Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective.

The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.

Effects of two different dual-task training protocols on gait, balance, and cognitive function in community-dwelling older adults: a 24-week randomized controlled trial.

Background: Although alternating dual-task (ADT) training is functionally easier for older adults, a large part of the motor and cognitive tasks is simultaneously performed, especially during activities of daily living that require maintaining body balance. Objective: To evaluate the effects of mixed dual-task training on mobility, cognitive function, and balance in community-dwelling older adults. Methods: Sixty participants were randomly allocated at a 1:1 ratio into the experimental group-single motor task (SMT) and simultaneous dual task (SDT) interchangeably in stage 1 (for 12 weeks) and after strictly with SDT in stage 2 (the last 12 weeks)-or into the control group-only SMT and SDT interchangeably in stages 1 and 2. Gait parameters were acquired by two inertial sensors. Physical and cognitive performance were acquired by specific questionnaires. Generalized linear mixed models were used for analyzing interaction and main effects. Results: No between-group difference was observed for gait performance. Both protocols improved mobility (mean change ((MC) = 0.74)), dual-task effect (MC = -13.50), lower limb function (MC = 4.44), static (MC = -0.61), and dynamic balance (MC = -0.23), body sway (MC = 4.80), and cognitive function (MC = 41.69). Conclusion: Both dual-task training protocols improved these outcomes.

Is foot clearance influenced by different types of dual task in once-only faller community-dwelling older adults?

BACKGROUND: Tripping is one of the main causes of falls in older adults and has an important association with minimum toe clearance (MTC). MTC variability while performing alternating (ADT) or concurrent (CDT) dual-task activities may be a useful gait parameter to differentiate once-only fallers from non-faller older adults. RESEARCH QUESTION: Is the MTC variability influenced by ADT and CDT in once-only faller community-dwelling older adults? METHODS: Twenty-two community-dwelling older adults with a self-report of up to one fall in the last 12 months were allocated to the fallers group and 38 to the non-fallers group. Gait data were collected by two foot-worn inertial sensors (Physilog® 5, GaitUp, Lausanne, Switzerland). MTC mean magnitude and variability, as well as the stride-to-stride variability, stride time and length, lower limb peak angular velocity, and foot forward linear speed at the MTC instant, were calculated across approximately 50 gait cycles for each participant and condition using the GaitUp Analyzer software (GaitUp, Lausanne, Switzerland). The statistical analyzes were performed in the Statistical Package for the Social Sciences (SPSS), v.22.0, using generalized mixed linear models, adopting an alpha of 5%. RESULTS AND SIGNIFICANCE: No interaction effect was observed; however, faller participants reduced the MTC variability (standard deviation) [(mean difference, MD = -0.099 cm; confidence interval, 95%CI = -0.183 to -0.015)], regardless of the condition. CDT compared to a single task (only gait) reduced the mean magnitude of the foot forward linear speed (MD=-0.264 m/s; 95%CI=-0.462 to -0.067), peak angular velocity (MD = -25.205 degrees/s; 95%CI = -45.507 to -4.904), and gait speed (MD = -0.104 m/s; 95%CI = -0.179 to -0.029), regardless of the group. These results suggest that MTC variability, regardless of condition, may be a promising gait parameter to differentiate once-only faller community-dwelling older adults from non-fallers.

Knee osteoarthritis pre-screening questionnaire (KOPS): cross-cultural adaptation and measurement properties of the brazilian version-KOPS Brazilian version.

