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Context: A variety of approaches have been proposed to prevent lower limb injuries in runners. However, the evidence for the effectiveness of interventions to reduce lower limb pain and injury after intensive running is very weak. Objective: The authors performed a systematic review to investigate the effects of foot orthoses on pain and the prevention of lower limb injuries in runners. Evidence Acquisition: The authors searched the MEDLINE/PubMed, Physiotherapy Evidence Database, Scielo, and Cochrane Central (from inception to February 2022) databases for randomized controlled trials that evaluated the effects of foot orthoses in runners. The authors then calculated mean differences and 95% confidence intervals from these trials. Heterogeneity was assessed using the I2 test. Furthermore, the authors compared the criteria between runners with foot orthoses and ones with no intervention (control group). Evidence Synthesis: Twelve studies (5321 runners) met our review criteria. The control and the foot orthoses group sustained 721 (37%) and 238 (24%) injuries, respectively. Compared with the control group, the use of foot orthoses resulted in a significant reduction in lower limb injury risk (risk ratio = 0.6; 95% confidence interval, 0.5–0.7; P = .00001, I2 = 54%; 7 studies, N = 2983: moderate-quality evidence). Moreover, the foot orthoses group corresponded to a 40% reduction in the risk of developing lower limb injuries. Conclusions: The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.

Introdução: A dor femoropatelar (DFP) tem sido frequentemente associada a anormalidades no alinhamento dos membros inferiores e tronco, principalmente durante atividades de descarga de peso. Nesse contexto, fatores proximais e locais têm sido amplamente discutidos. Fatores distais também podem estar envolvidos e precisam ser investigados com mais detalhes. Nosso objetivo foi comparar a cinemática do complexo tornozelo/pé em mulheres com pés pronados e dor femoropatelar pormeio de cinemática tridimensional de mulheres assintomáticas durante a execução dos testes step down anterior e lateral. Métodos: Cinquenta mulheres foram divididas em dois grupos: controle (n=16); e dor patelofemoral (n=34). Todos os voluntários foram avaliados usando captura de movimento tridimensional durante os testes step down anterior e lateral. Para cada sessão, foram realizadas nove repetições de cada teste clínico no membro mais doloroso das mulheres com DFP e no membro dominante das mulheres do grupo controle. A mobilidade do complexo tornozelo/pé foi medida e a amplitude de movimento foi calculada para todos os segmentos. Os dois grupos foram comparados por meio de análise multivariada (MANOVA). Resultados: As mulheres do grupo DFP apresentaram menor flexão do joelho e mobilidade significativamente maior de: retropé em relação à tíbia e ao laboratório; do antepé em relação à tíbia; e do antepé em relação ao retropé. Conclusão: Mulheres com DFP apresentaram maior mobilidade do complexo tornozelo/pé durante os testes de step down anterior e lateral, quando comparadas com mulheres assintomáticas.

BackgroudSeveral studies suggest that the central nervous system coordinates muscle activation by modulating neural commands directed to groups of muscles combined to form muscle synergies. Individuals with patellofemoral pain (PFP) move differently from asymptomatic individuals. Understanding the neural factors involved in the execution of tasks such as walking can help comprehend how the movement is planned and better understand this clinical condition.Research questionTo compare the muscle coordination of women with and without PFP during gait.MethodsEleven women with PFP and thirteen asymptomatic women were assessed using three-dimensional kinematics and electromyography (EMG) while walking at self-selected speed. Kinematics of the trunk, pelvis and lower limbs were analyzed through the Movement Deviation Profile. Muscle synergies were extracted from the EMG signals of eight lower limb muscles collected throughout the whole gait cycle.ResultsKinematic differences between the two groups (ptotal) when using 3 (p=0.017), 4 (p=0.004), and 5 (p=0.012) synergies to reconstruct all EMG signals. The PFP group also presented higher VAFmusclefor rectus femoris (p=0.048) and gastrocnemius medialis (p=0.019) when considering 4 synergies.SignificanceOur results suggest that women with PFP show lower motor complexity and deficit in muscle coordination to execute gait, indicating that gait in PFP gait is the result of different neural commands compared to asymptomatic women.

Background Approximately 25% of orthopedic knee conditions are related to patellofemoral pain (PFP), with young women being the most affected. It is thought that this condition is associated with modifications in the kinematics and muscle control patterns of the lower limb during weight-bearing support activities, which increases femur movement under the patella. Objectives To compare kinematics and muscle induced acceleration patterns between PFP subjects and healthy controls during the preparation phase of the single leg triple hop test. Study design Biomechanical analysis was performed using OpenSim. Ten physically active women (23.2 ± 4 years, 59.3 ± 5.8 kg, and 1.63 ± 0.06 m) with no history of lower limb injury (CG) and 11 volunteers (23.5 ± 2 years, 55.4 ± 4.9 kg, and 1.66 ± 0.04 m) with PFP (PFPG) were recruited. The participants performed a series of single leg triple hop tests while the ground reaction forces and kinematic data were recorded. Results Vector field statistical analysis indicated increased lumbar extension, anterior pelvic tilt, contralateral pelvic drop, and lower induced accelerations from the core and hip muscles in PFPG. Conclusion PFP volunteers presented with alterations in lumbar muscle control associated with a possible compensatory pelvic strategy to minimize knee extensor moment.

Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by a triad composed of cognitive alteration, urinary incontinence, and gait impairment associated with ventricular enlargement and normal cerebrospinal fluid pressure. Gait impairment is among the earliest symptoms; however, the reliability of the evaluation is not well-established and no consensus has been reaching regarding variables that should be analyzed and which parameters should be considered to accurately assess post-intervention improvement. Research question Are the degree of repeatability, standard error of measurement, and minimum detectable change considered to detect changes in gait variables in iNPH patients? Methods A total of 84 iNPH patients with a mean age of 77.1 (±6.4) years were analyzed. Gait deviation index (GDI), speed, cadence, cycle time, stride length, single support, and first and second double support were chosen as the variables to be analyzed. Statistical analysis was performed by an independent evaluator, with gait repeatability assessed by the intraclass correlation coefficient (ICC) and the standard error of measure (SEM). Results ICC values were 0.76–0.85 with excellent repeatability, while SEM demonstrated that the variables with best repeatability were the GDI (mean, 4.94; 95% confidence interval (CI), 4.63–5.43), representing a 7.65% mean relative error of the measurement (mean, 0.05 m; 95% CI, 0.05–0.06), and stride length (mean 0.05 m; 95% CI, 0.05–0.06), with a 7.69% mean relative error. Significance We concluded that GDI and stride length were the variables with the best repeatability and lower variability in the gait of iNPH patients.

Background and purpose The maintenance of postural control is influenced by the complexity of a given task. Tasks that require greater attention and cognitive involvement increase the risk of falls among older adults. The aim of the present study was to evaluate the adaptation of the postural control system to different levels of task complexity in physically inactive young and older women. Methods A cross-sectional study was conducted with adult women classified as physically inactive based on the results of the International Physical Activity Questionnaire. The participants were 27 young (20-30 years of age) and 27 older (60-80 years of age) women. Sway velocity of the center of pressure in the anterior-posterior and medial-lateral directions was calculated using a force plate under 6 conditions: standing directly on the force plate or on a foam placed over the force plate, eyes open or closed, and dual-task complexity with and without the foam. Results and discussion A 2-way analysis of variance revealed that sway velocity increased in both groups when the task conditions were altered. The older women exhibited significantly greater sway velocity compared with the young women on all tasks. However, the patterns of postural control adaptation to the different levels of complexity were similar among all participants. Conclusions In this study, the adaption of the postural control system to different levels of task complexity did not differ between physically inactive young and physically inactive older women. However, the physically inactive older women exhibited greater sway velocity compared with the young women.

BACKGROUND: Studies evaluating kinematics lead to different conclusions, not all changes appear in all assessed tasks and in all subgroups of patients with patellofemoral pain (PFP). The inconsistencies between studies could be reduced if we knew which task separates patients best from healthy controls. RESEARCH QUESTION: Identify which functional task, between gait, forward step down (FSD), lateral step down (LSD), stair ascent and descent and propulsion and landing phase of the single leg hop test (SLHT), differentiates the three-dimensional kinematics of women with patellofemoral pain from asymptomatic women. METHODS: This cross-sectional study evaluated thirty-five PFP and thirty-five asymptomatic women during the execution of the following tasks: gait, FSD, LSD, stair ascent and descent and the propulsion and landing phase of single leg hop test. Frontal, sagittal and transverse plane angles of the trunk, pelvis and hip, frontal and sagittal plane angles of the knee, ankle dorsiflexion, foot progression angle and hindfoot eversion were analyzed through the Movement Deviation Profile (MDP). To compare the groups, the multivariate analysis with Bonferroni post hoc test were used, with a significance level of p

Aim The aim of this study was to characterize upper limb motor function during a comparative analysis of electromyographic and upper limb movement analysis during drinking between healthy adults and individuals with DCP. Method Fifteen healthy individuals (CG) and fifteen individuals with DCP (DG) participated in the study. Upper limb function was analyzed during drinking and consisted of a task divided into three phases: the going, the adjustment, and the return. Results Electromyographic analysis revealed a lower activity of the anterior deltoid, posterior deltoid, and biceps brachii muscles in the DG. When comparing the interactions between groups and phases, only biceps brachii shower lower muscle activity during going and adjustment phases. The DG presented a smaller range of motion (ROM) for the shoulder, elbow, forearm and wrist movements. An interaction between groups and phases showed smaller ROM for the flexion and internal rotation of the shoulder, elbow flexion, forearm pronation, and ulnar deviation in the return phase compared to CG. Interpretation The results may contribute positively to the quantification of the level of motor impairment and may be used as a reference for the development of therapeutic interventions for patients with DCP.

