Text neck is not associated with neck and upper limb disability in young adults who use smartphones.

PURPOSE: The objective of the present study was to correlate neck and upper-limb disabilities with neck flexion in university students who are smartphone users. While handling smartphones, a posture with sustained neck flexion known as "Text Neck" is usually adopted, and some authors related to musculoskeletal symptoms on the neck and the upper limb. However, recent studies state that such an association is questionable. METHODS: This is an observational study when evaluating 192 university students through questionnaires such as the Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), besides the maximal neck flexion, grip and lateral pinch strength of the participants. RESULTS: The sociodemographic questionnaire demonstrated that most participants had used the device for 5 to 10 years, for five or more hours per day. The DASH questionnaire scores presented an average of 7.2 points, while the data regarding grip and lateral pinch strength showed averages of 29.5 kgf and 8.8 kgf, respectively. The NDI questionnaire scores presented an average of 10.5. The average range of motion of the maximum neck flexion was 27°. CONCLUSION: There was no association between neck flexion with the DASH and NDI or the grip and lateral pinch strength after the correlation and binary logistic regression analyses. The results show that the scores of DASH, NDI, hand grip and lateral pinch strength, have no association with the maximum neck flexion.

Assessment of knowledge about the neurophysiology of pain and self-perception of skills to assist individuals with pain among undergraduate physiotherapy students in Brazil: cross-sectional study / Avaliação do conhecimento sobre neurofisiologia da dor e autopercepção de habilidades para atender indivíduos com dor em graduandos e graduados em fisioterapia no Brasil: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Approaches to coping with pain, such as patient education, are directly related to the professionals' skill level. The identification of possible learning gaps in the different stages of training can contribute to the development of new teaching strategies and methods. This study aimed to evaluate and compare the level of knowledge about the neurophysiology of pain and the self-perception of abilities to care for individuals with pain in undergraduate and graduate students in physiotherapy in Brazil. METHODS: This is a cross-sectional analytical observational study, in which the Neurophysiological Pain Questionnaire (QND) was applied to assess the level of knowledge about the neurophysiology of pain. A self-administered questionnaire was also used to collect sociodemographic data from the sample and to assess self-perception of abilities to care for individuals with pain. The characteristics of the study population were defined by descriptive statistics. For the analysis of QND score distribution and self-perception of abilities to care for individuals with pain, the Shapiro-Wilk test was used. In the bivariate analysis to compare the distribution of the QND score and self-perception of abilities to care for individuals with pain between the stages of undergraduates and schooling after graduation, the Kruskal-Wallis test was used, with a significance level of 5% and 95% confidence interval. The statement Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used as a guide for reporting the results of the study. RESULTS: A total of 306 volunteers participated in the study, 208 undergraduate students (22.3 ± 3.2 years) and 98 physiotherapists (31.7± 8.7 years). The average QND score for undergraduate students was 6.17 and 8.56 for physiotherapists, considering a total of 12 points. There was a significantly higher difference in the scores obtained on the QND by undergraduates in the intermediate phase and in the last year (p<0.05), as well as in the self-perception of abilities to care for individuals with pain and perform a biopsychosocial approach to the patient, between the different phases of the course. However, among physiotherapists, no significant difference was observed in the total QND score, and in the self-perception of abilities to care for individuals with pain. CONCLUSION: The findings of this study suggest that the level of knowledge about the neurophysiology of pain and self-perception of skills to care for individuals with pain differs between academics and physiotherapy professionals. However, the low QND score of physiotherapy undergraduates, as well as the absence of significant differences in the QND between the different levels of physiotherapist training, suggest that curricular implementation and specific training on pain may be indispensable to increase the level of knowledge and skills of physiotherapists in the treatment of individuals with pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Abordagens para o enfrentamento da dor, como educação do paciente, estão diretamente relacionadas ao nível de habilidades dos profissionais. A identificação de possíveis lacunas do aprendizado nas diferentes fases de formação pode contribuir para o desenvolvimento de novas estratégias e métodos de ensino. O objetivo deste estudo foi avaliar e comparar o nível de conhecimento sobre neurofisiologia da dor e a autopercepção de habilidades para atender indivíduos com dor em alunos de graduação e graduados em fisioterapia no Brasil. MÉTODOS: Trata-se de um estudo observacional analítico do tipo transversal, em que foi aplicado o Questionário Neurofisiológico de Dor (QND) para avaliar o nível de conhecimento sobre neurofisiologia da dor. Também foi utilizado um questionário autoaplicado para coletar os dados sociodemográficos da amostra e avaliar a autopercepção de habilidades para atender indivíduos com dor. As características da população do estudo foram definidas pela estatística descritiva. Para a análise da distribuição do escore QND e da autopercepção de habilidades para atender indivíduos com dor foi utilizado o teste Shapiro-Wilk. Na análise bivariada para a comparação de distribuição do escore QND e da autopercepção de habilidades para atender indivíduos com dor entre as fases dos graduandos e a escolaridade após a formação foi utilizado o teste de Kruskal-Wallis, nível de significância de 5% e intervalo de confiança de 95%. A declaração Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) foi utilizada como guia para relatar os resultados do estudo. RESULTADOS: Um total de 306 voluntários participaram do estudo, sendo 208 alunos de graduação (22,3 ± 3,2 anos) e 98 fisioterapeutas (31,7± 8,7 anos). A pontuação média do QND para os alunos de graduação foi 6,17 e de 8,56 para os fisioterapeutas, considerando um total de 12 pontos. Observou-se uma diferença significativamente superior na pontuação obtida no QND pelos graduandos da fase intermediária e do último ano (p<0,05), bem como na autopercepção de habilidades para atender indivíduos com dor e realizar uma abordagem biopsicossocial do paciente entre as diferentes fases do curso. Contudo, entre os fisioterapeutas, não foi observada diferença significativa na pontuação total do QND e na autopercepção de habilidades para atender indivíduos com dor. CONCLUSÃO: Por meio dos achados deste estudo, foi possível observar que o nível de conhecimento sobre neurofisiologia da dor e autopercepção de habilidades para atender indivíduos com dor difere entre acadêmicos e profissionais de fisioterapia. Entretanto, a pontuação baixa do QND dos graduandos de fisioterapia, bem como a ausência de diferenças significativas do QND entre os diferentes níveis de formação dos fisioterapeutas, sugere que a implementação curricular e capacitações específicas sobre dor são indispensáveis para ampliar o nível de conhecimento e habilidades dos fisioterapeutas no tratamento de indivíduos com dor.

