THE EFFECTS OF NEUROMUSCULAR ELECTRICAL STIMULATION IN ASSOCIATION WITH WHEY PROTEIN SUPPLEMENTATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

OBJECTIVE: To analyze the effects of neuromuscular electrical stimulation of the femoral quadriceps associated or not with whey protein supplementation on the electromyographic activity and body mass distribution in volunteers undergoing anterior cruciate ligament reconstruction. METHODS: 24 volunteers were randomly divided into three groups: basal control, whey protein in association with neuromuscular electrical stimulation, and neuromuscular electrical stimulation alone. RESULTS: In the postoperative evaluation, during the mini squat, the basal group showed a decrease in the electromyographic activity of the vastus medialis (p = 0.005, eyes open; p = 0.003, eyes closed), vastus lateralis (p = 0.005, eyes open; p = 0.020; eyes closed) and rectus femoris (p = 0.075, eyes open; p = 0.074, eyes closed) and of body mass distribution in the injured limb (p < 0.001, eyes open; p < 0.001, eyes closed), and in the healthy limb (p < 0.001, eyes open; p < 0.001, eyes closed). CONCLUSION: The early use of neuromuscular electrical stimulation of the quadriceps femoris maintained the electromyographic activity of the vastus medialis and vastus lateralis muscles and prevented asymmetries in body mass distribution 15 days after anterior cruciate ligament reconstruction. Level of Evidence I, High quality randomized trial.

OBJETIVO: Analisar os efeitos da estimulação elétrica neuromuscular do quadríceps femoral associado ou não à suplementação com whey protein na atividade eletromiográfica e distribuição de massa corporal em voluntários submetidos à reconstrução do ligamento cruzado anterior. MÉTODOS: 24 voluntários foram divididos em três grupos: controle basal, whey protein associado com estimulação elétrica neuromuscular e estimulação elétrica neuromuscular isolada. RESULTADOS: Na avaliação pós-operatória, durante o miniagachamento, o grupo controle basal demonstrou diminuição da atividade eletromiográfica do vasto medial (p = 0,005, olhos abertos; p = 0,003, olhos fechados), vasto lateral (p = 0,005, olhos abertos; p = 0,020, olhos fechados) e reto femoral (p = 0,075, olhos abertos; p = 0,074, olhos fechados) e da distribuição de massa corporal no membro operado (p < 0,001, olhos abertos; p < 0,001, olhos fechados) e membro lesionado (p < 0,001, olhos abertos; p < 0,001, olhos fechados). CONCLUSÃO: O uso precoce de estimulação elétrica neuromuscular do quadríceps femoral, independentemente do uso de whey protein, foi eficaz para manter a atividade eletromiográfica dos músculos vasto medial e vasto lateral, e prevenir assimetrias na distribuição de massa corporal 15 dias após a reconstrução do ligamento cruzado anterior. Nível de Evidência I, Ensaio randomizado de alta qualidade.

The effects of neuromuscular electrical stimulation in association with whey protein supplementation after anterior cruciate ligament reconstruction / Efeitos da estimulação elétrica neuromuscular associado à suplementação com whey protein após reconstrução do ligamento cruzado anterior

ABSTRACT Objective: To analyze the effects of neuromuscular electrical stimulation of the femoral quadriceps associated or not with whey protein supplementation on the electromyographic activity and body mass distribution in volunteers undergoing anterior cruciate ligament reconstruction. Methods: 24 volunteers were randomly divided into three groups: basal control, whey protein in association with neuromuscular electrical stimulation, and neuromuscular electrical stimulation alone. Results: In the postoperative evaluation, during the mini squat, the basal group showed a decrease in the electromyographic activity of the vastus medialis (p = 0.005, eyes open; p = 0.003, eyes closed), vastus lateralis (p = 0.005, eyes open; p = 0.020; eyes closed) and rectus femoris (p = 0.075, eyes open; p = 0.074, eyes closed) and of body mass distribution in the injured limb (p < 0.001, eyes open; p < 0.001, eyes closed), and in the healthy limb (p < 0.001, eyes open; p < 0.001, eyes closed). Conclusion: The early use of neuromuscular electrical stimulation of the quadriceps femoris maintained the electromyographic activity of the vastus medialis and vastus lateralis muscles and prevented asymmetries in body mass distribution 15 days after anterior cruciate ligament reconstruction. Level of Evidence I, High quality randomized trial.

