Thiago Yukio Fukuda

Short-Term Effects of Hip Abductors and Lateral Rotators Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Controlled Clinical Trial

STUDY DESIGN Randomized clinical trial. OBJECTIVE To investigate the influence of strengthening the hip abductor and lateral rotator musculature on pain and function of females with patellofemoral pain syndrome (PFPS). BACKGROUND Hip muscle weakness in women athletes has been the focus of many recent studies and is suggested as an important impairment to address in the conservative treatment of women with PFPS. However, it is still not well established if strengthening these muscles is associated with clinical improvement in pain and function in sedentary females with PFPS. METHODS Seventy females (average±SD age, 25±07 years), with a diagnosis of unilateral PFPS, were distributed randomly into 3 groups: 22 females in the knee exercise group, who received a conventional treatment that emphasized stretching and strengthening of the knee musculature; 23 females in the knee and hip exercise group, who performed exercises to strengthen the hip abductors and external rotators in addition to the same exercises performed by those in the knee exercise group; and of the 25 females who did not receive any treatment. The females of the nontreatment group (control) were instructed to maintain their normal daily activities. An 11-point numerical pain rating scale (NPRS) was used to assess pain during stair ascent and descent. The lower extremity functional scale (LEFS) and the anterior knee pain scale (AKPS) were used to assess function. The single-limb single hop test was also used as a functional outcome to measure preintervention and 4-week postintervention function. RESULTS The 3 groups were homogeneous prior to treatment in respect to demographic, pain, and functional scales data. Both the knee exercise and the knee and hip exercise groups showed significant improvement in the LEFS, the AKPS, and the NPRS, when compared to the control group (P<.05 and P<.001, respectively). But, when we considered minimal clinically important differences, only the knee and hip exercise group demonstrated mean improvements in AKPS and pain scores that were large enough to be clinically meaningful. For the single-limb single hop test, both groups receiving an intervention showed greater improvement than the control group, but there was no difference between the 2 interventions (P>.05). CONCLUSION Rehabilitation programs focusing on knee strengthening exercises and knee strengthening exercises supplemented by hip strengthening exercises were both effective in improving function and reducing pain in sedentary women with PFPS. Improvements of pain and function were greater for the group that performed the hip strengthening exercises, but the difference was significant only for pain rating while descending stairs. LEVEL OF EVIDENCE Therapy, level 1b-.

Hip Posterolateral Musculature Strengthening in Sedentary Women With Patellofemoral Pain Syndrome: A Randomized Controlled Clinical Trial With 1-Year Follow-up

STUDY DESIGN Randomized controlled trial. OBJECTIVES To determine if adding hip-strengthening exercises to a conventional knee exercise program produces better long-term outcomes than conventional knee exercises alone in women with patellofemoral pain syndrome (PFPS). BACKGROUND Recent studies have shown that a hip-strengthening program reduces pain and improves function in individuals with PFPS. However, there are no clinical trials evaluating long-term outcomes of this type of program compared to conventional knee-strengthening and -stretching exercises. METHODS Fifty-four sedentary women between 20 and 40 years of age, with a diagnosis of unilateral PFPS, were randomly assigned knee exercise (KE) or knee and hip exercise (KHE). The women in the KE group (n = 26; mean age, 23 years) performed a 4-week conventional knee-stretching and -strengthening program. The women in the KHE group (n = 28; mean age, 22 years) performed the same exercises as those in the KE group, as well as strengthening exercises for the hip abductors, lateral rotators, and extensors. An 11-point numeric pain rating scale, the Lower Extremity Functional Scale, the Anterior Knee Pain Scale, and a single-hop test were used as outcome measures at baseline (pretreatment) and 3, 6, and 12 months posttreatment. RESULTS At baseline, demographic, pain, and functional assessment data were similar between groups. Those in the KHE group had a higher level of function and less pain at 3, 6, and 12 months compared to baseline (P<.05). In contrast, the KE group had reduced pain only at the 3- and 6-month follow-ups (P<.05), without any changes in Lower Extremity Functional Scale, Anterior Knee Pain Scale, or hop testing (P>.05) through the course of the study. Compared to the KE group, the KHE group had less pain and better function at 3, 6, and 12 months posttreatment (P<.05). For the Lower Extremity Functional Scale, the between-group difference in change scores from baseline at 3, 6, and 12 months posttreatment favored the KHE group by 22.0, 22.0, and 20.8 points, respectively. CONCLUSION Knee-stretching and -strengthening exercises supplemented by hip posterolateral musculature-strengthening exercises were more effective than knee exercises alone in improving long-term function and reducing pain in sedentary women with PFPS.

