Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews.

AIM/OBJECTIVE: The aim is to critically analyse and discuss the current literature and determine the effectiveness of rehabilitation for patients after surgical repair of rotator cuff tears for range of motion (ROM), pain, functional status and retear rates; in addition, an update of new literature is included. DESIGN: Overview of systematic reviews. DATA SOURCES: A search was performed with no restrictions to date of publication and language in the following databases: EBSCO, AMED, CINAHL, SPORTDiscus, EMBASE, Cochrane, LILACS, MEDLINE, PEDro, Scielo, SCOPUS and Web of Knowledge. The PRISMA guideline was followed to develop this review and the R-AMSTAR tool was used for critical appraisal of included reviews. ELIGIBILITY CRITERIA: Only systematic reviews and randomised controlled trials (RCTs) comparing the effectiveness of early with conservative rehabilitation, after surgical repair of the rotator cuff, were included. Moreover, the studies should report ROM, pain, functional status and/or retears rates before and after 3-24 months of the surgery. RESULTS: 10 systematic reviews and 11 RCTs were included for the final analysis. Conflicting results and conclusions were presented by the systematic reviews, the use of primary studies varied; also the methodological quality of the reviews was diverse. This updated review, with new meta-analysis, showed no difference for function, pain, ROM or retears ratio between early and conservative rehabilitation. SUMMARY/CONCLUSIONS: Early mobilisation may be beneficial, particularly for small and medium tears; however, more studies with higher quality are required, especially for patients with large tears who have been given less attention.

Determination of the motor unit behavior of lumbar erector spinae muscles through surface EMG decomposition technology in healthy female subjects.

INTRODUCTION: The aims of this study were to determine the motor unit behavior of the erector spinae muscles and to assess whether differences exist between the dominant/nondominant sides of the back muscles. METHODS: Nine healthy women, aged 21.7 years (SD = 0.7), performed a back extension test. Surface electromyographic decomposition data were collected from both sides of the erector spinae and decomposed into individual motor unit action potential trains. The mean firing rate for each motor unit was calculated, and a regression analysis was performed against the corresponding recruitment thresholds. RESULTS: The mean firing rate ranged from 15.9 to 23.9 pps and 15.8 to 20.6 pps on the dominant and nondominant sides, respectively. However, the early motor unit potentials of the nondominant lumbar erector spinae muscles were recruited at a lower firing rate. CONCLUSIONS: This technique may further our understanding of individuals with back pain and other underlying neuromuscular diseases. Muscle Nerve 55: 28-34, 2017.

Kinematic gait analysis using inertial sensors with subjects after stroke in two different arteries.

[Purpose] The aim of the present study was described the kinematic characteristics of gait in stroke patients with two different arteries involved. [Subjects and Methods] Two patients who had suffered a basilar (A) or middle (B) cerebral artery ischemic stroke were compared with a control (C). Seventeen inertial sensors were used with acquisition rate of 120 Hz. The participants walked 3 times on a 10 meter walkway. From the raw data, the three gait cycles from the middle of each trial were chosen and analyzed. [Results] During the stance phase, patients A and B had a lower hip angle at initial contact and maximum flexion angle during load response than the control. Patient A and the control subject had similar knee angle values at initial contact, and patient B presented a flexed position in the initial phase of the gait cycle. The maximum flexion angles during loading response were also higher for patient B. The sagittal plane excursion for the ankle joint was lower for patient B in comparison with the other subjects. [Conclusion] Differences during walking between patients who had stroke in different arteries may be related to an alternative compensatory strategy. Patient A and the control subject had similar gait cycle curves at all joints, while patient B showed a rigid synergic pattern.

The effectiveness of aquatic physical therapy in the treatment of fibromyalgia: a systematic review with meta-analysis.