RESUMO Objetivo: Analisar os efeitos da estimulação elétrica neuromuscular do quadríceps femoral associado ou não à suplementação com whey protein na atividade eletromiográfica e distribuição de massa corporal em voluntários submetidos à reconstrução do ligamento cruzado anterior. Métodos: 24 voluntários foram divididos em três grupos: controle basal, whey protein associado com estimulação elétrica neuromuscular e estimulação elétrica neuromuscular isolada. Resultados: Na avaliação pós-operatória, durante o miniagachamento, o grupo controle basal demonstrou diminuição da atividade eletromiográfica do vasto medial (p = 0,005, olhos abertos; p = 0,003, olhos fechados), vasto lateral (p = 0,005, olhos abertos; p = 0,020, olhos fechados) e reto femoral (p = 0,075, olhos abertos; p = 0,074, olhos fechados) e da distribuição de massa corporal no membro operado (p < 0,001, olhos abertos; p < 0,001, olhos fechados) e membro lesionado (p < 0,001, olhos abertos; p < 0,001, olhos fechados). Conclusão: O uso precoce de estimulação elétrica neuromuscular do quadríceps femoral, independentemente do uso de whey protein, foi eficaz para manter a atividade eletromiográfica dos músculos vasto medial e vasto lateral, e prevenir assimetrias na distribuição de massa corporal 15 dias após a reconstrução do ligamento cruzado anterior. Nível de Evidência I, Ensaio randomizado de alta qualidade.

Validation study of a software for proprioceptive evaluation / Estudo de validação de um programa de computador para avaliação proprioceptiva

Objective: To validate the PhisioPlay software for proprioceptive evaluation of the shoulder joint based on the data obtained by isokinetic dynamometry equipment. Methods: Thirty-one individuals constituted a single group for proprioceptive evaluation of both shoulder joints by means of joint position sense (JPS). The testing protocol of PhisioPlay consisted of the abduction movement of the shoulder to the target angles of 45° and 90° and the maintenance of these positions for 30 seconds. In the isokinetic dynamometer, the test was performed using its proprioceptive evaluation protocol for the same movement, target angles, and maintenance time established for the previous test. Results: For the 90° variables, statistical analysis pointed to agreement for the dominant limb in relation to the mean angulation and the absolute difference and for the non-dominant limb in relation to the absolute difference. The results of mean comparisons of the absolute differences via the Wilcoxon Test corroborate the literature regarding the behavior of the JPS considering joint amplitude, lateral dominance, and greater or lesser torque affecting the joint. Reliability and sensitivity measures also strengthen the conclusions. Conclusion: The results point to the construct validity of the PhisioPlay software for evaluating the JPS of the shoulder joint at 45° and 90° and suggest that the JPS is more influenced by the angle of the joint during the motor task than by the lateral dominance.

Objetivo: Validar do software PhisioPlay para avaliação proprioceptiva da articulação do ombro realizando movimento de abdução a 45º e 90º utilizando os dados obtidos por um equipamento de dinamometria isocinética. Métodos: Trinta e um indivíduos compuseram um único grupo de avaliação da propriocepção pelo senso de posição articular (SPA) do ombro. O protocolo de teste no PhisioPlay consistiu no movimento de abdução do ombro para o ângulo alvo de 45° e 90° e sua manutenção por 30 segundos. No dinamômetro isocinético o teste foi realizado utilizando seu protocolo de avaliação proprioceptiva para o mesmo movimento, ângulos alvo e tempo de manutenção no ângulo alvo estabelecidos para o teste anterior. Resultados: Para as variáveis de 90° foi observada concordância moderada para o membro dominante em relação à angulação média e à diferença absoluta, e para o membro não dominante em relação à diferença absoluta. O teste de Wilcoxon ao comparar os valores dos erros absolutos em relação ao ângulo alvo obtidos pelo PhisioPlay corroboram com a literatura sobre o comportamento do SPA observando amplitude articular, lateralidade e maior ou menor torque incidindo sobre a articulação. Medidas de confiabilidade e sensibilidade também reforçaram este comportamento. Conclusão: Os resultados apontam para validade de construto do software PhisioPlay para a avaliação do SPA da articulação do ombro a 45° e 90° e sugerem que o SPA é mais influenciado pela angulação da articulação durante a tarefa motora do que pela dominância lateral.

