Clinical Features and isokinetic Parameters in Assessing Injury Risk in elite Football Players.

Football players frequently face the occurrence of non-contact injuries. Although there are likely multiple factors that contribute to increased risk of non-contact injury, it remains a challenge to correlate all these factors. However, it is not clear how much of individual training abilities may interfere in these events. As such, the primary aim of the present study was to determine whether the reduction of functional performance of the thigh in the isokinetic knee tests, anthropometric and morbid history can establish risk factors for lower-limb musculoskeletal injuries throughout the season. The incidence of injuries and odds ratios were calculated for suspected risk factors. Hamstring/Quadriceps conventional ratio outside of the safety range (55-64%) may be involved in the occurrence of non-contact muscle injuries and the risk for any musculoskeletal injuries in the lower extremities is 16 times higher when extensor peak of torque exceeds 10% and 12 times higher when flexor peak of torque difference was greater than 10%. This kind of evaluation can result in intervention programs that may decrease the risk of lower-limb musculoskeletal injuries. Based on these results we can establish a specific and individualized exercise program for each athlete and thus protect them during the season.

Toward the Concept of 'Spiritist Chaplaincy'.

In Brazil, Spiritism is the third most common religious affiliation. Notwithstanding, there are few religious assistance programs dedicated to Spiritist patients in Brazilian general hospitals and, after searching for the term 'Spiritist Chaplaincy' on lay and medical databases, it returns zero results. This article describes the future development of a 'Spiritist Chaplaincy,' exploring its concept, design, precepts, and challenges, based upon the first results of a Spiritist religious assistance program for hospitalized patients. This proposed model seems feasible to be replicated, aiming to develop in the near future a structure compatible with a proper 'Spiritist Chaplaincy' instead of religious hospital visits.

The effect of a patellar bandage on the postural control of individuals with patellofemoral pain syndrome.

A patellar bandage is often used by individuals with patellofemoral pain syndrome (PPS) to reduce pain and the additional sensorial input improves proprioception of the knee joint. The aim of this work was to assess the effect of a patellar bandage on the postural control of individuals with and without PPS. [Subjects and Methods] An analysis was performed of variables of center of pressure (CoP) as recorded by a force plate. Information about the forces and moments in three directions was used to obtain the CoP. Thirty women participated in this study: 15 with PPS and 15 without PPS. All subjects performed 3 trials in a unipodal stance with and without a patellar bandage. The force plate data were used to calculate the following variables: CoP sway area, CoP displacement frequency, and CoP mean velocity for the anteroposterior (AP) and mediolateral (ML) directions. A the linear mixed effects model was used for statistical analysis. [Results] Postural sway was significantly reduced in individuals with PPS when a patellar bandage was applied. [Conclusion] Additional sensory input from a patellar bandage increase proprioceptive feedback and this could be related to the improvement in postural control of PPS subjects.

Complementary therapies for fibromyalgia syndrome -- a rational approach.

Fibromyalgia syndrome (FMS) is a complex chronic condition, the treatment of which still poses many challenges. Complementary therapies (CT) have gained increasing popularity among FMS patients. Past reviews evaluating effectiveness of CT for treatment of FMS revealed some potential benefits arising from certain modalities. However, with the data available, it becomes difficult to formulate a unique opinion about this matter. In the present paper, the authors propose some guidelines to conciliate the expectations of patients with the lack of solid evidence, in a practicable yet responsible way. Many items should be considered before prescribing, proscribing, or tolerating a CT, besides results from randomized controlled trials, such as efficacy (mechanisms of action); effectiveness (effect in practice); efficiency (cost-benefit ratio); safety; risk-benefit ratio; legislation; healthcare service involvement; practitioner characteristics; objective (purpose); and the potential of combination with conventional treatment.

Shared Death Experiences: A Multicultural Survey.

