Karina Gramani-Say

Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function

BACKGROUND Osteoarthritis (OA) is a chronic-degenerative disease. The knee is the most commonly affected joint and the symptoms are generally attributed to quadriceps muscle weakness. However, few studies have evaluated this relationship in a population with early stages of knee OA. OBJECTIVE To investigate whether a correlation among the knee extensor torque and the three subscales of the WOMAC questionnaire in men with early stages of knee OA exists. METHOD Twenty-one men with knee OA grades I or II (according to Kellgren and Lawrence criteria) participated in this study. The concentric and eccentric knee extensor torque were assessed using a Biodex System 3 Pro® isokinetic dynamometer, at a speed of 90º/s. Self-reported symptoms and disability were assessed using the WOMAC questionnaire. Spearmans correlation coefficient was used to test the relationship between the dependent variables (three subscales of WOMAC questionnaire) and the independent variables (average knee extensor peak torque). RESULTS We found a strong negative correlation between the concentric extensor torque and pain (r=-0.7, p<0.001) and a moderate and negative correlation among the concentric extensor torque and stiffness (r=-0.62, p=0.002) and physical function (r=-0.54, p=0.011). Eccentric extensor torque presented a moderate and negative correlation with the three subscales of the WOMAC (r=-0.40 to 0.69, p<0.05). CONCLUSIONS The concentric and eccentric knee extensor torque is significantly correlated with self-report symptoms of patients in initial stages of knee OA. Therefore, the strengthening of the quadriceps muscles, through concentric and eccentric exercise is indicated for these patients in order to minimize these symptoms.

A influência da altura do step no exercício de subida posterior: estudo eletromiográfico em indivíduos sadios e portadores da síndrome da dor femoropatelar

The aim of this study was to evaluate the influence of the step height in the electric activity of the vastus medialis oblique (VMO), vastus lateralis longus (VLL) e vastus lateralis oblique (VLO) on backward step-up exercise. Twenty-seven females, being 15 healthy (21.13 ± 2.17 years old) and 12 with Patellofemoral Pain Syndrome PPS (21.08 ± 2.31 years old) have participated in the study. The electric activity was recorded by surface electrodes. The volunteers performed the backward step-up exercise in two different heights: with the knee joint flexion at 45o and at 75o. The whole electric signal normalized by the average of repetitions was used to study the VMO:VLO and VMO:VLL activation ratio. The two-way ANOVA and Duncan post hoc (p < 0.05) showed that in the PPS group, the VMO: VLO and VMO: VLL ratio was greater at 45o than at 75o angle. In the Control group, the VMO: VLO ratio was greater at 45o than at 75o, while the VMO: VLL ratio was greater at 75o. The results of this study suggest that backward step-up exercise at 45o can be used for PPS treatment programs because it activated the VMO muscle in a more selective way.

Male subjects with early-stage knee osteoarthritis do not present biomechanical alterations in the sagittal plane during stair descent

Patients with osteoarthritis (OA) of the knee show a loss of functional independence due to difficulty performing tasks that require high demand of the knee joint, such as descending stairs. However, it is unclear how muscular and biomechanical changes were present in patients with OA in the early stages. Thus, the purpose of this study was to analyze the kinetics, kinematics and muscle activation of men with early-stage knee OA during stair descent and compare them with a healthy control group. We evaluated 31 volunteers who were divided into two groups. The Osteoarthritis Group (OAG) included 17 men with grade I or II knee OA (53 ± 6 years) and the Control Group (CG) included 14 healthy men (50 ± 6 years). We performed a kinematic evaluation of stair descent in the sagittal plane in order to analyze knee flexion angles. Electromyography (EMG) of the vastus lateralis muscle was also performed and the vertical ground reaction force was measured. The WOMAC questionnaire was administered to all volunteers. Statistical analysis consisted of the nonparametric Mann-Whitney U test for intergroup comparisons of all variables (p>0.05). There were no significant kinematic, kinetic or EMG differences between groups. For the WOMAC, the intergroup differences were significant in all three sections (pain: p=0.001, stiffness: p=0.008 and function: p=0.0005). In men with knee OA grade I or II, the stair decent is preserved in the sagittal plane, indicating that at these stages of the disease the functional adaptations are not expressed.

