Comparison of Foot Kinematics and Foot Plantar Area and Pressure Among Five Different Closed Kinematic Tasks.

BACKGROUND: Different closed kinematic tasks may present different magnitudes of knee abduction, foot pronation, and foot plantar pressure and area. Although there are plenty of studies comparing knee abduction between different tasks, the literature lacks information regarding differences in foot pronation and foot plantar pressure and area. We compared foot angular displacement in the frontal plane and foot plantar pressure and area among five closed kinematic tasks. METHODS: Forefoot and rearfoot angular displacement and foot plantar pressure and area were collected in 30 participants while they performed the following tasks: stair descent, single-leg step down, single-leg squat, single-leg landing, and drop vertical jump. Repeated-measures analyses of variance were used to investigate differences between tasks with α = 0.05. RESULTS: Single-leg squat and stair descent had increased foot total plantar area compared with single-leg landing (P = .005 versus .027; effect size [ES] = 0.66), drop vertical jump (P = .001 versus P = .001; ES = 0.38), and single-leg step down (P = .01 versus P = .007; ES = 0.43). Single-leg landing and single-leg step down had greater foot total plantar area compared with drop vertical jump (P = .026 versus P = .014; ES = 0.54). There were differences also in rearfoot and midfoot plantar area and pressure and forefoot plantar pressure. CONCLUSIONS: Differences in foot-striking pattern, magnitude of ground reaction force, and task speed might explain these findings. Clinicians should consider these findings to improve decisions about tasks used during rehabilitation of patients with foot conditions.

Comparison of Hip and Lumbopelvic Performance Between Chronic Low Back Pain Patients Suited for the Functional Optimization Approach and Healthy Controls.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: We explored the differences between chronic low back pain (CLBP) patients suited for the functional optimization approach and healthy controls in isometric hip-strength and lumbar-endurance tests and determined classificatory cutoff values for strength and endurance tests and ratios. SUMMARY OF BACKGROUND DATA: To optimize the treatment effect for CLBP, some approaches have classified patients into homogeneous subgroups matched to specific treatments. We evaluated CLBP patients suited for the functional optimization approach, who seek care because they experience symptoms during activities with high physical demands, although they are relatively asymptomatic. METHODS: Three hundred fifty subjects (healthy controls, 170; CLBP patients, 180) were stratified by age (18-40 and 41-65 yrs), sex, and physical activity level. The CLBP patients had an Oswestry Disability Index score < 20% and a Numeric Pain Rating Scale score < 3. The subjects underwent hip abductor, extensor, and flexor isometric strength tests; a deep abdominal function test; and lateral/frontal bridge and lumbar flexor/extensor endurance tests. RESULTS: Relative to the healthy controls, the CLBP patients showed significantly (P > 0.05) higher strength scores in the hip flexor and deep abdominal function tests but lower endurance in the lateral and frontal bridge and lumbar flexor and extensor tests. The cutoff values of the lumbar flexor test and the lumbar flexor/extensor, lateral bridge/lumbar flexor, frontal bridge/lumbar flexor, and hip extensor/flexor test ratios showed acceptable accuracy (AUC = 0.84, 0.82, 0.79, 0.75, and 0.73, respectively). CONCLUSION: In lumbopelvic and hip-performance tests, CLBP patients suited for the functional optimization approach showed differences from healthy controls. These patients could be discriminated from healthy controls on the basis of accurate cutoff values for strength and endurance tests and ratios, which should be considered in treatment decision-making when patients need to return to activities with higher physical demands. LEVEL OF EVIDENCE: 2.

Reference values and reliability for lumbopelvic strength and endurance in asymptomatic subjects.