OBJECTIVE: To assess the effectiveness of aquatic physical therapy in the treatment of fibromyalgia. DATA SOURCES: The search strategy was undertaken using the following databases, from 1950 to December 2012: MEDLINE, EMBASE, CINAHL, LILACS, SCIELO, WEB OF SCIENCE, SCOPUS, SPORTDiscus, Cochrane Library Controlled Trials Register, Cochrane Disease Group Trials Register, PEDro and DARE. REVIEW METHODS: The studies were separated into groups: Group I - aquatic physical therapy × no treatment, Group II - aquatic physical therapy × land-based exercises and Group III - aquatic physical therapy × other treatments. RESULTS: Seventy-two abstracts were found, 27 of which met the inclusion criteria. For the functional ability (Fibromyalgia Impact Questionnaire), three studies were considered with a treatment time of more than 20 weeks and a mean difference (MD) of -1.35 [-2.04; -0.67], P = 0.0001 was found in favour of the aquatic physical therapy group versus no treatment. The same results were identified for stiffness and the 6-minute walk test where two studies were pooled with an MD of -1.58 [-2.58; -0.58], P = 0.002 and 43.5 (metres) [3.8; 83.2], P = 0.03, respectively. CONCLUSION: Three meta-analyses showed statistically significant results in favour of the aquatic physical therapy (Fibromyalgia Impact Questionnaire, stiffness and the 6-minute walk test) during a period of longer than 20 weeks. Due to the low methodological rigor, the results were insufficient to demonstrate statistical and clinical differences in most of the outcomes.

Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects.

Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2×/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n = 11) and the general exercise group (GEG) (n = 11). The PG protocol was based on the Pilates method and the GEG performed exercises to manage NSCLBP. There were no differences between the groups. When analysed over time, the GEG demonstrated improvements in functionality between baseline and the end of treatment (P = .02; Cohen'sd¯ = 0.34) and baseline and follow-up (P = .04; Cohen'sd¯ = 0.31). There were no differences between the Pilates and general exercises with regard to pain and functionality in NSCLBP subjects but general exercises were better than Pilates for increasing functionality and flexibility.

Comparison of the electromyographic activity of the anterior trunk during the execution of two Pilates exercises - teaser and longspine - for healthy people.

This study compared abdominal electromyographic (EMG) activity during the performance of Pilates' exercises. 16 females participated in the study. EMG signals of the rectus abdominis (RA) and external oblique (EO) were recorded during Longspine performed on the mat, Cadillac, and Reformer and the Teaser performed on the mat, Cadillac, and Combo-chair. Values were normalized by the EMG peak of a dynamic task and divided in concentric and eccentric phases. Longspine performed on the mat increased EO activity in the concentric phase more than on the Reformer and the Cadillac (Mean Difference (MD)=12.2%; 95% Confidence Interval (CI) [3.36; 21.04]; p=.04). Differences in the eccentric phase of the RA favored the mat compared to the Reformer (MD=5.20%; 95% CI [-0.55; 10.95]; p=.02). Significant differences in eccentric contraction of the RA were found for teaser exercise performed on the mat versus Cadillac (MD=1.1%; 95% CI [-4.13; 6.33]; p=.04) and the mat versus the Combo-chair (MD=6.3%; 95% CI [1.31; 11.29]; p=.005). Higher concentric activation values for the EO were found when the teaser exercise was performed on the Cadillac. Exercises performed on the mat required greater rectus abdominis activation.

The effectiveness of postoperative physical therapy treatment in patients who have undergone arthroscopic partial meniscectomy: systematic review with meta-analysis.

STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVES: To evaluate the effectiveness of postoperative physical therapy treatment for patients who have undergone arthroscopic partial meniscectomy. BACKGROUND: There is no consensus on which treatment is best for patients post meniscectomy. METHODS: A search for articles published from 1950 to March 2013 was conducted in the MEDLINE, Embase, CINAHL, LILACS, SciELO, IBECS, Scopus, Web of Science, PEDro, Academic Search Premier, and Cochrane Central Register of Controlled Trials databases. The key words were physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, placebo, groups, tibial meniscus, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, controlled clinical trial, randomized, systematic review, and meta-analysis. RESULTS: Eighteen randomized controlled trials were included in the review, 6 of which were included in the meta-analysis. Outpatient physical therapy plus a home exercise program, compared to a home program alone, improved function compared to a home program alone (mean difference, 10.3; 95% confidence interval: 1.3, 19.3; P = .02) and knee flexion range of motion (mean difference, 9.1; 95% confidence interval: 3.7, 14.5; P = .0009). Inpatient physical therapy alone compared to inpatient plus outpatient physical therapy reduced the likelihood of effusion (odds ratio = 0.25; 95% confidence interval: 0.10, 0.61; P = .003). CONCLUSION: Physical therapy associated with home exercises seems to be effective in improving patient-reported knee function and range of motion in patients post-arthroscopic meniscectomy, although the included randomized controlled trials were classified from moderate to high risk of bias and should be interpreted with caution. LEVEL OF EVIDENCE: Therapy, level 1a-.

