A eletroterapia pode aprimorar o efeito de exercícios cinesiofuncionais no tratamento da dor lombar inespecífica crônica? / ¿Puede la electroterapia mejorar el efecto de los ejercicios kinesiofuncionales en el tratamiento del dolor lumbar crónico inespecífico? / Can electrotherapy improve the effect of kinesio-functional exercises in the treatment of chronic non-specific low back pain?

RESUMO O presente estudo teve como objetivo comparar o efeito de um protocolo de exercícios cinesiofuncionais (ECF) isolados ou associados a corrente interferencial (CI) ou corrente aussie (CA), sobre a intensidade da dor, a mobilidade/flexibilidade, a funcionalidade e a qualidade de vida (QV) de indivíduos com dor lombar inespecífica crônica. Trata-se de um ensaio clínico não randomizado, em que foram selecionados 42 sujeitos aleatorizados em três grupos: GI (treinamentos cinesiofuncional; n=14), GII (treinamentos cinesiofuncional + CI; n=14) e GIII (treinamento cinesiofuncional + CA; n=14). Os indivíduos foram submetidos a dez sessões de tratamento ao longo de 5 semanas e foram avaliados pré e pós-intervenção, usando escala visual analógica de dor (EVA); avaliação da QV pelo questionário SF-36; avaliação da mobilidade/flexibilidade lombar pelo teste de Schober modificado e o teste de sentar e alcançar com o banco de Wells; avaliação da incapacidade funcional através do índice Oswestry; e, para os aspectos depressivos, inventário de depressão de Beck (IDB). Na reavaliação, percebeu-se que houve melhora significativa em todos os grupos experimentais na intensidade da dor (p<0,0001) e na mobilidade/flexibilidade. No SF-36, verificamos que apenas os indivíduos tratados com exercícios associados à corrente elétrica apresentaram melhora dos domínios capacidade física, aspectos físicos e dor. A avaliação do IDB não apresentou modificações pré e pós-intervenção. Conclui-se que a associação das técnicas terapêuticas apresentou maior benefício aos indivíduos da amostra, uma vez que produziu melhora sobre as variáveis avaliadas, como dor, mobilidade/flexibilidade e qualidade de vida.

RESUMEN El presente estudio tuvo por objetivo comparar el efecto de un protocolo de ejercicios kinesiofuncionales (ECF) aislados o asociados con corriente interferencial (CI) o corriente aussie (CA) sobre la intensidad del dolor, la movilidad/flexibilidad, la funcionalidad y la calidad de vida (CV) de las personas con dolor lumbar crónico inespecífico. Este es un ensayo clínico no aleatorizado en el que participaron 42 individuos y se los dividieron al azar en tres grupos: GI (entrenamientos kinesiofuncionales; n=14), GII (entrenamientos kinesiofuncionales + CI; n=14) y GIII (entrenamiento kinesiofuncional + CA; n=14). Se sometieron a los participantes a diez sesiones de tratamiento, durante 5 semanas, y estos pasaron por una evaluación antes y después de la intervención por medio de una escala visual de dolor analógica (EVA); evaluación de la CV por el cuestionario SF-36; evaluación de la movilidad/flexibilidad lumbar utilizando la prueba de Schober modificada y la prueba de sentarse y llegar al banco Wells; evaluación de la incapacidad funcional empelando el índice de Oswestry; y, para los aspectos depresivos, el Inventario de Depresión de Beck (BDI). En la reevaluación, la intensidad del dolor (p<0,0001) y la movilidad/flexibilidad tuvieron una mejora significativa en todos los grupos experimentales. En el SF-36, solo los individuos tratados con ejercicios asociados con corriente eléctrica mejoraron la capacidad física, los aspectos físicos y los dominios del dolor. La evaluación del BDI no cambió antes ni después de la intervención. Se concluye que la asociación entre técnicas terapéuticas tuvo un efecto positivo para los individuos de la muestra por la mejora producida en las variables evaluadas, como el dolor, la movilidad/flexibilidad y la calidad de vida.