BACKGROUND: Shared-death-experiences (SDEs) and after-death-communication-experiences (ADCEs) are non-ordinary mental experiences related to the death of a known or unknown person. METHODS: These experiences were investigated by surveying four samples with different cultural backgrounds: Italian, Mexican, Brazilian and Taiwanese people. One-hundred-twenty-one participants reported 146 experiences of this type. RESULTS: Among the main characteristics of these experiences, visual, visual-auditory and feeling experiences, which comprised 74% of all experiences, were experienced both in the dream state and a normal state of consciousness. Furthermore, most of these experiences were lived before (47.3%) or after (39%) the death of the person in relationship with the participants. More importantly, these experiences influenced the participants' death interpretation favoring the belief that death affects only the body, but the consciousness of the deceased persons survives in another reality and sometimes can communicate with relatives and friends still alive in this reality. No substantial differences were observed among the different subsamples. CONCLUSION: As to the origin of SDEs/ADCEs, we discuss that whereas for most of them, in particular those lived after the death of a relative or a friend, we can assume hallucinatory characteristics triggered by emotional needs, for others, for example those related to unknown individuals and/or those experienced before the death of the person still in good health, it is not possible to exclude their anomalous connections and a real encounter with a deceased person.

Correlation between trochlear groove depth and patellar position during open and closed kinetic chain exercises in subjects with anterior knee pain.

The purpose of this study was to correlate the trochlear shape and patellar tilt angle and lateral patellar displacement at rest and maximal voluntary isometric contraction (MVIC) exercises during open (OKC) and closed kinetic chain (CKC) in subjects with and without anterior knee pain. Subjects were all women, 20 who were clinically healthy and 19 diagnosed with anterior knee pain. All subjects were evaluated and subjected to magnetic resonance exams during OKC and CKC exercise with the knee placed at 15, 30, and 45 degrees of flexion. The parameters evaluated were sulcus angle, patellar tilt angle and patellar displacement using bisect offset. Pearson's r coefficient was used, with p < .05. Our results revealed in knee pain group during CKC and OKC at 15 degrees that the increase in the sulcus angle is associated with a tilt increase and patellar lateral displacement. Comparing sulcus angle, patellar tilt angle and bisect offset values between MVIC in OKC and CKC in the knee pain group, it was observed that patellar tilt angle increased in OKC only with the knee flexed at 30 degrees. Based on our results, we conclude that reduced trochlear depth is correlated with increased lateral patellar tilt and displacement during OKC and CKC at 15 degrees of flexion in people with anterior knee pain. By contrast, 30 degrees of knee flexion in CKC is more recommended in rehabilitation protocols because the patella was more stable than in other positions.

Correlation between baropodometric parameters and functional evaluation in patients with surgically treated congenital idiopathic clubfoot.

The study aimed to investigate the correlation between baropodometric parameters and the functional score in the evaluation of the results of surgery in patients with clubfoot. Fifty-one patients (77 feet) underwent surgical treatment, with a mean follow-up of 9.58 years (5-15 years), and a mean age of 10.2 years (7-16 years). A total of 39 males and 12 females were included, with 25 unilateral cases and 26 bilateral cases. The patients underwent a functional evaluation and an assessment of plantar pressure distribution using computerized baropodometry. The functional evaluation results were statistically analyzed to investigate any correlations. Unilateral and bilateral cases were studied in two different groups. The Mann-Whitney and Spearman correlation tests were used for these analyses. The static contact area, weight bearing time, gait speed, and plantar pressure peak were not correlated with the functional evaluation in the unilateral and bilateral cases. There was a statistically significant correlation (P < 0.05) among the integral plantar force, distribution of force, total plantar pressure, distance between the center of foot pressure and center of body mass, and dynamic contact area only in the bilateral cases. Baropodometry was correlated with the functional evaluation of several parameters in patients with bilateral involvement.

Identification of Ankle Injury Risk Factors in Professional Soccer Players Through a Preseason Functional Assessment.