Isokinetic evaluation of knee muscles in soccer players: discriminant analysis / Avaliação isocinética dos músculos do joelho em jogadores de futebol: análise discriminante / Evaluación isocinética de los músculos de la rodilla en jugadores de fútbol: análisis discriminante

ABSTRACTIntroduction:Muscle activity in soccer players can be measured by isokinetic dynamometer, which is a reliable tool for assessing human performance.Objectives:To perform isokinetic analyses and to determine which variables differentiate the under-17 (U17) soccer category from the professional (PRO).Methods:Thirty four players were assessed (n=17 for each category). The isokinetic variables used for the knee extension-flexion analysis were: peak torque (Nm), total work (J), average power (W), angle of peak torque (deg.), agonist/ antagonist ratio (%), measured for three velocities (60°/s, 120°/s and 300°/s), with each series containing five repetitions. Three Wilks' Lambda discriminant analyses were performed, to identify which variables were more significant for the definition of each of the categories.Results:The discriminative variables at 60°/s in the PRO category were: extension peak torque, flexion total work, extension average power and agonist/antagonist ratio; and for the U17s were: extension total work, flexion peak torque and flexion average power. At 120°/s for the PRO category the discriminant variables were: flexion peak torque and extension average power; for the U17s they were: extension total work and flexion average power. Finally at 300°/s, the variables found in the PRO and U17 categories respectively were: extension average power and extension total work.Conclusion:Isokinetic variables for flexion and extension knee muscles were able to significantly discriminate between PRO and U17 soccer players.

RESUMOIntrodução:A atividade muscular em jogadores de futebol pode ser medida por meio do dinamômetro isocinético, que é um instrumento confiável para avaliação do desempenho humano.Objetivos:Conduzir análises isocinéticas e discriminar quais variáveis diferenciam a categoria sub-17 (S17) da profissional (PRO).Métodos:Trinta e quatro jogadores de futebol (n=17 para cada categoria) foram avaliados. As variáveis isocinéticas utilizadas para a análise de extensão-flexão do joelho foram: pico de torque (Nm), trabalho total (J), potência média (W), ângulo de pico de torque (graus), razão agonista/antagonista (%), testadas em três velocidades (60°/s, 120°/s e 300°/s), com cada série contendo cinco repetições. Três análises discriminantes foram feitas usando o método Wilk's Lambda para identificar quais variáveis fariam uma discriminação significativa entre as duas categorias.Resultados:As variáveis discriminantes a 60°/s na categoria PRO foram: pico de torque extensores, trabalho total flexores, potência média de extensores e razão agonista/antagonista; e para os S17 foram: trabalho total de extensores, pico de torque de flexores e potência média de flexores. A 120°/s para a categoria PRO as variáveis discriminantes foram: pico de torque de flexores e potência média de extensores; para os S17 foram: trabalho total de extensores e potência média de flexores. A 300°/s, as variáveis encontradas para as categorias PRO e S17 foram, respectivamente: potência média de extensores e trabalho total de extensores.Conclusão:As variáveis isocinéticas para os músculos do joelho flexores e extensores foram capazes de fazer uma discriminação significativa entre jogadores de futebol PRO e S17.

