A pilot study of the effects of suboccipital fascial release on heart rate variability in workers in the clothing industry: Randomized clinical trial.

INTRODUCTION: The routine of work inside the clothing industry has been associated with high levels stress perceived by the worker. The parameters of heart rate variability (HRV) are objective markers of the organic response to stress. OBJECTIVE: This trial evaluates if suboccipital fascial release (SFR) technique was able to influence HRV parameters in workers in the clothing industry. METHODS: Randomized clinical trial. Forty women who worked in clothing industry were randomized into two groups, untreated group (UG, n = 15) and treated group (TG, n = 25). Heart rate (HR) and HRV parameters were measured using a heart rate monitor. Statistical analysis of data distribution and within group and between groups analysis were performed with α adjusted to 0.05. RESULTS: Within group analysis in the TG showed significant changes in the following parameters: sympathovagal balance (low frequency/high frequency - LF/HF) (p ≤ 0.01), mean RR intervals (p ≤ 0.01), mean heart rate (Mean HR) (p ≤ 0.01), minimum heart rate (Min. HR) (p = 0.02) and maximum heart rate (Max. HR) (p ≤ 0.01). Between group analysis, on the other hand, showed significant variations in Very Low Frequency (VLF) (p = 0.04) and Max. HR (p = 0.03) in favor of the TG. No significant changes were observed in the UG during the same period. CONCLUSION: The comparison between groups showed that SFR may influence HRV parameters more than rest in workers in the clothing industry and possibly may contribute to the improvement of the stress experienced by them.

Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study.

Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η2 = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.

A pilot study of the effects of suboccipital fascial release on cortisol levels in workers in the clothing industry - randomized clinical trial.

INTRODUCTION: Repetitive and time sensitive demands of clothing workers has been associated with higher salivary cortisol levels that may reflect the stress experienced by the worker. OBJECTIVE: This trial evaluates if suboccipital fascial release (SFR) is associated with reduced salivary cortisol levels. METHODS: Randomized controlled trial with 40 workers, divided into: untreated group (UG, n = 15) and treated group (TG, n = 25). Both were removed from the work environment. The TG received the above technique and the UG remained lying at rest, both for five minutes. Salivary cortisol levels were measured by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Statistical analysis of data distribution, intragroup and intergroups, were performed with α adjusted to 0.05. RESULTS: Pre / post intragroup analyses showed significant differences in cortisol levels in both groups, as well as intergroup analyses with lower values in favor of TG (p = 0.014). CONCLUSION: The reduction in salivary cortisol levels in TG suggests that SFR may be more effective than rest in reducing stress. Future studies with increased experimental rigor are necessary to confirm this conclusion. CLINICAL TRIAL REGISTRATION NUMBER: REBEC - RBR - 56yk9m.

INTRODUCTION: Les exigences aiguës imposées aux travailleurs de l'industrie du vêtement ont été associées à de fortes concentrations de cortisol salivaire pouvant traduire le stress vécu par ces travailleurs. OBJECTIF: Cet essai vise à savoir si le relâchement des fascias des muscles sous-occipitaux est associé à une réduction des concentrations de cortisol salivaire. MÉTHODOLOGIE: Essai comparatif avec répartition aléatoire mené auprès de 40 travailleurs répartis en deux groupes: groupe non traité (GNT, n = 15) et groupe traité (GT, n = 25). Les sujets des deux groupes ont été retirés de leur milieu de travail. La technique ci-haut mentionnée a été utilisée sur les sujets du GT alors que les sujets du GNT sont restés au repos: pour les deux groupes, l'intervention a duré cinq minutes. Les concentrations de cortisol salivaire ont été mesurées à l'aide d'une trousse pour dosage d'immunoabsorption par enzyme liée (ELISA) offerte dans le commerce. L'analyse statistique de la distribution des données intra-groupes et inter-groupes a été effectuée avec α ajusté à 0.05. RÉSULTATS: L'analyse des données prétraitement et post-traitement à l'intérieur des groupes a révélé des différences appréciables de concentration de cortisol dans les deux groupes, les analyses entre les groupes montrant des concentrations plus faibles dans le GT (p = 0.014). CONCLUSION: La réduction des concentrations de cortisol salivaire dans le GT semble indiquer que le relâchement des fascias de muscles sous-occipitaux peut être plus efficace que le repos pour réduire le stress. Il faut mener d'autres études expérimentales plus rigoureuses pour confirmer cette conclusion. NUMÉRO D'ENREGISTREMENT DE L'ESSAI CLINIQUE: REBEC ­ RBR ­ 56yk9m.

Muscular activation patterns during active prone hip extension exercises.

