Eneida Yuri Suda

Ground reaction force in basketball cutting maneuvers with and without ankle bracing and taping

CONTEXT AND OBJECTIVE In basketball, the most common injuries are ankle sprains. For this reason, players frequently use external ankle devices or taping as prophylactic and rehabilitation measures. The purpose of this study was to evaluate ground reaction force (GRF) responses in basketball players while performing typical cutting maneuvers with and without ankle bracing and ankle taping. DESIGN AND SETTING Comparative study with experimental design of single-group repeated measurements, at Medical Rehabilitation Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. METHODS Vertical (Fy) and medial-lateral (Fz) GRF measurements were made under three conditions (taping, Aircast-type orthosis and basketball shoes alone), with analysis of peak forces at foot contact (Fymax1, Fzmax1, Fymax2 and Fzmax2), growth gradient (peak/time) (GG Fymax1, GG Fzmax1, GG Fymax2 and GG Fzmax2) and impulse after foot contact. RESULTS Bracing significantly reduced Fymax2 and GG Fymax2. GG Fzmax1 was significantly higher for the sport shoe condition than for the taping condition. Taping increased Fy in relation to the sport shoe at foot contact, but over a longer time interval, without increasing excessive ankle loading. Fz reached a peak in less time, which might generate greater inversion/eversion loading on a players foot. The Aircast exerted better shock-absorbing effect than did the other two conditions, since it generated less vertical force over longer time intervals and smaller medial-lateral forces in relation to taping. CONCLUSIONS Ankle bracing and ankle taping action mechanisms are still unclear and therefore should be carefully prescribed. More studies are needed to clarify taping and bracing effects on sporting activities.

Comparação dos efeitos da estimulação elétrica nervosa transcutânea e da hidroterapia na dor, flexibilidade e qualidade de vida de pacientes com fibromialgia

Este estudo visou comparar a eficacia da hidroterapia e da estimulacao eletrica transcutânea do nervo (TENS) na melhora da sintomatologia de pacientes com fibromialgia Participaram do estudo 10 sujeitos com fibromialgia (48,8±9,8 anos) divididos em dois grupos: um tratado com hidroterapia e outro com TENS. Todos foram avaliados antes e apos o tratamento quanto a flexibilidade (pelo indice terceiro dedo-solo), dor (por escala visual-analogica), qualidade de vida relacionada a saude (pelos questionarios SF-36 e Nottingham Health Profile - NHP) e tendencia a depressao (pelo Inventario de Beck). Os dados foram tratados estatisticamente, com nivel de significância fixado em p<0,05. O grupo TENS obteve melhora estatisticamente significante na intensidade da dor, na qualidade de vida medida pelo SF-36 e em alguns quesitos do NHP, enquanto a hidroterapia promoveu uma melhora na qualidade de vida medida pelo SF-36. Ambos os tratamentos foram assim eficazes ao melhorar o condicionamento fisico, porem a TENS propiciou melhores resultados quanto a dor e em maior numero das variaveis analisadas do que a hidroterapia, sugerindo ser mais eficaz no tratamento da fibromialgia.The purpose of this study was to compare the effects of hydrotherapy and of transcutaneous electric nerve stimulation (TENS) on symptomology of patients with fibromyalgia. Ten subjects (aged 48.8±9.8 years) with fibromyalgia were divided into two groups, one treated with hydrotherapy, the other with TENS. All were evaluated before and after treatment as to flexibility (by means of the fingertip-to-floor test), pain (by visual analogue scale), health-related quality of life (by the SF-36 and the Nottingham Health Profile - NHP - questionnaires) and trend to depression (by the Becks Depression Inventory). Data were statistically analysed, and significance level set at p<0.05. Results show that patients treated with TENS had significant pain reduction and better quality of life as measured by the SF-36 and some NHP items, while patients treated with hydrotherapy showed improvement in SF-36 scores. It may hence be said that both treatments were efficient in improving physical functioning, but TENS produced better results in relieving pain and in a greater number of variables, suggesting that it is more efficient for treating fibromyalgia.

