Myofascial release strategies and technique recommendations for athletic performance: A systematic review.

OBJECTIVE: To identify the effects of instrument-assisted soft tissue mobilization (IASTM) and foam roller self-myofascial release (FRSMR) strategies and verify their results in athletic performance. METHOD: Systematic review conducted in four databases from 2017. The inclusion criteria were randomized controlled trials assessing the effects of two forms of soft tissue mobilization on athletes' performance. The risk of bias was analyzed using the Cochrane Handbook scale. RESULTS: Ten studies were included for qualitative analysis. IASTM increased range of motion, knee joint kinetic force, peak torque, and angular velocity in dorsiflexion and plantar flexion. The technique increases isometric strength and isokinetic power in vertical jumping. FRSMR was relevant in counter movement jumping between the pre- and post-intervention conditions, mainly by increasing strength in the initial jumping phase. CONCLUSIONS: IASTM should be used in sports preparation to improve muscle response and explosive force production. FRSMR increases flexibility as it tends to restore tissue elasticity, but it does not improve aerobic activity. The suggested time for strategy intervention is at least 90 s per muscle group.

Acute effects of myofascial reorganization on trapezius muscle oxygenation in individuals with nonspecific neck pain.

BACKGROUND AND PURPOSE: Nonspecific neck pain (NNP) is a common idiopathic disorder in the general population that affects the trapezius muscle (TM) and blood supply, thereby compromising the fascial system. Myofascial reorganization (MR) is a physical therapy technique that can influence the dynamics of local fluids reducing excessive muscle tension and capillary constriction, and increasing local blood flow. This study aimed to investigate whether MR improves peripheral muscle oxygenation. METHODS: This was a quasi-experimental study with an intentional non-probability sample. Fifty participants (women: 36, men: 14) with and without NNP were assigned to either the experimental group (EG: n = 25, with NNP, subjected to MR) or the control group (CG: without NNP, no MR intervention). TM oxygenation was measured using near-infrared spectroscopy (NIRS) before and after a single intervention. All participants were evaluated and reassessed after 10 min. RESULTS: The results revealed that immediately after 10 min of MR, the EG exhibited an increase in the oxyhemoglobin level of the medium fibers of the TM (0.72 ± 1.47 vs. -0.14 ± 1.33 mmol/dL, p = 0.01). In addition, functional disability (CG: 5.48 ± 5.58%/EG: 21.12 ± 7.73%) and neck pain were measured using the neck disability index. The pain pressure threshold (CG: 70.49 ± 32.29 kgf/EG: 51.08 ± 27.65 kgf) and pain intensity (CG: 0.76 ± 1.56/EG: 3.28 ± 2.35) were also measured. CONCLUSION: The findings indicate that application of MR for 10 min increases the tissue oxyhemoglobin level in the TM of the group with NNP compared to the CG without NNP.

Function, strength, and muscle activation of the shoulder complex in Crossfit practitioners with and without pain: a cross-sectional observational study.

BACKGROUND: The shoulder joint is the most commonly injured joint in CrossFit practitioners, because of the high intensity and loads associated with this sport. Despite the large number of clinical cases, there is a shortage of studies that investigate influence of biomechanical aspects of upper limbs' injuries on CrossFit practitioners. This study hypothesized that there would be a difference in function, strength, and muscle activation between Crossfit practitioners with and without shoulder pain. METHODS: We divided 79 Crossfit practitioners into two groups according to whether they reported pain (n = 29) or no pain (n = 50) in the shoulder during Crossfit training. Muscle function, strength, and activation were assessed using the Disability Arm, Shoulder and Hand function questionnaire, Upper Quarter Y Balance Test and Closed Kinetic Chain Upper Extremity Stability Test shoulder tests, isometric muscle strength assessment by manual dynamometry and muscle activation by surface electromyography and pain report. RESULTS: The function based on questionnaire was associated with pain (p = 0.004). We observed a statistically significant difference between the two groups only in the surface electromyography activity of the lower trapezius, and in the variables of shoulder pain and function (p = 0.038). CONCLUSION: Crossfit practitioners with shoulder pain occurring during training showed good function and stability of the shoulder joint, but there was a reduction in the activation of stabilizing muscles, especially the lower trapezius. Trial registration Registro Brasileiro de Ensaios Clinico (Brasilian National Registry) with the ID: RBR-2gycyv.

