Mariana Arias Avila

Electrical stimulation and isokinetic training: effects on strength and neuromuscular properties of healthy young adults

OBJETIVO: Verificar os efeitos da estimulacao eletrica neuromuscular (EENM) associada a um programa de treinamento isocinetico em homens e mulheres jovens e sadios. METODOS: Vinte individuos (dez homens, dez mulheres, 21±1,5 anos) submeteram-se a um programa de treinamento isocinetico de ambos os seus extensores de joelho (tres series de dez repeticoes concentricas a 30°/s) duas vezes por semana por quatro semanas. Um membro foi submetido apenas ao treinamento de forca isocinetico (Ex) enquanto o outro foi submetido ao mesmo treinamento, mas com EENM associada a cada contracao (Ex+EENM). A corrente utilizada para a EENM foi a corrente russa (frequencia de 2.500Hz, 50 bursts/s, duracao de pulso de 200µs). O protocolo de avaliacao incluiu o torque extensor isometrico e isocinetico concentrico a 30°/s. RESULTADOS: Os grupos aumentaram seu pico de torque em ambas as modalidades testadas, sem diferenca entre Ex e Ex+EENM. O ângulo do pico de torque aumentou para o membro Ex, mostrando uma alteracao da relacao comprimento-tensao do grupo muscular testado, o que nao aconteceu com o membro Ex+EENM. Houve tambem uma diminuicao no tempo de aceleracao de ambos os membros, sem efeito da EENM sobre este parâmetro. CONCLUSOES: Estes resultados mostraram que a associacao entre a EENM e o treinamento voluntario isocinetico concentrico nao melhorou os ganhos de forca e de propriedades neuromusculares do proprio treinamento de forca voluntario para sujeitos jovens e sadios de ambos os generos.

Functional and morphological changes in the quadriceps muscle induced by eccentric training after ACL reconstruction

OBJECTIVES The purpose of this study was to investigate the contributions of functional and morphological factors in the recovery of the quadriceps muscle after anterior cruciate ligament (ACL) reconstruction. METHODS Nine subjects (31.3±5.8 years) underwent eccentric exercise sessions twice a week for 12 weeks. Quadriceps muscle function was evaluated using an isokinetic dynamometer (isometric and eccentric peak torque) and electromyography (RMS). Morphological changes were measured using magnetic resonance imaging. RESULTS The initial evaluation showed a significant deficit in knee extensor torque in the involved limb and significant muscle atrophy along the length of the quadriceps. EMG activity was lower in all tested situations. Eccentric training significantly increased isokinetic torque (from 199±51 to 240±63, p<0.05, respectively) and quadriceps area, with the greatest hypertrophy in the proximal thigh region (from 169±27 to 189±25.8 cm², p<0.01). The EMG activity of vastus medialis increased after the first six weeks of eccentric training. The increased extensor torque was correlated with quadriceps cross-sectional area (r=0.81, p<0.01) and EMG activity (r=0.69, p<0.05). After twelve weeks of training, there was a correlation only between torque and cross-sectional area (r=0.78, p<0.01). CONCLUSIONS 1) eccentric training proved to be a potent resource for the quadriceps recovery, both morphologically and functionally, 2) the contributions of functional and morphological factors varied according to the length of training.

Effects of Stretching and Strengthening Exercises, With and Without Manual Therapy, on Scapular Kinematics, Function, and Pain in Individuals With Shoulder Impingement: A Randomized Controlled Trial

STUDY DESIGN Randomized controlled trial. OBJECTIVE To evaluate the effects of an exercise protocol, with and without manual therapy, on scapular kinematics, function, pain, and mechanical sensitivity in individuals with shoulder impingement syndrome. BACKGROUND Stretching and strengthening exercises have been shown to effectively decrease pain and disability in individuals with shoulder impingement syndrome. There is still conflicting evidence regarding the efficacy of adding manual therapy to an exercise therapy regimen. METHODS Forty-six patients were assigned to 1 of 2 groups, one of which received a 4-week intervention of stretching and strengthening exercises (exercise alone) and the other the same intervention, supplemented by manual therapy targeting the shoulder and cervical spine (exercise plus manual therapy). All outcomes were measured preintervention and postintervention at 4 weeks. Outcome measures were scapular kinematics in the scapular and sagittal planes during arm elevation, function as determined through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, pain as assessed with a visual analog scale, and mechanical sensitivity as assessed with pressure pain threshold. RESULTS Independent of the intervention group, small, clinically irrelevant changes in scapular kinematics were observed postintervention. A significant group-by-time interaction effect (P = .001) was found for scapular anterior tilt during elevation in the sagittal plane, with a 3.0° increase (95% confidence interval [CI]: -1.5°, 7.5°) relative to baseline in the exercise-plus-manual therapy group compared to a decrease of 0.3° (95% CI: -4.2°, 4.8°) in the exercise-alone group. Pain, mechanical sensitivity, and the DASH score improved similarly for both groups by the end of the intervention period. CONCLUSION Adding manual therapy to an exercise protocol did not enhance improvements in scapular kinematics, function, and pain in individuals with shoulder impingement syndrome. The noted improvements in pain and function are not likely explained by changes in scapular kinematics.

