Association Between Knee Moments During Stair Navigation and Participant-Related Factors in Individuals With Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study.

CONTEXT: Altered knee joint mechanics may be related to quadriceps muscle strength, time since surgery, and sex following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to investigate the association between knee moments, with participant-related factors during stair navigation post-ACLR. DESIGN: Cross-sectional study. METHODS: A total of 30 participants (14 women) with ACLR, on average 7.0 (SD 4.4) years postsurgery were tested during stair ascent and descent in a gait laboratory. Motion capture was conducted using a floor-embedded force plate and 11 infrared cameras. Quadriceps concentric and eccentric muscle strength was measured with an isokinetic dynamometer at 60°/s, and peak torques recorded. Multiple regression analyses were performed between external knee flexion and adduction moments, respectively, and quadriceps peak torque, sex, and time since ACLR. RESULTS: Higher concentric quadriceps strength and female sex accounted for 55.7% of the total variance for peak knee flexion moment during stair ascent (P < .001). None of the independent variables accounted for variance in knee adduction moment (P = .698). No significant associations were found for knee flexion and adduction moments during for stair descent. CONCLUSION: Higher quadriceps concentric strength and sex explains major variance in knee flexion moments during stair ascent. The strong association between muscle strength and external knee flexion moments during stair ascent indicate rehabilitation tailored for quadriceps may optimize knee mechanics, particularly for women.

Back pain attitudes questionnaire: Cross-cultural adaptation to brazilian-portuguese and measurement properties.

BACKGROUND: The Back Pain Attitudes Questionnaire (Back-PAQ) was developed to evaluate attitudes and beliefs of the general public, people with back pain, and healthcare professionals about the spine. OBJECTIVES: To translate and cross-culturally adapt the Back-PAQ (34-item and 10-item versions) into Brazilian-Portuguese (Back-PAQ-Br) and test its measurement properties in a Brazilian sample. METHODS: The cross-cultural adaptation and testing of the measurement properties followed the recommendations of international guidelines. Members of the general public, people with back pain, and healthcare professionals, for a total of 139 individuals, took part in the assessment of internal consistency, construct validity, and ceiling and floor effects. The Hospital Anxiety and Depression Scale (HADS) and the Brazilian-Portuguese version of the Tampa Scale of Kinesiophobia (TSK) were used to evaluate construct validity. Test-retest reproducibility was determined on 77 participants. Retest was performed a minimum of 1 week and a maximum of 2 weeks from the original test. RESULTS: There was very high agreement between translators (88.2%). The Back-PAQ-Br showed excellent internal consistency (Cronbach's alpha 0.92) and excellent reproducibility (ICC 0.94; SEM 5.14 points on a 136 point scale), with a smallest detectable change (90% confidence level) of 11.93 points. There was strong correlation between Back-PAQ-Br and TSK (r = -0.72) and very weak correlation between Back-PAQ-Br and HADS (r = -0.23 for both depression and anxiety domains). No ceiling/floor effects were observed. CONCLUSION: The translation process and cross-cultural adaptation had very high agreement between translators. The Back-PAQ-Br has excellent measurement properties that are similar to the properties of the original version.

Knee biomechanics while navigating steps in participants with anterior cruciate ligament reconstruction, between 2 and 10 years following surgery.

OBJECTIVE: To compare knee angles and moments between the injured and contralateral knee in participants with anterior cruciate ligament reconstruction, and compared with uninjured controls while navigating steps. DESIGN: Cross-sectional study. SETTING: University laboratory-based study. PARTICIPANTS: Twenty-five participants (30.8 ± 9.7 years; 13 women) with anterior cruciate ligament reconstruction (2-10 years post-surgery), and 24 controls (31.0 ± 10 years, 13 women). MAIN OUTCOME MEASURES: Three-dimensional motion analysis was used to record peak knee angles and external moments during step ascent and descent in three planes, along with spatiotemporal variables. RESULTS: During step ascent, the reconstructed knee exhibited significantly: (1) lower peak flexion angles compared to the controls (P = 0.005); (2) lower flexion moments (P < 0.001) compared to contralateral side and controls. No significant differences were found in the frontal and transverse planes between groups and sides. During step descent, no significant differences in angles and moments were found. CONCLUSIONS: Side-to-side asymmetries and lower knee flexion angles and external knee flexion moments were evident in participants with anterior cruciate ligament reconstruction and compared to controls. These findings suggest that incomplete recovery and compensatory or protective changes in neuromuscular control and joint function may persist 2-10 years post-surgery.

Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey.

BACKGROUND: Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted. OBJECTIVE: To investigate which physical, personal, and amputee-specific factors predicted the presence and intensity of LBP in persons with nondysvascular transfemoral amputation (TFA) and transtibial amputation (TTA). DESIGN: A retrospective cross-sectional survey. SETTING: A national random sample of people with nondysvascular TFA and TTA. PARTICIPANTS: Participants (N = 526) with unilateral TFA and TTA due to nondysvascular etiology (ie, trauma, tumors, and congenital causes) and a minimum prosthesis use of 1 year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis. METHODS (INDEPENDENT VARIABLES): Personal (ie, age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (ie, level of amputation, years of prosthesis use, presence of phantom-limb pain, residual-limb problems, and nonamputated limb pain), and physical factors (ie, pain-provoking postures including standing, bending, lifting, walking, sitting, sit-to-stand, and climbing stairs). MAIN OUTCOME MEASURES (DEPENDENT VARIABLES): LBP presence and intensity. RESULTS: A multivariate logistic regression model showed that the presence of 2 or more comorbid conditions (prevalence odds ratio [POR] = 4.34, P = .01), residual-limb problems (POR = 3.76, P < .01), and phantom-limb pain (POR = 2.46, P = .01) influenced the presence of LBP. Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of POR, and the results must be interpreted with caution. In those with LBP, the presence of residual-limb problems (ß = 0.21, P = .01) and experiencing LBP symptoms during sit-to-stand task (ß = 0.22, P = .03) were positively associated with LBP intensity, whereas being employed demonstrated a negative association (ß = -0.18, P = .03) in the multivariate linear regression model. CONCLUSIONS: Rehabilitation professionals should be cognizant of the influence that comorbid conditions, residual-limb problems, and phantom pain have on the presence of LBP in people with nondysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP. LEVEL OF EVIDENCE: II.

Movement Patterns of the Knee During Gait Following ACL Reconstruction: A Systematic Review and Meta-Analysis.

BACKGROUND: Altered gait patterns follow ing anterior cruciate ligament reconstruction (ACLR) may be associated with long-term impairments and post-traumatic osteoarthritis. OBJECTIVE: This systematic review and meta-analysis compared lower limb kinematics and kinetics of the ACL reconstructed knee with (1) the contralateral limb and (2) healthy age-matched participants during walking, stair climbing, and running. The secondary aim was to describe the differences over time following ACLR for these biomechanical variables. METHOD: Database searches were conducted from inception to July 2014 and updated in August 2015 for studies exploring peak knee angles and moments following ACLR during walking, stair negotiation, and running. Risk of bias was assessed with a modified Downs and Black quality index for all included studies, and meta-analyses were performed. Forest plots were explored qualitatively for recovery of gait variables over time after surgery. RESULTS: A total of 40 studies were included in the review; 26 of these were rated as low risk and 14 as high risk of bias. The meta-analysis included 27 studies. Strong to moderate evidence indicated no significant difference in peak flexion angles between ACLR and control groups during walking and stair ascent. Strong evidence was found for lower peak flexion moments in participants with ACLR compared with control groups and contralateral limb during walking and stair activities. Strong to moderate evidence was found for lower peak adduction moment in ACLR participants for the injured compared with the contralateral limbs during walking and stair descent. The qualitative assessment for recovery over time indicated a pattern towards restoration of peak knee flexion angle with increasing time from post-surgery. Peak knee adduction moments were lower within the first year following surgery and higher than controls during later phases (5 years). CONCLUSION: Joint kinematics are restored, on average, 6 years following reconstruction, while knee external flexion moments remain lower than controls. Knee adduction moments are lower during early phases following reconstruction, but are higher than controls, on average, 5 years post-surgery. Findings indicate that knee function is not fully restored following reconstruction, and long-term maintenance programs may be needed.