Effects of myofascial reorganization associated with kinesiotherapy on chronic pain and functionality of breast cancer survivors: development of a study protocol / Efeitos da reorganização miofascial associada à cinesioterapia na dor crônica e funcionalidade de sobreviventes de câncer de mama: desenvolvimento de um protocolo de estudo

Abstract Introduction: Breast cancer is the most common type of cancer among women. Treatments can lead to complications modifying upper limbs movement patterns and generating pain and functionality loss. Kinesiotherapy and myofascial reorganization (MR) have shown positive effects reducing chronic pain and improving upper limbs function. We hypothesize that these techniques can maximize results and reduce treatment time in clinical practice. Objective: To develop a study protocol to verify whether MR associated with kinesiotherapy is more effective than isolated kinesiotherapy to treat chronic pain and upper limb dysfunction in breast cancer survivors. Methods: Participants will be divided into two groups: intervention group (myofascial reorganization + kinesiotherapy) and sham group (traditional massage + kinesiotherapy). Six treatment sessions (once a week) and three-time assessment will occur. Instruments for assessing pain and functionality will be Visual Analogue Scale, Body Pain Diagram, Disabilities of the Arm, Shoulder and Hand Questionnaire, and goniometry. Statistical analysis will be conducted based on intention-to-treat analysis. To analyze the difference of means between groups, we will use T-Student or U Mann-Whitney test. Repeated measures ANOVA will be used to check treatments effects. Significance level for all tests will be 5%. Conclusion: We believe that the developed study protocol will show that MR associated with kinesiotherapy improve chronic pain and upper limbs functionality of breast cancer survivors.

Resumo Introdução: O câncer de mama é o tipo de câncer mais comum entre as mulheres. Os tratamentos podem levar a complicações, modificando os padrões de movimento dos membros superiores e gerando dor e perda de funcionalidade. A cinesioterapia e a reorganização miofascial (RM) têm demonstrado efeitos positivos na redução da dor crônica e na melhora da função dos membros superiores. A hipótese do presente estudo é que essas técnicas podem maximizar os resultados e reduzir o tempo de tratamento na prática clínica. Objetivo: Desenvolver um protocolo para verificar se a RM associada à cinesioterapia é mais eficaz do que a cinesioterapia isolada no tratamento da dor crônica e disfunção do membro superior em sobreviventes de câncer de mama. Métodos: As participantes serão divididas em dois grupos: grupo intervenção (reorganização miofascial + cinesioterapia) e grupo sham (massagem tradicional + cinesioterapia). Serão realizadas seis sessões de tratamento (uma vez por semana) e três avaliações. Os instrumentos de avaliação da dor e da funcionalidade serão a Escala Visual Analógica, o Diagrama de Dor Corporal, o Questionário de Deficiências do Braço, Ombro e Mão e a goniometria. A análise estatística será realizada com base na análise de intenção de tratar. Para analisar a diferença de médias entre os grupos, serão utilizados o teste T-Student ou U Mann-Whitney. ANOVA de medidas repetidas será utilizada para verificar os efeitos dos tratamentos. O nível de significância para todos os testes será de 5%. Conclusão: Espera-se que a RM associada à cinesioterapia melhore a dor crônica e a funcionalidade dos membros superiores de sobreviventes de câncer de mama.

Activation of the gluteus maximus, gluteus medius and tensor fascia lata muscles during hip internal and external rotation exercises at three hip flexion postures.

BACKGROUND: Hip internal and external rotation exercises are usually performed in clinical practice. However, given the synergies required to stabilize the hip in the frontal plane, it is not clear how the activation of target muscles will differ between the two exercise directions. OBJECTIVE: I) Compare the activation of the upper and lower fibers of gluteus maximus (GMax), gluteus medius (GMed) and tensor fascia lata muscles between the hip internal and external rotation exercises; ii) Compare the maximal isometric force between hip internal and external rotation exercises and; iii) Assess the effect of varying hip flexion angles on muscle activation and maximal isometric force. STUDY DESIGN: A cross sectional study. METHODS: Electromyography and force production of twenty-one participants were measured during maximum isometric hip internal and external rotation in three postures: 0°, 45° and 90° of hip flexion. RESULTS: MANOVA results showed a larger activation of the GMed, tensor fascia lata and upper GMax (p < .001) for hip internal rotation compared to external rotation regardless of hip flexion angle. For the lower GMax, the same was observed when the hip was kept at 90° of flexion. Maximal isometric force during hip external rotation was greater than during hip internal rotation at 0° posture, and lower at 90° posture (p < .001). CONCLUSION: The gluteus and the tensor fascia lata muscles were substantially recruited during the hip internal rotation exercise, and barely recruited during the hip external rotation exercise. Hip flexion influences the myoeletric activity and isometric force production during the internal rotation exercise.

Effects of total knee arthroplasty for primary knee osteoarthritis on postural balance: A systematic review.