This study aimed to evaluate test and retest reliability according to examiner experience with the three-dimensional kinematics of the trunk, scapula, and arm segments during flexion and unilateral abduction of the arm. Ten men and 10 women (mean age, 25.1 [1.1] years) participated in this study. Each volunteer participated in six test sessions, four on the first day (two for each examiner) and two on the second day (one for each examiner). A 48-h interval was given between test days. The assessments were made by one examiner with movement analysis experience and a second examiner without experience. For each session (intra-day), the volunteers performed five repetitions of unilateral arm flexions and abductions using their dominant arms. After 1 h, the data were re-collected and all markers were replaced. Data from the trunk, scapula, and arm were analysed at 30°, 60°, 90°, and 120° of arm flexion and abduction using intraclass coefficient correlation, standard error of the measurement, and analysis of variance. The results did not differ between the experienced and inexperienced examiners except for trunk axial rotation at all studied angles and for arm rotation at 120° of abduction. The examiner previously trained in movement analysis marker placement demonstrated the same intra-tester reliability as the inexperienced tester when marker placement accuracy was the variable of interest.

Subacromial shoulder pain (SSP) accounts for 44-65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0-100%, p

Background There is no consensus on kinematics alterations during descending stairs in females with patellofemoral pain (PFP). In addition, there are no studies that have evaluated the three dimensional kinematics of the trunk, pelvis, hip, knee, and ankle using a multi-segmental model of the foot simultaneously during this task in patients with PFP and evaluated the subphases of stair descent. The objectives of this study were to compare the three dimensional kinematics of the trunk, pelvis, and lower limbs during different subphases of stair descent and identify the discriminatory capacity of the kinematic variables among women with PFP and healthy women. Methods In this cross-sectional study, thirty-four women with PFP and thirty-four pain free women between 18 and 35 years-old were submitted to three-dimensional kinematic evaluation during stair descent. Results It was observed that kinematic differences between the groups occurred in the first double support phase of the stair descent, with the variables of internal rotation of the hindfoot in relation to the tibia in the initial contact (2.1°; sensitivity = 68.6%, specificity = 61.8%) and contralateral pelvic drop in load response (1.3°, sensitivity = 65.7%, specificity = 63.7%) presenting the best ability to discriminate women with and without PFP. Conclusion Our results suggest that kinematic changes during stair descent should be used with caution during the evaluation and decision-making process in women with PFP.

This study aimed to compare the concentric and eccentric activity and the temporal order of peak activity of the hip and knee muscles between women with patellofemoral pain (PFP) and healthy women during the single leg triple hop test (SLTHT). Electromyographic (EMG) and Kinematic data were collected from 14 healthy women (CG) and 14 women diagnosed with PFP (PFG) during a single session of the single leg triple hop test. Integral surface electromyography (iEMG) data of the hip and knee muscles in eccentric and concentric phases and the length of time that each muscle needed to reach the maximal peak of muscle activity were calculated. The iEMG in the eccentric phase was significantly higher (p 0.05) than the concentric phase, for the gluteus maximus and gluteus medius muscles (CG and PFG) and for the vastus lateralis muscle (PFG). The vastus lateralis muscle was the first muscle to reach the highest peak of activity in the PFG, and the third to reach this peak in the CG. In the present study, the activity of the vastus lateralis muscle during the eccentric phase of the jump was greater than concentric phase, as a temporal anticipation of its peak in activity among women with PFP.

OBJECTIVE The purpose of this study was to evaluate the effect of treadmill training with body weight support on gait kinematics parameters in patients with PD using DBS. DESIGN Twelve patients completed the protocols (age: 60.9±10.6 years; disease duration: 20±7 years; and time since DBS surgery: 20±4 months). The same set of patients underwent two trainings protocols and four gait analyses (before and after each training). They received eight weeks of treadmill training without body weight support (16 sessions) in conjunction with physiotherapy program followed by six weeks of wash out period, followed by eight weeks of body-weight-supported treadmill training in conjunction with a same physiotherapy program. The Gait Kinematic Analysis involved eight infrared cameras that detected 19 reflective spherical markers attached in limb lower of patients. Statistical analysis used the Wilcoxon test (p≤0.05). RESULTS Both the training no showed significant differences in linear variables. As the angular variables, only training with support showed significant increase of ranges of motion: pelvis tilt, obliquity and rotation amplitude; hip adduction-abduction and rotation amplitude; percentage of peak flexion in swing phase; foot progression amplitude. CONCLUSION The body weight supported treadmill training may promote increase of mobility of lower limbs during gait and it could be a targeted intervention for PD patients treated with DBS.

