Clinical-like cryotherapy improves footprint patterns and reduces synovial inflammation in a rat model of post-traumatic knee osteoarthritis.

Cryotherapy is a non-pharmacological treatment commonly used to control inflammation and improve function after acute traumas. However, there are no definitive findings about its effects on chronic joint diseases such as knee osteoarthritis (KOA). The aim of this study was to investigate the effects of clinical-like cryotherapy on functional impairment and synovial inflammation in a rat model of KOA generated by anterior cruciate ligament transection (ACLT). Thirty-two male Wistar rats were randomly divided into four groups (n = 8/group): Control, KOA, KOA + Cryotherapy and KOA + Placebo. The last two groups were submitted to the relevant interventions twice a day for five days (61 to 65), with each session lasting 20 min. Gait test, skin temperature, thermal response threshold and joint swelling were assessed in all groups before ACLT surgery, and pre (60th day) and post (66th day) intervention protocols. On day 66, the animals were euthanized and exsanguinated to remove the synovial membrane for histopathological examination and synovial fluid to determine the leukocyte count and cytokine concentration. After the intervention period (66th day), footprint area only increased in the KOA + Cryotherapy group (P = 0.004; 14%) when compared to KOA and KOA + Placebo, but did not differ from controls. Cryotherapy lowered the synovial fluid leukocyte count (P < 0.0001; ≥95.0%) and cytokine concentration (P < 0.0001; ≥55%) when compared to the KOA and Placebo groups. Synovial score and synovial fibrosis did not differ in the KOA groups. In conclusion, footprint patterns improved in rats with ACLT-induced KOA as a result of clinical-like cryotherapy, which also lowered the synovial fluid leukocyte count and inflammatory cytokine concentration in these rats.

Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials.

OBJECTIVE: The objective was to evaluate the effectiveness of early rehabilitation on arm range of motion (ROM), strength and function after breast cancer surgery (BCS). Data sources: PubMed, MEDLINE, Bireme, Embase, LILACS and CINAHL databases were searched. METHODS: Two independent reviewers selected randomized controlled trials evaluating women who underwent early rehabilitation to restore arm ROM, strength or function after BCS. Cochrane Collaboration recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality was assessed by the PEDro scale. The International Classification of Functioning, Disability and Health was considered to analyze results. Effect size (ES) was calculated for clinical relevance interpretation of the outcomes of interest, and the evidence was summarized through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Up to June 2019, a total of 1658 references were identified and 15 studies were included. Twelve of them presented adequate methodological quality. A total of 1710 patients were evaluated. Few studies performed the simultaneous assessment of variables related to body structure and function and patient-reported outcomes. A moderate level of evidence was synthesized regarding the effectiveness of ROM exercises for improving arm flexion, abduction and external rotation (ES: 0.45-2.5). A low level of evidence was synthesized regarding the effectiveness of isolated strengthening exercises for patient-reported arm function. ROM exercises associated with muscle strengthening exhibited a moderate level of evidence for improving shoulder flexion (ES: 1.4-2.4). CONCLUSION: Both ROM and strengthening exercises associated with ROM exercises improved shoulder flexion, abduction and external rotation ROM after BCS. Shoulder abduction and external rotation showed less recovery, irrespective of the intervention applied.

Knee osteoarthritis induces atrophy and neuromuscular junction remodeling in the quadriceps and tibialis anterior muscles of rats.

Knee osteoarthritis (KOA) is associated with muscle weakness, but it is unclear which structures are involved in the muscle changes. This study assessed morphological alterations and the expression of genes and proteins linked to muscular atrophy and neuromuscular junctions (NMJs) in KOA, induced by anterior cruciate ligament transection (ACLT) in rats. Two groups of rats were assessed: control (without intervention) and KOA (ACLT surgery in the right knee). After 8 weeks, quadriceps, tibialis anterior (TA) and gastrocnemius muscles were analyzed (area of muscle fibers, NMJ, gene and protein expression). KOA group showed atrophy in quadriceps (15.7%) and TA (33%), with an increase in atrogin-1 and muscle RING-finger protein-1 (MuRF-1). KOA group showed quadriceps NMJ remodeling (reduction area and perimeter) and decrease in NMJ diameter in TA muscle. The expression of nicotinic acetylcholine receptor (nAChR) γ-nAChR increased and that of α-nAChR and muscle specific tyrosine kinase (MuSK) declined in the quadriceps, with a decrease in ε-nAChR in TA. MuRF-1 protein expression increased in quadriceps and TA, with no changes in neural cell adhesion molecule (NCAM). In conclusion, ACLT-induced KOA promotes NMJ remodeling and atrophy in quadriceps and TA muscles, associated with inflammatory signs and changes in muscle gene and protein expression.

