due to LBP, more pain sites, and higher duration of LBP were associated with complete nonrecovery within 6 months. PERSPECTIVE: This information relates to prognosis and to likely recovery times for patients with recent-onset LBP in EDs. The findings also confirm previous factors associated with poor outcomes in patients with recent-onset LBP.

Use of the STarT Back Screening Tool in patients with chronic low back pain receiving physical therapy interventions.

BACKGROUND: The STarT Back Screening Tool (SBST) is used to stratify care. It is unclear if the SBST approach works as well for patients in low- and medium-income countries as for patients from high-income countries. OBJECTIVES: (1) To investigate whether patients with chronic low back pain (LBP) stratified by the SBST are different at baseline; (2) to describe the clinical course for each SBST subgroup; (3) to investigate the SBST utility to predict clinical outcomes; and (4) to determine which SBST subgroup show greater clinical improvement. DESIGN: This is a secondary analysis of data derived from a previously published clinical trial. METHODS: 148 patients with chronic nonspecific LBP were included. Pain intensity, disability, global perceived effect, and the SBST were assessed at baseline and at 5, 12, and 24 weeks after baseline. Descriptive data were provided and ANOVA, unadjusted and adjusted regression models, and linear mixed models were used for data analysis. RESULTS: Duration of symptoms, use of medication, pain, disability, and global perceived effect were different between SBST subgroups. Clinical improvements over a 6-month period were consistently greater in patients classified as high risk. The SBST was able to predict disability but this predictability decreased when the analysis was adjusted for possible confounders. CONCLUSION: Clinical outcomes were different between SBST subgroups over 6 months. Adjusting for confounders influenced the predictability of SBST. Patients classified as high risk presented higher improvements in terms of disability.

Profile of Patients With Acute Low Back Pain Who Sought Emergency Departments: A Cross-sectional Study.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST). SUMMARY OF BACKGROUND DATA: LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries. METHODS: This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire. RESULTS: A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP. CONCLUSION: Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis. LEVEL OF EVIDENCE: 2.

Effects of a Knee Brace With a Patellar Hole Versus Without a Patellar Hole in Patients With Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial.

The objective of this study was to observe the immediate effect of a knee brace with a patellar hole versus without a patellar hole on pain perception in patients with knee osteoarthritis. To accomplish this, a double-blind, randomized controlled trial enrolled 108 patients divided into two groups (knee brace with a patellar hole or without a patellar hole). Patients were evaluated by the Visual Analogue Scale (VAS) in order to measure their pain sensation, the Timed Up and Go (TUG) test was used to evaluate their ability to walk, and the 8-m walking test (8MWT) was used to estimate their walking speed. Both groups presented significant reduction in pain perception, higher function of the lower extremities, and greater mobility while wearing a knee brace. However, the patients who wore a knee brace without a patellar hole presented more favorable results than those who wore a knee brace with a patellar hole: a 1.6-point reduction was found versus 1.1 points in the VAS, the patients presented 0.7 s less time versus 0.4 s in the TUG, and the speed was reduced by 1.4 s versus 0.8 s in the 8MWT. Therefore, the knee brace without a patellar hole presented more favorable results when compared with the knee brace with a patellar hole.

Analgesic efficacy of cerebral and peripheral electrical stimulation in chronic nonspecific low back pain: a randomized, double-blind, factorial clinical trial.