Relação entre nível geral de saúde, dor musculoesquelética e síndrome de burnout em professores universitários

O objetivo desse estudo foi verificar a relacao entre nivel de saude geral, dor musculoesqueletica, frequencia de sintomas musculoesqueleticos e a sindrome de burnout em professores universitarios. Foram avaliados 50 professores de uma universidade privada. O nivel de saude geral foi verificado pela versao em portugues da Personal Health Scale (PHS-Pt), a dor musculoesqueletica pelo Questionario Nordico de Sintomas Osteomusculares (QNSO) e a presenca da sindrome de burnout pelo questionario Maslach Burnout Inventory - Human Services Survey (MBI-HSS). A maioria dos professores apresentou comprometimento do nivel de saude (escore total PHS-Pt=6,7±3,8), sendo que 70% apresentaram dor no pescoco e 64% na regiao lombar nos ultimos 12 meses. Houve correlacao positiva entre nivel geral de saude e a dimensao exaustao emocional do inventario de burnout. Porem, nao houve correlacao entre as dimensoes do MBI-HSS e dor musculoesqueletica.

Envelhecimento, atividade física, massa corporal e arco plantar longitudinal influenciam no equilíbrio funcional de idosos?

Este estudo visou buscar relacoes entre caracteristicas antropometricas e de equilibrio funcional em uma amostra de 45 idosos fisicamente ativos, relacionando algumas variaveis selecionadas entre si - IMC, faixa etaria, tempo de pratica de atividade fisica, indice do arco longitudinal medial, alcance funcional e escore do teste de Tinetti. Estas relacoes foram investigadas com o intuito de verificar se as variaveis antropometricas, idade e pratica de atividade fisica tem influencia no equilibrio funcional de idosos. O arco longitudinal foi mensurado por meio da impressao plantar e entao classificado de acordo com o Indice do Arco de CAVANAGH E RODGERS (1987). O Indice do Arco apresentou significantes mudancas de acordo com o IMC, tendo uma maior incidencia de pes planos com o IMC ≥ 25 kg/m² (p = 0,0173). O tempo de pratica da atividade fisica ou a idade dos sujeitos nao influenciaram de maneira significativa nas variaveis de equilibrio. A faixa etaria tambem nao influenciou no tipo de pe. O equilibrio funcional de idosos fisicamente ativos nao sofreu influencia do tempo de pratica de atividade fisica, IMC e tipo de arco longitudinal plantar.

An 'Importance' Map of Signs and Symptoms to Classify Diabetic Polyneuropathy: An Exploratory Data Analysis

Aims/Hypothesis Early diagnosis of diabetic polyneuropathy (DPN) is critical for a good prognosis. We aimed to identify different groups of patients, based on the various common clinical signs and symptoms of DPN, that represent a progressive worsening of the disease before the onset of plantar ulceration or amputation. We also sought to identify the most important DPN-related variables that can discriminate between groups, thus representing the most informative variables for early detection. Methods In 193 diabetic patients, we assessed 16 DPN-related signs, symptoms, and foot characteristics, based on the literature and the International Consensus on the Diabetic Foot. We used multiple correspondence analysis and the Kohonen algorithm to group the variables into micro and macro-classes and to identify clusters of patients that represent different DPN conditions. Results Four distinct groups were observed. One group showed no indication of DPN. The remaining groups were characterized by a progressive loss of the vibration perception, without a worsening of symptoms or tactile perception. The 2 intermediate groups presented different aspects of DPN: one showed mostly DPN symptoms and the other showed the incipient vibration impairment, callus and crack formation, and foot arch alteration. The fourth group showed more severe foot and DPN conditions, including ulceration and amputation, absence of vibration and tactile perception (irrespective of how many compromised foot areas), and worse foot deformities and callus and crack formation. Conclusion Vibration perception was more informative than tactile sensitivity in discriminating early DPN onset because its impairment was evident in more groups. Symptoms and callus and cracks did not discriminate the severity status and should be interpreted in association with other clinical variables. Reconsideration of the current screening techniques is needed to clinically determine the early onset of neuropathy using tactile perception.