RESUMENIntroducción:La actividad muscular en jugadores de fútbol puede ser medida por medio del dinamómetro isocinético, que es un instrumento confiable para evaluación del desempeño humano.Objetivos:Conducir análisis isocinéticos y discriminar qué variables diferencian la categoría sub-17 (S17) de la profesional (PRO).Métodos:Fueron evaluados treinta y cuatro jugadores de fútbol (n=17 para cada categoría). Las variables isocinéticas utilizadas para el análisis de extensión-flexión de la rodilla fueron: pico de torque (Nm), trabajo total (J), potencia media (W), ángulo de pico de torque (grados), razón agonista/antagonista (%), probadas en tres velocidades (60°/s, 120°/s y 300°/s), con cada serie conteniendo cinco repeticiones. Fueron realizados tres análisis discriminantes usando el método Wilk's Lambda para identificar qué variables harían una discriminación significativa entre las dos categorías.Resultados:Las variables discriminantes a 60°/s en la categoría PRO fueron: pico de torque extensores, trabajo total flexores, potencia media de extensores y razón agonista/antagonista; y para los S17 fueron: trabajo total de extensores, pico de torque de flexores y potencia media de flexores. A 120°/s para la categoría PRO las variables discriminantes fueron: pico de torque de flexores y potencia media de extensores; para los S17 fueron: trabajo total de extensores y potencia media de flexores. A 300°/s, las variables encontradas para las categorías PRO y S17 fueron, respectivamente: potencia media de extensores y trabajo total de extensores.Conclusión:Las variables isocinéticas para los músculos de la rodilla flexores y extensores fueron capaces de hacer una discriminación significativa entre jugadores de fútbol PRO y S17.

Análise comparativa da atividade elétrica do músculo multífido durante exercícios do Pilates, série de Williams e Spine Stabilization / Analysis of the multifidus muscle during Pilates, Williams' flexion and Spine Stabilization

INTRODUÇÃO: A fraqueza da musculatura paraespinhal está relacionada à etiologia da dor lombar. Atualmente existem vários métodos que apresentam exercícios para o fortalecimento dessa musculatura. OBJETIVOS: Comparar e analisar o sinal eletromiográfico do músculo multífido bilateralmente durante exercícios do método Pilates, série de Williams e Spine Stabilization. MATERIAIS E MÉTODOS: Participaram do estudo dez mulheres voluntárias e saudáveis que realizaram os exercícios leg pull front support modificado do Pilates, o quarto exercício da série adicional de Williams e o quadruped exercise do Spine Stabilization. O sinal foi normalizado pelo pico eletromiográfico da atividade dinâmica e foram ajustados para 2000 amostras por segundo e o filtro em uma frequência de passagem de 20 a 450 Hz. A ANOVA foi utilizada para verificar diferenças entre os exercícios, o teste t para amostras dependentes foi usado para comparar a ativação entre os lados direito e esquerdo do multífido para cada exercício. RESULTADOS E CONSIDERAÇÕES FINAIS: Na comparação entre os exercícios, observaram-se diferenças significativas para o músculo multífido a favor do exercício do método Pilates tanto na fase concêntrica quanto na excêntrica, o que demonstra ser o exercício de melhor ativação elétrica para o músculo analisado.

INTRODUCTION: The back muscle weakness is related with the etiology of low back pain. Nowadays, there are several methods the focus is on back muscle strengthening. OBJECTIVES: The purpose of this study was to compare and analyze the multifidus muscle bilaterally during exercises of the Pilates method, Spine Stabilization and Williams' flexion. MATERIALS AND METHODS: Ten healthy female volunteers participated in the study. They performed the leg pull front support exercise from the Pilates method, the quadruped exercise from the Spine Stabilization and the fourth exercise from the additional Williams' flexion. The signal was normalized by the electromyographic peak of the dynamic activity and was adjusted to 2000 samples/s and filter with a frequency band from 20 to 450 Hz. ANOVA was used to verify differences between the exercises, the paired-sample t test was used to compare activation between the right and left multifidus for each exercise. RESULTS AND CONCLUSION: When the exercises where compared, statistically significant differences were observed in the concentric and eccentric phases for the Pilates exercise, showing that this exercise is the one who activates the musculature the most between the exercises evaluated.