A Comparison of Hip Strength Between Sedentary Females With and Without Patellofemoral Pain Syndrome

STUDY DESIGN Cross-sectional study. OBJECTIVE To compare the hip strength of sedentary females with either unilateral or bilateral patellofemoral pain syndrome (PFPS) to a control group of sedentary females of similar demographics without PFPS. BACKGROUND It has been suggested that hip muscle weakness may be an important factor in the etiology of young female athletes with PFPS. This syndrome is also common in sedentary females and it is unclear if similar findings of hip weakness would be present in this population. METHODS Females between 15 and 40 years of age (control group, n = 50; unilateral PFPS, n = 21; bilateral PFPS, n = 29) participated in the study. Strength for all 6 hip muscle groups was measured bilaterally on all subjects using a handheld dynamometer. RESULTS The hip musculature of sedentary females with bilateral PFPS was statistically weaker (range, 12%-36%; P<.05) than that of the control group for all muscle groups. The hip abductors, lateral rotators, flexors, and extensors of the injured side of those with unilateral PFPS group were statistically weaker (range, 15%-20%; P<.05)than that of the control group, but only the hip abductors were significantly weaker when compared to their uninjured side (20%; P<.05). CONCLUSION This study demonstrates that hip weakness is a common finding in sedentary females with PFPS.

Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study

Objectives: To estimate the effects of low level laser therapy in combination with a programme of exercises on pain, functionality, range of motion, muscular strength and quality of life in patients with osteoarthritis of the knee. Design: A randomized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups. Setting: Special Rehabilitation Services. Subjects: Forty participants with knee osteoarthritis, 2–4 osteoarthritis degree, aged between 50 and 75 years and both genders. Intervention: Participants were randomized into one of two groups: the laser group (low level laser therapy dose of 3 J and exercises) or placebo group (placebo laser and exercises). Main measures: Pain was assessed using a visual analogue scale (VAS), functionality using the Lequesne questionnaire, range of motion with a universal goniometer, muscular strength using a dynamometer, and activity using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire at three time points: (T1) baseline, (T2) after the end of laser therapy (three weeks) and (T3) the end of the exercises (11 weeks). Results: When comparing groups, significant differences in the activity were also found (P = 0.03). No other significant differences (P > 0.05) were observed in other variables. In intragroup analysis, participants in the laser group had significant improvement, relative to baseline, on pain (P = 0.001), range of motion (P = 0.01), functionality (P = 0.001) and activity (P < 0.001). No significant improvement was seen in the placebo group. Conclusion: Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief, function and activity on patients with osteoarthritis of the knees.

Nonsurgical Treatment of Acetabular Labrum Tears: A Case Series

STUDY DESIGN Case series. BACKGROUND While the literature has emphasized surgical treatment of acetabular labrum tears, there is a lack of information regarding conservative treatment. The purpose of this case series was to describe a nonsurgical program for those with clinical evidence of an acetabular labrum tear, that emphasized hip and lumbopelvic stabilization, correction of hip muscle imbalance, biomechanical control, and sport-specific functional progression. CASE DESCRIPTION The 4 patients in this series had clinical evidence and magnetic resonance imaging confirmation of an acetabular labrum tear and underwent a similar treatment protocol consisting of 3 phases. Phase 1 emphasized pain control, education in trunk stabilization, and correction of abnormal joint movement. Phase 2 focused on muscular strengthening, recovery of normal range of motion (ROM), and initiation of sensory motor training. And phase 3 emphasized advanced sensory motor training, with sport-specific functional progression. ROM, flexibility, pain, special tests, and level of function were assessed, and strength was measured with handheld dynamometry. OUTCOMES All patients demonstrated decreased pain, functional improvement, and correction of muscular imbalance. Increased muscle strength, primarily for the hip flexors (1%-39%), abductors (18%-56%), and extensors (68%-139%) was also noted. DISCUSSION All patients responded well to our program. This case series suggests that patients with clinical evidence of an acetabular labral tear confirmed with MRI can show meaningful improvement with nonsurgical intervention. LEVEL OF EVIDENCE Therapy, level 4.

Efficacy of adding the kinesio taping method to guideline-endorsed conventional physiotherapy in patients with chronic nonspecific low back pain: a randomised controlled trial