Mudanças no padrão temporal da EMG de músculos do tornozelo e pé pré e pós-aterrissagem em jogadores de voleibol com instabilidade funcional

INTRODUCTION: The ankle sprain is one of the most common injuries in athletes, including volleyball. 90% of ankle injuries in volleyball occur during landing after a blocking maneuver. The most common complication following ankle sprains is functional instability (FI), a condition that affect about 52% of the patients that suffered an ankle sprains . Functional ankle instability (FI) has been defined as a tendency for the foot to give way after an ankle sprain with no evidence of ligament injury. Hence, FI is an impairing condition for volleyball performance since it interferes in its basic skills. AIMS: The purpose of this study was to compare the EMG activation patterns of tibialis anterior (TA), peroneus longus (PL) and gastrocnemius lateralis (GL) in volleyball players with and without FI during landing after the blocking movement. METHODS: EMG activity was acquired for 21 subjects (mean age 20 ± 4 yrs) with FI (IG) and 19 control ones (CG). Linear envelopes were calculated for both groups for the time period between 200 ms before and 200 ms after the instant of impact, and time and magnitude of peak occurrence were extracted from the envelopes. Groups were compared using T test (α < 0.05). RESULTS: IG subjects showed a later peak occurrence for TA (CG = -107.4 ± 29.6 ms; IG = -134.0 ± 26.0 ms) and PL (CG = -11.0 ± 55.9 ms; IG = -41.7 ± 49.8 ms) and a lower peak magnitude for TA (CG = 68.5 ± 17.2%; FIG = 81.2 ± 28.8%) and PL (CG = 72.9 ± 27.3%; FIG = 59.1 ± 16.0%). CONCLUSIONS: These results suggest that individuals with FI present a later and lower activation pattern of muscular activity and different activation magnitudes that predispose them to ankle sprains, even in the absence of an anatomical damage.INTRODUCTION: The ankle sprain is one of the most common injuries in athletes, including volleyball. 90% of ankle injuries in volleyball occur during landing after a blocking maneuver. The most common complication following ankle sprains is functional instability (FI), a condition that affect about 52% of the patients that suffered an ankle sprains . Functional ankle instability (FI) has been defined as a tendency for the foot to give way after an ankle sprain with no evidence of ligament injury. Hence, FI is an impairing condition for volleyball performance since it interferes in its basic skills. AIMS: The purpose of this study was to compare the EMG activation patterns of tibialis anterior (TA), peroneus longus (PL) and gastrocnemius lateralis (GL) in volleyball players with and without FI during landing after the blocking movement. METHODS: EMG activity was acquired for 21 subjects (mean age 20 ± 4 yrs) with FI (IG) and 19 control ones (CG). Linear envelopes were calculated for both groups for the time period between 200 ms before and 200 ms after the instant of impact, and time and magnitude of peak occurrence were extracted from the envelopes. Groups were compared using T test (α < 0.05). RESULTS: IG subjects showed a later peak occurrence for TA (CG = -107.4 ± 29.6 ms; IG = -134.0 ± 26.0 ms) and PL (CG = -11.0 ± 55.9 ms; IG = -41.7 ± 49.8 ms) and a lower peak magnitude for TA (CG = 68.5 ± 17.2%; FIG = 81.2 ± 28.8%) and PL (CG = 72.9 ± 27.3%; FIG = 59.1 ± 16.0%). CONCLUSIONS: These results suggest that individuals with FI present a later and lower activation pattern of muscular activity and different activation magnitudes that predispose them to ankle sprains, even in the absence of an anatomical damage.

