Pedro Pezarat-Correia

Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain

Background: There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences. Objectives: To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain. Method: This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males) aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES) was used to assess shoulder pain, whereas neck pain was self-reported with a single question. Results: Mean values of sagittal head, cervical, and shoulder angles were 17.2±5.7, 47.4±5.2, and 51.4±8.5º, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys. Conclusions: This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture.

Intrarater and Interrater Reliability of Photographic Measurement of Upper-Body Standing Posture of Adolescents

OBJECTIVE The purposes of this study were to determine the intrarater and interrater reliability of a photographic measurement of the sagittal postures of the cervical spine and shoulder, quantitatively characterize the postural alignment of the head and shoulders in the sagittal plane of Portuguese adolescents 15 to 17 years old in natural erect standing, and analyze differences in postural angles between sexes. METHODS This cross-sectional study was conducted in 2 secondary schools in Portugal where 275 adolescent students (146 females and 129 males) aged 15 to 17 years were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and the Postural Assessment Software. RESULTS For interrater reliability, all of the intraclass correlation coefficient (ICC) values for the 3 angles were higher than 0.85. For intrarater reliability, the ICC values for the sagittal head angle, shoulder angle, and cervical angle were 0.83, 0.78, and 0.66, respectively. Mean values of sagittal head, cervical, and shoulder angles were 17.2° ± 5.7°, 47.4° ± 5.2°, and 51.4° ± 8.5°, respectively. Anterior head carriage was demonstrated by 68% of the adolescents, whereas 58% had protraction of the shoulder(s). Males had significantly higher mean cervical and sagittal head angles. CONCLUSIONS Forward head posture and protracted shoulders were common postural disorders in adolescents 15 to 17 years old, with females revealing a lower mean cervical angle. The intrarater and interrater evaluation of standing sagittal posture of the cervical spine and shoulders by photogrammetry was reliable.

Non-invasive assessment of sciatic nerve stiffness during human ankle motion using ultrasound shear wave elastography

Peripheral nerves are exposed to mechanical stress during movement. However the in vivo mechanical properties of nerves remain largely unexplored. The primary aim of this study was to characterize the effect of passive dorsiflexion on sciatic nerve shear wave velocity (an index of stiffness) when the knee was in 90° flexion (knee 90°) or extended (knee 180°). The secondary aim was to determine the effect of five repeated dorsiflexions on the nerve shear wave velocity. Nine healthy participants were tested. The repeatability of sciatic nerve shear wave velocity was good for both knee 90° and knee 180° (ICCs ≥ 0.92, CVs ≤ 8.1%). The shear wave velocity of the sciatic nerve significantly increased (p<0.0001) during dorsiflexion when the knee was extended (knee 180°), but no changes were observed when the knee was flexed (90°). The shear wave velocity-angle relationship displayed a hysteresis for knee 180°. Although there was a tendency for the nerve shear wave velocity to decrease throughout the repetition of the five ankle dorsiflexions, the level of significance was not reached (p=0.055). These results demonstrate that the sciatic nerve stiffness can be non-invasively assessed during passive movements. In addition, the results highlight the importance of considering both the knee and the ankle position for clinical and biomechanical assessment of the sciatic nerve. This non-invasive technique offers new perspectives to provide new insights into nerve mechanics in both healthy and clinical populations (e.g., specific peripheral neuropathies).

Recurrence quantification analysis and support vector machines for golf handicap and low back pain EMG classification

The quantification of non-linear characteristics of electromyography (EMG) must contain information allowing to discriminate neuromuscular strategies during dynamic skills. There are a lack of studies about muscle coordination under motor constrains during dynamic contractions. In golf, both handicap (Hc) and low back pain (LBP) are the main factors associated with the occurrence of injuries. The aim of this study was to analyze the accuracy of support vector machines SVM on EMG-based classification to discriminate Hc (low and high handicap) and LBP (with and without LPB) in the main phases of golf swing. For this purpose recurrence quantification analysis (RQA) features of the trunk and the lower limb muscles were used to feed a SVM classifier. Recurrence rate (RR) and the ratio between determinism (DET) and RR showed a high discriminant power. The Hc accuracy for the swing, backswing, and downswing were 94.4±2.7%, 97.1±2.3%, and 95.3±2.6%, respectively. For LBP, the accuracy was 96.9±3.8% for the swing, and 99.7±0.4% in the backswing. External oblique (EO), biceps femoris (BF), semitendinosus (ST) and rectus femoris (RF) showed high accuracy depending on the laterality within the phase. RQA features and SVM showed a high muscle discriminant capacity within swing phases by Hc and by LBP. Low back pain golfers showed different neuromuscular coordination strategies when compared with asymptomatic.