Lesão do músculo obturador externo em atletas de futebol profissional / Injury of the external obturator muscle in professional soccer athletes

Diversos estudos têm analisado os diferentes tipos de lesões que acometem o jogador de futebol. Nota-se, no entanto, que nenhum cita a lesão do músculo obturador externo. Na medida em que este é um músculo pequeno e monoarticular, sua incidência provavelmente é baixa e pouco documentada na literatura. Sendo assim, o objetivo deste estudo é apresentar quatro casos de estiramentos do obturador externo em uma equipe profissional de futebol no ano de 2006. Os dados foram coletados a partir de um programa de armazenamento denominado Sistema de Preparação Desportiva que fornece dados referentes ao nome, diagnóstico, mecanismo de trauma, história clínica, tempo de afastamento e evolução. Todos os atletas que apresentaram imagem de ressonância nuclear magnética compatível com ruptura do obturador externo foram inclusos no estudo. Quatro lesões por estiramento do músculo obturador externo foram encontradas, de um total de 28 lesões por estiramento muscular durante o ano de 2006. Todos os atletas apresentavam dor difusa na região do quadril durante os movimentos de rotação lateral e medial do quadril. O mecanismo de trauma predominante foi o movimento de rotação lateral do tronco sobre o fêmur em cadeia cinética fechada. Concluímos que a lesão do obturador externo pode ser confundida com uma lesão dos músculos adutores do quadril, devido à localização da dor relatada pelo indivíduo. A avaliação clínica deve basear-se no relato do atleta e na realização dos testes funcionais, principalmente para os músculos rotadores do quadril. O exame de ressonância nuclear magnética foi fundamental para localizar, classificar e avaliar a extensão da lesão neste estudo.

Several studies have investigated different injuries that occur among soccer players. However, it has been noticed that none has mentioned injury to the external obturator muscle. As a small and monoarticulated muscle, its incidence is probably low and barely documented in the literature. Therefore, the aim of this study is to present four external obturator muscle strain cases in a professional soccer team in 2008. The data was collected from a database using the software Sistema de Preparação Desportiva which provides data such as name, diagnosis, trauma mechanism, clinical history, time away from training and progress. All athletes who undertook Magnetic Resonance Imaging (MRI) of the external obturator muscle and presented rupture of the external obturator muscle were included in the study. Four external obturator muscle strain injuries were identified from a total of twenty-eight muscle strains during the year of 2006. All athletes presented diffuse pain on the hip for medial and lateral rotation of the joint. The predominant injury mechanism was lateral rotation of the trunk over the femur on closed kinetic chain. It was concluded that external obturator muscle strain injuries can be mistaken for those related to the hip adductor muscles due to the reported pain area. Clinical examination should be based on the athletes' report and functional tests, mainly for the hip rotator muscles. The MRI scan was essential to the location, classification and evaluation of the injury size.

Análise por dinâmica inversa, um complemento da avaliação fisioterapêutica do ombro / Inverse dynamics analysis as a complement of shoulder physical therapy assessment

O objetivo do estudo é apresentar a dinâmica inversa como um método complementar da avaliação fisioterapêutica. Para isso, serão determinados os picos de momento proximal resultante (MPR) e força proximal resultante (FPR) do ombro durante a elevação no plano escapular em três diferentes situações de carga: sem carga (SC), com peso livre (HA) e com resistência elástica (RE). Participaram do estudo 21 indivíduos do sexo masculino, os quais foram analisados por meio de videogrametria. Cada indivíduo realizou cinco repetições de elevação no plano escapular em cada situação de carga. Um modelo matemático tridimensional foi utilizado para o cálculo do MPR e da FPR. Foi realizada uma análise descritiva dos dados de comportamento da FPR e do MPR, os quais serão apresentados por meio dos seus valores médios a cada 10º de amplitude. Os picos da FPR nas situações SC, HA e RE no eixo x foram, respectivamente: 25 N, 49N, 49 N; no eixo y: 37N, 71 N, 41 N; no eixo z: 28 N, 53 N, 49 N. Já os resultados do MPR no eixo x nas situações SC, HA e RE foram, respectivamente: -7 N, - 21 N, -18 N; no eixo y: -1 N, -4 N, -3 N; no eixo z: 6 N, 19 N, 18 N. A sugestão da dinâmica inversa como um complemento da avaliação fisioterapêutica é uma tentativa de estabelecer possíveis informações objetivas durante a avaliação para que estas possam servir como uma base concreta no planejamento de um programa de reabilitação do ombro...