Effectiveness of electrophysical agents for treating pressure injuries: a systematic review.

Tissue injuries that affect the skin and/or adjacent tissues and are usually over a bony prominence are called pressure injuries. The prevalence of these dysfunctions remains high, and despite technological advances, there is no consensus on the most appropriate treatment. The objective of this review was to evaluate the efficacy of photobiomodulation (PBM), ultrasound, and high-frequency electrophysical agents in the healing of pressure injuries in adults and the elderly. The search was conducted in the PubMed, Embase, Cochrane Library, Web of Science, and PEDro databases; in clinical trial records, a list of references of the selected articles, as well as through manual search (Google), of the last 5 years in humans in English and Portuguese. Nine thousand and sixty-seven studies were identified, 13 pre-selected, and 6 were included in this systematic review. PBM showed similar efficacy to other technologies indicated in other studies in healing pressure injuries. PBM with red wavelength (660 nm) in stages 2 and 3 pressure injuries effectively promoted healing compared to standard care. It was observed that the use of PBM accelerates tissue repair in pressure injuries; therapeutic ultrasound showed similar efficacy to other electrophysical agents but was effective in reducing the area of pressure injuries when comparing pre- and post-intervention. No clinical studies using the high-frequency electrophysical agent have been described in the last 5 years.

Effect of photobiomodulation therapy (660 nm and 830 nm) on carrageenan-induced edema and pain behavior in mice / Efeito da terapia por fotobiomodulação (660 nm e 830 nm) no comportamento da dor e edema induzidos por carragenina em camundongos

ABSTRACT BACKGROUND AND OBJECTIVES: Photobiomodulation (PBM) is an important therapeutic tool for inflammatory process modulation. In this study, the anti-inflammatory and analgesic effect of two different energies and two different wavelengths (660 nm and 830 nm) were investigate and compared through the model of carrageenan-induced paw edema in mice. METHODS: Male Swiss mice, 36 animals (n=6 animals/group) were divided into six groups: Group 1 (saline-control), Group 2 (carrageenan), Group 3 (carrageenan + laser 660 nm, 5.88 J), Group 4 (carrageenan + laser 660 nm, 2.94 J), Group 5 (carrageenan + laser 830 nm, 5.88 J), and Group 6 (carrageenan + laser 830 nm, 2.94 J). PBM was applied 1h after the carrageenan injection which induced paw edema and hyperalgesia, which were measured by means of a plethysmometer and by flicker test using a water bath at 38ºC (±0.5ºC), respectively. Left paws of mice injected with carrageenan exhibited local edema that persisted for up to 6h after its administration. All animals were evaluated before, 1, 2, 3, 4, and 6 h after the injection of carrageenan. RESULTS: PBM, specially the 830 nm wavelength with 2.94 J of energy, reduced the paw edema induced by carrageenan. In addition, the 660 nm wavelengths (5.88 J / 2.94 J) and 830 nm (2.94 J) inhibited thermal hyperalgesia induced by carrageenan after 4 h of paw injection. CONCLUSION: There was evidence that the PBM 830 nm (2.94 J) produced a more pronounced anti-inflammatory effect, while the 660 nm (5.88 J / 2.94 J) energy laser was more effective to inhibit the hyperalgesia response induced by the carrageenan injection.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fotobiomodulação (FBM) é uma importante ferramenta terapêutica para modulação dos processos inflamatórios. Neste estudo, investigou-se o efeito anti-inflamatório e analgésico de duas energias e dois comprimentos de onda diferentes (660 nm e 830 nm) através do modelo de edema de pata induzido por carragenina em camundongos. MÉTODOS: Trinta e seis camundongos Swiss machos (n=6 animais/grupo) foram divididos em seis grupos: Grupo 1 (controle salino), Grupo 2 (carragenina), Grupo 3 (carragenina + laser 660 nm, 5,88 J), Grupo 4 (carragenina + laser 660 nm, 2,94 J), Grupo 5 (carragenina + laser 830 nm, 5,88 J) e Grupo 6 (carragenina + laser 830 nm, 2,94 J). A FBM foi aplicada 1h após a injeção de carragenina que induziu o edema de pata e a hiperalgesia térmica, os quais foram medidos por meio de um pletismômetro e pelo flicker test em banho-maria a 38ºC (±0,5ºC), respectivamente. As patas esquerdas injetadas com carragenina apresentaram edema local que persistiu por até 6h após sua administração. Todos os animais foram avaliados antes, 1, 2, 3, 4, e 6 horas após a injeção de carragenina. RESULTADOS: A FBM, principalmente o comprimento de onda 830 nm com 2,94 J de energia, reduziu o edema de pata induzido pela carragenina. Além disso, o comprimento de onda 660 nm (5,88 J / 2,94 J) e o 830 nm (2,94 J) inibiram a hiperalgesia térmica induzida pela carragenina após 4h da injeção na pata. CONCLUSÃO: Evidenciou-se que a FBM 830 nm (2,94 J) produziu efeito anti-inflamatório mais pronunciado, enquanto o laser de 660 nm (5,88 J / 2,94 J) de energia foi mais eficaz para reduzir a resposta de hiperalgesia induzida pela injeção de carragenina.