A subluxação do ombro hemiplégico é encontrada em significativo número de pacientes após acidente vascular encefálico (AVE). Alguns estudos têm demonstrado eficácia com o uso da estimulação elétrica funcional (EEF) na redução da subluxação do ombro hemiplégico. Objetivando verificar o efeito da EEF no tratamento da subluxação do ombro hemiplégico e sessões de fisioterapia, o presente estudo investigou e acompanhou 3 pacientes durante perí­odo de 8 semanas. Todos os sujeitos foram submetidos í aplicação da EEF 2 vezes por semana com duração de40 a50 minutos em cada sessão de fisioterapia. Não foi utilizado nenhum outro tipo de recurso fisioterapêutico durante o tratamento com a EEF. Os resultados, avaliados através de exame de Raio-X, revelaram redução da subluxação do ombro hemiplégico no caso de AVE recente, enquanto houve aumento da subluxação no caso do paciente portador de AVE há mais de 1 ano. Desta forma, a EEF parece ser um recurso eficaz para a redução da subluxação do ombro em pacientes portadores de AVE há menos de 1 ano.Palavras-chave: subluxação, estimulação elétrica funcional, acidente vascular encefálico.Â

Functional biomechanical tests allow the assessment of musculoskeletal system impairments in a simple way. Muscle force synergies associated with movement can provide additional information for diagnosis. However, such forces cannot be directly measured noninvasively. This study aims to estimate muscle activations and forces exerted during the preparation phase of the single leg triple hop test. Two different approaches were tested: static optimization (SO) and computed muscle control (CMC). As an indirect validation, model-estimated muscle activations were compared with surface electromyography (EMG) of selected hip and thigh muscles. Ten physically healthy active women performed a series of jumps, and ground reaction forces, kinematics and EMG data were recorded. An existing OpenSim model with 92 musculotendon actuators was used to estimate muscle forces. Reflective markers data were processed using the OpenSim Inverse Kinematics tool. Residual Reduction Algorithm (RRA) was applied recursively before running the SO and CMC. For both, the same adjusted kinematics were used as inputs. Both approaches presented similar residuals amplitudes. SO showed a closer agreement between the estimated activations and the EMGs of some muscles. Due to inherent EMG methodological limitations, the superiority of SO in relation to CMC can be only hypothesized. It should be confirmed by conducting further studies comparing joint contact forces. The workflow presented in this study can be used to estimate muscle forces during the preparation phase of the single leg triple hop test and allows investigating muscle activation and coordination.

Introdução: Os músculos flexores da coxa e flexores da perna têm importante função nas atividades funcionais. Para avaliação do comprimento desses músculos são comumente descritos os testes de Thomas, ângulo poplí­teo (AP) e ângulo poplí­teo modificado (APmod). Objetivo: Avaliar se existem diferenças nas medidas entre os testes AP e APmod em indiví­duos saudáveis e verificar se há correlação entre esta possí­vel diferença com um encurtamento do músculo í­liopsoas do membro contralateral. Métodos: Foram avaliados 30 indiví­duos saudáveis de ambos os sexos com idade entre 18 e 25 anos, nos quais foram realizados os testes de Thomas, AP e APmod. Foi utilizada a fotogrametria computadorizada para quantificar os testes. Resultados: Após análise estatí­stica, não foi observada diferença entre os valores obtidos nos testes AP e APmod (p > 0,05), nem correlações entre os testes AP e APmod versus o teste de Thomas do membro contra-lateral em ambos os membros. Conclusão: Constatamos que os flexores da coxa contralateral não influenciam na avaliação do comprimento muscular dos isquiotibiais e que não há diferença na medida entre AP e APmod, quando avaliamos indiví­duos saudáveis. Sugerimos novos estudos que avaliem esta real influência em indiví­duos adultos jovens que apresentem encurtamento do músculo í­liopsoas.Palavras-chave: músculo psoas, exame fí­sico, articulação do quadril, biomecânica.

