Freddy Beretta Marcondes

Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players

BACKGROUND Previous studies have shown a relationship between shoulder posterior capsule tightness and shoulder pain in overhead athletes. However, this relationship has not been studied in tennis players. OBJECTIVES Assessment of the shoulder range of motion (ROM), strength and posterior capsule tightness of skilled amateur tennis players who had complaints of dominant shoulder pain in comparison with tennis players without pain. METHOD Forty-nine skilled amateur tennis players were distributed in 2 groups: Control Group (n=22) and Painful Group (n=27). The first group was composed of asymptomatic subjects, and the second was composed of subjects with shoulder pain on the dominant side. These groups were evaluated to determine the dominant and non-dominant shoulder ROM (internal and external rotation), isometric shoulder strength (internal and external rotation) and posterior shoulder tightness by blind evaluators. RESULTS The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (p<0.05). The intragroup analysis (dominant versus non-dominant) in the Painful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (p<0.05). CONCLUSIONS The tennis players with pain in the dominant shoulder presented greater posterior capsule tightness, internal rotation deficit (ROM), external rotation gain (ROM) and deficits in external rotation strength than the tennis players without pain.

Combined Therapy (Ultrasound and Interferential Current) in Patients with Fibromyalgia: Once or Twice in a Week?

BACKGROUND AND PURPOSE Combined Therapy (CT) composed of ultrasound and Interferential Therapy has been reported as a cost-effective, local analgesic intervention on tender points in Fibromyalgia (FM). This study aims to investigate the difference between CT applied once a week and twice a week in patients with FM. METHOD Fifty patients with the diagnosis of FM were randomized into two groups (G1 = once a week treatment and G2 = twice a week treatment) with each group containing 25 patients. All eighteen tender points were assessed and treated with CT during each session, over a three-month time period. Interferential Therapy was modulated at 4,000 Hz of current carrier, 100 Hz of amplitude modulated frequency and at a bearable sensorial threshold of intensity. Pulsed ultrasound of 1 MHz at 20% of 2.5 W/cm² was used. For evaluation, the Visual Analogue Scale, Fibromyalgia Impact Questionnaire, Post Sleep Inventory and the tender point count were utilized, and the examiner was blinded to the group assignments. RESULTS G1 and G2 showed a significant improvement in Visual Analogue Scale (p < 0.0001 and p < 0.0005, respectively), Tender Points (p < 0.005 and p < 0.001, respectively), Fibromyalgia Impact Questionnaire and Post Sleep Inventory (p < 0.005 and p < 0.05, respectively). However, there was no significant difference between the two groups in all performed analyses. CONCLUSION There is no advantage in increasing the number of sessions of combined therapy in terms of reducing generalized pain, quality of life and sleep quality for patients with FM.

Comparison of peak torque, intensity and discomfort generated by neuromuscular electrical stimulation of low and medium frequency

BACKGROUND AND PURPOSE: Neuromuscular electrical stimulation (NMES) is an important tool in clinical practice to improve the recruitment of motor units. Optimal forms of NMES, as well as the optimal frequency to achieve the highest torque with the least possible discomfort are not well established. This study was designed to compare maximum electrically-induced torque (MEIT) in the quadriceps, the maximum intensity tolerated by the subject, and the level of discomfort generated by three types of stimulation. METHODS: Thirty subjects (mean age of 25.0 ± 3.0 years) participated in the study. Each subject was submitted to three currents: medium frequency (2500 Hz) modulated in low frequency (Russian Current), and two currents of low frequency (50 Hz), i.e. without an intrapulse interval (FES), and another with an intrapulse interval of 100 µs (VMS). The maximum voluntary isometric torque (MVIT) of the quadriceps was measured. The MEIT, the level of discomfort, and the maximum intensity reached were also measured while applying the three types of NMES. The order of the tests was randomized and the torque was normalized in relation to MVIT. RESULTS: The results showed no significant difference between the three types of NMES in relation to the generated torque. However, the subjects were able to tolerate a significantly higher intensity with the medium frequency current, and suffered less discomfort when compared to subjects exposed to low frequency currents. CONCLUSION: Russian Current, FES, and VMS can be used clinically in order to increase the torque of the quadriceps muscle. However, we suggest using the Russian Current in the early stages of a rehabilitation protocol because it showed better tolerance by the participants with less discomfort.

