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Background: The adapted arcometer has been validated for use in adults. However, its suitability for use in children can be questioned given the structural differences present in these populations., Objective: To verify the concurrent validity, repeatability, and intra- and inter-reproducibility of the adapted arcometer for the measurement of the angles of thoracic kyphosis and lumbar lordosis in children., Method: Forty children were evaluated using both sagittal radiography of the spine and the adapted arcometer. The evaluations using the arcometer were carried out by two trained evaluators on two different days. In the statistical treatment, the intraclass correlation coefficient (ICC), Pearson's product moment correlation, Spearman's rho, the paired t test, and Wilcoxon's test were used (α=.05)., Results: A moderate and significant correlation was found between the x-ray and the adapted arcometer regarding thoracic kyphosis, but no correlation was found regarding lumbar lordosis. Repeatability and intra-evaluator reproducibility of the thoracic kyphosis and lumbar lordosis were confirmed, which was not the case of inter-evaluator reproducibility., Conclusion: The adapted arcometer can be used to accompany postural alterations in children made by the same evaluator, while its use for diagnostic purposes and continued evaluation by different evaluators cannot be recommended. Further studies with the aim of adapting this instrument for use in children are recommended.

The Back School is characterized as an educational program aimed at individuals who have chronic pain in spine. In Brazil, a growing number of research studies on the effects of such programs have been observed in the last decades. Thus, the purpose of this systematic review was to identify studies on Back Schools carried out in Brazil with a population of adults and elderlies, and to compare their intervention methodologies, data collection tools, and results. A search for scientific articles and Master's and doctoral theses in several databases was conducted. The keywords used in that search were Postural Program; Postural School; Back School; Back Care Education; Back Education, as well as the respective terms in Portuguese. Eighteen studies were found, being fourteen quantitative and four qualitative studies.The studies showed many differences between them, in both the interventions proposed and the methodological design. However, the use of similar tools for assessing pain intensity, functional capacity, and quality of life between the quantitative studies allowed a partial comparison of the efficacy of those programs.The studies included in this systematic review demonstrated, in general, the immediate efficacy in reducing pain and improving functional capacity and quality of life after the Back School. Results, however, are still conflicting regarding the efficacy in the medium and long terms. Thus, it becomes necessary to conduct further studies that include follow-up assessments in the medium and long terms in order to obtain more accurate conclusions about the efficacy of Back Schools.

Attaching elastic tubes (ETs) to resistance training machines can affect the exercise load profile. The purpose of this study was to assess the training effects of added ETs, which were strategically attached to provide additional loads only during the deceleration phase of the knee extension exercise. Twenty-two healthy participants, assigned to either an experimental group (with ETs) or a control group (without ETs), participated in a 12-week strength-training program using a knee extension exercise machine. The acceleration effects were quantified and a method of attaching the ETs to the knee extension machine was developed. The effects of the added ETs were analysed by testing dynamic and isometric maximum contractions at four knee flexion angles (10 degrees, 30 degrees, 50 degrees, and 80 degrees). Analyses of covariance with the initial values as the covariate were used to examine the ETeffects. A greater increase in isometric maximum strength was found in the experimental group than in the control group at knee flexion angles of 10 degrees [effect size (ES) = 2.25] and 30 degrees (ES = 1.18). No significant difference in the dynamic maximum strength was found between the groups. The use of ETs increased strength at smaller knee flexion angles with quadriceps that were relatively short.