BACKGROUND: Knee osteoarthritis is often related to physical function impairment. Although total knee arthroplasty is considered effective for advanced cases of knee osteoarthritis, its effects on postural balance is a topic of debate. RESEARCH QUESTION: What are the effects of total knee arthroplasty for primary knee osteoarthritis on postural balance compared to preoperative status and/or to healthy controls?. METHODS: Longitudinal studies (with more than 1-month follow-up) assessing postural balance measures (either clinical-based such as balance scales or laboratory-based such as postural sway) were considered eligible and selected in a 2-phase process. Six main electronic databases were searched, complemented by 3 grey literature sources. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: A total of 19 studies were included for qualitative synthesis, of which 14 had low and 5 had a moderate risk of bias. The follow-up period ranged from 1-24 months. Most studies (n = 11) presented comparisons to preoperative status only. From these, 7 studies reported relevant improvements in postural balance, 2 reported partial improvements, and 2 no improvements. The remaining studies (n = 8) presented comparisons to healthy controls and, although improvements following total knee arthroplasty were consistently observed, only one study reported postural balance measures comparable to that of controls. CONCLUSIONS: The majority of studies reported relevant improvements (especially in clinical-based measures) compared to preoperative evaluations, although inconsistencies were found possibly due to variability in studies' populations, assessment tools, and follow-up times. Despite this, persistent deficits in postural balance were commonly observed when compared to healthy controls. SIGNIFICANCE: This evidence synthesis could better inform clinicians and researchers about the therapeutic effects and limitations of total knee arthroplasty concerning postural balance. Standardization of assessment tools is recommended to strengthen the certainty of cumulative evidence.

Comparison between Two Methods to Evaluate Function in Postoperative Breast Cancer Survivors.

INTRODUCTION: Treatment for breast cancer can cause adverse effects such as pain and reduced upper limb function which can affect activities of daily living. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most used tool for evaluating function in breast cancer survivors. However, some specific aspects have raised discussions about its restricted coverage, which can generate several biases. OBJECTIVE: To determine if DASH scores differed when assessed before and after task-oriented training (TOT) at 3 and 6 months after breast cancer surgery. DESIGN: Prospective cohort study. SETTING: Institutional study of 22 women assessed at 3 and 6 months after breast cancer surgery. MAIN OUTCOME MEASURES: The DASH questionnaire and TOT assessment. Two correlation tests were performed: Spearman's correlation between the total score of the two DASH scores (pre- and post-TOT) and the Kendall's tau correlation between each of the items. RESULTS: There was a moderate and excellent correlation between final DASH scores, pre- and post-TOT, at both 3 and 6 months postoperatively. However, when assessed individually, most of the DASH items were poorly correlated. There was also no agreement between the total DASH scores pre- and post-TOT as assessed by Bland-Altman plots. CONCLUSION: Both the DASH and TOT are considered useful in clinical practice to assess upper limb function, although the use of TOT in some of the DASH items may reduce memory bias and improve skills estimation.

Muscle activation in pelvic anteversion and retroversion / Ativação muscular durante a anteversão e retroversão pélvica

Abstract Introduction: The inability to maintain good pelvic stability has been attributed to inefficient muscle coordination and deconditioning of the stabilizing muscles. Despite this, little is known about the role of the pelvic muscles in anteversion and retroversion movements. Objective: To compare the neuromuscular activity of the tensor fascia lata, gluteus medius, upper and lower portions of the gluteus maximus, and multifidus in pelvic anteversion and retroversion. Methods: The neuromuscular activity of 17 healthy young adults (aged 25.3 ± 4.6 years) was assessed during five repetitions of the pelvic anteversion and retroversion movements. The Vicon-Nexus system (10 cameras) was used for the kinematic analysis of the pelvis in the sagittal plane (anteversion and retroversion), and the TeleMyo DTS Desk Receiver electromyograph and the Myomuscle v. 3.8 software to measure neuromuscular activity. The paired samples t-test was used to compare muscle activity between pelvic anteversion and retroversion movements using the Statistica v.8 software with a significance level of p < 0.05. Results: The comparison of the movements showed greater muscle activity in the inferior gluteus maximus in retroversion and greater activity in the multifidus in pelvic anteversion. The upper portion of the gluteus maximus showed relevant activation in both movements. Conclusion: There was more pronounced activity of the lower portion of the gluteus maximus in retroversion, while the upper gluteus maximus showed relevant activation level in both movements. The multifidi were more active in retroversion.

Resumo Introdução: A incapacidade de manter uma boa estabilidade pélvica tem sido atribuída à coordenação muscular ineficiente e ao descondicionamento dos músculos estabilizadores. Apesar disso, pouco se sabe sobre a função dos músculos pélvicos nos movimentos de anteversão e retroversão. Objetivo: Comparar a atividade neuromuscular do tensor da fáscia lata, glúteo médio, porções inferior e superior do glúteo máximo e multífidos durante a anteversão e retroversão pélvica. Métodos: A atividade neuromuscular de 17 adultos jovens saudáveis (25,3 ± 4,6 anos) foi avaliada durante cinco repetições dos movimentos de anteversão e retroversão pélvica. Utilizou-se o sistema Vicon-Nexus (10 câmeras) para a análise cinemática da pelve no plano sagital (anteversão e retroversão), e o eletromiógrafo TeleMyo DTS Desk Receiver e o software MyoMuscle v. 3.8 para mensurar a atividade neuromuscular. Testes t pareados foram conduzidos para comparar a atividade muscular entre os movimentos de anteversão e retroversão pélvica, utilizando-se o software Statistica v.8 com nível de significância de p < 0,05. Resultados: Quando comparados os movimentos, maior atividade muscular foi observada para o glúteo máximo inferior durante a retroversão e maior atividade para os multífidos durante a anteversão pélvica. A porção superior do glúteo máximo apresentou ativação relevante em ambos os movimentos. Conclusão: Houve atividade mais pronunciada da porção inferior do glúteo máximo na retroversão enquanto o glúteo máximo superior apresentou nível relevante de ativação em ambos os movimentos; os multífidos se mostraram mais ativos na retroversão.

