Translation, cross-cultural adaptation and validation of the Brazilian Portuguese version of the Victorian Institute of Sports Assessment for Gluteal Tendinopathy patient reported-outcome measure (VISA-G.BR).

BACKGROUND: Different outcome measures can be used to assess pain and disability in individuals with Greater Trochanteric Pain Syndrome (GTPS), including the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G), Oswestry Disability Index (ODI), Patient Specific Functional Scale (PSFS) and Global Perceived Effect (GPE). OBJECTIVE: To translate, cross-culturally adapt and validate VISA-G to Brazilian Portuguese and to evaluate the measurement properties of the VISA-G.BR, ODI, GPE, and PSFS in individuals with GTPS. DESIGN: This is a longitudinal clinimetric study. METHODS: Sixty-eight individuals with GTPS participated in this study. The questionnaires VISA-G.BR, ODI, PSFS, and GPE were administered to participants at the initial assessment, 24-48 h and 30 days after the initial assessment. Internal consistency and construct validity for the VISA-G.BR were assessed. Reliability, agreement, ceiling and floor effect, and responsiveness were described for all instruments. RESULTS: The Cronbach Alpha for internal consistency value for VISA-G.BR was 0.65. The construct validity analysis showed a strong correlation value between ODI and VISA-G.BR (r = -0.77). The agreement analysis performed for all questionnaires showed standard error of measurement values ranging from 0.64 (PSFS) to 4.2 (VISA-G.BR). GPE scale had a floor effect. The responsiveness analysis performed for all questionnaires showed low values of effect size ranging from -0.07 to 0.3. CONCLUSION: The VISA-G.BR is a valid and reliable instrument to assess the disability of individuals with GTPS. The ODI and PSFS instruments can also be used in the evaluation of this population.

Association between patient independence in performing an exercise program and adherence to home exercise program in people with chronic low back pain.

BACKGROUND: A high percentage of patients with chronic low back pain (LBP) do not adequately adhere to home exercise programs. There is no information regarding a possible association between patient independence in performing an exercise program and adherence to this exercise program. OBJECTIVE: To assess a possible association between patient independence in performing two different home exercise programs (treatment based on the Movement System Impairment-Based classification model (MSI) and treatment based on stretching and strengthening exercises for chronic LBP and adherence to those exercise programs. DESIGN: This was a secondary analysis of a randomized controlled trial. METHODS: The physical therapist assessed the patient's independence in performing the exercise program at the initial physical therapy sessions. Adherence was calculated during the 8-week treatment by the number of days performing the home exercise programs. Multivariate linear regression models were built to investigate whether patient independence in performing the home exercise program was associated with adherence to home exercise program for each treatment group adjusted for possible confounders (age, physical activity status, pain duration, pain intensity and disability at baseline). RESULTS: We observed a clinically important association between patient independence in performing the home exercise and adherence to a treatment based on the MSI model group (ß = -15.6 days, 95%CI = -24.5 to -6.7, R2 = 16%, p = 0.001). CONCLUSIONS: People with chronic LBP adhered more to a home exercise program based on the MSI model when they are more independent in performing the exercise program.

Baseline characteristics did not identify people with low back pain who respond best to a Movement System Impairment-Based classification treatment.

STUDY DESIGN: Secondary analysis of data from a randomized controlled trial. BACKGROUND: Treatment based on the Movement System Impairment-Based classification for chronic low back pain results in the same benefit when compared to other forms of exercise. It is possible that participant's characteristics measured at baseline can identify people with chronic low back pain who would respond best to a treatment based on the Movement System Impairment model. OBJECTIVES: To assess if specific characteristics of people with chronic low back pain measured at baseline can modify the effects of a treatment based on the Movement System Impairment model on pain and disability. METHODS: Four variables assessed at baseline that could potentially modify the treatment effects of the treatment based on the Movement System Impairment model were selected (age, educational status, physical activity status and STarT back tool classification). Separate univariate models were used to investigate a possible modifier treatment effect of baseline participant's characteristics on pain and disability after the treatment. Findings of interaction values above 1 point for the outcome mean pain intensity or above 3 points for disability (Roland Morris questionnaire) were considered clinically relevant. RESULTS: Linear regression analyses for the outcomes of pain and disability did not show interaction values considered clinically relevant for age, educational status, physical activity status and STarT back tool classification. CONCLUSION: Age, educational status, physical activity status and STarT back tool classification did not modify the effects of an 8-week treatment based on the Movement System Impairment model in patients with chronic low back pain. Registered at www.clinicaltrials.gov: NCT02221609 (https://clinicaltrials.gov/ct2/show/NCT02221609).

Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions.

Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.

Movement System Impairment-Based Classification Versus General Exercise for Chronic Low Back Pain: Protocol of a Randomized Controlled Trial.

BACKGROUND: Low back pain (LBP) is an important health problem in all developed countries and is associated with high levels of disability. Evidence-based clinical practice guidelines usually recommend different physical therapy interventions to manage this condition. However, those interventions usually result in small to moderate clinical effects. Recent studies suggest that interventions based on subgroup classifications may improve the effect sizes compared with rehabilitation programs where the same interventions were applied to all patients. OBJECTIVE: This study will investigate the efficacy of treatment based on a Movement System Impairment (MSI)-based classification model for patients with chronic LBP compared with general exercise. The primary outcomes will be pain intensity and disability at 2 months after randomization. DESIGN: The study is a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor. SETTING: The study setting will be a university physical therapy clinic in Brazil. PARTICIPANTS: A total of 148 individuals with chronic LBP will participate in the study. INTERVENTION: Included individuals will be randomly allocated to participate in an 8-week treatment program based on the MSI-based classification or a general exercise program of stretching and strengthening exercises. MEASUREMENTS: Pain intensity, disability, and global impression of recovery will be assessed by a blinded assessor at baseline and at follow-up appointments after treatment (2 months) and 4 and 6 months after randomization. LIMITATIONS: Therapists will not be blinded. CONCLUSIONS: The results of this study may contribute to a better understanding of the efficacy of treatments based on classification of participants with chronic LBP into subgroups.

Reliability of sagittal pelvic position assessments in standing, sitting and during hip flexion using palpation meter.

The objective of this study was to investigate reliability of assessing sagittal pelvic position using the palpation meter (PALM) in healthy subjects while sitting, standing and while in different hip flexion angles in standing. Twenty healthy subjects were assessed two times by the same examiner, with a 48-h interval between test sessions. Reliability indices of PALM measures (intraclass correlation coefficient, ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were calculated. ICC values showed excellent intra-rater reliability for measurements of sagittal pelvic position in standing and sitting position and for both standing hip flexion angles (ICC = .89-.96). SEM values ranged from .5° (hip flexion 90°) to 1.5° (sitting position). SDC values ranged from 1.5° (hip flexion 90°) to 4.0° (sitting position). The results of this study showed excellent intra-rater reliability for assessing sagittal pelvic position in standing, sitting and hip flexion in healthy subjects using the PALM.

Intraexaminer and interexaminer reliability of pressure biofeedback unit for assessing lumbopelvic stability during 6 lower limb movement tests.

OBJECTIVE: The purpose of this study was to assess examiners' intrarater and interrater reliability to use a pressure biofeedback unit (PBU) during 6 lower limb movement tests based on Movement System Impairment classification model for low back pain (LBP) in people with nonspecific LBP. METHODS: Thirty subjects (13 men and 17 women) with chronic nonspecific LPB were assessed during 6 lower limb movement tests based on Movement System Impairment classification using a PBU. Each test was performed twice by 2 assessors with a 48-hour interval between test sessions. Reliability indices of PBU measures (intraclass correlation coefficient [ICC]) were calculated. RESULTS: Intrarater reliability for hip and knee movement tests was good to excellent (ICC(3,3), 0-.60-0.95). Interrater reliability for hip and knee movement tests was fair to excellent (ICC(2,3), 0.40-0.86). Standard error of the measurement and smallest detectable change for the movement tests ranged from 1.4 to 11.3 mm Hg and from 3.9 to 31.3 mm Hg, respectively. CONCLUSIONS: The results of this study indicate that trained examiners can reliably perform PBU measures for patients with chronic LBP.

