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The structural and mechanical properties of the Achilles tendon 2 years after surgical repair.

BACKGROUND Acute ruptures of the Achilles tendon affect the tendons structural and mechanical properties. The long-term effects of surgical repair on these properties remain unclear. PURPOSE To evaluate effects of early mobilization versus traditional immobilization rehabilitation programs 2 years after surgical Achilles tendon repair, by comparing force-elongation and stress-strain relationships of the injured tendon to those of the uninjured tendon. METHODS A group of males with previous Achilles tendon rupture (n=18) and a group of healthy male controls (n=9) participated. Achilles tendon rupture group consisted of patients that had received early mobilization (n=9) and patients that had received traditional immobilization with a plaster cast (n=9). Comparisons of tendon structural and mechanical properties were made between Achilles tendon rupture and healthy control groups, and between the uninjured and injured sides of the two rehabilitation groups in Achilles tendon rupture group. Ultrasound was used to determine bilaterally tendon cross-sectional area, tendon resting length, and tendon elongation as a function of torque during maximal voluntary plantar flexion. From these data, Achilles tendon force-elongation and stress-strain relationships were determined. FINDINGS The Achilles tendon rupture group uninjured side was not different from healthy control group. Structural and mechanical parameters of the injured side were not different between the Achilles tendon rupture early mobilization and the immobilization groups. Compared to the uninjured side, the injured side showed a reduction in stress at maximal voluntary force, in Youngs modulus and in stiffness. INTERPRETATION Two years post-surgical repair, the Achilles tendon mechanical properties had not returned to the uninjured contralateral tendon values.

Use of neuromuscular electrical stimulation to preserve the thickness of abdominal and chest muscles of critically ill patients : a randomized clinical trial

OBJECTIVE To evaluate and compare the effects of neuromuscular electrical stimulation combined with conventional physical therapy on muscle thickness in critically ill patients. DESIGN Double-blind, randomized controlled trial. PATIENTS Twenty-five patients participated in the study. METHODS Patients on mechanical ventilation for 24-48 h were randomized to an intervention group (neuromuscular electrical stimulation + conventional physical therapy) or a conventional group (sham neuromuscular electrical stimulation + conventional physical therapy). Primary outcome was thickness of the rectus abdominis and chest muscles, determined on cross-sectional ultrasound images before and after the intervention. RESULTS Eleven patients were included in the intervention group and 14 in the conventional group. After neuromuscular electrical stimulation, rectus abdominis muscle thickness and chest muscle thickness were preserved in the intervention group, whereas there was a significant reduction in thickness in the conventional group, with a significant difference between groups. There was a significant difference between groups in length of stay in the intensive care unit, with shorter length of stay in the intervention group. CONCLUSION There was no change in rectus abdominis and chest muscle thickness in the intervention group. A significant decrease was found in these measures in the conventional group.

Muscle thickness of the pectoralis major and rectus abdominis andlevel of physical activity in chronic hemodialysis patients

INTRODUCTION Patients on chronic hemodialysis tend to lose lean body mass and have sedentary behavior. OBJECTIVE To compare the level of physical activity and the morphology of the muscles pectoralis major and rectus abdominis of patients on hemodialysis with healthy subjects. METHODS We studied 17 patients and 17 healthy individuals. Muscle thickness were evaluated by ultrasound, and the level of physical activity by the International Physical Activity Questionnaire (IPAQ), long version. RESULTS The patients had lower thicknesses of the pectoralis major (5.92 ± 0.35 mm vs. 8.35 ± 0.62 mm, p < 0.001) and rectus abdominis (0.96 ± 0.10 mm vs. 2 21 ± 0.40 mm, p < 0.001) compared to healthy subjects. Patients were physically less active than healthy individuals: 1502.55(788.19-2513.00) MET-minutes/week vs. 2268.0(1680.0-4490,8) MET-minutes/week (p = 0.006); the weekly caloric expenditure of patients was also lower: 1384.0(480,7-2253.7) kcal/kg/week vs. 1680.0(1677.4-4950.0) kcal/kg/week (p = 0.010). The average time spent sitting per week of the patients was higher than in healthy subjects (394.0 ± 33.1 min/day vs. 293.0 ± 38.6, p = 0.009) as well as the average time spent sitting during weekend (460.0 ± 40.1 vs. 201.0 ± 10.7, p = 0.003). CONCLUSION Chronic renal failure patients on hemodialysis have sedentary behavior and lower muscle thickness of the trunk.

Effect of Six-Minute Walk Test on Neuromuscular Properties of Patients with Chronic Obstructive Pulmonary Disease.

The objective of this study was to evaluate the neuromechanical properties of the knee extensor muscles before and after the 6‐minute walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients and control subjects.

Early ambulation using a cycle ergometer on quadriceps muscle morphology in mechanically ventilated critically ILL patients in the intensive care unit: a randomized controlled trial.

Patients in the intensive care unit (ICU) are exposed to prolonged immobility, which leads to loss of muscle mass. One resource that has proved to be of great utility in hospitals is the cycle ergometer, which is a stationary piece of equipment designed to enable cyclical rotations of lower and/or upper extremities and can be used to perform passive, active and resisted exercises.

Use of electrical neuromuscular stimulation to preserve the morphology of abdominal and chest muscles of critical patients: randomized clinical trial

Neuromuscular electrical stimulation (NMES) has been used as an early therapeutic modality at intensive care units (ICUs) to treat patients on invasive mechanical ventilation (IMV) to compensate and/or decrease loss of muscle mass.

Avaliação do torque passivo de flexão plantar e torque ativo de flexão dorsal em ginastas rítmicas e não atletas

O treinamento realizado por atletas de elite acarreta demandas funcionais especificas que produzem mudancas nos tendoes e nas propriedades musculares. Nas atletas de ginastica ritmica (GR) ha uma exigencia maior de controle motor em posicoes extremas de flexao plantar. Esta demanda pode alterar o torque passivo dos flexores plantares bem como influenciar na amplitude de movimento (ADM) de flexao dorsal e torque dos dorsiflexores. No presente estudo foi comparada a ADM de flexao dorsal de GR e meninas nao atletas (MNA), e determinada a correlacao entre o torque passivo dos flexores plantares (TPFP) e o torque ativo dos flexores dorsais (TAFD). O estudo incluiu 10 GR e 10 MNA. A ADM de flexao dorsal foi medida com um goniometro. O TPFP e TAFD foram avaliados por meio de um dinamometro isocinetico em cinco ângulos articulares (20o, 10o, 0o, -10o e -20o). O teste T para amostras independentes foi utilizado para a comparacao entre os grupos (α = 0,05). O coeficiente de correlacao de Pearson indicou uma correlacao negativa alta e moderada entre o TPFP e TAFD para as GR e NA, respectivamente. GR apresentaram menor ADM de flexao dorsal comparadas as MNA. O TPFP foi significativamente maior nas GR comparado as MNA. Por outro lado, o TAFD foi maior nas MNA. A correlacao do TPFP com o TAFD foi de r = -0,82; p < 0,01 e r = -0,68; p < 0,01 para GR e MNA, respectivamente. Os resultados sugerem que a alta demanda mecânica nos flexores plantares na GR aumenta o TPFP que pode influenciar negativamente na ADM dos flexores dorsais e no TAFD.