BACKGROUND: Etiologically, the risk of an ankle injury depends on extrinsic and intrinsic factors, such as muscle strength asymmetry, decreased flexibility, and decreased proprioception, as well as patient age and history of injuries. PURPOSE/HYPOTHESIS: The purpose of this study was to identify risk factors present in the preseason assessment that may predispose professional soccer players to ankle injuries. We hypothesized that analysis of these parameters could relate the incidence of injuries to the deficits found during the preseason period, enabling the identification of risk factors to predict the occurrence of injuries. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 89 professional soccer athletes were evaluated in the preseason period; the evaluation included athlete history and anthropometric data collection, an isokinetic ankle evaluation, and functional tests: the Dorsiflexion Lunge Test and Y-Balance Test (YBT). The athletes were monitored during the competitive period, and the incidence of injuries was surveyed. The association of quantitative variables and injury outcomes was analyzed using the Student t test for independent samples, with P < .05. For the association of categorical variables and injury outcomes, the chi-square test was performed, with P < .05. RESULTS: A higher incidence of ankle injuries was associated with lower YBT scores in the dominant (P = .04) and nondominant (P = .01) limbs. A higher body mass index was also associated with a higher injury occurrence (P = .01). CONCLUSION: Functional tests, such as the YBT, are indicated tools for assessing the physical capacities and possible risks of ankle sprains, as they can evaluate the ankle functional capacity in a complex way, identifying athletes more prone to ankle injuries. Athletes' body mass index should also be taken into account to prevent such injuries.

Functional tests and isokinetic knee assessment in street runner athletes correlation / Correlación entre pruebas funcionales y evaluación isokinética de rodilla en practicantes de carrera de calle / Correlação entre testes funcionais e avaliação isocinética do joelho em atletas corredores de rua

ABSTRACT Introduction: The assessment of biomechanical changes related to the lower limbs is necessary in clinical practice to measure the potential risks of injury and the influences on existing dysfunction. Biomechanical changes related to previous ankle injuries are known to influence the performance of the entire lower limb. Objective: The aim of this study was to correlate muscle strength tests, performance tests and ankle stability with the Single Hop Test (SHT). Methods: 82 amateur runners were evaluated with isokinetic tests of quadriceps and hamstring muscle strength, as well as Y Balance Test (YBT), Weight-bearing Lung Test (WBLT), and the SHT. Results: The results showed there was a significant correlation between the SHT and the YBT in subjects with hamstring/quadriceps ratio (I/Q ratio) <0.55, and the length of the unilateral SHT with the peak torque of ipsilateral knee extensors. Conclusion: The study was successful in correlating the functional tests in question with the results obtained in isokinetic dynamometry. Level of Evidence V; Cross-Sectional Study.

RESUMEN Introducción: La evaluación de los cambios biomecánicos relacionados con las extremidades inferiores es necesaria en la práctica clínica para medir los riesgos potenciales de lesión y las influencias sobre la disfunción existente. Se sabe que los cambios biomecánicos relacionados con lesiones previas de tobillo influyen en el rendimiento de toda la extremidad inferior. Objetivo: Correlacionar las pruebas de fuerza muscular, las pruebas de rendimiento y la estabilidad del tobillo con la prueba de salto simple (Single Hop Test, SHT). Métodos: Se evaluó a 82 corredores aficionados con pruebas isocinéticas de fuerza muscular de cuádriceps e isquiotibiales, además de pruebas como Y Balance Test (YBT), Weight-bearing Lung Test (WBLT) y la prueba SHT. Resultados: Los resultados mostraron que existía una correlación significativa entre el SHT y el YBT en sujetos con ratio isquiotibiales/cuádriceps (ratio I/Q) <0,55, y la longitud del SHT unilateral con el par máximo de los extensores de la rodilla ipsilateral. Conclusión: El estudio logró correlacionar las pruebas funcionales en cuestión con los resultados obtenidos en la dinamometría isocinética. Nivel de Evidencia V; Estudio Transversal.