The effects of cryotherapy on pain and function in individuals with knee osteoarthritis: a systematic review of randomized controlled trials.

OBJECTIVE: To investigate the effectiveness of cryotherapy on pain and physical function in knee osteoarthritis. DATA SOURCES: An electronic search was performed up to February 2019 on PubMed/MEDLINE, EMBASE, CINAHL, Lilacs, Cochrane, Web of Science, Ibecs, and Scielo databases with keywords knee osteoarthritis and cryotherapy. METHODS: Two authors independently performed the study selection. All languages and publication dates were considered. The PEDro scale was used to assess the methodological quality of the studies, and the body of evidence was analyzed and synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The clinical relevance of the included studies was evaluated using the criteria proposed in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Of the five studies, 202 subjects were included. All studies included participants with established knee osteoarthritis. The mean PEDro score was 4.20/10, and meta-analysis was not possible due to heterogeneity among the studies. The mean clinical relevance was 3/5. Only two studies were considered for analysis based on the GRADE approach, and low level of evidence was synthesized regarding the effectiveness of cryotherapy for pain management, knee stiffness, knee range of motion, and physical function. Application techniques, frequency, and duration did not affect outcomes. CONCLUSIONS: There were insufficient primary studies to draw any conclusions about the effectiveness of cryotherapy on pain and physical function on individuals with knee osteoarthritis.

Three-dimensional scapular kinematics, shoulder outcome measures and quality of life following treatment for breast cancer - A case control study.

BACKGROUND: There are no conclusive results concerning changes in scapular kinematics associated with upper limb dysfunctions after breast cancer surgery. OBJECTIVE: To compare the three-dimensional (3-D) scapular kinematics during elevation of the arm between women after breast cancer surgery and controls. Shoulder range of motion (ROM), muscle strength, pain intensity, upper limb function, and quality of life were also assessed. METHODS: Forty-two women were assigned to two groups (surgery group, n = 21; control group, n = 21). 3-D scapular kinematics was collected during elevation of the arm in the scapular plane. ROM was assessed using a digital inclinometer, muscle strength using a manual dynamometer, pain with the Visual Analogue Scale (VAS), upper limb function with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and quality of life with the 36-item Short-Form Health Survey (SF36). RESULTS: The surgery group presented decreased scapular upward rotation at 120° of arm elevation in the scapular plane (p < .05; d = -0.88), decreased shoulder external rotation ROM and strength of shoulder abduction and external rotation when the affected side was compared to the non-affected side and control group. Moreover, the surgery group also reported higher pain, increased upper limb disability and poorer quality of life compared with healthy controls. CONCLUSION: Scapular upward rotation seems to be decreased at 120° of arm elevation in women following breast cancer surgery. In addition, shoulder external rotation ROM, abduction strength, external rotation strength, function, and quality of life are also impaired in these women. They also experienced pain during the studied movements.

Exercise Prevents Diaphragm Wasting Induced by Cigarette Smoke through Modulation of Antioxidant Genes and Metalloproteinases.