Objective: To investigate (1) the accuracy of the palpatory method to identify anatomical points by comparison with the X-ray exams, (2) the validity of classifying spinal posture in the frontal plane using Digital Image-Based Postural Assessment (DIPA) software by comparison with the X-ray exams and (3) the intra and inter-evaluator reproducibility of the DIPA software., Materials and Methods: The postural assessment and X-ray examination of the spine, both in the frontal plane and standing position, were performed consecutively in 24 subjects. The postural assessment protocol consisted of: (1) palpation and the use of reflective markers containing lead to mark the spinous processes (SP) of the C7, T2, T4, T6, T8, T10, T12, L2, L4 and S2 vertebrae and; (2) acquisition of photographic records. First, the X-ray examinations were used to check the correlation between the palpated and marked SP and the true location of the SP of the vertebra in question, by assessing the distance between them. The spinal posture was classified based on the calculation of the scoliosis arrows in the DIPA (DIPA-SA). The X-ray examinations provided the scoliosis arrows (X-SA), the Cobb angles and the classification of spinal posture based on the Cobb angle. The results from the DIPA protocol were compared to those from the X-ray examination-based protocol. The statistical tests used were: (1) Kruskal-Wallis--differences in terms of the numerical distance between the markers and the anatomical landmarks, (2) Pearson's Correlation--DIPA-SA and Cobb angles, (3) Pearson's Correlation--X-SA and DIPA-SA; (4) Bland and Altman's graphic representation--X-SA and DIPA-SA, (5) Spearman's Correlation--classification of spinal posture obtained using the X-ray and DIPA protocols, (6) the intraclass correlation test (ICC) for the relationship between the DIPA-SA made by each evaluator (inter-evaluator), and (7) independent t-test to compare the data from the two evaluation days (intra-evaluator), α=0.05., Results: There were no significant differences between the location of the anatomical points located using palpation and identified with reflective markers and the respective location of the SP as identified using X-ray exams (χ²=9.366, p=0.404). Significant correlations were found between the DIPA-SA and the Cobb angles in the dorsal (r=0.75, p<0.001) and lumbar (r=0.76, p=0.007) regions; between the DIPA-SA and the X-SA in the dorsal (r=0.79, p<0.001) and lumbar (r=0.92, p<0.001) regions and; between the classifications of posture obtained with the DIPA and X-ray protocols (r=0.804, p<0.001). Bland and Altman's representation showed agreement between DIPA-SA and X-SA for both curvatures. Significant correlations were found for the intra-evaluator test in the thoracic (r=0.99, p<0.001) and lumbar (r=0.98, p<0.001) regions; for the inter-evaluator test in the thoracic (r=0.99, p<0.001) and lumbar (r=0.88, p<0.001) regions., Conclusion: The results suggest that the DIPA protocol constitutes a valid simple, practical and low-cost non-invasive tool for the evaluation of the spine in the frontal plane which can be used to obtain reproducible measurements (inter and intra-evaluators)., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective. to verify the validity and reproducibility of using the flexicurve to measure the angles of the thoracic and lumbar curvatures. Method. 47 subjects were evaluated by: (1) palpation and marking of the spinous processes using lead markers, (2) using X-rays in the sagittal plane to measure the Cobb angles, (3) molding the flexicurve to the spine, and (4) drawing the contour of the flexicurve onto graph paper. The angle of curvature was determined with the flexicurve based on a 3rd order polynomial. Results. No differences were found between the Cobb angles and the angles obtained using the flexicurve in thoracic and lumbar curvatures (P > 0.05). Correlations were strong and significant for the thoracic (r = 0.72, P < 0.01) and lumbar (r = 0.60, P < 0.01) curvatures. Excellent and significant correlations were found for both the intraevaluator and interevaluator measurements. Conclusion. The results show that there is no significant difference between the values obtained using the flexicurve and those obtained using the X-ray procedure and that there is a strong correlation between the two methods. This, together with the excellent level of inter- and intraevaluator reproducibility justifies its recommendation for use in clinical practice.

Background: The need for early identification of postural abnormalities without exposing patients to constant radiation has stimulated the development of instruments aiming to measure the spinal curvatures., Objective: To verify the validity, repeatability and reproducibility of angular measures of sagittal curvatures of the spine obtained using an adapted arcometer, by comparing them with Cobb angles of the respective curvatures obtained by using X-rays., Methods: 52 participants were submitted to two procedures designed to evaluate the thoracic and lumbar curvatures: (1) X-ray examination from which the Cobb angles (CA) of both curvatures were obtained, and (2) measuring the angles with the arcometer (AA). Two evaluators collected the data using the arcometer, with the rods placed at T1, T12, L1 and L5 spinous processes levels in a way as to permit linear measurements which, with aid of trigonometry, supplied the AA., Results: There was a very strong and significant correlation between AA and CA (r=0.94; p<0.01), with no-significant difference (p=0.32), for the thoracic curvature. There was a strong and significant correlation for the lumbar curvature (r=0.71; p<0.01) between AA and CA, with no-significant difference (p=0.30). There is a very strong correlation between intra-evaluator and inter-evaluator AA., Conclusion: It was possible to quantify reliably the thoracic and lumbar curvatures with the arcometer and it can thus be considered valid and reliable and for use in evaluating spinal curvatures in the sagittal plane.