BackgroundChronic nonspecific low back pain is a significant health condition with high prevalence worldwide and it is associated with enormous costs to society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. An intervention that has been widespread in recent years is the use of elastic bandages called Kinesio Taping. Although Kinesio Taping has been used extensively in clinical practice, current evidence does not support the use of this intervention; however these conclusions are based on a small number of underpowered studies. Therefore, questions remain about the effectiveness of the Kinesio Taping method as an additional treatment to interventions, such as conventional physiotherapy, that have already been recommended by the current clinical practice guidelines in robust and high-quality randomised controlled trials. We aim to determine the effectiveness of the addition of the use of Kinesio Taping in patients with chronic nonspecific low back pain who receive guideline-endorsed conventional physiotherapy.Methods/designOne hundred and forty-eight patients will be randomly allocated to receive either conventional physiotherapy, which consists of a combination of manual therapy techniques, general exercises, and specific stabilisation exercises (Guideline-Endorsed Conventional Physiotherapy Group) or to receive conventional physiotherapy with the addition of Kinesio Taping to the lumbar spine (Conventional Physiotherapy plus Kinesio Taping Group) over a period of 5 weeks (10 sessions of treatment). Clinical outcomes (pain intensity, disability and global perceived effect) will be collected at baseline and at 5 weeks, 3 months, and 6 months after randomisation. We will also collect satisfaction with care and adverse effects after treatment. Data will be collected by a blinded assessor. All statistical analysis will be conducted following the principles of intention to treat, and the effects of treatment will be calculated using Linear Mixed Models.DiscussionThe results of this study will provide new information about the usefulness of Kinesio Taping as an additional component of a guideline-endorsed physiotherapy program in patients with chronic nonspecific low back pain.

Pulsed Shortwave Treatment in Women With Knee Osteoarthritis: A Multicenter, Randomized, Placebo-Controlled Clinical Trial

Background Several forms of conservative treatment have been the focus of many recent studies in knee osteoarthritis (OA). Among these techniques, the application of pulsed shortwave (PSW) treatment has been widely used, but the optimal dose and application time have not been well established. Objective The purposes of this study were: (1) evaluate the effect of PSW treatment in different doses and (2) to compare low-dose and high-dose PSW groups with control and placebo groups. Design This was a randomized clinical trial. Setting The study was conducted in the physical therapy department of 2 large urban hospitals. Patients One hundred twenty-one women (mean age=60 years, SD=9) with a diagnosis of knee OA participated in the study. Intervention and Measurements Participants were distributed randomly into 4 groups: 35 participants did not receive any treatment (control group), 23 received a placebo treatment, 32 received low-dose PSW treatment (power of 14.5 W, treatment duration of 19 minutes, and total energy of 17 kJ), and 31 received high-dose PSW treatment (power of 14.5 W, treatment duration of 38 minutes, and total energy of 33 kJ). An 11-point numerical pain rating scale and the Knee Osteoarthritis Outcome Score were used to assess pain and function in 3 stages: at initial evaluation (pretreatment), immediately after treatment, and at 12-month follow-up. Results The 4 groups were homogeneous prior to treatment with respect to demographics, pain, and functional scale data. The results demonstrated the short-term effectiveness of the PSW at low and high doses in patients with knee OA. Both treatment groups showed a significant reduction in pain and improvement in function compared with the control and placebo groups (effect size: range=20.0–23.4 for the low-dose PSW group and range=15.7–16.5 for the high-dose PSW group). There were no differences in results between PSW doses, although a low dose of PSW appeared to be more effective in the long term. Limitations These results were achieved without physical exercise, which could have positively influenced the results. Conclusions Pulsed shortwave treatment is an effective method for pain relief and improvement of function and quality of life in the short term in women with knee OA. On the basis of the results, application of PSW treatment is recommended in the female population with knee OA. However, conclusions regarding the 12-month follow-up should be analyzed carefully due to the high dropout rate.

Open Kinetic Chain Exercises in a Restricted Range of Motion After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Clinical Trial

Background: Recent studies have shown that an early start of open kinetic chain (OKC) exercises for quadriceps strengthening in a full range of motion (ROM) could increase anterior knee laxity after anterior cruciate ligament (ACL) reconstruction with flexor tendons. However, there are no clinical trials that evaluated outcomes of OKC exercises in a restricted ROM for pain, function, muscle strength, and anterior knee laxity at 1 year after surgery. Purpose: To determine if an early start of OKC exercises for quadriceps strength in a restricted ROM would promote a clinical improvement without causing increased anterior knee laxity in patients after ACL reconstruction. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: A total of 49 patients between 16 and 50 years of age who underwent ACL reconstruction with semitendinosus and gracilis autografts were randomly assigned to an early start OKC (EOKC) exercise group or a late start OKC (LOKC) exercise group. The EOKC group (n = 25; mean age, 26 years) received a rehabilitation protocol with an early start of OKC (fourth week postoperatively) within a restricted ROM between 45° and 90°. The LOKC group (n = 24; mean age, 24 years) performed the same protocol with a late start of OKC exercises between 0° and 90° (12th week postoperatively). Quadriceps and hamstring muscle strength, 11-point numerical pain rating scale (NPRS), Lysholm knee scoring scale, single-legged and crossover hop tests, and anterior knee laxity were measured to assess outcomes at the 12-week, 19-week, 25-week, and 17-month postoperative follow-up (range, 13-24 months). Results: No difference (P < .05) was noted between groups with respect to demographic data. Both groups (EOKC and LOKC) had a higher level of function and less pain at the 19-week, 25-week, and 17-month assessments when compared with 12 weeks postoperatively (P < .05). The EOKC group had improved quadriceps muscle strength at the 19-week, 25-week, and 17-month follow-up when compared with 12 weeks postoperatively (P < .05); the LOKC group showed improvement only at the 17-month postoperative assessment. However, the analysis between groups showed no difference for all pain and functional assessments, including anterior knee laxity (P > .05). Conclusion: An early start of OKC exercises for quadriceps strengthening in a restricted ROM did not differ from a late start in terms of anterior knee laxity. The EOKC group reached the same findings in relation to pain decrease and functional improvement when compared with the LOKC group but showed a faster recovery in quadriceps strength. The nonweightbearing exercises seem appropriate for patients who have undergone ACL reconstruction, when utilized in a specific ROM. The magnitude of difference in quadriceps strength between the 2 rehabilitation protocols was around 5%; however, this difference was not clinically significant, especially because both groups had equal function on the hop tests.