BACKGROUND: The present study aimed to analyze the effects of physical training on an antioxidant canonical pathway and metalloproteinases activity in diaphragm muscle in a model of cigarette smoke-induced chronic obstructive pulmonary disease (COPD). METHODS: Male mice were randomized into control, smoke, exercise, and exercise + smoke groups, which were maintained in trial period of 24 weeks. Gene expression of kelch-like ECH-associated protein 1; nuclear factor erythroid-2 like 2; and heme-oxygenase1 by polymerase chain reaction was performed. Metalloproteinases 2 and 9 activities were analyzed by zymography. Exercise capacity was evaluated by treadmill exercise test before and after the protocol. RESULTS: Aerobic training inhibited diaphragm muscle wasting induced by cigarette smoke exposure. This inhibition was associated with improved aerobic capacity in those animals that were submitted to 24 weeks of aerobic training, when compared to the control and smoke groups, which were not submitted to training. The aerobic training also downregulated the increase of matrix metalloproteinases (MMP-2 and MMP-9) and upregulated antioxidant genes, such as nuclear factor erythroid-2 like 2 (NRF2) and heme-oxygenase1 (HMOX1), in exercise + smoke group compared to smoke group. CONCLUSIONS: Treadmill aerobic training protects diaphragm muscle wasting induced by cigarette smoke exposure involving upregulation of antioxidant genes and downregulation of matrix metalloproteinases.

Spotlight on topographical pressure pain sensitivity maps: a review.

Mechanical hyperalgesia defined as decreased pressure pain thresholds (PPTs) is commonly associated with pain. In this narrative review, we report the current state of the art within topographical pressure sensitivity maps. Such maps are based on multiple PPT assessments. The PPTs are assessed by an a priori defined grid with special focus on both spatial and temporal summation issues. The grid covers the muscle or the body region of interest using absolute or relative values determined from anatomical landmarks or anthropometric values. The collected PPTs are interpolated by Shepard or Franke and Nielson interpolation methods to create topographical pressure sensitivity maps. This new imaging technique has proven to be valuable in various disciplines including exercise physiology, neurology, physical therapy, occupational medicine, oncology, orthopedics, and sport sciences. The reviewed papers have targeted different body regions like the scalp, low back, neck-shoulder, and upper and lower extremities. The maps have delineated spatial heterogeneity in the pressure pain sensitivity underlining the different extents of pressure pain hyperalgesia in both experimentally induced and disease-associated pain conditions. Furthermore, various intervention studies have proven the utility of topographical pressure pain sensitivity maps. Topographical pressure pain sensitivity maps have contributed to revealing the efficacy of therapeutic, ergonomic, or training interventions that aim at reducing pain.

Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: A single-arm study.

BACKGROUND: Although hydrotherapy is widely used to treat women with fibromyalgia, no studies have investigated the effects of this intervention on scapular kinematics in this population. This study verified the effectiveness of a hydrotherapy program on scapular kinematics, pain and quality of life in women with fibromyalgia. METHODS: Twenty women completed the study and performed three evaluations before treatment (to establish a baseline), and two other evaluations (after 8 and 16weeks of hydrotherapy) at the end of treatment. Three-dimensional kinematics of the scapula was evaluated during arm elevation in two different planes with the Flock of Birds® system. Patients also answered quality of life and Fibromyalgia Impact Questionnaires and had pain assessed with a digital algometer. Treatment consisted of 2 weekly hydrotherapy sessions, lasting 45min each, for 16weeks. Data were analyzed with a two-way ANOVA (for kinematics results) and one-way ANOVA (for the other variables). Effect size was assessed with Cohen's d coefficient for all quantitative variables. RESULTS: Although an important improvement was achieved in terms of pain and quality of life (P<0.05, effect sizes varied from -1.93 to 1.61 depending on the variable), scapular kinematics did not change after treatment (P>0.05, effect sizes from -0.40 to 0.46 for all kinematic variables). INTERPRETATION: The proposed program of hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact in women with fibromyalgia. However, scapular kinematics did not change after the period of treatment. Although symptoms improved after the treatment, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition.

Bilateral changes in 3-D scapular kinematics in individuals with chronic stroke.

