Neuromuscular training and muscle strengthening in patients with patellofemoral pain syndrome: a protocol of randomized controlled trial.

BACKGROUND: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition, particularly among women. Patients with PFPS usually experience weakness in the gluteal muscles, as well as pain and impaired motor control during activities of daily living. Strengthening the hip muscles is an effective way of treating this disorder. Neuromuscular training has also been identified as a therapeutic tool, although the benefits of this intervention in patients with PFPS patients remain inconclusive. DESIGN: This is a protocol of randomized controlled trial with a blind assessor. Thirty-four women with a clinical diagnosis of PFPS participated. These participants were allocated into two groups (experimental and control). The experimental group performed twelve sessions to strengthen the knee extensors, hip abductor and lateral rotator muscles in association with neuromuscular training of the trunk and lower extremities. The control group performed the same number of sessions to strengthen the muscles of the hip and knee. The primary outcome was functional capacity (Anterior Knee Pain Scale - AKPS) at 4 weeks. Pain intensity, muscle strength and kinematic changes were also measured during the step down test after four weeks of intervention. Follow up assessments were conducted after three and six months to assess functional capacity and pain. The effects of the treatment (i.e. between-group differences) were calculated using mixed linear models. DISCUSSION: The present study was initiated on the 1st of April 2013 and is currently in progress. The results of this study may introduce another effective technique of conservative treatment and could guide physical therapists in the clinical decision-making process for women with PFPS. TRIAL REGISTRATION: Current Controlled Trials NCT01804608.

Does the examiner's experience matter in evaluation of the kinematics of the upper limb?

This study aimed to evaluate test and retest reliability according to examiner experience with the three-dimensional kinematics of the trunk, scapula, and arm segments during flexion and unilateral abduction of the arm. Ten men and 10 women (mean age, 25.1 [1.1] years) participated in this study. Each volunteer participated in six test sessions, four on the first day (two for each examiner) and two on the second day (one for each examiner). A 48-h interval was given between test days. The assessments were made by one examiner with movement analysis experience and a second examiner without experience. For each session (intra-day), the volunteers performed five repetitions of unilateral arm flexions and abductions using their dominant arms. After 1 h, the data were re-collected and all markers were replaced. Data from the trunk, scapula, and arm were analysed at 30°, 60°, 90°, and 120° of arm flexion and abduction using intraclass coefficient correlation, standard error of the measurement, and analysis of variance. The results did not differ between the experienced and inexperienced examiners except for trunk axial rotation at all studied angles and for arm rotation at 120° of abduction. The examiner previously trained in movement analysis marker placement demonstrated the same intra-tester reliability as the inexperienced tester when marker placement accuracy was the variable of interest.

Descending stairs: Good or bad task to discriminate women with patellofemoral pain?

BACKGROUND: There is no consensus on kinematics alterations during descending stairs in females with patellofemoral pain (PFP). In addition, there are no studies that have evaluated the three dimensional kinematics of the trunk, pelvis, hip, knee, and ankle using a multi-segmental model of the foot simultaneously during this task in patients with PFP and evaluated the subphases of stair descent. The objectives of this study were to compare the three dimensional kinematics of the trunk, pelvis, and lower limbs during different subphases of stair descent and identify the discriminatory capacity of the kinematic variables among women with PFP and healthy women. METHODS: In this cross-sectional study, thirty-four women with PFP and thirty-four pain free women between 18 and 35 years-old were submitted to three-dimensional kinematic evaluation during stair descent. RESULTS: It was observed that kinematic differences between the groups occurred in the first double support phase of the stair descent, with the variables of internal rotation of the hindfoot in relation to the tibia in the initial contact (2.1°; sensitivity = 68.6%, specificity = 61.8%) and contralateral pelvic drop in load response (1.3°, sensitivity = 65.7%, specificity = 63.7%) presenting the best ability to discriminate women with and without PFP. CONCLUSION: Our results suggest that kinematic changes during stair descent should be used with caution during the evaluation and decision-making process in women with PFP.

Female PFP patients present alterations in eccentric muscle activity but not the temporal order of activation of the vastus lateralis muscle during the single leg triple hop test.

This study aimed to compare the concentric and eccentric activity and the temporal order of peak activity of the hip and knee muscles between women with patellofemoral pain (PFP) and healthy women during the single leg triple hop test (SLTHT). Electromyographic (EMG) and Kinematic data were collected from 14 healthy women (CG) and 14 women diagnosed with PFP (PFG) during a single session of the single leg triple hop test. Integral surface electromyography (iEMG) data of the hip and knee muscles in eccentric and concentric phases and the length of time that each muscle needed to reach the maximal peak of muscle activity were calculated. The iEMG in the eccentric phase was significantly higher (p < 0.05) than the concentric phase, for the gluteus maximus and gluteus medius muscles (CG and PFG) and for the vastus lateralis muscle (PFG). The vastus lateralis muscle was the first muscle to reach the highest peak of activity in the PFG, and the third to reach this peak in the CG. In the present study, the activity of the vastus lateralis muscle during the eccentric phase of the jump was greater than concentric phase, as a temporal anticipation of its peak in activity among women with PFP.