The combined effect of anemia and dynapenia on mortality risk in older adults: 10-Year evidence from the ELSA cohort study.

BACKGROUND/OBJECTIVE: Anemia and dynapenia can occur simultaneously. Separately, both conditions increase the mortality risk with advancing age. However, there is no epidemiological evidence on the combined effect of these conditions on mortality in older adults. We investigated whether combined anemia and dynapenia increase the mortality risk, and whether there are gender differences. METHODS: A 10-year follow-up study was conducted involving 5,310 older adults from the English Longitudinal Study of Ageing (ELSA). According to the diagnosis of anemia (hemoglobin concentration < 13.0 g/dL in men and < 12.0 g/dL in women) and dynapenia (grip strength < 26 kg for men and < 16 kg for women), individuals at baseline were categorized as "non-anemic/non-dynapenic", "dynapenic", "anemic" and "anemic/dynapenic". The outcome was all-cause mortality during the follow-up period. RESULTS: A total of 984 deaths were computed during the follow-up (63.7% in non-anemic/non-dynapenic, 22.8% in dynapenic, 7.5% in anemic and 6.0% in anemic/dynapenic). Adjusted Cox proportional hazard models stratified by sex showed that anemia and dynapenia combined was associated with an increased mortality risk in men (HR: 1.64; 95% IC 1.08 - 2.50) and women (HR: 2.17; 95% CI 1.44 - 3.26). Anemia in men (HR: 1.68; 95% CI 1.22 - 2.32) and dynapenia in women (HR: 1.37; 95% CI 1.09 - 1.72) were also risk factors for mortality. CONCLUSIONS: The coexistence of anemia and dynapenia increases the mortality risk, highlighting the need for early identification, prevention, and treatment of these conditions to reduce their complications and the mortality risk.

Physiotherapeutic approach in seamstresses with neck pain: A single-blind, randomized clinical trial.

PURPOSE: To investigate and compare the effects of therapeutic exercise, therapeutic ultrasound and photobiomodulation on pain, functionality and recruitment pattern of motor units, after a rehabilitation protocol for seamstresses with neck pain. MATERIALS AND METHODS: All 36 female, randomly divided into three groups; i)exercise control group, ii)exercise and photobiomodulation group, iii)exercise and ultrasound group. The groups were composed of sewing machine operators with complaints neck pain. Clinical evaluations: Visual analog pain scale, questionnaires Nordic Musculoskeletal Questionnaire and the International Physical Activity Questionnaire, and electromyographic evaluations of the sternocleidomastoid and upper trapezius muscles. All variables were compared before and after the protocol. For statistical analysis, the values of mean, standard deviation and standard error of the mean were used. The values obtained were compared using the One-Way ANOVA with post-hoc Tukey, and Cohen's-d, with a significance coefficient of p < 0.05. RESULTS: In the Ultrasound and laser groups there was a greater tendency to improve pain (p < 0.0001) and size of the effect on pain reduction (ultrasound = d:1.99; photobiomodulation = d:1.81). Between groups, there was a significant difference in post-treatment for the onset of right trapezius (p = 0.024) in the exercise and photobiomodulation groups (p = 0.0347). The photobiomodulation group showed pre and post-intervention differences in the left trapezius maximum onset (p = 0.010). CONCLUSION: Interventions with photobiomodulation, ultrasound, and exercise assist to pain, function, and muscular activation in seamstresses with neck pain.

Electromyography in muscle activation lumbar region in a comparison between manual therapy and photobiomodulation associated with kinesiotherapy in individuals with low back pain

INTRODUCTION: About 10 million people have low back pain (LBP) disability in Brazil. Several therapies are used to treat this condition, such as kinesiotherapy, manual therapy (MT), and photobiomodulation (PBM). Although the use of these methods in LBP has been investigated, studies evaluating the efficacy of the association between these techniques are still needed. OBJECTIVE: To evaluate the activation of the lumbar region muscles by PBM or MT associated with kinesiotherapy for the treatment of LBP. METHODS: Twenty individuals with chronic LBP were randomlydivided into two groups. The first group (MT) received vertebral mobilization associated with a kinesiotherapy exercise program. The second group (830nm-PBM) received PBM associated with the exercise program, twice a week for 8 weeks. Evaluation of pain perceived was performed by the visual analogic scale (VAS), lumbar disability by the Oswestry questionnaire, muscle strength by strain gauge, and activation through surface electromyography (EMG). Data were collected before and after the treatment. EMG data was analyzed by MatLab®. The ANOVA two-way test was used (degree of significance p≤0.05), and the size of the effect by the Hedge test. RESULTS: Considering pain, the two groups presented a significant result (p<0.05). In muscle activation, only the multifidus was different during the side bridge (p<0.05) when compared intragroup. None of the variables were different when evaluating intergroup. CONCLUSION: Both MT and PBM associated with kinesiotherapy for 8 weeks are effective in reducing pain, and improving motor control and stability of the lumbar spine in patients with chronic LBP.