Whole Body Vibration Training on Muscle Strength and Brain-Derived Neurotrophic Factor Levels in Elderly Woman With Knee Osteoarthritis: A Randomized Clinical Trial Study.

Background: Osteoarthritis of the knee (kOA) is a chronic, progressive, degenerative health condition that contributes to the imbalance between the synthesis and destruction of articular cartilage. Recently, whole body vibration (WBV) training has been recommended as an effective alternative for strength training in elderly people, and various physiological effects are obtained in response to exercise performed on a vibratory platform, such as an increase in muscle activation and improved muscle performance. However, the effects of WBV particularly on the strength of the quadriceps muscle and neuronal plasticity are unknown. Objective: The aim of this study was to evaluate the effects of adding WBV to squat training on the isometric quadriceps muscle strength (IQMS) and the plasma levels of brain-derived neurotrophic factor (BDNF) in elderly woman with kOA. Methods: Fifteen elderly women ≥65 years of age with kOA were randomized into two interventions: (1) the vibration group (VG), in which participants performed squat exercise training in association with WBV or (2) the exercise group (EG), in which participants performed squat exercise training without vibration, for 12 weeks 3×/week. Results: Compared to the EG group, the VG group demonstrated a significantly greater delta (Δ) in IQMS values (IC95% 0.43-7.06; p ≤ 0.05) and in Δ BDNF plasma levels (IC95% -32.51 to 4.217; p ≤ 0.05) after the intervention period. There was an association between increase of Δ BDNF plasma levels and increase of Δ IQMS (ß = 0.57; R 2 = 0.32; p = 0.03). Conclusion: The addition of WBV to squat exercise training improves lower limb muscle performance in elderly women with kOA. These findings suggest that the improvement in muscle performance is related to neuromuscular adaptations induced by WBV. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03918291.

Influência do tratamento do câncer na rotação pélvica avaliada por baropodometria / Influence of cancer treatment on pelvic rotation assessed by baropodometry

Introdução: O câncer tem sido um crescente problema de saúde pública no Brasil. Comumente, a pessoa com câncer pode apresentar diversas alterações posturais, como a rotação da pelve, ocasionadas pela doença e por efeitos adversos secundários às formas de tratamento. Objetivo: Analisar a influência do posicionamento rotacional da pelve de pessoas com câncer por meio da baropodometria. Métodos: Foram incluídos 45 indivíduos, divididos em: Grupo Quimioterapia e/ou Radioterapia (GQR), Grupo Câncer em Acompanhamento (GCA) e Grupo Controle sem Câncer (GCS). Todos os voluntários foram avaliados quanto ao posicionamento da pelve por meio da baropodometria. Resultados: Não foram encontradas alterações significativas no posicionamento rotacional da pelve nas comparações entre os grupos com câncer e grupo controle (p: 0,112; Poder: 0,838; f2: 1,121). Conclusão: Os resultados sugerem que o câncer e suas formas de tratamento não exerceram influência sobre a postura rotacional da pelve. (AU)

Introduction: Cancer has been a growing public health problem in Brazil. Patients with cancer may commonly present a number postural changes such as the pelvis rotation due to the disease itself and also to secondary adverse effects produced by its forms of treatment. Objective: To assess the rotational positioning of the pelvis in cancer patients using computerized baropodometry. Methods: A total of 45 volunteers were divided into: Chemotherapy combined with radiotherapy Group (QRG), Follow up Cancer Group (CAG) and Control Group without Cancer (CG). All subjects were assessed for the positioning of the pelvis using baropodometry Results: No significant changes were found in the rotational positioning of the pelvis in the comparison between the cancer groups and the control group (p: 0,112; Power: 0,838; Effect: 1,121). Conclusion: The results suggest that the cancer and its forms of treatment have no influence on the rotational posture of the pelvis. (AU)

Soluble TNF receptors are produced at sites of inflammation and are inversely associated with self-reported symptoms (WOMAC) in knee osteoarthritis.