BACKGROUND: Stroke can lead to altered scapular motion that may limit the ability to perform activities of daily living. The aims were to evaluate scapular kinematics of individuals with chronic stroke and the correlation with paretic arm function. METHODS: Scapular kinematics was assessed in thirty-four individuals (Chronic stroke=17; controls=17) during arm elevation and lowering in scapular and self-selected planes, and during hair combing. The use of the paretic arm to perform activities of daily living was assessed by the Motor Activity Log (MAL-30). Scapular kinematics was compared among paretic and non-paretic arms, and controls. Correlation between scapular kinematics and MAL-30 was also verified. FINDINGS: Paretic and non-paretic arms showed increased scapular internal rotation (p<0.05) during arm lowering in the scapular plane, and during arm elevation and lowering in the self-selected plane compared to controls. Increased internal rotation (p<0.05) was also found in the paretic arm during hair combing compared to controls. Increased scapular anterior tilt (p<0.05) was observed in the paretic arm during arm elevation while performing the activity of hair combing and during arm elevation and lowering in the scapular and self-selected planes compared to controls. The non-paretic arm showed increased anterior tilt (p<0.05) during arm elevation and lowering in self-selected plane compared to controls. No difference in scapular upward rotation among neither arms, nor correlation between scapular kinematics and MAL-30 were found (p>0.05). INTERPRETATION: Individuals with chronic stroke showed bilateral scapular kinematics alterations. However, these alterations are not correlated with paretic arm function.

Pressure pain threshold is higher in hypertensive compared with normotensive older adults: A case-control study.

AIM: To establish whether there are differences in pain sensitivity between hypertensive and normotensive older adults. METHODS: A cross-sectional case control study was carried out. A total of 72 older adults, 36 normotensive and 36 hypertensive, participated in the study. The pressure pain threshold (PPT) was assessed on seven points bilaterally in both groups by means of pressure algometry. Two-factor analysis of variance (anova) - group and sex - was carried out, and the magnitude of the differences was calculated using Cohen's index. RESULTS: The PPT values were higher in the group of hypertensive older adults compared with the normotensive older adults; that difference was significant (P < 0.05) for the following points: right and left trochanters, left trapezium, left L3/L4 and left anterior tibialis muscle, with both trochanter and left L3/L4 PPT showing moderate magnitude of the differences. The correlations shown among the PPT were stronger in the group of hypertensive older adults. Thus, hypoalgesia was more generalized among the hypertensive older adults compared with the normotensive older adults. Sex did not influence that difference, although the magnitude of the difference was greater among men compared with women. CONCLUSIONS: Hypoalgesia, as assessed by means of PPT, showed a relationship with arterial hypertension in older adults. The influence of sex on hypoalgesia shown by hypertensive individuals is controversial. Geriatr Gerontol Int 2017; 17: 967-972.

Immediate Effects of Mobilization With Movement vs Sham Technique on Range of Motion, Strength, and Function in Patients With Shoulder Impingement Syndrome: Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to compare the immediate effects of mobilization with movement (MWM) with sham technique on range of motion (ROM), muscle strength, and function in patients with shoulder impingement syndrome. METHODS: A randomized clinical study was performed. Participants (mean age ± standard deviation, 31 ± 8 years; 56% women) were divided into 2 groups: group 1 (n = 14), which received the MWM technique in the first 4 sessions and the sham technique in the last 4 sessions; and group 2 (n = 13), which was treated with the opposite order of treatment conditions described for group 1. Shoulder ROM, isometric peak force assessed with a handheld dynamometer, and function as determined through the Disabilities of the Arm, Shoulder and Hand and Shoulder Pain and Disability Index (SPADI) questionnaires were collected at preintervention, interchange, and postintervention moments. RESULTS: Two-way analysis of variance revealed no significant group-by-time interaction for any outcome but did reveal a main time effect for shoulder external rotation (P = .04) and abduction (P = .01) ROM, Disabilities of the Arm, Shoulder and Hand (P < .01), SPADI Pain (P < .01), SPADI Function (P < .01), and SPADI Total (P < .01). Only abduction movement and SPADI Pain overcame the clinical relevance threshold. The isometric peak force tests revealed no effects. CONCLUSION: The MWM technique was no more effective than a sham intervention in improving shoulder ROM during external rotation and abduction, pain, and function in patients with shoulder impingement syndrome.

Socio-Cultural Factors and Experience of Chronic Low Back Pain: a Spanish and Brazilian Patients' Perspective. A Qualitative Study.