BACKGROUND: Despite the criteria already established for the classification of knee osteoarthritis (OA), a radiographic and/or clinical knee OA diagnosis usually occurs in cases of fully manifest or more advanced disease, which can make health promotion, prevention, and functional rehabilitation in more advanced stages of the disease less effective. In addition, radiographic knee OA can generate more financial costs for health services. Therefore, developing and validating screening instruments to assess the probability of development and progression of knee OA would be of great value for both clinical practice and science. OBJECTIVE: To cross-culturally adapt and investigate the measurement properties of the Knee OA Pre-screening Questionnaire Brazilian version. METHODS: A total of 250 individuals of both sexes aged between 35 and 92 years [(mean (standard deviation): 63 (11) years old; 74.1 (15.1) kg; 1.59 (0.09) m; 29.38 (5.44) kg/m2] participated in this study. The cross-cultural adaptation and analyses of the measurement properties of the KOPS Brazilian version included: (1) assessment of conceptual and item equivalence; (2) assessment of semantic equivalence; (3) assessment of operational equivalence; and (4) assessment of measurement equivalence, reliability, and validity. RESULTS: Cronbach's alpha for the internal consistency among the six components of the KOPS Brazilian version was 0.71. The test-retest 72 h apart for each component resulted in a coefficient correlation intraclass ranging from 0.74 to 1.00. The probability of an individual randomly chosen from the population having KL ≥ 1 and KOPS Brazilian version ≥ 21 points was 0.74 (area under the curve of the Receiver Operating Characteristic - AUC of ROC); furthermore, the AUC for KL ≥ 2 and the KOPS Brazilian version ≥ 23 points was 0.77. CONCLUSION: The KOPS Brazilian version is a reliable and valid instrument for early screening of knee OA in individuals aged 35 years and over in the Brazilian context.

Concern About Falling, Confidence in Balance, Quality of Life, and Depression Symptoms in Community-Dwelling Older Adults After a 24-week Dual-Task Training With Variable and Fixed Priority: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of a 24-week dual-task training with progression from variable to fixed priority on the concern about falling, confidence in balance, quality of life, and depression symptoms in community-dwelling older adults. METHODS: A total of 60 participants (60-80 y.o.) were randomly allocated into a dual-task training group with progression from variable to fixed priority (experimental group) or into a dual-task training group with variable priority (control group). RESULTS: No between-group difference was observed after the intervention. A significant time effect showed a reduction in concern about falling [mean difference (MD) = -2.91)] and depression symptoms (MD = -1.66), an increase in the physical function (MD = 7.86), overall mental health (MD = 5.82), perception of vitality, energy, and less fatigue (MD = 10.45), general perception of overall health (MD = 6.81), and their health compared to the last year (MD = 11.89). CONCLUSION: The experimental protocol was not superior to the control one. However, both protocols improved these outcomes.

Knee osteoarthritis pre-screening questionnaire (KOPS): cross-cultural adaptation and measurement properties of the brazilian version—KOPS Brazilian version

Abstract Background: Despite the criteria already established for the classification of knee osteoarthritis (OA), a radiographic and/or clinical knee OA diagnosis usually occurs in cases of fully manifest or more advanced disease, which can make health promotion, prevention, and functional rehabilitation in more advanced stages of the disease less effective. In addition, radiographic knee OA can generate more financial costs for health services. Therefore, developing and validating screening instruments to assess the probability of development and progression of knee OA would be of great value for both clinical practice and science. Objective: To cross-culturally adapt and investigate the measurement properties of the Knee OA Pre-screening Questionnaire Brazilian version. Methods: A total of 250 individuals of both sexes aged between 35 and 92 years [(mean (standard deviation): 63 (11) years old; 74.1 (15.1) kg; 1.59 (0.09) m; 29.38 (5.44) kg/m2] participated in this study. The cross-cultural adaptation and analyses of the measurement properties of the KOPS Brazilian version included: (1) assessment of conceptual and item equivalence; (2) assessment of semantic equivalence; (3) assessment of operational equivalence; and (4) assessment of measurement equivalence, reliability, and validity. Results: Cronbach's alpha for the internal consistency among the six components of the KOPS Brazilian version was 0.71. The test-retest 72 h apart for each component resulted in a coefficient correlation intraclass ranging from 0.74 to 1.00. The probability of an individual randomly chosen from the population having KL ≥ 1 and KOPS Brazilian version ≥ 21 points was 0.74 (area under the curve of the Receiver Operating Characteristic - AUC of ROC); furthermore, the AUC for KL ≥ 2 and the KOPS Brazilian version ≥ 23 points was 0.77. Conclusion: The KOPS Brazilian version is a reliable and valid instrument for early screening of knee OA in individuals aged 35 years and over in the Brazilian context.