Electromyographic Analysis of Trunk Muscles during the Golf Swing Performed with Two Different Clubs

The aim of this study was to compare the EMG patterns of trunk muscles throughout the golf swing, performed with two different clubs, and also to describe the activity patterns in the average golfer. Nine male golfers performed ten swings using the pitching wedge and the 4-iron, alternately. Surface electromyography (EMG) was recorded from trunk muscles of both sides: rectus abdominis (RA), external oblique (EO), erector spinae (ES) and gluteus maximus (GM). 3D high-speed video analysis was used for determination of golf swing phases. Muscles had their highest activation during the forward swing and acceleration phases. The highest mean activation regarding the maximal EMG (EMGMAX), was found in the right EO (59–67% EMGMAX) and in the GM of the trailing leg (62–72% EMGMAX). In the majority of the cases and phases, trunk muscles showed higher mean values of EMG activation when golfers performed with 4-iron club. However, no club effect was verified in trunk muscles.

Electromyographic analysis of lower limb muscles during the golf swing performed with three different clubs

Abstract The aim of this study was to describe and compare the EMG patterns of select lower limb muscles throughout the golf swing, performed with three different clubs, in non-elite middle-aged players. Fourteen golfers performed eight swings each using, in random order, a pitching wedge, 7-iron and 4-iron. Surface electromyography (EMG) was recorded bilaterally from lower limb muscles: tibialis anterior, peroneus longus, gastrocnemius medialis, gastrocnemius lateralis, biceps femoris, semitendinosus, gluteus maximus, vastus medialis, rectus femoris and vastus lateralis. Three-dimensional high-speed video analysis was used to determine the golf swing phases. Results showed that, in average handicap golfers, the highest muscle activation levels occurred during the Forward Swing Phase, with the right semitendinosus and the right biceps femoris muscles producing the highest mean activation levels relative to maximal electromyography (70–76% and 68–73% EMGMAX, respectively). Significant differences between the pitching wedge and the 4-iron club were found in the activation level of the left semitendinosus, right tibialis anterior, right peroneus longus, right vastus medialis, right rectus femuris and right gastrocnemius muscles. The lower limb muscles showed, in most cases and phases, higher mean values of activation on electromyography when golfers performed shots with a 4-iron club.

Muscle coordination during breaststroke swimming: Comparison between elite swimmers and beginners

ABSTRACT The present study aimed to compare muscle coordination strategies of the upper and lower limb muscles between beginners and elite breaststroke swimmers. Surface electromyography (EMG) of eight muscles was recorded in 16 swimmers (8 elite, 8 beginners) during a 25 m swimming breaststroke at 100% of maximal effort. A decomposition algorithm was used to identify the muscle synergies that represent the temporal and spatial organisation of muscle coordination. Between-groups indices of similarity and lag times were calculated. Individual muscle patterns were moderately to highly similar between groups (between-group indices range: 0.61 to 0.84). Significant differences were found in terms of lag time for pectoralis major (P < 0.05), biceps brachii, rectus femoris and tibialis anterior (P < 0.01), indicating an earlier activation for these muscles in beginners compared to elites (range: −13.2 to −3.8% of the swimming cycle). Three muscle synergies were identified for both beginners and elites. Although their composition was similar between populations, the third synergy exhibited a high within-group variability. Moderate to high indices of similarity were found for the shape of synergy activation coefficients (range: 0.63 to 0.88) but there was a significant backward shift (−8.4% of the swimming cycle) in synergy #2 for beginners compared to elites. This time shift suggested differences in the global arm-to-leg coordination. These results indicate that the synergistic organisation of muscle coordination during breaststroke swimming is not profoundly affected by expertise. However, specific timing adjustments were observed between lower and upper limbs.

