Motor alterations in the kinetic chain in individuals with chronic shoulder pain.

BACKGROUND: Shoulder pain may be related to biomechanical dysfunctions in the kinetic chain. OBJECTIVE: To compare the mobility and muscular endurance of thoracolumbar spine and hip, and the neuromuscular control of the lower extremity of individuals with and without shoulder pain and to determine the discriminative capacity between groups of these variables. DESIGN: A cross-sectional study. METHOD: One hundred and two individuals with and without shoulder pain were evaluated to range of motion (ROM) of the thoracolumbar spine and hips, the muscular endurance time of the thoracolumbar spine and hips muscles, and the neuromuscular control of the lower extremity, by the Star Excursion Balance Test (SEBT). RESULTS: Individuals with shoulder pain presented lower ROM and muscular endurance time in all tests evaluated (p < 0.01-p = 0.03), greater perception of pain during all ROM and muscle endurance (p < 0.01-p = 0.04) evaluations, and less neuromuscular control of the lower extremity in the compound reach (p < 0.01-p = 0.01), anterior and posteromedial (p < 0.01-p = 0.04) directions of the SEBT on both sides. The anterior reach direction of the SEBT of the contralateral limb to the shoulder pain (AUC=0.80, cut-off point=47.7%) presented excellent capacity to discriminate individuals with shoulder pain, while the other variables showed between acceptable and small capacity (AUC=0.58-0.76). CONCLUSION: Individuals with chronic shoulder pain presented alterations in joint mobility, muscular endurance time of the thoracolumbar spine and hips and neuromuscular control of the lower extremity. The anterior reach of the SEBT of the contralateral limb showed excellent discriminative capacity.

Analysis of the spine posture, mobility and strength in healthy individuals with and without scapular dyskinesis / Análise da postura, mobilidade e força da coluna vertebral em indivíduos saudáveis com e sem discinese escapular

Spine posture, mobility and strength can be associated with changes in scapular movement and shoulder pain. However, these aspects have not been assessed in healthy individuals with scapular dyskinesis without shoulder and/or back pain. Objective: To analyze spine posture, mobility and strength in healthy individuals with and without scapular dyskinesis. Method: Cross-sectional study, fifty-two college-aged individuals were divided into two groups, according to scapular dyskinesis testing: a group without scapular dyskinesis (n= 19; age= 22.95±2.86 years; BMI= 22.97±3.12 kg/m²; 10 males) and another with scapular dyskinesis (n= 33; age= 22.06±2.73 years; BMI= 22.14±3.22 kg/m²; 10 males). Posture of the head and shoulders was analyzed from photographs by a postural assessment software (PAS/SAPO). Thoracic kyphosis and range of motion of the cervical and thoracolumbar spine were measured by a digital inclinometer, and the strength of the cervical and thoracolumbar spine muscles by a hand-held dynamometer. Intergroup comparison for all the variables was conducted using analysis of variance (one-way ANOVA), considering p≤0.05 as significant. Results: No intergroup difference was found for spine posture (p= 0.18-0.99), mobility (p= 0.23-0.96) and strength (p= 0.42-0.99). Conclusion: Spine posture, mobility and strength do not differ between healthy individuals with and without scapular dyskinesis. The outcomes suggest that scapular dyskinesis may be related to interpersonal variations. Future prospective studies be conducted in order to verify if these variables can change and influence the development of shoulder pain.