Muscle fiber conduction velocity in different gait phases of early and late-stage diabetic neuropathy

We investigated the muscle fiber conduction velocity (MFCV) during gait phases of the lower limb muscles in individuals with various degrees of diabetic peripheral neuropathy (DPN). Forty-five patients were classified into severity degrees of DPN by a fuzzy model. The stages were absent (n=11), mild (n=14), moderate (n=11) and severe (n=9), with 10 matched healthy controls. While walking, all subjects had their sEMG (4 linear electrode arrays) recorded for tibialis anterior (TA), gastrocnemius medialis (GM), vastus lateralis (VL) and biceps femoris (BF). MFCV was calculated using a maximum likelihood algorithm with 30ms standard deviation Gaussian windows. In general, individuals in the earlier stages of DPN showed lower MFCV of TA, GM and BF, whilst individuals with severe DPN presented higher MFCV of the same muscles. We observed that mild patients already showed lower MFCV of TA at early stance and swing, and lower MFCV of BF at swing. All diabetic groups showed a markedly reduction in MFCV of VL, irrespective of DPN. Severe patients presented higher MFCV mainly in distal muscles, TA at early and swing phases and GM at propulsion and midstance. The absent group already showed MFCV of VL and GM reductions at the propulsion phase and of VL at early stance. Although MFCV changes were not as progressive as the DPN was, we clearly distinguished diabetic patients from controls, and severe patients from all others.

Reduced complexity of force and muscle activity during low level isometric contractions of the ankle in diabetic individuals

Background: This study evaluated the structure and amount of variability of surface electromyography (sEMG) patterns and ankle force data during low‐level isometric contractions in diabetic subjects with different degrees of neuropathy. Methods: We assessed 10 control subjects and 38 diabetic patients, classified as absent, mild, moderate, or severe neuropathy, by a fuzzy system based on clinical variables. Multichannel sEMG (64‐electrode matrix) of tibialis anterior and gastrocnemius medialis muscles were acquired during isometric contractions at 10%, 20%, and 30% of the maximum voluntary contraction, and force levels during dorsi‐ and plantarflexion were recorded. Standard deviation and sample entropy of force signals were calculated and root mean square and sample entropy were calculated from sEMG signals. Differences among groups of force and sEMG variables were verified using a multivariate analysis of variance. Findings: Overall, during dorsiflexion contractions, moderate and severe subjects had higher force standard deviation and moderate subjects had lower force sample entropy. During plantarflexion, moderate subjects had higher force standard deviation and all diabetic subjects had lower entropy. Tibialis anterior presented higher root mean square in absent group and lower entropy in mild subjects. For gastrocnemius medialis, entropy was higher in severe and lower in moderate subjects. Interpretation: Diabetic neuropathy affects the complexity of the neuromuscular system during low‐level isometric contractions, reducing the systems capacity to adapt to challenging mechanical demands. The observed patterns of neuromuscular complexity were not associated with disease severity, with the majority of alterations recorded in moderate subject. Highlights:Complexity was assessed with sample entropy as a measure of variability temporal construct.Higher amount of variability and lower force complexity were present in diabetics.Lower complexity of EMG of tibialis anterior was observed in diabetics.The majority of alterations in force complexity were observed in moderate cases.Neuromuscular complexity alterations were not associated with neuropathy severity.