Viability of the random pattern dorsal skin flap in mice submitted to photobiomodulation and therapeutic ultrasound / Viabilidade do retalho cutâneo randômico dorsal em camundongos submetidos à fotobiomodulação e ultrassom terapêutico

INTRODUCTION: The skin flap is a surgical technique widely used in clinical practice and generally presents postoperative complications. Therefore, elucidating interventions that assist in tissue conservation is essential. Photobiomodulation (PBM) and therapeutic ultrasound (TUS) are non-invasive alternatives for assisting tissue repair, however, there is no consensus on the parameters used. OBJECTIVE: To describe the effectiveness of the different parameters of PBM and TUS in the viability of the dorsal random pattern skin flap in mice. METHODS: Fifty-five Swiss mice were used, distributed in eleven groups. The animals were submitted to surgical technique including revascularization of the area limited through a plastic barrier (polyester/polyethylene) with the same dimension as the flap. PBM or TUS was applied for five consecutive days. Photographic and thermographic recordings were performed with Cyber-Shot DSC-P72 and FlirC2 cameras and analyzed using the ImageJ® and FLIR Tools software, respectively. In the statistical analysis, the data were submitted to the GraphPad Prism® 8.0 software. Analysis of variance (ANOVA Two-way) and Tukey's post-test was performed, considering 5% significance level. RESULTS: Groups 5 (PBM830 nm; 10 J/cm²) and 6 (TUS 3 MHz; 0.4 W/cm²) showed percentages of viable tissue significantly higher on the third and fifth day of the experiment, when compared to the other groups. The temperature decreased significantly in group 1 when compared to the others in the postoperative period. CONCLUSION: The continuous TUS at 3 MHz and PBM 830 nm were more effective in improving the viability of the dorsal random pattern skin flap in mice.

INTRODUÇÃO: O retalho cutâneo é uma técnica cirúrgica amplamente empregada na prática clínica e comumente apresenta complicações pós-operatórias. Portanto, elucidar intervenções que auxiliem na conservação do tecido são fundamentais. A fotobiomodulação (FBM) e o ultrassom terapêutico (UST) são alternativas não invasivas que auxiliam no reparo tecidual, contudo, ainda não há consenso sobre os parâmetros a serem utilizados. OBJETIVO: Descrever a efetividade dos diferentes parâmetros da FBM e do UST na viabilidade do retalho cutâneo randômico dorsal em camundongos. MÉTODOS: Utilizou-se 55 camundongos Swiss, distribuídos em onze grupos. Os animais foram submetidos à técnica cirúrgica com a revascularização da área limitada através de uma barreira plástica (poliéster/polietileno) da mesma dimensão do retalho. Aplicou-se a FBM ou UST durante cinco dias consecutivos. O registro fotográfico e termográfico foi realizado com as câmeras Cyber-Shot DSC-P72 e FlirC2, sendo posteriormente analisados nos softwares ImageJ® e FLIR Tools, respectivamente. Na análise estatística, os dados foram submetidos ao software GraphPad Prism® 8.0 e ao teste Shapiro-Wilk para a análise da normalidade. Realizou-se a análise de variância (ANOVA Two-way) e pós-teste de Tukey, com nível de significância de 5%. RESULTADOS: Os grupos 5 (FBM 830 nm; 10 J/cm²) e 6 (UST 3 MHz; 0,4W/cm²) apresentaram porcentagens de tecido viável significativamente maiores no terceiro e quinto dia do experimento. A temperatura reduziu significativamente no grupo-1 quando comparado aos demais no pós-operatório. CONCLUSÃO: O UST contínuo a 3 MHz e FBM 830 nm, foram mais eficazes melhorando a viabilidade a do retalho cutâneo randômico dorsal em camundongos.

Viability of transverse rectus abdominis musculocutaneous flap treated with photobiomodulation and therapeutic ultrasound: an experimental model.

Report the effects of photobiomodulation (PBM) and therapeutic ultrasound (TUS) on the viability of TRAM in mice. MATERIALS AND METHODS: Fifty-five mice Swiss were subjected to treatment for 5 days. Group 1, treatment was performed with the agents switched off. Groups 2 to 5 were treated with different wavelengths 660 and 830 nanometers (nm) and groups 6 to 11 with TUS of 1 and 3 MHz frequency. Macrometric analyses were performed using a specific camera and analyzed by the ImageJ® software. Thermographic analyses were performed with the Flir C2 and analyzed using the FLIR Tools software. RESULTS: Group 9 obtained 95% of viable area on the 3rd day and 85% on the 5th day, showing the effectiveness of the TUS in the flap viability. Regarding skin temperature, there was a difference only in the immediate postoperative period in group 1, which had a lower temperature than the other groups. CONCLUSIONS: TUS demonstrated greater efficiency in maintaining the viability of TRAM. PBM 830 nm also demonstrated good results in the viability of TRAM.

Effects of photobiomodulation on different application points and different phases of complex regional pain syndrome type I in the experimental model.