A postura, mobilidade e força da coluna podem estar associadas com mudanças no movimento da escápula e dor no ombro. Objetivo: Analisar a postura da coluna vertebral, mobilidade e força em indivíduos saudáveis com e sem discinese escapular. Método: Estudo transversal com cinquenta e dois indivíduos em idade universitária foram divididos em dois grupos, de acordo com o teste de discinese escapular: um grupo sem discinese escapular (n= 19; idade= 22,95±2,86 anos; IMC= 22,97±3,12 kg/m²; 10 masculino) e outro com discinese escapular (n= 33; idade= 22,06±2,73 anos; IMC= 22,14±3,22 kg/m²; 10 masculino). A postura da cabeça e dos ombros foi analisada a partir de fotografias por um software de avaliação postural (PAS/SAPO). A cifose torácica e a amplitude de movimento da coluna cervical e torácica foram medidas por um inclinômetro digital, e a força dos músculos cervical e torác lombar por um dinamômetro portátil. A comparação intergrupo para todas as variáveis foi realizada utilizando-se a análise de variância (ANOVA unidirecional), considerando p≤0,05 como significativa. Resultados: Não foi encontrada diferença entre grupos postura (p= 0,18-0,99), mobilidade (p= 0,23-0,96) e força da coluna (p= 0,42-0,99). Conclusão: Postura, mobilidade e força da coluna vertebral não diferem entre indivíduos saudáveis com e sem discinese escapular. Os resultados sugerem que a discinese escapular pode estar relacionada a variações interpessoais. Estudos prospectivos futuros devem ser conduzidos afim de verificar se essas variáveis podem modificar e influenciar o desenvolvimento da dor no ombro.

Use of low-level laser therapy (808 nm) to muscle fatigue resistance: a randomized double-blind crossover trial.

OBJECTIVE: The purpose of this study was to investigate whether low-level laser (light) therapy (LLLT) can provide fatigue resistance via maximum repetitions (RM) with an isokinetic dynamometer, and decrease electromyography fatigue index (EFI). BACKGROUND DATA: LLLT has been used to increase muscle performance when applied before or after intense exercises. MATERIALS AND METHODS: This study was a randomized, double-blind, crossover trial with placebo. Seven young men (21±3 years of age) who were clinically healthy, were allocated into two groups: active laser (LLLT) and placebo laser (Placebo). Both groups were assessed at baseline, at one training session, and at the end of this study. Baseline and final assessments recorded the number of RM of knee flexion-extensions using an isokinetic dynamometer at 60 degrees/sec in conjunction with EFI recorded by median frequency. The training sessions consisted of three sets of 20 RM of knee flexion-extensions using an isokinetic dynamometer at 60 degrees/sec plus LLLT (808 nm, 100 mW, 4 J), or placebo, applied to quadriceps femoris muscles between sets, and after the last series of this exercise. After 1 week (washout period), all volunteers were exchanged among groups and then all assessments were repeated. RESULTS: LLLT group increased RM (52%; p=0.002) with a small EFI for the vastus medialis (p=0.004) and rectus femoris (p=0.004). CONCLUSIONS: These results suggest an increased muscle fatigue resistance when LLLT is applied during rest intervals, and after the last series of intense exercises.

Efeitos do treinamento de dupla tarefa no controle do equilíbrio dinâmico e estático de idosas pré-frágeis: um estudo piloto / Effects of a dual-task training on dynamic and static balance control of pre-frail elderly: a pilot study

Introdução: Este estudo quase-experimental justificou-se pela necessidade de determinar os efeitos de uma estratégia de intervenção que vise melhorar o equilíbrio em idosas pré-frágeis. A hipótese era que o treinamento em esteira tipo dupla tarefa, comparado a um treinamento simples em esteira, pudesse promover diferença no controle postural do grupo. Objetivos: Este estudo teve como objetivo verificar as medidas de controle postural em um grupo de idosos pré-frágeis após um programa de intervenção fisioterapêutica com base no treinamento em esteira tipo dupla tarefa. Materiais e métodos: Foram selecionados seis idosos pré-frágeis, do sexo feminino, residentes em comunidade. A pesquisa foi realizada duas vezes por semana por 45 minutos, durante quatro semanas. A intervenção na condição de tarefa simples consistiu no treino em esteira, enquanto a condição de dupla tarefa consistiu em treino em esteira associado a estímulos visuais. Apenas o grupo de intervenção foi submetido ao treino tipo de dupla tarefa. Resultados: Os grupos apresentaram melhoras nas variáveis de equilíbrio em diferentes tarefas, especialmente naquelas do equilíbrio estático. Ambos os grupos apresentaram as mudanças mais notáveis nas variáveis relacionadas à marcha.As variáveis de Berg e as baropodométrica mostraram que o grupo experimental manteve todos os valores similares ou melhores, mesmo um mês após a conclusão do treinamento, ao contrário do grupo controle.Conclusões: O desempenho da dupla tarefa não teve nenhum valor adicional em relação à melhora do equilíbrio em geral, porém observamos que a eficácia da estimulação visual tende a ocorrer na manutenção do equilíbrio das variáveis de curto prazo