Uninvolved versus target muscle contraction during contract: relax proprioceptive neuromuscular facilitation stretching.

OBJECTIVE: The purpose of this study was to compare the acute effect of the contract-relax (CR) stretching technique on knee active range of motion (ROM) using target muscle contraction or an uninvolved muscle contraction. DESIGN: pre-test post-test control experimental design. SETTING: Clinical research laboratory. PARTICIPANTS: Sixty healthy men were randomly assigned to one of three groups. INTERVENTIONS: The Contract-Relax group (CR) performed a traditional hamstring CR stretch, the Modified Contract-Relax group (MCR) performed hamstring CR stretching using contraction of an uninvolved muscle distant from the target muscle, and the Control group (CG) did not stretch. MAIN OUTCOME MEASURES: Active knee extension test was performed before and after the stretching procedure. RESULTS: Two-way between-within analysis of variance (ANOVA) results showed a significant interaction between group and pre-test to post-test (p < 0.001). Post-hoc examination of individual groups showed no significant change in ROM for the CG (0.8°, p = 0.084), and a significant moderate increase in ROM for both the CR (7.0°, p < 0.001) and MCR (7.0°, p < 0.001) groups. CONCLUSIONS: ROM gain following a CR PNF procedure is the same whether the target stretching muscle is contracted, or an uninvolved muscle is contracted.

The Brazilian-Portuguese versions of the McGill Pain Questionnaire were reproducible, valid, and responsive in patients with musculoskeletal pain.

OBJECTIVE: To cross-culturally adapt the Short Form of the McGill Pain Questionnaire (SF-MPQ) into Brazilian-Portuguese and test the clinimetric properties of the newly developed SF-MPQ and the previously cross-culturally adapted Brazilian-Portuguese Long Form of the McGill Pain Questionnaire (LF-MPQ). STUDY DESIGN AND SETTING: The SF-MPQ was translated and adapted into Brazilian-Portuguese following recommendations from current guidelines. Both SF-MPQ and LF-MPQ were administered in a prospective longitudinal design to 203 patients with a range of musculoskeletal conditions to evaluate their clinimetric properties. RESULTS: Both questionnaires demonstrated high levels of internal consistency (Cronbach α range=0.70-0.79), reliability (intraclass correlation coefficient(2,1) range=0.69-0.85), and agreement (standard error of the measurement range=0.80-6.92). We observed positive and moderate-to-high correlations among the SF-MPQ, the LF-MPQ, and the Numerical Rating Scale (Pearson r ranging from 0.49 to 0.68). No ceiling or floor effects were detected. Both versions demonstrated acceptable levels of responsiveness (effect size range=0.30-0.60; correlations range=0.23-0.51; and area under the curve range=0.56-0.76). CONCLUSIONS: The Brazilian-Portuguese versions of the MPQ were found to be reproducible, valid, and responsive for the assessment of pain in patients with musculoskeletal conditions.

Influence of scapular position on cervical rotation range of motion.

STUDY DESIGN: Cross-sectional study, quasi-experimental design. OBJECTIVES: To compare the active cervical rotation range of motion (ROM) between healthy young subjects with a neutral vertical scapular alignment and subjects with scapular depression, and to examine the influence of modifying the vertical position of the scapulae on active cervical rotation ROM. BACKGROUND: Altered scapular alignment is proposed to be related to neck dysfunction and pain. Changes in the alignment of either the scapulae or the cervical spine can potentially influence the biomechanics of the other by altering the tension at the cervicoscapular muscles. METHODS AND MEASURES: Fifty-eight college age students with neutral vertical scapular alignment (NS group, n = 29) or depressed scapular alignment (DS group, n = 29) volunteered to participate in the study. Cervical rotation ROM was assessed using the CROM device in 2 conditions: condition 1, resting scapular position; condition 2, neutral vertical scapular position with forearms supported. RESULTS: The ANOVA revealed no significant group-by-condition interaction (F = 0.19, df = 1, P = .66). There was a significant main effect of condition (F = 47.16, df = 1, P<.001). For both groups, there was an increase in cervical rotation ROM in condition 2 when compared to condition 1 (mean +/- SD, 10.2 degrees +/- 3.1 degrees; 95% Cl: 4.1 degrees to 16.4 degrees). There was no main effect of group (F = .41, df = 1, P = .53). CONCLUSION: Our results suggest that in a young healthy population the vertical scapular alignment does not influence cervical rotation ROM. Supporting the upper limbs, however, results in a significant and similar increase in cervical rotation ROM for both groups.