RESUMO Introdução: A avaliação de alterações biomecânicas relacionadas aos membros inferiores é necessária na prática clínica para mensurar os riscos potenciais de alguma lesão e as influencias sobre uma disfunção existente. As alterações biomecânicas relacionadas a lesões prévias de tornozelo são conhecidas pela influência na performance de todo o membro inferior. Objetivo: Correlacionar testes de força muscular, testes de performance e estabilidade do tornozelo com o teste de salto simples (Single Hop Test - SHT). Métodos: Foram avaliados 82 corredores amadores com testes isocinéticos de força muscular de quadríceps e isquiotibiais, além de testes Y Balance Test (YBT), Weight-bearing Lung Test (WBLT), e o SHT. Resultados: Os resultados demonstraram haver correlação significativa entre o SHT e o YBT nos indivíduos com relação Isquiotibiais/Quadríceps (relação I/Q) <0,55, e o comprimento do SHT unilateral com o pico de torque de extensores de joelho ipsilateral. Conclusão: O estudo foi bem sucedido em correlacionar os testes funcionais em questão com os resultados obtidos na dinamometria isocinética. Nível de Evidência V; Estudo Transversal.

Neurophysiological, cognitive-behavioral and neurochemical effects in practitioners of transcendental meditation - A literature review.

The term meditation can be used in many different ways, according to the technique to which it refers. Transcendental Meditation (MT) is one of these techniques. TM could serve as a model for research on spiritual meditation, unlike the meditation techniques based on secular knowledge. The purpose of the present study is to conduct a bibliographic review to organize scientific evidence on the effects of TM on neurophysiology, neurochemistry, and cognitive and behavioral aspects of its practitioners. To conduct this critical narrative review of the literature, we searched for scientific papers on the PubMed database of the National Center for Biotechnology Information. The keywords used in the search were Transcendental Meditation, Neuroscience of meditation e Meditation and behavior. We selected 21 papers that analyzed different aspects that could be altered through meditation practice. We concluded that TM has positive and significant documentable neurochemical, neurophysiological, and cognitive-behavioral effects. Among the main effects are the reduction of anxiety and stress (due to the reduction of cortisol and norepinephrine levels), increase of the feeling of pleasure and well-being (due to the increase of the synthesis and release of dopamine and serotonin), and influence on memory recall and possible consolidation. Further studies are needed using creative and innovative methodological designs that analyze different neural circuitry and verify the clinical impact on practitioners.

Energy expenditure during cane-assisted gait in patients with knee osteoarthritis.

OBJECTIVE: To compare the energy expenditure in patients with unilateral knee osteoarthritis while walking with canes of different lengths. METHODS: A quasi-experimental study (single-group) was carried out on thirty patients with unilateral knee osteoarthritis. An adjustable aluminum cane was used, and three different cane lengths were determined for each subject: C1--length from the floor to the greater trochanter; C2--length from the floor to the distal wrist crease; and C3--length obtained by the formula: height x 0.45 + 0.87 m. Resting and walking heart rates were measured with a Polar hear rate meter. Walking speed was calculated by the time required for the patient to walk 10 m. Gait energy cost was estimated using the physiological cost index, and results were compared. RESULTS: The sample consisted of 25 women and five men (average age of 68 years). Statistically significant differences in physiological cost index measurements were observed between unassisted walking and assisted walking with a cane of any length (p<0.001), as well as between walking with a C2-length cane and unassisted walking, and walking with a C1-length cane and walking with a C3-length cane (p=0.001; p = 0.037; p=0.001; respectively). CONCLUSION: These data demonstrate that small alterations in the length of canes used for weight-bearing ambulation in patients with unilateral knee osteoarthritis increase the energy expenditure measured by the physiological cost index during walking. Further studies are needed for a more precise quantification of the increase in energy expenditure during cane-assisted gait and an assessment of the effectiveness of cane use in relieving pain and improving function in patients with knee osteoarthritis.

Preseason intrinsic risk factors-associated odds estimate the exposure to proximal lower limb injury throughout the season among professional football players.