BACKGROUND: Chronic non-specific low back pain is a major socioeconomic public health issue worldwide and, despite the volume of research in the area, it is still a difficult-to-treat condition. The conservative analgesic therapy usually comprises a variety of pharmacological and non-pharmacological strategies, such as transcutaneous electrical nerve stimulation. The neuromatrix pain model and the new findings on the process of chronicity of pain point to a higher effectiveness of treatments that address central rather than peripheral structures. The transcranial direct current stimulation is a noninvasive technique of neuromodulation that has made recent advances in the treatment of chronic pain. The simultaneous combination of these two electrostimulation techniques (cerebral and peripheral) can provide an analgesic effect superior to isolated interventions. However, all the evidence on the analgesic efficacy of these techniques, alone or combined, is still fragmented. This is a protocol for a randomized clinical trial to investigate whether cerebral electrical stimulation combined with peripheral electrical stimulation is more effective in relieving pain than the isolated application of electrical stimulations in patients with chronic nonspecific low back pain. METHODS/DESIGN: Ninety-two patients will be randomized into four groups to receive transcranial direct current stimulation (real/sham) + transcutaneous electrical nerve stimulation (real/sham) for 12 sessions over a period of four weeks. The primary clinical outcome (pain intensity) and the secondary ones (sensory and affective aspects of pain, physical functioning and global perceived effect) will be recorded before treatment, after four weeks, in Month 3 and in Month 6 after randomization. Confounding factors such as anxiety and depression, the patient's satisfaction with treatment and adverse effects will also be listed. Data will be collected by an examiner unaware of (blind to) the treatment allocation. DISCUSSION: The results of this study may assist in clinical decision-making about the combined use of cerebral and peripheral electrical stimulation for pain relief in patients with chronic low back pain. TRIAL REGISTRATION: NCT01896453.

Atuação fisioterapêutica pré-operatória no paciente com miotonia de Thomsen: relato de caso / Performance preoperative physiotherapy in patients with myotonia Thomsen: case report

Introdução: A doença de Thomsen e de Becker são as miotonias congênitas mais prevalentes. De acordo com a literatura atual a sua freqüência é de 1:100000 pessoas, a miotonia de Thomsen é caracterizada por ser uma autossômica dominante e a de Becker é autossômica recessiva. Objetivo: Descrever a intervenção fisioterapêutica pré-operatória no paciente com Miotonia de Thomsen. Relato de caso: Paciente do sexo feminino, DLS, 14 anos de idade, raça branca, natural da cidade de São Paulo, diagnosticada com dois anos de vida como portadora de Miotonia de Thomsen. Acompanhada pelo grupo de coluna da Irmandade Santa casa de Misericórdia de São Paulo, de acordo com o seu crescimento e evolução do quadro álgico e limitações nas atividades de vida diária e foi encaminhada para o grupo de fisioterapia da IMSC-SP. Foi realizada avaliação da amplitude de movimento com flexímetro, aplicação do escore de qualidade de vida SF-36 e avaliação da dor EVA. Resultados: Após 12 sessões de fisioterapia a amplitude de movimento Flexão (95º), Extensão (30º), ambos os ângulos foram mantidos, (EVA=2) e de acordo com o SF-36 a paciente apresentou aumento do escore confirmando a melhora da qualidade de vida. Conclusão: A fisioterapia se mostrou eficaz estabilizando a amplitude de movimento, melhora da dor e qualidade de vida de acordo com o questionário SF-36 estabilizando o quadro clínico necessário para cirurgia.

Introduction: Thomsen's and Becker are the most prevalent congenital myotonias. According to the current literature is the frequency of 1:1000000 people, Thomsen myotonia is characterized as an autosomal dominant and autosomal recessive Becker is. Objective: to describe the prooperative physiotherapeutic inteventions in patients with Myotonia of Thomsen. Case report: A female patient, DLS, 14 years old, born in the city of São Paulo, diagnosed with two years of life as having Myotonia of Thomsen white race. Accompanied by Spine Group of the Santa Casa de Misericórdia de São Paulo, according to their growth and evolution of the hypertonic scenario was diagnosed with postural alteration of neuromuscular scoliosis structural type, developed a strong and painful picture limitations in activities of daily living and was referred to the physiotherapy group of IMSC-SP. Assessment of range of motion with fleximeter, application score the SF-36 and VAS pain evaluation was performed. Results: After 12 sessions of physiotherapy range of flexion (95º), extension (30º), both angles were kept (EVA=2) and move according to the SF-36 the patient had higher scores confirming the improved quality of life. Conclusion: The therapy was effective stabilizing range of motion, pain relief and quality of life according to the SF-36 questionnaire stabilizing the clinical picture needed for surgery.