Pulsed Electromagnetic Field and Exercises in Patients With Shoulder Impingement Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

OBJECTIVE To evaluate the effects of pulsed electromagnetic field (PEMF) and exercises in reducing pain and improving function and muscle strength in patients with shoulder impingement syndrome (SIS). DESIGN Double-blind, randomized controlled trial with a 3-month posttreatment follow-up. SETTING Outpatient rehabilitation of a public hospital. PARTICIPANTS Patients (N=56) between 40 and 60 years of age, with a diagnosis of SIS, were randomly assigned to receive active PEMF (n=26; mean age, 50.1y) or placebo PEMF (n=30; mean age, 50.8y). INTERVENTIONS After 3 weeks of active or placebo PEMF, both groups performed the same program of exercises that focused on shoulder strengthening. MAIN OUTCOME MEASURES A visual analog scale, the University of California/Los Angeles shoulder rating scale, the Constant-Murley shoulder score, and handheld dynamometry for muscle strength were used as outcome measures at baseline (pretreatment), at 3 weeks (after active or placebo PEMF), at 9 weeks (postexercise), and at 3 months posttreatment. RESULTS Patients in the active PEMF group had a higher level of function and less pain at all follow-up time frames compared with baseline (P<.05). However, the placebo PEMF group had increased function and reduced pain only at the 9-week and 3-month follow-ups (P<.05)-that is, after performing the associated exercises. For the shoulder dynamometry, the active PEMF group had increased strength for lateral rotation at 9 weeks (P<.05), and increased strength for medial rotation at 9 weeks and 3 months (both P<.05) when compared with baseline. There was no significant difference for shoulder strength in the placebo PEMF group (P>.05), as well as no significant differences (P>.05) for all outcome measures. CONCLUSIONS The combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SIS. However, these results should be carefully interpreted because of the lack of differences between groups.

Isometric strength ratios of the hip musculature in females with patellofemoral pain: a comparison to pain-free controls.

Abstract Magalhães, E, Silva, APMCC, Sacramento, SN, Martin, RL, and Fukuda, TY. Isometric strength ratios of the hip musculature in females with patellofemoral pain: a comparison to pain-free controls. J Strength Cond Res 27(8): 2165–2170, 2013—The purpose of the study was to compare hip agonist-antagonist isometric strength ratios between females with patellofemoral pain (PFP) syndrome and pain-free control group. One hundred and twenty females between 15 and 40 years of age (control group: n = 60; PFP group: n = 60) participated in the study. Hip adductor, abductor, medial rotator, lateral rotator, flexor, and extensor isometric strength were measured using a hand-held dynamometer. Comparisons in the hip adductor/abductor and medial/lateral rotator and flexor/extensor strength ratios were made between groups using independent t-tests. Group comparisons also were made between the anteromedial hip complex (adductor, medial rotator, and flexor musculature) and posterolateral hip complex (abductor, lateral rotator, and extensor musculature). On average, the hip adductor/abductor isometric strength ratio in the PFP group was 23% higher when compared with the control group (p = 0.01). The anteromedial/posterolateral complex ratio also was significantly higher in the PFP group (average 8%; p = 0.04). No significant group differences were found for the medial/lateral rotator ratio and flexor/extensor strength ratios. The results of this study demonstrate that females with PFP have altered hip strength ratios when compared with asymptomatic controls. These strength imbalances may explain the tendency of females with PFP to demonstrate kinematic tendencies that increase loading on the patellofemoral joint (i.e., dynamic knee valgus).