Impact of COVID-19 Pandemic on Life-Space Mobility of Older Adults Living in Brazil: REMOBILIZE Study.

Background: The COVID-19 pandemic hit Brazil in a scenario of substantial socioeconomic and health inequalities. It is unknown the immediate impact of social restriction recommendations (i.e., lockdown, stay-at-home) on the life-space mobility of older people. Objective: To investigate the immediate impact of COVID-19 pandemic on life-space mobility of community-dwelling Brazilian older adults and examine the social determinants of health associated with change in life-space mobility. Design: Baseline data from a prospective cohort study (REMOBILIZE Study). Setting: Community. Subject: A convenience snowball sample of participants aged 60 and older (n = 1,482) living in 22 states in Brazil. Methods: We conducted an online and phone survey using an adapted version of the Life-Space Assessment (LSA). Linear regression models were used to investigate social determinants of health on the change in LSA score. Results: Regardless of their gender and social determinants of health, participants showed a significant reduction in life-space mobility since COVID-19 pandemic outbreak. Life-space mobility reduction was higher among black individuals, those living alone and aged between 70 and 79. Other variables associated with change in life-space mobility, to a lesser extent, were sex, education and income. Conclusion: Social restriction measures due to pandemic caused substantial reduction in older adults' life-space mobility in Brazil. Social inequalities strongly affected vulnerable groups. Concerted actions should be put in place to overcome the deterioration in life-pace mobility amongst these groups. Failure in minimizing health inequalities amplified by the pandemic may jeopardize the desired achievements of the Decade of Healthy Aging.

Long-term use of minimal footwear in older adult women with knee osteoarthritis: Mechanisms of action in the knee adduction moment.

Studies have shown the short- and long-term effects of wearing minimalist footwear in reducing knee loads in patients with knee osteoarthritis (OA). This study aimed to investigate the mechanisms underpinning the reduction in external knee adduction moment (EKAM) in older adult women who wore this type of footwear through a randomized controlled trial. Fifty-six participants with medial compartment knee OA were equally allocated to either an intervention group (IG) that wore minimalist footwear (Moleca®) or to a control group (CG) that continued regular clinical treatment for OA for six months. The influence of lower limb joint kinematics and joint frontal moments, center of pressure displacement, and foot progression angle in predicting the reduction of EKAM were assessed after a six-month intervention. Surprisingly, none of the seven independent variables predicted the first peak EKAM in the multiple regression model for the IG. For the CG, the increase of one unit in the first peak of the hip adduction moment resulted in a 1.01 units increase in the first peak EKAM. Additionally, a one-unit reduction in the ankle eversion angle resulted in an increase of 0.16 units in the percent change in the first peak EKAM. Thus, wearing the Moleca® shoe for six months helped the participants keep a natural gait pattern without increasing the hip moment or the ankle inversion angle compared to the women who did not wear the Moleca® footwear. ClinicalTrials.gov (NCT01342458).

Dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults: A protocol for a randomized controlled trial : Variable- and fixed-priority dual-task for older adults.

BACKGROUND: Functional independence and safe mobility, especially in older people, mostly rely on the ability to perform dual tasks, particularly during activities with variable- and fixed-priority attention. The aim of this study is to compare the dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults. METHODS: This is an assessor- and participant-blinded, two-arm, randomized controlled trial with 60 community-dwelling male and female older adults between the ages of 60 and 80 years old. Participants will be randomly allocated into either the intervention group or the control group using a computer-generated permuted block randomization schedule. The intervention group will undertake a progressive dual-task training in which the participants will be progressively submitted to dual-task walking and postural balance exercises with variable- to fixed-priority instructions. The control group will be submitted to dual-task training with variable-priority attention exercises. Both groups will receive 48 sessions lasting for 60 min each over 24 weeks. The primary outcome will be the gait speed under single- and dual-task conditions. Secondary outcomes will include spatiotemporal gait parameters, functional balance, executive function, falls, quality of life, and depression symptoms. All the analyses will be based on the intention-to-treat principle. DISCUSSION: This is the first assessor- and participant-blinded, two-arm, randomized controlled trial with 6 months of intervention and an additional 6-month post-training follow up aiming to evaluate the effectiveness of training with progression from variable- to fixed-priority instructions on gait biomechanics, postural balance, falls episodes, executive functioning, and quality of life in community-dwelling older adults. If our hypotheses are confirmed, this training protocol can be implemented widely to improve gait speed and other functional activities and quality of life in community-dwelling older adults. This study protocol can be used to improve these functional aspects of community-dwelling older adults. This study may also contribute to future guidelines for the improvement of these clinical and biomechanical aspects in older people. TRIAL REGISTRATION: ClinicalTrials.gov Identifier - NCT03886805, Registered 22 March 2019.