BACKGROUND: Changes in activation patterns of hip extensors and pelvic stabilizing muscles are recognized as factors that cause low back disorders and these disturbances could have an impact on the physiological loading and alter the direction and magnitude of joint reaction forces. OBJECTIVE: To investigate activation patterns of the gluteus maximus, semitendinosus and erector spinae muscles with healthy young individuals during four different modalities of therapeutic exercise. METHODS: Thirty-one volunteers were selected: (16 men and 15 women), age (24.5+/-3.47years), body mass of 66.89+/-11.89kg and a height of 1.70+/-0.09m). They performed four modalities of therapeutic exercise while the electromyographic activity of the investigated muscles was recorded to determine muscle pattern activation for each exercise. RESULTS: Repeated measure ANOVA revealed that muscle activation patterns were similar for the four analyzed exercises, starting with the semitendinosus, followed by the erector spinae, and then, the gluteus maximus. The gluteus maximus was the last activated muscle during hip extension associated with knee flexion (p<0.0001), knee extension (p<0.0001), and with lateral rotation and knee flexion (p<0.05). CONCLUSION: Findings of the present study suggested that despite individual variability, the muscle firing order was similar for the four therapeutic exercises.

Validity analysis of one-repetition maximum strength test for determining the hamstrings-to-quadriceps ratio

One of the approaches to evaluate injury prediction is the hamstrings-to-quadriceps peak torque conventional ratio (H:Q ratio). The gold standard for assessment of muscle strength in vivo is by isokinetic dynamometry; however, the one-repetition maximum strength test (1-RM) presents high correlation with isokinetic data. This study aimed to compare measures of H:Q ratio in young adults obtained by dynamometry and 1-RM testing. No significant differences were observed in the H:Q ratio when comparing 1-RM and dynamometry testing. However, there was a significant and strong correlation between the measurements obtained in the two tests. Despite this correlation, data from both tests are not equal as the H:Q ratio obtained from 1-RM test presents a systematic error. Nonetheless, the results can enhance the applicability of 1-RM test in clinical settings

Gains in flexibility related to measures of muscular performance: impact of flexibility on muscular performance.

OBJECTIVE: Studies that investigated possible correlations between flexibility and muscular performance are scarce in the literature. Therefore, the purpose of this study was to investigate the impact of a program of static stretching on the flexibility of the hamstrings and on muscular performance of the knee flexors and extensors. DESIGN: Pre-post experimental design. SETTING: University laboratory. PARTICIPANTS: Thirty subjects aged 22.8 +/- 4.9 years with bilaterally shortened hamstrings. INTERVENTION: Using a protocol that has been previously described, the intervention consisted of 30 sessions of static stretching, performed bilaterally five times a week for 6 weeks. MAIN OUTCOME MEASUREMENTS: Measures of knee range of motion and isokinetic muscular performance (peak torque, angle of peak torque, and work) of knee flexors and extensors at speeds of 60 and 300 degrees/s. RESULTS: After intervention, significant gains in measures of flexibility (P < 0.0001) were observed, with an average gain of the knee-extension angle of 12.6 degrees, ranging from -1.2 to 30.7 degrees. In addition, we found significant increases in the following parameters of muscular performance: angle of peak torque of hamstrings at 60 and 300 degrees/s (P < 0.0001 and 0.018) and for work at 60 and 300 degrees/s for knee flexors (P = 0.012 and 0.005) and for knee extensors (P < 0.0001). CONCLUSIONS: The intervention resulted in gains in measures of flexibility, and these gains had a positive impact on some parameters of muscular performance.

Análise da confiabilidade do teste clínico de queda do navicular / Reliability analysis of the clinical application of the navicular drop test

Introdução: A utilização de medidas confiáveis e práticas são necessárias para a tomada de decisões clínicas.O Teste da Queda do Navicular (TQN) fornece informações importantes na avaliação dos membros inferiores. Assim, os objetivos do presente estudo foram verificar a confiabilidade do TQN, conforme realizado na clínica, e analisar uma forma de minimizar a interferência do avaliador. Materiais e métodos: Participaram do estudo 15 indivíduos (30 pés), selecionados por conveniência. O TQN foi aplicado de forma independente por dois examinadores experientes na realização do teste, o qual foi realizado apenas uma vez em cada pé, utilizando-se um paquímetro de plástico. Foi realizada uma análise descritiva dos dados. Para avaliação da confiabilidade inter examinadores, foi utilizado o índice de correlação intraclasse (ICC₂,₁) e a discrepância das medidas entre avaliadores foi analisada pelo erro típico da medição. Resultados: A média e o desvio padrão para o primeiro e segundo examinador foram 8,7 ± 5,3 e 9,7 ± 4,7 milímetros. O teste apresentou excelente confiabilidade interexaminador (ICC = 0,93). O erro típico da medição foi 2,16 milímetros. Conclusão: Os procedimentos para minimizar a interferência do avaliador resultaram, contraditoriamente, em uma piora dos índices de confiabilidade. O TQN pode ser simplificado por meio do uso de instrumentos comuns na clínica e registrado a partir de uma única medida. Mesmo apresentando boa confiabilidade, o TQN apresenta um erro típico da medida, que deve ser levado em consideração para a tomada de decisão. Mudanças no teste, por vezes necessárias em um ambiente clínico, deverão ser analisadas quanto à conservação de suas propriedades