Adding motor control training to muscle strengthening did not substantially improve the effects on clinical or kinematic outcomes in women with patellofemoral pain: A randomised controlled trial.

DESIGN: Randomized controlled trial. BACKGROUND: Patients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP. METHODS: Thirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement Control & Strengthening group (MC&S group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization. RESULTS: The MC&S group did not present significantly better function (MD -2.5 points, 95% CI;-10.7-5.5) or pain (MD -0.3 points, 95% CI;-1.7-1.0) at 4 weeks. There was a small difference in favour of the MC&S group for AKPS scores at 3 months (MD -8.5 points; 95% CI;-16.8 to -0.3). No significant between-group differences were observed for the other outcomes. CONCLUSION: Movement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.

Kinematic and electromyographic analysis in patients with patellofemoral pain syndrome during single leg triple hop test.

Possible delays in pre-activation or deficiencies in the activity of the dynamic muscle stabilizers of the knee and hip joints are the most common causes of the patellofemoral pain syndrome (PFPS). The aim of the study was to compare kinematic variables and electromyographic activity of the vastus lateralis, biceps femoris, gluteus maximus and gluteus medius muscles between patients with PFPS and health subjects during the single leg triple hop test (SLTHT). This study included 14 female with PFPS (PFPS group) and 14 female healthy with no history of knee pain (Healthy group). Kinematic and EMG data ware collected through participants performed a single session of the SLTHT. The PFPS group exhibited a significant increase (p<0.05) in the EMG activity of the biceps femoris and vastus lateralis muscles, when compared with the healthy group in pre-activity and during the stance phase. This same result was also found for the vastus lateralis muscle (p<0.05) when analyzing the EMG activity during the eccentric phase of the stance phase. In kinematic analysis, no significant differences were found between the groups. These results indicate that biceps femoris and vastus lateralis muscles mainly during the pre-activation phase and stance phases of the SLTHT are more active in PFPS group among healthy group.

Kinematic and Kinetic Analysis of the Single-Leg Triple Hop Test in Women With and Without Patellofemoral Pain.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To compare the biomechanical strategies of the trunk and lower extremity during the transition period between the first and second hop of a single-leg triple hop test in women with and without patellofemoral pain (PFP). BACKGROUND: Recent literature has shown that PFP is associated with biomechanical impairments of the lower extremities. A number of studies have analyzed the position of the trunk and lower extremities for functional activities such as walking, squatting, jumping, and the step-down test. However, studies on more challenging activities, such as the single-leg triple hop test, may be more representative of sports requiring jumping movements. METHODS: Women between 18 and 35 years of age (control group, n = 20; PFP group, n = 20) participated in the study. Three-dimensional kinematic and kinetic data were collected during the transition period between the first and second hops while participants performed the single-leg triple hop test. RESULTS: Compared to the control group, women with PFP exhibited greater (P<.05) anterior and ipsilateral trunk lean, contralateral pelvic drop, hip internal rotation and adduction, and ankle eversion, while exhibiting less hip and knee flexion. A significant difference (P<.05) in time to peak joint angle was also found between groups for all the variables analyzed, except anterior pelvic tilt and hip flexion. In addition, women with PFP exhibited greater (P<.05) hip and knee abductor internal moments. CONCLUSION: Compared to the control group, women with PFP exhibited altered trunk, pelvis, hip, knee, and ankle kinematics and kinetics.

Propulsion phase of the single leg triple hop test in women with patellofemoral pain syndrome: a biomechanical study.

Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.

Effectiveness of phototherapy incorporated into an exercise program for osteoarthritis of the knee: study protocol for a randomized controlled trial.

BACKGROUND: Osteoarthritis is a chronic disease with a multifactor etiology involving changes in bone alignment, cartilage, and other structures necessary to joint stability. There is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (low-level laser therapy and light-emitting diode therapy) in the same apparatus for the treatment of osteoarthritis. The aim of the proposed study is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for individuals with osteoarthritis of the knee. METHODS/DESIGN: A double-blind, controlled, randomized clinical trial will be conducted involving patients with osteoarthritis of the knee. Evaluations will be performed using functional questionnaires before and after the treatment protocols, in a reserved room with only the evaluator and participant present, and no time constraints placed on the answers or evaluations. The following functional tests will also be performed: stabilometry (balance assessment), dynamometry (muscle strength of gluteus medius and quadriceps), algometry (pain threshold), fleximeter (range of motion), timed up-and-go test (functional mobility), and the functional reach test. The participants will then be allocated to three groups through a randomization process using opaque envelopes: exercise program, exercise program + phototherapy, or exercise program + placebo phototherapy, all of which will last for eight weeks. DISCUSSION: The purpose of this randomized clinical trial is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for osteoarthritis of the knee. The study will support the practice based on evidence to the use of phototherapy in individuals with a diagnosis of osteoarthritis of the knee. Data will be published after the study is completed. TRIAL REGISTRATION: The protocol for this study has been submitted to Clinical Trials, registration number NCT02102347, on 29 March 2014.