INTRODUCTION: This quasi-experimental study is justified by the need to determine the effects of an intervention strategy aimed at improving the static and dynamic balance in pre-frail elderly women. We hypothesized that dual-task training on a treadmill, compared to simple training on a treadmill,may promote statistical difference in postural control of this group. OBJECTIVES: This study aimed to verify the measures of postural control in a group of pre-frail elderly after a physical therapy intervention program based on dual-task treadmill training.MATERIALS AND METHODS: We selected six female pre-frail elderly subjects living in the community. The research was conducted twice a week for 45 minutes, for four weeks. The simple task training consisted only in the use of a treadmill and the dual-task training consisted on the use of a treadmill associated with visual stimuli. Only the intervention group was submitted to the dual-task training. RESULTS: Groups showed improvements in the variables of balance in different tasks, especially on static balance. Both groups showed the most notable changes in the variables related to gait. The BBS scores and the baropodometric variables showed that the experimental group could keep all values similar or better even one month after completion of training, unlike the control group.CONCLUSION: The dual-task performance had no additional value in relation to the improvement of balance in general, but we observed that the effectiveness of visual stimulation seems to occur in the maintenance of short-term balance variables.

Efeito agudo de três técnicas de alongamento muscular sobre o torque flexor do joelho / The acute effect of three muscle thechniques on knee flexion torque

Introdução: Exercícios de alongamento são comumente usados precedendo a realização de atividades físicas, no entanto, pesquisas recentes têm sugerido uma redução da força muscular após o alongamento. Objetivo: O objetivo deste estudo foi observar o efeito agudo de três técnicas de alongamento muscular sobre o torque flexor do joelho, produzido pelos músculos ísquiotibiais. Método: Sessenta mulheres jovens, saudáveis, (idade média de 22,S ± 3 anos), com encurtamento clínico dos ísquiostibiais, foram alocadas aleatoriamente em 4 grupos: controle, alongamento estático, manter-relaxar, e agonista-manter-relaxar. Todas foram submetidas a um protocolo de avaliação no qual realizaram 5 contrações concêntricas máximas de flexão/extensão do joelho a 600/s antes e após a aplicação do respectivo alongamento, o qual teve duração média de um minuto. O grupo controle permaneceu 5 minutos em repouso. Os dados foram analisados estatisticamente e o nível de significância foi atribuído em 5%. Resultados: Não foi identificada diferença entre os grupos antes nem depois da intervenção. Também não houve diferença intragrupo após a intervenção. Conclusão: Os resultados sugerem que o alongamento da musculatura posterior da coxa, com duração média de um minuto, não provoca modificações imediatas no torque flexor do joelho.

Introduction: Stretching exercises are commonly used prior to physical activities, however, recent researchs identified reduction of muscle strength post-stretching. Objective: The aim of this study was to observe the acute effect of three techniques of muscle stretching on torque produced by hamstrings on the knee. Method: Sixty women, healthy, mean age 22.55 ± 3.04 years, with shortening hamstrings, were randomly distributed into 4 groups (control, static stretching, hold-relax, and agonist-hold-relax). They were submitted to evaluation protocol in which performed 5 maximal concentric contractions of knee flexion/extension at 60°/s before and after the application of stretching technique, which had total duration about 48-60s, depending on the group. The control group remained at rest 5 minutes. The data were statistically analyzed and the levei of significance set at 5%. Results: No difference was detected between groups before or after the intervention. There was no intragroup difference after the intervention in any of the groups. Conclusion: The results suggest that the muscle stretching, lasting up to 60 seconds does not cause acute changes in the knee flexion torque.