Utilização do campo eletromagnético na reabilitação / Use of the electromagnetc field in rehabilitation

Objetivos: O objetivo deste estudo foi realizar uma revisão bibliográfica sobre as funções biológicas dos campos eletromagnéticos em diversas patologias. Materiais e métodos: Este trabalho é uma revisão bibliográfica com busca nas base de dados da CAPES, através das seguintes palavras: Campos eletromagnéticos pulsados, patologias musculoesqueléticas e campos magnéticos. Resumo: Os Campos eletromagnéticos pulsados são utilizados desde 850 A.C para tratamento, porém nos últimos 20 anos os mesmos têm sido muito estudados no mundo. Conclusão: Na literatura existe uma grande variedade de trabalhos a respeito do tema, porém com metodologias diferentes, gerando uma gama de diferentes resultados.

Estabilização segmentar cervical: revisão da literatura / Cervical segmental stabilization: literature review

A prevalência de cervicalgia varia de 22% a 30%, indicando que 67% dos indivíduos vão sofrer de dor na cervical em alguma fase da vida. Foi realizada uma revisão de literatura sobre a estabilização cervical, comparando a eficácia do treino de flexão crâniocervical com outras técnicas. Foram pesquisados artigos científicos nas bases de dados SciELO, MEDLINE, LILACS, PubMed e Science Direct com os descritores: Cervicalgia, Atlas Cervical, Whiplash Injuries e Neck Pain no idioma inglês entre os anos 2000-2011. O treino de baixa carga de flexão crâniocervical promove uma melhor funcionalidade e redução da dor nos pacientes com disfunção na musculatura cervical.

Abordagem fisioterapêutica em paralisia facial após carcinoma adenoide cístico: relato de caso / Physiotherapeutic approach in facial paralysis following adenoid cysticcarcinoma: case report

JUSTIFICATIVA E OBJETIVOS: Após busca na literatura, foi observado que a atuação da fisioterapia em indivíduos com paralisia facial (PF) depois de retirada de tumores, não é bem descrita, portanto o objetivo deste estudo foi apresentar os resultados obtidos com um programa de reabilitação fisioterapêutica aplicado a uma paciente portadora de PF após a retirada de tumorcístico de adenoide em órbita esquerda. RELATO DO CASO: Paciente do sexo feminino, 41 anos, diagnosticada com carcinoma adenoide cístico em órbita esquerda, apresentando sinais e sintomas de paralisia do nervo facial. Na avaliação inicial, relatou ter realizado três procedimentos cirúrgicos para ressecção do tumor, retirada do globo ocular esquerdo e parte do osso temporal, porém evoluiu com metástase no sistema linfático e paralisia do nervo facial. Apresentou paralisia e anestesia dos músculos da hemiface esquerda, diminuição da abertura bucal e cicatriz cirúrgica na região lateral esquerda do pescoço estendendo-se a frente do pavilhão auditivo, até o couro cabeludo.Foi então proposto um programa de tratamento fisioterapêutico,com os objetivos de estimular as funções motoras, sensitivas e aumentar a amplitude de movimento (ADM) da abertura bucal. CONCLUSÃO: A abordagem fisioterapêutica associada à ressecção do tumor promoveu melhora clínica quanto à ADM da articulação temporomandibular, sensibilidade da hemiface acometida, bem como aumento de força dos músculos supraciliar e orbicular da boca.