Can the Use of Unstable Surfaces and Instruction for Conscious Abdominal Contraction Increase the EMG Activity of the Periscapular Muscles During the Dynamic Push-Up?

CONTEXT: It is believed that conscious abdominal contraction (CAC) during exercise encourages greater periscapular activation through existing myofascial connections. On the other hand, it is postulated that the use of unstable surfaces would promote greater neuromuscular demand. OBJECTIVE: To analyze the effect of CAC on periscapular muscle activity during push-up plus exercise on stable and unstable surfaces and to evaluate the correlation between electromyographic (EMG) activity of the serratus anterior (SA) and abdominal oblique muscles. DESIGN: Repeated-measures design in a single group, pre-post CAC. SETTING: Biomechanics laboratory. PARTICIPANTS: Twenty-three male volunteers without a history of lesions in the upper limbs participated in the study. MAIN OUTCOME MEASURES: Five repetitions of push-ups on stable and unstable surfaces were performed with and without instruction for CAC. The normalized amplitude of the EMG activity was obtained from the muscles of the upper, middle, and lower trapezius, SA upper (SA_5th) and lower (SA_7th) portions, external oblique (EO), and internal oblique. RESULTS: CAC increased the activity of the EO, internal oblique, middle trapezius, and SA (P < .05) in both surfaces. The use of the unstable surface increased the EMG activity of the EO, SA_7th, and middle trapezius and decreased the EMG activity of the SA_5th. However, all changes observed in EMG signals were of low magnitude, with effect sizes lower than 0.45. There was a weak correlation between the EMG activity of the EO and SA_5th (r = .24) and a strong correlation between the EO and SA_7th (r = .70). CONCLUSION: The isolated use of CAC or unstable surface during push-up seems to present no practical relevance, but the combined use of these strategies may increase activation of the SA_7th and middle trapezius muscles.

Are body posture and self-reported musculoskeletal symptoms different between employees in the healthcare and administrative sectors?

BACKGROUND: Several professionals in hospitals can be affected by work-related musculoskeletal disorders (WMSDs). OBJECTIVE: To evaluate and compare the body posture and self-reported musculoskeletal symptoms of employees in the healthcare and administrative section of a university hospital. METHODS: Body posture and self-reported musculoskeletal symptoms of 106 employees were quantitatively evaluated. The sample was divided into two groups: health care group (HCG) composed of 57 professionals (88% were females) with an average age of 34±7 years, mass of 66.52±14.78 kg, height of 1.62±0.07 m, and body mass index (BMI) of 25.37±4.50 kg/m2; and the administrative section group (ADMG) composed of 49 professionals (57% were females) with an average age of 30±7 years, mass of 74.90±14.12 kg, height of 1.68±0.09 m, and BMI of 26.76±4.40 kg/m2. RESULTS: The only significant difference between groups for the body posture was the greater right Q-angle in the CG (p = 0.039). Self-reported musculoskeletal symptoms in the seven days prior to assessment were not associated with work section. CONCLUSION: The work section within the university hospital did not influence body posture or self-reporting of musculoskeletal symptoms among the healthcare and administrative staff.