BACKGROUND: Assessing the lumbopelvic region is useful for detecting many musculoskeletal dysfunctions and also performance deficits. Several clinical tests are used to assess this region, however, reference values and results related to method, reliability and error measurements of these tests have not been reported. OBJECTIVES: To establish reference values and determine reliability, standard error of measurement (SEM), typical error of measurement (TEM) and minimum detectable change (MDC) of a set of clinical tests used for assessing the lumbopelvic region in subjects divided by gender, age group and physical activity levels. METHODS: An observational study was conducted. For reference values, 152 subjects performed eight clinical tests (isometric strength of hip muscles; deep abdominal function and endurance tests) used to assess the lumbopelvic region. Reliability analyses were assessed using the Intraclass Correlation Coefficient (ICC2,1) and error measurements were calculated by using the SEM, TEM and the MDC. RESULTS: Reference values were established for each group and results showed significant (p<0.05) differences concerning gender, age group and physical activity levels in clinical tests. All tests presented good reliability indices with an ICC higher than 0.80 for reliability; MDC values were greater than mean of SEM in all tests, confirming its usage for clinical practice assessments. CONCLUSION: Reference values are necessary in the evaluation of subjects and these results can contribute for clinical practice, providing clinical training targets. Also, evaluation of reliability and error measurements in this set of tests allows its use in clinical practice.

Construct and discriminant validity of STarT Back Screening Tool - Brazilian version.

BACKGROUND: The STarT Back Screening Tool (SBST) was developed to stratify low back pain patients according to their risk of future physical disability so that prognostic subgroups can receive matched treatments in primary care. OBJECTIVE: To measure the construct and discriminative validity of the SBST-Brazil questionnaire. METHOD: A hundred and fifty one patients were recruited to test the construct and discriminative validity comparing the SBST-Brazil to the Brazilian Version of the Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ) and Fear-Avoidance Beliefs Questionnaire-Work (FABQ-W) and Physical Activity (FABQ-PA) subscales at baseline. Spearman's rank-order correlation and area under the curve (AUC) derived from receiver operating curves (ROC) for total scores and psychosocial subscale score of the SBST-Brazil were used for construct and discriminant validity analysis, respectively. RESULTS: The SBST-Brazil total and psychosocial subscale scores had good and moderate correlation with ODI (r=0.61; r=0.56, respectively) and good with RMDQ (r=0.70; r=0.64, respectively). Both scores of the SBST-Brazil total and psychosocial subscale correlated weakly and moderately with the FABQ-PA (r=0.28; r=0.34, respectively) and weakly with the FABQ-W (r=0.18; r=0.20, respectively). The discriminant validity with AUCs for the total and psychosocial subscale scores against reference standard ranged from 0.66 for kinesiophobia to 0.88 for disability. CONCLUSION: The SBST-Brazil showed a moderate to good correlation with the disability tools, but a weak correlation with fear-avoidance beliefs. The results of discriminant validity suggest that SBST-Brazil is able to discriminate low back pain patients with disability and fear-avoidance beliefs.

Active Trigger Points in the Cervical Musculature Determine the Altered Activation of Superficial Neck and Extensor Muscles in Women With Migraine.

OBJECTIVE: Previous studies have demonstrated the presence of active trigger points (TrPs) in women with migraine reproducing their headache attacks. No study has investigated whether these TrPs can alter cervical muscle function in migraine. Our objective was to analyze differences in the activation of superficial neck flexor and extensor muscles in women with migraine considering the presence of active TrPs in the splenius capitis (SC), the upper trapezius (UT), and the sternocleidomastoid (SCM) muscles. METHODS: Surface electromyography (EMG) was recorded from the superficial flexors (SCM and anterior scalene) and the extensor (SC, UT) muscles bilaterally as participants performed a staged task of cranio-cervical flexion (CCF; 5 contractions representing a progressive increase in CCF range of motion) in 70 women with migraine. They were stratified according to the presence or the absence of active TrPs in the SCM, the SC, or the UT musculature. A comparison of EMG normalized root mean square (RMS) values was conducted with a 2×5 analysis of covariance with the task level as the within-subject variable, group stratified by active TrPs as the between-subjects variable and the presence of neck pain as a covariable. RESULTS: All patients exhibited active TrPs in their cervical muscles, which reproduced their migraine. Women with migraine exhibiting active TrPs in the SCM (P<0.01), the UT (P<0.05), or the SC (P<0.05) muscles had lower normalized RMS values of their superficial neck flexors than those without active TrPs in the same muscles. In addition, individuals exhibiting active TrPs in the SC and the UT (both, P<0.05) muscles had higher normalized RMS values in the SC muscle than those without active TrPs in the same muscles. CONCLUSIONS: The presence of active TrPs in the cervical musculature determines an altered activation of superficial neck and extensor muscles during low-load, isometric CCF contractions in women with migraine.