BACKGROUND: Low back pain (LBP) could be influenced by socio-cultural factors. Pain narratives are important to understand the influence of environment on patients with chronic LBP. There are few studies that have explored the experience of patients with chronic LBP in different socio-cultural environments. The aim of this study was to describe the experience of patients with chronic LBP in Spain and Brazil. METHODS: A qualitative phenomenology approach was implemented. Chronic LBP patients from the University Hospital of Salamanca (Spain), and/or Federal University of São Carlos (Brazil) were included, using purposeful sampling. Data were collected from 22 Spanish and 26 Brazilian patients during in-depth interviews and using researchers' field notes and patients' personal diaries and letters. A thematic analysis was performed and the guidelines for reporting qualitative research were applied. RESULTS: Forty-eight patients with a mean age of 50.7 years (SD: ± 13.1 years) were included in the study. The themes identified included: a) ways of perceiving and expressing pain-the participants focused constantly on their pain and anything outside it was considered secondary; b) the socio-familial environment as a modulator of pain-most participants stated that no one was able to understand the pain they were experiencing; c) religion as a modulator of pain-all Brazilian patients stated that religious belief affected the experience of pain; and d) socio-economic and educational status as a modulator of pain-the study reported that economic factors influenced the experience of pain. CONCLUSIONS: The influences of LBP can be determined based on the how a patient defines pain. Religion can be considered as a possible mechanism for patients to manage pain and as a form of solace.

Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: part 2 - muscle activity.

This study aimed to compare muscle activity in individuals with isolated acromioclavicular osteoarthritis (ACO), ACO associated with rotator cuff disease (ACO+RCD), and controls. Seventy-four participants (23 isolated ACO, 25 ACO+RCD, 26 controls) took part in this study. Disability was assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Muscle activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD) was collected during arm elevation in the sagittal and scapular planes. Pain during motion was assessed with the numerical pain rating scale. Analysis of the DASH, pain and kinematics were reported in part 1 of this study. For each muscle, separate 2-way linear mixed-model ANOVAs were performed to compare groups. ACO+RCD group had more UT and AD activity than the the isolated ACO and control other groups, more AD activity than the isolated ACO group during the ascending phase, and more AD activity than the ACO and control groups during the descending phase in both planes. Isolated ACO group had less SA activity than the control group only in the sagittal plane. Alterations in shoulder muscle activity are present in individuals with isolated ACO and with ACO+RCD and should be considered in rehabilitation.

Comparison between the effects of 4 different electrical stimulation current waveforms on isometric knee extension torque and perceived discomfort in healthy women.

INTRODUCTION: We studied the effects of different neuromuscular electrical stimulation (NMES) currents, 2 kHz-frequency alternating currents (KACs, Russian and Aussie) and 2 pulsed currents (PCs), on isometric knee extension torque and discomfort level, both in isolation and combined, with maximum voluntary contraction (MVC). METHODS: Twenty-one women (age 21.6 ± 2.5 years) were studied. We evaluated torque evoked by NMES or NMES combined with maximum voluntary contraction of the quadriceps muscle of healthy women. Discomfort level was measured using a visual analog pain scale. RESULTS: Despite comparable levels of discomfort, evoked torque was lower for Russian current compared with the other modalities (Russian 50.8%, Aussie 71.7%, PC500 76.9%, and PC200 70.1%; P < 0.001). There was no advantage in combining NMES with MVC compared with isolated NMES. CONCLUSIONS: The Aussie and PC approaches proved superior to Russian current for inducing isometric knee extension torque. This information is important in guiding decision making with regard to NMES protocols for muscle strengthening.

Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: part 1 - Three-dimensional shoulder kinematics.