Highlights • Hip muscle weakness in PFP patients may be consequence and not the cause of pain. • Pain and disability may not be associated with kinematics after treatment. • Hip muscle weakness may have no causal relationship with dynamic knee valgus. • The mechanical factors that may impair the management of PFP are likely to be overestimated. • PFP patients should be treated on a biopsychosocial approach., Background Patellofemoral pain is a very common musculoskeletal condition. In the last years, evidence regarding this disease increased exponentially. Although widely investigated, this problem still frustrates patients and clinicians for having an unfavorable prognosis. Some gaps still exist in the understanding and managing of patellofemoral pain. Numerous cross-sectional association studies show an association between gluteus muscular strength and dynamic knee valgus in patients with patellofemoral pain. In spite of this biological plausibility, many evidences challenge the direct relationship between these factors. Recent studies have concluded that women with patellofemoral pain show muscular weakness of the hip based on the cross-sectional studies, however prospective studies indicate that hip weakness cannot be considered a risk for development of patellofemoral pain. In addition, some clinical trials have demonstrated that strength training of the gluteal muscles promotes significant improvement in symptoms but not alter the kinematics of the patients with patellofemoral pain. These findings cast doubt on whether the cause of this condition is really being treated, whether all individuals suffering from patellofemoral pain present dynamic knee valgus or if this is a disturbance present in only a subgroup of patients and whether the strengthening of the hip musculature is an option to consider for prevention of patellofemoral pain. Conclusion Certainly, more studies should be conducted to clarify the influence of mechanical patterns on this condition, but with the existing evidence so far, the importance given to these issues in the evaluation and clinical decision on treatment of these patients seems questionable. Therefore, this masterclass explores the understanding about patellofemoral pain, highlighting mainly the importance of muscular strength and dynamic knee valgus, as well as other possible factors that must be consider during the evaluation and the decision making in these patients.

Introduction Kinesio taping consists of the attachment of a thin elastic tape over specific muscles, the thickness of which is similar to that of the epidermis. Objective The aim of the present study was to compare the effect of Kinesio taping and placebo taping on muscle torque, muscle activity and jumping performance soccer players. Methods Thirty athletes were randomly allocated to two groups (Group A: Kinesio taping and Group B: placebo taping). The participants were instructed to perform the Hop test's and were submitted to an isokinetic evaluation of the knee extensors as well as an electromyographic evaluation of the retus femoris muscle of the dominant lower limb. Next, Kinesio taping was performed for the activation of the rectus femoris muscle in Group A and placebo taping was performed in Group B. The participants were reevaluated 30 minutes after taping and 24 hours after the first evaluation using the same tests. Intra-group and inter-group comparisons were made considering the three evaluation times. Results No statistically significant differences were found between groups at any evaluation time regarding the Hop test's, root mean square of the electromyographic signal or peak torque of the knee extensors of the dominant lower limb (p>0.05). Conclusion Kinesio taping for the activation of the rectus femoris muscle has no effect on peak muscle torque, muscle activity or jumping performance among soccer players.

This study compared the linear parameters between children who are blind and children with low vision. Six children who are blind and five children with low vision, aged between five and seven years (mean = 5.9 years old) were analysed by three-dimensional gait analysis and linear parameters of gait: velocity, cadence, stride length, and step width from 12 gait cycles. The comparison of the numerical variable was made using the Mann-Whitney Test. The only significant difference was found in stride length. The results suggested that an adapted gait provided stability which, in turn, improved balance. This finding seems to indicate the importance of commencing orientation and mobility (O&M) training as soon as possible to improve gait, balance, and movement with children who are blind or have low vision.

Introdução: A mão e o punho são as articulações do membro superior que mais se movimentam, sendo responsáveis por grande parte da função do membro superior. Um dos esportes em que estas articulações mais são solicitadas é o tênis, que exige que todas as articulações do membro superior estejam em harmonia e, para isso, é necessário força muscular suficiente. Objetivos: Comparar a força de preensão palmar e pinça do membro dominante com o não dominante em atletas de tênis; correlacionar estas variáveis com tempo de prática, horas de treinos semanal e idade. Material e métodos: Foram selecionados 32 jogadores amadores do gênero masculino com média de idade de 38,6 anos para a mensuração da força de preensão palmar e pinça. Resultados: Houve uma assimetria significativa entre mão dominante e não dominante nas variáveis: força de preensão palmar e de pinça e não encontramos correlação entre a força de preensão palmar e pinça com o tempo de prática desportiva, idade e horas de treino semanal. Conclusão: A mão dominante apresenta valores maiores de preensão palmar e pinça, porém não há relação dessas variáveis com a prática esportiva.Palavras-chave: dinamômetro, força muscular, tênis.

Introdução: A sí­ndrome da dor femoropatelar (SDFP) constitui uma das alterações musculoesqueléticas mais comuns na prática clí­nica do fisioterapeuta. Dentre as atividades funcionais estudadas destaca-se o salto, movimento muito utilizado como estratégia de reabilitação e como critério de avaliação para alta ambulatorial destes pacientes. Objetivo: Investigar o padrão das alterações cinemáticas dos membros inferiores encontrados durante o salto de indiví­duos com sí­ndrome da dor femoropatelar. Material e métodos: Foi realizada uma busca sistematizada nos bancos de dados eletrônicos: Pedro e Pubmed, onde foram inicialmente selecionados para estudo os ensaios clí­nicos, casos controle, estudos prospectivos e transversais. Resultados: Durante a pesquisa foram pré-selecionados e analisados 191 artigos, após a leitura do resumo foram selecionados 176 e ao final da seleção, três artigos preencheram todos os critérios de inclusão e especificações estabelecidas previamente. Conclusão: A cinemática do salto em mulheres com a sí­ndrome da dor femoropatelar é um assunto que ainda necessita de mais estudos que abordem essa temática, uma vez que o número de trabalhos publicados com esse tema é restrito e aqueles que encontramos não apresentam um consenso no que diz respeito às suas caracterí­sticas cinemáticas.Palavras-chave: fenômenos biomecânicos, salto, sí­ndrome da dor femoropatelar.