The purpose of this study was to compare the cycling technique of triathletes and cyclists on the basis of the cocontraction of selected muscles of the lower limbs and economy at different cadences. The economy (EC) and percent cocontraction from nine triathletes and eight cyclists were compared at 60, 75, 90 and 105 rpm cadences. Tests were performed on two separate days. The maximal oxygen uptake was measured and the second ventilatory threshold (VO(2VT)) was estimated on the first day using a stationary bicycle. On the second day the four different cadences were tested at approximately 5% below the VO(2VT). The EMG activity of the rectus femoris (RF), biceps femoris (BF) and vastus lateralis (VL) was recorded and the EMG signal was normalized using the 60 rpm dynamic contraction. The percent cocontractions were calculated from RF/BF and VL/BF muscles. The EC was also calculated. The results showed that cyclists were significantly more economic, indicating that they exerted more power with less VO(2), and presented significantly lower percent cocontraction than triathletes (p<0.05). Thus, the results suggest that the cyclists had a better technique than the triathletes. The simultaneous use of the percent cocontraction and economy seems to be a good performance indicator for cyclists and triathletes.

Background and Purpose: Pain is currently evaluated with "subjective" methods (eg, patient self-report). This study aimed to test whether fatigue indexes are able to accurately discriminate between subjects with and subjects without low back pain., Subjects: Sixty subjects separated into 2 groups--a group with low back pain (n=30) and a group without low back pain (n=30)--participated in this study., Methods: Electromyographic (EMG) and force data were obtained during a muscle fatigue test. The same test was repeated to monitor recovery. Linear regression analysis was used to obtain fatigue indexes., Results: Subjects with pain produced significantly lower force values than those without pain. The use of fatigue indexes and force values permitted accurate classification in 89.5% of cases., Discussion and Conclusion: The results confirm that subjects with pain show early myoelectrical manifestations of muscle fatigue and that EMG can be a useful tool in the evaluation of low back pain.

The purpose of this study was to determine the validity of using the electromyography (EMG) signal as a noninvasive method of estimating the lactate threshold (LT) power output in recreational cyclists. Using an electromagnetic bicycle ergometer and constant pedaling cadence of 80 rpm, 24 recreational cyclists performed an incremental exercise protocol that consisted of stepwise increases in power output of 25 W every 3 min until exhaustion. The EMG signal was recorded from the right vastus lateralis (VL) and right rectus femoris (RF) throughout the test. Blood samples were taken from the fingertip every 3 min. The LT was determined by examining the relation between the lactate concentration and the power output using a log-log transformation model. The root mean square (RMS) value from the EMG signal was calculated for every 1-second non-superimposing window. Sets of pairs of straight regression lines were plotted and the corresponding determination coefficients (R(2)) were calculated. The intersection point of the pair of lines with the highest R(2) product was chosen to represent the EMG threshold (EMGT). The results showed that the correlation coefficients (r) between EMGT and LT were significant (p < 0.01) and high for the VL (r = 0.826) and RF (r = 0.872). The RF and VL muscles showed similar behavior during the maximal incremental test and the EMGT and LT power output were equivalent for both muscles. The validity of using EMG to estimate the LT power output in recreational cyclists was confirmed.

The effective force applied on the crank, the index of pedalling effectiveness, and the economy of movement at 60, 75, 90, and 105 rev/min cadences were examined in nine cyclists and eight triathletes. Tests were performed on two days. Maximal oxygen uptake was measured and the second ventilatory threshold was estimated on day 1 using a stationary bicycle. On day 2, the four different cadences were tested at about 5% below the second ventilatory threshold. A strain gauge instrumented clip-less pedal mounted on the bicycle enabled us to measure the normal and tangential forces exerted on the pedal, while the pedal and crank angles were monitored with the aid of a video system. Based on this information, the effective force and the index of pedalling effectiveness were calculated. Cyclists produced significantly more effective force and a higher index of pedalling effectiveness at 60 and 75 rev/min and were significantly more economic at all cadences than triathletes. The significant and positive correlation between effective force and economy at all cadences suggests that improvement of the effective force would reflect on economy.