Self-reported musculoskeletal disorders by the nursing team in a university hospital / Distúrbios musculoesqueléticos autorreferidos na equipe de enfermagem em um hospital universitário

ABSTRACT BACKGROUND AND OBJECTIVES: The hospital environment is considered to be unhealthy, and, moreover, the work performed by nursing professionals presents several risk factors for the development of pain. In this sense, the present study aims to analyze the musculoskeletal disorders in the nursing team and to correlate with the level of physical activity, anthropometric characteristics and the professional profile at the University Hospital in Petrolina, Pernambuco. METHODS: This was a cross-sectional study with 143 nursing professionals, of which 122 were female (37±7 years) and 21 were male (33±6 years). The individuals answered the International Physical Activity Questionnaire and the Nordic Musculoskeletal Questionnaire. RESULTS: Pain was reported in 77 volunteers, which corresponds to 53.8% of the sample. In 35 (24.4%) volunteers there was the presence of musculoskeletal disorders in more than one body segment. Regarding pain distribution by body segment, the higher prevalence's were observed in the lumbar region and the knees, both with 17.4%. In addition, there were associations between being male and pain in the elbows (PR=5.5, 95% CI: 1.1, 25.5, p=0.028) and ankles (PR=5.1, 95% CI: 1.3; 19.2, p=0.016), and pain and physical inactivity for the elbow segments (PR=3.4, 95% CI: 1.1, 10.3, p=0.027) and knees (PR=2.4, 95% CI: 1.1, 5.0, p=0.021). CONCLUSION: It can be noticed that the prevalence of pain in the team of professionals analyzed was high and that the risk factors, such as physical inactivity and being male were associated with a greater onset of musculoskeletal disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: O ambiente hospitalar é considerado como insalubre, além disso, a atividade laboral desempenhada pelos profissionais de enfermagem apresenta diversos fatores de risco para o desenvolvimento de dor. Nesse sentido, o presente estudo teve por objetivo analisar os distúrbios musculoesqueléticos na equipe de enfermagem e correlacionar com o nível de atividade física, características antropométricas e o perfil profissional no Hospital Universitário em Petrolina, Pernambuco. MÉTODOS: Trata-se de um estudo transversal, com 143 profissionais de enfermagem, sendo 122 do sexo feminino (37±7 anos) e 21 do sexo masculino (33±6 anos). Os indivíduos responderam aos questionários Internacional de Atividade Física e ao Nórdico de Sintomas Osteomusculares. RESULTADOS: Foi constatada a presença de dor em 77 voluntários, o que equivale a 53,8% da amostra. Em 35 (24,4%) voluntários houve a presença de distúrbios musculoesqueléticos em mais de um segmento corporal. Quanto à distribuição de dor por segmento corporal, foram observadas maiores prevalências na região lombar e nos joelhos, ambas com 17,4%. Além disso, foram verificadas associações entre o sexo masculino e dor nos cotovelos (RP=5,5, IC 95%:1,1;25,5, p=0,028) e tornozelos (RP=5,1, IC 95%:1,3;19,2, p=0,016), e dor e inatividade física para os segmentos em cotovelos (RP=3,4, IC 95%:1,1;10,3, p=0,027) e joelhos (RP= 2,4, IC95%: 1,1; 5,0, p=0,021). CONCLUSÃO: Observou-se que a prevalência de dor na equipe de profissionais analisada foi elevada, e que fatores de risco como a inatividade física e o sexo masculino, foram associados com maior surgimento dos distúrbios musculoesqueléticos.

Pain and musculoskeletal discomfort in physiotherapists of the intensive care unit and ward of a university hospital: a retrospective cohort study / Dor e desconforto musculoesquelético em fisioterapeutas da unidade de terapia intensiva e enfermaria de um hospital universitário: um estudo de coorte retrospectivo