Background Patellofemoral pain has a poor long-term prognosis, which can be explained by a pain sensitization process. The pain sensitization process may be related to the increase of stress in the patellofemoral joint that is already associated with kinematic alterations and weakness in the musculature of the hip and knee. Methods Were compared the pressure pain threshold, temporal summation, conditioned pain modulation, angular kinematics, and muscle strength between 26 patellofemoral pain and 24 asymptomatic women and then correlated pain sensitization variables with biomechanical variables in pain group. The pressure pain threshold was determined on seven points of the knee, tibialis anterior muscle, and elbow. Ten consecutive stimuli were performed for temporal summation, and cold water was used as the conditioning stimulus for conditioned pain modulation. The strength of hip and knee muscles was determined using a manual dynamometer. Three-dimensional kinematics were evaluated during the lateral step down, considering peak and excursion values of the movement and the Movement Deviation Profile. Findings The pressure pain threshold of the elbow (2.13 [1.84–2.41] vs. 1.63 [1.25–2] kg/cm2), all sites of the knee were lower, as well as the Movement Deviation Profile was higher (9.33 [9.20–9.46] vs. 12.43 [12.1–12.75]) in the pain group. No difference in temporal summation, conditioned pain modulation, muscle strength and discrete kinematic values were found. No significant correlation was found between the Movement Deviation Profile and pressure pain threshold. Interpretation Biomechanical factors, pain processing, and modulation in women with patellofemoral pain, when different from asymptomatic individuals, are not necessarily associated.

Patients with patellofemoral pain (PFP) present altered activation of the hip and knee muscles. Electromyography (EMG) analyses in PFP patients are usually performed individually for each muscle. However, several studies suggest that the central nervous system may modulate neural commands directed to groups of co-activated muscles, called muscle synergies. Investigating the synergistic organization in PFP will advance our knowledge of the influence of pain on muscle coordination. This study aimed to compare the motor coordination between women with and without PFP during the lateral step down (LSD). 15 women with PFP and 14 asymptomatic women underwent three-dimensional kinematics and EMG assessment during LSD. The Movement Deviation Profile (MDP) was calculated from kinematic data. Muscle synergies were extracted from EMG data of eight lower limb muscles using a non-negative factorization algorithm. Results revealed differences in MDP and an altered synergistic control between women with PFP and asymptomatic while performing the same motor gesture. Particularly, the variability accounted for (VAF) when using 3 synergies to reconstruct EMGs of the PFP group was higher than in the control group, suggesting reduced complexity of motor control in PFP. Detailed synergy analyses highlighted specific differences between groups in vastii and rectus femoris, which are muscles with a crucial role during the squat phase and the transition to rise phase of the LSD. This study shows the ability of muscle synergies analysis to reveal impaired motor coordination in PFP patients, and has the potential to be explored as a complementary tool to current clinical assessment techniques., The study was financed in part by the Coordenação de Aper-feiçoamento de Pessoal de Nível Superior – Brasil (CAPES) –Finance Code 001.

Background: Handgrip strength is currently considered a predictor of overall muscle strength and functional capacity. Therefore, it is important to find reliable and affordable instruments for this analysis, such as the modified sphygmomanometer test (MST). Objectives: To assess the concurrent criterion validity of the MST, to compare the MST with the Jamar dynamometer, and to analyze the reproducibility (i.e. reliability and agreement) of the MST in individuals with Parkinson's disease (PD). Method: The authors recruited 50 subjects, 24 with PD (65.5±6.2 years of age) and 26 healthy elderly subjects (63.4±7.2 years of age). The handgrip strength was measured using the Jamar dynamometer and modified sphygmomanometer. The concurrent criterion validity was analyzed using Pearson's correlation coefficient and a simple linear regression test. The reproducibility of the MST was evaluated with the coefficient of intra-class correlation (ICC 2,1 ), the standard error of measurement (SEM), the minimal detectable change (MDC), and the Bland-Altman plot. For all of the analyses, α≤0.05 was considered a risk. Results: There was a significant correlation of moderate magnitude (r≥0.45) between the MST and the Jamar dynamometer. The MST had excellent reliability (ICC 2,1 ≥0.7). The SEM and the MDC were adequate; however, the Bland-Altman plot indicated an unsatisfactory interrater agreement. Conclusions: The MST exhibited adequate validity and excellent reliability and is, therefore, suitable for monitoring the handgrip strength in PD. However, if the goal is to compare the measurements between examiners, the authors recommend that the data be interpreted with caution.