Índice de incapacitação das lombalgias em motoristas de caminhão / Disability index of low back pain in truck drivers

INTRODUÇÃO: As lombalgias são causas de morbidade e incapacidade na realização de atividades de vida diária. Motoristas de caminhão apresentam risco aumentado de desenvolvimento da lombalgia em razão das demandas mecânico-posturais características da profissão. OBJETIVO: Investigar o nível de interferência das lombalgias nas atividades de vida diária de motoristas de caminhão. MÉTODOS: Foi realizado um estudo transversal, no qual foram entrevistados 30 motoristas de caminhão, do sexo masculino, com idade entre 25 e 35 anos e com mais de cinco anos de experiência na profissão. Apenas os indivíduos que referiram dor lombar crônica, persistente há mais de três meses, foram instruídos a responder o questionário sobre o índice de incapacitação de Oswestry para dor lombar, com intuito de classificar os níveis de interferência das lombalgias nas atividades de vida diária. RESULTADOS: Vinte e nove motoristas de caminhão atenderam aos critérios de inclusão do estudo (média de idade 31,83±3,63 anos, tempo de experiência 8,93±2,4 anos e média de 13,66±2,47 horas diárias de trabalho). Vinte e dois motoristas (75,86%) apresentavam incapacidade mínima (score 8,45±6,58) e sete (24,14%), incapacidade moderada (score 27,14±6,3). CONCLUSÃO: Apenas 24,14% da amostra estudada apresentou incapacidade moderada, interferindo assim na realização de atividades de vida diária, tais como: problemas ao sentar, levantar peso e ficar de pé.

INTRODUCTION: Low back pain leads the morbidity and disability in performing daily living activities. Truck drivers have high risks to developing low back pain due to postural and mechanical characteristics of the profession. OBJECTIVE: To investigate the low back pain interference level in daily living activities of the truck drivers. METHODS: This is a cross-sectional studythat recruited 30 truck drivers, male, aged between 25 and 35 years old and more than five years of experience in this profession. Only individuals with chronic low back pain (at least three months), were instructed to answer the Oswestry disability index questionnaire, to classify the low back pain interference levels in daily activities. RESULTS: Twenty-ninetruck drivers were included (mean age 31.83±3.63 years, meanexperience 8.93±2.4 years and a mean daily work 13.66±2.47 hours). Twenty-two truck drivers (75.86%) showed minimal disability (score 8.45±6.58) and seven (24.14%), moderate disability (score 27.14±6.3). CONCLUSION: Only 24.14% of the sample showed moderate disability, that can be interfering in the daily living activities performance of the truck drivers, such as; problems when sitting, lifting and standing up.

Alteração da flexibilidade aguda dos isquiotibiais após alongamento passivo / Aleration af the acute flexibility af the hamstring muscles after passive allonge

Introdução: A utilização de manobras de alongamento é um dos recursos mais empregados na prática clínica de reabilitação e na prática esportiva. Os intervalos de tempo adequados entre as sessões de alongamento têm sido investigados. Objetivo: O objetivo deste trabalho foi verificar as alterações da flexibilidade aguda dos isquiotibiais após uma sessão de alongamento passivo de 30 e 60 segundos. Método: Foram avaliados 20 indivíduos, dezessete mulheres e três homens com idade entre 18 e 30 anos, divididos em dois grupos: grupo A submetido ao alongamento passivo de 30 segundos, grupo B ao alongamento passivo de 60 segundos. Foi realizada a medida do ângulo poplíteo utilizando-se um goniômetro no período pré e pós-alongamento e 24 horas após o alongamento. Resultados: Os dados obtidos mostram que a média de alteração no ângulo poplíteo do grupo B é maior que a do grupo A. Conclusão: A análise dos dados indicou maiores alterações do ângulo poplíteo com o alongamento mantido no tempo de 60 segundos.

Introduction: The use of stretch techniques is one of the most employed resources in clinical rehabilitation practice sports and sportive practice. Appropriate time intervals between the sessions elongation have been very investigated. Objective: The goal of this work was to verify the changes of the flexibility of hamstring after a passive stretch session of 30 and 60 seconds. Methods: 20 volunteers had been evaluated, seventeen women and three men aged between 18 and 30 years, divided into two groups: group A submited passive stretch group of 30 seconds; group b: passive stretch of 60 seconds. Angle measure was performed using goniometry poplíteal in pre-and post-stretch and this measure was repected 24 hours later. Results: The data show that the average change in popliteal angle in group B is greater than that of group A. Conclusion: Analysis of the data indicated greater poplíteal angle changes with the stretch maintained in 60 seconds.