BACKGROUND: Complex regional pain syndrome type I (CRPS-I) consists of disorders caused by spontaneous pain or induced by some stimulus. The objective was to verify the effects of photobiomodulation (PBM) using 830 nm wavelength light at the affected paw and involved spinal cord segments during the warm or acute phase. METHODS: Fifty-six mice were randomized into seven groups. Group (G) 1 was the placebo group; G2 and G3 were treated with PBM on the paw in the warm and acute phase, respectively; G4 and G5 treated with PBM on involved spinal cord segments in the warm and acute phase, respectively; G6 and G7 treated with PBM on paw and involved spinal cord segments in the warm and acute phase, respectively. Edema degree, thermal and mechanical hyperalgesia, skin temperature, and functional quality of gait (Sciatic Static Index [SSI] and Sciatic Functional Index [SFI]) were evaluated. RESULTS: Edema was lower in G3 and G7, and these were the only groups to return to baseline values at the end of treatment. For thermal hyperalgesia only G3 and G5 returned to baseline values. Regarding mechanical hyperalgesia, the groups did not show significant differences. Thermography showed increased temperature in all groups on the seventh day. In SSI and SFI assessment, G3 and G7 showed lower values when compared to G1, respectively. CONCLUSIONS: PBM irradiation in the acute phase and in the affected paw showed better results in reducing edema, thermal and mechanical hyperalgesia, and in improving gait quality, demonstrating efficacy in treatment of CRPS-I symptoms.

Comparison of photobiomodulation in the treatment of skin injury with an open wound in mice.

This study aimed to investigate the effects of photobiomodulation at a wavelength of 660 and 830 nm at different numbers of application points in the healing of open wounds in mice. In total, 120 mice were divided into 10 groups. The animals were submitted to cutaneous lesion of the open wound type (1.5 × 1.5 cm). Photobiomodulation at a wavelength of 660 and 830 nm and total energy of 3.6 J were used, applied at 1, 4, 5, and 9 points, for 14 days. The animals were subjected to analysis of the lesion area, skin temperature, and histological analysis. Macroscopic analysis results showed a difference (p < 0.05) between the irradiated groups and the sham group at 14 days PO. There was no statistical difference in skin temperature. Histological analysis findings showed better results for the epidermis thickness. Regarding the number of blood vessels, a difference was found between the 1- and 5-point 830-nm photobiomodulation groups and between the 4-point 660-nm group and the naive group. A significant difference in the number of fibroblasts was observed between the 830- and 660-nm photobiomodulation groups and the naive and sham groups. When comparing photobiomodulation wavelength, the 830-nm groups were more effective, and we emphasize the groups irradiated at 5 points, which showed an improvement in macroscopic analysis and epidermis thickness, an increase in the number of vessels, and a lower number of fibroblasts on the 14th day after skin injury.

Dry Needling and Photobiomodulation Decreases Myofascial Pain in Trapezius of Women: Randomized Blind Clinical Trial.

OBJECTIVE: The purpose of this study was to assess whether dry needling (DN) added to photobiomodulation (PBM) has effects on the treatment of active myofascial trigger points in the upper trapezius. METHODS: This study was a randomized clinical trial, with 43 participants divided into 3 groups: DN and PBM (DNP), DN, and DN outside of the trigger point (DNout). Each group received 1 session of DN followed by PBM therapy with the machine turned on or off. Pain, disability, pain pressure threshold, and muscle activity were assessed before the intervention and afterward at intervals of 10 minutes, 30 minutes, 1 week, and 1 month. RESULTS: Pain decreased after intervention in the DNP and DNout groups, with mean differences, respectively, of 1.33 cm (95% confidence interval [CI], 0.019-2.647) and 2.78 cm (95% CI, 1.170-2.973). Scores for the disability questionnaire decreased in all groups after intervention (F = 36.53, P < .0001) after the intervention, with mean differences of 3.8 points in the DNP group (95% CI, 1.082-5.518), 3.57 in the DN group (95% CI, 0.994-6.149), and 5.43 in the DNout group (95% CI, 3.101-7.756). There were no significant differences between or within groups in pain pressure threshold (F = 2.14, P = .139), with mean differences after 30 minutes of 0.139 kgf for the DNP group (95% CI, -0.343 to 0.622), 0.273 for the DN group (95% CI, -0.661 to 1.209), and -0.07 for the DNout group (95% CI, -0.465 to 0.324). Muscle activation for the DN group increased 8.49% after the intervention, where for the DNP group it decreased 11.5%, with a significant difference between groups. CONCLUSION: DN added to PBM presented similar results compared to DNout and DN. In this sample, the effects of the application of DN outside of the trigger point had better effects on pain and disability scores than DN applied directly on the trigger point.

Photobiomodulation promotes neural regeneration when compared to simvastatin treatment in a sciatic nerve crush model.

To determine whether the effects of photobiomodulation (PBM) were associated with the use of Simvastatin in the functional recovery from sciatic nerve in mice submitted to crush injury. Fifty Swiss mice (approximately 3 months old; average weight 40 g) were randomly divided into six groups: naive, sham, control, PBM (660 nm, 10 J/cm2; 30 mW; 0.6 J per day for 28 days; 0.06 cm2; 16.8 J total and 20 s), Simvastatin (20 mg/kg), and PBM/Simv (association of the two protocols). The sciatic functional index (SFI), thermal heat hyperalgesia, mechanical hyperalgesia, and thermographic evaluation were used as analyses. The evaluations were performed preoperatively and 7, 14, 21, and 28 days after the initial injury analyzed by two-way analysis of variance (ANOVA) for mixed models followed by the Bonferroni post-test. All groups except sham and naive presented an SFI compatible with severe peripheral nerve injury on the 7th day of evaluation. The PBM group presented better results in the SFI analysis (p < 0.001) on the 21st postoperative day compared to the control group. This benefit was maintained when compared to the Simvastatin (p < 0.001) and PBM/Simv groups (p < 0.01). The results of the thermal and mechanical hyperalgesia and thermography analyses were not significant (p > 0.05). The obtained results showed that PBM alone was more effective compared to Simvastatin alone or PBM combined with Simvastatin for sciatic nerve injury in mice.