Static body postural misalignment in individuals with temporomandibular disorders: a systematic review

BACKGROUND: The association between body postural changes and temporomandibular disorders (TMD) has been widely discussed in the literature, however, there is little evidence to support this association. OBJECTIVES: The aim of the present study was to conduct a systematic review to assess the evidence concerning the association between static body postural misalignment and TMD. METHOD: A search was conducted in the PubMed/Medline, Embase, Lilacs, Scielo, Cochrane, and Scopus databases including studies published in English between 1950 and March 2012. Cross-sectional, cohort, case control, and survey studies that assessed body posture in TMD patients were selected. Two reviewers performed each step independently. A methodological checklist was used to evaluate the quality of the selected articles. RESULTS: Twenty studies were analyzed for their methodological quality. Only one study was classified as a moderate quality study and two were classified as strong quality studies. Among all studies considered, only 12 included craniocervical postural assessment, 2 included assessment of craniocervical and shoulder postures,, and 6 included global assessment of body posture. CONCLUSION: There is strong evidence of craniocervical postural changes in myogenous TMD, moderate evidence of cervical postural misalignment in arthrogenous TMD, and no evidence of absence of craniocervical postural misalignment in mixed TMD patients or of global body postural misalignment in patients with TMD. It is important to note the poor methodological quality of the studies, particularly those regarding global body postural misalignment in TMD patients. .

The Brazilian version of STarT Back Screening Tool - translation, cross-cultural adaptation and reliability.

BACKGROUND: Psychosocial factors are not routinely identified in physical therapy assessments, although they can influence the prognosis of patients with low back pain. The "STarT Back Screening Tool" (SBST) questionnaire aids in screening such patients for poor prognosis in the primary care setting and classifies them as high, medium, or low risk based on physical and psychosocial factors. OBJECTIVES: This study sought to translate and cross-culturally adapt the SBST to the Brazilian Portuguese language and test the reliability of the Brazilian version. METHOD: The first stage of the study consisted of the translation, synthesis, and back-translation of the original version of the STSB, including revision by the Translation Group, pretest of the translated version, and assessment by an expert panel. The pre-final Brazilian version was applied to 2 samples comprising 52 patients with low back pain; these patients were of both genders and older than 18 years of age. To assess the instrument's reliability, an additional sample comprising 50 patients was subjected to 2 interviews, and the results were assessed using the quadratic weighted kappa value. The instrument's internal consistency was assessed using Cronbach's alpha (n=105), and the standard error of measurement was also calculated (n=50). RESULTS: Translation and back-translation attained consensus, and only item 6 required changes; the reformulated version was applied to an additional sample comprising 52 individuals who did not report any doubts related to this item. The reliability of the SBST-Brazil was 0.79 (95% confidence interval: 0.63-0.95), the internal consistency was 0.74 for the total score and 0.72 for the psychosocial subscale, and the standard error of measurement was 1.9%. CONCLUSION: The translated and cross-culturally adapted SBST-Brazil proved to be reliable for screening patients according to their risk of poor prognosis and the presence of psychosocial factors.

The Brazilian version of STarT Back Screening Tool - translation, cross-cultural adaptation and reliability / Versão brasileira do STarT Back Screening Tool - tradução, adaptação transcultural e confiabilidade

Background: Psychosocial factors are not routinely identified in physical therapy assessments, although they can influence the prognosis of patients with low back pain. The "STarT Back Screening Tool" (SBST) questionnaire aids in screening such patients for poor prognosis in the primary care setting and classifies them as high, medium, or low risk based on physical and psychosocial factors. Objectives: This study sought to translate and cross-culturally adapt the SBST to the Brazilian Portuguese language and test the reliability of the Brazilian version. Method: The first stage of the study consisted of the translation, synthesis, and back-translation of the original version of the STSB, including revision by the Translation Group, pretest of the translated version, and assessment by an expert panel. The pre-final Brazilian version was applied to 2 samples comprising 52 patients with low back pain; these patients were of both genders and older than 18 years of age. To assess the instrument's reliability, an additional sample comprising 50 patients was subjected to 2 interviews, and the results were assessed using the quadratic weighted kappa value. The instrument's internal consistency was assessed using Cronbach's alpha (n=105), and the standard error of measurement was also calculated (n=50). Results: Translation and back-translation attained consensus, and only item 6 required changes; the reformulated version was applied to an additional sample comprising 52 individuals who did not report any doubts related to this item. The reliability of the SBST-Brazil was 0.79 (95% confidence interval: 0.63-0.95), the internal consistency was 0.74 for the total score and 0.72 for the psychosocial subscale, and the standard error of measurement was 1.9%. Conclusion: The translated and cross-culturally adapted SBST-Brazil proved to be reliable for screening patients according to their risk of poor prognosis and the presence of ...