This study described the three-dimensional shoulder motion during the arm elevation in individuals with isolated acromioclavicular osteoarthritis (ACO) and ACO associated with rotator cuff disease (RCD), as compared to controls. Seventy-four participants (ACO=23, ACO+RCD=25, Controls=26) took part of this study. Disability was assessed with the DASH, three-dimensional kinematics were collected during arm elevation in the sagittal and scapular planes, and pain was assessed with the 11-point numeric pain rating scale. For each kinematic variable and demographic variables, separate linear mixed-model 2-way ANOVAs were performed to compare groups. Both ACO groups had higher DASH and pain scores. At the scapulothoracic joint, the isolated ACO group had greater internal rotation than control, and the ACO+RCD group had greater upward rotation than both other groups. At the sternoclavicular joint, both groups with ACO had less retraction, and the isolated ACO group had less elevation and posterior rotation. At the acromioclavicular joint, the isolated ACO group had greater upward rotation, and both ACO groups had greater posterior tilting. Patients with ACO had altered shoulder kinematics, which may represent compensatory responses to reduce pain and facilitate arm motion during arm elevation and lowering.

Neuromuscular electrical stimulation induces beneficial adaptations in the extracellular matrix of quadriceps muscle after anterior cruciate ligament transection of rats.

OBJECTIVE: The aim of this study was to assess the effect of neuromuscular electrical stimulation (NMES) on the extracellular matrix remodeling of the quadriceps muscle after anterior cruciate ligament (ACL) transection in rats. The hypothesis of this study was that ACL transection would induce maladaptive modifications in the extracellular matrix through the increase in connective tissue (CT) accumulation and net degradation of type IV collagen of the quadriceps muscle. In addition, clinical-like NMES, applied to the quadriceps muscle immediately after the ACL transection, would reduce the accumulation of the CT content and net degradation of type IV collagen. DESIGN: Wistar male rats were randomized into five different groups: ACL (surgery and ACL transection), Sham (surgery without ACL transection), ACLES (surgery, ACL transection, and NMES), ShamES (surgery without ACL transection, but NMES), and Control (intact animals). The vastus medialis, rectus femoris, and vastus lateralis muscles of the quadriceps were harvested 1, 2, 3, 7, and 15 days after surgery. Matrix metalloproteinase-2 (MMP-2) (messenger RNA [mRNA] levels and activity), collagen IV (mRNA and protein levels), and CT density were assessed. RESULTS: The ACL transection increased the CT content and MMP-2 mRNA levels and decreased collagen IV mRNA and protein levels. NMES minimized the CT density in all muscles and reduced the MMP-2 mRNA levels mainly in the vastus lateralis muscle at 7 days. Moreover, type IV collagen mRNA levels were increased in all muscles at 7 days, as was the protein level only at 15 days, in the NMES groups. CONCLUSIONS: This study showed that ACL transection increases CT content and MMP-2 mRNA levels and induces rapid changes in basement membranes, causing net degradation of type IV collagen during the first 2 wks after ACL injury. Furthermore, clinical-like NMES minimized the accumulation of CT density, regulated the MMP-2 mRNA levels, and increased both type IV collagen mRNA and protein levels.

Three-dimensional scapular motion during arm elevation is altered in women with fibromyalgia.

BACKGROUND: The core feature of fibromyalgia is pain, which may play a role in various mechanisms that might lead to alterations in shoulder kinematics. Alterations in muscle activity and presence of tender points in the shoulder girdle have already been described in this population; however there is lack of evidence on three-dimensional scapular motion in women with fibromyalgia. METHODS: Forty women with fibromyalgia and 25 healthy women (control group) matched in terms of age, weight and height, took part in this study. Three-dimensional scapular kinematics of the dominant arm were collected during elevation and lowering of the arm in the sagittal and scapular planes. Pain was evaluated by the Visual Analogue Scale and the Numerical Pain Rating Scale. Group comparisons were performed with one-way ANOVA for pain and two-way ANOVA for the kinematic variables (scapular internal/external rotation, upward/downward rotation and anterior/posterior tilt), with group and humeral elevation angle as categorical factors. Significance level was set at P<0.05. FINDINGS: Fibromyalgia women presented higher pain scores (P<0.001) than the control group. Fibromyalgia women also presented greater scapular upward rotation (P<0.001, both planes) and greater scapular posterior tilt (P<0.001, both planes) than the control group. INTERPRETATION: Women with fibromyalgia present greater scapular upward rotation and posterior tilt in the resting position and during arm elevation and lowering of the arm in sagittal and scapular planes. These alterations may be a compensatory mechanism to reduce pain during arm movement.