Interaction between cognitive status, fear of falling, and balance in elderly persons.

OBJECTIVE: Evaluate the cognitive function and its relationship with balance, history of falls, and fear of falling in the elderly. METHODS: We evaluated 250 elderly persons aged at least 60 years, who answered a sociodemographic questionnaire about the occurrence of falls in the last year. The cognitive function, balance, and fear of falling were assessed using the Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES-I) scores, respectively. Participants were allocated into two groups based on the Mini-Mental State Examination (MMSE) score, the Group with Possible Cognitive Decline (GPCD) and the group with no cognitive decline (GNCD). We performed Student's t-test and Pearson's correlation for independent samples. RESULTS: The Group with Possible Cognitive Decline (GPCD) showed lower balance (p=0.003) and greater fear of falling (p=0.008) (BBS=50.98±4.68; FES-I=26.06±8.78) compared to the GNCD (BBS=52.53±3.047; FES-I=23.21±7.74). CONCLUSION: Elderly persons with cognitive decline have lower balance, greater fear of falling, and greater recurrence of falls.

Patellofemoral Pain Syndrome Modifies the Movement of the Rearfoot, but It Does Not Alter Plantar Pressure Distribution.

Objective To compare the plantar pressure distribution and the kinematics of the rearfoot on the stance phase of subjects with or without patellofemoral pain syndrome (PFPS). Methods A total of 26 subjects with PFPS and 31 clinically healthy subjects, who were paired regarding age, height and mass, participated in the study. The plantar pressure distribution (peak pressure) was assessed in six plantar regions, as well as the kinematics of the rearfoot (maximum eversion angle, percentage of the stance phase when the maximum angle was reached, and percentage of the stance phase in which the rearfoot was in eversion). The data were analyzed by descriptive and inferential statistics, with a significance level of p ≤ 0.05. Results The pressure on the six plantar regions analyzed and the magnitude of the maximum eversion angle of the rearfoot when walking on flat surfaces did not present differences among the subjects with PFPS. However, the PFPS subjects showed, when walking, an earlier maximum eversion angle of the rearfoot than the subjects on the control group, and stayed less time with the rearfoot in eversion. Conclusion The PFPS seems to be related to modifications on the temporal pattern on the kinematics of the rearfoot.

Patellofemoral Pain Syndrome Modifies the Movement of the Rearfoot, but It Does Not Alter Plantar Pressure Distribution / A síndrome da dor patelofemoral altera o movimento do retropé, mas não modifica a distribuição da pressão plantar

Abstract Objective To compare the plantar pressure distribution and the kinematics of the rearfoot on the stance phase of subjects with or without patellofemoral pain syndrome (PFPS). Methods A total of 26 subjects with PFPS and 31 clinically healthy subjects, who were paired regarding age, height and mass, participated in the study. The plantar pressure distribution (peak pressure) was assessed in six plantar regions, as well as the kinematics of the rearfoot (maximum eversion angle, percentage of the stance phase when the maximum angle was reached, and percentage of the stance phase in which the rearfoot was in eversion). The data were analyzed by descriptive and inferential statistics, with a significance level of p≤ 0.05. Results The pressure on the six plantar regions analyzed and the magnitude of the maximum eversion angle of the rearfoot when walking on flat surfaces did not present differences among the subjects with PFPS. However, the PFPS subjects showed, when walking, an earlier maximum eversion angle of the rearfoot than the subjects on the control group, and stayed less time with the rearfoot in eversion. Conclusion The PFPS seems to be related to modifications on the temporal pattern on the kinematics of the rearfoot.

Resumo Objetivo Comparar a distribuição da pressão plantar e a cinemática do retropé durante a fase de apoio da marcha de sujeitos com e sem síndrome da dor patelofemoral (SDPF). Métodos Participaram 26 sujeitos com SDPF e 31 clinicamente saudáveis, pareados em idade, estatura e massa corporal. Foi avaliada a distribuição da pressão plantar (pico de pressão) em seis regiões plantares, e a cinemática do retropé (ângulo máximo de eversão do retropé, porcentagem da fase de apoio da marcha em que o ângulo é atingido, e porcentagem da fase de apoio em que o retropé permaneceu em eversão). Os dados foram analisados por meio da estatística descritiva e inferencial, com nível de significância de p≤ 0,05. Resultados A pressão nas seis regiões plantares analisadas e a magnitude do ângulo máximo de eversão do retropé durante a marcha em superfície plana não se mostrou diferente nos sujeitos com SDPF. No entanto, sujeitos com SDPF apresentaram, dentro do ciclo da marcha, ângulo máximo de eversão do retropé mais cedo do que sujeitos do grupo controle, e permaneceram menos tempo com o retropé em eversão. Conclusão A SDPF parece estar relacionada à alteração no padrão temporal na cinemática do retropé.