Effects of Photobiomodulation Therapy and Restriction of Wrist Extensor Blood Flow on Grip: Randomized Clinical Trial.

Objective: To evaluate the influence of two different photobiomodulation therapy (PBMT) protocols (red 660 nm vs. infrared 830 nm) combined with a blood flow restriction (BFR) training protocol in wrist extensor muscles on handgrip, wrist extension force, and electromyographic behavior [root mean square (RMS)]. Background: PBMT has been widely used to increase muscle performance and recovery in recent clinical trials. However, there is no evidence whether PBMT (red and/or infrared) can promote better results when combined with BFR, a known method to induce better strength gains. Methods: This study was a randomized controlled trial including 58 volunteers allocated into four groups: (1) control (conventional strengthening), (2) BFR (strengthening with BFR), (3) 660 nm (BFR strengthening with 660 nm PBMT-35 mW; 0.05 cm2; 2.10 J, total energy 18.9 J), and (4) 830 nm (BFR strengthening with 830 nm PBMT-32 mW; 0.101 cm2; 1.92 J, total energy 17.2 J). Data were analyzed by using a mixed-effects model, with a 5% significance index. Results: A statistically significant increase was obtained for handgrip strength for the 660 nm group [27.36 ± 2.61 kilogram force (kgF)] compared with the 830 nm group (23.04 ± 3.06 kgF) (p = 0.010) and for wrist extensor strength in the 660 nm (7.77 ± 0.58 kgF) and BFR (7.54 ± 0.92 kgF) groups compared with the control group (5.33 ± 0.61 kgF) (p = 0.001 and p = 0.004, respectively). The RMS value for the 660 nm group was significantly higher than control (p < 0.0001), BFR (p < 0.0001), and the 830 nm group (p = 0.0009). Conclusions: The association of PBMT (660 nm) and BFR was effective for increasing handgrip strength of the wrist extensors, associated with an increase in RMS.

High energy photobiomodulation therapy in the early days of injury improves sciatic nerve regeneration in mice / Aplicação de alta energia da terapia de fotobiomodulação nos primeiros dias de lesão otimiza a regeneração de nervo ciático em camundongos

INTRODUCTION: Different studies have evaluated the effects of electrophysical agents on regeneration after peripheral nerve injury. Among them, the most used in clinical and experimental research is photobiomodulation therapy (PBMT). OBJECTIVE: To analyze the effect of standard energy (16.8 J) of PBMT on peripheral nerve regeneration, applied at different periods after sciatic nerve injury in mice. METHODS: Thirty male Swiss mice were divided into six groups: naive; sham; control; LLLT-01 (660 nm, 16.8 J of total energy emitted in 1 day); LLLT-04 (660 nm, 4.2 J per day, 16.8 J of total energy emitted in 4 days); LLLT-28, (660 nm, 0.6 J per day, 16.8 J of total energy emitted over 28 days). The animals were evaluated using thermal hyperalgesia, Sciatic Functional Index (SFI), and Static Sciatic Index (SSI). Data were obtained at baseline and after 7, 14, 21, and 28 days after surgery. RESULTS: For the SFI and SSI, all groups showed significant differences compared to the control group, and the LLLT-04 group presented the best results among those receiving PBMT. In the assessment of thermal hyperalgesia, there was a significant difference in the 14th day of evaluation in the LLLT-04 group. CONCLUSION: The application of 16.8 J was useful in sciatic nerve regeneration with an improvement of hyperalgesia, with higher efficacy when applied in four days (4.2 J/day).

INTRODUÇÃO: Estudos avaliaram os efeitos de diferentes terapias aplicadas após lesão nervosa periférica, com o intuito de promover a regeneração local. Dentre elas, a mais utilizada em pesquisa clínica e experimental é a terapia de fotobiomodulação (TFBM). OBJETIVO: Analisar o efeito da fotobiomodulação (16,8 J) na regeneração nervosa periférica, aplicada em diferentes regimes após a lesão do nervo ciático em camundongos. MÉTODOS: Foram utilizados trinta camundongos machos (Swiss) divididos em: naive; sham; controle; LBI-01 (660 nm, 16,8 J de energia total emitida em 1 dia); LBI-04 (660 nm, 4,2 J por dia, 16,8 J de energia total emitida em 4 dias); LBI-28, (660 nm, 0,6 J por dia, 16,8 J de energia total emitida durante 28 dias). Os animais foram avaliados utilizando a hiperalgesia térmica, Índice Funcional do Ciático (IFC) e Índice estático do ciático (IEC). Os dados foram obtidos na linha de base e após 7, 14, 21, e 28 dias após a cirurgia. RESULTADOS: Para o IFC e IEC, todos os grupos mostraram um aumento no valor e diferenças significativas em relação ao grupo de controle, e o grupo LBI-04 apresentou os melhores resultados, alcançando valor basal no 21° dia dentre os que foram submetidos a TFBM. Na avaliação da hiperalgesia térmica, houve aumento do tempo de resposta com diferença significativa no 14° dia de avaliação no grupo LBI-04. CONCLUSÃO: A aplicação de 16,8 J foi eficaz na regeneração do nervo ciático quando distribuída ao longo dos 4 primeiros dias pós-lesão, com dose diária de 4,2 J/ponto.