ABSTRACT This study aimed to compare the effect of a Kinesio-functional exercise protocol (KFE) isolated or associated with Interferential Current (IC) or Aussie Current (AC) on pain intensity, mobility/flexibility, functionality, and quality of life (QoL) of individuals with chronic non-specific low back pain. This is a non-randomized clinical trial, in which 42 individuals were randomly divided into three groups: GI (KFE; n=14), GII (KFE+IC; n=14) and GIII (KFE+AC, n=14). The individuals underwent 10 treatment sessions (five weeks). The individuals were evaluated before and after the intervention, using the Pain visual analog scale (VAS); the assessment of QoL was conducted using the SF-36 questionnaire; the assessment of lumbar mobility/flexibility, by the modified Schober test and the Wells Bank; the assessment of functional disability, using the Oswestry Index; and for depressive aspects, the Beck Depression Inventory (BDI) was used. In the reassessment, we observed a significant improvement in all experimental groups regarding pain intensity (p <0.0001) and mobility/flexibility. In SF-36, we found that only individuals treated with exercises associated with electrical current improved their physical capacity, physical aspects, and pain domains. The BDI assessment did not show any changes before or after the intervention. We conclude that the association of therapeutic techniques showed greater benefit to the individuals in the sample since it improved the evaluated variables, such as pain, mobility/flexibility, and quality of life.

Transcutaneous electrical nerve stimulation, acupuncture, and spinal cord stimulation on neuropathic, inflammatory and, non-inflammatory pain in rat models.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS), manual acupuncture (MA), and spinal cord stimulation (SCS) are used to treat a variety of pain conditions. These non-pharmacological treatments are often thought to work through similar mechanisms, and thus should have similar effects for different types of pain. However, it is unclear if each of these treatments work equally well on each type of pain condition. The purpose of this study was to compared the effects of TENS, MA, and SCS on neuropathic, inflammatory, and non-inflammatory pain models. METHODS: TENS 60 Hz, 200 µs, 90% motor threshold (MT), SCS was applied at 60 Hz, an intensity of 90% MT, and a 0.25 ms pulse width. MA was performed by inserting a stainless-steel needle to a depth of about 4-5 mm at the Sanyinjiao (SP6) and Zusanli (ST36) acupoints on a spared nerve injury (SNI), knee joint inflammation (3% carrageenan), and non-inflammatory muscle pain (intramuscular pH 4.0 injections) in rats. Mechanical withdrawal thresholds of the paw, muscle, and/or joint were assessed before and after induction of the pain model, and daily before and after treatment. RESULTS: The reduced withdrawal thresholds were significantly reversed by application of either TENS or SCS (P < 0.05). MA, on the other hand, increased the withdrawal threshold in animals with SNI and joint inflammation, but not chronic muscle pain. CONCLUSIONS: TENS and SCS produce similar effects in neuropathic, inflammatory and non-inflammatory muscle pain models while MA is only effective in inflammatory and neuropathic pain models.

Corrente Russa associada ao ultrassom ou a fonoforese reduz o fibro edema gelóide / Russian Current associated with ultrasound or phonophoresis reduces cellulite

Introdução: O fibro edema gelóide (FEG) ocasiona deformações locais no tecido subcutâneo. Correntes excito motoras, como a corrente russa (CR), e métodos que associam efeitos mecânicos e térmicos no tecido, como o ultrassom (US), são usados para tratar a FEG. O US pode ainda ser aplicado com a fonoforese (FN) para aumentar a absorção percutânea de princípios ativos. Objetivo: Verificar o efeito da CR associada ao US ou à FN no tratamento da FEG em glúteos e coxas de mulheres jovens. Métodos: Participaram mulheres com FEG que realizaram 10 sessões de CR com US ou com FN. As voluntárias foram avaliadas antes e após os tratamentos. Resultados: Obteve-se diminuição da espessura das dobras cutâneas, redução do grau de FEG, redução da distorção da imagem corporal e índice de satisfação elevado das voluntárias com os resultados de ambos tratamentos, porém a FN associada à CR apresentou efeito mais evidente. Conclusão: Os tratamentos utilizados fornecem resultados rápidos e satisfatórios na redução do FEG.

Introduction: Geloid fibroedema (GF) or Cellulitis causes local deformations in the subcutaneous tissue. Electric Stimulation Therapy, such as the Russian Current (RC), and methods associating mechanical and thermal effects on tissue, such as Ultrasound (US), are used to treat GF. US can still be applied with Phonophoresis (Ph) to increase percutaneous absorption of active principles. Objective: To verify the effect of RC associated with US or Ph in the treatment of GF in glutes and thighs of young women. Methods: GF women who performed 10 sessions of RC with US or with Ph participated. The volunteers were evaluated before and after the treatments. Results: There was a reduction in the thickness of the skin folds, reduction of the GF degree, reduction of the body image distortion and high index of satisfaction of the volunteers with the results of both treatments, but the Ph associated to the CR showed a more evident effect. Conclusion: The treatments used provide fast and satisfactory results in the reduction of GF.