Isokinetic hip muscle strength: a systematic review of normative data.

The aim of this study was to conduct a systematic review to determine the quality of evidence of studies assessing isokinetic hip muscle strength in adult non-injured individuals. We also aimed to summarise and pool data of normative values for hip muscle strength. The influence of methodological and participant-related factors on hip strength performance was explored as well. Guidelines proposed in the PRISMA were used to undertake a search strategy involving the keyword 'hip' associated with a set of keywords reflecting muscle strength. Five databases were searched: ProQuest, PubMed, Science Direct, Scopus and Web of Science. From the 2,939 records initially retained, 28 articles were included in this systematic review. Eight articles were classified as high quality. This systematic review exposed the methodological fragility of most studies assessing hip strength in non-injured adult population. Only data from studies with a small number of participants are available to be used as reference. A few individual studies suggest no differences in torque parameters between dominant and non-dominant lower limbs; differences in torque parameters between age groups; and between male and female participants. Overall, reference values for hip muscle performance in isokinetic tests are mostly unclear.

Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-ß1 and Interleukin-4 Levels: Experimental Study in Mice.

Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor ß1 (TGF-ß1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-ß1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-ß1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.

How does completing an Ironman triathlon affect postural control? / Como a conclusão de um triatlo Ironman afeta o controle postural?

Abstract Despite the increase in the number of Ironman competitions worldwide, thousands of athletes have been joining Ironman experience but only a few studies have been published on the effects of this competition on postural control. This study aims to investigate the ability to maintain a static posture in three different positions before and after an Ironman competition and the blood glucose level behavior. Forty-nine volunteers underwent balance evaluation using the force plate VSRTM Sport. The area of the center of gravity (ACOG) was assessed pre- and post-competition in the bipodal, unipodal, and tandem postures. Glucose levels were also assessed concurrently. The ACOG findings showed a significant post-competition increase in the three postures assessed, with no significant interaction between the postures. The glucose test showed an increase in the post-competition glycemic levels. The findings showed reduced postural control, suggesting that prolonged exercise stimulation could lead to a disturbance in postural control.

Resumo Apesar do aumento no número de competições Ironman em todo o mundo e milhares de atletas se juntarem à experiência Ironman, apenas alguns estudos foram publicados sobre os efeitos dessa competição no controle postural. Este estudo tem como objetivo investigar a capacidade de manter uma postura estática em três posições diferentes antes e depois de uma competição de Ironman e o comportamento do nível de glicose no sangue. Quarenta e nove voluntários foram submetidos à avaliação do equilíbrio usando uma plataforma de força, VSRTM Sport. A área do centro de gravidade (ACOG) foi avaliada pré e pós-competição nas posturas bipodal, unipodal e tandem. Os níveis de glicose também foram avaliados simultaneamente. Os achados do ACOG mostraram um aumento significativo pós-competição nas três posturas avaliadas, sem interação significativa entre as posturas. O teste de glicose mostrou aumento nos níveis glicêmicos pós-competição. Os resultados mostraram decréscimo no controle postural, sugerindo que a estimulação prolongada ao exercício poderia levar a um distúrbio no controle postural.

Interaction between cognitive status, fear of falling, and balance in elderly persons

OBJECTIVE: Evaluate the cognitive function and its relationship with balance, history of falls, and fear of falling in the elderly. METHODS: We evaluated 250 elderly persons aged at least 60 years, who answered a sociodemographic questionnaire about the occurrence of falls in the last year. The cognitive function, balance, and fear of falling were assessed using the Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES-I) scores, respectively. Participants were allocated into two groups based on the Mini-Mental State Examination (MMSE) score, the Group with Possible Cognitive Decline (GPCD) and the group with no cognitive decline (GNCD). We performed Student's t-test and Pearson's correlation for independent samples. RESULTS: The Group with Possible Cognitive Decline (GPCD) showed lower balance (p=0.003) and greater fear of falling (p=0.008) (BBS=50.98±4.68; FES-I=26.06±8.78) compared to the GNCD (BBS=52.53±3.047; FES-I=23.21±7.74). CONCLUSION: Elderly persons with cognitive decline have lower balance, greater fear of falling, and greater recurrence of falls.

Immediate Effects of Spinal Manipulation on Shoulder Motion Range and Pain in Individuals With Shoulder Pain: A Randomized Trial.