BACKGROUND AND OBJECTIVES: After literature review, we observed that the role of physical therapy in patients with facial paralysis (FP) after tumor removal is not well described; therefore, the objective of this study was to evaluate the results after a physical therapy rehabilitation program applied to a patient with FP following removal of adenoid cystic tumor in the left orbit. CASE REPORT: Female patient, 41 years, diagnosed with adenoidcystic carcinoma in left orbit, with symptoms and signs of facial nerve paralysis. In the first assessment she reported having undergone three surgical procedures for tumor resection, removal of left eyeball and part of the temporal bone, but had metastasis to the lymphatic system, and facial nerve paralysis. She had anesthesia and paralysis of the muscles on the left hemiface, reduced mouth opening, and surgical scar on the left lateral neck extending forward to the ear, up to the scalp. A physical therapy program was proposed with the objective of stimulating motor and sensory functions, and increasing mouth range of motion (ROM). CONCLUSION: Physical therapy approach associated with tumor resection provided clinical improvement of temporomandibular joint ROM, improvement of sensitivity of affected hemiface,as well increased strength of supercilii and orbicular oris muscles.

Disfunção sacro-ilíaca / Sacroiliac dysfunction

Este estudo

Estabilização Segmentar lombar / Lumbar segmental stability

A dor lombar devida à instabilidade do tronco tem se revelado um problemade saúde pública mundial, pois a instabilidade lombar é considerada representante significativa de um subgrupo dentro da população com dores lombares crônicas, programas de exercícios para estabilizaçãodo tronco tem se tornado popular no tratamento das dores e complicações da coluna vertebral. O objetivo deste artigo é discutir os conceitos básicos sobre estabilização segmentar, assim como referências que mostram eficiência da técnica.

Low back pain due to instability ofthe trunk has been a public health problem worldwide, since the lumbar instability is considered as representing a significant subgroup within the population with chronic low back pain, exercise programs for trunk stabilization has become popular in the treatment the pain and complications of the spine. The aim of this paper is to discuss the basics of segmental stabilization, as well as referencesthat show efficiency of the technique.

Tratamento fisioterapêutico na síndrome complexa de dor regional tipo I: relato de caso / Physical therapy treatment for regional pain complex syndrome type I: case report

JUSTIFICATIVA E OBJETIVOS: A síndrome complexa de dor regional do tipo I (SCDR I) geralmente possui tratamento multidisciplinar,porém há uma lacuna na literatura referente ao tratamento fisioterapêutico e a conduta a ser utilizada. Sendo assim,o objetivo deste estudo foi descrever os resultados obtidos com o tratamento fisioterapêutico isoladamente em uma paciente. RELATO DO CASO: Paciente do sexo feminino, 48 anos, diagnosticada com SCDR I, após fratura do quinto metatarso devido a uma entorse de tornozelo, permanecendo com tala suropodália por 12 semanas. Submeteu-se a tratamento fisioterapêutico com mobilização articular, fortalecimento muscular, treino de carga e de controle neuromuscular. Após 13 sessões, ocorreu melhora da maioria dos sinais e sintomas iniciais. CONCLUSÃO: O tratamento fisioterapêutico isoladamente pode proporcionar melhora dos sinais e sintomas da SCDR I,porém, há a necessidade de estudos clínicos aleatórios para obter resultados mais eficazes.

BACKGROUND AND OBJECTIVES: The complex regional pain syndrome type I (CRPS I) has generally multidisciplinary treatment; however there is a gap in the literature related to physioterapy and the approach used. Therefore, the objective is to describe the results obtained with physical therapy treatment alone in one patient. CASE REPORT: Female patient, 48 years, diagnosed with CRPS I after fracture of the fifth metatarsal because of an ankle sprain, staying with short leg splint for 12 weeks. The same was referred to physical therapy, which used joint mobilization, muscles trengthening, weight-bearing and neuromuscular control.After 13 sessions, there was improvement in most of the initial signs and symptoms. CONCLUSION: The physical therapy alone can provide improvement of the signs and symptoms of CRPS I, however, there is a need for randomized clinical trials to obtain more effective results.