ABSTRACT BACKGROUND AND OBJECTIVES: Both biomechanical and emotional factors may contribute to the development of work-related musculoskeletal disorders in physical therapists working at a hospital, but we still do not know if these professionals present musculoskeletal symptoms related to the sector and working time. The objective of this study was to compare the self-report of pain and musculoskeletal discomfort of the physical therapists working in the intensive care unit and ward of a university hospital and retrospectively evaluate, 12 months of work, self-report of pain and musculoskeletal discomfort of physiotherapists in these sectors. METHODS: The self-report of pain and the musculoskeletal discomfort of the 18 physical therapists working in this hospital were evaluated by the Nordic Musculoskeletal Questionnaire in the admission period (T0) and after 12 months (T1). RESULTS: No association was found between the self-report of pain and musculoskeletal discomfort and the working sector of these professionals. However, there was a temporal association between the self-report of pain and musculoskeletal complaints in the intensive care unit sector in the following regions: neck (p=0.043), shoulders (p=0.009), upper back (p=0.043), lower back (p=0.043) and hip and thigh region (p=0.027). The second shift of these professionals was not associated with pain and musculoskeletal discomfort. CONCLUSION: The self-report of pain and musculoskeletal discomfort of physical therapists of this university hospital, both in the admission period (T0) and after 12 months of work (T1) was not associated with the sector in which they work. However, after 12 months, the physical therapists working in the intensive care unit showed an increase in the amount of self-report of pain and musculoskeletal discomfort.

RESUMO JUSTIFICATIVA E OBJETIVOS: Tanto os fatores biomecânicos quanto emocionais podem contribuir para o surgimento de distúrbios osteomusculares em fisioterapeutas que atuam dentro de um hospital; porém ainda não se sabe se esses profissionais apresentam dor e desconforto musculoesquelético relacionados ao setor e ao tempo de trabalho. Os objetivos deste estudo foram comparar o autorrelato de dor e o desconforto musculoesquelético dos fisioterapeutas da unidade de terapia intensiva e enfermarias e avaliar retrospectivamente, em 12 meses de trabalho, o autorrelato de dor e desconforto musculoesquelético dos fisioterapeutas desses setores. MÉTODOS: O autorrelato de dor e o desconforto musculoesquelético dos 18 fisioterapeutas que atuam nesse hospital foi avaliado pelo Questionário Nórdico de Sintomas Osteomusculares, no período atual (T1) e comparados retrospectivamente com os dados avaliados no período admissional (T0). RESULTADOS: Não houve associação entre o autorrelato de dor e o desconforto musculoesquelético e os setores de atuação desses profissionais, porém houve uma associação temporal entre o autorrelato de dor e o desconforto musculoesquelético na unidade de terapia intensiva, nas regiões de pescoço (p=0,043), ombros (p=0,009), parte superior das costas (p=0,043), parte inferior das costas (p=0,043) e região de quadril e coxas (p=0,027). A segunda jornada de trabalho desses fisioterapeutas não se mostrou associada com a dor e o desconforto musculoesquelético. CONCLUSÃO: O autorrelato de dor e desconforto musculoesquelético de fisioterapeutas desse hospital universitário, tanto no período admissional (T0) quanto após 12 meses de trabalho (T1) não se mostrou associado com o setor de atuação desses profissionais. Depois de 12 meses, os fisioterapeutas da unidade de terapia intensiva apresentaram aumento no autorrelato de dor e desconforto musculoesquelético.

Pain and musculoskeletal discomfort in military police officers of the Ostensive Motorcycle Patrol Group / Dor e desconforto musculoesquelético em policiais militares do Grupamento de Rondas Ostensivas com Apoio de Motocicletas