OBJECTIVE: The purpose of this study was to investigate the influence of thoracic spinal manipulation (SM) on shoulder pain and ranges of motion in individuals with shoulder pain. METHODS: The sample was composed of 60 individuals, randomly allocated into the manipulation group (n = 30), who received the SM, and the placebo group (n = 30) who received a placebo manipulation. Pain evaluation was performed using the visual analog scale, and evaluation of shoulder flexion and abduction ranges of motion was assessed using a goniometer pre- and post-intervention. The intervention was performed by either upper thoracic SM or a placebo manipulation. RESULTS: The manipulation group demonstrated increased flexion and abduction of the painful shoulder (P < .01) and increased abduction of the nonpainful shoulder (P = .03), but only the abduction of the painful shoulder reached the minimal detectable change. The placebo group showed a post-intervention increase in the flexion (P = .03) and abduction (P < .01) movement of the painful shoulder. Both groups presented a statistically significant reduction in post-intervention pain (P < .01), but not clinically significant. CONCLUSION: Although the SM demonstrated a statistically significant difference for shoulder pain, this was not over the clinically meaningful change. Only the abduction of the painful shoulder reached the minimal detectable change.

Reference values and equations reference of balance for children of 8 to 12 years.

PURPOSE: There are still no normative data in balance sway for school-age children in Brazil. We aimed to establish the reference ranges for balance scores and to develop prediction equations for estimation of balance scores in children aged 8 to 12 years old. METHODS: The study included 165 healthy children (83 boys and 82 girls; age, 8-12 years) recruited from a public school in the city of Florianópolis, Santa Catarina, Brazil. We used the Sensory Organization Test to assess the balance scores and both a digital scale and a stadiometer to measure the anthropometric variables. We tested a stepwise multiple-regression model with sex, height, weight, and mid-thigh circumference of the dominant leg as predictors of the balance score. RESULTS: For all experimental conditions, girls' age accounted for over 85% of the variability in balance scores; while, boys' age accounted only 55% of the variability in balance scores. Therefore, balance scores increase with age for boys and girls. CONCLUSION: This study described the ranges of age- and sex-specific normative values for balance scores in children during 6 different testing conditions established by the sensory organization test. We confirmed that age was the predictor that best explained the variability in balance scores in children between 8 and 12 years old. This study stimulates a new and more comprehensive study to estimate balance scores from prediction equations for overall Brazilian pediatric population.

Análise das variáveis espaços temporais e angulares da marcha em indivíduos cegos / Analysis of the spatial-temporal and angular variables of gait of blind individuals

Analisar e descrever as variáveis espaços temporais e angulares da marcha de indivíduos cegos totais. Método: Estudo foi composto por 19 indivíduos com idade média de 28±6 anos, sendo estes divididos em dois grupos, o primeiro composto por oito indivíduos cegos totais (GCT), e o segundo grupo por 11 indivíduos com visão normal (GVN). As variáveis foram coletadas pelo sistema Peak Motus e analisadas no software Ariel Performance Analysis System. Os indivíduos caminharam em um trajeto com sete metros de extensão, livre de obstáculos, em velocidade auto selecionada, até que seis passadas fossem consideradas válidas. Para o tratamento estatístico dos dados utilizou-se o Teste t de student, com nível de significância de p≤0,05. Resultados: Os sujeitos do GCT apresentaram redução significativa da velocidade da marcha, cadência, comprimento da passada, fase de balanço e do ângulo máximo de flexão do joelho, bem como aumento da fase de apoio e do período de duplo apoio, quando comparados com os sujeitos no GVN. Não foi encontrada diferença significativa para ângulo máximo de extensão do quadril entre os grupos pesquisados. Conclusão: Os achados deste estudo mostraram que a ausência da informação visual induz nos sujeitos cegos uma marcha mais lenta, com redução do comprimento da passada, ângulo de flexão do joelho e fase de balanço, e, aumento da fase de apoio e do período de duplo apoio, quando comparados a sujeitos de visão normal

Analyze and describe the spatial-temporal and angular variables of gait of total blind individuals. Method: The present study included 19 individuals with a mean age of 28±6 years, who were divided into two groups, the first composed of eight blinded individuals, and the second group of 11 individuals with normal vision. The variables were collected by the Peak Motus system and were analyzed with the Ariel Performance Analysis System Software. The subjects walked at a self-selected speed on a seven-meter long, obstacle-free route, until reaching six valid strides. For statistical analysis, the Student t test was applied, with significance level of p≤0.05. Results: The blind individuals showed a significant reduction of gait velocity, cadence, stride length, swing phase and maximum angle of knee flexion, as well as increased support phase and double-support period, compared to the subjects with normal vision. No significant difference was found for maximum hip extension angle between the groups. Conclusion: The findings of this study showed that the absence of visual information associated with postural and balance changes induce the blind subjects to have slower gait, with reduced stride length, angle of knee flexion and swing phase, and increased support phase and period of double-support, when compared to subjects with normal vision