The aim of the study was to analyze the concentrations of sTNFR1 and sTNFR2 in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and to determine their relationship to self-reported pain, stiffness and physical function. Twenty-seven patients with knee OA and 19 healthy subjects were enrolled in the study. The Western Ontario and McMaster University Osteoarthritis Index questionnaire was used to evaluate self-reported physical function, pain and stiffness. The sTNFR1 and sTNFR2 levels in the plasma and synovial fluid were measured by enzyme-linked immunosorbent assay. The sTNFR1 levels in synovial fluid of OA patients (2,587 ± 66.12 pg/mL) were 2.5-fold higher than in corresponding blood samples and were 1.5-fold higher than in the plasma of healthy controls. The plasma sTNFR2 levels in the patients with knee OA were lower than in healthy controls (2,249 ± 126.3 vs. 2,700 ± 126.3 pg/mL, p < 0.05), and sTNFR2 levels in synovial fluid of knee OA patients (2,021 ± 107.0 pg/mL) were lower than in the plasma of healthy controls. Synovial fluid sTNFR1 levels were negatively correlated with pain and physical function self-reported (r s - 0.6785, p < 0.0001 and r s - 0.4194, p = 0.03, respectively). Synovial fluid sTNFR2 levels were negatively correlated with pain and joint stiffness (r s - 0.5433, p = 0.01 and r s - 0.4249, p = 0.02, respectively). The findings of this study demonstrated the presence of soluble receptors for TNF-alpha, particularly sTNFR1, in the synovial fluid of patients with primary knee OA and the relationship of these receptors with clinical parameters.

Involvement of BDNF in knee osteoarthritis: the relationship with inflammation and clinical parameters.

The aim of this study was to analyze the levels of brain-derived neurotrophic factor (BDNF) in both the plasma and synovial fluid of patients with primary knee osteoarthritis compared with control individuals and to investigate the relationship between BDNF levels and self-reported pain. Twenty-seven patients with knee osteoarthritis (OA) and 19 healthy subjects were enrolled in the study. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. Radiographic grading of OA in the knee was performed using the Kellgren-Lawrence criteria. The BDNF levels in the plasma and synovial fluid were measured by enzyme-linked immunosorbent assay. The mean plasma BDNF levels of the knee OA patients were significantly higher than that of the healthy controls (2,378 ± 1,067.2 vs. 1,756 ± 804.3 pg/mL, p < 0.05). BDNF levels in the synovial fluid of OA patients (358.9 ± 178.4 pg/mL) were sixfold lower than in corresponding blood samples (p < 0.0001) and fourfold lower than in the plasma of healthy controls (p < 0.0001). Subsequent analyses showed that the plasma BDNF levels significantly correlated with self-reported pain (Western Ontario and McMaster Universities Osteoarthritis Index) (r s = 0.39, p = 0.04). Furthermore, no correlation was found between the plasma and synovial fluid BDNF concentrations and knee OA severity. The findings of this study suggest that systemic BDNF levels are most likely associated with the mechanism of joint pain in knee OA in the acute stage of joint inflammatory process. Further studies are necessary to address the functional role of BDNF in the modulation of pain to establish new therapeutic implications.

The effect of adding whole-body vibration to squat training on the functional performance and self-report of disease status in elderly patients with knee osteoarthritis: a randomized, controlled clinical study.

OBJECTIVES: The study objectives were to evaluate the effects of adding whole-body vibration to squat training on functional performance and self-report of disease in elderly individuals with knee osteoarthritis (OA). DESIGN: This was a prospective, randomized trial in which selected variables were evaluated at three periods: 3 weeks prior to the training, immediately prior, and after the end of the training. SUBJECTS: Twenty-three (23) elderly subjects were evaluated using four functional performance tests: Berg Balance Scale (BBS), Timed Get Up and Go Test (TGUG), Chair Stand Test (CST), and 6-Minute Walk Test (6MWT), and a self-report of the status of disease (WOMAC). INTERVENTIONS: The intervention lasted for 12 weeks, 3 times per week. The participants were randomized into two groups: (1) squat training with whole-body vibration, and (2) squat training without vibration. RESULTS: Although there was no statistical difference in functional performance and self-report of disease status between the groups, performance in all the functional tests and in all the domains of WOMAC improved in the vibration group compared to their initial status. In the exercise group, performance improved only two tests (BBS and 6MWT), and there was a reduction in self-reported pain (WOMAC) compared to their initial status. CONCLUSIONS: Although the addition of whole-body vibration to squat training failed to result in a significant improvement in functional performance and self-reported status of knee osteoarthritis in the elderly, the intragroup results suggest that whole-body vibration may represent a feasible and effective way of improving the functionality and self-perception of disease status in older adults with knee OA.