Metabolic cost of locomotion during treadmill walking with blood flow restriction.

We explored whether interval walking with blood flow restriction (BFR) increases net metabolic cost of locomotion in healthy young men at their optimal walking speed. We also determined whether decreased walking economy resulting from BFR might be accompanied by an increase in ventilation relative to VO2 and VCO2. Finally, we examined possible relationships between the changes in ratings of perceived exertion (RPE) and those obtained in minute ventilation (VE) during walking with BFR. Eighteen healthy men (age: 22·5 ± 3·4 years) performed graded treadmill exercise to assess VO2max. In a randomized fashion, participants also performed five bouts of 3‐min treadmill exercise with and without BFR at their optimal walking speed. Walking with BFR elicited an overall increase in net VO2 (10·4%) compared with that seen in the non‐BFR condition (P<0·05). The participants also demonstrated greater VE and VE/VO2 values while walking with BFR (P<0·05). Conversely, VE/VCO2 was similar between conditions at each walking bout. We found no significant correlation between the changes in VE and RPE induced by walking with BFR (r = 0·38, P>0·05). Our results indicate that (i) BFR decreases net walking economy in healthy young men, even at their optimal walking speed; (ii) heightened ventilatory drive may explain a small proportion of BFR effects on walking economy; and (iii) the ventilatory responses to BFR walking may be largely independent of changes in perceived exertion and are likely matched to the flux of CO2 between muscles and respiratory centres.

Impact of Exercise Training on Physiological Measures of Physical Fitness in the Elderly

BACKGROUND Older persons are the fastest growing segment of the population living in the Western hemisphere. Longevity comes at a price, including a higher rate of morbidity, functional and mental disability and the eventual loss of independence. Physical inactivity further aggravates the decline in physiological function along the aging process. Therefore, the promotion of regular exercise may be seen as one of the main non-pharmacological approaches that should be recommended to older adults. METHODS We performed a comprehensive review on the interaction between exercise training and improved physical fitness in the elderly. Specifically, 175 papers describing the overall benefits of exercise training on the cardiovascular, neuromuscular and brain function of older adults were included. The effectiveness of training for improving quality of life at an older age was also reviewed. RESULTS Exercise training can partially reverse the age-related physiological decline and enhance work capacity in the elderly. Numerous studies have shown that maintaining a minimum quantity and quality of physical exercise decreases the risk of cardiovascular mortality, sarcopenia, prevents the onset of osteopenia and even exerts a prophylactic role against neurodegeneration. The systemic physiologic effects are profound and may be directly linked to a favorable feedforward cycle whereby improved physiologic function begets improved physical function and so on. CONCLUSION We conclude that structured training programs should be designed to improve the physiological function in this population. Finally, the benefits of exercise training vary as a function of training volume and this relationship is independent of age and sex.

Provocative mechanical tests of the peripheral nervous system affect the joint torque-angle during passive knee motion

This study aimed to determine the influence of the head, upper trunk, and foot position on the passive knee extension (PKE) torque‐angle response. PKE tests were performed in 10 healthy subjects using an isokinetic dynamometer at 2°/s. Subjects lay in the supine position with their hips flexed to 90°. The knee angle, passive torque, surface electromyography (EMG) of the semitendinosus and quadriceps vastus medialis, and stretch discomfort were recorded in six body positions during PKE. The different maximal active positions of the cervical spine (neutral; flexion; extension), thoracic spine (neutral; flexion), and ankle (neutral; dorsiflexion) were passively combined for the tests. Visual analog scale scores and EMG were unaffected by body segment positioning. An effect of the ankle joint was verified on the peak torque and knee maximum angle when the ankle was in the dorsiflexion position (P < 0.05). Upper trunk positioning had an effect on the knee submaximal torque (P < 0.05), observed as an increase in the knee passive submaximal torque when the cervical and thoracic spines were flexed (P < 0.05). In conclusion, other apparently mechanical unrelated body segments influence torque‐angle response since different positions of head, upper trunk, and foot induce dissimilar knee mechanical responses during passive extension.