VASTUS LATERALIS OBLIQUE ACTIVITY DURING GAIT OF SUBJECTS WITH PATELLOFEMORAL PAIN / ATIVIDADE DO VASTO LATERAL OBLÍQUO NA MARCHA DE SUJEITOS COM DOR FEMOROPATELAR / ACTIVIDAD DEL VASTO LATERAL OBLICUO EN LA MARCHA DE SUJETOS CON DOLOR FEMOROPATELAR

ABSTRACT Introduction: So far, little is known about the behavior of electromyographic activity of vastus lateralis oblique muscle during treadmill gait in subjects with and without patellofemoral pain syndrome. Objective: The purpose of this study was to investigate the electromyographic activity of the patellar stabilizers muscles and the angle of the knee joint flexion in subjects with and without patellofemoral pain syndrome. Method: Fifteen subjects without (21 ± 3 years) and 12 with patellofemoral pain syndrome (20 ± 2 years) were evaluated. The electromyographic activity and flexion angle of the knee joint were obtained during gait on the treadmill with a 5 degree inclination. Results: The knee flexion angle was significantly lower in the subjects with patellofemoral pain syndrome when compared with the healthy controls. The electromyographic activity of vastus lateralis longus was significantly greater during gait on the treadmill with inclination in subjects with patellofemoral pain syndrome. The results also showed that the electromyographic activity of vastus lateralis oblique and vastus medialis oblique were similar in both groups, regardless of the condition (with/without inclination). Conclusion: We have shown that knee kinematics during gait differs among patients with and without patellofemoral pain syndrome and healthy controls and that a different motor strategy persists even when the pain is no longer present. In addition, the findings suggested that the vastus lateralis oblique has a minor role in patellar stability during gait.

RESUMO Introdução: Até o presente, pouco é conhecido sobre o comportamento da atividade eletromiográfica do músculo vasto lateral oblíquo durante a marcha em esteira em sujeitos com e sem síndrome da dor femoropatelar. Objetivo: A finalidade deste estudo foi investigar a atividade eletromiográfica dos músculos estabilizadores patelares e o ângulo de flexão do joelho em sujeitos com e sem síndrome da dor femoropatelar. Método: Quinze sujeitos sem (21 ± 3 anos) e 12 com síndrome da dor femoropatelar (20 ± 2 anos) foram avaliados. A atividade eletromiográfica e o ângulo de flexão da articulação do joelho foram obtidos durante a marcha em esteira com inclinação de 5 graus. Resultados: O ângulo de flexão do joelho foi significativamente menor nos sujeitos com síndrome da dor femoropatelar quando comparados aos controles saudáveis. A atividade eletromiográfica do vasto lateral longo foi significativamente maior durante a marcha na esteira com inclinação nos sujeitos com síndrome da dor femoropatelar. Os resultados também mostraram que a atividade eletromiográfica dos músculos vasto lateral oblíquo e vasto medial oblíquo foram similares em ambos os grupos, independentemente da condição (com e sem inclinação). Conclusão: Mostramos que a cinemática do joelho durante a marcha é diferente entre sujeitos com e sem síndrome da dor femoropatelar e que a estratégia motora diferente persiste mesmo quando a dor não está mais presente. Adicionalmente, os achados sugerem que o vasto lateral oblíquo tem papel secundário na estabilidade patelar durante a marcha.

RESUMEN Introducción: Hasta la fecha, se sabe poco sobre el comportamiento de la actividad electromiográfica del músculo vasto lateral oblicuo durante la marcha sobre una cinta rodante en sujetos con y sin síndrome del dolor femoropatelar. Objetivo: El propósito de este estudio fue investigar la actividad electromiográfica de los músculos estabilizadores de la rótula y el ángulo de flexión de la articulación de la rodilla en sujetos con y sin síndrome del dolor femoropatelar. Método: Se evaluaron 15 sujetos sin (21 ± 3 años) y 12 con dolor femoropatelar (20 ± 2 años). La actividad electromiográfica y el ángulo de flexión de la articulación de la rodilla se obtuvieron analizando la marcha en una cinta rodante con inclinación de 5 grados. Resultados: El ángulo de flexión de la articulación de la rodilla fue significativamente menor en los sujetos con síndrome femoropatelar en comparación con los controles sanos. La actividad electromiográfica del músculo vasto lateral largo fue significativamente mayor durante la marcha en cinta rodante con inclinación en sujetos con síndrome femoropatelar. Los resultados también mostraron que la actividad electromiográfica de los músculos vasto lateral oblicuo y vasto medial oblicuo fueron similares en ambos grupos, independientemente de la condición (plana e inclinada). Conclusión: Hemos demostrado que la cinemática de la rodilla durante la marcha difiere entre los sujetos con y sin síndrome femoropatelar y la estrategia motora diferente persiste también cuando el dolor ya no está presente. Además, los hallazgos sugieren que el músculo vasto lateral oblicuo tiene un papel menor en la estabilidad de la rótula durante la marcha.