Contextualização: Fatores psicossociais não são rotineiramente identificados na avaliação fisioterapêutica e podem influenciar o prognóstico de pacientes com dor lombar. O questionário "STarT Back Screening Tool" (SBST) auxilia na triagem desses pacientes em relação ao risco de mau prognóstico no tratamento primário, considerando fatores físicos e psicossociais, classificando-os em de baixo, médio e alto risco. Objetivos: Traduzir e adaptar transculturalmente o SBST para Língua Portuguesa do Brasil e testar a sua confiabilidade. Método: A primeira etapa consistiu na tradução, síntese, retro-tradução, revisão pelo grupo de tradução, pré-teste e avaliação dos documentos pelo Comitê. A versão pré-final foi aplicada em duas amostras de 52 pacientes cada, com dor lombar, de ambos os sexos e idade acima de 18 anos. Para verificação da confiabilidade intra-avaliador, foram realizadas duas entrevistas em outra amostra de 50 pacientes, e os resultados, analisados pelo Kappa ponderado quadrático. Também foram calculados a consistência interna, por meio do Alfa de Cronbach (n=105), e o erro padrão de medida (n=50). Resultados: O consenso foi atingido na tradução e retrotradução, e apenas o item 6 foi reformulado e reaplicado em outros 52 pacientes, os quais não tiveram dúvida. A confiabilidade foi de 0,79 (95% IC 0,63-0,95), a consistência interna para pontuação total foi de 0,74 e, para a subescala psicossocial, de 0,72, e o erro de padrão da medida foi de 1,9%. Conclusão: O SBST-Brasil traduzido e adaptado culturalmente mostrou-se confiável para triar pacientes em relação ao risco de mau prognóstico de tratamento, levando em consideração fatores psicossociais. .

Static body postural misalignment in individuals with temporomandibular disorders: a systematic review.

BACKGROUND: The association between body postural changes and temporomandibular disorders (TMD) has been widely discussed in the literature, however, there is little evidence to support this association. OBJECTIVES: The aim of the present study was to conduct a systematic review to assess the evidence concerning the association between static body postural misalignment and TMD. METHOD: A search was conducted in the PubMed/Medline, Embase, Lilacs, Scielo, Cochrane, and Scopus databases including studies published in English between 1950 and March 2012. Cross-sectional, cohort, case control, and survey studies that assessed body posture in TMD patients were selected. Two reviewers performed each step independently. A methodological checklist was used to evaluate the quality of the selected articles. RESULTS: Twenty studies were analyzed for their methodological quality. Only one study was classified as a moderate quality study and two were classified as strong quality studies. Among all studies considered, only 12 included craniocervical postural assessment, 2 included assessment of craniocervical and shoulder postures,, and 6 included global assessment of body posture. CONCLUSION: There is strong evidence of craniocervical postural changes in myogenous TMD, moderate evidence of cervical postural misalignment in arthrogenous TMD, and no evidence of absence of craniocervical postural misalignment in mixed TMD patients or of global body postural misalignment in patients with TMD. It is important to note the poor methodological quality of the studies, particularly those regarding global body postural misalignment in TMD patients.

Electromyographic and magnetic resonance imaging evaluations of individuals with patellofemoral pain syndrome.