BACKGROUND/AIM: Football players frequently face the occurrence of non-contact musculoskeletal injuries. The purpose of the study was to verify whether the evaluation of combined risk factors could produce a score system to determine the probability of injury in football players during the Brazilian football season. METHODS: Sixty-two male professional soccer players recruited from the first and second division soccer teams, with ages between 18 and 36 years. Functional performance evaluations were carried out at the beginning of the preseason which included strength and jumping tests, history of injuries and characteristics of athletes. RESULTS AND CONCLUSIONS: The results were grouped and a score/monogram was constructed.

Cardiac and Musculoskeletal Responses to the Effects of Passive and Active Tilt Test in Healthy Subjects.

BACKGROUND: Maintenance of orthostatism requires the interaction of autonomic and muscle responses for an efficient postural control, to minimize body motion and facilitate venous return in a common type of syncope called neurocardiogenic syncope (NCS). Muscle activity in standing position may be registered by surface electromyography, and body sway confirmed by displacement of the center of pressure (COP) on a force platform. These peripheral variables reflect the role of muscles in the maintenance of orthostatism during the active tilt test, which, compared with muscle activity during the passive test (head-up tilt test), enables the analyses of electromyographic activity of these muscles that may anticipate the clinical effects of CNS during these tests. OBJECTIVE: to evaluate and compare the effects of a standardized protocol of active and passive tests for CNS diagnosis associated with the effects of Valsalva maneuver (VM). METHODS: twenty-thee clinically stable female volunteers were recruited to undergo both tests. EMG electrodes were placed on muscles involved in postural maintenance. During the active test, subjects stood on a force platform. In addition to electromyography and the platform, heart rate was recorded during all tests. Three VMs were performed during the tests. RESULTS: progressive peripheral changes were observed along both tests, more evidently during the active test. CONCLUSION: the active test detected changes in muscle and cardiovascular responses, which were exacerbated by the VM.

Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises.

OBJECTIVE: To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics. METHODS: A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention. RESULTS: All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities. CONCLUSION: Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/).

Implications for public health of the religiosity-longevity relation.

A growing body of scientific studies has demonstrated a consistently positive association between religious-spiritual (R/S) involvement and beneficial effects on physical health, culminating with increased longevity. This protective effect on the mortality risk is not only statistically significant but also clinically relevant. The mechanisms involved in this association include psycho-neuro-endocrine-immune pathways, greater adherence to healthy behaviors and diverse social factors. Public health strategies could better explore this association. This can be done on an individual (health professionals adopting simple measures) or institutional scale (health institutions joining religious organizations). Some evidence suggests that the benefits of R/S to health and longevity would be more present in populations from more religious regions. In this sense, the Americas (Latin and North) are privileged places for the exploration of this association, compared to regions where there is certain indifference about R/S practices. Exploring this interface can improve the supply and usage of health care, especially for marginalized populations. To achieve this, health professionals, religious leaders and policy makers need to work together.

Are We Ready for a True Biopsychosocial-Spiritual Model? The Many Meanings of "Spiritual".

The biopsychosocial model is a modern humanistic and holistic view of the human being in health sciences. Currently, many researchers think the biopsychosocial model should be expanded to include the spiritual dimension as well. However, "spiritual" is an open and fluid concept, and it can refer to many different things. This paper intends to explore the spiritual dimension in all its meanings: the spirituality-and-health relationship; spiritual-religious coping; the spirituality of the physician affecting his/her practice; spiritual support for inpatients; spiritual complementary therapies; and spiritual anomalous phenomena. In order to ascertain whether physicians would be willing to embrace them all in practice, each phrase from the Physician's Pledge on the Declaration of Geneva (World Medical Association) was "translated" in this paper to its spiritual equivalent. Medical practice involves a continuous process of revisions of applied concepts, but a true paradigm shift will occur only when the human spiritual dimension is fully understood and incorporated into health care. Then, one will be able to cut stereotypes and use the term "biopsychosocial-spiritual model" correctly. A sincere and profound application of this new view of the human being would bring remarkable transformations to the concepts of health, disease, treatments, and cure.