Efeito imediato da utilização da joelheira elástica em indivíduos com osteoartrite

BACKGROUND Knee osteoarthritis (KOA) is one of the major reasons for seeking medical and physical therapy services, because it usually causes difficulties in performing daily life activities. There are several types of treatment, with varied results. The use of knee sleeve as an adjuvant resource has been controversial in the literature. OBJECTIVE To assess the immediate efficacy of elastic knee sleeve on pain and functional capacity of individuals with KOA. METHODS Seventy-four patients (132 knees) with symptomatic KOA were assessed by use of the Stair Climb Power Test (SCPT), Timed Up and Go (TUG) and 8-Meter Walk (8MW) tests, in addition to the VAS for pain. The tests were performed with and without knee sleeves, with a cover on the knees to hide knee sleeve. The order and the presence of the knee sleeve were randomized, and the investigator was blind. RESULTS A statistically significant difference was found between the two compared circumstances (with and without knee sleeve) when using the VAS (P < 0.001), which showed a reduction in pain with the knee sleeve use. Analyses of the three functional tests under both circumstances were performed, resulting in statistically significant differences in 8MW and TUG tests (P < 0.05), but not in SCPT (P > 0.1339). CONCLUSION The elastic knee sleeve proved to be effective to immediately improve the functional capacity and pain of individuals with KOA, because it enhanced performance during the tests proposed. Thus, the knee sleeve is an adjuvant resource for treating KOA, because it is practical, useful, and of easy clinical use, and can aid in the practice of therapeutic exercises.

Força do manguito rotador em indivíduos com síndrome do impacto comparado ao lado assintomático

Objective: To evaluate the strength of internal rotation, external rotation and elevation of the shoulders of symptomatic compared with asymptomatic patients, associating muscle strength with joint function. Methods: Forty-eight individuals diagnosed with unilateral SIS were evaluated in relation to isomeric muscle strength of symptomatic and asymptomatic shoulders (using a hand-held isometric dynamometer), in addition to evaluating function using the Constant-Murley scale. The subjects were divided into 2 groups: group 1 = 35 to 49 years, group 2 = 50 to 65 years. Results: A reduction in strength of internal rotation, external rotation and elevation of the symptomatic shoulder were found, compared with the asymptomatic side (p <0.0001), but there was no reduction in the strength of medial rotation in the subjects of group 1. It was observed that muscle strength is directly proportional to shoulder function, with individuals with little strength of the rotator cuff having less function. Conclusion: SIS causes decreased muscle strength of internal rotation, external rotation and elevation compared with the asymptomatic side. It also causes decreased shoulder function. The reduced function is proportional to the decrease in muscle strength of the rotator cuff. Level of evidence: level III, analytical study.

Tradução e adaptação cultural do Rowe score para a língua portuguesa

OBJECTIVE: To translate and culturally adapt the Rowe score for use in Brazil. METHODS: The translation and cross-cultural adaptation process initially involved the steps of translation, synthesis, back-translation and revision by the Translation Group. The pre-final version of the questionnaire was then created. The Stability and Function fields were applied to 20 patients with anterior shoulder luxation, and the Mobility field was applied to 20 health professionals. RESULTS: It was found that some of the patients had difficulty understanding some of the expressions of the questionnaire, so these were replaced with terms that were easier to understand. All health professionals understood the translation of the Mobility field. The altered questionnaire was then reapplied to another 20 patients, and this time it was understood by all the assessed subjects. CONCLUSION: After a careful process of translation and cultural adaptation, a definitive version of the Rowe questionnaire was obtained in Brazilian Portuguese. Level of Evidence II, Development of diagnostic criteria on consecutive patients.

Construct and discriminant validity of STarT Back Screening Tool – Brazilian version

Highlights • SBST-Brazil showed a moderate to good correlation with disability tools.• SBST-Brazil demonstrated weak correlations with fear-avoidance beliefs.• SBST-Brazil discriminates LBP patients with disability and fear-avoidance beliefs.

TranslaTion To PorTuguese language and cross-culTural adaPTaTion of The modified roWe score for oVerhead aThleTes

Objetctive: Study was to translate and culturally adapt the modified Rowe score for overhead athletes. Methods: The translation and cultural adaptation process initially involved the stages of translation, synthesis, back-translation, and revision by the Translation Group. It was than created the pre-final version of the questionnaire, being the areas “function” and “pain” applied to 20 athletes that perform overhead movements and that suffered SLAP lesions in the dominant shoulder and the areas “active compression test and anterior apprehension test” and “motion” were applied to 15 health professionals. Results: During the translation process there were made little modifications in the questionnaire in order to adapt it to Brazilian culture, without changing the semantics and the idiomatic concept originally described. Conclusion: The questionnaire was easily understood by the subjects of the study, being possible to obtain the Brazilian version of the modified Rowe score for overhead athletes that underwent surgical treatment of the SLAP lesion.