Efeito do treino isocinético excêntrico sobre a razão I/Q do torque e EMGs em sujeitos saudáveis / Effect of isokinetic eccentric training on H/Q torque ratio and SEMG in healthy subjects / Efecto del entrenamiento isocinético excéntrico sobre el índice I/C de torque y EMGs en sujetos sanos

OBJETIVO: Avaliar os efeitos do treino isocinético excêntrico dos extensores do joelho sobre a razão Isquiotibiais/Quadríceps (I/Q) do torque e do eletromiograma de superfície (EMGs), em sujeitos saudáveis. MÉTODOS: Vinte homens ativos e saudáveis com idade média 22,5±2,1 anos; massa corporal 67,8±9,5 kg; estatura 1,72±0,10 m; e índice de massa corporal (IMC) de 22,5±2,0 kg/m2 foram avaliados quanto ao torque (isométrico e excêntrico a 30 e 120o/s) e EMGs dos extensores e flexores do joelho, antes e após 6 semanas de treino isocinético excêntrico (30o/s) dos extensores do joelho. RESULTADOS: O torque extensor do joelho aumentou em todos os modos e velocidades avaliados (P<0,01); a razão I/Q do torque declinou em todas as medidas realizadas (P<0,01), porém a razão I/Q do EMGs manteve-se nos valores pré-treino (P>0,05). As correlações torque/EMGs mostraram-se fracas (r<0.3; P>0,05) para todos os modos de contração, no pré- e pós-treino, porém, houve diferença (P>0,01) na comparação entre o modo excêntrico (30º e 120º/s) e isométrico, pré e pós-treino. CONCLUSÕES: O treino isocinético excêntrico dos extensores do joelho aumentou a diferença na razão I/Q do torque, porém, não alterou a razão I/Q do EMGs, sugerindo que a adaptação pelo aumento do torque associado ao treino excêntrico não alterou o recrutamento das unidades motoras avaliadas pelo EMGs. .

OBJECTIVE: To evaluate the effects of isokinetic eccentric training of the knee extensors on Hamstring/Quadriceps (H/Q) torque and surface electromyogram (SEMG) ratio in healthy subjects. METHODS: Twenty active, healthy men, with an average age of 22.5±2.1 years; body mass of 67.8±9.5 kg; height of 1.72±0.10 m; and body mass index (BMI) of 22.5±2.0 kg/m2, were evaluated for torque (isometric and eccentric 30o/s and 120o/s) and SEMG of the knee extensors and flexors, before and after 6 weeks of isokinetic eccentric training (30o/s) of the knee extensors. RESULTS: Knee extensor torque increased in all modes and speeds evaluated (P<0.01), the H/Q torque ratio declined in all measurements (P<0.01), but the H/Q SEMG ratio remained at pre-training values (P>0.05). The torque/SEMG correlation was weak (r<0.3; P>0.05) for all modes of contraction, pre-and post-training. However, there were significant differences (P>0.01) in the comparison between the eccentric (30o/s and 120o/s) and isometric modes, pre-and post-training. CONCLUSIONS: Isokinetic eccentric training of the knee extensors increased the difference in torque H/Q ratio, but did not alter the SEMG H/Q ratio. This suggests that adaptation by increasing the torque, associated with eccentric training, did not alter the recruitment of motor units assessed by SEMG. .