ABSTRACT BACKGROUND AND OBJECTIVES: Work-related musculoskeletal disorders have shown a high prevalence among workers, among these, law enforcement officers have been greatly affected. The aim of this study was to analyze the occurrence of musculoskeletal disorders symptoms in the Ostensive Motorcycle Patrol Group of the Military Police of Pernambuco, PE. METHODS: This was a cross-sectional study developed from February to June 2016. The subjects were 28 police officers from the Ostensive Motorcycle Patrol Group, of the 5th Battalion of the Military Police. Data was collected through a self-administered questionnaire with sociodemographic variables and professional characteristics. The Nordic Musculoskeletal Questionnaire and the visual analog scale were used. RESULTS: In the study sample, most of the individuals were male with an average of 62±8 working hours per week. Regarding the presence of musculoskeletal symptoms, the most affected anatomical region was the back, followed by the knees and then the chest. As for the pain perception of the subjects, the spine and lower limbs showed higher pain intensity when compared to other regions. Most of the sample believe that musculoskeletal symptoms are related to work. CONCLUSION: The findings in this study demonstrate the presence of musculoskeletal symptoms in the studied population. The analysis of the musculoskeletal disorders of these police officers will serve as an input for the planning of intervention actions to improve the general conditions of the service provided by the Ostensive Motorcycle Patrol Group.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os distúrbios osteomusculares relacionados ao trabalho têm apresentado alta prevalência nos trabalhadores, dentre esses, a classe de policiais tem sido bastante acometida. O objetivo deste estudo foi analisar a ocorrência de sintomas de distúrbios osteomusculares em policiais do Grupamento de Rondas Ostensivas Com Apoio de Motocicletas da Polícia Militar de Pernambuco, PE. MÉTODOS: Trata-se de um estudo do tipo transversal, desenvolvido entre os meses de fevereiro a junho de 2016, com 28 indivíduos da Rondas Ostensivas Com Apoio de Motocicletas da Polícia Militar do 5° Batalhão de Polícia Militar. Os dados foram obtidos por meio de um questionário autoaplicável com variáveis sociodemográficas, características profissionais, Questionário Nórdico de Sintomas Osteomusculares e escala analógica visual. RESULTADOS: Dentre a amostra estudada, a maioria dos indivíduos era do sexo masculino, sendo observada uma média de 62±8 horas trabalhadas por semana. Em relação à presença de sintomas osteomusculares, a região anatômica mais acometida foi a lombar, seguida pelos joelhos e região torácica. Quanto à percepção de dor dos policiais, a coluna vertebral e os membros inferiores apresentaram maior intensidade de dor quando comparados às outras regiões avaliadas. A maioria dos indivíduos da amostra relatou que os sintomas osteomusculares estavam relacionados ao trabalho. CONCLUSÃO: Os resultados deste estudo demonstram a presença de sintomas osteomusculares na população estudada de forma unânime. A análise dos distúrbios osteomusculares desses policiais servirá como subsídio para o planejamento de ações de intervenção voltados para a melhoria das condições gerais de prestação de serviços da Rondas Ostensivas Com Apoio de Motocicletas.

Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: A randomized controlled trial.

BACKGROUND: Efforts have been made to retard the progressive debilitating pain and joint dysfunction in patients with knee osteoarthritis. We aimed to evaluate the therapeutic effect of a low-cost minimalist footwear on pain, function, clinical and gait-biomechanical aspects of elderly women with knee osteoarthritis. METHODS: Throughout a randomized, parallel and controlled clinical trial, fifty-six patients with medial knee osteoarthritis were randomly allocated to an intervention (n=28) or control group (n=28), and assessed at baseline and after three and six months. The intervention involved wearing Moleca(®) footwear for at least 6h/day, 7 days/week, over 6 months. The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index was the primary outcome. The secondary outcomes were the other subscales, Lequesne score, distance walked in 6 min, knee oedema and effusion, knee adduction moment and paracetamol intake. Intention-to-treat analysis was performed using two-way casewise ANOVA (< .05) and Cohen's d coefficient. FINDINGS: Intervention group showed improvement in pain (effect size: 1.41, p<.001), function (effect size: 1.22, p=.001), stiffness (effect size: 0.76, p=.001), Lequesne score (effect size: 1.07, p<.001), and reduction by 21.8% in the knee adduction moment impulse (p=.017) during gait wearing Moleca(®). The analgesic intake was lower in the intervention group. INTERPRETATION: The long-term use of Moleca(®) footwear relieves pain, improves self-reported function, reduces the knee loading while wearing Moleca(®), refrains the increase of analgesic intake in elderly women with knee osteoarthritis and can be considered as a conservative mechanical treatment option. ClinicalTrials.gov (NCT01342458).

Attenuation of foot pressure during running on four different surfaces: asphalt, concrete, rubber, and natural grass.