Força do manguito rotador em indivíduos com síndrome do impacto comparado ao lado assintomático / Rotator cuff strength in subjects with shoulder impingement syndrome compared with the asymptomatic side

OBJETIVO: Avaliar a força muscular de rotação interna, externa e elevação dos ombros sintomáticos comparado aos assintomáticos, associando a força muscular à função da articulação. MÉTODOS: Quarenta e oito indivíduos com diagnóstico de SIO unilateral foram avaliados quanto a força muscular isométrica do ombro sintomático e assintomático (utilizando um dinamômetro isométrico manual), além de serem avaliados quanto a função utilizando a escala de Constant-Murley. Os indivíduos foram distribuídos em 2 grupos: grupo 1 = 35 a 49 anos; grupo 2 = 50 a 65 anos. RESULTADOS: Foi encontrada redução da força de rotação interna, externa e elevação no ombro sintomático, comparado ao lado assintomáticos (p< 0,0001), mas não foi observada redução da força de rotação medial nos sujeitos do grupo 1. Também observamos que a força muscular é diretamente proporcional a função do ombro, onde indivíduos com pouca força do manguito rotador apresentam menor função. CONCLUSÃO: A SIO causa diminuição da força muscular de rotação interna, externa e elevação comparado ao lado assintomático, além de causar diminuição da função do ombro. A redução da função é proporcional a diminuição da força muscular do manguito rotador. Nível de Evidência III, Estudo analítico.

OBJECTIVE: To evaluate the strength of internal rotation, external rotation and elevation of the shoulders of symptomatic compared with asymptomatic patients, associating muscle strength with joint function. METHODS: Forty-eight individuals diagnosed with unilateral SIS were evaluated in relation to isomeric muscle strength of symptomatic and asymptomatic shoulders (using a hand-held isometric dynamometer), in addition to evaluating function using the Constant-Murley scale. The subjects were divided into 2 groups: group 1 = 35 to 49 years, group 2 = 50 to 65 years. RESULTS: A reduction in strength of internal rotation, external rotation and elevation of the symptomatic shoulder were found, compared with the asymptomatic side (p <0.0001), but there was no reduction in the strength of medial rotation in the subjects of group 1. It was observed that muscle strength is directly proportional to shoulder function, with individuals with little strength of the rotator cuff having less function. CONCLUSION: SIS causes decreased muscle strength of internal rotation, external rotation and elevation compared with the asymptomatic side. It also causes decreased shoulder function. The reduced function is proportional to the decrease in muscle strength of the rotator cuff. Level of evidence: level III, analytical study.

A abordagem fisioterapêutica na disfunção da articulaçãotemporomandibular. Revisão da literatura / The physical therapy approach in temporomandibular joint disorder. Review

A disfunção da articulação temporomandibular é uma das principais causas de dor orofacial. Há alguns anos estudos vem mostrando a atuação da fisioterapia através de diversas abordagens no tratamentoda disfunção temporomandibular (DTM). O objetivo desse trabalho émostrar uma revisão da literatura sobre as técnicas abordagem da fisioterapia na DTM. Conclusão: A literatura mostra a importância da fisioterapia no tratamento da DTM, através de estudos utilizandorecursos da eletroterapia, exercícios, técnicas de liberação miofacial, mobilização e manipulação articular. Algumas técnicas e recursos carecem de maiores estudos para comprovar sua eficácia notratamento da DTM.

The temporomandibular joint dysfunction is major cause orofacial pain.A few years research has shown the performance of physical therapy through various approaches in the treatment of temporomandibular disorders (TMD).The aim of this study is to present aliterature review of the technical approach to therapy in TMD. Conclusion:The literature shows the importanceof physical therapy in the treatment ofTMD, through studies using resourcesof electrotherapy, exercises, myofascialrelease techniques, joint mobilizationand manipulation. Some techniques and resources need more studies to prove its effectiveness in the treatment of TMD.