The effects of knee extensor eccentric training on functional tests in healthy subjects

BACKGROUND It is well known that eccentric training increases muscle strength and promotes greater neural activation, and therefore has been used in the recovery of knee extensors. The hypothesis of this study was that there would be a strong correlation between knee extensor torque and functional tests. OBJECTIVES To investigate the relationship between knee extensor peak torque and functional tests of agility (runs) and propulsion (hop for distance) after short-term isokinetic eccentric training. METHODS Twenty healthy and active male undergraduate students (age 22.5 ± 2.1 years; height 1.72 ± 0.10 m; weight 67.8 ± 9.5 kg; body mass index: 22.5 ± 2.0 kg/m²), with no abnormalities or history of injury of the limbs, performed an isokinetic assessment of the knee extensors and flexors and also functional tests before and after isokinetic training, which consisted of 3 sets of 10 MVECs at 30º/s, with 3 minutes of rest between sets, twice a week for 6 weeks. RESULTS The eccentric training increased the extensor peak torque (16, 27 and 17%; P<0.01) and decreased the H/Q ratio (10, 20 and 13%; P<0.01) for the isometric and eccentric modes at 30°/s and 120°/s, respectively. It also decreased the time in two of the five agility tests (carioca and pivot diagonal; P<0.01), and increased the distance in the hop tests, for both dominant and non-dominant limbs (P<0.01). CONCLUSIONS Although the eccentric training led to an increase in extensor peak torques as well as an improvement in most of the functional tests, the hypothesis that a strong correlation would be observed between peak torques and functional tests was not confirmed. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number 12607000590460.

Reliability of isokinetic evaluation in passive mode for knee flexors and extensors in healthy children

BACKGROUND The isokinetic dynamometer has been considered the gold-standard measurement of muscle performance. However, the reliability for the passive mode in children has not been reported to date. OBJECTIVES The purpose was to evaluate the reliability of the isokinetic dynamometer in passive mode in children. METHOD Twenty-one healthy children (ten girls, eleven boys), aged 5 to 12 years (age: 8.5±2.2 years), were evaluated using an isokinetic dynamometer. Each participant was tested twice with a one-week interval and performed five consecutive cycles of knee extension and flexion. The test was performed at 60º/s in the concentric passive mode and the children performed maximal contractions. The measured variables were peak torque, average peak torque, total work, and average power, time to peak torque and angle of peak torque for dominant and non-dominant lower limbs. Reliabilities were determined using intraclass correlation coefficient (ICC3,1), standard error of measurement (SEM and SEM%), and coefficient of variation (CV). RESULTS We found good reliability in both lower limbs for peak torque, average peak torque, total work and average power of knee flexors and extensors, with ICC3,1 values greater than 0.80; SEM ranging from 6.7 to 79.2; SEM% ranging from 10.4% to 16.8%; CV lower than 15%. Bland-Altman analysis showed that the bias was low than 10% and limits of agreement (LOAs) ranging from 33.9% to 59.2%, and -28.8% and -52.8%, showing that measures tended to disagree. However, time to peak torque (ICC3,1<0.68; SEM > 0.34; SEM%>37.4%; CV>41.7%; bias >24.0%; LOA>101.0%) and angle of peak torque (ICC3,1<0.76; SEM>9.3; SEM%>27.6%; CV>15.3%; bias>11.0%; LOA>61.0%) were not reliable. CONCLUSIONS The findings indicate that isokinetic evaluation in passive mode for knee extensors and flexors of dominant and non-dominant lower limbs of children without disabilities was reliable for peak torque, average peak torque, work, and power. However, average time to peak torque and angle of peak torque were not reliable.