Confiabilidade intra e interexaminador da avaliação do alinhamento da cabeça nas posições sentado e em pé / La exactitud intra y entre examinador en la evaluación de la alienación de la cabeza en las posturas sentada y de pie / Intra- and inter-examiner reliability of head alignment assessment in sitting and standing positions

RESUMO Objetivou-se verificar a confiabilidade intra e interexaminador dos ângulos de anteriorização e de inclinação da cabeça nas vistas anterior e lateral nas posições sentado e em pé e se as medidas independem da posição utilizada. Participaram 78 sujeitos com 23,5±5,8 anos, 63,7±10,3 kg e 166,5±8,2 cm de estatura. Os sujeitos foram fotografados nas posturas em pé e sentado, seguindo o protocolo do Software para Avaliação Postural (SAPO). Foram analisados o alinhamento horizontal da cabeça nas vistas anterior e lateral (AHC_A; AHC_L) e o alinhamento vertical da cabeça na vista lateral (AVC_L). Três avaliadores analisaram as imagens, repetindo essa análise sete dias depois. O coeficiente de correlação intraclasse (ICC) e o teste t pareado foram aplicados, com nível de significância de p≤0,05. Na análise da confiabilidade interexaminadores, dos seis ângulos avaliados, três foram classificados como excelentes, um como aceitável e apenas um como não aceitável. Quanto ao nível de confiabilidade intraexaminador, em dez avaliações o ICC foi classificado como excelente, em seis como muito bom, em uma como aceitável e somente em uma como não aceitável. Não foram observadas diferenças entre as posições sentado e em pé nas diversas avaliações realizadas no estudo. Concluiu-se que as avaliações dos ângulos de anteriorização e inclinação da cabeça nas vistas anterior e lateral e nas posições sentado e em pé mostraram-se confiáveis quando realizadas por examinadores diferentes ou pelo mesmo examinador em dias diferentes. Adicionalmente, constatou-se que os resultados das avaliações independem da posição utilizada.

RESUMEN Se evalúa la exactitud intra y entre examinador de los ángulos anteriores y de inclinación de la cabeza en las vistas anterior y lateral durante las posturas sentada y de pie, así como si hay dependencia de las mediciones en las posturas empleadas. Participaron 78 sujetos de 23,5±5,8 años, 63,7±10,3 kg y 166,5±8,2 cm de estatura. Se fotografiaron a los sujetos en las posturas de pie y sentada, siguiendo el software de Evaluación Postural (SAPO). Se analizaron la alienación horizontal de la cabeza en las vistas anterior y lateral (AHC_A; AHC_L) y la alienación vertical de la cabeza en la vista lateral (AVC_L). Tres evaluadores analizaron estas imágenes, y lo repitieron después de siete días. Se emplearon el coeficiente de correlación intraclase (ICC) y la prueba pareada, con un nivel de significación de p≤0,05. En el análisis de la exactitud entre examinador, de seis ángulos evaluados, tres fueron excelentes, uno aceptable y sólo uno no aceptable. En cuanto al nivel de exactitud intraexaminador, el ICC fue excelente en diez evaluaciones, muy bueno en seis, aceptable en una y no aceptable en solamente una. En las posturas evaluadas en este estudio no se observó diferencias. Se concluye que las evaluaciones de los ángulos anteriores y de inclinación de la cabeza en las vistas anterior y lateral y en la postura sentada y de pie fueron fiables cuando eran realizadas por distintos examinadores o por el mismo examinador en otros días. También se observó que los resultados de las evaluaciones no dependen de la postura empleada.

ABSTRACT To verify the intra- and inter-examiner reliability of the head anteriorization and inclination angles in the front and side views in sitting and standing positions and whether or not the measurements differ from the positions used. 78 people participated, aged 23.5±5.8 years old, 63.7 ± 10.3 kg of weight, and 166.5 ± 8.2cm of height. The people were photographed in standing and sitting positions, following the protocol of Postural Assessment Evaluation Software (PAES). The horizontal head alignment was analyzed in anterior and lateral views (HHA_A; HHA_L). The vertical head alignment was analyzed in lateral view (VHA_L). Three evaluators analyzed the images, repeating the analysis seven days later. Interclass Correlation Coefficient (ICC) and paired t-test were applied with significance level of p≤0.05. From the inter-examiner reliability analysis, 3 out of the 6 evaluated angles were rated as excellent, 1 as acceptable and 1 as unacceptable. Regarding the level of intra-examiner reliability, in 10 assessments the ICC was rated as excellent, in 6 as very good, in 1 as acceptable and in 1 as unacceptable. No differences were observed between sitting and standing positions in the assessments made. The evaluations of head anteriorization and inclination angles in anterior and lateral views in sitting and standing positions were reliable when made by different examiners or by the same examiner in different days. Additionally, it was confirmed that evaluation results do not depend on the position used.