Análise da efetividade de terapias para lombalgia crônica não-específica: uma revisão de ensaios clínicos randomizados / analysis from effectiveness of therapies for non-specific chronic low back pain: a review of randomized controlled trial

A lombalgia é um importante problema clínico, social, econômico e de saúde pública. Várias estratégias terapêuticas são freqüentemente empregadas no tratamento da lombalgia crônica não-específica (LCNE), contudo, a efetividade destas é sistematicamente revisada. O objetivo desse estudo foi realizar uma revisão sistemática da evidência das técnicas utilizadas no tratamento de pacientes adultos com LCNE. As bases de dados pesquisadas incluíram Biblioteca Cochrane, Medline, Pubmed e Scielo dos quais foram aceitos somente ensaios clínicos randomizados. A qualidade metodológica dos artigos foi avaliada através da escala PEDro e o nível de evidência das terapêuticas foi determinado. Dezoito estudos foram selecionados e avaliados nos quais a média na escala PEDro indicou alta qualidade metodológica. Os tipos de tratamento encontrados foram: terapia manual, fisioterapia convencional, exercícios, acupuntura, back school, voga e terapia cognitivo-comportamental. Os resultados da escala PEDro sugerem que os critérios de cegamento dos sujeitos e, principalmente, dos terapeutas possam ser inapropriados em estudos de tratamento fisioterapêutico. Os achados denotaram relativamente forte evidência suportando a efetividade do voga, dos exercícios, do programa cognitivo-comportamental associado a exercícios e da terapia manual em curto prazo, conflitante evidência para a fisioterapia convencional e as back schools em pacientes com LCNE. A evidência identificada não apóia a aplicação da acupuntura no tratamento dessa morbidade. A incorporação e aplicação de condutas eficientes baseadas em evidências devem ser estimuladas na prática clínica e estas devem respeitar as necessidades de cada paciente. Contudo, devem ser realizados novos estudos com ensaios clínicos randomizados de alta qualidade metodológica, principalmente, que abordem terapias multidisciplinares em relação à LCNE.

Low back pain is an important clinical, social, economic and public health problem. Many therapeutics strategies are commonly used in treatment of non-specific chronic low back pain, although their effectiveness has been being review systematiclly. The objective of this study was to perform a systematic review of evidence in treatment of adults patients with non-specific chronic low back pain. Databases searched included Cochrane Library, Medline, Pubmed e Scielo have been included only randomized controlied trials. Methodological quality of articles was evaluated through scale PEDro and the levei of evidence from the therapeutics was determined. Eigthteen studies with average indicating high methodological quality in PEDro scale were selected e appraised. The treatment types found were manual therapy, conventional physiotherapy, exercises, acupuncture, back school, voga and cognitive-behavioral therapy. Pedro scale results suggest that blind subjects and, mainly, blind therapist criteria are inappropriate in studies about physiotherapist treatment. Findings revealed relatively strong evidence supporting the effectiveness of yoga , exercises, cognitive-behavioral program association the exercises and manual therapy in short term, conflicting evidence for conventional physiotherapy and back schools in subjects with non-specific chronic low back pain.

Avaliação isocinética da performance funcional dos músculos quadríceps femoral e isquiotibiais de jogadores profissionais de futebol / Isocinetic evaluation of the functional performance of quadriceps and ischiotibial muscles in professional soccer players

O objetivo deste trabalho foi analisar o pico de torque concêntrico e excêntrico e a relação isquioitibiais/quadríceps, em jogadores profissionais de futebol, ao final do campeonato paulista da 2ª divisão. Oito jogadores foram avaliados em um aparelho isocinético Biodex System II. Entre os jogadores avaliados não encontramos diferenças significativas entre os membros dominantes e não dominantes, prevalecendo um maior valor de pico de torque para o músculo quadríceps femoral do que os ísquios-tibiais de acordo com nossa expectativa.

The aim of this study was to analyze eccentric and concentric peak torque and the relation between ischiotibial/quadriceps, in professional soccer players, at the end of the second division of Paulista championship. Eight players were evaluated using a Biodex System II isokinetic. We did not find significant difference between the dominant and the non-dominant limbs, a higher torque peak of the femoral quadriceps muscle prevailed on ischiotitibial according to our expectative.