Influência da limitação da amplitude de movimento sobre a melhora da flexibilidade do ombro após um treino de seis semanas / Influence of the range of motion (rom) limitation on the shoulder flexibility improvement after a six-week training

Estudos anteriores têm mostrado que o nível aeróbico e de força pré-treinamento influenciam os ganhos obtidos após um período de treino. Nenhum estudo investigou esta relação em um programa de flexibilidade. O objetivo deste estudo foi observar a influência da limitação da amplitude de movimento (ADM) sobre a melhora da ADM de rotação externa de ombro após um programa de alongamento de seis semanas. 30 voluntários, estudantes de fisioterapia, com limitação da ADM de rotação externa de ombro foram divididos de forma randomizadas em três grupos: grupo controle (GC), grupo experimental 1 (GE1), com maior limitação de ADM e grupo experimental 2 (GE2), com menor limitação de ADM. Os sujeitos do grupo experimental foram submetidos a um programa de seis semanas de alongamento ativo para melhora da ADM de rotação externa de ombro. Na análise dos resultados, o teste de ANOVA one-way mostrou uma diferença significativa entre a média do ganho de ADM de rotação externa de ombro entre os três grupos (p=0,001), sendo que o GE1 teve o maior ganho de ADM (30,1° ± 8,6°) seguido pelos grupos GE2 (15,2° ± 7,5°) e GC (1,1° ± 5,8°). O teste de correlação de Pearson mostrou uma correlação negativa significativa entre ADM prévia e ganho de ADM (r= -0,70, p=0,001). Os resultados deste estudo mostraram que a ADM prévia de rotação externa de ombro influencia o ganho de ADM deste movimento após um programa de alongamento de seis semanas em uma população jovem e saudável. Indivíduos com maior limitação de ADM respondem com um ganho de ADM mais pronunciado.

Previous research has shown that pre-training aerobic and strength status can influence on the training results, with untrained individuals presenting a more pronounced improvement. No study has investigated this correlation in a flexibility program so far. The purpose of this study was to observe the influence of the range of motion (ROM) limitation on ROM gain after a six-week shoulder external rotation stretching training. 30 volunteer physiotherapy students, with limited shoulder external rotation ROM were randomly assigned to one of three groups: control group (CG), experimental group 1 (EG1), with wider ROM limitation, and experimental group 2 (EG2), with narrower ROM limitation. Subjects in the experimental groups were submitted to a 6-week program of active shoulder external rotation stretching. One-way ANOVA showed a significant difference in mean external rotation ROM gains among all three groups (p=0.001), with EG1 having the highest ROM increase (30.1° ± 8.6°), followed by EG2 (15.2° ± 7.5°) and CG (1.1° ± 5.8°). The Pearson correlation analysis showed a significant negative correlation between previous ROM and ROM improvement (r= -0.70, p=0.001).The results of our study showed that shoulder external rotation ROM limitation influences ROM improvement after a six-week stretching program in a healthy young population. Subjects with more pronounced ROM limitation respond with a more remarkable ROM improvement.

Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region.

A position of scapula depression will maintain the upper trapezius muscle region in a lengthened position, causing excessive strain. This strain could lead to peripheral nociceptive nerves sensitization in the affected area, changing the pressure pain threshold (PPT). Thus, people with a faulty alignment of scapular depression may have lower PPT levels in the upper trapezius region when compared to subjects with normal vertical scapular position. The purpose of this double-blind study was to assess the influence of scapular position on the PPT of the upper trapezius region in a young healthy population. Fifty two physical therapy students of the Catholic University of Minas Gerais-PUC-Minas, Brazil, with normal shoulder (NS group, n=26, 6 men and 20 women) or depressed shoulder (DS group, n=26, 6 men and 20 women) volunteered to participate in this study. An electronic pressure algometer was used to measure the PPT on the upper trapezius muscle region. The results showed a significant difference between groups, with the DS group (19.0+/-9.0 N/cm(2)) demonstrated lower mean PPT values when compared to NS group (26.1+/-9.6 N/cm(2)) (p<0.01). Our results showed that healthy young subjects with depressed scapula position had significant lower upper trapezius PPT values when compared to subjects with normal scapula position.