OBJECTIVES: To analyze the electrical activity of the vastus medialis obliquus (VMO), vastus lateralis longus (VLL) and vastus lateralis obliquus (VLO) muscles of individuals with patellofemoral pain syndrome (PFPS) during maximum voluntary isometric contraction (MVIC) of lower leg extension with the knee at 30 degrees; to assess pain using a visual analogue scale (VAS); and to assess patellar positioning using magnetic resonance imaging (MRI). METHODS: Twelve women with PFPS and 12 clinically normal women were evaluated. They performed five MVICs of lower leg extension at 30 degrees for electromyographic (EMG) analysis. Using MRI, the sulcus angle (SA), congruence angle (CA), patellar tilt angle (PTA) and patellar displacement (PD) were obtained. The following statistical tests were used: analysis of variance (ANOVA) for repeated measurements to assess EMGs; Mann-Whitney U test to analyze MRIs; Pearson's (r) correlation test between EMGs and MRIs; and one-way ANOVA to evaluate pain (p < or = 0.05). RESULTS: In the PFPS group, there was greater electrical activity in the VLL than in the VMO. In both groups, there was greater electrical activity in the VMO and VLL than in the VLO. In the PFPS group, the MRI showed higher SA and lower CA values, and there was a negative correlation between the VMO and the PTA. CONCLUSION: The data suggest that, in individuals with PFPS, greater electrical activity in the VLL combined with an increased SA and a decreased CA may contribute to patellar instability.

Avaliação eletromiográfica e ressonância magnética do joelho de indivíduos com síndrome da dor femoropatelar / Electromyographic and magnetic resonance imaging evaluations of individuals with patellofemoral pain syndrome

OBJETIVOS: Analisar a atividade elétrica (EMG) dos músculos vasto medial oblíquo (VMO), vasto lateral longo (VLL) e vasto lateral oblíquo (VLO) de indivíduos com síndrome da dor femoropatelar (SDFP) durante contração isométrica voluntária máxima (CIVM) de extensão da perna com o joelho a 30(0), a dor por meio da Escala Visual Analógica (EVA) e o posicionamento da patela por meio da ressonância magnética nuclear por imagem (RMNI). MÉTODOS: Avaliaram-se 12 mulheres com SDFP e 12 clinicamente normais, que realizaram cinco CIVM de extensão da perna no ângulo de 30(0) para análise da EMG. Avaliou-se o ângulo do sulco (AS), ângulo de congruência (AC), ângulo de inclinação patelar (AIP) e deslocamento patelar (DP) pela RMNI. Utilizaram-se testes estatísticos: ANOVA, análise de variância de medidas repetidas para EMG; o teste Mann-Whitney U para análise da RMNI; o teste de correlação de Pearson (r) entre EMG e RMNI e análise de variância one-way para avaliação da dor (p<0,05). RESULTADOS: Verificou-se maior atividade elétrica do músculo VLL em relação ao VMO no grupo com SDFP. Em ambos os grupos, os músculos VMO e VLL apresentaram maior atividade elétrica que o VLO. Para o grupo SDFP, a RMNI revelou maiores valores do AS e menores do AC, e verificou-se uma correlação negativa entre VMO e AIP. CONCLUSÃO: Os dados sugerem que maior atividade elétrica do VLL, juntamente com o aumento do AS e diminuição do AC, possam ser fatores favorecedores da instabilidade patelar nos indivíduos com SDFP.

OBJECTIVES: To analyze the electrical activity of the vastus medialis obliquus (VMO), vastus lateralis longus (VLL) and vastus lateralis obliquus (VLO) muscles of individuals with patellofemoral pain syndrome (PFPS) during maximum voluntary isometric contraction (MVIC) of lower leg extension with the knee at 30°; to assess pain using a visual analogue scale (VAS); and to assess patellar positioning using magnetic resonance imaging (MRI). METHODS: Twelve women with PFPS and 12 clinically normal women were evaluated. They performed five MVICs of lower leg extension at 30° for electromyographic (EMG) analysis. Using MRI, the sulcus angle (SA), congruence angle (CA), patellar tilt angle (PTA) and patellar displacement (PD) were obtained. The following statistical tests were used: analysis of variance (ANOVA) for repeated measurements to assess EMGs; Mann-Whitney U test to analyze MRIs; Pearson's (r) correlation test between EMGs and MRIs; and one-way ANOVA to evaluate pain (p<0.05). RESULTS: In the PFPS group, there was greater electrical activity in the VLL than in the VMO. In both groups, there was greater electrical activity in the VMO and VLL than in the VLO. In the PFPS group, the MRI showed higher SA and lower CA values, and there was a negative correlation between the VMO and the PTA. CONCLUSION: The data suggest that, in individuals with PFPS, greater electrical activity in the VLL combined with an increased SA and a decreased CA may contribute to patellar instability.