Background Several clinical effects have been attributed to the use of biofeedback (BF) as an adjuvant in the treatment of women with stress urinary incontinence (SUI). Objectives To determine whether BF is more effective than other interventions for women with SUI in terms of quantification of urine leakage, episodes of urinary loss, quality of life and muscle strength. Data sources Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS from January 2000 to February 2017. Study selection Randomised controlled trials (RCTs) addressing the effects of pelvic muscle floor training (PFMT) with BF for the conservative treatment of women with SUI. Data extraction and data synthesis Two independent assessors extracted data from articles. The risk of bias for individual studies was assessed using the Jadad scale and Physiotherapy Evidence Database (PEDro) scale. Mean differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses. Results In total, 1194 studies were retrieved and 11 were included in this review. Only two RCTs demonstrated a low risk of bias according to the PEDro scale. The results demonstrated that PFMT with BF was no better than alternative interventions in terms of muscle strength measured using a perineometer. Limitations Low methodological quality of studies, heterogeneity of outcomes, and differences in implementation of intervention protocols and BF modalities. Conclusions PFMT with BF does not offer therapeutic benefits over alternative interventions (no training, PFMT alone and vaginal electrical stimulation) for the treatment of female SUI. Systematic review registration number PROSPERO CRD42017060780.

Objetivo. Verificar o efeito da TENS modo burst (TENSb) sobre a espasticidade e a mobilidade de pacientes com hemiparesia após aci­dente vascular cerebral (AVC). Método. Foram selecionados nove indivíduos (6 homens) com média de idade de 61,3±9,3 anos, hemi­paréticos crônicos espásticos. A espasticidade do músculo quadríceps foi avaliada por meio da escala de Ashworth Modificada, pelo teste do pêndulo e seu respectivo índice de relaxamento corrigido (IRC), e pelo teste de Duncan-Ely. A mobilidade foi avaliada pelo teste Time Up and Go (TUG). Foram realizadas quatro aplicações de 30 minutos de TENSb (frequência de 100Hz e duração de pulso de 120μs) em dias consecutivos. Foram feitas avaliações antes e depois das quatro aplicações e após 72 horas da última sessão. Resultados. Houve au­mento do IRC após as aplicações de 0,4±0,2 para 0,9±0,3 (p

Objetivo. Verificar o efeito da TENS modo burst (TENSb) sobre a espasticidade e a mobilidade de pacientes com hemiparesia apos acidente vascular cerebral (AVC). Metodo. Foram selecionados nove individuos (6 homens) com media de idade de 61,3±9,3 anos, hemipareticos cronicos espasticos. A espasticidade do musculo quadriceps foi avaliada por meio da escala de Ashworth Modificada, pelo teste do pendulo e seu respectivo indice de relaxamento corrigido (IRC), e pelo teste de Duncan-Ely. A mobilidade foi avaliada pelo teste Time Up and Go (TUG). Foram realizadas quatro aplicacoes de 30 minutos de TENSb (frequencia de 100Hz e duracao de pulso de 120μs) em dias consecutivos. Foram feitas avaliacoes antes e depois das quatro aplicacoes e apos 72 horas da ultima sessao. Resultados. Houve aumento do IRC apos as aplicacoes de 0,4±0,2 para 0,9±0,3 (p

Diagnosis of lumbar spinal stenosis (LSS) is based on clinical examination and imaging. The aim of this study was to evaluate the influence of 3D gait analysis as a tool in the differential diagnosis of LSS. Fourteen patients participated in the study that consisted of three phases: (1) capture six gait cycles after rest, (2) walk on a treadmill for a maximum of 20 min, (3) capture six gait cycles after effort. From these data, the kinematic variables were compared with the perception of pain and the cross sectional area of the spinal canal as measured by magnetic resonance. Most of correlations were weak and showed that the most significant results are reported by the Gait Deviation Index (GDI). The Gait Deviation Index demonstrated moderate negative correlation with the perception of pain after effort was made by both limbs. This means that there is a significant decrease in the overall function of the lower limbs according to the increase in pain symptoms. This situation may be reflected in decreased cadence and speed beyond the times of single support for the left limb, and the balance of the right limb, as part of a strategy to protect against pain and imbalance. We found no correlation between gait and pain in the cross-sectional area of the spinal canal. Therefore, we believe that there is no advantage for the patient to make a 3-D gait analysis because the analysis does not add relevant information to clinical diagnosis.