Efeito da rotação do quadril na síndrome da dor femoropatelar

ABSTRACTEffect of Hip Rotation on Patellofemoral Pain Syndrome Objective: The purpose of this study was to evaluate the effect of hip rotation on the electrical activity of the Vastus MedialisObliquus (VMO), Vastus Lateralis Obliquus (VLO) and Vastus Lateralis Longus (VLL) muscles when squatting with 45o kneeflexion, in association with the neutral position, 45o lateral rotation and 15 and 30o medial hip rotation. Method: 27 women wereevaluated: 15 healthy women as a control group (21.1 ± 2.1 years) and 12 subjects with patellofemoral pain syndrome (PFPS)(21.0 ± 2.3 years). The electrical activity of the quadriceps muscle was detected using simple active differential surface electrodes,an eight-channel electromyography system and the Aqdados 7.2.6 software. The data were normalized by the mean squattingpercentage at 75o with the hip in the neutral position – RMS (μV). Two-way ANOVA with repeated measurements followed bythe Tukey post hoc test (p≤0.05) was used for statistical analysis. Results: The results revealed interaction between groups andmuscles (p=0.00), independent of hip position (p=0.39), and there was no interaction between groups and hip positions (p=0.96).The VMO and VLL muscles of the PFPS group showed significantly greater electrical activity than did VMO (p=0.00) and VLL(p=0.04) muscles from the control group. On the other hand, the electrical activity of the VLO muscle did not present any sig-nificant difference between the groups (p=0.99). Conclusion: Under the experimental conditions utilized, the results suggestedthat hip rotation did not alter the electrical activity of the quadriceps portions in either group when squatting with 45o knee flexion.

Men with Early Degrees of Knee Osteoarthritis Present Functional and Morphological Impairments of the Quadriceps Femoris Muscle

ObjectiveQuadriceps muscle weakness is common in knee osteoarthritis (OA). Reasons for weakness may include atrophy, reduction in the muscle fibers number, and changes in the muscle activation. It is uncertain when these muscular changes begin to appear. Therefore, the purpose of this study was to determine whether men with early stages of knee OA already had functional and quadriceps muscle morphologic alterations. DesignForty men were divided into two groups: control group (healthy subjects) and OA group (subjects with knee OA). A biopsy of the vastus lateralis muscle was performed for morphometric analysis. Isokinetic evaluation of knee extensor torque, concentric and eccentric (90 and 180 degrees/sec), was performed simultaneously with vastus lateralis electromyographic activity evaluation. ResultsSignificant differences were found in knee extensor torque (P < 0.05) and in normalized root mean square (P < 0.01) during the eccentric contractions (both velocities), with higher values for the control group. No differences were found during concentric contractions. The OA group presented greater values of the minimum diameter of type 1 fibers and greater proportion and relative cross-sectional area of type 2b fibers (P < 0.05). ConclusionsMen with early stages of knee OA do not present alterations of concentric strength but had decreased eccentric strength and morphologic quadriceps muscle changes, indicating neuromuscular adaptations.

Measuring postural control during mini-squat posture in men with early knee osteoarthritis

Studies have suggested a compromised postural control in individuals with knee osteoarthritis (OA) evidenced by larger and faster displacement of center of pressure (COP). However, quantification of postural control in the mini-squat posture performed by patients with early knee OA and its relation to muscle strength and self-reported symptoms have not been investigated. The main aim of this cross-sectional, observational, controlled study was to determine whether postural control in the mini-squat posture differs between individuals with early knee OA and a control group (CG) and verify the relation among knee extensor torque (KET) and self-reported physical function, stiffness and pain. Twenty four individuals with knee OA grades I and II (OAG) (mean age: 52.35±5.00) and twenty subjects without knee injuries (CG) (mean age: 51.40±8.07) participated in this study. Participants were assessed in postural control through a force plate (Bertec Mod. USA), which provided information about the anterior-posterior (AP) and medial-lateral (ML) COP displacement during the mini-squat, in isometric, concentric and eccentric knee extensor torque (KET) (90°/s) through an isokinetic dynamometer (BiodexMulti-Joint System3, Biodex Medical Incorporation, New York, NY, USA), and in self-reported symptoms through the WOMAC questionnaire. The main outcomes measured were the AP and ML COP amplitude and velocity of displacement; isometric, concentric, and eccentric KET and self-reported physical function, stiffness and pain. No significant differences were found between groups for postural control (p>0.05). Significant lower eccentric KET (p=0.01) and higher scores for the WOMAC subscales of pain (p=<0.001), stiffness (p=0.001) and physical function (p<0.001) were found for the OAG. Moderate and negative correlations were found between the AP COP amplitude of displacement and physical function (ρ=-0.40, p=0.02). Moderate and negative correlations were observed between the AP COP velocity of displacement and physical function (ρ=0.47, p=0.01) and stiffness (ρ=-0.45, p=0.02). The findings of the present study emphasize the importance of rehabilitation from the early degrees of knee OA to prevent postural instability and the need to include quadriceps muscle strengthening, especially by eccentric contractions. The relationship between the self-reported symptoms and a lower and slower COP displacement suggest that the postural control strategy during tasks with a semi-flexed knee should be further investigated.