Effects of a Pilates protocol in individuals with non-specific low back pain compared with healthy individuals: Clinical and electromyographic analysis.

BACKGROUND: Electromyography may be useful for assessing and understanding trunk muscle activation, and Pilates is commonly used as a treatment for low back pain. The objective of this study was to verify electromyography of trunk muscles after a Pilates protocol in individuals with non-specific low back pain and in healthy individuals. METHODS: Volunteers were divided into two groups: non-specific low back pain (n = 19) and clinically healthy (n = 16) groups. Clinical assessments, classification of patients into subgroups, electromyography evaluations of the right lumbar extensor and right transverse abdominal/internal oblique muscle of the abdomen were performed before and after an 8-week Pilates protocol. FINDINGS: Comparisons were made before and after the protocol and with the control group. There was significant improvement in pain, flexibility, resistance and strength of trunk muscles. In addition, after the Pilates, there was a decrease in the time elapsed between the onset and peak of lumbar muscle activation during the evaluation of trunk extension in the low back pain group, coming closer to the time of the abdominal muscle, as it also occurred in the control group. INTERPRETATION: Pilates caused clinical improvement and balanced trunk muscle activation in the low back group, becoming similar to that of the control group. Furthermore, the effects of the proposed protocol were the same between the groups. Thus, Pilates may be indicated for management of non-specific low back pain.

Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study

Aims: The purpose of our study was to compare the hip and knee muscle activity before and after a hip abduction exercise program in women with patellofemoral pain (PFP). Methods: Eleven women with PFP were included in our pre/post design study. Participants were assessed before and after 12-week hip abduction exercise program. All participants performed 6 stair climbing repetitions, 3 sets of rope jumps over 30 s and 5 sets of 8 squats to standardize the physical activity level before data collection. We recorded the electromyographic activity from gluteus medius, vastus medialis (VM) and vastus lateralis (VL) for double-legged squat with and without isometric hip abduction. Additionally, participants were asked to perform a step-down test to assess objective function (maximum number of repetitions over 30 s) and completed a clinical evaluation. Results: Longer duration of VM (Mean difference [95% CI]) = -0.97 [-1.48; -0.46], ES [effect size] = 0.66) and VL (-0.81 [-1.35; -0.27], ES = 0.54) were found after the hip abduction exercise program only for free squat. The participants also performed higher number of step-down repetitions (-3.54 [-5.84; -1.25], ES = 1.03) after the hip abduction exercise program and showed improvement in pain reports. Conclusion: A 12-week hip abduction exercise program changed the quadriceps muscle activation pattern and improved pain and objective function of women with PFP. The exercises promoted a longer VM and VL activation duration. Additionally, they promoted a clinical improvement in the patients with PFP.(AU)

Comparative effect of photobiomodulation associated with dexamethasone after sciatic nerve injury model.

To analyze the effect of photobiomodulation and dexamethasone on nerve regeneration after a sciatic nerve crushing model. Twenty-six Swiss mice were divided into the following groups: naive; sham; injured, low-level laser therapy (LLLT) (660 nm, 10 J/cm2, 0.6 J, 16.8 J total energy emitted during the 28 days of radiation, 20 s, for 28 days); dexamethasone (Dex) (local injection of 2 mg/kg for 10 consecutive days); and LLLT group associated with Dex (LLLT/Dex), with the same parameters of the other groups. For nerve injury, a portable adjustable pinch was used. The animals were evaluated using the Sciatic Functional Index (SFI) and Sciatic Static Index (SSI). The results obtained were evaluated with Image J™ and Kinovea™. Data and images were obtained at baseline and after 7, 14, 21, and 28 days after surgery. The evaluation of hyperalgesia, using Hargreaves, and behavior through the open field was also performed. In functional and static analysis, all groups presented significant differences when compared to the injured group. In the analysis of the SSI results, the group treated with both LLLT and dexamethasone was more effective in improving the values of this parameter, and in the SFI, the laser-treated group obtained better results. In the evaluation through the open field and the Hargreaves, there was no difference. The application of LLLT and dexamethasone was effective in nerve regeneration according to the results and was more effective when LLLT was associated with dexamethasone than in LLLT alone for the SSI.

Eficácia de um protocolo de exercícios em cadeia cinética fechada para indivíduos com dor femoropatelar / Effectiveness of a closed kinetic chain exercise protocol for individuals with femoropatelar pain

Introdução: Acredita-se que resultados controversos quanto à melhor abordagem terapêutica para a Dor Femoropatelar (DFP) estejam relacionados a não padronização dos voluntários antes das avaliações com relação ao nível de estresse articular. Objetivo: Verificar a eficácia de um protocolo de fortalecimento para indivíduos com DFP submetidos a um protocolo de estresse articular prévio às avaliações a fim de padronizar os indivíduos. Métodos: Participaram 24 indivíduos (14 DFP /10 controle). Utilizou-se testes ortopédicos, teste funcional step down, escalas e questionários para dor e funcionalidade. O grupo DFP realizou um protocolo de fortalecimento durante três meses. Resultados: Melhora nos testes ortopédicos, no teste funcional step down (p=0,000) e em todos os questioná- rios e escalas (p=0,000) foram observadas. O grupo DFP assemelhou-se ao grupo controle em relação ao teste funcional e aos questionários (p>0,05). Conclusão: O protocolo foi efetivo, o grupo DFP assemelhou-se ao grupo controle após a intervenção.