The practice of running has consistently increased worldwide, and with it, related lower limb injuries. The type of running surface has been associated with running injury etiology, in addition other factors, such as the relationship between the amount and intensity of training. There is still controversy in the literature regarding the biomechanical effects of different types of running surfaces on foot-floor interaction. The aim of this study was to investigate the influence of running on asphalt, concrete, natural grass, and rubber on in-shoe pressure patterns in adult recreational runners. Forty-seven adult recreational runners ran twice for 40 m on all four different surfaces at 12 ± 5% km · h(-1). Peak pressure, pressure-time integral, and contact time were recorded by Pedar X insoles. Asphalt and concrete were similar for all plantar variables and pressure zones. Running on grass produced peak pressures 9.3% to 16.6% lower (P < 0.001) than the other surfaces in the rearfoot and 4.7% to 12.3% (P < 0.05) lower in the forefoot. The contact time on rubber was greater than on concrete for the rearfoot and midfoot. The behaviour of rubber was similar to that obtained for the rigid surfaces - concrete and asphalt - possibly because of its time of usage (five years). Running on natural grass attenuates in-shoe plantar pressures in recreational runners. If a runner controls the amount and intensity of practice, running on grass may reduce the total stress on the musculoskeletal system compared with the total musculoskeletal stress when running on more rigid surfaces, such as asphalt and concrete.

Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial.

BACKGROUND: Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short-term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. METHODS/DESIGN: Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes- Moleca®-for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca® is a women's double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention-to-treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment-time interactions (α = 5%). DISCUSSION: This is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca® shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment. TRIAL REGISTRATION: NCT01342458.

Changes in the plantar pressure distribution during gait throughout gestation.

BACKGROUND: The intention of this investigation was to longitudinally describe and compare the plantar pressure distribution in orthostatic posture and gait throughout pregnancy. METHODS: A prospective longitudinal observational study was conducted with six pregnant women (mean ± SD age, 32 ± 3 years) with a mean ± SD weight gain of 10.0 ± 1.4 kg. Peak pressure, contact time, contact area, and maximum force in five plantar areas were evaluated using capacitive insoles during gait and orthostatic posture. For 1 year, the plantar pressures of pregnant women were evaluated the last month of each trimester. Comparisons among plantar areas and trimesters were made by analysis of variance. RESULTS: For orthostatic posture, no differences in contact time, contact area, peak pressure, and maximum force throughout the trimesters were found. During gait, peak pressure and maximum force of the medial rearfoot were reduced from the first to third and second to third trimesters. Maximum force increased at the medial forefoot from the first to second trimester. Contact area increased at the lateral rearfoot from the second to third trimester and at the midfoot from the first to third trimester. Contact time increased at the midfoot and medial and lateral forefoot from the first to third trimester. CONCLUSIONS: Pregnant women do not alter plantar pressure during orthostatic posture, but, during gait, the plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. These adjustments help maintain the dynamic stability of the pregnant woman during locomotion.

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

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

Inexpensive footwear decreases joint loading in elderly women with knee osteoarthritis.

Recent literature has highlighted that the flexibility of walking barefoot reduces overload in individuals with knee osteoarthritis (OA). As such, the aim of this study was to evaluate the effects of inexpensive, flexible, non-heeled footwear (Moleca) as compared with a modern heeled shoes and walking barefoot on the knee adduction moment (KAM) during gait in elderly women with and without knee OA. The gait of 45 elderly women between 60 and 70 years of age was evaluated. Twenty-one had knee OA graded 2 or 3 according to Kellgren and Lawrence's criteria, and 24 who had no OA comprised the control group (CG). The gait conditions were: barefoot, Moleca, and modern heeled shoes. Three-dimensional kinematics and ground reaction forces were measured to calculate KAM by inverse dynamics. For both groups, the Moleca provided peak KAM and KAM impulse similar to barefoot walking. For the OA group, the Moleca reduced KAM even more as compared to the barefoot condition during midstance. On the other hand, the modern heeled shoes increased this variable in both groups. Inexpensive, flexible, and non-heeled footwear provided loading on the knee joint similar to a barefoot gait and significant overload decreases in elderly women with and without knee OA, compared to modern heeled shoes. During midstance, the Moleca also allowed greater reduction in the knee joint loads as compared to barefoot gait in elderly women with knee OA, with the further advantage of providing external foot protection during gait.