Water- versus land-based treatment for postural control in postmenopausal osteoporotic women: a randomized, controlled trial

Abstract Objective: To compare the effects of water-based and land-based physical therapy on postural control of older women with osteoporosis. Methods: Thirty-six postmenopausal women with osteoporosis were allocated into two groups: land-based or water-based. Volunteers received 12 weeks of a supervised land-based or water-based physical therapy treatment. The outcome measure was postural control of the body during quiet standing on upright stance (eyes opened and closed), tandem and one-limb stance on a force plate. A two-way ANOVA with a Tukey HSD post-hoc test were used to highlight differences between pre- and post-intervention evaluations. Effect sizes were measured with Cohen d coefficient. For all variables, a level of 5% of significance was adopted. Results: Significant improvements at tandem (p < 0.05, effect sizes from −0.67 to −1.35) and one-limb stance (p < 0.05, effect sizes from −0.76 to −1.03) for women carrying out water-based treatment were observed. Land-based treatment did not present significant improvement. Conclusions: Group-based water-based physical therapy treatment may be more effective than land-based therapy to improve postural control at one-limb stance in women with osteoporosis.

Expression of receptors of advanced glycation end product (RAGE) and types I, III and IV collagen in the vastus lateralis muscle of men in early stages of knee osteoarthritis.

Abstract Alterations in the contractile and non-contractile proteins of the skeletal muscle may reduce muscle function in knee osteoarthritis (OA), and the formation and accumulation of advanced glycation end products, particularly in collagen, can influence the quality of these muscle proteins. The objective of this study was to evaluate the reactivity of types I, III and IV collagen and the expression and localization of receptor for advanced glycation end products (RAGE) in the vastus lateralis (VL) muscle in early stages of knee OA. The hypothesis was that these patients present a higher expression of RAGE and increased immunoreactivity in the collagen. Thirty-five men were divided into two groups: the control group (CG; n = 17) and the osteoarthritis group (OAG; n = 18). All participants were submitted to a biopsy of the VL. The muscle samples were analyzed by immunohistochemistry for collagen and for RAGE and laminin. The expression of RAGE was counted (intracellular, extracellular and total). Students t-test for independent samples and Mann–Whitney U test were used for the RAGEs intergroup analysis (α ≤ 0.05). A semiquantitative analysis was performed to assess the collagen reactivity. No significant differences were observed in the intracellular, extracellular or total localization of RAGE (p > 0.05). Higher immunoreactivity was observed in the OAG for all types of collagen, with more reactivity for collagen III and IV. We concluded that in the initial stages of knee OA, no differences were observed for RAGE levels between the groups. However, the OAGs higher collagen expression may represent adaptations for reducing muscle stiffness and avoiding injury.

Falls and Postural Stability in Older Individuals: Implications for Activities of Daily Living

The risk of falling is associated with aging-related motor and sensory declines. In fact, a higher incidence of falls has been observed in individuals of over 60 years who are known to have balance problems. The current knowledge regarding the mechanisms involved in the recovery of postural orientation and body equilibrium shows that the main changes occur as individuals become older and in those who are sedentary or are affected by some diseases. Extensive research and preventive efforts regarding the causes and consequences of falling have been conducted to better understand this issue. Fortunately, older individuals who practice regular physical activity present a healthy lifestyle and a lower risk and incidence of falling which may be associated with functioning of the postural control system. Recently, public health policies have been adopted by many countries in order to improve the quality of life of older individuals and reduce the high number of fallers among the elderly.

Static postural sway of women with and without fibromyalgia syndrome: A cross-sectional study

Background There is a frequent complaint about balance problems among fibromyalgia syndrome patients; however, there are not enough studies that have shown static postural sway of women with fibromyalgia syndrome. This study aimed to compare static postural sway of women with and without fibromyalgia syndrome. Methods This is a cross‐sectional study in which twenty‐nine women with fibromyalgia syndrome and 20 without took part. A posturography evaluation was performed in six different situations (bipedal, right tandem and left tandem, with eyes opened and closed), and questionnaires for clinical depression symptoms, clinical anxiety symptoms, sleep quality, and Visual Analogue Scales for Pain and Fatigue were applied. Mann‐Whitney U test was used to check differences among groups; Wilcoxon matched‐pair test was used to check differences intragroup; Cohen d coefficient was used to measure effect sizes and Pearson Correlation Coefficient was used for correlations among variables. Level of significance adopted was 5%. Findings Women with fibromyalgia syndrome have presented worse postural sway than women without fibromyalgia syndrome in all situations (P < 0.05), and worse scores in all questionnaires (P < 0.05). In the eyes closed situations, women with fibromyalgia syndrome presented worse postural sway than women without in the same conditions. Interpretation Women with fibromyalgia syndrome have worse performance in the static posture test, more prominent in reduced support bases with eyes closed. Pain, fatigue, depression and anxiety may have directly influenced postural sway in fibromyalgia syndrome patients. HighlightsWomen with fibromyalgia have worse postural control than healthy age‐matched women.This behavior is better observed in reduced support bases with vision suppression.Pain, fatigue, depression and anxiety are related to this worse performance.