Papel do músculo vasto medial oblíquo na patogênese da S161ndrome da Dor Patelofemoral: uma revisão crítica da literatura / The role of vastus medialis oblique muscle on patellofemoral pain syndrome pathogenesis: a critical review

O objetivo desta revisão foi analisar criticamente estudos que investigaram o desequilíbrio muscular na presença de Síndrome da Dor Patelofemoral (SDPF), a fim de determinar se é possível a atribuição de um papel patogênico às disfunções do músculo Vasto Medial Oblíquo (VMO). A metodologia de levantamento bibliográfico foi uma busca no banco de dados MEDLINE, limitada até julho de 2002 e consulta a listas de referências de artigos relevantes. Todos os estudos incluídos utilizaram eletromiografia e foram divididos de acordo com seu enfoque principal (fadiga, tempo de disparo, intensidade de ativação e exercícios específicos). Os resultados revelaram uma metodologia heterogênea entre os estudos. Somente dois estudos adequadamentedesenhados demonstraram alterações nos tempos de disparo dos músculos VMO e Vasto Lateral em portadores de SDPF quando comparados a indivíduos saudáveis. O fato dos estudos revistos terem desenho transversal impossibilita determinar se alterações eletromiográficas são causa ou consequência da dor e disfunção patelofemoral

Assessment of psychological pain management techniques: a comparative study between athletes and non-athletes

Athletes usually deal with injuries and pain. They seem to have similar pain threshold when compared to non-athletes, although they have higher pain tolerance and the exact cause for that is unknown. High levels for pain tolerance and control can improve performance and time for injury recovery. The literature shows that use of coping strategies can increase pain control; possible differences on coping with pain between athletes and non-athletes are poorly described. The purpose of this study was to evaluate frequency of coping strategies used by athletes and non-athletes of both genders and look for possible association between preferred coping style and pain intensity. The sample included 160 subjects with actual pain experience, 80 athletes (52 male, 28 female) and 80 non-athletes (50 male and 30 female). All subjects were evaluated for pain intensity, frequency and duration and for coping strategies using a questionnaire (SBS-V). The results show that athletes and non-athletes, despite of gender, use with the same frequency coping strategies. The less common coping strategies for all groups were those poor-adaptative (p < 0.001); the most commonly strategy used was self-statement and regulation of body tension (p < 0.001). Female athletes use more frequently poor-adaptative strategies when pain intensity increases (p < 0.05)

A pubalgia no jogador de futebol / Pubic pain in the soccer player

A pubalgia tornou-se um problema comum no futebol, preo-cupando atletas, treinadores, ortopedistas e fisioterapeutas. A articulaçäo do púbis é capaz de absorver parte das forças des-cendentes e ascendentes que säo aplicadas ao corpo e seu com-portamento depende diretamente dos movimentos da articu-laçäo sacroilíaca. Esses fatores tornam essa articulaçäo extre-mamente importante, colocando-a algumas vezes em situa-ções estressantes. Por ter como características tratamento di-fícil e de tempo prolongado, torna-se imprescindível o conhe-cimento da fisiopatologia relacionada à pubalgia. Embora näo haja ainda um consenso entre os autores, vários mecanismos têm sido sugeridos na tentativa de explicar o desenvolvimen-to da pubalgia. A proposta deste artigo é discutir esses possí-veis mecanismos, tentando correlacioná-los com a experiên-cia dos autores junto a jogadores profissionais de futebol, mos-trando possíveis caminhos relacionados à prevençäo e reabi-litaçäo. Isso inclui boa flexibilidade dos músculos relaciona-dos com o osso púbico, mobilizaçäo da articulaçäo sacroilía-ca, correçäo de desbalanceamentos de força, calçados e cam-pos de treinamento adequados.