Introduction: It is believed that controversial results regarding the best therapeutic approach for atellofemoral Pain (DFP) are related to non-standardization of volunteers before assessments regarding joint stress level. Objective: To verify the effectiveness of a strengthening protocol for individuals with DFP undergoing a joint stress protocol prior to the evaluations in order to standardize the individuals. Methods: Twenty-four subjects (14 DFP / 10 healthy-control) participated. Orthopedic tests, functional step down test, scales and questionnaires for pain and functionality were used. The DFP group underwent a strengthening protocol for three months. Results: Improvement in orthopedic tests, step down functional test (p = 0.000) and in all questionnaires and scales (p = 0.000) were observed. The DFP group resembled the control group in relation to functional test and questionnaires (p> 0.05). Conclusion: The protocol was effective, the DFP group resembled the control group after the intervention.

Fadiga dos músculos extensores do punho diminui a força de preensão palmar / La fatiga de los músculos extensores de muñeca disminuye la fuerza de prensión palmar / Fatigue of the wrist extensor muscles decreases palmar grip strength

RESUMO O objetivo deste estudo foi avaliar os efeitos de um protocolo de fadiga dos músculos extensores de punho na força de preensão e da pinça lateral através da dinamometria e eletromiografia de superfície (EMG). Foram selecionados 40 indivíduos do sexo masculino, divididos em dois grupos: preensão ou pinça lateral. O protocolo de fadiga foi baseado no teste de 1 Repetição Máxima (1-RM), seguido da realização do movimento de extensão de punho repetidas vezes com carga de 75% da 1-RM. Os voluntários realizaram as tarefas de preensão ou pinça lateral associadas à dinamometria. A EMG foi realizada para ambos os grupos, analisando o comportamento, segundo o protocolo, pela frequência mediana (FM) do extensor radial do carpo (ERC), do extensor ulnar do carpo (EUC) e do flexor superficial dos dedos (FD). A dinamometria de preensão ou pinça lateral e a EMG foram realizadas antes e após o protocolo de fadiga para ambos os grupos. O protocolo de fadiga foi eficaz na diminuição da força de preensão palmar (43,5±3,85 kgf inicial e 36,50±5,1 kgf final) e da pinça lateral (10,26±1,01 kgf inicial e 8,54±0,86 kgf final), bem como na diminuição da FM, sugerindo uma condição de fadiga do EUC no grupo preensão. Os achados do presente estudo possibilitam relacionar a fadiga dos extensores de punho à diminuição de força em atividades funcionais, como a preensão, o que pode implicar em disfunções musculoesqueléticas do membro superior.

RESUMEN En este estudio se evalúa los resultados de un protocolo de fatiga de los músculos extensores de muñeca en la fuerza de presión y de pinza empleando la dinamometría y la electromiografía de superficie (EMG). Se eligieron a cuarenta hombres, los cuales fueron divididos en dos grupos: el de presión y el de pinza lateral. Se basó el protocolo de fatiga en la prueba de 1 Repetición Máxima (1RM), y se realizó el movimiento de extensión de muñeca muchas veces con carga del 75% de la 1RM. Los participantes realizaron la tarea de prensión o de pinza lateral asociada a la de dinamometría. La EMG fue realizada por ambos grupos, en los que se evaluó el comportamiento ante el protocolo de la frecuencia mediana (Fm) del extensor radial del carpo (ERC), del extensor cubital del carpo (ECC) y del flexor superficial de los dedos (FD). Se realizaron la dinamometría de presión o de pinza lateral y la EMG antes y después del protocolo de fatiga en ambos grupos. El protocolo de fatiga fue eficaz en la disminución de la fuerza de presión palmar (43,5±3,85 kgf inicial y 36,50±5,1 kgffinal) y de pinza lateral (10,26±1,01 kgf inicial y 8,54±0,86 kgf final), así como en la disminución de la Fm, lo que demuestra una condición de fatiga del ECC en el grupo de presión. Los resultados de este estudio permiten relacionar la fatiga de los extensores de muñeca a la disminución de fuerza en las actividades funcionales, lo que puede causar trastornos musculoesqueléticos del miembro superior.

ABSTRACT The objective of this study was to evaluate the effects of a wrist extensor muscles fatigue protocol at the handgrip and lateral pinch strength through dynamometry and surface electromyography (EMG). Forty male individuals were divided into two groups: handgrip and lateral pinch group. The fatigue protocol was based on the 1 Maximal Repetition (1-MR) test, followed by wrist extension movement repeated multiple times with a load of 75% of 1-MR. The volunteers performed hand grip and lateral pinch with a dynamometer. Surface EMG was performed by both groups to analyze the behavior of median frequency (MF) during a fatigue protocol. The muscles extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum and flexor digitorum superficialis were analyzed. The strength and EMG evaluations were carried out before and after the fatigue protocol in both groups. The fatigue protocol was effective on hand grip strength reduction (43.5±3.85 kgf in baseline and 36.50±5.1 kgf final) and lateral pinch strength reduction (10.26±1.01 kgf in baseline and 8.54±0.86 kgf final) (p<0.05, 95% CI). At the EMG analysis, using median frequency, an ulnaris carpal extensor muscle fatigue at the handgrip group was evidenced. The findings indicate that wrist extensors fatigue can decrease the strength in functional activities such as handgrip, resulting in upper limb dysfunctions.