Bilateral impairments of shoulder abduction in chronic hemiparesis: Electromyographic patterns and isokinetic muscle performance

OBJECTIVE To analyze electromyographic (EMG) patterns and isokinetic muscle performance of shoulder abduction movement in individuals who sustained a cerebrovascular accident (CVA). DESIGN Twenty-two individuals who sustained a CVA and 22 healthy subjects volunteered for EMG activity and isokinetic shoulder abduction assessments. EMG onset time, root mean square (RMS) for upper trapezius and deltoid muscles, as well as the isokinetic variables of peak torque, total work, average power and acceleration time were compared between limbs and groups. RESULTS The paretic side showed a different onset activation pattern in shoulder abduction, along with a lower RMS for both muscles (21.8±13.4% of the maximal voluntary isometric contraction (MVIC) for the deltoid and 25.9±15.3% MVIC for the upper trapezius, about 50% lower than the control group). The non-paretic side showed a delay in both muscles activation and a lower RMS for the deltoid (32.2±13.7% MVIC, about 25% lower than the control group). Both sides of the group of individuals who sustained a CVA presented a significantly lower isokinetic performance compared to the control group (paretic side ∼60% lower; non-paretic side ∼35% lower). CONCLUSIONS Shoulder abduction muscle performance is impaired in both paretic and non-paretic limbs of individuals who sustained a CVA.

Three-dimensional scapular motion during arm elevation is altered in women with fibromyalgia.

BACKGROUND The core feature of fibromyalgia is pain, which may play a role in various mechanisms that might lead to alterations in shoulder kinematics. Alterations in muscle activity and presence of tender points in the shoulder girdle have already been described in this population; however there is lack of evidence on three-dimensional scapular motion in women with fibromyalgia. METHODS Forty women with fibromyalgia and 25 healthy women (control group) matched in terms of age, weight and height, took part in this study. Three-dimensional scapular kinematics of the dominant arm were collected during elevation and lowering of the arm in the sagittal and scapular planes. Pain was evaluated by the Visual Analogue Scale and the Numerical Pain Rating Scale. Group comparisons were performed with one-way ANOVA for pain and two-way ANOVA for the kinematic variables (scapular internal/external rotation, upward/downward rotation and anterior/posterior tilt), with group and humeral elevation angle as categorical factors. Significance level was set at P<0.05. FINDINGS Fibromyalgia women presented higher pain scores (P<0.001) than the control group. Fibromyalgia women also presented greater scapular upward rotation (P<0.001, both planes) and greater scapular posterior tilt (P<0.001, both planes) than the control group. INTERPRETATION Women with fibromyalgia present greater scapular upward rotation and posterior tilt in the resting position and during arm elevation and lowering of the arm in sagittal and scapular planes. These alterations may be a compensatory mechanism to reduce pain during arm movement.

Respiratory Sinus Arrhythmia and its Association with Pain in Women with Fibromyalgia Syndrome.

To assess the cardiac autonomic control at rest and during the deep breathing test (DBT) and its association with pain in women with fibromyalgia syndrome (FMS).

How to report electrotherapy parameters and procedures for pelvic floor dysfunction

Electrical stimulation is widely used for pelvic floor muscle dysfunctions (PFMDs), but studies are not always clear about the parameters used, jeopardizing their reproduction. As such, this study aimed to be a reference for researchers and clinicians when using electrical stimulation for PFMD. This report was designed by experts on electrophysical agents and PFMD who determined all basic parameters that should be described. The terms were selected from the Medical Subject Headings database of controlled vocabulary. An extensive process of systematic searching of databases was performed, after which experts met and discussed on the main findings, and a consensus was achieved. Electrical stimulation parameters were described, including the physiological meaning and clinical relevance of each parameter. Also, a description of patient and electrode positioning was added. A consensus-based guideline on how to report electrical stimulation parameters for PFMD treatment was developed to help both clinicians and researchers.

Prevalence of musculoskeletal pain in climacteric women of a Basic Health Unit in São Paulo/SP

BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate the prevalence of musculoskeletal pain in climacteric women of a Basic Health Unit in Sao Paulo. METHODS: This is a descriptive cross-sectional study, with the participation of 93 climacteric women with average age of 49.1±6.1 years, with medical history containing obstetric background and pain characterization, including the presence, location, and intensity of these complaints. For data collection, we used a map of pain and a visual analog scale associated with the faces pain rating scale. RESULTS: Of the total, 87 women (93%) reported pain, with an average onset of symptoms of 5.8±7.7 years, and average pain in the visual analog and the faces scales of 6.9±3mm. The pain was classified by most of the women (53%) as intense, and the places of greater involvement were the spine (71%), followed by the knees (58%) and shoulders (47%). Thus, the musculoskeletal pain showed to be a frequent complaint among climacteric women, involving 93% of the volunteers in this study, ranked by the majority as an intense pain. CONCLUSION: It is important to recognize the magnitude of this complaint in primary care to elaborate preventive and therapeutic actions aiming at improving the quality of life of these women.