Efeito dos exercícios de fortalecimento, de marcha e de equilíbrio no tratamento de osteoartrite de joelho / Eff ect of strength, gait and balance exercises, in the treatment of knee osteoarthritis

A osteoartrite (OA) é uma doença reumática, degenerativa e progressiva que atinge as articulações sinoviais. Indivíduos com OA apresentam dor, rigidez articular matinal, sinais infl amatórios, crepitações, hipotrofi a muscular e limitações na amplitude de movimento. A fi sioterapia utiliza de recursos terapêuticos, como exercícios, para reduzir os sintomas e melhorar a qualidade de vida do indivíduo com OA. Este trabalho teve por fi nalidade verifi car o efeito da associação de exercícios de fortalecimento, de marcha e de equilíbrio sobre a dor, a amplitude de movimento, o equilíbrio, a qualidade de vida e a capacidade funcional de indivíduos com OA de joelho. Estudo clínico cego, no qual participaram 16 indivíduos com OA de joelho de ambos os gêneros e idade média de 61,38 ±16,10 anos. Os participantes realizaram 12 sessões de fi sioterapia, realizando exercícios de fortalecimento, marcha e equilíbrio. Eles foram avaliados antes e após o tratamento, por meio da escala visual analógica de dor, do questionário Western Ontario and McMaster Universities Osteoarthritis (WOMAC), do questionário de qualidade de vida SF-36, da goniometria, teste Timed Up and Go, teste de caminhada rápida de 10 metros, Escala de equilíbrio de Berg e teste de Romberg. Obteve-se diminuição da dor e, melhora da qualidade de vida nos domínios do questionário SF-36: aspectos funcionais, dor, estado geral de saúde e aspectos emocionais. O tratamento também proporcionou aumento da amplitude de movimento em fl exão, melhorou o equilíbrio no teste de Romberg com os olhos fechados e funcionalidade nos domínios rigidez e aspecto funcional do questionário WOMAC. Os exercícios de fortalecimento, marcha e equilíbrio foram capazes de reduzir a dor, melhorar a amplitude de movimento, equilíbrio, funcionalidade e qualidade de vida de pacientes com OA de joelho....(AU)

Osteoarthritis (OA) is a rheumatic, degenerative and progressive disease that aff ects the synovial joints. Individuals with OA experience pain, morning stiff ness, infl ammatory signals, crackles, muscular atrophy and limitations in range of motion. Physical therapy uses therapeutic resources, such as exercise, to reduce symptoms and improve the quality of life of individuals with OA. This study aimed to verify the eff ect of strengthening exercises association, gait and balance on pain, range of motion, balance, quality of life and functional capacity of patients with knee OA. Blind clinical study, which involved 16 subjects with knee OA of both genders, mean age of 61.38 ± 16.10 years. The participants underwent 12 physiotherapy sessions, performing strengthening exercises, gait and balance. They were evaluated before and after treatment by visual analogue pain scale, the questionnaire Western Ontario and McMaster Universities Osteoarthritis (WOMAC), the quality of life questionnaire SF-36, goniometry, Timed Up and Go test, test fast walk 10 meters, Berg balance Scale and Romberg test. Obtained decreased pain and improved quality of life in the domains of the SF-36 questionnaire: functional aspects, pain, general health and emotional aspects. The treatment also provided increased range of motion in fl exion, improved balance in the Romberg test with eyes closed and functionality in the areas stiff ness and functional aspect of the WOMAC questionnaire. Strengthening exercises, gait and balance were able to reduce pain, improve range of motion, balance, functionality and quality of life of patients with knee OA....(AU)

Terapia combinada associada à drenagem linfática reduz lipodistrofia localizada no abdômen de mulheres jovens / Combined therapy associated with lymphatic drainage reduce lipodystrophy located on abdomen of young women

Introdução: A Lipodistrofia localizada (LL) é o excesso de tecido adiposo em locais do corpo. A terapia combinada (TC) e a drenagem linfática manual (DLM) podem agir na redução da LL. Objetivo: Verificar o efeito da TC associada à DLM sobre a LL no abdômen de mulheres jovens e o grau de satisfação da imagem corporal. Método: Estudo clínico cego, no qual participaram 12 mulheres com LL no abdômen. As participantes realizaram 10 sessões de TC associado a DLM. As mulheres foram avaliadas antes e após o tratamento, através da aferição do peso e altura; perimetria abdominal; adipometria; registro fotográfico; e aplicação da Escala de Satisfação com a Imagem Corporal. Resultados: Redução da perimetria, da dobra cutânea na região, da porcentagem de gordura corporal e melhora da satisfação da imagem corporal dos indivíduos. Conclusão: O tratamento apresentou resultados rápidos e satisfatórios na redução da LL no abdômen de mulheres. (AU)