The aim of this study was to verify relation between kinematic variables of temporal-spatial parameters and manual ability and between own temporal-spatial variables during the movement of bring a mug to the mouth in adults with dyskinetic cerebral palsy (DCP). Sixteen adults with DCP were evaluated by MACS (Manual Ability Classification System), and by temporal-spatial variables of tridimensional kinematics of the movement to bring a bug to the mouth by means of 9 cameras infra-red Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). The Spearman correlation coefficient (ρ) was used to correlate variables. As a result, we found weak correlation between the classification of manual ability and the adjusting phase (ρ=0.219), the velocity variables - average velocity (ρ=-0.313), peak velocity (ρ=-0.282) and time to peak velocity (ρ=-0.250). No correlation was found between the variables going and returning phase and MACS. Moderate correlation was found between going and returning phase (ρ=0.559), between the going phase and time to peak velocity (ρ=0.518) and between the adjusting phase and peak velocity (ρ=-0.562). A strong correlation was found between the mean velocity and peak velocity (ρ=0.947) and between the adjusting phase and average velocity (ρ=-0.635). In conclusion, functional impairment may be related to longer adjusting phase and decrease of movement speed in subjects with PCD. Kinematic variables were related to each other in moderate and strong way and indicated that the phases runtime influences the movement speed. El objetivo de este estudio fue verificar si hay una relación entre las variables cinemáticas espacio-temporales y la habilidad manual y entre las propias variables espacio-temporales estudiadas durante el movimiento de traer una taza a la boca en adultos con parálisis cerebral tipo discinética (PCD). Dieciséis adultos con PCD fueron sometidos a una evaluación de habilidad manual por medio de la escala MACS (Manual Ability Classification System) y análisis de las variables espacio-temporales de la cinemática tridimensional del movimiento para llevar una taza a la boca por medio de 9 cámaras infrarrojas Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). El coeficiente de correlación de Spearman (r) fue aplicado para verificar la relación entre las variables estudiadas. Como resultado, fue encontrada una débil correlación entre la clasificación de la habilidad manual y la fase de ajuste del movimiento (r=0,219), las variables de velocidad - velocidad media (r=-0,313), velocidad máxima (r=-0,282) y tiempo para alcanzar la velocidad máxima (r=-0,250). No se encontró correlación entre la variable tiempo de ida y la variable de regreso del movimiento y la MACS. Correlación moderada se encontró entre la fase de ida y la fase de regreso del movimiento (r=0,559), entre la fase de ida y el tiempo para alcanzar la velocidad máxima (r=0,518) y entre la fase de ajuste y la velocidad máxima (r=-0,562). Fuerte correlación se encontró entre la velocidad media y la velocidad máxima (r=0,947) y entre la fase de ajuste y la velocidad media (r=-0,635). A modo de conclusión, el perjuicio funcional puede ser relacionado con más tiempo de ejecución de la fase de ajuste y con la reducción de la velocidad del movimiento en sujetos con PCD. Las variables cinemáticas se relacionaban de manera moderada y fuerte e O objetivo deste estudo foi verificar se existe relação entre as variáveis cinemáticas espaçotemporais e a habilidade manual e entre as próprias variáveis espaçotemporais estudadas durante o movimento de levar uma caneca à boca em indivíduos adultos com paralisia cerebral do tipo discinético (PCD). Dezesseis adultos com PCD foram submetidos à avaliação da habilidade manual por meio da escala MACS (Manual Ability Classification System) e análise das variáveis espaçotemporais da cinemática tridimensional do movimento de levar uma caneca à boca por meio de 9 câmeras de infravermelho Vicon(r) MX 40 (Oxford Metrics Group, Oxford, UK). O coeficiente de correlação de Spearman (ρ) foi aplicado para verificar relação entre as variáveis estudadas. Como resultado, foi encontrada fraca correlação entre a classificação da habilidade manual e a fase de ajuste do movimento (ρ=0,219), as variáveis de velocidade - velocidade média (ρ=-0,313), velocidade máxima (ρ=-0,282) e tempo para atingir o pico de velocidade (ρ=-0,250). Não foi encontrada correlação entre a variável tempo de ida e a variável tempo de retorno do movimento e a MACS. Correlação moderada foi encontrada entre a fase de ida e a fase de retorno do movimento (ρ=0,559), entre a fase de ida e o tempo para atingir o pico de velocidade (ρ=0,518) e entre a fase de ajuste e a velocidade máxima (ρ=-0,562). Forte correlação foi encontrada entre a velocidade média e o pico de velocidade (ρ=0,947) e entre a fase de ajuste e a velocidade média (ρ=-0,635). Como conclusão, o prejuízo funcional pode ser relacionado ao maior tempo de execução da fase de ajuste e com a redução da velocidade do movimento em indivíduos com PCD. As variáveis cinemáticas se relacionaram de maneira moderada e forte e indicaram que o tempo de execução das fases influencia a velocidade do movimento.