Influence of ankle devices in the jump and landing biomechanical responses in basketball

FUNDAMENTOS E OBJETIVO: O segmento mais frequentemente lesado no basquetebol e o tornozelo, sendo a entorse por inversao a lesao mais comum. Para evita-la, e comum o uso de implementos. O objetivo deste estudo foi avaliar a forca reacao do solo (FRS) em jogadores de basquete durante execucao do salto em tres situacoes: uso de tenis, bandagem e tenis, e tenis e ortese tipo Aircast. METODOS: Oito atletas foram analisados durante o salto, atraves de uma plataforma de forca, nas tres situacoes citadas, para analise das componentes vertical e horizontal medio-lateral da FRS. RESULTADOS E CONCLUSAO: Nao houve diferenca estatistica significativa entre as tres situacoes na componente vertical da FRS durante o salto, embora o uso de bandagem tenda a apresentar, na impulsao, maiores valores do pico de forca vertical (3,10 ± 0,46PC; 3,01 ± 0,39PC; 3,03 ± 0,41PC) e do gradiente de crescimento (GC) (12,33 ± 12,21PC; 8,16 ± 3,89PC; 8,46 ± 3,85PC), e durante a aterrissagem, menores valores de pico de forca vertical (5,18 ± 1,35PC; 5,56 ± 1,31PC; 5,49 ± 1,44PC) e do GC (88,83 ± 33,85PC; 95,63 ± 42,64PC; 94,53 ± 31,69PC). Durante a impulsao, a forca medial do salto com Aircast foi significativamente menor que com tenis (p = 0,0249) e apresentou valor semelhante ao do uso da bandagem, enquanto a forca lateral foi significativamente maior com a bandagem do que com tenis (p = 0,0485) e tendeu a ser maior do que o Aircast. Na aterrissagem o componente medio-lateral da FRS ficou inalterado nas tres situacoes. Concluiu-se que a bandagem potencializou a forca direcionada ao salto vertical durante a impulsao, porem nao estabilizou tanto quanto o Aircast os movimentos de inversao e eversao do pe. Durante a aterrissagem, os implementos nao foram efetivos para reduzir a forca medio-lateral, mas com a bandagem, houve um tempo maior para absorcao do impacto.Bases and objective: The segment most frequently injured in basketball is the ankle, being the inversion sprain the most common lesion. In order to avoid it, ankle devices are frequently used. The objective of this study was to evaluate the ground reaction force (GRF) in basketball players during jump performance in three situations: use of basketball sport shoes, sport shoes with bracing and sport shoes with Aircast-type orthosis. Methods: Eight athletes were analyzed during jump through a force platform in the three situations mentioned for the analysis of the medial-lateral vertical and horizontal components of the ground reaction force. Results and conclusion: No significant statistical differences between the three situations were verified in the vertical ground reaction force during jump, although the use of bracing trends to present, during impulsion, higher peak values of the vertical force (3.10 ± 0.46PC; 3.01 ± 0.39PC; 3.03 ± 0.41PC) and the growth gradient (GC) (12.33 ± 12.21PC; 8.16 ± 3.89PC; 8.46 ± 3.85PC), and during landing, lower peak values of the vertical force (5.18 ± 1.35PC; 5.56 ± 1.31PC; 5.49 ± 1.44PC) and the GC (88.83 ± 33.85PC; 95.63 ± 42.64PC; 94.53 ± 31.69PC). During impulsion, the jump medial force with Aircast was significantly lower than with sport shoes (p = 0.0249) and presented values similar to values obtained with the use of bracing, while the lateral force was significantly higher with bracing than with the use of the sport shoes (p = 0.0485) and trended to be higher than with the use of the Aircast. In the landing, the medial-lateral component of the ground reaction force remained unchanged in the three situations. One concludes that the use of bracing has potentialized the force towards the vertical jump during impulsion, however, it did not stabilize the foot inversion and eversion movements as much as the Aircast. During landing, the devices were not effective to reduce the medial-lateral force, however, with the use of the bracing, a longer time for the impact absorption was verified.

Management of neuropathy musculoskeletal deficits is much more than general global exercises: physiotherapy-based programs for diabetes long-term complications

to the editor: We read with interest the Physiology in Medicine review by Allen et al. ([1][1]) on the role of the neuromuscular consequences of diabetic neuropathy (DPN). Three main points in the review deserve attention and should be further discussed. First, DPN-related motor unit (MU) loss is