Introduction: Localized Lipodystrophy (LL) is the excess of adipose tissue at body sites. Combination therapy (CT) and manual lymphatic drainage (DLM) may act to reduce LL. Objective: To verify the effect of CT associated with DLM on the LL in the abdomen of young women and the degree of body image satisfaction. Method: Blind clinical study, in which 12 women with LL participated in the abdomen. Participants underwent 10 CT sessions associated with DLM. The women were evaluated before and after treatment by measuring the weight and height; abdominal circumference; plicometry; photographic record; and application of Satisfaction Scale with Body Image. Results: We observed reduction in abdominal circumference, skinfold thickness, reducing the percentage of body fat and improved body image satisfaction of individuals. Conclusion: The treatment presented fast and satisfactory results in the reduction of LL in the abdomen of women. (AU)

Exercise pre-conditioning reduces brain inflammation and protects against toxicity induced by traumatic brain injury: behavioral and neurochemical approach.

Although the favorable effects of physical exercise in neurorehabilitation after traumatic brain injury (TBI) are well known, detailed pathologic and functional alterations exerted by previous physical exercise on post-traumatic cerebral inflammation have been limited. In the present study, it is showed that fluid percussion brain injury (FPI) induced motor function impairment, followed by increased plasma fluorescein extravasation and cerebral inflammation characterized by interleukin-1ß, tumor necrosis factor-α (TNF-α) increase, and decreased IL-10. In addition, myeloperoxidase (MPO) increase and Na⁺,K⁺-ATPase activity inhibition after FPI suggest that the opening of blood-brain barrier (BBB) followed by neurtrophils infiltration and cerebral inflammation may contribute to the failure of selected targets leading to secondary damage. In fact, Pearson's correlation analysis revealed strong correlation of MPO activity increase with Na⁺,K⁺-ATPase activity inhibition in sedentary rats. Statistical analysis also revealed that previous running exercise (4 weeks) protected against FPI-induced motor function impairment and fluorescein extravasation. Previous physical training also induced IL-10 increase per se and protected against cerebral IL-1ß, and TNF-α increase and IL-10 decrease induced by FPI. This protocol of physical training was effective against MPO activity increase and Na⁺,K⁺-ATPase activity inhibition after FPI. The present protection correlated with MPO activity decrease suggests that the alteration of cerebral inflammatory status profile elicited by previous physical training reduces initial damage and limits long-term secondary degeneration after TBI. This prophylactic effect may facilitate functional recovery in patients suffering from brain injury induced by TBI.

Further antinociceptive effects of myricitrin in chemical models of overt nociception in mice.

The present work explored the antinociceptive effects of the flavonoid myricitrin in models of overt nociception triggered by intraplantar injection of chemical algogens into the hind paw of mice. The nociception induced by bradykinin (3 nmol/paw i.pl.) was abolished by prior treatment with myricitrin (10-100mg/kg, i.p.) with ID(50) of 12.4 (8.5-18.1)mg/kg. In sharp contrast, myricitrin failed to affect the nociception elicited by prostaglandin E(2) (3 nmol/paw i.pl.). Cinnamaldehyde (10 nmol/paw i.pl.)-induced nociception was reduced by myricitrin (100mg/kg, i.p.) and camphor (7.6 mg/kg,s.c.) in 43±10% and 57±8%, respectively. Myricitrin (30-100mg/kg, i.p.) and amiloride (100mg/kg, i.p.) inhibited nociceptive responses induced by acidified saline (pH 5/paw i.pl.), with ID(50) of 22.0 (16.1-30.0)mg/kg and inhibition of 71±6% and 64±5%, respectively. Moreover, myricitrin (10-30 mg/kg, i.p.) and ruthenium red (3mg/kg, i.p.) significantly reduced the nociception induced by menthol (1.2 µmol/paw i.pl.) with the mean ID(50) of 2.4 (1.5-3.7)mg/kg and inhibition of 95±3% and 51±7%, respectively. In addition, myricitrin administration (30 and 100mg/kg, i.p.) markedly reduced menthol-induced mechanical allodynia. However, myricitrin (100mg/kg, i.p.) prevented (only in time of 60 min) cold allodynia induced by menthol. Collectively, the present results extend prior data and show that myricitrin promotes potent antinociception, an action that is likely mediated by an inhibition of the activation of nociceptors by bradykinin and TRPs agonist (i.e. cinnamaldehyde, acidified saline and menthol), probably via inhibition of PKC pathways. Thus, myricitrin could constitute an attractive molecule of interest for the development of new analgesic drugs.