OBJETIVO: Evaluar los efectos del entrenamiento isocinético excéntrico de los extensores de la rodilla sobre el índice isquiotibiales/cuadriceps (I/C) del torque y de la electromiografía de superficie (EMGs), en sujetos sanos. MÉTODOS: Veinte hombres sanos y activos con edad promedio de 22,5±2,1 años, masa corporal 67,8±9,5 kg, altura 1,72 ± 0,10 m e índice de masa corporal (IMC) de 22,5 ± 2,0 kg/m2 fueron evaluados para el torque (isométrico y excéntrico 30º y 120º/s) y electromiografía de superficie de los extensores y de los flexores de la rodilla antes y después de 6 semanas de entrenamiento isocinético excéntrico (30º/s) de los extensores de la rodilla. RESULTADOS: El torque extensor de la rodilla aumentó en todos los modos y velocidades evaluados (P<0,01); el índice I/C de torque se redujo en todas las mediciones (P<0,01), no obstante, el índice I/C de la EMG se mantuvo en los valores del pre-entrenamiento (P>0,05). Las correlaciones torque/EMG se presentaron débiles (r<0,3, P>0,05) para todos los modos de contracción en las condiciones pre y post-entrenamiento, sin embargo, hubo diferencias significativas (P>0,01) entre los modos excéntrico (30º y 120º/s) e isométrico en el pre y post-entrenamiento. CONCLUSIONES: El entrenamiento isocinético excéntrico de los extensores de la rodilla aumentó la diferencia en la relación torque/IC, sin embargo, no alteró el índice I/C de la EMGs, lo que sugiere que la adaptación al aumentar el torque motor asociado con el entrenamiento excéntrico no afectó a la contratación de unidades motoras evaluadas por EMGs. .

Bilateral impairments of shoulder abduction in chronic hemiparesis: electromyographic patterns and isokinetic muscle performance.

OBJECTIVE: To analyze electromyographic (EMG) patterns and isokinetic muscle performance of shoulder abduction movement in individuals who sustained a cerebrovascular accident (CVA). DESIGN: Twenty-two individuals who sustained a CVA and 22 healthy subjects volunteered for EMG activity and isokinetic shoulder abduction assessments. EMG onset time, root mean square (RMS) for upper trapezius and deltoid muscles, as well as the isokinetic variables of peak torque, total work, average power and acceleration time were compared between limbs and groups. RESULTS: The paretic side showed a different onset activation pattern in shoulder abduction, along with a lower RMS for both muscles (21.8±13.4% of the maximal voluntary isometric contraction (MVIC) for the deltoid and 25.9±15.3% MVIC for the upper trapezius, about 50% lower than the control group). The non-paretic side showed a delay in both muscles activation and a lower RMS for the deltoid (32.2±13.7% MVIC, about 25% lower than the control group). Both sides of the group of individuals who sustained a CVA presented a significantly lower isokinetic performance compared to the control group (paretic side ∼60% lower; non-paretic side ∼35% lower). CONCLUSIONS: Shoulder abduction muscle performance is impaired in both paretic and non-paretic limbs of individuals who sustained a CVA.

Joint inflammation alters gene and protein expression and leads to atrophy in the tibialis anterior muscle in rats.

OBJECTIVE: The aim of this study was to evaluate the effect of tibiotarsal joint inflammation in rat tibialis anterior muscle through muscle fiber cross-sectional area (CSA) and gene expression (atrogin-1, muscle ring finger-1 [MuRF1], myogenic differentiation-1 [MyoD], p38 mitogen-activated protein kinase [p38MAPK], nuclear factor kappa B-dependent [NFκB], tumor necrosis factor-alpha [TNF-α]). DESIGN: Wistar rats were randomly divided into three periods (2, 7, and 15 days) and assigned into four groups within each experimental period: control, sham, inflammation, and immobilization. Real-time polymerase chain reaction, Western blot, immunofluorescence, and muscle fiber CSA analyses were performed. RESULTS: At 2 days, the inflammation group increased atrogin-1, MuRF1, and myostatin and reduced MyoD expression. At 7 days, the inflammation group increased atrogin-1, MuRF1, NFκB, p38MAPK, MyoD, myostatin, and TNF-α expression and TNF-α protein and reduced muscle fiber CSA. At 15 days, gene and protein expression in the inflammation group returned to basal levels, and CSA values were similar to those in control and sham groups. The immobilization groups have a similar pattern in all experimental periods, with increased atrogin-1, MuRF1, NFκB, and TNF-α gene expression and reduced muscle fiber CSA. The sham group had increased myostatin and atrogin-1 expression at 2 days and increased MyoD and myostatin expression at 7 days. CONCLUSIONS: Joint inflammation stimulated the expression of muscle factors related to atrophy, growth, differentiation, and mass regulation followed by muscle atrophy.