INTRODUCTION: Reliable and practical measures are necessary for making clinical decisions. The Navicular Drop Test (NDT) provides important information during evaluation of lower limbs. The purpose of the present article was to assess the psychometric properties of NDT as usually done in clinical environment, and to analyze a way to minimize the evaluator interference. MATERIALS AND METHODS: Fifteen people (30 feet), selected by convenience, participated. The NDT was performed independently by two investigators experienced in the test realization. The test was performed once in each foot, using a plastic caliper. Descriptive analysis of data was done. In order to evaluate the inter-examiner reliability, intraclass correlation index (ICC2,1) was used. The divergence between the measures was examined by the typical error measurement. RESULTS: The mean and standard deviation for the first and second examiner was 8.7 ± 5.3 and 9.7 ± 4.7 mm. The test showed excellent inter-examiner reliability (ICC = 0.93). The typical error of measurement was 2.16 mm. CONCLUSION: The procedures to minimize the interference of evaluator, paradoxically, showed worse indices of reliability. The NDT can be simplified by using common clinical tools and recorded from a single measure. Even though it showed a good reliability, the NDT contains a typical error of measurement which has to be considered for decision making. Changes in the test, sometimes required in a dynamic clinical environment, should be analyzed for maintenance of test properties.

Utilização do teste de 1-RM na mensuração da razão entre flexores e extensores de joelho em adultos jovens / Use of 1-RM test in the measurement of knee flexors and extensors ratio in young adults

A razão de força entre agonista/antagonista fornece informação significativa sobre o equilíbrio muscular sendo importante na detecção de alterações musculoesqueléticas, na orientação de medidas preventivas e na implementação de programas de treinamento específicos. A dinamometria isocinética fornece valores fidedignos sobre o torque gerado e, subsequentemente, sobre a razão de força entre flexores e extensores. Porém, trata-se de um método pouco acessível. Uma possível alternativa para avaliação de força é o teste de uma repetição máxima (1-RM), que é o mais utilizado para avaliação da força dinâmica. Contudo, não existem na literatura trabalhos que tenham utilizado o teste de 1-RM para quantificação da razão entre flexores e extensores de joelho. O objetivo deste estudo foi utilizar o teste de 1-RM na mensuração da razão entre flexores e extensores de joelho em adultos jovens, a fim de encontrar dados normativos. A amostra foi composta por 80 adultos jovens (com média de idade de 22,7 ± 3,40 anos), sendo 40 homens e 40 mulheres, sem lesões osteomioarticulares, que foram submetidos à aplicação do IPAQ-curto, pesagem e predição de 1-RM, aquecimento, teste de 1-RM unilateralmente nos bancos flexor e extensor e posterior análise de dados. Foram encontrados valores de razão agonista/antagonista de 52,34 por cento (±9,72) para homens e 43,19 por cento (±5,82) para mulheres (havendo uma diferença significativa entre os grupos). Valores de referência quanto à razão dos flexores e extensores de joelho utilizando o teste de 1-RM em adultos jovens foram encontrados, podendo servir como referência para indivíduos assintomáticos nessa faixa etária.

Force ratio between agonist and antagonist muscles provides significant information about muscular equilibrium, which helps to detect musculoskeletal changes and to guide preventive and rehabilitation programs. Isokinetic dynamometry provides reliable values for muscle torque and subsequently on the force ratio between knee flexors and extensors. However, this method is not clinically accessible. A possible alternative to evaluate this force is the One-Repetition Maximum test (One-Rep Max or just 1-RM), which is the most commonly used test for dynamic force assessment. However, there is no report in the literature of the use of 1-RM test for the quantification of knee flexors and extensors ratio. For this reason, the objective of this study was to use the 1-RM test to measure the ratio between knee extensors and flexors in young adults in order to find reference values. The studied sample was composed of 80 young adults (40 men and 40 women), mean age of 22.21 (±3.58) years with no musculoskeletal injuries. They were submitted to the following procedure: IPAQ-short version, weighing and prognostic of 1-RM, warm-up, and unilateral 1-RM test (at the flexor and extensor machine). After the test application, the data were analyzed and the mean values for the ratio between agonist/antagonist found were 52.34 percent (±9.72) for men and 43.19 percent (±5.82) for women (which were significantly different between groups). The values found in the present study may be used as reference for asymptomatic individuals with similar age.