The objective of this study is present the inverse dynamics as a complementary method of physiotherapeutic assessment. For this reason, will be determined the proximal net moment (PNM) and proximal net force (PNF) peaks of the shoulder during the elevation in the scapular plane in three different loads situations: without load (WL), with free load (FL) and with elastic resistance (ER). Twenty-one male subjects participated in the study and were analysed by videogrametry. Each subject performed five repetitions of shoulder elevation in the scapular plane in each load situation. A three-dimensional mathematic model was used to calculate the PNM and PNF. A descriptive data analysis was made in the PNM and PNF behavior data, wich will be presented by their mean values every 10 degrees of range. The PNF peaks in the situations WL, FL and ER in the x axis were, respectively: 25 N, 49N, 49 N; in the y axis: 37N, 71 N, 41 N; in the z axis: 28 N, 53 N, 49 N. The results of MPR in the x axis in the situations WL, FL and ER were, respectively: -7 N, - 21 N, -18 N; in the y axis: -1 N, -4 N, -3 N; in the z axis: 6 N, 19 N, 18 N. The suggestion of the inverse dynamics as a complement of the physiotehrapeutic assessment is an attempt to establish possible objective information during the assessment in order to serve as a factual base in the shoulder rehabilitation program planning...

Análise do comportamento de torque no movimento de flexo-extensão do cotovelo / Analysis of torque behavior in the elbow flexion-extension movement

O propósito deste trabalho foi comparar o comportamento de torque do movimento de flexão e extensão. Foi escolhido um sujeito com fratura de diáfise umeral no membro dominante e lesão do nervo radial que aconteceu durante a cirurgia. Esta avaliação foi realizada quatro anos após o término da reabilitação. Cybex dinamômetro foi usado para mensurar o torque isocinético de flexão e extensão nas condições concêntricas e excêntricas. A magnitude do pico de torque tinha valores maiores no membro contralateral do que no membro dominante. As diferenças entre os valores variaram de acordo com a situação. A conclusão foi que devido à fratura a magnitude do torque isocinético no membro dominante tinha valores menores do que o contralateral.

The purpose of this study was to compare torque behavior of the elbow flexion and extension movement. One subject with fracture of the humeral diaphysis in the dominant limb and radial nerve lesion, which occurred during the surgery, was selected. This evaluation was carried out four years ago after finishing rehabilitation. A cybex dynamometer was used to measure isokinetic elbow flexion and extension torque and in the concentric and eccentric conditions. The magnitude peak torque had greater values in the contra-lateral upper limb than in the dominant upper limb. The differences between the values varied in accordance with the situation. One concluded that due fracture the torque isokinetic magnitude in the dominant limb had smaller values than the values of the contra lateral limb.

Análise eletromiográfica do quadríceps durante a extensão do joelho em diferentes velocidades / Electromyographical analysis of the quadriceps during knee extension at different speeds

A síndrome de dor fêmuro-patelar (SDFP) é uma disfunção comum, geralmente causada por trações laterais excessivas da patela. Indivíduos com SDFP, usualmente apresentam inibição do vasto medial oblíquo (VMO), o qual é responsável pela tração medial patelar. O tratamento conservador envolve o reforço do quadríceps para promover melhor estabilidade e tração patelar. Muitos pesquisadores buscam o recrutamento seletivo do VMO, com o intuito de otimizar o tratamento. O objetivo deste estudo é investigar, através da eletromiografia, a interferência da velocidade angular e diferentes formas de fixação do tubo elástico na atividade quadricipital. Dez indivíduos do sexo masculino com ausência de lesão muscular ou articular participaram deste estudo. Indivíduos com ângulo Q fora do intervalo de 10-15° foram excluídos da pesquisa. O tubo elástico foi fixado paralelo e oblíquo em relação ao corpo do indivíduo. As extensões de joelho foram realizadas com velocidades angulares de 60 e 120°/seg. Nenhuma atividade seletiva do VMO foi encontrada. Comparando os níveis de atividade muscular, durante as duas velocidades angulares houve aumento no nível de atividade eletromiográfica em todas porções do quadríceps, apenas para a fixação do tubo elástico paralela. Os resultados sugerem uma atividade sinérgica entre o VMO e as outras porções do quadríceps.